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Discussed under various terms such as mental skills, mental rehearsal, cognitive training, and non-technical skills, psychological performance skills are gaining greater acceptance for their contributions to excellence in surgical performance. Mental imagery, specifically performance-enhancing mental imagery for surgeons, has received the greatest attention in the surgical literature. As part of the surgeon's imagery mindset (SIM), this form of mental rehearsal contributes to optimal surgical performance for both developing and practicing surgeons. We discuss the nature of SIM and describe 5 basic guidelines for maximizing the application of performance-enhancing mental imagery in surgical contexts.
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Cirurgia Geral , Cirurgiões , Humanos , Cirurgiões/educação , Competência Clínica , Cirurgia Geral/educaçãoAssuntos
Hérnia Inguinal/cirurgia , Herniorrafia , Laparoscopia , Adulto , Anestesia Local , Dor Crônica/etiologia , Dor Crônica/prevenção & controle , Educação Médica Continuada , Feminino , Hérnia Inguinal/genética , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Recidiva , Cirurgiões/educação , Telas Cirúrgicas , Técnicas de SuturaAssuntos
Educação de Pós-Graduação em Medicina , Cirurgiões/educação , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Canadá/epidemiologia , Prestação Integrada de Cuidados de Saúde , Educação de Pós-Graduação em Medicina/história , Acessibilidade aos Serviços de Saúde , História do Século XX , História do Século XXI , Humanos , Padrões de Prática Médica , Cirurgiões/história , Cobertura Universal do Seguro de Saúde , Doenças Vasculares/diagnóstico , Doenças Vasculares/epidemiologia , Doenças Vasculares/história , Procedimentos Cirúrgicos Vasculares/históriaRESUMO
BACKGROUND: Access to safe, high-quality surgical care in sub-Saharan Africa is a critical gap. Interventions to improve surgical quality have been developed, but research on their implementation is still at a nascent stage. We retrospectively applied the Exploration, Preparation, Implementation, Sustainment framework to characterize the implementation of Safe Surgery 2020, a multicomponent intervention to improve surgical quality. METHODS: We used a longitudinal, qualitative research design to examine Safe Surgery 2020 in 10 health facilities in Tanzania's Lake Zone. We used documentation analysis with confirmatory key informant interviews (n = 6) to describe the exploration and preparation phases. We conducted interviews with health facility leaders and surgical team members at 1, 6, and 12 months (n = 101) post initiation to characterize the implementation phase. Data were analyzed using the constant comparison method. RESULTS: In the exploration phase, research, expert consultation, and scoping activities revealed the need for a multicomponent intervention to improve surgical quality. In the preparation phase, onsite visits identified priorities and barriers to implementation to adapt the intervention components and curriculum. In the active implementation phase, 4 themes related to the inner organizational context-vision for safe surgery, existing surgical practices, leadership support, and resilience-and 3 themes related to the intervention-innovation-value fit, holistic approach, and buy-in-facilitated or hindered implementation. Interviewees perceived improvements in teamwork and communication and intra- and inter-facility learning, and their need to deliver safe surgery evolved during the implementation period. CONCLUSIONS: Examining implementation through the exploration, preparation, implementation, and sustainment phases offers insights into the implementation of interventions to improve surgical quality and promote sustainability.
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Medicina Baseada em Evidências/organização & administração , Implementação de Plano de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/educação , Humanos , Liderança , Estudos Longitudinais , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Pesquisa Qualitativa , Melhoria de Qualidade , Estudos Retrospectivos , Cirurgiões/educação , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Desenvolvimento Sustentável , TanzâniaRESUMO
BACKGROUND: Thoracic surgery (TS) residency positions are in high demand. There is no study describing the nationwide attributes of successful matriculants in this specialty. We examined the characteristics of TS resident applicants and identified factors associated with acceptance. METHODS: Applicant data from 2014 to 2017 application cycles was extracted from the Electronic Residency Application System and stratified by matriculation status. Medical education, type of general surgery residency, and research achievements were analyzed. The number of peer-reviewed publications and the corresponding impact factor for the journals where they were published were quantified. RESULTS: There were 492 applicants and 358 matriculants. The overall population was primarily male (79.5%), white (55.1%), educated at United States allopathic medical schools (66.5%), and trained at university-based general surgery residencies (59.6%). Education at United States allopathic schools (odds ratio [OR], 2.54; P < .0001), being a member of the American Osteopathic Association (OR, 3.27; P = .021), general surgery residency affiliation with a TS residency (OR, 2.41; P = .0003) or National Cancer Institute designated Comprehensive Cancer Center (OR, 1.76; P = .0172), and being a first-time applicant (OR, 4.71, P < .0001) were independently associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 3 vs 2, P < .0001) and more frequently published in higher impact journals (P < .0001). CONCLUSIONS: Our study includes objective and quantifiable data from recent application cycles and represents an in-depth examination of applicants to TS residency. The type of medical school and residency, as well as academic productivity, correlate with successful matriculation.
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Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Faculdades de Medicina , Cirurgiões/educação , Cirurgia Torácica/educação , Procedimentos Cirúrgicos Torácicos/educação , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados UnidosRESUMO
BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an aggressive locoregional treatment for peritoneal carcinomatosis (PC). Studies demonstrate improved perioperative and oncologic outcomes at high-volume centers. METHODS: This study retrospectively analyzed all patients with PC from various malignancies who underwent attempted CRS/HIPEC at the authors' institution from 2007 to 2017. Clinicopathologic, perioperative, and oncologic outcomes of early (2007-2012) and late (2012-2017) experience were compared, and multivariate analyses for factors predictive of perioperative and oncologic outcomes were performed. RESULTS: The study enrolled 388 patients (157 early and 231 late). The late experience contained more appendiceal low-grade mucinous neoplasms (LGMNs; 21% vs 9%) and had a lower Peritoneal Cancer Index (PCI; 10 vs 16). Moreover, achieving a similar rate of CC-0/1 required fewer organ resections, involved shorter operations (298 vs 347 min), and had lower estimated blood loss (EBL) (400 vs 200 ml) (p < 0.05). More procedures were aborted (20% vs 3%; p < 0.01). The late experience had fewer ICU admissions (13% vs. 55%) and a lower perioperative mortality rate (0% vs 3%) (p < 0.05). In the multivariate analyses, PCI and number of organ resections were independent predictors of multiple perioperative outcomes [EBL, operating room time, intensive care unit (ICU) admission, ICU length of stay (LOS), overall LOS]. Survival was significantly longer in the late cohort (median overall survival: NR vs 31 months; progression-free survival: 22 vs 11 months; p < 0.01), even after control for tumor histology. CONCLUSIONS: At the authors' high-volume center, with increased surgeon and institutional experience over time, perioperative and oncologic outcomes have improved significantly for patients undergoing CRS/HIPEC for PC.
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Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/terapia , Adenocarcinoma Mucinoso/mortalidade , Adenocarcinoma Mucinoso/terapia , Antineoplásicos/uso terapêutico , Neoplasias do Apêndice/mortalidade , Neoplasias do Apêndice/terapia , Competência Clínica , Terapia Combinada , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Prognóstico , Estudos Retrospectivos , Cirurgiões/educação , Cirurgiões/normas , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Importance: Mindfulness meditation training has been shown to be feasible in surgical trainees, but affective, cognitive, and performance benefits seen in other high-stress populations have yet to be evaluated. Objective: To explore potential benefits to stress, cognition, and performance in postgraduate year 1 (PGY-1) surgery residents receiving modified mindfulness-based stress reduction (modMBSR). Design, Setting, and Participants: This follow-up study is an analysis of the Mindful Surgeon pilot randomized clinical trial of modMBSR (n = 12) vs an active control (n = 9), evaluated at baseline (T1), postintervention (T2), and 1 year (T3), took place at an academic medical center residency training program among PGY-1 surgery residents. Data were collected between June 2016 and June 2017 and analyzed from June 2017 to December 2017. Interventions: Weekly 2-hour modMBSR classes and 20 minutes of daily home practice during an 8-week period vs an active control (different content, same structure). Main Outcomes and Measures: Preliminary evidence of efficacy was explored, primarily focusing on perceived stress and executive function and secondarily on burnout, depression, motor skill performance, and changes in blood oxygen level-dependent functional neuroimaging during an emotion regulation task. Group mean scores were calculated at T1, T2, and T3 and in linear mixed-effects multivariate analysis. Effect size for analysis of covariance is presented as partial η2 with the following cutoff points: small, less than 0.06; medium, 0.06 to 0.14; large, greater than 0.14. Results: Postgraduate year 1 surgery residents (N = 21; 8 [38%] women) were randomized to a modMBSR arm (n = 12) or an active control arm (n = 9). Linear mixed-effects modeling revealed differences at T2 and T3 in perceived stress (mean [SD] difference at T2: modMBSR, 1.42 [5.74]; control, 3.44 [6.71]; η2 = 0.07; mean [SD] difference at T3: modMBSR, 1.00 [4.18]; control, 1.33 [4.69]; η2 = 0.09) and in mindfulness (mean [SD] difference at T2: modMBSR, 3.08 [3.63]; control, 1.56 [4.28]; η2 = 0.13; mean [SD] difference at T3: modMBSR, 2.17 [3.66]; control, -0.11 [6.19]; η2 = 0.15). Burnout at T2 (mean [SD] difference: modMBSR, 4.50 [9.08]; control, 3.44 [6.71]; η2 = 0.01) and T3 (mean [SD] difference: modMBSR, 5.50 [9.96]; control, 5.56 [9.69]; η2 = 0.01) showed similar increase in both groups. Working memory increased more at T2 in the modMBSR arm (mean [SD] difference, 0.35 [0.60]) than in the control arm (mean [SD] difference, 0.21 [0.74]; η2 = 0.02) and at T3 (modMBSR, 0.68 [0.69]; control, 0.26 [0.58]; η2 = 0.20). Cognitive control decreased more in the control arm at T2 (mean [SD] difference at T2: modMBSR, 0.15 [0.40]; control, -0.07 [0.32]; η2 = 0.13) and at T3 (mean [SD] difference: modMBSR, 0.07 [0.59]; control, -0.26 [0.53]; η2 = 0.16). Mean (SD) circle-cutting time improved more at T2 in the modMBSR arm (-24.08 [63.00] seconds) than in the control arm (-4.22 [112.94] seconds; η2 = 0.23) and at T3 in the modMBSR arm (-4.83 [77.94] seconds) than in the control arm (11.67 [145.17] seconds; η2 = 0.13). Blood oxygen level-dependent functional neuroimaging during an emotional regulation task showed unique postintervention activity in the modMBSR arm in areas associated with executive function control (dorsolateral prefrontal cortex) and self-awareness (precuneus). Conclusions and Relevance: In this pilot randomized clinical trial, modMBSR in PGY-1 surgery residents showed potential benefits to well-being and executive function, suggesting a powerful role for mindfulness-based cognitive training to support resident well-being and performance, as mandated by the Accreditation Council for Graduate Medical Education. Trial Registration: ClinicalTrials.gov identifier: NCT03141190.
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Currículo , Educação de Pós-Graduação em Medicina/organização & administração , Internato e Residência , Atenção Plena/educação , Estresse Psicológico/prevenção & controle , Cirurgiões/educação , Cirurgiões/psicologia , Adulto , Atitude do Pessoal de Saúde , Cognição , Feminino , Humanos , Masculino , Projetos Piloto , Adulto JovemRESUMO
Introdução: Os objetivos deste estudo foram: (1) delinear um programa de treinamento em habilidades de pesquisa científica, (2) avaliar o perfil da participação dos residentes de Cirurgia Plástica em artigos, e (3) analisar o impacto da implementação do programa de treinamento sobre índices bibliométricos quantitativos. Métodos: Trata-se de uma análise bibliométrica da participação de residentes de Cirurgia Plástica de uma única instituição em artigos publicados em periódicos revisados por pares entre 2006 e 2014. Dados coletados: número de autores, posição dos residentes entre os autores, títulos, bases de indexação e fator de impacto dos periódicos, desenhos dos estudos e níveis de evidência. Dois períodos (janeiro/2006- janeiro/2010 [A] e fevereiro/2010-fevereiro/2014 [B]) foram criados para estudar o perfil evolutivo do impacto da implementação do programa de treinamento delineado neste estudo. Resultados: Houve predomínio significativo (p < 0,05) de artigos publicados em periódicos nacionais, em língua portuguesa, nas bases de dados SciELO e LILACS, artigos sem residentes como autor correspondente, sem fator de impacto, sem hipóteses e com nível de evidência III (estudos retrospectivos). A análise comparativa interperíodos revelou um aumento significativo (p < 0,05) de artigos publicados, de residentes com publicações ao término da residência, da participação de um ou mais residentes e de artigos publicados em inglês (período A < período B). Conclusão: A implementação do programa de treinamento em habilidades de pesquisa científica determinou um aumento da atividade de pesquisa (artigos revisados por pares) durante a residência.
Introduction: The objectives of this study were as follows: (1) to outline a scientific research skills training program, (2) to evaluate the profile of participation of plastic surgery residents in articles, and (3) to analyze the impact of the implementation of the training program on quantitative bibliometric indexes. Methods: This was a bibliometric analysis of the participation of plastic surgery residents of a single institution in articles published in peer-reviewed journals between 2006 and 2014. The data collected were the number of authors, position of residents among authors, article titles, indexing databases and impact factor of the journals, study design, and levels of evidence. Two periods (January 2006 to January 2010 [A] and February 2010 to February 2014 [B]) were created to study the evolutionary profile of the impact of the implementation of the training program outlined in this study. Results: A significant predominance (p < 0.05) was observed among articles published in national journals in the Portuguese language and in the SciELO and LILACS databases, and articles without residents as corresponding author, without impact factor, without assumptions, and with a level of evidence III (retrospective studies). The inter-period comparative analysis revealed a significant increase (p < 0.05) in the numbers of published articles and residents with publications at the end of their residency, in the involvement of one or more residents, and in the articles published in English (period A < period B). Conclusion: The implementation of a scientific research skills training program led to an increase in research activity of (peer-reviewed articles) during the residency.
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Humanos , Cirurgia Plástica/educação , Cirurgiões/educação , Internato e Residência/métodos , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Bibliometria , Métodos de Estudo da Matéria Médica , Pesquisa Científica e Desenvolvimento Tecnológico , Características do EstudoRESUMO
Congenital heart disease is the most common birth defect worldwide, and accounts for a high proportion of the world's infant mortality. About 9 of every 10 babies born each year are born in areas without adequate access to heart surgery; overcoming this problem will necessitate addressing the worldwide shortage of an estimated 3,700 pediatric cardiac surgeons. Establishing sustainable heart surgery programs requires more than an investment of money: political, social, and cultural issues unique to each environment need to be addressed. Organizations desiring to help develop cardiac surgical centers need to focus on communication and bidirectional education, and to make a long-term commitment to each site. By identifying and addressing obstacles, success rates are high.
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Procedimentos Cirúrgicos Cardíacos , Prestação Integrada de Cuidados de Saúde/organização & administração , Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde/organização & administração , Cardiopatias Congênitas/cirurgia , Área Carente de Assistência Médica , Avaliação das Necessidades/organização & administração , Procedimentos Cirúrgicos Cardíacos/educação , Educação Médica , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/mortalidade , Humanos , Intercâmbio Educacional Internacional , Missões Médicas/organização & administração , Desenvolvimento de Programas , Cirurgiões/educaçãoRESUMO
BACKGROUND: The demand for training in complex general surgical oncology (CGSO) fellowships currently exceeds the number of positions offered; however, there are scarce data defining the applicant pool or characteristics associated with successful matriculation. Our study described the applicant population and to determine factors associated with acceptance into the fellowship. STUDY DESIGN: Data were extracted from the Electronic Residency Application System for applicants in 2015 and 2016 and stratified based on matriculation status. Applicant demographics, including medical education, residency, and research achievements, were analyzed. Academic productivity was quantified using the number of peer-reviewed publications as well as the journal with the highest impact factor in which an applicant's work was published. RESULTS: Data were gathered on a total of 283 applicants, of which 105 matriculated. The overall population was primarily male (63.2%), Caucasian (40.6%), educated at a U.S. allopathic medical school (53.4%), and trained at a university-based General Surgery residency (55.5%). Education at a U.S. allopathic school (OR = 5.63, p < 0.0001), university-based classification of the applicant's surgical residency (OR = 4.20, p < 0.0001), and a residency affiliation with a CGSO fellowship (OR = 2.61, p = 0.004) or National Cancer Institute designated Comprehensive Cancer Center (OR = 3.16, p < 0.001) were found to be associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 10 vs. 4.5, p < 0.0001) and more frequently achieved publication in journals with higher impact factors (p < 0.0001). CONCLUSIONS: This study represents the first objective description of the CGSO fellowship applicant pool. Applicants' medical school, residency, and research data points correlated with successful matriculation.
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Certificação/métodos , Bolsas de Estudo , Necessidades e Demandas de Serviços de Saúde , Internato e Residência/estatística & dados numéricos , Neoplasias/cirurgia , Avaliação de Programas e Projetos de Saúde , Cirurgiões/educação , Adulto , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Cirurgiões/provisão & distribuição , Cirurgiões/tendências , Oncologia CirúrgicaRESUMO
OBJECTIVE: To investigate the effectiveness of motor imagery (MI) for technical skill and non-technical skill (NTS) training in minimally invasive surgery (MIS). SUBJECTS AND METHODS: A single-blind, parallel-group randomised controlled trial was conducted at the Vattikuti Institute of Robotic Surgery, King's College London. Novice surgeons were recruited by open invitation in 2015. After basic robotic skills training, participants underwent simple randomisation to either MI training or standard training. All participants completed a robotic urethrovesical anastomosis task within a simulated operating room. In addition to the technical task, participants were required to manage three scripted NTS scenarios. Assessment was performed by five blinded expert surgeons and a NTS expert using validated tools for evaluating technical skills [Global Evaluative Assessment of Robotic Skills (GEARS)] and NTS [Non-Technical Skills for Surgeons (NOTSS)]. Quality of MI was assessed using a revised Movement Imagery Questionnaire (MIQ). RESULTS: In all, 33 participants underwent MI training and 29 underwent standard training. Interrater reliability was high, Krippendorff's α = 0.85. After MI training, the mean (sd) GEARS score was significantly higher than after standard training, at 13.1 (3.25) vs 11.4 (2.97) (P = 0.03). There was no difference in mean NOTSS scores, at 25.8 vs 26.4 (P = 0.77). MI training was successful with significantly higher imagery scores than standard training (mean MIQ score 5.1 vs 4.5, P = 0.04). CONCLUSIONS: Motor imagery is an effective training tool for improving technical skill in MIS even in novice participants. No beneficial effect for NTS was found.
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Anastomose Cirúrgica/educação , Competência Clínica , Simulação por Computador , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Robóticos/educação , Cirurgiões/educação , Anastomose Cirúrgica/normas , Cognição , Educação Médica Continuada , Avaliação Educacional , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Avaliação de Programas e Projetos de Saúde , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Robóticos/normas , Análise e Desempenho de TarefasRESUMO
The Hospital Privileges Practice Guideline Writing Group of the Society for Vascular Surgery is making the following five recommendations concerning guidelines for hospital privileges for vascular surgery and endovascular therapy. Advanced endovascular procedures are currently entrenched in the everyday practice of specialized vascular interventionalists, including vascular surgeons, but open vascular surgery remains uniquely essential to the specialty. First, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency and fellowship training. Second, applicants for new hospital privileges wishing to perform vascular surgery should have completed an Accreditation Council for Graduate Medical Education-accredited vascular surgery residency or fellowship or American Osteopathic Association-accredited training program before 2020 and should obtain American Board of Surgery certification in vascular surgery or American Osteopathic Association certification within 7 years of completion of their training. Third, we recommend that applicants for renewal of hospital privileges in vascular surgery include physicians who are board certified in vascular surgery, general surgery, or cardiothoracic surgery. These physicians with an established practice in vascular surgery should participate in Maintenance of Certification programs as established by the American Board of Surgery and maintain their respective board certification. Fourth, we provide recommendations concerning guidelines for endovascular procedures for vascular surgeons and other vascular interventionalists who are applying for new or renewed hospital privileges. All physicians performing open or endovascular procedures should track outcomes using nationally validated registries, ideally by the Vascular Quality Initiative. Fifth, we endorse the Intersocietal Accreditation Commission recommendations for noninvasive vascular laboratory interpretations and examinations to become a Registered Physician in Vascular Interpretation, which is included in the requirements for board eligibility in vascular surgery, but recommend that only physicians with demonstrated clinical experience in the diagnosis and management of vascular disease be allowed to interpret these studies.
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Procedimentos Endovasculares/normas , Privilégios do Corpo Clínico/normas , Corpo Clínico Hospitalar/normas , Sociedades Médicas/normas , Cirurgiões/normas , Procedimentos Cirúrgicos Vasculares/normas , Certificação/normas , Competência Clínica/normas , Educação Médica Continuada/normas , Educação de Pós-Graduação em Medicina/normas , Procedimentos Endovasculares/educação , Humanos , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educaçãoRESUMO
OBJECTIVE: To determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative medicine (CAM) (referred to as IM GPs) working within National Health Service (NHS) England. DESIGN: Retrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age-sex weighting Related Prescribing Unit) using NHS Digital data over 2016. Publicly available data were used on prevalence of relevant comorbidities, demographics of patient populations and deprivation scores. SETTING: Primary Care. PARTICIPANTS: 7283 NHS GP surgeries in England. PRIMARY OUTCOME MEASURE: The association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory tract infection (RTI) and urinary tract infection (UTI) separately) as outcome. RESULTS: IM GP surgeries (n=9) were comparable to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. Negative binomial regression models showed that statistically significant fewer total antibiotics (relative risk (RR) 0.78, 95% CI 0.64 to 0.97) and RTI antibiotics (RR 0.74, 95% CI 0.59 to 0.94) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries. In contrast, the number of antibiotics prescribed for UTI were similar between both practices. CONCLUSION: NHS England GP surgeries employing GPs additionally trained in IM/CAM have lower antibiotic prescribing rates. Accessibility of IM/CAM within NHS England primary care is limited. Main study limitation is the lack of consultation data. Future research should include the differences in consultation behaviour of patients self-selecting to consult an IM GP or conventional surgery, and its effect on antibiotic prescription. Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against antimicrobial resistance.
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Antibacterianos/uso terapêutico , Terapias Complementares/educação , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/educação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Comorbidade/tendências , Estudos Transversais , Inglaterra , Feminino , Medicina Geral/organização & administração , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Encaminhamento e Consulta , Análise de Regressão , Infecções Respiratórias/tratamento farmacológico , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Adulto JovemRESUMO
INTRODUCTION: Mental skills training, which refers to the teaching of performance enhancement and stress management psychological strategies, may benefit surgeons. Our objective was to review the application of mental skills training in surgery and contrast it to other domains, examine the effectiveness of this approach in enhancing surgical performance and reducing stress, and provide future directions for mental skills training in surgery. MATERIALS AND METHODS: A systematic literature search of MEDLINE, PubMed, PsycINFO, and ClinicalKey was performed between 1996 and 2016. Keywords included were mental readiness, mental competency, mental skill, mental practice, imagery, mental imagery, mental rehearsal, stress management training, stress coping, mental training, performance enhancement, and surgery. Reviews of mental skills interventions in sport and well-regarded sport psychology textbooks were also reviewed. Primary outcome of interest was the effect of mental skills on surgical performance in the simulated or clinical environment. RESULTS: Of 490 identified abstracts, 28 articles met inclusion criteria and were reviewed. The majority of the literature provides evidence that mental imagery and stress management training programs are effective at enhancing surgical performance and reducing stress. Studies from other disciplines suggest that comprehensive mental skills programs may be more effective than imagery and stress management techniques alone. CONCLUSIONS: Given the demonstrated efficacy of mental imagery and stress management training in surgery and the incremental value of comprehensive mental skills curricula used in other domains, a concerted effort should be made to apply comprehensive mental skills curricula during surgical training.
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Prática Psicológica , Desempenho Psicomotor , Estresse Psicológico/prevenção & controle , Cirurgiões/educação , Cirurgiões/psicologia , Adaptação Psicológica , Competência Clínica , Humanos , Psicologia do EsporteRESUMO
This article continues a series developed by the American Head and Neck Society's Education Committee entitled "Do you know your guidelines?" It is hoped that these features will increase awareness of and adherence to current best practices in head and neck cancer care. In this installment, the National Comprehensive Cancer Network (NCCN) guidelines for surgical therapy are reviewed. © 2016 Wiley Periodicals, Inc. Head Neck 39: 791-796, 2017.