Development of a Near Peer Clinical Anatomy Review Session during the Surgery Clerkship: Pre- and Post-Test Results among Third Year Medical Students.

Introduction: Our institution created a review of anatomy relevant to general surgery for third-year medical students. This study was designed to evaluate this review program and determine if participation increased third-year medical students' anatomy knowledge and confidence identifying anatomical structures in the operating room. Methods: A formalin-embalmed cadaver-based review of anatomy was created and taught in near-peer fashion to third-year medical students. An anonymous survey and anatomy test were administered to participants pre- and post-session. The survey and test were designed to evaluate anatomy knowledge as well as student confidence identifying structures in the operating room. Survey data were compared using the Wilcoxon signed rank test. Results: Seventy third-year medical students completed the anatomy review. There was a statistically significant improvement in students' confidence levels identifying structures in the operating room (p < 0.001) and in anatomy test scores (p < 0.001). Subjectively, students were thankful for the review session and found it helpful. Conclusions: This near-peer review session designed at our institution was successful in improving immediate anatomy test scores and confidence levels identifying structures in the operating room. A course similar to this could be included at other medical schools to improve medical student confidence in identifying relevant anatomic structures in the operating room.

Patient Perspectives of Rural Kansas Maternity Care.

INTRODUCTION: Pregnant women in rural areas face a unique set of challenges due to geographic maldistribution of obstetric services. The perspectives of rural Kansas women were sought regarding experience of birth and satisfaction with maternity care. METHODS: Medical student research assistants facilitated discussion groups and structured interviews in rural Kansas communities distributed throughout the state with women who had an uncomplicated delivery in the last 24 months. Participants were recruited via convenience sampling from clinic medical records and appointments over a two-to-three-week period. Guiding questions were used to facilitate discussion. Survey instruments were used to gather information about satisfaction with maternity care. Data for qualitative and quantitative analysis was aggregated using Rural Urban Commuting Area (RUCA) codes. RESULTS: Fourteen groups with 47 total participants completed the survey and discussion. Participants came from large rural, small rural, and isolated areas in Kansas as described by RUCA Code Four Category Classification. Survey results indicated that satisfaction with maternity care in participants' home county was significantly higher in small rural and isolated compared to large Rural RUCAs. Qualitative analysis results showed positive experiences related to doctor characteristics, relationship with doctor, doctor's involvement with care, alternative labor options, and distance convenience. Negative experiences were related to doctor bedside manner, doctor not there until delivery, and staff related complaints. CONCLUSIONS: Kansas women in small rural and isolated RUCA codes appeared to be more satisfied with care.

Chief Resident Indirect Supervision in Training Safety Study: Is a Chief Resident General Surgery Service Safe for Patients?

OBJECTIVE: There has been concern expressed amongst the medical educational community regarding the readiness of general surgery residents in the United States to be competent practicing attendings upon graduation and that limited autonomy may be a contributing factor to this unpreparedness. The purpose of this study was to evaluate an RRC-accredited general surgery residency chief resident acute care surgery service with indirect supervision of cases in terms of safety and outcomes compared to traditional general surgeon cases with direct supervision. The study focused on common general surgical procedures, specifically cholecystectomies, appendectomies, and inguinal and ventral hernia repairs. DESIGN: A retrospective review was conducted of patient data from August 2016 to June 2018 to review all patients 16 years old and older who had received one of the following procedures: appendectomy, cholecystectomy, inguinal hernia repair, or ventral hernia repair. Patient characteristics, procedure type, procedure time, estimated blood loss, complications, length of hospital stay, 30-day readmission, 30-day ED visit, need for reoperation, and mortality were compared between attending direct supervision and chief resident indirect supervision surgery services. SETTING: A single institution associated with a community based-university associated hybrid general surgery residency was included in this study. PARTICIPANTS: Patients aged 16 years or older who underwent one of the operations of interest and were discharged between the dates of August 2016 and June 2018. The operations were performed by, or indirectly supervised by, attendings who were both private surgeons and also covered the chief resident service. RESULTS: A total of 1000 cases were reviewed, with a total of 960 included in the final data after exclusions applied. Of the 960 cases included, 68.4% were traditional attending surgeon cases with direct supervision and 31.6% were chief resident service cases with indirect supervision. A total of 161 appendectomies, 396 cholecystectomies, 201 inguinal hernias and 202 ventral hernias were included. Overall, patients in the chief resident service were more often minorities (27.7 vs. 9.4%, p < 0.001), female (56.4 vs. 44.6%, p = 0.001), younger (40 vs. 55 years, p < 0.001), had a higher BMI (31.2 vs. 29.6, p = 0.018), and a lower ASA class (class 1+2 was 86.4 vs. 65.6%, p < 0.001). The median Charleson Comorbidity Index of the chief resident service patients was lower than that of the attending service (0 vs. 2, p < 0.001). Chief resident service cases were also more often urgent cases (40.6 vs. 22.8%, p < 0.001). Overall, the 30-day complication rate was similar between the two services (5.6 vs. 5.8%, p = 1.000). Complications observed from chief resident service and attending service supervised cases included pneumonia (0.3 vs. 0.5%, p = 1.000), surgical site infection (2.3 vs. 1.5%, p = 0.389), UTI (1.0 vs. 0.6%, p = 0.685), acute kidney injury (0.0 vs. 0.8%, p = 0.333), small bowel obstruction (0.0 vs. 0.6%, p = 0.314), cerebrovascular accident (0.0 vs. 0.2%, p = 1.000), and hematoma/seroma (2.3 vs. 1.7%, p = 0.500). There were no statistically significant differences in procedure-specific complications between services. There was one 30-day mortality in the study population, in the attending service group. CONCLUSIONS: This study's data suggest that a chief resident acute care surgery service with indirect supervision of cases is safe in this community with regards to appendectomies, cholecystectomies and hernia repairs.