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1.
Ann R Coll Surg Engl ; 102(1): 49-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31755741

RESUMO

INTRODUCTION: Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). MATERIALS AND METHODS: Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. RESULTS: Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. DISCUSSION AND CONCLUSION: General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.


Assuntos
Cirurgia Geral/educação , Torção do Cordão Espermático/cirurgia , Urologia/educação , Adulto , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pediatria/educação , Pediatria/estatística & dados numéricos , Inquéritos e Questionários , Urologistas/educação , Urologistas/normas , Urologia/estatística & dados numéricos , País de Gales
2.
Ann R Coll Surg Engl ; 102(1): 36-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31660752

RESUMO

INTRODUCTION: The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS: We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS: There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS: Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Admissão do Paciente/estatística & dados numéricos , Traumatologia/educação , Ferimentos e Lesões/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Estudos Retrospectivos , Jornada de Trabalho em Turnos/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , País de Gales , Local de Trabalho/organização & administração , Local de Trabalho/estatística & dados numéricos , Ferimentos e Lesões/cirurgia
3.
J Surg Res ; 245: 649-655, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31542695

RESUMO

BACKGROUND: Limiting variability is an essential element to improving quality of care. Frequent resident turnover represents a significant barrier to clinical standardization. Trainees joining new surgical services must familiarize themselves with the guidelines and protocols that direct patient care as well as their learning objectives and expectations. A clinical decision support system (CDSS) is a dynamic, searchable electronic resource intended for use at the point of care. The CDSS can provide convenient and timely access to relevant information for residents, allowing them to incorporate the most up-to-date protocols and guidelines in their daily care of patients. The objective of this quality improvement intervention was to determine the objective rate of CDSS utilization and its subjective value to residents. MATERIALS AND METHODS: An internally developed, web-based CDSS including essential, clinically useful documents was created for use by trainees on a busy pediatric surgery service. A standardized orientation was provided to each resident and fellow on joining the service, complemented by a summary card to be attached to the trainee's ID badge. CDSS usage was monitored using web analytics. Trainees who rotated before and after the CDSS launch were surveyed regarding attitudes toward clinical resources and confidence in patient management. RESULTS: Documents published to the CDSS included 33 clinical guideline documents and 207 additional educational and support files including reference materials from service orientation were made available to trainees and staff. Goals for resident usage were established by evaluation and adaptation of early traffic patterns. Analysis of web traffic collected over 14 consecutive months revealed utilization above target levels, with 4.0 average weekly page views per trainee (IQR: 1.6-5.6). A total of 60 survey responses were received (54% of trainees invited); majorities of rotating trainees and survey respondents were trainees in general surgery and most were interns. Mean composite scores reflected a trend toward improved satisfaction when seeking CDSM (before intervention 3.18 [SD 0.73], after intervention 3.92 [SD 0.70], range 1-5) which was statistically significant (P = 0.005). Mean scores also improved across five of six components of the composite score (mean improvement 0.75, range: 0.53-0.92), four of which were statistically significant (P = 0.001-0.038). Most (59%) respondents reported that they used the CDSS frequently. CONCLUSIONS: Convenient access to a CDSS resulted in greater than expected utilization as well as higher resident satisfaction with and confidence in materials provided. A CDSS is a promising tool offering quick access to high-quality information in challenging trainee environments.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Cirurgia Geral/educação , Internato e Residência , Criança , Humanos , Qualidade da Assistência à Saúde
4.
Ann R Coll Surg Engl ; 102(1): 3-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31858833

RESUMO

INTRODUCTION: Achieving a standard of clinical research at the pinnacle of the evidence pyramid is historically expensive and logistically challenging. Research collaboratives have delivered high-impact prospective multicentre audits and clinical trials by using trainee networks with a range of enabling technology. This review outlines such use of technology in the UK and provides a framework of recommended technologies for future studies. METHODS: A review of the literature identified technology used in collaborative projects. Additional technologies were identified through web searches. Technologies were grouped into themes including access (networking and engagement), collaboration and event organisation. The technologies available to support each theme were studied further to outline relative benefits and limitations. FINDINGS: Thirty-three articles from trainee research collaboratives were identified. The most frequently documented technologies were social media applications, website platforms and research databases. The Supportive Technologies in Collaborative Research framework is proposed, providing a structure for using the technologies available to support multicentre collaboration. Such technologies are often overlooked in the literature by established and start-up collaborative project groups. If used correctly, they might help to overcome the physical, logistical and financial barriers of multicentre clinical trials.


Assuntos
Pesquisa Biomédica/métodos , Tecnologia Biomédica/métodos , Comportamento Cooperativo , Relações Interprofissionais , Ensaios Clínicos como Assunto , Comunicação , Cirurgia Geral/educação , Humanos , Internet , Redes Sociais Online , Estudantes de Medicina
5.
Rev. méd. Urug ; 35(4): 298-301, dic. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1026158

RESUMO

La formación de cirujanos generales es responsabilidad de las clínicas quirúrgicas de la Facultad de Medicina. Su programa de formación de tres años presentaba carencias en cuanto al volumen y complejidad de la cirugía que cada residente realizaba. Objetivo: presentar los resultados de la producción quirúrgica de los residentes de Cirugía General luego de la implementación del cuarto año curricular del posgrado en la Clínica Quirúrgica 3 del Hospital Maciel y compararlos con los del período previo cuya duración era de tres años. Material y método: estudio observacional, descriptivo y retrospectivo de la producción quirúrgica de los residentes de la Clínica Quirúrgica 3 que cursaron en el período 2011-2015. Las variables consideradas fueron: número total de cirugías realizadas por todos los residentes, promedio de cirugías totales y por año por residente, número máximo y mínimo de cirugías realizadas por un residente, porcentaje total de cirugías de coordinación y urgencia, y promedio de cirugías por residente de acuerdo a la categorización en altas, mayores, corrientes y menores. Los datos se extrajeron del sistema de descripciones operatorias de la Administración de los Servicios de Salud del Estado, Hospital Maciel. Conclusiones: el incremento de un año en la duración de la residencia de Cirugía General determinó un aumento en el número y complejidad de la cirugía realizada por los residentes en la Clínica Quirúrgica 3 del Hospital Maciel, así como un incremento de las cirugías de coordinación en relación con las de urgencia y emergencia.


The general surgeons training program is under the responsibility of the Surgical Clinics of the School of Medicine. The 3-year training program evidenced deficiencies in terms of the volume and complexity of the surgeries carried out by the different residents. Objective: to present the surgical outcome of the General Surgery residents after the implementation of the fourth year in the curriculum of graduate studies of the Surgical Clinic 3 at Maciel Hospital and to compare it to that of the residents trained in the previous 3-year studies plan. Method: observational, descriptive and retrospective study of the surgical outcome of residents of the Surgical Clinic 3 who studied in the 2011-2015 period. Below follow the variables considered: total number of surgeries carried out by all residents, average number of surgeries per year and per resident, maximum and minimum number of surgeries by a resident, total percentage of coordination and urgent surgeries and average number of surgeries by resident according to the classification into high complexity, complex, regular and minor. Data were taken from the ASSE surgery description system - Maciel Hospital. Conclusions: increasing one year the duration of the general surgery residence resulted in a higher number and complexity of surgeries carried out by the residents of Surgical Clinic 3 at Maciel Hospital, as well as an increase in the coordination surgeries when compared to urgency and emergency surgeries.


A formação de cirurgiões gerais é responsabilidade das Clínicas Quirúrgicas da Facultad de Medicina. O programa de formação de 3 anos apresentava carências tanto em relação ao volume como também à complexidade da cirurgia que cada residente realizava. Objetivo: apresentar os resultados da produção cirúrgica dos Residentes de Cirurgia Geral depois da implementação do quarto ano curricular da pós-graduação na Clínica Quirúrgica 3 do Hospital Maciel e compará-los com os do período prévio cuja duração era de 3 anos. Material e método: estudo observacional, descritivo e retrospectivo da produção cirúrgica dos Residentes da Clínica Quirúrgica 3 que cursaram no período 2011 ­ 2015. As variáveis estudadas foram: número total de cirurgias realizadas por todos os residentes, média de cirurgias totais e por ano por residente, número máximo e mínimo de cirurgias realizadas por residente, porcentagem total de cirurgias eletivas e de urgência e média de cirurgias por residente segundo a classificação como de grande, meio e pequeno porte e corrente. Os dados foram obtidos do sistema de descrições operatórias de ASSE - Hospital Maciel. Conclusões: o incremento de um ano na duração da residência de cirurgia geral levou a um aumento no número e na complexidade das cirurgias realizadas pelos residentes na Clínica Quirúrgica 3 del Hospital Maciel, bem como uma aumento das cirurgias eletivas em relação às de urgência e emergência.


Assuntos
Cirurgia Geral/educação , Educação de Pós-Graduação em Medicina , Educação Médica , Internato e Residência
9.
Am Surg ; 85(9): 961-964, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638507

RESUMO

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board-exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CT imaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs' performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.


Assuntos
Competência Clínica , Medicina de Emergência/normas , Cirurgia Geral/normas , Ferimentos e Lesões/cirurgia , Cuidados Críticos , Medicina de Emergência/educação , Cirurgia Geral/educação , Mortalidade Hospitalar , Humanos , Tempo de Internação , Duração da Cirurgia , Avaliação de Resultados da Assistência ao Paciente , Pennsylvania , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Estados Unidos
10.
N Engl J Med ; 381(18): 1741-1752, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31657887

RESUMO

BACKGROUND: Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS: A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS: Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS: Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.


Assuntos
Esgotamento Profissional/epidemiologia , Cirurgia Geral/educação , Internato e Residência , Abuso Físico/estatística & dados numéricos , Assédio Sexual/estatística & dados numéricos , Discriminação Social/estatística & dados numéricos , Esgotamento Profissional/psicologia , Feminino , Humanos , Masculino , Estado Civil , Corpo Clínico Hospitalar , Recursos Humanos em Hospital , Abuso Físico/psicologia , Relações Médico-Paciente , Relações Profissional-Família , Fatores Sexuais , Assédio Sexual/psicologia , Discriminação Social/psicologia , Ideação Suicida , Inquéritos e Questionários , Estados Unidos/epidemiologia
11.
J Laparoendosc Adv Surg Tech A ; 29(10): 1362-1367, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31560642

RESUMO

Background: Most residents do not have a defined program for simulation training in video surgery in Brazil. The training takes place for the most part in vivo or in short courses. The goal of this article is to describe and evaluate a set of exercises using low-cost materials, created by the residents themselves, to enable basic skills training in video surgery. Materials and Methods: Seven exercises were elaborated aiming to simulate main maneuvers performed in video surgery. The residents were guided by a written and video description showing the execution of the exercises, performed the exercises, and answered a questionnaire. After 3 weeks of free training, the residents performed the exercises and answered the questionnaire again. Results: Seven residents started the study; however, 6 completed the two steps. Among the participants, 83% received in vivo video surgery training, and only 2 (33%) received some supervised simulation training in minimally invasive surgery before this time. All participants considered the set of seven exercises representative of the actual skills in video surgery. There was no difficulty in acquiring the materials or in assembling them to carry out the training. All the participants had a shorter training time than initially proposed, on average 1 day/week for 20 minutes. Conclusions: A simple set of exercises can be elaborated by the residents themselves and make feasible the simulated training in video surgery even without the availability of sophisticated and expensive materials. The presence of a tutor and the scheduling of exclusive training seem necessary for more satisfactory results.


Assuntos
Cirurgia Geral/educação , Internato e Residência , Pediatria/educação , Treinamento por Simulação/métodos , Criança , Competência Clínica , Humanos , Inquéritos e Questionários , Gravação em Vídeo
12.
Surg Technol Int ; 35: 27-35, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31498872

RESUMO

BACKGROUND: Virtual and Augmented Reality (VR/AR) has been used in surgery for several decades. Over the past 5-10 years, however, new technological advances, including high-resolution screens, mobile graphical processing units (mGPUs) and position-sensing technologies, have been incorporated into relatively low-cost VR and AR devices. This review focuses on the current impact of the application of these "Phase 2" VR/AR technology in surgical training. METHODS: A narrative literature review was undertaken using PubMed and Web of Science to identify comparative studies related to the impact of Phase 2 VR or AR tools on surgical training, defined in terms of the acquisition of technical surgical skills. Eleven studies on the effectiveness of VR/AR in surgical education were identified for full review. Further, the grey literature was searched for articles describing the current state of VR/AR in surgical education. A quality analysis using the Newcastle Ottawa scale showed a median score of 7 (out of a maximum achievable score of 9). RESULTS: All studies showed a positive association between the use of VR/AR in surgical training and skill acquisition in terms of improving the speed of acquisition of surgical skills, the surgeon's ability to multitask, the ability to perform a procedure accurately, hand-eye coordination and bimanual operation. The grey literature presented a common, positive theme of the benefits of VR/AR in surgical training. CONCLUSIONS: Based on the limited evidence available, VR/AR appears to have positive training benefits in improving the speed of acquisition of surgical skills. However, the significant heterogeneity in study methodology and the relative recency of wider VR/AR adoption in surgical training mean that only tentative conclusions can be drawn at this stage. Further research, ideally with large sample sizes, robust outcome measures and longer follow-up periods, is recommended.


Assuntos
Cirurgia Geral , Interface Usuário-Computador , Realidade Virtual , Cirurgia Geral/educação
13.
Surgery ; 166(4): 572-579, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31399217

RESUMO

BACKGROUND: For surgery residents, opportunities to systematically learn about surgical equipment are limited. Our facility holds a simulation-based boot camp for incoming, first-year general surgery residents. The aim of this study was to assess the effectiveness of this boot camp at increasing resident confidence and improving technical skills. METHODS: Boot camp for incoming surgery residents is held annually and provides hands-on simulation relating to endoscopy, laparoscopy, bronchoscopy, and abdominal access. Before the boot camp, participants completed a pretest, which includes self-confidence, experience, and a skills-assessment. Identical assessments of self-confidence and skills were completed after the boot camp as a posttest. Data was accrued from 2016 to 2018. RESULTS: A total of 26, first-year, general surgery residents participated in the boot camp. Most participants had never used an endoscopic simulator (61.5%), handled a colonoscope (57.7%), a gastroscope (80.8%), or gained operative access to the abdomen (76.9%). The assessments of self-confidence and skills demonstrated a mean increase in all 4 topics. All differentials demonstrated statistical significance (P <. 001). CONCLUSION: A 1-day, simulation-based boot camp for incoming surgery residents with a focus on endoscopy, laparoscopy, and abdominal access increases resident confidence as well as several basic aspects of technical skill.


Assuntos
Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Internato e Residência/organização & administração , Treinamento por Simulação/métodos , Adulto , Estudos de Coortes , Endoscopia/educação , Feminino , Humanos , Laparoscopia/ética , Masculino , Avaliação de Programas e Projetos de Saúde , Autoimagem , Fatores de Tempo
14.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
15.
Oral Maxillofac Surg Clin North Am ; 31(4): 621-626, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416664

RESUMO

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.


Assuntos
Competência Clínica , Tecnologia Educacional/tendências , Cirurgia Geral/educação , Internato e Residência , Otolaringologia/educação , Treinamento por Simulação , Educação Baseada em Competências , Avaliação Educacional , Humanos , Internato e Residência/métodos , Internato e Residência/tendências , Procedimentos Cirúrgicos Reconstrutivos/educação , Treinamento por Simulação/tendências
16.
J Grad Med Educ ; 11(4 Suppl): 34-46, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428258

RESUMO

Background: Investments in training physician specialists through postgraduate medical education (PGME) are critical for Sub-Saharan Africa, given the increasing burden of non-communicable diseases. Objectives: The objectives of this scoping review were to (1) understand the breadth of publications on PGME from Sub-Saharan Africa, and (2) conduct a thematic analysis of lessons learned by specific training programs. Methods: We conducted a literature search of 7 databases for PGME literature published between January 1991 and December 2016. Two reviewers independently reviewed titles and abstracts for inclusion. Full-text articles were then reviewed, and bibliometric data were extracted to create a profile of PGME-related publications. Two authors coded the manuscripts to identify articles written about specific PGME programs. These were analyzed for lessons learned. Results: We identified 813 publications that reported on postgraduate medical education in Sub-Saharan Africa. Most articles were published between 2005 and 2016. Nations leading in publication were South Africa and Nigeria, followed by Ethiopia, Uganda, Kenya, Ghana, and Malawi. The largest number of articles related to general surgery training, followed by family medicine, emergency medicine, and anesthesiology. Thematic analysis revealed advantages of training programs for health facilities, challenges related to teaching, resourcing, and standardizing of training, and lessons learned related to international partnerships, faculty engagement, and research support for trainees. Conclusions: PGME in Sub-Saharan Africa has evolved over the past 26 years. Future growth will require strategic support to scale programs, support new specialties, trainees, and teachers, and leverage best practice models to sustain PGME programs.


Assuntos
Educação de Pós-Graduação em Medicina , Internato e Residência , Ensino , África ao Sul do Saara , Medicina de Emergência/educação , Medicina de Família e Comunidade/educação , Cirurgia Geral/educação , Humanos
19.
Int J Comput Assist Radiol Surg ; 14(9): 1611-1617, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31363983

RESUMO

PURPOSE: Manual feedback from senior surgeons observing less experienced trainees is a laborious task that is very expensive, time-consuming and prone to subjectivity. With the number of surgical procedures increasing annually, there is an unprecedented need to provide an accurate, objective and automatic evaluation of trainees' surgical skills in order to improve surgical practice. METHODS: In this paper, we designed a convolutional neural network (CNN) to classify surgical skills by extracting latent patterns in the trainees' motions performed during robotic surgery. The method is validated on the JIGSAWS dataset for two surgical skills evaluation tasks: classification and regression. RESULTS: Our results show that deep neural networks constitute robust machine learning models that are able to reach new competitive state-of-the-art performance on the JIGSAWS dataset. While we leveraged from CNNs' efficiency, we were able to minimize its black-box effect using the class activation map technique. CONCLUSIONS: This characteristic allowed our method to automatically pinpoint which parts of the surgery influenced the skill evaluation the most, thus allowing us to explain a surgical skill classification and provide surgeons with a novel personalized feedback technique. We believe this type of interpretable machine learning model could integrate within "Operation Room 2.0" and support novice surgeons in improving their skills to eventually become experts.


Assuntos
Competência Clínica , Retroalimentação , Cirurgia Geral/educação , Cirurgia Geral/instrumentação , Aprendizado de Máquina , Fenômenos Biomecânicos , Análise por Conglomerados , Humanos , Cadeias de Markov , Modelos Estatísticos , Movimento (Física) , Análise de Regressão , Procedimentos Cirúrgicos Robóticos , Cirurgiões
20.
Adv Exp Med Biol ; 1156: 49-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31338777

RESUMO

Technology for developing three-dimensional (3D) virtual models in anatomical sciences education has seen a great improvement in recent years. Various data used for creating stereoscopic virtual models have also been constantly improving. This paper focuses specifically on the methodologies of creating stereoscopic virtual models and the techniques and materials used in developing stereoscopic virtual models from both our previous studies and other published literature. The presentation and visualization of stereoscopic models are highlighted, and the benefits and limitations of stereoscopic models are discussed. The practice of making 3D measurements on the lengths, angles, and volumes of models can potentially be used to help predict typical measurement parameters of anatomical structures and for the placement of surgical instruments. Once stereoscopic virtual models have been constructed, their visualization and presentation can be implemented in anatomy education and clinical surgical trainings.


Assuntos
Anatomia , Percepção de Profundidade , Cirurgia Geral , Imagem Tridimensional , Modelos Anatômicos , Anatomia/educação , Anatomia/métodos , Cirurgia Geral/educação , Humanos , Imagem Tridimensional/métodos
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