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Autonomy general surgery residents

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https://www.readbyqxmd.com/read/29885185/evaluation-of-educational-environment-for-postgraduate-residents-using-post-graduate-hospital-educational-environment-measure
#1
Asif Sandhu, Naeem Liaqat, Khadija Waheed, Sara Ejaz, Amna Khanum, Ambreen Butt, Fawad Ahmad Randhawa, Sajid Hameed Dar
The objective of this study was to determine the level of educational environment among residents working in our hospital using Post graduate hospital educational environment measure (PHEEM). This cross-sectional study was conducted at services hospital, Lahore. All the Post-graduate residents (PGR's) working at Services hospital, Lahore were asked to fill a proforma having 2 parts: Bio-data and PHEEM. Out of 110 PGR's, 87 completed questionnaires, of which majority labelled education environment into level 3 (71%)...
May 2018: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/29559055/failure-on-the-american-board-of-surgery-examinations-of-general-surgery-residency-graduates-correlates-positively-with-states-malpractice-risk
#2
Daniel L Dent, Mohammed J Al Fayyadh, Jeremy A Rawlings, Ramy A Hassan, Jason W Kempenich, Ross E Willis, Ronald M Stewart
It has been suggested that in environments where there is greater fear of litigation, resident autonomy and education is compromised. Our aim was to examine failure rates on American Board of Surgery (ABS) examinations in comparison with medical malpractice payments in 47 US states/territories that have general surgery residency programs. We hypothesized higher ABS examination failure rates for general surgery residents who graduate from residencies in states with higher malpractice risk. We conducted a retrospective review of five-year (2010-2014) pass rates of first-time examinees of the ABS examinations...
March 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29436708/nursing-wound-care-practices-in-haiti-facilitators-and-barriers-to-quality-care
#3
B A Timmins, C Thomas Riché, M W Saint-Jean, J Tuck, L Merry
AIM: To describe the facilitators and barriers for nurses to perform quality wound care in three surgical wards of a hospital in Port-au-Prince, Haiti. BACKGROUND: Up to a quarter of patients in low- and middle-income countries may acquire at least one infection while hospitalized. There is a paucity of research investigating nursing wound care practices in low- and middle-income countries regarding the prevention of hospital-acquired infections. METHODS: The design was qualitative descriptive...
February 13, 2018: International Nursing Review
https://www.readbyqxmd.com/read/29398631/enhancing-confidence-in-graduating-general-surgery-residents-establishing-a-chief-surgery-resident-service-at-an-independent-academic-medical-center
#4
Benjamin T Jarman, Colette T O'Heron, Kara J Kallies, Thomas H Cogbill
OBJECTIVE: Providing opportunities for autonomy to enhance the development of independence and confidence during surgery residency remains among the greatest challenges of the current training paradigm. The objective of this study was to evaluate the implementation and outcomes of a chief resident service (CRS). DESIGN: A CRS was designed with operative, call and office responsibilities. Supervision and evaluation were consistent with institutional guidelines. CRS operative logs from 2011 to 2014 were compared with logs from the participants' first year in practice...
February 2, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29277387/relationship-of-procedural-numbers-with-meaningful-procedural-autonomy-in-general-surgery-residents
#5
Herbert P Stride, Brian C George, Reed G Williams, Jordan D Bohnen, Megan J Eaton, Mary C Schuller, Lihui Zhao, Amy Yang, Shari L Meyerson, Rebecca Scully, Gary L Dunnington, Laura Torbeck, John T Mullen, Samuel P Mandell, Michael Choti, Eugene Foley, Chandrakanth Are, Edward Auyang, Jeffrey Chipman, Jennifer Choi, Andreas Meier, Douglas Smink, Kyla P Terhune, Paul Wise, Debra DaRosa, Nathaniel Soper, Jay B Zwischenberger, Keith Lillemoe, Jonathan P Fryer
BACKGROUND: Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. METHODS: Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents...
March 2018: Surgery
https://www.readbyqxmd.com/read/29141086/use-of-entrustable-professional-activities-in-the-assessment-of-surgical-resident-competency
#6
Justin P Wagner, Catherine E Lewis, Areti Tillou, Vatche G Agopian, Chi Quach, Timothy R Donahue, O Joe Hines
Importance: Competency-based assessments of surgical resident performance require metrics of entrustable autonomy. Objectives: To designate entrustable professional activities (EPAs) in global performance and in specific operations, and to identify differences in perceived capability, autonomy, and expectations between surgical faculty and residents. Design, Setting, and Participants: This survey study was conducted from August 9, 2016, through August 24, 2016, in the Department of Surgery at the UCLA David Geffen School of Medicine...
April 1, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29064891/how-many-observations-are-needed-to-assess-a-surgical-trainee-s-state-of-operative-competency
#7
Reed G Williams, David B Swanson, Jonathan P Fryer, Shari L Meyerson, Jordan D Bohnen, Gary L Dunnington, Rebecca E Scully, Mary C Schuller, Brian C George
OBJECTIVE: To establish the number of operative performance observations needed for reproducible assessments of operative competency. BACKGROUND: Surgical training is transitioning from a time-based to a competency-based approach, but the number of assessments needed to reliably establish operative competency remains unknown. METHODS: Using a smart phone based operative evaluation application (SIMPL), residents from 13 general surgery training programs were evaluated performing common surgical procedures...
October 23, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28986275/quantification-of-resident-work-in-colorectal-surgery
#8
Elizabeth A Bailey, Adam P Johnson, Ira L Leeds, Rachel L Medbery, Vanita Ahuja, Thomas VanderMeer, Elizabeth C Wick, Busayo Irojah, Rachel R Kelz
OBJECTIVE: To examine resident intraoperative participation, perceived autonomy, and communication patterns between residents and attending surgeons using a novel survey tool. DESIGN: This was a prospective multi-institutional study. Operative residents completed the survey tool immediately after each colorectal resection performed during the study period. Resident intraoperative participation was quantified including degree of involvement in the technical aspects of the case, self-perception of autonomy, and communication strategies between the resident and attending...
October 3, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28950992/what-factors-influence-attending-surgeon-decisions-about-resident-autonomy-in-the-operating-room
#9
Reed G Williams, Brian C George, Shari L Meyerson, Jordan D Bohnen, Gary L Dunnington, Mary C Schuller, Laura Torbeck, John T Mullen, Edward Auyang, Jeffrey G Chipman, Jennifer Choi, Michael Choti, Eric Endean, Eugene F Foley, Samuel Mandell, Andreas Meier, Douglas S Smink, Kyla P Terhune, Paul Wise, Debra DaRosa, Nathaniel Soper, Joseph B Zwischenberger, Keith D Lillemoe, Jonathan P Fryer
BACKGROUND: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. METHODS: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure...
December 2017: Surgery
https://www.readbyqxmd.com/read/28882683/structured-operative-autonomy-an-institutional-approach-to-enhancing-surgical-resident-education-without-impacting-patient-outcomes
#10
Brandon M Wojcik, Zhi Ven Fong, Madhukar S Patel, David C Chang, Dustin R Long, Haytham M A Kaafarani, Emil Petrusa, John T Mullen, Keith D Lillemoe, Roy Phitayakorn
BACKGROUND: Although barriers to granting surgical residents autonomy in the operating room are well described, few have proposed practical strategies to overcome these barriers. Our department adopted a multidisciplinary approach to develop a rotation that aimed to grant chief residents structured operative autonomy. In this study, we assess the feasibility of implementation, impact on patient safety, and educational benefit to residents after the program's pilot year. STUDY DESIGN: During a 1-month rotation, chief residents began cases alone using their own operative block time...
December 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28781132/-taking-training-to-the-next-level-the-american-college-of-surgeons-committee-on-residency-training-survey
#11
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...
November 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28742711/readiness-of-us-general-surgery-residents-for-independent-practice
#12
MULTICENTER STUDY
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...
October 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
#13
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...
November 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
#14
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)...
November 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28607848/progressive-surgical-autonomy-in-a-plastic-surgery-resident-clinic
#15
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
#16
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
#17
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 2018: 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
#18
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...
April 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
#19
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
#20
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
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