Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

PURPOSE: There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. MATERIALS AND METHODS: This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. RESULTS: From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. CONCLUSIONS: SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned.

Sex and Labor Trafficking in Paraguay: Risk Factors, Needs Assessment, and the Role of the Health Care System.

Trafficking of adults and children for both sex and labor is a human rights violation occurring with alarming frequency throughout the world, and resulting in profound harm to close-knit communities and severe health consequences for victims. Certain areas, such as the country of Paraguay, are at a higher risk for trafficking due to unique economic, cultural, and geographic factors. Thousands of people, especially children, are trafficked within Paraguay's borders, and many eventually are transported to neighboring countries and sometimes to Europe and elsewhere. Using case study methodology and "city" as the unit of study, researchers interviewed 18 key anti-trafficking stakeholders from government and nongovernmental organizations in two major metropolitan centers for trafficking in Paraguay, Asunción, and Encarnación. Through semistructured interviews, this qualitative study examines risk factors for trafficking, health outcomes, interventions needed within the health care sector, and programs needed to combat trafficking. We identified risk factors including poverty, marginalization of indigenous people, gender inequality, domestic servitude of children (criadazgo), and political hesitance to enact protective legislation. Victims of trafficking were reported to suffer from physical injuries, unintended pregnancies, sexually transmitted infections, and mental health issues such as depression and posttraumatic stress disorder. These predispose victims to difficulties reintegrating into their communities and ultimately to retrafficking. A major gap was identified in the lack of sufficient lodging and rehabilitation services for rescued victims, affordable access to trauma-sensitive health care for victims, and scarce mental health services. Many of the findings are applicable across the world and may be of use to guide future anti-trafficking efforts in Paraguay and beyond.