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1.
Urology ; 135: 28-31, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31628969

RESUMEN

OBJECTIVE: To address information overload for trainees, a concise electronic case-based urology learning program (CBULP) was developed. Previous qualitative assessments suggested CBULP's potential efficacy/utility. Herein we assess CBULP more stringently by evaluating test performance before/after reviewing a CBULP curriculum covering core concepts in testicular cancer. METHODS: Eleven of 33 CBULP testicular cancer cases were strategically selected for this curriculum. A 26 question multiple-choice test was developed to assess fundamental knowledge about testis cancer tumor biology and evaluation/management. Pretest was administered to PGY4/PGY1 residents at 2 pilot urology-training programs, and medical students interested in Urology. Participants were given 4 weeks to review the curriculum and the test was then repeated. A control group (4 PGY1s) was administered the pretest and repeat test in an analogous manner without provision of the CBULP curriculum. RESULTS: Twenty individuals took the pretest (7 medical students, 8 PGY1s, and 5 PGY4s), and 17 (85%) took the post-test (5 medical students, 8 PGY1s, and 4 PGY4s,). As expected, PGY4s performed significantly better than the other 2 groups on the pre- and post-test. However, significant improvement in test performance was seen across all groups that utilized the CBULP curriculum (P <.02), with highest increase demonstrated by PGY1 residents (4.75 more questions correct, P = .002). The control arm did not demonstrate significant improvement (P = .20). CONCLUSION: Significant improvement in test performance was observed after completion of the CBULP testicular series. This study suggests that CBULP can be an efficacious and clinically useful educational resource for urologic residents and students interested in the field.


Asunto(s)
Curriculum , Educación de Pregrado en Medicina/métodos , Internado y Residencia/métodos , Neoplasias Testiculares/diagnóstico , Urología/educación , Adulto , Competencia Clínica , Instrucción por Computador/métodos , Educación de Pregrado en Medicina/estadística & datos numéricos , Evaluación Educacional/estadística & datos numéricos , Humanos , Internado y Residencia/estadística & datos numéricos , Masculino , Evaluación de Programas y Proyectos de Salud , Estudiantes de Medicina/estadística & datos numéricos , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapia
2.
Ann Otol Rhinol Laryngol ; 129(2): 101-109, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31522512

RESUMEN

OBJECTIVE: To assess the prevalence of microlaryngeal teaching course in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in an effort to evaluate the nature, perceived value and barriers to implementation of microlaryngeal courses. METHOD: A 14-question survey to all ACGME-accredited otolaryngology programs in the United States. RESULT: Out of 119 ACGME-accredited otolaryngology programs identified on the ACGME Fellowship and Residency Electronic Interactive Database, responses were received from 67 programs (56%). Although 90% of respondents indicated that instruction courses in one discipline or another existed at their institution for their otolaryngology residents, only 33% indicated that their program offers a hands-on instruction course in microlaryngeal surgery. Of those programs that offered a microlaryngeal surgery course, 100% felt the residents appreciated the course; 95% of those programs that did not have a course felt their residents would appreciate a microlaryngeal course at their institution if they were able to offer one. Among programs without a microlaryngeal teaching course, the largest perceived barriers were cost and availability of appropriate equipment. CONCLUSION: Microlaryngeal courses for otolaryngology residency training are limited in availability in the United States, and there is variability in training across the country. All respondents in our survey indicated the value in these courses for microlaryngeal surgical skill training. There is a clear role for increasing availability of low-cost microlaryngeal stations and courses.


Asunto(s)
Disección/educación , Internado y Residencia/métodos , Laringe/cirugía , Otolaringología/educación , Acreditación , Curriculum , Humanos , Microcirugia/educación , Encuestas y Cuestionarios , Estados Unidos
4.
World Neurosurg ; 131: 313-320, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31658575

RESUMEN

Learning the endless intricacies of operative neurosurgical anatomy requires that surgeons complement their intraoperative experiences with a variety of educational resources. In the past 2 decades, rapid improvements in digital graphics and computing power have enabled a new generation of 3-dimensional (3D) virtual resources that overcome limitations of more traditional 2-dimensional materials. Today, dozens of immersive 3D visualization platforms exist for applications such as learning neuroanatomy, simulating operative techniques, and planning surgical interventions with patient-specific models. The purpose of this article is to identify current applications of 3D digital modeling and virtual reality in neurosurgery. In addition, we showcase a new series of freely available 3D virtual-reality models created to assist in learning complex cranial anatomy. We anticipate these models to have a wide range of educational, clinical, and research applications. Three-dimensional visualization is poised to modernize the ways we learn and teach neurosurgical anatomy outside of the operating room. Future generations of neurosurgeons are expected to benefit from these technologies from the earliest stages of training.


Asunto(s)
Internado y Residencia/métodos , Modelos Anatómicos , Procedimientos Neuroquirúrgicos/educación , Cráneo/anatomía & histología , Realidad Virtual , Diseño de Equipo , Humanos , Imagen Tridimensional , Internet , Tornillos Pediculares , Impresión Tridimensional
6.
Plast Reconstr Surg ; 144(4): 597e-605e, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31568292

RESUMEN

BACKGROUND: Rhinoplasty is known for its complexity in planning and execution. For trainees, knowledge acquisition is often adequately attained. The mastery of skills, however, occurs by means of hands-on exposure, which continues to be a challenge. This article discusses the positive progress made in rhinoplasty training, and objectively demonstrates a need for more hands-on rhinoplasty exposure for residents. METHODS: A systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Concurrently, an online survey was developed, assessing resident comfort and training in rhinoplasty, and e-mailed to Canadian and U.S. plastic surgery training programs. RESULTS: ONE HUNDRED THIRTY-EIGHT: residents completed the survey, 62 junior (first- to third-year residents) and 76 senior residents (fourth- to sixth-year residents). Seventy-two percent of senior residents (95 percent of sixth-year residents) reported adequate rhinoplasty exposure, as opposed to 13 percent of junior residents. Seventy-five percent of senior residents most often participated as observers or first assistants, 25 percent participated as co-surgeons, and 73.9 percent did not perform a key rhinoplasty step more than five times. Residents felt the three most difficult steps of rhinoplasty were nasal osteotomy (76.1 percent), caudal septum/anterior nasal spine manipulation (65.2 percent), and nasal tip sutures (55.8 percent), and 73.9 percent felt that simulator training would substantially improve confidence. CONCLUSIONS: Despite sufficient exposure to rhinoplasties, residents were least confident in performing rhinoplasties relative to other aesthetic procedures, likely because of the high proportion of rhinoplasty exposure that is observational as opposed to hands-on acquisition of surgical maneuvers in the operating room. The survey established the maneuvers residents find the most difficult, and as programs adopt competency-based training, developing rhinoplasty simulators targeting specific identified steps may help improve competence for rhinoplasty skills.


Asunto(s)
Internado y Residencia/métodos , Modelos Educacionales , Rinoplastia/educación , Entrenamiento Simulado , Predicción , Humanos , Internado y Residencia/tendencias , Autoinforme
7.
West J Emerg Med ; 20(5): 726-730, 2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31539329

RESUMEN

INTRODUCTION: In 2017, all medical students applying for residency in emergency medicine (EM) were required to participate in the Standardized Video Interview (SVI). The SVI is a video-recorded, uni-directional interview consisting of six questions designed to assess interpersonal and communication skills and professionalism. It is unclear whether this simulated interview is an accurate representation of an applicant's competencies that are often evaluated during the in-person interview. OBJECTIVE: The goal of this study was to determine whether the SVI score correlates with a traditional in-person interview score. METHODS: Six geographically and demographically diverse EM residency programs accredited by the Accreditation Council for Graduate Medical Education participated in this prospective observational study. Common demographic data for each applicant were obtained through an Electronic Residency Application Service export function prior to the start of any scheduled traditional interviews (TI). On each TI day, one interviewer blinded to all applicant data, including SVI score, rated the applicant on a five-point scale. A convenience sample of applicants was enrolled based on random assignment to the blinded interviewer. We studied the correlation between SVI score and TI score. RESULTS: We included 321 unique applicants in the final analysis. Linear regression analysis of the SVI score against the TI score demonstrated a small positive linear correlation with an r coefficient of +0.13 (p=0.02). This correlation remained across all SVI score subgroups (p = 0.03). CONCLUSION: Our study suggests that there is a small positive linear correlation between the SVI score and performance during the TI.


Asunto(s)
Acreditación/normas , Educación de Postgrado en Medicina/métodos , Medicina de Emergencia/educación , Internado y Residencia/métodos , Entrevistas como Asunto/normas , Profesionalismo/normas , Grabación en Video/normas , Adulto , Humanos , Masculino , Estudios Prospectivos , Estudiantes de Medicina , Estados Unidos , Adulto Joven
9.
Urology ; 134: 56-61, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31491451

RESUMEN

OBJECTIVE: To determine whether implicit gender bias exists in the urology residency application process, we compared linguistic differences in letters of recommendation (LOR) submitted for male and female applicants. METHODS: LOR were abstracted from residency applications to a urology residency program. Linguistic Inquiry and Word Count, a validated text analysis software program, characterized the linguistic content of the letters. Analyzed letters were compared according to gender of the applicant using multivariable analysis, examining the association of applicant gender, letter writer, and letter characteristics. Multivariable analysis was also performed to determine the association of letter characteristics with matching into a urology residency. RESULTS: Of 460 letters evaluated, letters for male applicants are written in a more authentic tone compared to letters written for female applicants. Letters written for male applicants contain significantly more references to personal drive, work, and power than letters written for female applicants. Significant differences are maintained on multivariable analysis when controlling for race and Step 1 score of the applicant. Letters with references to power were significantly more likely to be associated with an applicant who matched into urology than an applicant who didn't match. CONCLUSION: Significant linguistic differences exist among LOR written for men and women applying into urology, suggesting that gender bias may permeate resident recruitment. These differences may affect the likelihood of women matching into urology.


Asunto(s)
Internado y Residencia , Solicitud de Empleo , Selección de Personal , Sexismo , Urología/educación , Femenino , Humanos , Internado y Residencia/ética , Internado y Residencia/métodos , Masculino , Selección de Personal/ética , Selección de Personal/métodos , Sexismo/ética , Sexismo/prevención & control , Estados Unidos
10.
Oral Maxillofac Surg Clin North Am ; 31(4): 621-626, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31416664

RESUMEN

Simulation involves the re-creation of real-life situations, processes, or structures for the purpose of improving safety, effectiveness, and efficiency of health care services: simulation provides a controlled and safe environment for training and assessment. In an age in which regulatory burdens, fiscal challenges, and renewed focus on patient safety increasingly constrain surgical residency programs, innovation in teaching is vital for the future of oral and maxillofacial surgery (OMS) training. Of the simulation technologies in modern day health care education, many have found their way into OMS training. This article reviews these technologies, and some examples of their uses in OMS.


Asunto(s)
Competencia Clínica , Tecnología Educacional/tendencias , Cirugía General/educación , Internado y Residencia , Otolaringología/educación , Entrenamiento Simulado , Educación Basada en Competencias , Evaluación Educacional , Humanos , Internado y Residencia/métodos , Internado y Residencia/tendencias , Procedimientos Quirúrgicos Reconstructivos/educación , Entrenamiento Simulado/tendencias
11.
J Bone Joint Surg Am ; 101(16): e82, 2019 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-31436666

RESUMEN

BACKGROUND: Although experiences in the operating room can help surgeons to learn simple bone-drilling techniques, outside training may be better suited for complex procedures. We adapted a rotary handpiece to evaluate the bone-drilling skills of orthopaedic resident physicians during the 2017 Southwest Orthopaedic Trauma Association (SWOTA) motor skills course. METHODS: Twenty-five postgraduate year (PGY)-1 orthopaedic residents from 7 institutions were asked to perform a bicortical drilling task 3 times both before and after attending a motor skills course. Kinetic and kinematic data were collected using force, acceleration, and visual sensors. RESULTS: Sixteen parameters were measured. The interdependence of these parameters (taken separately for precourse and postcourse performance) is presented. Evidence for motor skill acquisition across a short time scale is elucidated. Noteworthy correlations include overpenetration with force (0.65 mm), palmar-dorsal (P-D) toggle (0.65°), vibration in the P-D direction (0.53 m/s), time (-0.41 sec), and RPM (revolutions per minute; -0.36); time with both RPM (0.38) and P-D toggle (-0.40°); and force with both RPM (-0.41) and P-D toggle (0.32°). Differences in performance before and after the motor skills course include reduction in overpenetration (28.8 to 18.2 mm), reduction in skiving (22% to 6%), and reduction in preparation time (27.3 to 9.65 sec). Additionally, there were several differences in performance by institution that were significant (overpenetration, toggle in the P-D and radial-ulnar [R-U] directions, and both drilling force and drilling time). CONCLUSIONS: Understanding how performance and outcome parameters are correlated provides powerful insight into how surgical procedures can be best performed. In particular, we hope that these findings will inform new training paradigms. Variations in resident training from 1 institution to another are evidenced in surgical performance. Similarly, the methods used here to quantify changes in performance across the 3-day SWOTA training course allow a unique vehicle for optimization of these types of training opportunities outside of the operating room.


Asunto(s)
Competencia Clínica , Educación de Postgrado en Medicina/métodos , Internado y Residencia/métodos , Destreza Motora/fisiología , Procedimientos Ortopédicos/educación , Procedimientos Ortopédicos/instrumentación , Adulto , Animales , Huesos/cirugía , Evaluación Educacional , Humanos , Modelos Anatómicos , Ortopedia/educación
14.
Plast Reconstr Surg ; 144(3): 496e-507e, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31461050

RESUMEN

BACKGROUND: Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. METHODS: A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. RESULTS: Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. CONCLUSIONS: A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.


Asunto(s)
Educación Basada en Competencias/métodos , Microcirugia/educación , Procedimientos Quirúrgicos Reconstructivos/educación , Entrenamiento Simulado/métodos , Cirugía Plástica/educación , Competencia Clínica , Curriculum , Humanos , Internado y Residencia/métodos , Modelos Anatómicos , Prótesis e Implantes , Cirujanos/educación , Realidad Virtual
16.
Pediatrics ; 144(2)2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31363070

RESUMEN

Physician-scientists represent a critical component of the biomedical and health research workforce. However, the proportion of physicians who spend a significant amount of effort on scientific research has declined over the past 40 years. This trend has been particularly noticeable in pediatrics despite recent scientific work revealing that early life influences, exposures, and health status play a significant role in lifelong health and disease. To address this problem, the Duke University Department of Pediatrics developed the Duke Pediatric Research Scholars Program for Physician-Scientist Development (DPRS). The DPRS is focused on research training during pediatric residency and fellowship. We aim to provide sufficient research exposure and support to help scholars develop a research niche and scholarly products as well as identify the career pathways that will enable them to achieve their research goals. Herein, we describe the DPRS's organizational structure, core components, recruitment strategies, and initial results, and we discuss implementation challenges and solutions. Additionally, we detail the program's integration with the department's residency and fellowship training programs (with particular reference to the challenges of integrating research into small- to medium-sized residency programs) and describe the development and integration of related initiatives across Duke University School of Medicine. The program served as the basis for 2 successful National Institutes of Health Stimulating Access to Research in Residency (R38) applications, and we hope it will serve as a model to integrate formalized research training for residents and fellows who wish to pursue research careers in academic medicine.


Asunto(s)
Investigación Biomédica/educación , Investigación Biomédica/métodos , Personal de Laboratorio Clínico/educación , Pediatras/educación , Desarrollo de Programa/métodos , Investigación Biomédica/tendencias , Selección de Profesión , Competencia Clínica , Humanos , Internado y Residencia/métodos , Internado y Residencia/tendencias , Personal de Laboratorio Clínico/tendencias , Tutoría/métodos , Tutoría/tendencias , Pediatras/tendencias
18.
Surgery ; 166(4): 460-468, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31307774

RESUMEN

BACKGROUND: The operative experience of today's surgery residents is different than years past. Although overall volume remains stable, the composition is changing. As such, trends in open versus laparoscopic surgery for general surgery residents were examined. METHODS: The Accreditation Council for Graduate Medical Education national operative log reports from 1994 to 2018 were analyzed for the 15 operations recorded as both open and laparoscopic. Operative volume was examined for total major, surgeon chief, and surgeon junior cases. RESULTS: From 1994 to 2018, 26,258 residents graduated with 955.2 ± 31.7 total major cases. The 15 identified operations comprised 38.4% of this volume. During the 25-year study period, laparoscopic volume increased (+9.67 cases per year), whereas open volume decreased (-3.25 cases per year, P < .0001 for each). Similar trends were seen for both chief and surgeon junior cases (P < .05 for both). For 2 of the 4 core general surgery operations examined (hernia and proctocolectomy), the open approach was still the dominant approach, providing residents an opportunity to perform open surgery in an era of increasing minimally invasive approaches. CONCLUSION: For select procedures, the frequency of laparoscopy has surpassed open surgery for general surgery residents. These trends raise the concern that when necessary, general surgery graduates may not have adequate experience converting to open.


Asunto(s)
Competencia Clínica , Educación de Postgrado en Medicina/métodos , Cirugía General/educación , Laparoscopía/educación , Laparotomía/educación , Procedimientos Quirúrgicos Operativos/educación , Adulto , Bases de Datos Factuales , Femenino , Humanos , Internado y Residencia/métodos , Laparoscopía/métodos , Laparotomía/métodos , Masculino , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/métodos , Estados Unidos
19.
Matern Child Health J ; 23(9): 1159-1166, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31267340

RESUMEN

Background Learning to identify and address social determinants of health (SDH) is a crucial component of pediatric residency training. A virtual tour of an impoverished neighborhood previously demonstrated efficacy in increasing residents' self-assessed knowledge and competence, but its impact on performance has not yet been reported. Online simulated cases are emerging as feasible assessment tools to measure trainees' skills across various healthcare settings. We developed online simulated cases to evaluate residents' retention of the virtual tour's key SDH-related learning objectives 1 month after completing this curriculum. Methods Three online simulated cases with interpolated open-ended questions were created to assess residents' ability to identify SDH, recommend appropriate resources, and display empathy. Scoring rubrics to objectively evaluate responses were developed and borderline scores were decided by a team of educators. Results 19 residents participated. Mean scores for all cases exceeded pre-established borderline scores (statistically significant in two of the three cases). More than 90% of residents identified relevant SDH in the primary care and emergency department cases. Ninety-five percent of residents recommended appropriate resources in all cases, and 89% displayed empathy. Discussion Residents' performance in online simulated cases demonstrated retention and application of the virtual tour's learning objectives, including recognizing SDH, offering appropriate resources, and displaying empathy, which supports the long-term effectiveness of the virtual tour curriculum to train pediatricians about SDH. Online simulated cases provided a standardized and cost-effective way to measure residents' skills related to curricular uptake, suggesting that this assessment approach may be adapted to evaluate other educational interventions.


Asunto(s)
Curriculum/normas , Simulación de Paciente , Pediatría/educación , Determinantes Sociales de la Salud , Adulto , Curriculum/estadística & datos numéricos , Educación de Postgrado en Medicina/métodos , Femenino , Humanos , Internado y Residencia/métodos , Internado y Residencia/normas , Internado y Residencia/estadística & datos numéricos , Aprendizaje , Masculino , Pediatría/métodos , Pediatría/normas , Características de la Residencia/estadística & datos numéricos
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