Operative Confidence Among U.S General Surgery Residents

2021 ◽  
pp. 000313482110385
Author(s):  
Adel Elkbuli ◽  
Haley Ehrlich ◽  
Toria Gargano ◽  
Kevin Newsome ◽  
Huazhi Liu ◽  
...  
Keyword(s):  
General Surgery ◽  
Online Survey ◽  
Influential Factors ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Binary Outcomes ◽  
Case Volume ◽  
General Surgery Residency ◽  
Operative Case ◽  
Community Teaching

Background General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors. Methods A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs. Multivariable logistic regression was used for calculating the adjusted odds ratio (aOR) for binary outcomes. Significance was defined as P-values ≤ .05 or 95% confidence intervals (CIs) >1 or <1. Results There were 120/558 (21.5%) GSR respondents. General surgery residents with >200 overall operative case volume reported significantly higher confidence with minor cases (P = .05) and major cases (P = .02). General surgery residents that performed both minor and major surgeries reported higher confidence with minor cases at 85.7% compared to GSRs that performed mostly minor surgeries (64.7%) and mostly major surgeries (62.5%). General surgery residents who performed >50 minor surgeries during their PGY 1 and 2 were less confident with major cases than GSRs who performed <50 minor surgeries (aOR: 19.98, 95% CI: 1.26, 318). General surgery residents from community teaching hospitals reported higher confidence with major and minor cases than GSRs from university teaching hospitals and combined programs. Conclusion Increased case volume, predominant case type, early surgical experience during PGY 1 and 2 years, and training at community teaching hospitals were identified as the most important factors that positively influence perception of operative confidence and autonomy among GSRs. These may have important implications in the development of future surgeons.

The Effect of the 80-Hour Work Week on General Surgery Resident Operative Case Volume

2006 ◽  
Vol 72 (10) ◽  
pp. 924-928 ◽  
Author(s):  
Julie Tran ◽  
Roger Lewis ◽  
Christian De Virgilio
Keyword(s):  
General Surgery ◽  
Median Number ◽  
Case Volume ◽  
General Surgery Residency ◽  
House Calls ◽  
Surgical Residents ◽  
Operative Case ◽  
General Surgery Resident ◽  
Surgery Resident ◽  
Surgery Residency Program

To meet the new duty hour restrictions on July 1, 2003, our general surgery residency program underwent many changes. The purpose of this study was to examine whether the implementation of these changes, made in part to comply with new duty hour restrictions, would adversely impact general surgery residents’ operative volume. The operative cases of categorical surgical residents were recorded from July 1, 2000 to December 31, 2004. The main outcome measure was the median number of operative cases performed by each resident per quarter (a 3-month period). The number of in-house calls each resident took per quarter was also recorded. From 2000 to 2004, the median number of in-house calls per quarter significantly decreased (27, 25, 15, 10, and 14, respectively; P < 0.001). The median number of operative procedures performed did not vary from quarter to quarter (P = 0.49). There was a trend toward an increase in number of cases performed at the postgraduate year (PGY) 1 (P = 0.07) and 2 (P = 0.04) levels, a decrease at the PGY3 level (P = 0.058), and no change at the PGY4 and 5 years. The 80-hour work week did not adversely affect the operative experience of our categorical surgical residents despite significant reductions of in-house call.

Trends of core versus subspecialty operative procedures completed in general surgery residency training programs

2021 ◽  
pp. postgradmedj-2021-140503
Author(s):  
Faiz Tuma ◽  
Rafael D Malgor ◽  
Nikit Kapila ◽  
Mohamed K Kamel
Keyword(s):  
Residency Training ◽  
General Surgery ◽  
Operative Procedures ◽  
Steady Increase ◽  
Subspecialty Training ◽  
Paediatric Surgery ◽  
Case Volume ◽  
General Surgery Residency ◽  
The Core ◽  
Case Logs

IntroductionGeneral surgery residency involves performing subspecialty procedures in addition to the core general procedures. However, the proportion of core general surgery versus subspecialty procedures during training is variable and its temporal changes are unknown. The goal of our study was to assess the current trends in core general surgery and subspecialty procedure distributions during general surgery residency training.MethodsData were collected from the ACGME core general surgery national resident available report case logs from 2007 to 2019. Descriptive and time series analyses were used to compare proportions of average procedures performed per resident in the core general surgery category versus the subspecialty category. F-tests were conducted to show whether the slopes of the trend lines were significantly non-zero.ResultsThe mean of total procedures completed for major credit by the average general surgery resident increased from 910.1 (SD=30.31) in 2007 to 1070.5 (SD=37.59) in 2019. Over that same period, the number of general, cardiothoracic, plastic and urology surgery procedures increased by 24.9%, 9.8%, 76.6% and 19.3%, respectively. Conversely, vascular and paediatric surgery procedures decreased by 7.6% and 30.7%, respectively. The neurological surgery procedures remain stable at 1.1 procedures per resident per year. A significant positive correlation in the trend reflecting total (p<0.0001), general (p<0.0001) and plastic (p<0.0016) surgery procedures and the negative correlation in the trend lines for vascular (p<0.0006) and paediatric (p<0.0001) surgery procedures were also noted.ConclusionsTrends in overall surgical case volume performed by general surgery residents over the last 12 years have shown a steady increase in operative training opportunity despite the increasing number of subspecialty training programmes and fellowships. Further research to identify areas for improvement and to study the diversity of operative procedures, and their outcomes is warranted in the years to come.

scholarly journals Residents' Perspectives on Patient Safety in University and Community Teaching Hospitals

2014 ◽  
Vol 6 (3) ◽  
pp. 603-607 ◽  
Author(s):  
Deborah L. Jones
Keyword(s):  
Internal Medicine ◽  
Patient Safety ◽  
General Surgery ◽  
Health Care Professionals ◽  
Diagnostic Radiology ◽  
Transitions Of Care ◽  
Teaching Hospitals ◽  
Safety Issues ◽  
Communication Problems ◽  
Community Teaching

Abstract Background Patient safety is an important concept in resident education. To date, few studies have assessed resident perceptions of patient safety across different specialties. Objective The study explored residents' views on patient safety across the specialties of internal medicine, general surgery, and diagnostic radiology, focusing on common themes and differences. Methods In fall 2012, interviews of small groups of senior residents in internal medicine, general surgery, and diagnostic radiology were conducted at 3 academic medical centers and 3 community teaching hospitals in 3 major US metropolitan areas. In total, 33 residents were interviewed. Interviews used interactive discussion to explore multiple facets of patient safety. Results Residents identified lack of information, common errors, volume and acuity of patients, and inadequate supervision as major risks to patient safety. Specific threats to patient safety included communication problems, transitions of care, information technology interface issues, time constraints, and work flow. Residents disclosed that reporting safety issues was viewed as burdensome and carrying some degree of risk. There was variability as to whether residents would report safety threats they encountered. Conclusions Residents are aware of threats to patient safety and have a unique perspective compared with other health care professionals. Transitions of care and communication problems were the most common safety threats identified by the residents interviewed.

scholarly journals The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 489-496 ◽  
Author(s):  
Alessia Ferrarese ◽  
Valentina Gentile ◽  
Marco Bindi ◽  
Matteo Rivelli ◽  
Jacopo Cumbo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Learning Curve ◽  
General Surgery ◽  
Training Model ◽  
Influential Factors ◽  
Case Volume ◽  
Surgical Trainee ◽  
Acceptable Error ◽  
Surgical Residents ◽  
Curve Model

AbstractA well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient.Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy.Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress.Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.

General Surgery Residency Training No Longer Provides Sufficient Operative Case Numbers to Confer Proficiency in Vascular Trauma

2018 ◽  
Vol 227 (4) ◽  
pp. e206
Author(s):  
Michael S. Clemens ◽  
Zachary M. Arthurs ◽  
Marlin W. Causey ◽  
Joseph J. DuBose ◽  
Todd E. Rasmusssen ◽  
...  
Keyword(s):  
Residency Training ◽  
General Surgery ◽  
Vascular Trauma ◽  
General Surgery Residency ◽  
Operative Case

scholarly journals Does operative experience during residency correlate with reported competency of recent general surgery graduates?

2012 ◽  
pp. S171-S177
Author(s):  
Arash Safavi ◽  
Sarah Lai ◽  
Sonia Butterworth ◽  
Morad Hameed ◽  
Dan Schiller ◽  
...  
Keyword(s):  
General Surgery ◽  
Alimentary Tract ◽  
Resident Education ◽  
Response Rate ◽  
Surgical Experience ◽  
Questionnaire Response ◽  
Case Volume ◽  
Operative Case ◽  
Recent Graduates ◽  
Survey Responses

Background: Identification of attributes of residency training that predict competency would improve surgical education. We hypothesized that case experience during residency would correlate with self-reported competency of recent graduates. Methods: Aggregate case log data of residents enrolled in 2 general surgery programs were collected over a 12-month period and stratified into Surgical Council on Resident Education (SCORE) categories. We surveyed recent (< 5 yr) residency graduates on procedural competency. Resident case volumes were correlated with survey responses by SCORE category. Results: In all, 75 residents performed 11 715 operations, which were distributed by SCORE category as follows: essential-common (EC) 9935 (84.8%), essential-uncommon (EU) 889 (7.6%) and complex 891 (7.6%). Alimentary tract procedures were the most commonly performed EC (2386, 24%) and EU (504, 56.7%) procedures. The least common EC procedure was plastic surgery (4, 0.04%), and the least common EU procedure was abdomen–spleen (1, 0.1%). The questionnaire response rate was 45%. For EC procedures, self-reported competency was highest in skin and soft tissue, thor acic and head and neck (each 100%) and lowest in vascular–venous (54%), whereas for EU procedures it was highest in abdomen–general (100%) and lowest in vascular–arterial (62%). The correlation between case volume and self-reported competency was poor (R = 0.2 for EC procedures). Conclusion: Self-reported competency correlates poorly with operative case experience during residency. Other curriculum factors, including specific rotations and timing, balance between inpatient and outpatient surgical experience and competition for cases, may contribute to procedural competency acquisition during residency.

scholarly journals Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume

JAMA Surgery ◽  
2013 ◽  
Vol 148 (9) ◽  
pp. 829 ◽  
Author(s):  
Samuel I. Schwartz ◽  
Joseph Galante ◽  
Amy Kaji ◽  
Matthew Dolich ◽  
David Easter ◽  
...  
Keyword(s):  
General Surgery ◽  
Case Volume ◽  
Operative Case

Present Status of Autonomy in Surgical Residency—a Program Director's Perspective

2015 ◽  
Vol 81 (8) ◽  
pp. 786-790 ◽  
Author(s):  
Mitesh Patel ◽  
Jasneet S. Bhullar ◽  
Gokulakkrishna Subhas ◽  
Vijay Mittal
Keyword(s):  
General Surgery ◽  
Residency Program ◽  
Online Survey ◽  
Program Directors ◽  
The United States ◽  
General Surgery Residency ◽  
Surgery Residency Program ◽  
Residency Program Directors ◽  
E Mail

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. Questions were asked regarding classification of autonomy, percentage of case completed by the resident independently, and in what area a resident worked with minimal supervision. Of the 202 delivered, 85 program directors were responded (42%). Seventy-eight per cent of programs classified a resident as surgeon junior whether the resident completed more than 50 per cent of the case. Most classified autonomy as either the resident completing >75 per cent of a case (41%) or completing the critical steps of a surgery (41%). Eighty-eight per cent stated that chief residents completed the majority of cases under supervision, whereas only 12 per cent stated the chief had autonomy in the operating room and also acted as teaching assistant. While, 60 per cent stated their chief residents did not work in any area of the hospital independently. Despite differences in how autonomy is defined among programs, most program directors feel that their chief residents do not achieve complete autonomy. Programs should allow their residents to work in a progressive responsibility as they progress into their fourth and fifth years of residency to achieve autonomy.

scholarly journals Caduceus or Rod of Asclepius? Exploring Logos of University Teaching Hospitals in Nigeria

2020 ◽  
Vol 3 (1) ◽  
pp. 47-55
Author(s):  
Kehinde Kazeem Kanmodi ◽  
Ifeoluwa Oluwasolafunmi Ogidan ◽  
Oluwatobi Emmanuel Adegbile ◽  
Precious Ayomide Kanmodi
Keyword(s):  
Online Survey ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Bivariate Analysis ◽  
P Value ◽  
Cross Sectional ◽  
Systematic Screening ◽  
Search Data ◽  
The University ◽  
University Teaching Hospitals

AbstractBackground: Historically, the Rod of Asclepius is considered as the correct symbol of Medicine. Unfortunately, many medical/health institutions in the world have erroneously interchanged the Rod of Asclepius symbol with erroneous symbols (e.g. Caduceus) to depict Medicine. This study aims to assess the official logos (i.e. institutional symbols) of university teaching hospitals in Nigeria and determine if these logos actually depict the true symbol of Medicine.Methods: This study was a cross-sectional online survey of teaching hospitals in Nigeria on their official logos. A total of 40,556 operating hospitals and clinics in Nigeria were identified. After systematic screening, a total of 35 hospitals were identified as university teaching hospitals and used for the survey. Official information about the geopolitical zone, ownership and official logo of the selected hospitals was obtained (via online and offline search). Data collected was analysed using SPSS version 22 software.Results: Out of the 35 surveyed university teaching hospitals, only 7 did not have snake(s) as part of their official logo. However, out of the remaining 28 hospitals that have snake(s) as part of their official logos, only 57.1% (16/28) of them have only one snake in their logo. Exactly half of the surveyed hospitals having logos with two entwined snakes (i.e. Caduceus) were owned by the federal government. Bivariate analysis showed that there exists statistically significant relationship between the geopolitical zone where a hospital is situated and the number of entwined snakes indicated in their official logo (p-value=0.034).Conclusion: This study shows that the correct symbol of Medicine is not universally indicated in the official logos of the university teaching hospitals in Nigeria.

scholarly journals Cause for concern: Resident experience in operative trauma during general surgery residency at a Canadian centre

2020 ◽  
Author(s):  
Paul Engels ◽  
Andrew Versolatto ◽  
Qian Shi ◽  
Angela Coates ◽  
Timothy Rice
Keyword(s):  
General Surgery ◽  
Trauma Surgery ◽  
Trauma Exposure ◽  
Median Number ◽  
Trauma Centre ◽  
Operative Trauma ◽  
General Surgery Residency ◽  
Operative Case ◽  
General Surgery Training ◽  
Procedure Type

Background: The ability to provide competent operative trauma care is a core objective of general surgery training but recent publications question the ability of graduates to meet this standard. To assess the adequacy of operative trauma exposure during residency, we constructed and analyzed a retrospective trauma operative case log for general surgery residents at a Canadian trauma centre.  Methods: The Hamilton General Hospital Trauma Registry was used to identify all patients from July 2008 to June 2018 who underwent a trauma operation on the neck, chest, or abdomen.  Medical records were reviewed to determine procedure type and resident presence. Results: In our study, 417 patients underwent 570 operations (422 abdominal, 103 thoracic, and 45 neck).  For the 35 residents that completed their general surgery residency during the study, the median number of trauma laparotomies was 5, with only 14/35 (40%) present for ≥10 trauma operations.  Only 10 residents (29%) were exposed to a neck exploration and 18 (51%) exposed to a thoracic operation for trauma.    Conclusions: Operative trauma exposure amongst general surgery residents at an academic Canadian trauma centre was limited. Cumulative operative trauma surgery exposure of a typical graduating resident was inadequate when compared to Canadian and American accrediting-body standards.

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