scholarly journals Preoperative Practice Paired With Instructor Feedback May Not Improve Obstetrics-Gynecology Residents' Operative Performance

2017 ◽  
Vol 9 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Jamie Kroft ◽  
Michael Ordon ◽  
Leslie Po ◽  
Nora Zwingerman ◽  
Katie Waters ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Controlled Trial ◽  
Intraclass Correlation ◽  
Assessment Scores ◽  
Surgical Trainees ◽  
Significant Difference ◽  
Instructor Feedback ◽  
Operative Performance ◽  
Optimal Approach ◽  
Laparoscopic Salpingectomy

ABSTRACT Background There is evidence that preoperative practice prior to surgery can improve trainee performance, but the optimal approach has not been studied. Objective We sought to determine if preoperative practice by surgical trainees paired with instructor feedback improved surgical technique, compared to preoperative practice or feedback alone. Methods We conducted a randomized controlled trial of obstetrics-gynecology trainees, stratified on a simulator-assessed surgical skill. Participants were randomized to preoperative practice on a simulator with instructor feedback (PPF), preoperative practice alone (PP), or feedback alone (F). Trainees then completed a laparoscopic salpingectomy, and the operative performance was evaluated using an assessment tool. Results A total of 18 residents were randomized and completed the study, 6 in each arm. The mean baseline score on the simulator was comparable in each group (67% for PPF, 68% for PP, and 70% for F). While the median score on the assessment tool for laparoscopic salpingectomy in the PPF group was the highest, there was no statistically significant difference in assessment scores for the PPF group (32.75; range, 15–36) compared to the PP group (14.5; range, 10–34) and the F group (21.25; range, 10.5–32). The interrater correlation between the video reviewers was 0.87 (95% confidence interval 0.70–0.95) using the intraclass correlation coefficient. Conclusions This study suggests that a surgical preoperative practice with instructor feedback may not improve operative technique compared to either preoperative practice or feedback alone.

scholarly journals Autonomy in the Operating Room: A Multicenter Study of Gender Disparities During Surgical Training

2021 ◽  
Vol 13 (5) ◽  
pp. 666-672
Author(s):  
Jenny X. Chen ◽  
Edward H. Chang ◽  
Francis Deng ◽  
Shari Meyerson ◽  
Brian George ◽  
...  
Keyword(s):  
Surgical Training ◽  
Gender Disparities ◽  
Training Level ◽  
Surgical Performance ◽  
Surgical Trainees ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Operative Performance ◽  
And Performance ◽  
Multivariable Regression Models

ABSTRACT Background Gender disparities are prevalent in medicine, but their impact on surgical training is not well studied. Objective To quantify gender disparities in trainee intraoperative experiences and explore the variables associated with ratings of surgical autonomy and performance. Methods From September 2015 to May 2019, attending surgeons and trainees from 71 programs assessed trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale after surgical procedures. Multivariable regression models were used to examine the association of trainee gender with autonomy and performance evaluations. Results A total of 3255 trainees and attending surgeons completed 94 619 evaluations. Attendings gave lower ratings of operative autonomy to female trainees than male trainees when controlling for training level, attending, and surgical procedure (effect size B = −0.0199, P = .008). There was no difference in ratings of autonomy at the beginning of training (P = .32); the gap emerged as trainees advanced in years (B = −0.0163, P = .020). The gender difference in autonomy was largest for the most complex cases (B = −0.0502, P = .002). However, there was no difference in attending ratings of surgical performance for female trainees compared to male trainees (B = −0.0124, P = .066). Female trainees rated themselves as having less autonomy and worse performance than males when controlling for training level, attending, procedure, case complexity, and attending ratings (autonomy B = −0.0669, P < .001; performance B = −0.0704, P < .001). Conclusions While there was no significant difference in ratings of operative performance, a small difference between ratings of operative autonomy for female and male surgical trainees was identified.

scholarly journals Can the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score Be Reliably Administered Over the Phone? A Randomized Study

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879151 ◽  
Author(s):  
Brandon J. Erickson ◽  
Peter N. Chalmers ◽  
Jon Newgren ◽  
Marissa Malaret ◽  
Michael O’Brien ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Power Analysis ◽  
Assessment Tool ◽  
A Priori ◽  
Randomized Study ◽  
Intraclass Correlation ◽  
Level Of Evidence ◽  
Orthopaedic Clinic ◽  
Significant Difference ◽  
A Priori Power Analysis

Background: The Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow outcome score is a functional assessment tool for the upper extremity of the overhead athlete, which is currently validated for administration in person. Purpose/Hypothesis: The purpose of this study was to validate the KJOC score for administration over the phone. The hypothesis was that no difference will exist in KJOC scores for the same patient between administration in person versus over the phone. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Fifty patients were randomized to fill out the KJOC questionnaire either over the phone first (25 patients) or in person first (25 patients) based on an a priori power analysis. One week after the patients completed the initial KJOC on the phone or in person, they then filled out the score via the opposite method. Results were compared per question and for overall score. Results: There was a mean ± SD of 8 ± 5 days between when patients completed the first and second questionnaires. There were no significant differences in the overall KJOC score between the phone and paper groups ( P = .139). The intraclass correlation coefficient comparing paper and phone scores was 0.802 (95% CI, 0.767-0.883; P < .001), with a Cronbach alpha of 0.89. On comparison of individual questions, there were significant differences for questions 1, 3, and 8 ( P = .013, .023, and .042, respectively). Conclusion: The KJOC questionnaire can be administered over the phone with no significant difference in overall score as compared with that from in-person administration.

scholarly journals In Vivo Randomized Controlled Study of the Bone Response of All-Suture Anchors and Biocomposite Anchors

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091496
Author(s):  
Christopher M.B. Stewart ◽  
Haseem Raja ◽  
Emma Torrance ◽  
Lennard Funk
Keyword(s):  
Interrater Reliability ◽  
Suture Anchor ◽  
Controlled Trial ◽  
Intraclass Correlation ◽  
Controlled Study ◽  
Suture Anchors ◽  
Randomized Controlled ◽  
Bone Response ◽  
Significant Difference

Background: Suture anchors are widely used for labral reconstruction surgery. However, there has been some concern over the development of osteolysis around the anchor. This has been reported for both biocomposite and all-suture anchors, but they have not been compared directly in vivo. Purpose: To compare the bone response to 2 common suture anchors: a traditional biocomposite push-fit anchor and an all-suture anchor. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Included in this study were 17 patients with a total of 37 unique suture anchors. Magnetic resonance imaging scans were performed at 3 weeks and 6 months postoperatively. A total of 38 senior radiologists and shoulder surgeons evaluated the images using a previously validated system for grading the bone response around suture anchors. The mean difference in grading at 3 weeks and 6 months was calculated using unpaired t tests, and the interrater reliability was evaluated with an intraclass correlation coefficient (ICC). Results: At 3 weeks, there was no statistically significant difference in the degree of osteolysis surrounding each suture anchor type ( P = .258), with little bone response. However, on the 6-month scans, there was a significantly lower level of osteolysis seen in the all-suture anchors compared with the biocomposite anchors ( P = .040). Interrater reliability was excellent, with an ICC value of 0.975 (95% CI, 0.962-0.985). Conclusion: All-suture anchors cause significantly less osteolysis in glenoid bone at 6 months compared with biocomposite anchors.

scholarly journals The Construct Validity and Reliability of an Assessment Tool for Competency in Cochlear Implant Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Patorn Piromchai ◽  
Pornthep Kasemsiri ◽  
Sudanthi Wijewickrema ◽  
Ioanna Ioannou ◽  
Gregor Kennedy ◽  
...  
Keyword(s):  
Construct Validity ◽  
Cochlear Implant ◽  
Assessment Tool ◽  
Intraclass Correlation ◽  
Assessment Instrument ◽  
Validity And Reliability ◽  
Implant Surgery ◽  
Surgical Trainees ◽  
Cochlear Implant Surgery ◽  
Objective Feedback

Introduction. We introduce a rating tool that objectively evaluates the skills of surgical trainees performing cochlear implant surgery.Methods. Seven residents and seven experts performed cochlear implant surgery sessions from mastoidectomy to cochleostomy on a standardized virtual reality temporal bone. A total of twenty-eight assessment videos were recorded and two consultant otolaryngologists evaluated the performance of each participant using these videos.Results. Interrater reliability was calculated using the intraclass correlation coefficient for both the global and checklist components of the assessment instrument. The overall agreement was high. The construct validity of this instrument was strongly supported by the significantly higher scores in the expert group for both components.Conclusion. Our results indicate that the proposed assessment tool for cochlear implant surgery is reliable, accurate, and easy to use. This instrument can thus be used to provide objective feedback on overall and task-specific competency in cochlear implantation.

Can Surgical “Warm-Up” With Instructor Feedback Improve Operative Performance of Surgical Trainees?

2015 ◽  
Vol 22 (6) ◽  
pp. S17-S18 ◽  
Author(s):  
J Kroft ◽  
M Ordon ◽  
L Po ◽  
N Zwingerman ◽  
JY Lee ◽  
...  
Keyword(s):  
Warm Up ◽  
Surgical Trainees ◽  
Instructor Feedback ◽  
Operative Performance

scholarly journals An Assessment Tool for Aseptic Technique in Resident Physicians: A Journey Towards Validation in the Real World of Limited Supervision

2010 ◽  
Vol 2 (1) ◽  
pp. 85-89 ◽  
Author(s):  
Monica L. Lypson ◽  
Stanley J. Hamstra ◽  
Paula T. Ross ◽  
Larry D. Gruppen ◽  
Lisa M. Colletti
Keyword(s):  
Operating Room ◽  
Internal Consistency ◽  
Validation Study ◽  
Assessment Tool ◽  
Intraclass Correlation ◽  
Global Scale ◽  
Aseptic Technique ◽  
Surgical Residents ◽  
Significant Difference ◽  
Operating Room Nurses

Abstract Purpose The purpose of this study was to describe the validation process for assessing an instrument to assess residents' aseptic technique skills. Methods The validation study entailed comparisons of the performance of aseptic technique procedures between postgraduate year–1 (PGY-1) surgical residents and PGY-2/3 surgical residents. We also compared the performance of PGY-1 surgical residents from 2 different academic years for the same procedures. Finally, we compared the performance of novices (medical students) and experts (operating room nurses) in an effort to determine validity. Results Our initial analysis found no significant difference between the performance of PGY-1 (mean score, 75.8) and PGY-2/3 (mean score, 75.6) surgical residents for aseptic technique (t(55)  =  0.84, P  =  0.404). Further investigation of validity was obtained to determine whether the no difference results reflected a lack of reliability or validity or a true equivalence between the 2 cohorts. The comparison of novices and experts produced the following findings. For reliability, the internal consistency of the checklist for each of the 2 raters was 0.87 and 0.71 (Cronbach α), interrater reliability was 0.74, with P &lt; 0.001 (intraclass correlation coefficient) for the global scale. (Internal consistency was done within instrument, ie, between items not between raters.) For validity, operating room nurses outperformed students on the global scale (t14  =  7.47, P &lt; 0.0001 and t(14)  =  10.66, P &lt; 0.0001 for the 2 raters, respectively) and on several checklist items. The effect size values for raters were large (Cohen d  =  3.0 and 4.4), providing validity evidence for the ability of this assessment to detect difference in performance on this task. Conclusion The validation study showed that the instrument exhibited reliability and evidence for validity, making it useful for the assesment of aseptic technique skills in different specialties. Programs may want to consider using a validated instrument to check competence given that appropriate use of sterile technique frequently occurs in the context of unsupervised activities. Further work is needed to enhance resident skills in the area of aspectic technique because of limited improvement despite additional clinical experience.

The Use of Aromatherapy to Reduce Chemotherapy-Induced Nausea in Children With Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial

2018 ◽  
Vol 35 (6) ◽  
pp. 392-398 ◽  
Author(s):  
Anna Evans ◽  
Jemily Malvar ◽  
Cassie Garretson ◽  
Eliza Pedroja Kolovos ◽  
Mary Baron Nelson
Keyword(s):  
Essential Oil ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Controlled Study ◽  
Children With Cancer ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Statistical Significant Difference ◽  
Significant Difference

Introduction: Chemotherapy-induced nausea can be distressing and difficult to manage in children with cancer. The purpose of this study was to investigate the utility of ginger aromatherapy in relieving chemotherapy-induced nausea in children with cancer. Method: This randomized, double-blind, placebo-controlled study of 49 children with cancer explored whether inhalation of the aroma of essential oil of ginger during chemotherapy decreased nausea compared with a placebo (water) or control (Johnson’s baby shampoo) measured by prechemotherapy and postchemotherapy assessment with the Pediatric Nausea Assessment Tool (PeNAT). Results: While well received, well tolerated, nontoxic, and noninvasive, ginger aromatherapy did not significantly decrease nausea in patients enrolled in this study. Among 21 patients who indicated feeling nausea prechemotherapy, 67% reported improvement, 5% worsening, and 28% no change in their postinfusion PeNAT score. We failed to detect a statistical significant difference in the change in PeNAT scores among the three groups.

scholarly journals Medication Literacy Tool in a Student-Run Free Clinic

2020 ◽  
pp. 37-47
Author(s):  
Jessica B. Richmond ◽  
Anjali Desai
Keyword(s):  
Assessment Tool ◽  
Education Level ◽  
Primary Language ◽  
Literacy Assessment ◽  
Free Clinic ◽  
Assessment Scores ◽  
Significant Difference ◽  
Patient Reported ◽  
Literacy Methods ◽  
Language And Education

Introduction: Low medication literacy can lead to prescription non-adherence and medical errors. The goal of this study was to create an easy-to-use comprehensive medication literacy assessment tool to aid in identification of patients with trouble reading and interpreting medication labels in the primary care setting. The secondary goal was to evaluate the role of primary language and education level on medication literacy and determine if patient reported difficulty with reading labels correlated with a lower medication literacy. Methods: Forty-two patients of the Cooper Rowan Clinic, a student-run free clinic, were given a demographic survey and 7-item questionnaire based on a standard prescription label. The study was limited to patients over the age of 16 who were able to read in either English or Spanish. Results: A significant difference was noted in average scores between the English and Spanish-speaking groups. In addition, a positive correlation was found between education level and assessment scores. The assessment scores of participants who self-reported having trouble reading their label were lower but not significantly different from those who did not report difficulty reading a label. Conclusions: The assessment was easily administered in a student-run clinic and could be used for medication literacy evaluation and quality improvement in other clinics. This tool also shows that primary language and education play a role in the ability to interpret labels. Further testing could be performed to establish the validity of the assessment with longer, well-established health literacy tests.

Nurse-led Care Program with Patients with Heart Failure Using Johnson’s Behavioral System Model: A Randomized Controlled Trial

2020 ◽  
Vol 33 (3) ◽  
pp. 204-214
Author(s):  
Behnoush Rahmani ◽  
Nahid Aghebati ◽  
Habibollah Esmaily ◽  
Kristine L. Florczak
Keyword(s):  
Heart Failure ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Intervention Group ◽  
Care Program ◽  
System Model ◽  
Behavioral System ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Experimental Group

Patients with heart failure experience system imbalance and have multiple symptoms. A nurse-led care program based on Johnson’s behavioral system model was used to improve the balance of the behavioral system of heart failure patients. One hundred and fifty patients were randomly assigned into two groups. In the experimental group, the patient’s status was evaluated by a behavioral subsystem assessment tool related to the level of imbalance. The patients in the intervention group received care individually based on their worst subsystem scores over a period of 2 weeks. The results showed significant improvement in restorative, ingestive, eliminative, aggressive/protective, dependency, and achievement ( p < .05) subsystems in the experimental group. However, no significant difference was seen in sexual and affiliative ( p > .05) subsystems.

scholarly journals Comparison of submucosal and subserosal approaches toward optimized indocyanine green tracer-guided laparoscopic lymphadenectomy for patients with gastric cancer (FUGES-019): a randomized controlled trial

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Qi-Yue Chen ◽  
Qing Zhong ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
Zhi-Yu Liu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Randomized Controlled Trial ◽  
Lymph Node ◽  
Indocyanine Green ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Resectable Gastric Cancer ◽  
Optimal Approach

Abstract Background Application of indocyanine green (ICG) fluorescence imaging is effective in guiding laparoscopic radical lymphadenectomy for gastric cancer. However, the optimal approach for indocyanine green injection is controversial. Therefore, the objective of this study was aimed to compare the efficacy and ICG injection between the preoperative submucosal and intraoperative subserosal approaches for lymph node (LN) tracing during laparoscopic gastrectomy. Method This randomized controlled trial (ClinicalTrials.gov, NCT04219332) included 266 patients with potentially resectable gastric cancer (cT1–T4a, N0/+, M0) enrolled from a tertiary teaching center between December 2019 and October 2020. The primary endpoint was total number of retrieved LNs. Results In total, 259 patients (n = 130 and n = 129 in the submucosal and subserosal groups, respectively) were included in the per-protocol analysis. There are no significant differences in total number of retrieved LNs between the two groups (49.8 vs. 49.2, P = 0.713). The rate of LN noncompliance in the submucosal group was comparable to that in the subserosal group (32.3% vs. 33.3%, P = 0.860). No significant difference was found between the submucosal and subserosal groups in terms of the incidence (17.7% vs. 16.3%; P = 0.762) or severity of postoperative complications. The mean fluorescence cost in the submucosal group was higher than that in the subserosal group ($335.3 vs. $182.4; P < 0.001). The overall treatment satisfaction score was lower in the submucosal group than in the subserosal group (70.5 vs. 76.1%, P = 0.048). Conclusion ICG administered by subserosal injection was comparable to that administered by submucosal injection for lymph node tracing in gastric cancer. However, the former approach imposed a lower economic and mental burden on patients undergoing laparoscopic D2 lymphadenectomy. Trial registration ClinicalTrials.gov, NCT04219332.

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