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 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.

Risk of chronic opioid use after simultaneous versus staged bilateral knee arthroplasty

2020 ◽  
pp. rapm-2020-102060
Author(s):  
Lauren Wilson ◽  
Megan Fiasconaro ◽  
Jiabin Liu ◽  
Jashvant Poeran ◽  
Lazaros Poultsides ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Oral Morphine ◽  
Opioid Use ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Chronic Opioid Use ◽  
Opioid Users ◽  
Multivariable Regression Models ◽  
Adjusted Model ◽  
Timing Strategies

BackgroundSeveral studies have identified excess risk associated with undergoing simultaneous (compared with unilateral or staged) bilateral total knee arthroplasty (BTKA). However, few have addressed subsequent chronic opioid use. Given the substantial morbidity and mortality associated with prolonged opioid use, we evaluated the incidence of postoperative chronic opioid use following simultaneous versus staged BTKA, based on the different timing strategies of staged procedures.MethodsIn this retrospective cohort study, patients who underwent BTKA procedures (2012–2016; Truven Health MarketScan; n=14 407) were classified as having undergone simultaneous or staged BTKA (<3 months, 3–6 months or 6–12 months apart). Outcomes were postoperative chronic opioid use and oral morphine equivalents prescribed on discharge. Multivariable regression models measured associations between type/timing of BTKA and outcomes. ORs and 95% CIs were reported.ResultsUnadjusted frequency of chronic opioid use did not differ between groups, (Simultaneous: 11.3%, staged <3 months: 10.7%, staged 3–6 months: 11.7%, staged >6 months: 10.2%; p=0.247). In an adjusted model, there was no significant difference in the odds of becoming chronic opioid users between staged and simultaneous BTKA (staged <3 months OR 1.03, 95% CI 0.88 to 1.21/staged 3–6 months OR 0.94, 95% CI 0.79 to 1.12/staged >6 months OR 0.96, 95% CI 0.82 to 1.13; p=0.755). Patients undergoing staged BTKAs <6 months apart (compared with simultaneous) were prescribed slightly greater oral morphine equivalents on hospital discharge (staged <3 months 6% increase, 95% CI 3% to 10%; staged 3–6 months 4%, 95% CI 1% to 8%; p=0.002).ConclusionAlthough patients undergoing staged BTKA <6 months apart were prescribed greater quantities of opioids on discharge, there was no significant difference in the odds of postoperative chronic opioid use compared with simultaneous BTKA. The timing of BTKA procedures does not appear to influence the likelihood of postoperative chronic opioid dependence.

scholarly journals 602 Specialty Training Progression from Core Surgical Training: Is There Evidence from Plastic Surgery of The Importance of Location, Location, Location?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Vinnicombe ◽  
M Little ◽  
K Johal
Keyword(s):  
Plastic Surgery ◽  
Surgical Training ◽  
Specialty Training ◽  
Surgical Trainees ◽  
Significant Difference ◽  
National Training ◽  
Competitive Nature

Abstract Introduction Obtaining a National Training Number (NTN) in Plastic Surgery is highly competitive (&lt;40 posts per year), with applicant:post ratios between 3.73 to 4.19 in 2017-2019. Our aim was to compare deaneries for numbers successfully progressing directly from CT2 into a ST3 post in Plastic Surgery. Method Data for surgical trainees progressing directly from CT2 to ST3 (2017-2019) in all specialties was obtained from the GMC. The percentage of those directly progressing that obtained a Plastic Surgery NTN and the total number progressing was calculated. Results A total of 840 trainees obtained a NTN directly from CT2 between 2017 and 2019, 61 of whom did so in plastic surgery. Of those directly progressing, there was no significant difference between deaneries for the percentage of plastic surgery posts obtained. The highest number of trainees progressed from London deaneries (16 total (26%); 7 South, 6 NC&E, 3 NW) and the lowest number from Yorkshire and Humber (1). Conclusions Higher numbers of those undertaking core surgical training in London progress directly from CT2 to ST3 in Plastic Surgery. Low total numbers highlight the competitive nature of obtaining a Plastic Surgery NTN, necessitating many to undertake additional experience prior to obtaining a training number.

scholarly journals The Association between Delivery during the COVID-19 Pandemic and Immediate Postpartum Maternal Cognitive Function

2020 ◽  
Vol 9 (11) ◽  
pp. 3727
Author(s):  
Hagai Hamami ◽  
Eyal Sheiner ◽  
Tamar Wainstock ◽  
Elad Mazor ◽  
Talya Lanxner Battat ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Postpartum Period ◽  
Regression Models ◽  
Medical Center ◽  
Significant Difference ◽  
Neurocognitive Test ◽  
Multivariable Regression ◽  
Objective Tests ◽  
Multivariable Regression Models ◽  
Attention Function

Survivors of the 2003 SARS epidemic were found to have higher rates of adverse mental conditions. This study aimed to assess cognitive function in women delivering during the COVID-19 pandemic, as compared to women who delivered before the COVID-19 pandemic. A cohort study was performed during the immediate postpartum period of women delivering singletons at term. Cognitive function was assessed using an objective neurocognitive test (Symbol Digit Modalities Test SDMT90, SDMT4) and a subjective self-estimation questionnaire (Attention Function Index AFI). The exposed group was recruited during the COVID-19 outbreak in Israel (May 2020), whereas the comparison group consisted of women delivering at the same medical center before the COVID-19 pandemic (2016–2017). Multivariable regression models were constructed to control potential confounders. There were 79 parturients recruited during the COVID-19 pandemic and compared with 123 women who delivered before the COVID-19 pandemic. Women delivering during the COVID-19 pandemic scored lower in the subjective AFI test compared to the unexposed group (70.0 ± 15.4 vs. 75.1 ± 14.7, p = 0.018). However, no significant difference was found in the objective SDMT tests scores. These results remained similar in the multivariable regression models when controlling for maternal age, ethnicity and time from admission to assessment, for AFI, SDMT90 and SDMT4 scores (p = 0.014; p = 0.734; p = 0.786; respectively). While no significant difference was found in objective tests, our findings propose that the exposure to the COVID-19 pandemic is independently associated with a significant decrease in subjective maternal cognitive function during the immediate postpartum period.

scholarly journals P-O05 Deconstructing Operations to Improve Recording of Surgical Training Experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Ffion Dewi ◽  
Darren Scroggie ◽  
Samir Pathak ◽  
Natalie Blencowe ◽  
Andrew Hollowood ◽  
...  
Keyword(s):  
Surgical Training ◽  
University Teaching ◽  
Surgical Experience ◽  
Training Experience ◽  
Suggested Approach ◽  
Worked Example ◽  
Surgical Trainees ◽  
And Performance ◽  
The Impact ◽  
Training Opportunities

Abstract Background A new outcomes-based curriculum is soon to be implemented for UK surgical trainees. Performance will be evaluated against the standard expected of a new consultant. Accurate recording of operative experience and performance will therefore be crucial to demonstrate achievement of this standard. The current eLogbook system for recording surgical experience has many benefits including simplicity and accessibility, but may misrepresent actual experience because most operations are considered as a whole; unlike some colorectal operations, involvement in steps within many upper gastrointestinal (UGI) operations cannot be recorded. Methods Impact on training by the COVID-19 pandemic led to discussion and identification of cultural and logistical barriers to accurate recording of experience. To address these, a modification to enhance the current eLogbook system was developed by trainees and trainers at a university teaching hospital. An existing typology was used to deconstruct common UGI operations into their component steps, which can be recorded at this more detailed level.  Results The modified deconstructed logbook concept is described using a worked example, which can be applied to any operation. We also describe the integration of a component-based training discussion into the surgical team brief and debrief; this complements the deconstructed logbook by promoting a training culture. Conclusions Using the described techniques, trainees of all levels can comprehensively and accurately describe their surgical experience. Senior trainees will benefit from recording complex operations which they are not expected to complete in their entirety, whilst less experienced trainees will benefit from the ability to record their involvement in more basic parts of operations. The suggested approach will reduce misrepresentation of experience, encourage proactive planning of training opportunities, and reduce the impact of crises such as pandemics on surgical training.

Injured Adolescents, Not Just Large Children: Difference in Care and Outcome between Adult and Pediatric Trauma Centers

2013 ◽  
Vol 79 (3) ◽  
pp. 267-273 ◽  
Author(s):  
Kazuhide Matsushima ◽  
Eric W. Schaefer ◽  
Eugene J. Won ◽  
Pamela A. Nichols ◽  
Heidi L. Frankel
Keyword(s):  
Regression Models ◽  
Multivariable Analysis ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Complication Rates ◽  
Trauma Centers ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
Emergent Laparotomy

Adolescent injury victims receive care at adult trauma centers (ATCs) and pediatric trauma centers (PTCs). The purpose of this study was to identify care variations and their impact on the outcome of adolescent trauma patients treated at PTC versus ATC. We queried the Pennsylvania Trauma Systems Foundation database for trauma patients between 13 and 18 years of age from 2005 to 2010. Mortality and hospital complication rates between ATC and PTC were compared in univariable and multivariable analysis. In addition, the differences in the delivery of care were also compared. Of 9033 total patients, 6027 (67%) received care at an ATC. Patients in the ATC group were older (16.7 vs 14.9 years, P < 0.001) and more severely injured (Injury Severity Score: 14.5 vs 12.2, P < 0.001). Admission diagnostic computed tomography (CT), emergent laparotomy and craniotomy, blood transfusion, and drug screening were more frequently performed at an ATC. After adjustment for potential confounders in multivariable regression models, treatment at a PTC was significantly associated with fewer CTs for transferred patients (odds ratio [OR], 0.28; P < 0.001) and with less frequent emergent laparotomy for all patients (OR, 0.65; P = 0.007). The ATC group had a significantly higher hospital mortality rate (2.9 vs 0.9%, P < 0.001) and complication rate (9.7 vs 4.8%, P < 0.001). However, these outcomes were not significantly different between PTC and ATC in multivariable regression models. In the state of Pennsylvania, there were no significant differences in risk-adjusted outcomes between PTC and ATC despite significant difference in use of CT scanning and emergent laparotomy.

Exploring The Effect of Visual Information Degradation on Human Perception and Performance In A Human-Telerobot System

2020 ◽  
Vol 64 (1) ◽  
pp. 1302-1307
Author(s):  
Richard Stone ◽  
Minglu Wang ◽  
Thomas Schnieders ◽  
Esraa Abdelall
Keyword(s):  
Visual Information ◽  
Human Perception ◽  
Low Level ◽  
Hit Rate ◽  
Word Level ◽  
Level Of Automation ◽  
Significant Difference ◽  
Human Operators ◽  
And Performance ◽  
High Level

Human-robotic interaction system are increasingly becoming integrated into industrial, commercial and emergency service agencies. It is critical that human operators understand and trust automation when these systems support and even make important decisions. The following study focused on human-in-loop telerobotic system performing a reconnaissance operation. Twenty-four subjects were divided into groups based on level of automation (Low-Level Automation (LLA), and High-Level Automation (HLA)). Results indicated a significant difference between low and high word level of control in hit rate when permanent error occurred. In the LLA group, the type of error had a significant effect on the hit rate. In general, the high level of automation was better than the low level of automation, especially if it was more reliable, suggesting that subjects in the HLA group could rely on the automatic implementation to perform the task more effectively and more accurately.

scholarly journals Otoskills training during covid-19 pandemic: a before-after study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maxime Fieux ◽  
Antoine Gavoille ◽  
Fabien Subtil ◽  
Sophie Bartier ◽  
Stéphane Tringali
Keyword(s):  
Surgical Training ◽  
Rating Scale ◽  
Surgical Simulation ◽  
Global Rating Scale ◽  
Middle Ear Surgery ◽  
Global Rating ◽  
Training Requirements ◽  
Significant Difference ◽  
Before And After ◽  
Total Performance

Abstract Background The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. Methods In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. Results Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents. Conclusions This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

scholarly journals Prospective study to assess the tissue response to HPC-coated p48 flow diverter stents compared to uncoated devices in the rabbit carotid artery model

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Tim Lenz-Habijan ◽  
Pervinder Bhogal ◽  
Catrin Bannewitz ◽  
Ralf Hannes ◽  
Hermann Monstadt ◽  
...  
Keyword(s):  
Foreign Body ◽  
Flow Diverter ◽  
Foreign Body Response ◽  
Tissue Response ◽  
Acute Setting ◽  
Significant Difference ◽  
And Performance ◽  
Surface Modified ◽  
Common Carotid Arteries

Abstract Background Flow diverters (FDs) are widely used in the treatment of intracranial aneurysms, but the required medication increases the risk of haemorrhagic complications and limits their use in the acute setting. Surface modified FDs may limit the need for dual antiplatelet therapy (DAPT). Hydrophilic polymer coating (HPC) may reduce the need of medication. Methods This explorative study, approved by the local authorities and the local welfare committee, compared stent behaviour and overall tissue response between HPC-coated FDs and uncoated FDs, both implanted into the common carotid arteries of eight New Zealand white rabbits. Endothelialisation, inflammatory response, and performance during implantation were assessed. Angiographic follow-up was performed to observe the patency of the devices after implantation and after 30 days. Histological examinations were performed at 30 days to assess foreign body reaction and endothelialisation. Kruskal-Wallis and Wilcoxon tests were used to compare non-parametric variables. Results Angiography showed that both coated and uncoated FDs performed well during implantation. All devices remained patent during immediate follow-up and after 30 days. Histopathology showed no significant difference in inflammation within the vessel wall between the two cohorts (2.12 ± 0.75 vs. 1.96 ± 0.79, p = 0.7072). Complete endothelialisation of the stent struts was seen with very similar (0.04 ± 0.02 mm vs. 0.04 ± 0.03 mm, p = 0.892) neoendothelial thickness between the two cohorts after 30 days. Conclusion Taking into account the limitation in sample size, non-significant differences between the HPC-coated and uncoated FDs regarding implantation, foreign body response, and endothelialisation were found.

scholarly journals An analysis of the cost of postgraduate training in surgery in Ireland compared to other specialties

2021 ◽  
Author(s):  
Earley H. ◽  
Mealy K.
Keyword(s):  
Surgical Training ◽  
Financial Support ◽  
Postgraduate Training ◽  
Medical Training ◽  
Medical Council ◽  
List Type ◽  
Training Costs ◽  
Considerable Cost ◽  
Surgical Trainees ◽  
The Cost

Abstract Introduction Postgraduate specialty training in Ireland is associated with considerable cost. Some of these are mandatory costs such as medical council fees, while others are necessary to ensure career progression, such as attendance at courses and conferences. In particular, surgical specialities are believed to be associated with high training costs. It is unknown how these costs compare to those borne by counterparts in other specialities. Aims The aims of this study were to Quantify the amount that trainees in Ireland spend on postgraduate training Determine whether a difference exists between surgery and other non-skill-based specialties in terms of expenditure on training Methods A standardised non-mandatory questionnaire was circulated to trainees across two training centres in Ireland. Trainees at all levels were invited to participate. Results Sixty responses were obtained. Fifty-seven questionnaires were fully completed and included for analysis. The median expenditure on training was higher for surgical than non-surgical specialities. Subgroup analysis revealed surgical training was associated with higher expenditure on higher degrees and courses compared to medical training (p = 0.035). > 95% of trainees surveyed felt that greater financial support should be available for trainees during the course of their training. Conclusions This study demonstrated that a career in surgery is associated with higher ongoing costs for higher degrees and courses than counterparts in non-surgical training. All surgical trainees surveyed felt that better financial support should be available. Increasing financial support for may be a tangible way to mitigate against attrition during training.

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