PATCH-DP: a single-arm phase II trial of intra-operative application of HEMOPATCH™ to the pancreatic stump to prevent post-operative pancreatic fistula following distal pancreatectomy.

BACKGROUND: Post-operative pancreatic fistula (POPF) is the most significant cause of morbidity following distal pancreatectomy. Hemopatch™ is a thin, bovine collagen-based hemostatic sealant. We hypothesized that application of Hemopatch™ to the pancreatic stump following distal pancreatectomy would decrease the incidence of clinically-significant POPF. METHODS: We conducted a prospective, single-arm, multicentre phase II study of application of Hemopatch™ to the pancreatic stump following distal pancreatectomy. The primary outcome was clinically-significant POPF within 90 days of surgery. A sample size of 52 patients was required to demonstrate a 50% relative reduction in Grade B/C POPF from a baseline incidence of 20%, with a type I error of 0.2 and power of 0.75. Secondary outcomes included incidence of POPF (all grades), 90-day mortality, 90-day morbidity, re-interventions, and length of stay. RESULTS: Adequate fixation Hemopatch™ to the pancreatic stump was successful in all cases. The rate of grade B/C POPF was 25% (95%CI: 14.0-39.0%). There was no significant difference in the incidence of grade B/C POPF compared to the historical baseline (p = 0.46). The 90-day incidence of Clavien-Dindo grade ≥3 complications was 26.9% (95%CI: 15.6-41.0%). CONCLUSION: The use of Hemopatch™ was not associated with a decreased incidence of clinically-significant POPF compared to historical rates. (NCT03410914).

Trigger videos: a novel application of a tool for surgical faculty development.

BACKGROUND: Trigger videos have occasionally been used in medical education; however, their application to surgical faculty development is novel. We assessed participants' attitudes towards workshops on intraoperative teaching (IOT) that were anchored by trigger videos, and studied whether they could generate discussion-for-learning among surgeons in this workshop setting. METHODS: Surgeons from multiple specialties attended one of six faculty development workshops where IOT trigger videos were shown and discussed during break-out sessions. Participants completed questionnaires to (1) evaluate videos via survey and feedback, and (2) identify adoptable and discardable IOT techniques. Teaching techniques were collated to identify planned IOT changes and survey data and feedback were analyzed. RESULTS: A total of 135 surgeons identified 292 adoptable and 202 discardable IOT techniques based on trigger videos and discussions, and 94% of participants reported that the trigger videos were useful and encouraged them to discuss and consider new IOT techniques in their own practice. CONCLUSIONS: Participants reported that the trigger videos were useful and motivating. Surgeons critically reflected on IOT during the sessions, identifying numerous adoptable and discardable techniques relevant to their own teaching styles. Trigger videos can be a valuable tool for surgical faculty development and can be tailored to other medical specialties.

Impact of the Surgical Research Methodology Program on surgical residents' research profiles.

OBJECTIVE: To evaluate whether implementing the formal Surgical Research Methodology (SRM) Program in the surgical residency curriculum improved research productivity compared with the preceding informal Research Seminar Series (RSS). METHODS: The SRM Program replaced the RSS in July 2009. In the SRM Program, the curriculum in Year-1 consisted of 12 teaching sessions on the principles of clinical epidemiology and biostatistics, whereas the focus in Year-2 was on the design, conduct, and presentation of a research project. The RSS consisted of 8 research methodology sessions repeated annually for 2 years along with the design, conduct, and presentation of a research project. Research productivity was measured as the number of peer-reviewed publications and the generation of studies with higher levels of evidence. Outcome measures were independently assessed by 2 authors to avoid bias. Student t test and chi-square test were used for the analysis. Frequencies, mean differences with 95% CI, and effect sizes have been reported. RESULTS: In this study, 81 SRM residents were compared with 126 RSS residents. The performance of the SRM residents was superior on all metrics in our evaluation. They were significantly more productive and published more articles than the RSS residents (mean difference = 1.0 [95% CI: 0.5-1.5], p < 0.001) with an effect size of 0.26. The SRM residents presented significantly more projects that were of higher levels of evidence (systematic reviews/meta-analyses, randomized controlled trials, and prospective cohorts) than the RSS residents (52.5% vs 29%, p = 0.005). In addition, the research performance improved 11.0 grades (95% CI: 8.5%-13.5%, p < 0.001) with an effect size of 0.51 in favor of the SRM Program. CONCLUSION: Although not all surgeons opt for a career as surgeon-scientist, knowledge of research methodology is crucial to appropriately apply evidence-based findings in clinical practice. The SRM Program has significantly improved the research productivity and performance of the surgical residents from all disciplines. The implementation of a similar research methodology program is highly recommended for the benefit of residents' future careers and ultimately, evidence-based patient care.

Standardized methodological assessment of research presentations (SHARP): development of a new instrument.

BACKGROUND: There are currently no validated guidelines to assess the quality of the content and the delivery style of scientific podium surgical presentations. We have developed a simple, short, and reliable instrument to objectively assess the overall quality of scientific podium presentations. METHODS: A simple and efficient rating instrument was developed to assess the scientific content and presentation style/skills of the surgical residents' presentations from 1996 to 2013. Absolute and consistency agreement for the different sections of the instrument was determined and assessed overtime, by stage of the project and study design. Intraclass correlation coefficients with 95% confidence intervals were calculated and reported using a mixed-effects model. RESULTS: Inter-rater reliability for both absolute and consistency agreement was substantial for total score and for each of the 3 sections of the instrument. The absolute agreement for the overall rating of the presentations was .87 (.63 to .98) and .78 (.50 to .95), and the consistency agreement was .90 (.70 to .99) and .87 (.67 to .97) for the 2012 and 2013 institutional research presentations, respectively. Rater agreement for evaluating project stage and different study designs varied from .70 to .81 and was consistent over the years. The consistency agreement in rating of the presentation was .77 for both faculty and resident raters. CONCLUSIONS: Standardized methodological assessment of research presentations (SHARP) instrument rates the scientific quality of the research and style of the delivered presentation. It is highly reliable in scoring the quality of the all study designs regardless of their stage. We recommend that researchers focus on presenting the key concepts and significant elements of their evidence using visually simple slides in a professionally engaging manner for effective delivery of their research and better communication with the audience.

Exploring how surgeon teachers motivate residents in the operating room.

BACKGROUND: Motivation in teaching, mainly studied in disciplines outside of surgery, may also be an important part of intraoperative teaching. We explored techniques surgeons use to motivate learners in the operating room (OR). METHODS: Forty-four experienced surgeon teachers from multiple specialties participated in 9 focus groups about teaching in the OR. Focus groups were transcribed and subjected to qualitative thematic analysis by 3 reviewers through an iterative, rigorous process. RESULTS: Analysis revealed 8 motivational techniques. Surgeons used motivation techniques tacitly, describing multiple ways that they facilitate resident motivation while teaching. Two major categories of motivational techniques emerged: (1) the facilitation of intrinsic motivation; and (2) the provision of factors to stimulate extrinsic motivation. CONCLUSIONS: Surgeons unknowingly but tacitly and commonly use motivation in intraoperative teaching and use a variety of techniques to foster learners' intrinsic and extrinsic motivation. Motivating learners is 1 vital role that surgeon teachers play in nontechnical intraoperative teaching.