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1.
Can J Surg ; 63(5): E396-E408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009899

RESUMO

BACKGROUND: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. METHODS: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. RESULTS: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. CONCLUSION: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Padrões de Prática Médica/estatística & dados numéricos , Âmbito da Prática/tendências , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Canadá , Competência Clínica/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Feminino , Cirurgia Geral/economia , Cirurgia Geral/educação , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/economia , Padrões de Prática Médica/tendências , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Cirurgiões/economia , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/educação
2.
Can J Surg ; 63(5): E418-E421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009901

RESUMO

SUMMARY: The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS's successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.


Assuntos
Congressos como Assunto/organização & administração , Infecções por Coronavirus/prevenção & controle , Currículo , Cirurgia Geral/educação , Cooperação Internacional , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Canadá/epidemiologia , Congressos como Assunto/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Cirurgia Geral/métodos , Guiana/epidemiologia , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Quênia/epidemiologia , Nigéria/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Suíça/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia , Estados Unidos/epidemiologia , Comunicação por Videoconferência/organização & administração , Comunicação por Videoconferência/normas , Ferimentos e Lesões/cirurgia
3.
Surgery ; 168(5): 898-903, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32868108

RESUMO

BACKGROUND: This study utilized the Team Strategies and Tools to Enhance Performance and Patient Safety and the Nontechnical Skills for Surgeons grading systems to evaluate the nontechnical skills of general surgery and obstetrician/gynecologist residents to see if these grading systems were concordant. These simulations were also intended to teach about crisis resources available at our institution. METHODS: Nineteen teams were created consisting of either one general surgery resident or 2 Obstetrician/Gynecologist residents plus 2 Anesthesia residents and 2 to 4 nurses. Each team was given a short briefing on Team Strategies and Tools to Enhance Performance and Patient Safety, then performed 2 simulated operating room crises. All exercises were graded by 2 independent observers with experience in the operating room and in using the Team Strategies and Tools to Enhance Performance and Patient Safety and Nontechnical Skills for Surgeons grading systems. RESULTS: Averaged general surgery Team Strategies and Tools To Enhance Performance and Patient Safety score increased between scenarios (14.3-17; P ≤ .01), as did obstetrician/gynecologist Team Strategies and Tools to Enhance Performance and Patient Safety score (14.9-19.2; P ≤ .01). Averaged general surgery Nontechnical Skills for Surgeons score increased between scenarios (10.3-12.2; P ≤ .02), as did obstetrician/gynecologist Nontechnical Skills for Surgeons score (10.2-14.3; P ≤ .01). Surgery Team Strategies and Tools to Enhance Performance and Patient Safety scores demonstrated a strong correlation of movement with Nontechnical Skills for Surgeons scores (r = 0.83), as did obstetrician/gynecologist (r = 0.91). On average both general surgery (11%-100%; P ≤ .01) and obstetrician/gynecologist (50%-90%; P ≤ .01) saw a statistically significant increase in their awareness of the crisis checklist. CONCLUSION: Team Strategies and Tools to Enhance and Patient Safety scores and Nontechnical Skills for Surgeons are effective and concordant tools for gauging general surgery and obstetrician/gynecologist resident nontechnical skills. In situ simulations are an effective way to teach general surgery and obstetrician/gynecologist residents about available crisis resources.


Assuntos
Competência Clínica , Cirurgia Geral/educação , Ginecologia/educação , Internato e Residência , Obstetrícia/educação , Salas Cirúrgicas , Treinamento por Simulação , Humanos , Equipe de Assistência ao Paciente , Segurança do Paciente
4.
Surgery ; 168(5): 888-897, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32912781

RESUMO

BACKGROUND: The American College of Surgeons/Association of Program Directors in Surgery operative skills curriculum standardizes training. However, simulation resources are variable with curriculum implementation institution dependent. Our aim was to use Kern's six steps of curricular development to demonstrate how to tailor the American College of Surgeons/Association of Program Directors in Surgery Phase 2 curriculum to program specific needs. METHODS: Problem identification and general needs assessment was performed. Targeted needs assessment of general surgery residents and attendings was conducted to determine perceived importance of operative skills and residents' confidence with these skills and attendings perceptions of deficiencies in technical skills using the Objective Structured Assessment of Technical Skills criteria. Educational strategies were developed dependent on program resources. The program was piloted between 2018 to 2019 and implemented in the 2019 to 2020 academic year. Assessment of resident technical skills and resident or faculty teaching skills was performed for each session. Resident confidence with procedures was assessed using the Zwisch scale before and after modules. Curricular evaluations were completed by residents after each module. RESULTS: The previous curriculum did not comprehensively cover Phase 2 modules and was not tailored to the needs of residents. Targeted needs assessment revealed differences in prioritization of learning for techniques by seniority (most important operation for faculty: laparoscopic cholecystectomy, postgraduate year 4 and 5: laparoscopic partial colectomy, interns: open inguinal/femoral hernia repair). Faculty identified technical skills on which to focus (ie, interns' knowledge of a specific procedure, postgraduate year 4 and 5 flow of the operation and forward planning). Educational strategies employed included wet and dry lab simulations and online materials. Residents reported increased procedural confidence after curriculum completion. CONCLUSION: This comprehensive implementation of the American College of Surgeons/Association of Program Directors in Surgery Phase 2 skills curriculum effectively used resources and expertise of an institution and focused on the knowledge and technical deficiencies of the target learners. Improvement in learner confidence was demonstrated by this approach.


Assuntos
Competência Clínica , Currículo , Cirurgia Geral/educação , Internato e Residência , Determinação de Necessidades de Cuidados de Saúde , Animais , Humanos , Cirurgiões , Suínos
5.
BMC Med Educ ; 20(1): 324, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962691

RESUMO

BACKGROUND: The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time. METHOD: Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes. RESULTS: A total of 1047 student responses for 7 questionnaires were analysed. During a 6-week period, 24 surgical topics were discussed with 51 contact hours. Eighty-seven per cent definitely agreed (highest agreement) with the statement 'students benefitted from the discussions'. Over 95% have either participated for all or most sessions. A majority of the respondents (83.4%) 'definitely agreed' that the discussions helped to improve their clinical sense. Of the total respondents, 79.3% definitely agreed that the discussions helped to build an interest in clinical medicine. Around 90% agreed that both exam-oriented and clinical practice-oriented topics were highly important and relevant. Most widely raised concerns were the poor Internet connectivity and limitation of access to the meeting platform. CONCLUSION: Online teaching with a novel structure is feasible and effective in a resource-limited setting. Students agree that it could improve clinical interest while meeting the expected learning outcomes.


Assuntos
Betacoronavirus , Medicina Clínica/educação , Infecções por Coronavirus/epidemiologia , Educação a Distância/organização & administração , Educação de Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Pneumonia Viral/epidemiologia , Escolha da Profissão , Competência Clínica , Humanos , Pandemias , Satisfação Pessoal , Mídias Sociais , Sri Lanka , Estudantes de Medicina , Inquéritos e Questionários
7.
Br J Hosp Med (Lond) ; 81(9): 1-6, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32990069

RESUMO

Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.


Assuntos
Competência Clínica , Infecções por Coronavirus , Educação , Cirurgia Geral/educação , Pandemias , Pneumonia Viral , Treinamento por Simulação , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação/métodos , Educação/organização & administração , Avaliação Educacional , Humanos , Modelos Anatômicos , Modelos Educacionais , Pandemias/prevenção & controle , Satisfação Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Autoimagem , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Reino Unido
8.
S Afr Med J ; 110(9): 916-919, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32880278

RESUMO

BACKGROUND: In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge. OBJECTIVES: To report changes in SA hospital surgical practices in response to COVID-19 preparedness. METHODS: In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes. RESULTS: A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit. CONCLUSIONS: Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Cirurgia Geral/educação , Admissão e Escalonamento de Pessoal , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Betacoronavirus , Tomada de Decisão Clínica , Estudos Transversais , Educação de Pós-Graduação em Medicina , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Hospitais Privados , Hospitais Públicos , Humanos , Salas Cirúrgicas , Pandemias , Seleção de Pacientes , África do Sul/epidemiologia , Inquéritos e Questionários , Telefone , Comunicação por Videoconferência
9.
Surg Clin North Am ; 100(5): 849-859, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882167

RESUMO

Over the last 2 decades, rural locations have realized a steady decrease in surgical access and direct care. Owing to societal expectations for equal general and subspecialty surgical care in urban or rural areas, the ability to attract, train, and hold onto the rural surgeon has come into question. Our current general surgery training curriculum has been reevaluated as to its relevance for rural surgery and several alternatives to the traditional surgical training model have been proposed. The authors discuss and evaluate current and proposed methods for surgical training curriculums and methods for rural surgeon retention through continuing education models.


Assuntos
Cirurgia Geral/educação , Serviços de Saúde Rural , Currículo , Internato e Residência , Estados Unidos
10.
Surg Clin North Am ; 100(5): 869-877, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882169

RESUMO

Rural hospitals are closing at an increasing rate. From 2010 to 2014, 47 rural hospitals closed, affecting 1.5 million people. The presence of surgeons is critical to keeping these hospitals open; to provide initial trauma care, cancer screening, and care to populations that cannot easily travel; and to provide solid general surgery procedures to almost 60 million Americans. Actions to provide surgeons trained for rural practice include exposure of surgery to students in high school (and earlier), recruitment of rural students into medical school, rural rotations in medical school, rural tracts within surgical residencies, and programs to support and retain rural surgeons.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Serviços de Saúde Rural , Recursos Humanos , Currículo , Cirurgia Geral/educação , Estados Unidos
11.
Am Surg ; 86(9): 1178-1184, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32935996

RESUMO

BACKGROUND: Nonoperative management of adhesive small bowel obstruction (ASBO) results in resolution for the majority of patients. Previous studies have demonstrated that outcomes for patients with ASBO are improved when patients are admitted to a surgical service, but the effect of general surgery resident coverage is unclear. This study measures quality outcomes for patients with ASBO after the establishment of a new general surgery residency program. METHODS: An institutional review board-approved retrospective chart review of admissions for ASBO was conducted following the implementation of a protocol for ASBO nested within a newly developed resident-run emergency general surgery (EGS) service. Patients successfully treated without operative intervention were analyzed. RESULTS: During the study period, 612 patients were admitted for ASBO. After initiation of the residency, 74% of ASBO were admitted to a surgical service compared with 35% prior to residency (P < .01). Length of stay was reduced by 0.77 days (P = .016), average direct total cost per patient was reduced by 24% (P = .002), and 30-day readmissions were reduced by 35.7% (P = .046). There was no significant difference in mortality (1.4% vs 1.0%). DISCUSSION: Admission to a resident-run surgical service was associated with statistically significant improvement in outcomes for patients with ASBO. These data corroborate prior studies demonstrating the positive impact of residency programs on patient outcomes and provide additional evidence that general surgery residency programs improve outcomes for patients with surgical disease.


Assuntos
Tratamento Conservador/métodos , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Obstrução Intestinal/terapia , Tempo de Internação/tendências , Readmissão do Paciente/tendências , Idoso , Feminino , Humanos , Intestino Delgado , Masculino , Estudos Retrospectivos
12.
JAMA Surg ; 155(9): 870-875, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32936281

RESUMO

On March 1, 2020, the first case of coronavirus disease 2019 (COVID-19) was confirmed in New York, New York. Since then, the city has emerged as an epicenter for the ongoing pandemic in the US. To meet the anticipated demand caused by the predicted surge of patients with COVID-19, the Department of Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medicine developed and executed an emergent restructuring of general surgery resident teams and educational infrastructure. The restructuring of surgical services described in this Special Communication details the methodology used to safely deploy the necessary amount of the resident workforce to support pandemic efforts while maintaining staffing for emergency surgical care, limiting unnecessary exposure of residents to infection risk, effectively placing residents in critical care units, and maintaining surgical education and board eligibility for the training program as a whole.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Internato e Residência/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Cidade de Nova Iorque , Pneumonia Viral/transmissão
13.
Wilderness Environ Med ; 31(3): 291-297, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32855020

RESUMO

INTRODUCTION: Cricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills. METHODS: This study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model. Total scores were assessed using a checklist. This consisted of 13 steps and was scored as misapplication/omission=0, correct performance and timing with hesitation=1, and correct performance and timing without hesitation=2. One of these steps, local anesthesia of the area if time is available, was not performed owing to time limitations. The highest possible score was 24. Data are presented as mean±SD with range, as appropriate. Normal distribution was evaluated using the Kolmogorov-Smirnov test, Student t test, and Mann-Whitney U test, and correlation analysis was used for statistical analysis. RESULTS: Students completed the cricothyroidotomy procedure steps in 116±46 (55-238) s. At performance assessment, the score achieved was 12±5 (2-24). The highest total score of 24 was achieved by 3 students (5%). Total scores exhibited negative and significant correlation with procedure time (r=-0.403, P=0.002). CONCLUSIONS: The model developed in this study is an inexpensive and effective method that can be used in cricothyroidotomy training for student paramedics. We think that repeating the cricothyroidotomy procedure on the model will increase success levels.


Assuntos
Materiais Biocompatíveis , Cartilagem Cricoide/cirurgia , Medicina Ambiental/métodos , Cirurgia Geral/educação , Medicina Selvagem/métodos , Animais , Modelos Animais , Carneiro Doméstico , Traqueia
14.
Surgery ; 168(5): 882-887, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32747138

RESUMO

The American College of Surgeons launched the Accredited Education Institutes (ACS-AEIs) in 2005 to create a network of simulation centers to offer the highest-quality surgical education and training and to pursue cutting-edge scholarship. Specific standards and criteria were developed to accredit simulation centers, and decisions made based on the application, site surveyor visit, and ACS-AEI Accreditation Committee review. In addition to granting accreditation and providing recommendations for improvement, site surveyors and the Accreditation Committee identified best practices defined as areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education. Best practices were compiled into a list starting in 2011 for dissemination to all members of the ACS-AEI Consortium through on-line videos, newsletters, and workshops at the Annual ACS Surgical Simulation Summit. Using thematic analysis, the authors classified common themes from the 337 best practices identified during 247 accreditation reviews between June 2011 and June 2019. As best practices were extracted, the authors compiled them into a single database. Eight overarching themes were identified, including approaches to faculty development, scholarly activity, development of curricula, use of resources, delivery of educational content, assessment of learners, and collaboration between centers. The authors discuss themes in the context of their practical relevance and highlight strategies used at different centers, with an emphasis on the importance of each theme in developing a successful simulation program.


Assuntos
Acreditação , Cirurgia Geral/educação , Treinamento por Simulação/normas , Humanos , Inquéritos e Questionários , Fatores de Tempo
16.
Surgery ; 168(4): 586-593, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32811696

RESUMO

BACKGROUND: The aim of this study was to determine trends in the experience of general surgery residents with endocrine surgery cases. METHODS: American Association of Endocrine Surgeons national general surgery case logs from 1989 through 2019 were reviewed. The numbers of individuals completing residency and the mean and median number of endocrine surgery cases by type and by level of operating resident surgeon were abstracted from annual data and analyzed. Descriptive statistics and linear regression analyses were performed modeling endocrine surgery cases over time and stratified by procedure type and resident level. RESULTS: The number of individuals completing general surgery residency each year increased from 981 to 1,219 (P < .001). The average total number of endocrine surgery cases performed increased from 17 to 33.2 (P < .001) but has declined since its peak at 36.9 in 2010 to 2011 (P = .014). Thyroid operations increased from 11.4 to 19.8 (P < .001) but peaked at 23.5 in 2010 to 2011 and have since declined (P < .001). Parathyroid operations more than doubled from 4.2 to 9.7 (P < .001). Adrenal operations increased from 1 to 2.2 (P < .001) and pancreatic endocrine operations increased from 0.2 to 1.5 (P < .001). Surgeon Chief endocrine surgery cases peaked at 14.4 in 2003 to 2004 but have since declined by 22.2% (P < .001). Surgeon Junior endocrine surgery cases increased overall (P < .001) but peaked at 22.8 in 2011 to 2012. There was increasing heterogeneity over time in trainee experience (P < .001). CONCLUSION: After having increased for 2 decades, the number of endocrine surgery cases performed by general surgery residents is currently in decline. Possible contributing factors include growth in the number of general surgery residents, variable and narrowed case mix, and encroachment by other learners.


Assuntos
Procedimentos Cirúrgicos Endócrinos/educação , Procedimentos Cirúrgicos Endócrinos/tendências , Cirurgia Geral/educação , Internato e Residência/tendências , Competência Clínica , Procedimentos Cirúrgicos Endócrinos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Estados Unidos
18.
Am Surg ; 86(9): 1119-1123, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32804539

RESUMO

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) provides no specific guidelines for surgical critical care (SCC) training during general surgery residency. Growing emphasis is placed on this experience with increasing case requirements and dedicated SCC content on board certification exams. METHODS: A digital survey was distributed to ACGME-accredited general surgery residencies via email. Respondents reported number and setting of critical care months during residency and rated comfort level within 5 critical care principles and overall satisfaction with their SCC experience. Study cohorts were formed to compare experiences and competencies between respondents based on setting, months, postgraduate year (PGY) level, and formal surgical intensive care unit (SICU) experience. Differences between cohorts were compared using the Mantel-Haenszel test (P < .05). RESULTS: Seventy-three residents responded with 45% training at academic centers versus 46% in community hospitals. Approximately 50% completed a formal SICU rotation, while 9% reported no dedicated critical care rotation during residency. Overall, 78% felt satisfied with their SCC experience. Residents training at academic centers were more satisfied overall and felt more comfortable with ventilator management. Those who completed 5 or more months of critical care training reported greater confidence with intravenous sedation and ventilator management, while residents having a formal SICU rotation felt more confident with vasopressor and ventilator management. DISCUSSION: Variability remains within SCC training among general surgery residents with perceived benefits seen in training at academic centers and completing a formal SICU rotation. Although limited, these findings offer a foundation for developing an effective SCC curriculum.


Assuntos
Competência Clínica , Cuidados Críticos , Currículo/normas , Educação de Pós-Graduação em Medicina/normas , Cirurgia Geral/educação , Internato e Residência/métodos , Humanos , Estudos Retrospectivos
19.
J Surg Educ ; 77(5): 1005-1007, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32773336

RESUMO

OBJECTIVE: In response to ongoing concerns regarding transmission of the novel coronavirus (COVID-19), surgical practice has changed for the foreseeable future. Practice guidelines recommend only urgent or emergent surgical procedures be performed to minimize viral transmission. This effectively limits standard training and practice for surgical residents. The purpose of this article is to describe opportunities in surgical simulation, and highlights the challenges associated with training in the COVID-19 era. DESIGN: This is a perspective summarizing the potential role of surgical simulation to target training gaps caused by decreased surgical caseloads. CONCLUSIONS: This manuscript concisely discusses simulation options available to training programs, including the novel concept of "surgical kits." These kits include all instruments necessary to simulate a procedure at home, effectively pairing safety and utility.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Impressão Tridimensional , Treinamento por Simulação/métodos , Competência Clínica , Feminino , Humanos , Internato e Residência/métodos , Masculino , Modelos Educacionais , Otolaringologia/educação , Gestão da Segurança , Estados Unidos
20.
Surgery ; 168(4): 730-736, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32622473

RESUMO

BACKGROUND: Effective surgical education is key to resident professional and personal development. There is little literature defining or assessing effective surgical educators and no common definition of effectiveness in use. The opinion of surgical residents has never been qualitatively studied. Our aim was to determine what general surgery residents perceive as qualities of effective surgical educators. METHODS: A qualitative and quantitative study of general surgery senior residents (postgraduate year [PGY]-4 and -5) at a single tertiary academic institution was performed. In-depth semistructured interviews were conducted with all senior residents to determine the overall opinion of effective educators. Thematic analysis was performed using grounded theory. Participants completed a Likert-based survey to determine which qualities of an effective educator were (1) most critical and (2) had been most commonly encountered during training. Institutional review board approval was obtained. RESULTS: Data saturation occurred after 13 interviews (7 PGY-4, 6 PGY-5). Interviewees described attitudes, behaviors, and cognitions essential for effective surgical educators. They described important attributes of the trainee-trainer relationship and learning environment. On quantitative analysis, excellent communication, promoting a positive learning climate, timely constructive feedback, and technical expertise were ranked as most critical. Residents most often encountered educators with excellent communication, who fostered a positive learning climate, with clinical and technical expertise, and who provided leadership or mentorship. CONCLUSION: General surgery residents believe effective educators recognize the importance of communication and a positive learning environment, are able to adapt to the learner or environment, have clinical and technical expertise, and form a bond with their learner. This framework can inform faculty development programs to improve surgical education.


Assuntos
Atitude do Pessoal de Saúde , Docentes de Medicina , Cirurgia Geral/educação , Internato e Residência , Competência Profissional , Comunicação , Docentes de Medicina/psicologia , Docentes de Medicina/normas , Retroalimentação , Teoria Fundamentada , Humanos , Liderança , Tutoria
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