A Novel Educational Tool to Improve Medical Student Knowledge Acquisition During Surgical Rotations.

BACKGROUND: The addition of a novel education tool helps students improve understanding of general surgery topics. However, the effect of the new tool on objective exam performance is unknown. MATERIALS: A 10-item card of high-yield general surgery topics was implemented in the third-year surgery clerkship. Students reviewed these topics with general surgery residents. Scores from the National Board of Medical Examiners (NBME) surgery subject exam and Step 2 Clinical Knowledge (CK) board exam were compared among students who completed the Ask-a-Resident Topic card to a control group. RESULTS: Students who participated in the curriculum demonstrated significantly better scores on the NBME Surgery exam, t (236) = -2.56, P = .006. There was not a significant effect of the curriculum on Step 2 CK scores, although students who participated in the curriculum (M = 250.7, SD = 13.4) achieved higher scores than the control group (M = 247.8, SD = 14.2). DISCUSSION: The novel curriculum may improve objective student performance on standardized surgery exams.

A scalable tool for adjudication of time sensitive cases during COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, prioritization of care and utilization of scarce resources are daily considerations in healthcare systems that have never experienced these issues before. Elective surgical cases have been largely postponed, and surgery departments are struggling to correctly and equitably determine which cases need to proceed. A resource to objectively prioritize and track time sensitive cases would be useful as an adjunct to clinical decision-making. METHODS: A multidisciplinary working group at Emory Healthcare developed and implemented an adjudication tool for the prioritization of time sensitive surgeries. The variables identified by the team to form the construct focused on the patient's survivability according to actuarial data, potential impact on function with delay in care, and high-level biology of disease. Implementation of the prioritization was accomplished with a database design to streamline needed communication between surgeons and surgical adjudicators. All patients who underwent time sensitive surgery between 4/10/20 and 6/15/20 across 5 campuses were included. RESULTS: The primary outcomes of interest were calculated patient prioritization score and number of days until operation. 1767 cases were adjudicated during the specified time period. The distribution of prioritization scores was normal, such that real-time adjustment of the empiric algorithm was not required. On retrospective review, as the patient prioritization score increased, the number of days to the operating room decreased. This confirmed the functionality of the tool and provided a framework for organization across multiple campuses. CONCLUSIONS: We developed an in-house adjudication tool to aid in the prioritization of a large cohort of canceled and time sensitive surgeries. The tool is relatively simple in its design, reproducible, and data driven which allows for an objective adjunct to clinical decision-making. The database design was instrumental in communication optimization during this chaotic period for patients and surgeons.

Enhancing Medical Student Education and Combating Mistreatment During a Surgery Clerkship With a Novel Educational Tool: A Pilot Study.

BACKGROUND: Medical education changes dramatically from preclinical to clinical years, and the learning environment becomes key as students strive to develop clinical competence and informed career decisions. This change becomes heightened on a surgical clerkship where student mistreatment is often perceived, and the fast-paced nature of surgery can result in limited resident-student interactions and time for examination preparation. OBJECTIVE: To evaluate medical student and resident perception of educational strategies during a surgical clerkship and to determine whether the addition of a novel educational tool would increase satisfaction with the surgical clerkship on examination preparation and team dynamics. SETTING: University of North Carolina at Chapel Hill, Department of Surgery. STUDY DESIGN: During the 2018-2019 academic year, a 10-item "Ask a Resident Topics" (ART) card of high yield general surgery topics was implemented as part of the third-year surgery clerkship curriculum. Students were asked to review a topic and then discuss it with a general surgery resident. They were expected to complete at least 6 of 10 topics by the end of the rotation for credit. At the end of the year, third-year medical students were administered a 23-item survey regarding their experience on the surgery clerkship and with the ART cards. Fourth-year medical students and those students at satellite sites who did not receive the ART cards were administered the same survey, minus specific questions about the ART card, and were used as a preintervention control. General surgery residents who participated in teaching were similarly surveyed. RESULTS: Of those students that completed the ART cards, 84% felt it improved their understanding of general surgery and were more likely to report the surgery clerkship prepared them well for the NBME examination compared to those who did not (Χ2 (1, N = 87) = 4.95, p = 0.03). They were also more likely to report residents were willing to discuss surgery topics with them (Χ2 (1, N = 87) = 2.77, p = 0.10). Seventy-three percent of students thought the card did not add undue stress to their clerkship. Sixty-three percent of all students felt they were a productive member of the surgery team, and this did not vary by intervention group (Χ2 (1, N = 87) = 0.03, p = 0.9). Students who completed the ART card were more likely to report being interested in surgery than those who did not (Χ2 (1, N = 87) = 4.20, p = 0.04). Hundred percent of residents surveyed felt the ART card provided value for themselves as a teacher and for the student as a learner. CONCLUSIONS: The ART card is mutually beneficial to both residents and medical students during the surgical clerkship. This tool is easy to implement, helps students improve their understanding of general surgery, increases camaraderie among the surgical team, and has a positive impact on students pursuing a career in surgery.

Optimal Management of the Hyperkinetic Gallbladder: A Comparison of Outcomes Between Operative and Nonoperative Approaches.

BACKGROUND: A hyperkinetic gallbladder is defined as a hepatobiliary iminodiacetic acid (HIDA) scan ejection fraction (EF) of >80%. This condition is poorly described, and there is no current consensus on optimal management. The intent of this study was to determine if cholecystectomy improves symptoms in patients with a hyperkinetic gallbladder when compared to those managed nonoperatively and if there were variables predictive of symptom improvement with or without cholecystectomy. MATERIALS AND METHODS: This retrospective study included patients from 3 academic hospitals in the Atlanta metro area between the years 2006 and 2018. All patients with an EF >80% were included. Following voluntary exclusion patients were contacted by phone. Each patient was administered a questionnaire regarding their surgical history, medical management, and current symptom profile via Otago score. Institutional Institutional Review Board approval was obtained. RESULTS: 4785 HIDA scans were performed, and 194 reported an EF >80% (incidence 15.7%). 96% of these scans were reported as normal by the radiologist. 68 patients were able to be contacted by phone and completed the questionnaire. 18 patients underwent cholecystectomy, and 89% reported that their symptoms attributed to gallbladder disease were no longer present. 50 patients did not undergo cholecystectomy, and alternate diagnoses, medication prescriptions, diet modification, emergency department visits, and Otago score were higher in this cohort. DISCUSSION: Patients who undergo cholecystectomy for a diagnosis of hyperkinetic gallbladder, on average, report improvement in symptoms when compared to patients managed nonoperatively. This study supports the practice of reporting and managing hyperkinetic gallbladders as a pathologic entity.

Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training.

Importance: Prior studies demonstrate a high prevalence of burnout and depression among surgeons. Limited data exist regarding how these conditions are perceived by the surgical community. Objectives: To measure prevalence of burnout and depression among general surgery trainees and to characterize how residents and attendings perceive these conditions. Design, Setting, and Participants: This cross-sectional study used unique, anonymous surveys for residents and attendings that were administered via a web-based platform from November 1, 2016, through March 31, 2017. All residents and attendings in the 6 general surgery training programs in North Carolina were invited to participate. Main Outcomes and Measures: The prevalence of burnout and depression among residents was assessed using validated tools. Burnout was defined by high emotional exhaustion or depersonalization on the Maslach Burnout Inventory. Depression was defined by a score of 10 or greater on the Patient Health Questionnaire-9. Linear and logistic regression models were used to assess predictive factors for burnout and depression. Residents' and attendings' perceptions of these conditions were analyzed for significant similarities and differences. Results: In this study, a total of 92 residents and 55 attendings responded. Fifty-eight of 77 residents with complete responses (75%) met criteria for burnout, and 30 of 76 (39%) met criteria for depression. Of those with burnout, 28 of 58 (48%) were at elevated risk of depression (P = .03). Nine of 77 residents (12%) had suicidal ideation in the past 2 weeks. Most residents (40 of 76 [53%]) correctly estimated that more than 50% of residents had burnout, whereas only 13 of 56 attendings (23%) correctly estimated this prevalence (P < .001). Forty-two of 83 residents (51%) and 42 of 56 attendings (75%) underestimated the true prevalence of depression (P = .002). Sixty-six of 73 residents (90%) and 40 of 51 attendings (78%) identified the same top 3 barriers to seeking care for burnout: inability to take time off to seek treatment, avoidance or denial of the problem, and negative stigma toward those seeking care. Conclusions and Relevance: The prevalence of burnout and depression was high among general surgery residents in this study. Attendings and residents underestimated the prevalence of these conditions but acknowledged common barriers to seeking care. Discrepancies in actual and perceived levels of burnout and depression may hinder wellness interventions. Increasing understanding of these perceptions offers an opportunity to develop practical solutions.