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Autonomy general surgery residents

Frederick Thurston Drake, Shahram Aarabi, Brandon T Garland, Ciara R Huntington, Jarod P McAteer, Morgan K Richards, Nicole Kansier Zern, Kenneth W Gow
STUDY OBJECTIVE: To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. BACKGROUND: Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room...
May 2017: Annals of Surgery
Jonathan P Fryer, Ezra N Teitelbaum, Brian C George, Mary C Schuller, Shari L Meyerson, Christina M Theodorou, Joseph Kang, Amy Yang, Lihui Zhao, Debra A DaRosa
OBJECTIVE: We have previously demonstrated the feasibility and validity of a smartphone-based system called Procedural Autonomy and Supervision System (PASS), which uses the Zwisch autonomy scale to facilitate assessment of the operative performances of surgical residents and promote progressive autonomy. To determine whether the use of PASS in a general surgery residency program is associated with any negative consequences, we tested the null hypothesis that PASS implementation at our institution would not negatively affect resident or faculty satisfaction in the operating room (OR) nor increase mean OR times for cases performed together by residents and faculty...
March 28, 2017: Journal of Surgical Education
Matthew M Hutter, Kevin E Behrns, Nathaniel J Soper, Fabrizio Michelassi
There is the need for well-trained advanced GI surgeons. The super specialization seen in academic and large community centers may not be applicable for surgeons practicing in other settings. The pendulum that has been swinging toward narrow specialization is swinging the other way, as many trained subspecialists are having a harder time finding positions after fellowship, and if they do find a position, the majority of their practice can actually be advanced GI surgery and not exclusively their area of focused expertise...
January 24, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Olga Kantor, Andrew B Schneider, Marko Rojnica, Andrew J Benjamin, Nancy Schindler, Mitchell C Posner, Jeffrey B Matthews, Kevin K Roggin
BACKGROUND: To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. METHODS: We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation...
March 2017: Surgery
Brandon M Wojcik, Zhi Ven Fong, Madhukar S Patel, David C Chang, Emil Petrusa, John T Mullen, Roy Phitayakorn
OBJECTIVE: General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program...
November 2016: Journal of Surgical Education
Roy Phitayakorn, Rachel R Kelz, Emil Petrusa, Rebecca S Sippel, Cord Sturgeon, Kepal N Patel, Nancy D Perrier
BACKGROUND: Proficiency with common endocrine operations is expected of graduating, general surgery residents. However, no expert consensus guidelines exist about these expectations. METHODS: Members of the American Association of Endocrine Surgeons were surveyed about their opinions on resident proficiency with common endocrine operations. RESULTS: Overall response rate was 38%. A total of 92% of the respondents operate with residents. On average, they believed that the steps of a total thyroidectomy for benign disease and a well-localized parathyroidectomy could be performed by a postgraduate year 4 surgery resident...
January 2017: Surgery
Yusuke Watanabe, Amin Madani, Elif Bilgic, Katherine M McKendy, Gada Enani, Iman Ghaderi, Gerald M Fried, Liane S Feldman, Melina C Vassiliou
BACKGROUND: General surgery residency may not adequately prepare residents for independent practice. It is unclear; however, if non-ACGME-accredited fellowships are better meeting training needs. The purpose of this mixed-method study was to determine perceived preparedness for practice and to identify gaps in fellowship training. METHODS: A survey was developed using an iterative qualitative methodology based on interviews and focus groups of graduated fellows and program directors...
October 14, 2016: Surgical Endoscopy
Dawn M Elfenbein
Importance: In the surgical community, there is concern that general surgery residents are choosing subspecialty training in large numbers because of a crisis in confidence at the end of training. Confidence is an essential quality of surgeons, and recent studies have attempted to quantify and measure it in graduating general surgery residents. Objectives: To systematically review the quality of evidence provided and to critically analyze the language used to describe the findings using quantitative methods...
December 1, 2016: JAMA Surgery
Gurjit Sandhu, Christopher P Magas, Adina B Robinson, Christopher P Scally, Rebecca M Minter
OBJECTIVE: The purpose of this study was to identify behaviors that faculty and residents exhibit during intraoperative interactions, which support or inhibit progressive entrustment leading to operative autonomy. BACKGROUND: In the operating room, a critical balance is sought between direct faculty supervision and appropriate increase in resident autonomy with indirect faculty supervision. Little is known regarding perspectives of faculty and residents about how attendings increasingly step back and safely delegate autonomy to trainees...
May 9, 2016: Annals of Surgery
Eric Singman, Divya Srikumaran, Kathy Hackett, Brian Kaplan, Albert Jun, Derek Preece, Pradeep Ramulu
BACKGROUND: The Wilmer General Eye Services (GES) at the Johns Hopkins Hospital is the clinic where residents provide supervised comprehensive medical and surgical care to ophthalmology patients. The clinic schedule and supervision structure allows for a progressive increase in trainee responsibility, with graduated autonomy and longitudinal continuity of care over the three years of ophthalmology residency training. This study sought to determine the number of cases the GES contributes to the resident surgical experiences...
January 27, 2016: BMC Medical Education
Aimee K Gardner, Ross E Willis, Brian J Dunkin, Kent R Van Sickle, Kimberly M Brown, Michael S Truitt, John M Uecker, Lonnie Gentry, Daniel J Scott
BACKGROUND: Despite numerous efforts to ensure that surgery residents are adequately trained in the areas of laparoscopy and flexible endoscopy, there remain significant concerns that graduates are not comfortable performing many of these procedures. METHODS: Online surveys were sent to surgery residents (98 items, PGY1-5 Categorical) and faculty (78 items, general surgery, and gastrointestinal specialties) at seven institutions. De-identified data were analyzed under an IRB-approved protocol...
July 2016: Surgical Endoscopy
Mary E Klingensmith, Thomas H Cogbill, Frederick Luchette, Thomas Biester, Kelli Samonte, Andrew Jones, Frank R Lewis, Mark A Malangoni
OBJECTIVES: Surgery residency serves 2 purposes-prepare graduates for general surgery (GS) practice or postresidency surgical fellowship, leading to specialty surgical practice (SS). This study was undertaken to elucidate factors influencing career choice for these 2 groups. METHODS: All US allopathic surgery residency graduates from 2009 to 2013 (n = 5512) were surveyed by the American Board of Surgery regarding confidence, autonomy, and reasons for career selection between GS and SS...
September 2015: Annals of Surgery
Mitesh Patel, Jasneet S Bhullar, Gokulakkrishna Subhas, Vijay Mittal
As surgery residents graduate and begin their careers as junior attending surgeons, the question of whether a surgeon can complete a case alone still lingers. Allowing autonomy during residency answers this question. The purpose of this study was to gather input from general surgery residency program directors on how they achieve autonomy for residents in their programs. An online survey of 18 questions was sent to all general surgery residency program directors in the United States between April and June of 2013 via e-mail...
August 2015: American Surgeon
Laura Torbeck, Adam Wilson, Jennifer Choi, Gary L Dunnington
BACKGROUND: To further understand how faculty promote resident autonomy in the operating room (OR), we explored their perceptions, and those of senior residents, on the behaviors and techniques they employ to foster independence. METHODS: Twenty postgraduate year PGY4 and PGY5 residents were asked to list 3 general surgery faculty who give the most and least autonomy to residents in the OR. Two focus groups were conducted with residents to identify behaviors and techniques for promoting autonomy from the resident perspective...
October 2015: Surgery
Jason W Kempenich, Ross E Willis, Robert Rakosi, John Wiersch, Paul Joseph Schenarts
OBJECTIVE: Identify barriers to resident autonomy in today's educational environment as perceived through 4 selected groups: senior surgical residents, teaching faculty, hospital administration, and the general public. DESIGN: Anonymous surveys were created and distributed to senior residents, faculty, and hospital administrators working within 3 residency programs. The opinions of a convenience sample of the general public were also assessed using a similar survey...
November 2015: Journal of Surgical Education
Mary E Klingensmith, Michael Awad, Keith A Delman, Karen Deveney, Thomas J Fahey, Jason S Lees, Pamela Lipsett, John T Mullen, Douglas S Smink, Jeffrey Wayne
OBJECTIVE: To assess the attitudes of residents and program directors (PDs) involved in flexible training to gauge satisfaction with this training paradigm and elicit limitations. DESIGN: Anonymous surveys were sent to residents and PDs in participant programs. Respondents were asked to rate responses on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). SETTING: A total of 9 residency programs that are collaborating to prospectively study the effect of flexible tracks on resident performance and outcome...
November 2015: Journal of Surgical Education
Lauren Smithson, Khortnal Delvecchio, Vijay K Mittal
OBJECTIVE: A survey of general surgery (GS) program directors (PD) was performed to determine how Accreditation Council for Graduate Medical Education (ACGME) hepatopancreatobiliary (HPB) requirements are met and compare the findings with previous national averages. The objectives were to establish whether GS residencies are in compliance with ACGME recommendations. Secondary objectives aimed to determine if fellowship affects residency training. METHODS: A 30-question survey was sent out to GS PDs registered with Association of Program Directors in Surgery...
September 2015: Journal of Surgical Education
P I Okonta
INTRODUCTION: The ethical principle of autonomy as expressed in the practice of informed consent is a core tenet of clinical practice and good patient physician relationship. AIM: The aim was to identify specific gaps in the knowledge of trainee obstetricians and gynecologists in Nigeria about the informed consent process and its content. It also sought to describe the practice of informed consent in their respective institutions. MATERIALS AND METHODS: A survey of Residents in obstetrics and gynecology attending the revision course of the Faculty of obstetrics and gynecology of the national postgraduate medical college was done to determine their knowledge of the informed consent process and its practice in their institutions...
July 2015: Nigerian Journal of Clinical Practice
Ronald B Hirschl
There have been many changes in the "making of a surgeon". Some of the key aspects that have altered residency/fellow training include work hour restrictions; a decrease in autonomy; and the explosion in knowledge, the change in technology, and the movement of complex cases away from General Surgery. There are a number of opportunities for enhancing current surgical training which include the following: 1) returning to reasonable work hour limits; 2) improving the efficiency of resident/fellow training by promoting early development of operative skills and starting down the path toward competency-based education; 3) increasing autonomy in the General and Pediatric Surgery residencies by developing and implementing structured processes for graded autonomy, further promoting the teaching assistant role, and even incorporating time as an attending into the period of training; and 4) developing a paradigm of uniform core surgery training followed by additional qualifications and training in both General Surgery and the surgical specialties...
May 2015: Journal of Pediatric Surgery
María Pilar Córcoles-Jiménez, Ascensión Villada-Munera, María Ángeles Del Egido-Fernández, Eduardo Candel-Parra, Mónica Moreno-Moreno, María Delirio Jiménez-Sánchez, Antonio Piña-Martínez
This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture...
December 2015: Clinical Nursing Research
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