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1.
Surg Endosc ; 34(1): 192-201, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30888498

RESUMO

BACKGROUND: Transanal total mesorectal excision (TaTME) is a new complex technique with potential to improve the quality of surgical mesorectal excision for patients with mid and low rectal cancer. The procedure is technically challenging and has shown to be associated with a relative long learning curve which might hamper widespread adoption. Therefore, a national structured training pathway for TaTME has been set up in the Netherlands to allow safe implementation. The aim of this study was to monitor safety and efficacy of the training program with 12 centers. METHODS: Short-term outcomes of the first ten TaTME procedures were evaluated in 12 participating centers in the Netherlands within the national structured training pathway. Consecutive patients operated during and after the proctoring program for rectal carcinoma with curative intent were included. Primary outcome was the incidence of intraoperative complications, secondary outcomes included postoperative complications and pathological outcomes. RESULTS: In October 2018, 12 hospitals completed the training program and from each center the first 10 patients were included for evaluation. Intraoperative complications occurred in 4.9% of the cases. The clinicopathological outcome reported 100% for complete or nearly complete specimen, 100% negative distal resection margin, and the circumferential resection margin was positive in 5.0% of patients. Overall postoperative complication rate was 45.0%, with 19.2% Clavien-Dindo ≥ III and an anastomotic leak rate of 17.3%. CONCLUSIONS: This study shows that the nationwide structured training program for TaTME delivers safe implementation of TaTME in terms of intraoperative and pathology outcomes within the first ten consecutive cases in each center. However, postoperative morbidity is substantial even within a structured training pathway and surgeons should be aware of the learning curve of this new technique.


Assuntos
Cirurgia Colorretal/educação , Educação de Pós-Graduação em Medicina/métodos , Protectomia/educação , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/educação , Adulto , Idoso , Competência Clínica , Procedimentos Clínicos , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Curva de Aprendizado , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Países Baixos , Complicações Pós-Operatórias/epidemiologia , Protectomia/métodos , Cirurgia Endoscópica Transanal/métodos , Resultado do Tratamento
2.
Dis Colon Rectum ; 62(12): 1528-1532, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31725583

RESUMO

BACKGROUND: Performing colonoscopies is an integral component of colorectal surgery residency training. There exists a paucity of literature regarding colonoscopy quality metrics with colorectal trainee involvement. OBJECTIVE: This study aimed to investigate the effect of colorectal surgery resident participation on quality metrics in screening colonoscopy. DESIGN: Screening colonoscopies performed between August 1, 2016, and July 31, 2018, were queried from a prospectively maintained institutional database. Data were cross-checked with resident case logs to verify colonoscopies with resident participation. SETTING: This study was conducted by the colorectal surgery department at a tertiary level hospital in the United States. PATIENTS: Consecutive, asymptomatic patients aged ≥45 years, undergoing screening colonoscopy, were selected. MAIN OUTCOME MEASURES: The quality parameters measured included overall, male, and female adenoma detection rates; total examination time; withdrawal time; cecal intubation rate; quality of bowel preparation; complications; and medication dosage. RESULTS: A total of 4594 patients were included in the study with a mean age of 60.5 ± 8.4 years (range, 45-91); 51.7% were women. Overall, 4186 of the colonoscopies were performed without resident participation, and 408 were performed with resident participation. Scope insertion, withdrawal, and total examination times were longer in the resident group. Cecal intubation rate, polypectomy rate, sex-specific and overall adenoma detection rates, and complication rates were similar between the groups. In the multivariate model, trainee involvement had no significant impact on adenoma detection rate. In addition, the trainee group utilized a higher mean dose of fentanyl. LIMITATIONS: The retrospective nature of the data with possible coding errors of the database and the inability to quantify the amount of resident participation and to clarify the degree of attending surgeon assistance and oversight were limitations of the study. CONCLUSIONS: Colorectal surgery resident participation in screening colonoscopy takes longer and appears safe, while achieving all national quality metrics without compromising adenoma detection rates. Changes in colonoscopy scheduling in regard to length of time may prove beneficial when there is resident participation. See Video Abstract at http://links.lww.com/DCR/B43. PARTICIPACIÓN DE LOS RESIDENTES DE CIRUGÍA COLORRECTAL EN COLONOSCOPIAS DE CRIBADO: ¿CÓMO AFECTA LA CALIDAD?: La realización de colonoscopias es un componente integral del entrenamiento de residencia en cirugía colorrectal. Existe una escasez de literatura con respecto a las medidas de calidad de la colonoscopia con la participación de los aprendices colorrectales.Investigar el efecto de la participación de residentes de cirugía colorrectal en las medidas de calidad en la colonoscopia de cribado.Las colonoscopias de cribado realizadas entre el 1 de agosto de 2016 y el 31 de julio de 2018 se consultaron desde una base de datos institucional mantenida prospectivamente. Los datos se cotejaron con registros de casos de residentes para verificar las colonoscopias con participación de residentes.Departamento de cirugía colorrectal en un hospital de tercer nivel de los Estados Unidos.Pacientes consecutivos, asintomáticos, edad ≥45 años, sometidos a colonoscopia de detección.Parámetros de calidad que incluyen tasas generales de detección de adenoma en hombres y mujeres, tiempo total de examen, tiempo de retiro, tasa de intubación cecal, calidad de la preparación intestinal, complicaciones y dosis de medicamentos.Se incluyeron un total de 4.594 pacientes en el estudio con una edad media de 60,5 ± 8,4 años (rango, 45-91) y 51,7% mujeres. En total 4,186 de las colonoscopias se realizaron sin participación de los residentes y 408 se realizaron con la participación de los residentes. Los tiempos de inserción, retiro y examen total del alcance fueron más largos en el grupo residentes. La tasa de intubación cecal, la tasa de polipectomía, las tasas de detección de adenoma específicos de género y generales, y las tasas de complicaciones fueron similares entre los grupos. En el modelo multivariado, la participación de los aprendices no tuvo un impacto significativo en la tasa de detección de adenoma. Además, el grupo de aprendices utilizó una dosis media más alta de fentanilo.Carácter retrospectivo de los datos con posibles errores de codificación de la base de datos. Incapacidad para cuantificar la cantidad de participación de los residentes y para aclarar el grado de asistencia y supervisión del cirujano.La participación de los residentes de cirugía colorrectal en la colonoscopia de cribado lleva más tiempo y parece segura, mientras se logran todas las medidas de calidad nacionales sin comprometer las tasas de detección de adenoma. Los cambios en la programación de la colonoscopia con respecto al período de tiempo pueden ser beneficiosos cuando hay participación de residentes. Vea el resumen del video en http://links.lww.com/DCR/B43.


Assuntos
Doenças do Colo/diagnóstico , Colonoscopia/métodos , Colonoscopia/normas , Cirurgia Colorretal/educação , Fentanila/administração & dosagem , Idoso , Competência Clínica , Feminino , Humanos , Internato e Residência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária , Fatores de Tempo , Estados Unidos
7.
J Surg Educ ; 76(6): e182-e188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31377204

RESUMO

OBJECTIVE: We investigated the association of perceived trainee autonomy with patient clinical outcomes following colorectal surgery. DESIGN: This was a prospective multi-institutional study that consisted of surgery trainees completing a survey tool immediately after participating in colorectal resections to rate their self-perceived autonomy and case characteristics. Self-perception of autonomy was classified as observer, assistant, surgeon, or teacher. The completed trainee surveys were linked with patient information available through each hospital's internal NSQIP directory. The primary outcome was death and serious morbidity (DSM) and secondary outcome was 30-day readmissions. Separate mixed effects regression models were used to examine the association between perceived trainee autonomy and DSM or 30-day readmissions. Fixed effects were used to control for the effects of the training environment. The models were constructed to adjust for patient and trainee characteristics associated with each outcome independently. SETTING: This study was conducted at 7 general surgery training programs (5 academic medical centers and 2 independent training programs) with general surgery or colorectal surgery services. PARTICIPANTS: This study included a total of 63 residents and fellows rotating on surgery services that performed colorectal resections at the included 7 general surgery training programs from January until March 2016. RESULTS: The 63 trainees that participated in this study completed 417 surveys with over a 95% response rate. National Surgical Quality Improvement Program (NSQIP) patient records were available for 67% (n = 273) of completed surveys. The clinical year of the trainees were 6.1% PGY 1/2, 36% Post graduate year (PGY) 3, 40.9% PGY 4/5, and 17% fellows. Residents perceived their participation in the case to be that of an observer in 9.2% of surveys, an assistant in 51.6% of surveys, and the surgeon/teacher in 39.3% of surveys. About 50% of patients were male, 80% were White, the majority had an American Society of Anesthesiologists classification of 3, almost half had prior abdominal surgery, and over 80% of surgeries were elective. The primary operation types performed were laparoscopic (40.3%) and open (35.9%) partial colectomies. The rate of DSM in patients was approximately 24% when trainees perceived their role as observers, 23% when trainees perceived their role as assistants, and 18% when trainees perceived their role as surgeons/teachers. After adjustment for patient, trainee, and training environment, we found that the perceived level of trainee autonomy of a surgeon/teacher was associated with a 4-fold lower rate of DSM (odds ratio: 0.23, confidence of interval: 0.05-0.97, p = 0.045) compared to observers. The rate of readmissions was approximately 20% when trainees perceived their role as observers, 14% when trainees perceived their role as assistants and 9% when trainees perceived their role as surgeons/teachers. After adjustment for patient, trainee, and training environment, we found that the perceived level of trainee autonomy of a surgeon/teacher was significantly associated with a 10-fold lower rate of 30-day readmissions (odds ratio: 0.09, confidence of interval: 0.01-0.70, p = 0.022) compared to observers. CONCLUSIONS: There was an association between increased perceived trainee autonomy and improved patient outcomes, suggesting that when trainees identify with an increased role in the operation, patients may have improved care. Further research is needed to understand this association further.


Assuntos
Cirurgia Colorretal/educação , Educação de Pós-Graduação em Medicina , Cirurgia Geral/educação , Avaliação de Resultados em Cuidados de Saúde , Autonomia Profissional , Adulto , Competência Clínica , Feminino , Humanos , Internato e Residência , Masculino , Readmissão do Paciente/estatística & dados numéricos , Pennsylvania , Estudos Prospectivos , Melhoria de Qualidade , Inquéritos e Questionários
11.
Surg Technol Int ; 34: 199-207, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31034575

RESUMO

BACKGROUND: The educational environment is a crucial metric of medical education that affects the course participants' motivation, achievement, happiness and success. The aim of this study was to evaluate the educational environment of a cadaver course in robotic colorectal surgery by comparing the perceptions of the participating residents to those of the participating surgeons. METHODS: This was a cross-sectional study carried out in 2017. Participants from the U.S. and Europe attended a course using eight fresh frozen cadaver torsos with no prior abdominal surgery. After course completion, participants anonymously completed 50-item Dundee Ready Educational Environment Measure (DREEM) questionnaires to evaluate five components of the educational environment: perception of learning, perception of teachers, academic self-perception, perception of atmosphere, and social self-perception. Internal consistency of the questionnaire was assessed using Cronbach's alpha coefficient. Mean scores were compared using an independent samples t-test. RESULTS: Twenty of 24 participants completed the DREEM questionnaire, consisting of 9 residents and 11 surgeons (12 from the U.S., 8 from Europe). The internal consistency of the questionnaire was excellent (alpha=0.97). The mean total score was excellent for both residents and surgeons, and the difference between the groups was not significant (154.1±25.8 vs. 168.1±18.9, p=0.197). Perception of learning was significantly better among surgeons ("teaching highly thought of") than among residents ("a more positive perception") (40.5±3.6 vs. 35.7±5.6, p=0.04). CONCLUSIONS: This study suggests that the residents' perception of learning may have been negatively influenced by the participation of surgeons in the same cadaver station.


Assuntos
Cirurgia Colorretal/educação , Avaliação de Programas e Projetos de Saúde , Procedimentos Cirúrgicos Robóticos/educação , Atitude do Pessoal de Saúde , Cadáver , Estudos Transversais , Avaliação Educacional , Humanos , Internato e Residência , Cirurgiões/educação , Inquéritos e Questionários
12.
Colorectal Dis ; 21(8): 903-908, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30963654

RESUMO

AIM: Robotic techniques are being increasingly used in colorectal surgery. There is, however, a lack of training opportunities and structured training programmes. Robotic surgery has specific problems and challenges for trainers and trainees. Ergonomics, specific skills and user-machine interfaces are different from those in traditional laparoscopic surgery. The aim of this study was to establish expert consensus on the requirements for a robotic train-the-trainer curriculum amongst robotic surgeons and trainers. METHOD: This is a modified Delphi-type study involving 14 experts in robotic surgery teaching. A reiterating 19-item questionnaire was sent out to the same group and agreement levels analysed. A consensus of 0.8 or higher was considered to be high-level agreement. RESULTS: Response rates were 93-100% and most items reached high levels of agreement within three rounds. Specific requirements for a robotic faculty development curriculum included maximizing dual-console teaching, theatre team training, nontechnical skills training, patient safety, user-machine interface training and telementoring. CONCLUSION: A clear need for the development of a train-the-trainer curriculum has been identified. Further research is needed to assess feasibility, effectiveness and clinical impact of a robotic train-the-trainer curriculum.


Assuntos
Cirurgia Colorretal/educação , Currículo/normas , Procedimentos Cirúrgicos Robóticos/educação , Capacitação de Professores/normas , Adulto , Consenso , Técnica Delfos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Chirurg ; 90(4): 257-263, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30796461

RESUMO

The incorporation of coloproctology as a part of the surgical training and further education of assistant and specialist physicians shows great differences between Germany, Austria and Switzerland. In this article the international and national possibilities before and after specialist medical training are described in detail. In Austria, an optional coloproctology module can already be chosen in the third year of surgical training. Coloproctology is a compulsory component during the complete surgical training in Germany but a lower number of operations are required. In the basic module in Switzerland coloproctology is compulsory but contained in the operation catalogue to a lesser extent, although it has to be explicitly chosen in the further specialist training. The mandatory training in coloproctology in Germany enables all surgical assistants to undergo training, even if it is less intensive. As a result of partially compulsory and partially optional modules in Switzerland, a lower proportion of trainees receive specific training but it is more detailed. The number of trainees who are trained in coloproctology is even smaller in Austria due to the coloproctological training being optional. In the German-speaking regions a variety of specialized courses and further education are available for assistants and surgeons to further deepen their knowledge, no matter which form of training they had. At the international level the European Board of Surgical Qualification (EBSQ) for coloproctology has been available since 1998 and for many European specialists is the only possibility for formal specialization. The quality of a coloproctology training and further education curriculum may vary with national and international factors; however, it is a parameter for high standards in coloproctology in routine daily work, for the numbers of young coloproctology surgeons and is associated with a sufficient research performance in this discipline.


Assuntos
Cirurgia Colorretal , Currículo , Cirurgia Geral , Áustria , Cirurgia Colorretal/educação , Cirurgia Geral/educação , Alemanha , Cirurgiões , Suíça
17.
J Surg Res ; 238: 137-143, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30771683

RESUMO

BACKGROUND: Little information exists to help colon and rectal surgery residency programs determine which factors applicants find important when selecting a training program. Our aim was to identify factors applicants find pertinent in the selection of their desired colon and rectal surgery residency program. METHODS: After the 2016 and 2017 National Resident Matching Program (The Match), a 58-question anonymous web-based survey was sent to all trainees who applied to our colon and rectal surgery residency program to determine factors applicants find important in selecting colon and rectal surgery residency training programs. RESULTS: Of 196 invitation emails sent, a total of five were returned with unidentifiable addresses leaving 191 surveys for possible completion. The survey response rate was 62.8% (n = 120). The top 10 areas identified as strongly to moderately influential in residency program selection included faculty experience, balanced training, operative volume, operative complexity, autonomy, faculty reputation, employment opportunities, Accreditation Council for Graduate Medical Education index case volumes, office/clinic complexity, and current resident/fellow input. CONCLUSIONS: Multiple elements were identified as strongly to moderately influential when selecting a training program. Training programs can use these named factors for resident recruitment, development, and self-assessment.


Assuntos
Escolha da Profissão , Cirurgia Colorretal/educação , Internato e Residência/estatística & dados numéricos , Cirurgiões/psicologia , Atitude do Pessoal de Saúde , Docentes/psicologia , Humanos , Autonomia Profissional , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
18.
ANZ J Surg ; 89(3): 180-183, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30776846

RESUMO

BACKGROUND: Video recordings of open surgical procedures could provide a method for enhancing surgical education, analysing operative performance and presenting cases to a wider audience of surgeons. The aim of this pilot study was to systematically search the World Wide Web to determine the availability of open surgery videos and to evaluate their potential training value in terms of the educational content presented. METHODS: A broad search for open right hemicolectomy videos was performed on the three most used English language internet search engines (Google.com, Bing.com and Yahoo.com). All videos of open right hemicolectomy with an English language title were included. Laparoscopic surgery, single-incision laparoscopic surgery and robotic- and hand-assisted surgery videos were excluded, as were videos from fee charging websites. RESULTS: A total of 31 relevant websites were identified and 21 open surgery videos were finally included. The characteristics of the patients were presented only in four (19%) videos. A video commentary was present in 12 cases (57.1%) and this was in English language in 11. The median number of views per month was 84.1. CONCLUSIONS: Open surgery videos have a significantly higher number of views per month compared to laparoscopic surgery videos, but current methodologies used to record and render the surgeon's point of view in open operative surgery remain limited.


Assuntos
Colectomia/educação , Cirurgia Colorretal/educação , Internet , Gravação em Vídeo , Humanos , Projetos Piloto
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