scholarly journals An ACGME Duty Hour Compliant 3-Person Night Float System for Neurological Surgery Residency Programs

2014 ◽  
Vol 6 (2) ◽  
pp. 315-319 ◽  
Author(s):  
Brian T. Ragel ◽  
Mark Piedra ◽  
Paul Klimo ◽  
Kim J. Burchiel ◽  
Heidi Waldo ◽  
...  
Keyword(s):  
Work Schedule ◽  
Meaningful Difference ◽  
Residency Programs ◽  
Night Float ◽  
System A ◽  
Oregon Health ◽  
Before And After ◽  
Work Hour ◽  
Operative Experience ◽  
Neurological Surgery

Abstract Background In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted the 24+6-hour work schedule and 80-hour workweek, and in 2011, it enhanced work hour and supervision standards. Innovation In response, Oregon Health & Science University's (OHSU) neurological surgery residency instituted a 3-person night float system. Methods We analyzed work hour records and operative experience for 1 year before and after night float implementation in a model that shortened a combined introductory research and basic clinical neurosciences rotation from 12 to 6 months. We analyzed residents' perception of the system using a confidential survey. The ACGME 2011 work hour standards were applied to both time periods. Results After night float implementation, the number of duty hour violations was reduced: 28-hour shift (11 versus 235), 8 hours off between shifts (2 versus 20), 80 hours per week (0 versus 17), and total violations (23 versus 275). Violations increased only for the less than 4 days off per 4-week interval rule (10 versus 3). No meaningful difference was seen in the number of operative cases performed per year at any postgraduate year (PGY) training level: PGY-2 (336 versus 351), PGY-3 (394 versus 354), PGY-4 (803 versus 802), PGY-5 (1075 versus 1040), PGY-7 (947 versus 913), and total (3555 versus 3460). Residents rated the new system favorably. Conclusions To meet 2011 ACGME duty hour standards, the OHSU neurological surgery residency instituted a 3-person night float system. A nearly complete elimination of work hour violations did not affect overall resident operative experience.

Increased rate of complications on a neurological surgery service after implementation of the Accreditation Council for Graduate Medical Education work-hour restriction

2012 ◽  
Vol 116 (3) ◽  
pp. 483-486 ◽  
Author(s):  
Travis M. Dumont ◽  
Anand I. Rughani ◽  
Paul L. Penar ◽  
Michael A. Horgan ◽  
Bruce I. Tranmer ◽  
...  
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Accreditation Council ◽  
Graduate Medical ◽  
Before And After ◽  
Work Hour ◽  
Neurological Surgery

Object The Accreditation Council for Graduate Medical Education instituted mandatory 80-hour work-week limitations in July 2003. The work-hour restriction was met with skepticism among the academic neurosurgery community and is thought to represent a barrier to teaching, ultimately compromising patient care. The authors hypothesize that the introduction of the mandatory resident work-hour restriction corresponds with an overall increase in morbidity rate. Methods This study compares the morbidity and mortality rates on an academic neurological surgery service before and after institution of the work-hour restriction. Complications are individually assessed at a monthly divisional conference by neurosurgical faculty and residents. A prospective database was commenced in July 2000 recording all complications, complications that were deemed to be potentially avoidable (“possibly preventable”), and complications that were deemed unavoidable. The incidence of morbidity and mortality from July 2000 to June 2003 is compared with the incidence from July 2003 to June 2006. Results The overall rate of morbidity and mortality increased from 103 to 114 per 1000 patients treated after institution of the work-hour restriction, although this increase was not statistically significant (χ21, N = 8546 = 2.6, p = 0.106). The morbidity rate increased from 70 to 89 per 1000 patients treated after institution of the work-hour restriction (χ21, N = 8546 = 10, p = 0.001). The overall mortality rate was diminished from 32 to 27 per 1000 patients treated after institution of the work-hour restriction (χ21, N = 8546 = 3.2, p = 0.075). Morbidities considered avoidable or possibly preventable were seen to increase from 56 to 66 per 1000 patients treated (χ21, N = 8546 = 5.7, p = 0.017). Avoidable or possibly preventable mortalities numbered 3 per 1000 patients treated, and this rate did not change after introduction of the work-hour restriction (χ21, N = 8546 = 0.08, p = 0.777). Conclusions The morbidity rate on a neurological surgery service is increased after implementation of the work-hour restriction. Mortality rates remain unchanged.

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

2021 ◽  
pp. 000348942199696
Author(s):  
Hilary C. McCrary ◽  
Sierra R. McLean ◽  
Abigail Luman ◽  
Patricia O’Sullivan ◽  
Brigitte Smith ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Head And Neck ◽  
National Survey ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Residency Programs ◽  
Surgery Training ◽  
Robotic Surgery Training ◽  
Operative Experience

Objective: The aim of this study is to describe the current state of robotic surgery training among Otolaryngology—Head and Neck Surgery (OHNS) residency programs in the United States. Methods: This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. Results: A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. Conclusion: This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. Level of Evidence: IV

scholarly journals Characteristics of Highly Rated Internal Medicine Attendings Before and After the 2004 Work-Hour Restrictions

2016 ◽  
Vol 181 (1) ◽  
pp. 76-81
Author(s):  
Renee Mallory ◽  
Jeffrey L. Jackson ◽  
Donald Mondragon ◽  
Christos Hatzigeorgiou ◽  
Kent J. DeZee ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Before And After ◽  
Work Hour

Ketersediaan Handrub Meningkatkan Kebiasaan Cuci Tangan Ibu Rumah Tangga

2021 ◽  
Vol 7 (1) ◽  
pp. 43
Author(s):  
Desy Ardiyati ◽  
Linda Suwarni ◽  
Abduh Ridha
Keyword(s):  
Public Health ◽  
Diarrheal Disease ◽  
Hand Washing ◽  
Morbidity And Mortality ◽  
P Value ◽  
Meaningful Difference ◽  
West Kalimantan ◽  
Work Area ◽  
Before And After ◽  
Very High

Diarrheal disease is a problem of public health that is still occurring in Indonesia, especially in children because of morbidity and mortality is still very high. Hand washing is one of the prevention factors of diarrhoea disease but the habit of hand washing habits is still low. Pontianak City is in the first position of 14 districts/cities for diarrhea cases that are handled according to gender in West Kalimantan province. Pontianak City Health Office report year 2015 diarrhea pain figure of 22.24 per 1000 inhabitants. The aim of this study is to determine the effectiveness of the use of handrub on the habit of washing housewives in the work area Alianyang Pontianak City. The result showed that there is a significant increase in housewives hand washing behaviors that support 44.4% increase to 55.6% in experimental groups with (p value = 0.000). Based on the results of research and discussion, it can be concluded that the use of handrub is effective against the behavior of housewives' hand washing because there is a meaningful difference between before and after using handrub.

Enhancing forensic exposures in residency training

2019 ◽  
Vol 15 (1) ◽  
pp. 13-19
Author(s):  
Tobias Wasser ◽  
Saksham Chandra ◽  
Katherine Michaelsen
Keyword(s):  
Design Methodology ◽  
Psychiatry Residents ◽  
Content Type ◽  
Forensic Evaluations ◽  
Residency Programs ◽  
General Psychiatry ◽  
Before And After ◽  
Secondary Analyses ◽  
Forensic Setting ◽  
The Impact

Purpose The purpose of this paper is to review the impact of a new, brief forensic rotation for general psychiatry residents on the variety of residents’ forensic exposures. Design/methodology/approach The authors surveyed residents who trained before and after the implementation of the new rotation to assess the impact of the rotation on the residents’ forensic experiences during training across a variety of domains. Findings Even in a highly clinical forensic setting, residents participating in the required rotation reported significantly greater variety of forensic experiences than those who had not completed the required rotation, including types of settings and assessments, Rotation completers reported greater exposure to various types of settings and assessments, and courtroom-related experiences, as well as the overall number of forensic exposures. The two groups did not differ in their forensic exposures in general psychiatry settings, civil-forensic evaluations or diverse forensic populations. Secondary analyses showed that increased exposure to court-based experiences and multiple forensic settings was associated with forensic fellowship interest. Originality/value This study demonstrates that a brief, mandatory forensic clinical rotation may increase residents’ exposure to forensic settings, assessments and courtroom-related experiences and that increased exposure to courtroom-based experiences in particular may increase interest in forensic fellowship. While not surprising, the results demonstrate that residents were not otherwise having these forensic experiences and that even time-limited forensic rotations can enhance the breadth of residents’ forensic exposures. Further, the rotation achieved these outcomes without using typical forensic sites but instead highly clinical sites, which may be particularly encouraging to residency programs without ready access to classic forensic rotation sites. This study contributes to the small but expanding body of the literature describing the value of increasing psychiatry residents’ training in clinical forensic psychiatry.

The Effects of the Addition of a Pediatric Surgery Fellow on the Operative Experience of the General Surgery Resident

2015 ◽  
Vol 81 (6) ◽  
pp. 610-613
Author(s):  
Alexander Raines ◽  
Tabitha Garwe ◽  
Ademola Adeseye ◽  
Alejandro Ruiz-Elizalde ◽  
Warren Churchill ◽  
...  
Keyword(s):  
General Surgery ◽  
Pediatric Surgery ◽  
Resident Education ◽  
Single Institution ◽  
Residency Programs ◽  
Relative Value ◽  
General Surgery Resident ◽  
Operative Experience ◽  
Surgery Resident

Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 ( P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 ( P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.

The Effect and Use of Milestones in the Assessment of Neurological Surgery Residents and Residency Programs

2018 ◽  
Vol 75 (1) ◽  
pp. 147-155 ◽  
Author(s):  
Lisa N. Conforti ◽  
Nicholas A. Yaghmour ◽  
Stanley J. Hamstra ◽  
Eric S. Holmboe ◽  
Benjamin Kennedy ◽  
...  
Keyword(s):  
Residency Programs ◽  
Neurological Surgery

Cinematic Angiography for Measurements of Blood Flow in Cerebral Aneurysms With Stents

2007 ◽  
Author(s):  
Makoto Ohta ◽  
Naoko Fujimura ◽  
Luca Augsburger ◽  
Hasan Yilmaz ◽  
Daniel A. Ru¨fenacht
Keyword(s):  
Blood Flow ◽  
High Speed ◽  
Cerebral Aneurysms ◽  
Flow Speed ◽  
Circulation System ◽  
Parent Artery ◽  
Vortex Center ◽  
System A ◽  
Before And After ◽  
Movement Distance

Background and Purpose: The assessment of blood flow speed by imaging modalities is important for endovascular treatments, such as stent implantation, of cerebral aneurysms. The subtracted vortex centers path line method (SVC method) is one of the ways of determining flow speed quantitatively using the image sequence. And a cinematic angiography (CA) is a high speed image acquisition system using X-ray and contrast media integrated in Digital Subtraction Angiography (DSA) for endovascular therapy. The combination of SVC and CA may useful for determining the blood flow speed during the operation using DSA. In this study, we applied this combination to analyze hemodynamic changes before and after stenting. Methods: A transparent tubular model was constructed of silicone which included an aneurysm 10 mm in diameter and having a 5 mm neck on a straight parent artery with a diameter of 3.5 mm. The model was integrated into a pulsatile circulation system. A double layer stent was placed in the parent artery on the aneurysm. By CA, successive images at 25 frames per second with injection of contrast were obtained. Results and conclusion: Rotating vortexes of contrast, which advanced along the wall of the aneurysm, were observed in successive images of the aneurysm cavity. The movement distance of the vortex center was measured and the results show that the vortex speed decrease after stenting. This indicates the possibility of applying the SVC method to medical imaging equipment for analysis of the flow in aneurysms containing stent.

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