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Autonomy general surgery residents

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https://www.readbyqxmd.com/read/28781132/-taking-training-to-the-next-level-the-american-college-of-surgeons-committee-on-residency-training-survey
#1
Richard B Damewood, Patrice Gabler Blair, Yoon Soo Park, Linda K Lupi, Rachel Williams Newman, Ajit K Sachdeva
OBJECTIVE: The American College of Surgeons (ACS) appointed a committee of leaders from the ACS, Association of Program Directors in Surgery, Accreditation Council for Graduate Medical Education, and American Board of Surgery to define key challenges facing surgery resident training programs and to explore solutions. The committee wanted to solicit the perspectives of surgery resident program directors (PDs) given their pivotal role in residency training. DESIGN: Two surveys were developed, pilot tested, and administered to PDs following Institutional Review Board approval...
August 3, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28742711/readiness-of-us-general-surgery-residents-for-independent-practice
#2
Brian C George, Jordan D Bohnen, Reed G Williams, Shari L Meyerson, Mary C Schuller, Michael J Clark, Andreas H Meier, Laura Torbeck, Samuel P Mandell, John T Mullen, Douglas S Smink, Rebecca E Scully, Jeffrey G Chipman, Edward D Auyang, Kyla P Terhune, Paul E Wise, Jennifer N Choi, Eugene F Foley, Justin B Dimick, Michael A Choti, Nathaniel J Soper, Keith D Lillemoe, Joseph B Zwischenberger, Gary L Dunnington, Debra A DaRosa, Jonathan P Fryer
OBJECTIVE: This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy. BACKGROUND: The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28712687/assessing-residents-readiness-for-or-autonomy-a-qualitative-descriptive-study-of-expert-surgical-teachers-best-practices
#3
Xiaodong Phoenix Chen, Amy M Sullivan, Adnan Alseidi, Gifty Kwakye, Douglas S Smink
PURPOSE: Providing resident autonomy in the operating room (OR) is one of the major challenges for surgical educators today. The purpose of this study was to explore what approaches expert surgical teachers use to assess residents' readiness for autonomy in the OR. We particularly focused on the assessments that experts make prior to conducting the surgical time-out. METHODS: We conducted semistructured in-depth interviews with expert surgical teachers from March 2016 to September 2016...
July 13, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28623114/characterizing-the-relationship-between-surgical-resident-and-faculty-perceptions-of-autonomy-in-the-operating-room
#4
Katelyn A Young, Samantha M Lane, John E Widger, Nina M Neuhaus, James T Dove, Marcus Fluck, Marie A Hunsinger, Joseph A Blansfield, Mohsen M Shabahang
OBJECTIVE: Characterize the concordance among faculty and resident perceptions of surgical case complexity, resident technical performance, and autonomy in a diverse sample of general surgery procedures using case-specific evaluations. DESIGN: A prospective study was conducted in which a faculty surgeon and surgical resident independently completed a postoperative assessment examining case complexity, resident operative performance (Milestone assessment) and autonomy (Zwisch model)...
June 13, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28607848/progressive-surgical-autonomy-in-a-plastic-surgery-resident-clinic
#5
Kristopher M Day, Jillian K Scott, Lani Gao, Tara M Lee, Jimmy L Waldrop, Larry A Sargent, J Woody Kennedy, Jason P Rehm, Mark A Brzezienski
BACKGROUND: Resident clinics are thought to catalyze educational milestone achievement through opportunities for progressively autonomous surgical care, but studies are lacking for general plastic surgery resident clinics (PSRCs). We demonstrate the achievement of increased surgical autonomy and continuity of care in a PSRC. METHODS: A retrospective review of all patients seen in a PSRC from October 1, 2010, to October 1, 2015, was conducted. Our PSRC is supervised by faculty plastic surgery attendings, though primarily run by chief residents in an accredited independent plastic surgery training program...
May 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28398961/accreditation-council-for-graduate-medical-education-acgme-surgery-resident-operative-logs-the-last-quarter-century
#6
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/28363675/effect-of-ongoing-assessment-of-resident-operative-autonomy-on-the-operating-room-environment
#7
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
https://www.readbyqxmd.com/read/28120274/advanced-gi-surgery-training-a-roadmap-for-the-future-the-white-paper-from-the-ssat-task-force-on-advanced-gi-surgery-training
#8
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
https://www.readbyqxmd.com/read/27932029/implementing-a-resident-acute-care-surgery-service-improving-resident-education-and-patient-care
#9
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
https://www.readbyqxmd.com/read/27886972/the-resident-run-minor-surgery-clinic-a-pilot-study-to-safely-increase-operative-autonomy
#10
REVIEW
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
https://www.readbyqxmd.com/read/27865597/expert-consensus-of-general-surgery-residents-proficiency-with-common-endocrine-operations
#11
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
https://www.readbyqxmd.com/read/27743124/don-t-fix-it-if-it-isn-t-broken-a-survey-of-preparedness-for-practice-among-graduates-of-fellowship-council-accredited-fellowships
#12
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
https://www.readbyqxmd.com/read/27603429/confidence-crisis-among-general-surgery-residents-a-systematic-review-and-qualitative-discourse-analysis
#13
REVIEW
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
https://www.readbyqxmd.com/read/27163961/progressive-entrustment-to-achieve-resident-autonomy-in-the-operating-room-a-national-qualitative-study-with-general-surgery-faculty-and-residents
#14
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...
June 2017: Annals of Surgery
https://www.readbyqxmd.com/read/26818129/benchmarking-the-wilmer-general-eye-services-clinics-baseline-metrics-for-surgical-and-outpatient-clinic-volume-in-an-educational-environment
#15
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
https://www.readbyqxmd.com/read/26487226/what-do-residents-need-to-be-competent-laparoscopic-and-endoscopic-surgeons
#16
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
https://www.readbyqxmd.com/read/26258313/factors-influencing-the-decision-of-surgery-residency-graduates-to-pursue-general-surgery-practice-versus-fellowship
#17
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/26215240/present-status-of-autonomy-in-surgical-residency-a-program-director-s-perspective
#18
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
https://www.readbyqxmd.com/read/26209569/identification-of-behaviors-and-techniques-for-promoting-autonomy-in-the-operating-room
#19
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
https://www.readbyqxmd.com/read/26160132/how-do-perceptions-of-autonomy-differ-in-general-surgery-training-between-faculty-senior-residents-hospital-administrators-and-the-general-public-a-multi-institutional-study
#20
MULTICENTER STUDY
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
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