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1.
J Pak Med Assoc ; 71(9): 2198-2202, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34580514

RESUMO

OBJECTIVE: To evaluate whether or not prior laparoscopic training improves performance during robotic surgery utilising DaVinci robotic skills simulator. METHODS: The cross-sectional study was conducted at the Civil Hospital, Karachi, from May 4 to November 11, 2018, and comprised first year residents in Group A with no laparoscopic skills and fourth year residents doing laparoscopic cholecystectomy independently and surgical faculty members in Group B who had laparoscopic skills. Both the groups had no previous exposure to robotic surgery and skills simulator. There were 4 exercises which were repeated three times by each participant. Scoring was done using the DaVinci robotic skills simulator software. Data was analysed using SPSS 22. RESULTS: Of the 30 surgeons, there were 15(50%) in Group A with a mean age of 26±0.56 years, and 15(50%) in Group B with a mean age of 32 ± 9.16 Years (p<0.001). The overall mean age was 32±9.16 years (range: 25-52 years). There were 19(63.3) females in the sample compared to 11(36.6%) males. Mean scores of Ring walk 2, Peg board 2, and Suture sponge 3 were better in Group A, while mean score of Matchboard 2 was better in Group although B (p>0.05). Group B fared better in the individual scoring of Suture sponge 2 (p>0.05). CONCLUSIONS: Laparoscopic skills apparently did not confer any benefit while performing exercises on the DaVinci skills simulator.


Assuntos
Cirurgia Geral , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Treinamento por Simulação , Adulto , Competência Clínica , Estudos Transversais , Feminino , Cirurgia Geral/educação , Humanos , Masculino , Adulto Jovem
4.
Epidemiol Infect ; 149: e210, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34526170

RESUMO

Little is known about the impact of COVID-19 on the outcomes of patients undergoing surgery and intervention. This study was conducted between 20 March and 20 May 2020 in six hospitals in Istanbul, and aimed to investigate the effects of surgery and intervention on COVID-19 disease progression, intensive care (ICU) need, mortality and virus transmission to patients and healthcare workers. Patients were examined in three groups: group I underwent emergency surgery, group II had an emergency non-operating room intervention, and group III received inpatient COVID-19 treatment but did not have surgery or undergo intervention. Mortality rates, mechanical ventilation needs and rates of admission to the ICU were compared between the three groups. During this period, patient and healthcare worker transmissions were recorded. In total, 1273 surgical, 476 non-operating room intervention patients and 1884 COVID-19 inpatients were examined. The rate of ICU requirement among patients who had surgery was nearly twice that for inpatients and intervention patients, but there was no difference in mortality between the groups. The overall mortality rates were 2.3% in surgical patients, 3.3% in intervention patients and 3% in inpatients. COVID-19 polymerase chain reaction positivity among hospital workers was 2.4%. Only 3.3% of infected frontline healthcare workers were anaesthesiologists. No deaths occurred among infected healthcare workers. We conclude that emergency surgery and non-operating room interventions during the pandemic period do not increase postoperative mortality and can be performed with low transmission rates.


Assuntos
COVID-19/epidemiologia , COVID-19/transmissão , Cirurgia Geral/estatística & dados numéricos , Adulto , COVID-19/diagnóstico , Cuidados Críticos/estatística & dados numéricos , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Feminino , Pessoal de Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Turquia/epidemiologia
7.
Medicine (Baltimore) ; 100(34): e27041, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449488

RESUMO

ABSTRACT: To quantify the impact of coronavirus disease 19 (COVID-19) on the surgical volume of residents' medical practice in Costa Rica's General Surgery Residency Program.The COVID-19 pandemic has caused a significant disruption in people's lives. Health systems worldwide have been forced to adapt to the new normal, which has posed a challenge for medical residency programs, especially in the surgical field.This transversal study includes the surgical records of all residents of the General Surgery program who worked as main surgeons at the Mexico Hospital of the Costa Rican Social Security between December 23, 2019, and June 25, 2020.As main surgeons, a total of 10 residents performed 291 pre-pandemic surgeries and 241 pandemic surgeries.When comparing the distribution of procedures performed by residency levels, it is observed that the postgraduate year -2 increased the number of procedures performed during the pandemic period (pre-pandemic 19% vs pandemic 27%, P = .028). There was no statistically significant difference between the pre-pandemic and pandemic periods in the remaining levels.When comparing the procedures by unit, a statistically significant decrease was observed in the Endocrine-Abdominal Wall Unit (pre-pandemic 18.3% vs pandemic 5.4%, P < .001). Conversely, a statistically significant increase was identified in Surgical Emergencies Unit procedures (40.0% vs post 51.7%, P = .007). No statistically significant differences were observed in the remaining the Units.The COVID-19 pandemic had no statistically significant effect on surgeries performed by residents of the General Surgery Residency Program as main surgeons in a national training center in Costa Rica. The Department's timely measures and pro-resident attitude were the key reasons for the above results.


Assuntos
COVID-19/epidemiologia , Cirurgia Geral/educação , Internato e Residência/organização & administração , Costa Rica , Estudos Transversais , Humanos , Pandemias , SARS-CoV-2
8.
Medicine (Baltimore) ; 100(32): e26939, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397945

RESUMO

ABSTRACT: Traditionally, surgical residency training is more focused on obtaining surgical skills through a well-established coaching system worldwide. However, constant advances in medical science require surgeons to learn not only surgical skills but also the ability of scientific research to improve clinical practice and future professional development. The study aims to emphasize that professional education in terms of scientific research is also significant for surgical residency training.All residents who had been recruited in a medical center for the surgery residency program between years 2006 and 2015 were evaluated in the study. Generally, every resident is assigned to a mentor since the first year of residency. Then, the mentor would help the resident qualify a 2-step evaluation in terms of scientific research during the residency training program.A total of 193 residents were evaluated in the study. All of them had completed the first step regarding oral presentation of their designated research, and the majority of residents obtained 80 to 90 points that were rated by referees. Overall, 102 residents (52.8%) had completed the second step with the publication of a research manuscript. The percentage of residents who had fulfilled the criteria of this 2-step assessment ranged from 35.3% to 81.8% by year.The continuing education for surgical residents should not be limited in coaching clinical practice. Scientific research is also essential for current surgical residency training, and a formal mentorship program may be beneficial for the future professional development of surgical residents. However, the success of the 2-step evaluation could possibly depend on the career choices of the residents instead of the mentorship program.


Assuntos
Atitude do Pessoal de Saúde , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Tutoria/métodos , Mentores , Cirurgiões/educação , Humanos , Inquéritos e Questionários , Taiwan
9.
Rev. cuba. anestesiol. reanim ; 20(2): e698, 2021. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1289350

RESUMO

Introducción: La videolaparascopía es un procedimiento frecuente en los servicios de urgencias de cirugía general. El dolor agudo después de estas intervenciones es de naturaleza compleja y requiere un tratamiento analgésico efectivo. Objetivo: Determinar la utilidad del empleo de bupivacaína intraperitoneal en el alivio del dolor posoperatorio en la videolaparascopía de urgencia. Métodos: Se realizó un estudio longitudinal prospectivo y analítico en 80 pacientes mayores de 18 años, anunciados para videolaparoscopía bajo anestesia general orotraqueal en el servicio de urgencias del HMC: Dr. Luis Díaz Soto, desde septiembre de 2016 hasta septiembre de 2018. Los pacientes fueron divididos aleatoriamente en dos grupos de 40 cada uno. Al grupo 1 se aplicó lidocaína transdérmica preincisional en las incisiones de piel y, al término de la cirugía, se irrigaron ambos hemidiafragmas con bupivacaína al 0,25 por ciento. Al grupo 2 se le administró dosis preincisional de analgésicos endovenosos solamente. Resultados: Predominó significativamente el sexo femenino sin diferencia entre grupos. La analgesia posoperatoria fue mejor en el grupo 1 estadísticamente significativa a las 4, 8 y 12 horas. Los requerimientos de analgesia de rescate fueron menores en el grupo 1 (p=0,0024). No se reportaron efectos adversos. Conclusiones: La administración de lidocaína transdérmica preincisional y la instilación de bupivacaína intraperitoneal al final de la videolaparoscopía de urgencia, reduce significativamente el dolor en las primeras horas de posoperatorio. Su aplicación es sencilla, fácil y segura sin evidencias de efectos adversos(AU)


Introduction: Videolaparoscopy is a frequent general surgery procedure in emergency services. Acute pain after these interventions is complex in nature and requires effective analgesic treatment. Objective: To determine the usefulness of intraperitoneal bupivacaine in the relief of postoperative pain in emergency videolaparoscopy. Methods: A prospective, analytical and longitudinal study was carried out in eighty patients older than eighteen years old, announced for videolaparoscopy under orotracheal general anesthesia in the emergency department of Hospital Militar Central Dr. Luis Díaz Soto, from September 2016 to September 2018. The patients were randomly divided into two groups of forty individuals each. Group 1 was applied pre-incisional transdermal lidocaine on skin incisions and, at the end of surgery, both hemidiaphragms were irrigated with bupivacaine 0.25 percent. Group 2 received pre-incisional doses of intravenous analgesics only. Results: The female sex predominated significantly, without difference between the two groups. Postoperative analgesia was better in group 1, insofar it was statistically significant at four, eight and twelve hours. Rescue analgesia requirements were lower in group 1 (p=0.0024). No adverse effects were reported. Conclusions: The administration of pre-incisional transdermal lidocaine and the instillation of intraperitoneal bupivacaine at the end of emergency videolaparoscopy significantly reduces pain during the first hours after surgery. Its application is simple, easy and safe, without evidence of adverse effects(AU)


Assuntos
Humanos , Dor Pós-Operatória/tratamento farmacológico , Cirurgia Geral , Bupivacaína/uso terapêutico , Estudos Longitudinais , Serviço Hospitalar de Emergência , Analgesia/métodos
10.
Pediatr Surg Int ; 37(10): 1415-1420, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34272598

RESUMO

PURPOSE: To analyze the initial impact of the SARS-CoV-2 pandemic on surgical skills training and performance of Pediatric Surgery Residents. METHODS: Retrospective study considering the modifications on the Pediatric Surgery Residency training from March 1st-May 31st, 2020. Exposure to OR learning opportunities was compared to the same 2018-2019 trimesters. An anonymous survey about self-perception on surgical skills development was also performed. RESULTS: Residents performed 209 procedures as leading surgeons during the 2020 trimester with a mean number of surgeries per resident of 20.9, representing a reduction of 46% and 56.8% compared to the 2018-2019 averages, respectively. Reduction in both the number and the percentage of total procedures (n: 209, 56.8%) compared to both 2019 (n: 354, 68.7%, p: 0.000272) and 2018 (n: 420, 76.1%, p < 0,00,001) showed statistical correlation with no changes in their complexity pattern. From the survey (response rate: 100%), hours dedicated to simulation-based training were highly increased. More time was spent studying, but only 60% achieved better preparation for surgery and 70% perceived a decrease in surgical confidence. CONCLUSIONS: Even though the pandemic promoted new teaching strategies and the use of simulation-based training, it drastically reduced "on-the-job" learning opportunities with potential effects on residents' performance and self-confidence during surgery.


Assuntos
COVID-19/prevenção & controle , Cirurgia Geral/educação , Internato e Residência/organização & administração , Pandemias , COVID-19/epidemiologia , COVID-19/psicologia , Criança , Competência Clínica , Humanos , Pandemias/prevenção & controle , Estudos Retrospectivos , SARS-CoV-2 , Inquéritos e Questionários
12.
J Vasc Surg ; 74(2S): 33S-46S, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34303458

RESUMO

The ever-increasing diversity of the U.S. population has resulted in a challenge to a vascular surgery workforce that does not represent the national demographics. Educational institutions, medical organizations, and medical agencies, through initiatives and programs, have attempted to increase the number of underrepresented minorities, with, however, only modest changes during the past 30 years. Several obstacles have been identified, some of which include racism, issues of finances, lack of mentors and scholarly activities, and inequity in promotion. In the present study, we have reviewed the reported data addressing these concerns and provided guidance toward the amelioration of these issues with the hope of constructive change toward encouraging a diverse vascular surgery workforce.


Assuntos
Educação de Pós-Graduação em Medicina , Cirurgia Geral/educação , Internato e Residência , Seleção de Pessoal , Racismo , Critérios de Admissão Escolar , Estudantes de Medicina , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Diversidade Cultural , Humanos , Mentores , Grupos Minoritários , Fatores Raciais , Estados Unidos
13.
J Surg Oncol ; 124(5): 711-721, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34212384

RESUMO

Contemporary models of surgical education that are founded on sound educational theories and constructs need to be used across the continuum of professional development of surgeons starting with the first day of medical school, through surgery residency and fellowship training, to the last day of surgical practice. The highly learner-centered and individually-focused special interventions of preceptoring, proctoring, mentoring, and coaching should be linked to innovative competency-based education models to address the educational needs of learners at all levels, and especially of surgeons in practice to continually improve their knowledge, skills, and performance, with the aspirational goal of achieving expertise and mastery. Each of these interventions is distinct with its own unique characteristics, applications, and anticipated impact, which must be clearly recognized for the interventions to be used most effectively. Broad acceptance and adoption of the aforementioned special interventions require recognition of the value each brings to the learner and the educational program. Professional organizations should play a key role in designing innovative educational programs that include these interventions, supporting their integration into surgical education and surgical practice, and influencing changes in the cultures in surgery to facilitate broad adoption of these interventions.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina , Cirurgia Geral/educação , Internato e Residência , Tutoria/métodos , Cirurgiões/educação , Humanos , Aprendizagem , Estudos Longitudinais
14.
Am J Surg ; 222(4): 679-684, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34226039

RESUMO

BACKGROUND: High-quality workplace-based assessments are essential for competency-based surgical education. We explored education leaders' perceptions regarding faculty competence in assessment. METHODS: Surgical education leaders were surveyed regarding which areas faculty needed improvement, and knowledge of assessment tools. Respondents were queried on specific skills regarding (a)importance in resident/medical student education (b)competence of faculty in assessment and feedback. RESULTS: Surveys (n = 636) were emailed, 103 responded most faculty needed improvement in: verbal (86%) and written (83%) feedback, assessing operative skill (49%) and preparation for procedures (50%). Cholecystectomy, trauma laparotomy, inguinal herniorrhaphy were "very-extremely important" in resident education (99%), but 21-24% thought faculty "moderately to not-at-all" competent in assessment. This gap was larger for non-technical skills. Regarding assessment tools, 56% used OSATS, 49% Zwisch; most were unfamiliar with all non-technical tools. SUMMARY: These data demonstrate a significant perceived gap in competence of faculty in assessment and feedback, and unfamiliarity with assessment tools. This can inform faculty development to support competency-based surgical education.


Assuntos
Educação Baseada em Competências , Avaliação Educacional/métodos , Docentes de Medicina , Cirurgia Geral/educação , Competência Profissional , Desenvolvimento de Pessoal , Educação de Pós-Graduação em Medicina , Retroalimentação , Humanos , Internato e Residência , Inquéritos e Questionários
15.
Am J Surg ; 222(4): 687-691, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34238588

RESUMO

BACKGROUND: Surgical educators have worked to manage the hopes and fears as well as the recurring rumors that plague the surgical clerkship. It is not known if this has effected change over time. METHODS: We gathered information on hopes, fears, and rumors during our clerkship orientations from 2017 to 2019 using anonymous polling software with real-time feedback. We analyzed 468 responses using qualitative content analysis. RESULTS: Students hoped for practical skills acquisition, self-improvement, and understanding the surgical profession. They feared lack of time and knowledge, burnout, mistreatment, and subjective evaluation. Rumors included negative perceptions of surgical culture work environment, and fear of mistreatment despite clerkship changes intended to allay these fears. CONCLUSION: Students starting surgery clerkships hope to gain surgical and clinical skills but concerns about surgical culture and mistreatment appear to remain unchanged despite structural improvements in the clerkship experience. Surgeons should look beyond the clerkship itself to change these perceptions.


Assuntos
Atitude do Pessoal de Saúde , Estágio Clínico , Cirurgia Geral/educação , Estudantes de Medicina/psicologia , Competência Clínica , Educação de Graduação em Medicina , Avaliação Educacional , Medo , Feminino , Objetivos , Humanos , Masculino , Cultura Organizacional , Pesquisa Qualitativa , Adulto Jovem
16.
Thorac Surg Clin ; 31(3): 303-308, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34304838

RESUMO

Teaching multiple, evolving surgical approaches to thoracic surgical residents at a time of decreasing surgeon volume, increasing scrutiny of quality, greater demands on surgical efficiency, and reduced resident work hours requires a new mindset and new methods of education. The challenge presented to general thoracic surgeon educators and residents is explained, and encouragement is drawn from the examples of previous educational crises and their solutions.


Assuntos
Internato e Residência , Cirurgiões , Educação de Pós-Graduação em Medicina , Cirurgia Geral , Humanos
17.
Surg Clin North Am ; 101(4): 541-554, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242598

RESUMO

Surgical education requires proficiency with multiple types of learning to create capable surgeons. This article reviews a conceptual framework of learning that starts with the biological basis of learning and how neural networks encode memory. We then focus on how information can be absorbed, organized, and recalled, discussing concepts such as cognitive load, knowledge retrieval, and adult learning. Influences on memory and learning such as stress, sleep, and unconscious bias are explored. This overview of the biological and psychological aspects to learning provides a foundation for the articles to follow.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Aprendizagem/fisiologia , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/psicologia , Ensino/psicologia , Encéfalo/anatomia & histologia , Encéfalo/fisiologia , Humanos , Preconceito/psicologia , Sono/fisiologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Estados Unidos
18.
Surg Clin North Am ; 101(4): 565-576, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242600

RESUMO

Large group settings display no signs of disappearing. Most surgeons charged with this education have received no formal training. Lecturing remains the most common method of educating large groups. Even though factors required for an excellent lecture are known, their inconsistent application results in variation of effectiveness. Long-standing principles of rhetoric and recent advances in neuroscience, cognitive science, learning models, and teaching theory play a role in achieving effectiveness. This article makes recommendations for creating and delivering lectures, including active learning opportunities and modern innovations in information technology supporting teaching methods. Effective lecturing skills are acquired by persistent deliberate practice.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Aprendizagem , Modelos Educacionais , Ensino , Humanos , Aprendizagem Baseada em Problemas , Estados Unidos
19.
Surg Clin North Am ; 101(4): 577-586, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242601

RESUMO

Surgical training programs have long used quantitative measures of knowledge, as well as subjective evaluation of technical skills, to define the competence of trainees. However, a growing body of literature has shown the importance of nontechnical surgical skills as vital components of quality surgical care. Institutions must train nontechnical surgical skills, including leadership, communication, teamwork, situational awareness, and decision making, and incorporate these attributes into their evaluative processes to maximally enhance surgical performance at every career stage.


Assuntos
Conscientização , Competência Clínica , Comunicação , Tomada de Decisões , Cirurgia Geral/educação , Liderança , Equipe de Assistência ao Paciente , Humanos , Relações Interprofissionais , Modelos Educacionais , Assistência Perioperatória/educação , Assistência Perioperatória/métodos , Estados Unidos
20.
Surg Clin North Am ; 101(4): 587-595, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242602

RESUMO

The operating room continues to be the location where surgical residents develop both technical and nontechnical skills, ultimately culminating with them being capable of safe and independent practice. The process of intraoperative instruction is, by necessity, moving from an apprentice-based model where skills are acquired somewhat randomly through repeated exposure and evaluation is done in a global gestalt fashion. Modern surgical education demands that intraoperative instruction be intentional and that evaluation provides formative and summative feedback. This chapter describes some best practice approaches to intraoperative teaching and evaluation.


Assuntos
Competência Clínica , Feedback Formativo , Cirurgia Geral/educação , Internato e Residência/métodos , Procedimentos Cirúrgicos Operatórios/educação , Ensino , Humanos , Estados Unidos
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