Strategies for giving feedback in the operating room

2021 ◽  
pp. postgradmedj-2021-141268
Author(s):  
Akos Marton ◽  
James Ashcroft
Keyword(s):  
Operating Room ◽  
Surgical Training ◽  
Learner Performance ◽  
Specific Feedback ◽  
Giving Feedback

Feedback is crucial to learning and is a difficult concept to define, occurring as a consequence of learner performance with the ultimate aim of influencing change in the learner. Here, we discuss strategies for giving feedback in the operating room revolving around the following themes: encouraging a sociocultural process, forming an educational alliance, sharing training goals, finding the appropriate time, giving task-specific feedback, approaching unsatisfactory performance and providing follow-up. It is essential that surgeons understand the fundamental feedback theories at play in the operating room described in this article and how they influence surgical training at all stages.

scholarly journals Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fabrizio Rivera ◽  
Alessandro Bardelli ◽  
Andrea Giolitti
Keyword(s):  
Operating Room ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Medium Term ◽  
Operating Room Table ◽  
Sf 36 ◽  
Standard Operating ◽  
The Mean

Abstract Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

Blood, Sweat, Toil, and Tears of Surgical Training. Part I: Blood

2007 ◽  
Vol 15 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Andrew J Drain ◽  
Jonathon I Ferguson ◽  
Sharon Wilkinson ◽  
Samer AM Nashef
Keyword(s):  
Adverse Effect ◽  
Blood Loss ◽  
Operating Room ◽  
Clinical Outcomes ◽  
Surgical Training ◽  
Clinical Service ◽  
Significant Difference ◽  
Potential Impact ◽  
The Impact ◽  
Cardiac Operations

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.

scholarly journals Education in Neurology Resident Documentation Using Payroll Simulation

2017 ◽  
Vol 9 (2) ◽  
pp. 231-236 ◽  
Author(s):  
John W. Liang ◽  
Vicki L. Shanker
Keyword(s):  
Medical Decision ◽  
Financial Loss ◽  
Income Loss ◽  
Face To Face ◽  
Number Of Patients ◽  
Specific Feedback ◽  
Didactic Lecture ◽  
E Mail

ABSTRACT Background Approaches for teaching neurology documentation include didactic lectures, workshops, and face-to-face meetings. Few studies have assessed their effectiveness. Objective To improve the quality of neurology resident documentation through payroll simulation. Methods A documentation checklist was created based on Medicaid and Medicare evaluation and management (E/M) guidelines. In the preintervention phase, neurology follow-up clinic charts were reviewed over a 16-week period by evaluators blinded to the notes' authors. Current E/M level, ideal E/M level, and financial loss were calculated by the evaluators. Ideal E/M level was defined as the highest billable level based on the documented problems, alongside a supporting history and examination. We implemented an educational intervention that consisted of a 1-hour didactic lecture, followed by e-mail feedback “paystubs” every 2 weeks detailing the number of patients seen, income generated, income loss, and areas for improvement. Follow-up charts were assessed in a similar fashion over a 16-week postintervention period. Results Ten of 11 residents (91%) participated. Of 214 charts that were reviewed preintervention, 114 (53%) had insufficient documentation to support the ideal E/M level, leading to a financial loss of 24% ($5,800). Inadequate documentation was seen in all 3 components: history (47%), examination (27%), and medical decision making (37%). Underdocumentation did not differ across residency years. Postintervention, underdocumentation was reduced to 14% of 273 visits (P < .001), with a reduction in the financial loss to 6% ($1,880). Conclusions Improved documentation and increased potential reimbursement was attained following a didactic lecture and a 16-week period in which individual, specific feedback to neurology residents was provided.

scholarly journals Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes

2020 ◽  
Author(s):  
Barbara Hall ◽  
Judith Goh ◽  
Maqsudul Islam ◽  
Anubha Rawat
Keyword(s):  
Pelvic Organ Prolapse ◽  
Training Program ◽  
Patient Outcomes ◽  
Surgical Training ◽  
Pelvic Organ ◽  
Vaginal Repair ◽  
Low Resource ◽  
Prolapse Recurrence ◽  
Surgical Training Program

Abstract Introduction and hypothesis The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were: Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 Vaginal length < 4 cm Results Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.

PP151 Comparison Of Patients Undergoing New Technology For Prostate Cancer

2018 ◽  
Vol 34 (S1) ◽  
pp. 125-126
Author(s):  
Deyvid Silva ◽  
Letícia Lazarini ◽  
Araujo Aline ◽  
Evelinda Trindade ◽  
Otavio Becker ◽  
...  
Keyword(s):  
Intensive Care ◽  
Operating Room ◽  
Gleason Score ◽  
Open Surgery ◽  
Sao Paulo ◽  
High Intensity Focused Ultrasound ◽  
Disease Stage ◽  
Consecutive Series ◽  
São Paulo

Introduction:Prostate neoplasia affects more than one million people worldwide. Surgical treatments have evolved from open or video prostatectomy, up to the High Intensity Focused Ultrasound (HIFU) technique. HIFU studies cite less costs and better quality of life during the first year of follow-up. The objective of this study is to describe a consecutive series of eligible patients, with Gleason score 6 and 7, and compare resources used along those three treatment techniques.Methods:A comparative and retrospective study was conducted during the first 2017 semester, at Hospital de Transplantes de São Paulo, São Paulo city, Brazil. Consecutive eligible patients were matched by age, disease stage and profile and Gleason score 6 or 7. Resources used were assessed through medical records review and in- and out-patient visit interviews.Results:A total of 152 patients were followed: 50 underwent open surgery prostatectomy, 50 underwent video prostatectomy and 52 underwent HIFU. Mean age did not differ between groups (66.6, 64.1 and 65.6 years, respectively). All patients were followed for at least three months. The average operating room time was 4.7, 4.1 and 2.3 hours, and the average anesthetic recovery time was 2.0, 1.9 and 2.0 hours, respectively. Average inpatient length of stay was 2.5, 2.7 and 1.5 days, respectively. Postoperatively, nine (18 percent) open surgery patients, and 14 (28 percent) video-prostatectomy patients required an average of one full day of intensive care, compared to only one (2 percent) HIFU patient. During follow-up, the same effectiveness was observed between the groups, none required re-intervention. Thus, considering the 50 percent economy in hours of operating room and of days of hospital stay, as well as 10 times less use of intensive care unit days when the HIFU technique was compared to conventional surgeries, it is estimated the HIFU program allowed 30 percent cost savings.Conclusions:The HIFU program presented effectiveness and savings. The hospital can increase access to care for prostate neoplasia patients.

scholarly journals Improvement of Intraoperative Antibiotic Prophylaxis in Prolonged Cardiac Surgery by Automated Alerts in the Operating Room

2003 ◽  
Vol 24 (1) ◽  
pp. 13-16 ◽  
Author(s):  
Giorgio Zanetti ◽  
Hugh L. Flanagan ◽  
Lawrence H. Cohn ◽  
Richard Giardina ◽  
Richard Platt
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Operating Room ◽  
Spillover Effect ◽  
Control Group ◽  
Reminder System ◽  
Preoperative Administration ◽  
Group 5 ◽  
The Impact

AbstractObjective:To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations.Design:Randomized, controlled, evaluator-blinded trial.Setting:University-affiliated hospital.Patients:Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery.Intervention:Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered.Results:Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02).Conclusion:The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis.

scholarly journals Successful Limb-Sparing Wide Excision of a Giant Lipofibromatosis in a 5-Year-Old Girl

2018 ◽  
Vol 11 (1) ◽  
pp. 179-184
Author(s):  
Putu Anda Tusta Adiputra
Keyword(s):  
Operating Room ◽  
Distal Femur ◽  
Surgical Decision ◽  
Left Tibia ◽  
Course Of Action ◽  
Left Limb ◽  
Set Up ◽  
Painless Mass ◽  
Bony Erosion

A 5-year-old girl presented with a big painless mass, sized 24 × 37 × 35 cm, in her lower left limb. MRI revealed a huge heterogeneous mass splaying from the left distal femur to the calcaneal region without bony erosion but compressing the arteries and causing bowing of the left tibia and fibula bones. The difficulty was to determine the best course of action taken which would either be limb salvation or amputation. Considering that only a few muscles could be saved, the author initially recommended amputation but still considered a limb-sparing procedure. After a double set-up examination in the operating room, the author ultimately decided to save the affected limb. The salvaged limb was found to be viable after the surgery, and there was no further recurrence over a subsequent 6-month follow-up period. The careful surgical decision is vital in giving the best possible care to the patient.

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