A Medium-Term Comparison of Quality of Life and Pain After Robotic or Laparoscopic Cholecystectomy.

INTRODUCTION: We sought to compare medium-term outcomes between robotic-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC) using validated quality of life (QoL) and pain assessments. MATERIALS AND METHODS: Patients who underwent RC or LC between 2012 and 2017 at a single academic institution were examined. Cases converted to open were excluded. Patients were contacted by telephone in 2019 and completed two standardized surveys to rate their QoL and pain. RESULTS: Of those screened, 122 (35.8%) completed both surveys. Ninety three (76.2%) underwent RC and 29 (23.8%) underwent LC. The groups (RC versus LC) were similar based on mean age (47.9 versus 45.5 y, P = 0.48), gender (66.7% versus 72.4% female, P = 0.56), race (86.0% White/5.4% Black versus 72.4% White/13.8% Black, P = 0.2), insurance status (98.9% versus 100.0% insured, P = 0.58), median body mass index (31.8 versus 31.3, P = 0.43), and median Charlson Comorbidity Index (1 versus 0, P = 0.14). Fewer RC patients had a history of steroid use compared to LC (16.1% versus 34.5%, P = 0.03). No overall significant difference in QoL was demonstrated. LC group had higher severity of "tiring-exhausting pain" (P = 0.04), "electric-shock pain" (P = 0.003), and "shooting pain" (P = 0.05). The "overall intensity" of pain in the "gallbladder region" between the groups was similar at the time of follow-up (P = 0.31). CONCLUSIONS: QoL over 2-7 y following time of surgery is comparable for robotic-assisted versus conventional laparoscopic cholecystectomies. The laparoscopic approach may be associated with a higher severity of subset categories of pain, but overall pain between the two approaches is comparable.

The assessment of emotional intelligence among candidates interviewing for general surgery residency.

BACKGROUND: There is an increasing demand for physicians to possess strong personal and social qualities embodied in the concept of emotional intelligence (EI). However, the residency selection process emphasizes mainly academic accomplishments. In this system, the faculty interview is the primary means of evaluating the nontangible, nonacademic attributes of a candidate. OBJECTIVE: To determine whether the impressions derived from faculty interviews correlate with an applicant's actual EI as measured by a validated objective instrument. STUDY DESIGN: Participating applicants interviewing for a surgical residency position at Stanford completed an EI inventory Trait Emotional Intelligence Questionnaire (TEIQue). Faculty estimated the EI of the applicants they interviewed using a corresponding 360° evaluation form. Multivariate linear regression was performed to identify demographic and academic factors predictive of EI. Applicant TEIQue scores and faculty 360° impressions were correlated using Pearson coefficients. RESULTS: Mean EI of the cohort was higher than that of the average population (5.43 vs 4.89, p<0.001). Age was the only demographic variable that significantly informed EI (B = 0.07, p = 0.005). Among the academic factors considered, United States Medical Licensing Examination Step 1 score was a slight negative predictor of EI (B =-0.007, p = 0.04). Applicant global EI scores did not correlate with faculty impressions of overall EI (r = 0.27, p = 0.06). Of the 4 domains that comprise global EI, sociability and emotionality demonstrated a moderate correlation between applicant and faculty scores (r = 0.31, p = 0.03 and r = 0.27, p = 0.05, respectively). None of the fifteen individual facets of EI demonstrated any correlation between applicant and faculty ratings (r =-0.12 to 0.26, p = 0.06-0.91). No association was found between applicant TEIQue and traditional faculty interview evaluations (r = 0.18, p = 0.19). CONCLUSIONS: Applicant EI correlated poorly with academic parameters and was not accurately assessed by faculty interviews. Methods that better capture this dimension should be incorporated into the residency selection process.

The effect of positive and negative verbal feedback on surgical skills performance and motivation.

There is considerable effort and time invested in providing feedback to medical students and residents during their time in training. However, little effort has been made to measure the effects of positive and negative verbal feedback on skills performance and motivation to learn and practice. To probe these questions, first-year medical students (n = 25) were recruited to perform a peg transfer task on Fundamentals of Laparoscopic Surgery box trainers. Time to completion and number of errors were recorded. The students were then randomized to receive either positive or negative verbal feedback from an expert in the field of laparoscopic surgery. After this delivery of feedback, the students repeated the peg transfer task. Differences in performance pre- and post-feedback and also between the groups who received positive feedback (PF) vs negative feedback (NF) were analyzed. A survey was then completed by all the participants. Baseline task times were similar between groups (PF 209.3 seconds; NF 203 seconds, p = 0.58). The PF group averaged 1.83 first-time errors while the NF group 1 (p = 0.84). Post-feedback task times were significantly decreased for both groups (PF 159.75 seconds, p = 0.05; NF 132.08 seconds, p = 0.002). While the NF group demonstrated a greater improvement in mean time than the PF group, this was not statistically significant. Both groups also made fewer errors (PF 0.33 errors, p = 0.04; NF 0.38 errors, p = 0.23). When surveyed about their responses to standardized feedback scenarios, the students stated that both positive and negative verbal feedback could be potent stimulants for improved performance and motivation. Further research is required to better understand the effects of feedback on learner motivation and the interpersonal dynamic between mentors and their trainees.