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1.
Can J Surg ; 63(3): E229-E230, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386472

RESUMO

Summary: The coronavirus disease 2019 (COVID-19) pandemic has accentuated the importance of leadership training for health care professionals, particularly surgeons. Surgeons are expected to lead and thrive in multidisciplinary teams. There is, however, a critical gap in teaching residents about fundamental leadership principles, such as developing productive and vision-driven teams, conflict resolution and emotional intelligence. We discuss the merits of leadership training for surgical residents and future directions for implementing a leadership curriculum for Canadian residency programs in the competency by design era.


Assuntos
Infecções por Coronavirus , Cirurgia Geral/educação , Internato e Residência/organização & administração , Liderança , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral , Canadá , Competência Clínica , Currículo , Cirurgia Geral/normas , Internato e Residência/métodos , Internato e Residência/normas , Equipe de Assistência ao Paciente/normas , Ensino
3.
J Educ Eval Health Prof ; 17: 1, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31955547

RESUMO

PURPOSE: Senior nursing and medical interns' lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needle stick (NSI)/sharp (SI) injuries may harm themselves. Trainees' self-reported NSI/SI rate was known to be especially high during the first two months of internship in Taiwan. This prospective cohort study aimed to know the effect of new developed (virtual reality (VR) game, which uses the Gangne's learning model to improved universal precaution for NSI/SI prevention and decrease the rates of needle stick/sharp injuries in new-coming medical and nursing interns in Taiwan. . METHODS: From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational NSI/SI prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors. RESULTS: In comparison with medical interns, a higher proportion of nursing interns have had the past experiences of deep occupational NSI/SI. Before VR training, the familiarity and confidence for NSI/SI prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep NSI/SI exhibited better performance on the accuracy rate and time need for complete 20 decisions than those without past experiences in VR practice. The performances of all trainees were improved after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about NSI/SI prevention. CONCLUSION: This self-developed VR game system using Gangne's flow improved universal precaution for NSI/SI prevention and reduced the NSI/SI rates in the first two months of nursing and medical internship.


Assuntos
Educação em Enfermagem , Internato e Residência/métodos , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Realidade Virtual , Educação em Enfermagem/métodos , Pessoal de Saúde , Humanos , Estudantes de Medicina , Estudantes de Enfermagem
4.
Am J Surg ; 219(2): 299-303, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31928779

RESUMO

BACKGROUND: Safety-net hospitals frequently underperform on surgical quality measures. To achieve equitable surgical care, creative strategies are needed to improve care for this vulnerable population. METHODS: We designed a trainee-led quality improvement (QI) program to promote evidence-based analgesia prescribing. The program included a collaborative resident leadership model and used educational interventions and performance feedback. RESULTS: Before the QI program, 48% of patients were discharged on acetaminophen post-operatively, and 0% were discharged on ibuprofen. In the most recent month since the QI program was launched, 100% of patients were discharged on acetaminophen, and 81% on ibuprofen. CONCLUSION: Our trainee-led quality improvement program demonstrates that surgical trainees can accelerate change and may be a powerful force for improving health equity through safer post-operative discharge prescribing practices at a safety-net hospital.


Assuntos
Analgésicos Opioides/uso terapêutico , Medicina Baseada em Evidências/educação , Epidemia de Opioides/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Melhoria de Qualidade , Provedores de Redes de Segurança/organização & administração , Adulto , Uso de Medicamentos , Educação de Pós-Graduação em Medicina/métodos , Feminino , Humanos , Internato e Residência/métodos , Masculino , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Guias de Prática Clínica como Assunto , Medição de Risco , Estados Unidos
5.
Am J Surg ; 219(2): 335-339, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31952786

RESUMO

BACKGROUND: Mental skills limit surgical residents' skill decay resulting from stress. However, optimal mental skills delivery is unknown. We sought to compare the impact of implementing our curriculum in small groups and individually. METHODS: At baseline, residents completed assessments of mental skills and laparoscopic suturing. Residents then participated in a comprehensive mental skills curriculum at two institutions. At the first institution, residents completed small group training, whereas residents at the second institution trained individually. Following mental skills training, residents completed FLS training, at which time they completed the Short State Stress Questionnaire detailing their engagement. At post-test, residents completed baseline assessments again. RESULTS: Twenty-one residents completed training. Small groups were less engaged after training than individuals (Group average engagement: 26.4 vs. Individual average engagement: 29.6, p = 0.06). CONCLUSIONS: Delivering mental skills individually facilitates greater engagement than training in small groups, but regardless of delivery method, our MSC can achieve the same outcomes on surgical performance.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/métodos , Treinamento por Simulação/métodos , Estresse Psicológico/prevenção & controle , Adulto , Currículo , Feminino , Humanos , Internato e Residência/métodos , Laparoscopia/educação , Masculino , Saúde Mental , Projetos Piloto , Amostragem , Técnicas de Sutura
6.
Acad Med ; 95(2): 293-300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31348059

RESUMO

PURPOSE: The rise of coaching programs in medical education sparks questions about ways to support physician coaches in learning new educational practices specific to coaching. How coaches learn from one another is of particular interest considering the potential value of social learning. Using communities of practice as a conceptual framework, the authors examine the sense of community and relationships among coaches in a new medical student coaching program, the value of this community, and the facilitators and barriers influencing community development. METHOD: In this qualitative study, investigators conducted 34 interviews with physician coaches at 1 institution over 2 years (2017-2018) and observed 36 coach meetings. Investigators analyzed interview transcripts using thematic analysis and used observation field notes for context and refinement of themes. RESULTS: Coaches described a sense of community based on regular interactions; shared commitment to medical education; and new roles with similar experiences, joys, and challenges. They valued the sense of camaraderie and support, learning from one another, and opportunities for professional growth that strengthened their identities as educators and enhanced job satisfaction. Facilitators of community included regular meetings, leadership and administrative support, and informal opportunities to interact outside of meetings. Barriers included time constraints and geographic challenges for coaches at off-site locations. CONCLUSIONS: The sense of community among coaches was a valued and beneficial part of their coaching experience. Coaches' interactions and relationships promoted skill acquisition, knowledge transfer, professional development, and career satisfaction. Thus, incorporating support for social learning in coaching programs promotes coach faculty development.


Assuntos
Internato e Residência/métodos , Tutoria , Desenvolvimento de Pessoal/métodos , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa
7.
J Trauma Acute Care Surg ; 88(2): 242-248, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804411

RESUMO

BACKGROUND: Establishing proficiency in specific trauma procedures during surgical residency has been limited to annual courses with limited data on its effect on the delivery of health care and patient outcomes. There is a wide variety of training on content and complexity with recent studies looking at time to imaging or secondary survey. In this study, we implement monthly case-based simulation after initial training on a variety of bedside trauma procedures. The overall goal is to evaluate the effect of simulation on time to specific interventions. METHODS: This is a prospective, observational study between July 2018 and February 2019 at a single-institution, Level I trauma center with a large surgical residency program. A trauma simulation program was implemented in November 2018 to train and evaluate surgical residents from post-graduate year 1 through 5. All rotating residents participated in an initial course on basic trauma procedures, such as percutaneous sheath placement, tube thoracostomy, and resuscitative thoracotomy followed by an end-of-month simulation. All Level I activations from preintervention starting in July to October 2018 (preintervention) and October 2018 through February 2019 (postintervention) were reviewed; monitored variables included age, sex, mechanism of injury, blunt or penetrating, and time to intervention in the trauma bay. Median times to intervention were recorded with interquartile ranges (IQR). Pearson's coefficient was used to measure the strength of the relationship between simulation and time to patient intervention. RESULTS: Median time to most interventions improved over time but with more consistent improvement after the implementation of formal simulation and procedural training in November 2018. Median pretraining time for resuscitative thoracotomy was 14 minutes (IQR, 8-32 minutes); posttraining median time was 3 minutes (IQR, 2.7-8 minutes, p = 0.02). Median pretraining time to tube thoracostomy was 13 minutes (IQR, 5.5-19 minutes); posttraining time was 6 minutes (IQR, 4-31 minutes, p = 0.04). Pearson's coefficient (r) measured strength of correlation and was highest for tube thoracostomy followed by resuscitative thoracotomy and percutaneous sheath access with r values of 0.46, 0.35, and 0.24, respectively. CONCLUSION: High-complexity, routine procedural training, and trauma simulation are associated with decreased time to interventions within a short period of time. Routine implementation of a training program emphasizing efficient, effective approaches to bedside procedures is necessary to train our residents in these high-acuity, low-frequency situations. Future investigations are warranted in the effect of simulation on short-term and long-term patient outcomes. LEVEL OF EVIDENCE: Therapeutic, level III.


Assuntos
Internato e Residência/métodos , Treinamento por Simulação/métodos , Especialidades Cirúrgicas/educação , Tempo para o Tratamento/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Melhoria de Qualidade , Treinamento por Simulação/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
8.
Ann R Coll Surg Engl ; 102(2): 149-152, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31538799

RESUMO

INTRODUCTION: Surgeons are required to have a sound knowledge regarding all operating theatre equipment they wish to use. This is important to ensure patient safety and theatre efficiency. Arthroscopy forms a significant part of all orthopaedic subspecialty practice. Proficiency in performing arthroscopic procedures is assessed during registrar training. The aim of this survey was to determine the competence of orthopaedic trainee registrars in setting up the arthroscopy stack system and managing intraoperative problems. MATERIALS AND METHODS: Electronic survey forms were sent to all orthopaedic training programme directors in the UK to be forwarded to trainees in their deanery. The electronic survey contained 13 questions aimed at determining trainee experience and competence level with working with the arthroscopy stack system. RESULTS: A total of 138 responses were received from 14 deaneries in the UK. Almost all registrars had experienced intraoperative delays because of equipment malfunction that required addressing by more competent staff. However, 82% of respondents had not received any formal training for operating the arthroscopy stack system. Some 82% of registrars of ST7 grade or above, who had performed over 50 arthroscopic procedures and achieved a level 4 PBA competence, were unable to set up the stack system and successfully address these delays. CONCLUSIONS: Inadequate training is delivered to orthopaedic registrars from both the training programme and arthroscopy-themed courses with regards to set-up and operation of the arthroscopy tower system. This training should be part of the curriculum to ensure patient safety and efficient theatre practice.


Assuntos
Artroscopia/instrumentação , Competência Clínica , Currículo , Internato e Residência/estatística & dados numéricos , Ortopedia/educação , Artroscopia/educação , Simulação por Computador , Avaliação Educacional/estatística & dados numéricos , Humanos , Internato e Residência/métodos , Articulação do Joelho/cirurgia , Inquéritos e Questionários/estatística & dados numéricos , Reino Unido
9.
Urology ; 135: 28-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31628969

RESUMO

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


Assuntos
Currículo , Educação de Graduação em Medicina/métodos , Internato e Residência/métodos , Neoplasias Testiculares/diagnóstico , Urologia/educação , Adulto , Competência Clínica , Instrução por Computador/métodos , Educação de Graduação em Medicina/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina/estatística & dados numéricos , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia
10.
Ann Otol Rhinol Laryngol ; 129(2): 101-109, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31522512

RESUMO

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


Assuntos
Dissecação/educação , Internato e Residência/métodos , Laringe/cirurgia , Otolaringologia/educação , Acreditação , Currículo , Humanos , Microcirurgia/educação , Inquéritos e Questionários , Estados Unidos
11.
Am J Surg ; 219(1): 33-37, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30898304

RESUMO

INTRODUCTION: Our simulation center, supported by four departments (Surgery, OB/GYN, Urology, and Anesthesiology), is accredited as a comprehensive Accredited Educational Institute (AEI) and is now expanding to accommodate all departments on campus. METHODS: A 61-point questionnaire was administered to 44 stakeholders, representing all of UME and GME. Data were compared for AEI vs. non-AEI activities. RESULTS: Responses were collected from all 44 groups (100% response rate). Overall, 43 simulation activities were hosted within the AEI and 40 were hosted by non-AEI stakeholders. AEI activities were more likely to be mandatory (93% vs. 75%, p = 0.02), have written learning objectives (79% vs 43%, p < 0.001), and use validated assessment metrics (33% vs. 13%, p = 0.03). CONCLUSION: These data suggest that the AEI courses are more robust in terms of structured learning and assessment compared to non-AEI courses. Campus-wide application of uniform quality standards is anticipated to require significant faculty, course, and program development.


Assuntos
Academias e Institutos , Acreditação , Recursos em Saúde , Internato e Residência/métodos , Treinamento por Simulação/normas , Especialidades Cirúrgicas/educação , Inquéritos e Questionários , Estados Unidos
13.
Anesthesiology ; 132(1): 159-169, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31770142

RESUMO

BACKGROUND: Compassionate behavior in clinicians is described as seeking to understand patients' psychosocial, physical and medical needs, timely attending to these needs, and involving patients as they desire. The goal of our study was to evaluate compassionate behavior in patient interactions, pain management, and the informed consent process of anesthesia residents in a simulated preoperative evaluation of a patient in pain scheduled for urgent surgery. METHODS: Forty-nine Clinical Anesthesia residents in year 1 and 16 Clinical Anesthesia residents in year 3 from three residency programs individually obtained informed consent for anesthesia for an urgent laparotomy from a standardized patient complaining of pain. Encounters were assessed for ordering pain medication, for patient-resident interactions by using the Empathic Communication Coding System to code responses to pain and nausea cues, and for the content of the informed consent discussion. RESULTS: Of the 65 residents, 56 (86%) ordered pain medication, at an average of 4.2 min (95% CI, 3.2 to 5.1) into the encounter; 9 (14%) did not order pain medication. Resident responses to the cues averaged between perfunctory recognition and implicit recognition (mean, 1.7 [95% CI, 1.6 to 1.9]) in the 0 (less empathic) to 6 (more empathic) system. Responses were lower for residents who did not order pain medication (mean, 1.2 [95% CI, 0.8 to 1.6]) and similar for those who ordered medication before informed consent signing (mean, 1.9 [95% CI, 1.6 to 2.1]) and after signing (mean, 1.9 [95% CI, 1.6 to 2.0]; F (2, 62) = 4.21; P = 0.019; partial η = 0.120). There were significant differences between residents who ordered pain medication before informed consent and those who did not order pain medication and between residents who ordered pain medication after informed consent signing and those who did not. CONCLUSIONS: In a simulated preoperative evaluation, anesthesia residents have variable and, at times, flawed recognition of patient cues, responsiveness to patient cues, pain management, and patient interactions.


Assuntos
Anestesiologia/educação , Empatia , Consentimento Livre e Esclarecido/psicologia , Internato e Residência/métodos , Relações Médico-Paciente , Cuidados Pré-Operatórios/psicologia , Anestesiologia/métodos , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Masculino , Simulação de Paciente , Cuidados Pré-Operatórios/métodos
14.
Ann Otol Rhinol Laryngol ; 129(5): 462-468, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31845588

RESUMO

PURPOSE: Investigate if otolaryngology residency home programs (HP) are associated with advantages in National Resident Matching Program match compared to applicants without HPs. METHODS: Surveys were distributed to fourth-year medical students applying to otolaryngology residency (2015-2016 cycle) via OHNS (2015-2016) Applicants Closed Facebook Page and Otomatch. Applicant data analyzed included HP, United States Medical Licensing Examination (USMLE) scores, number of away rotations, and matching at top choice. RESULTS: Applicants were grouped: (1) HP, (2) no HP but have ENT staff (staff), and (3) no HP or staff (none). Ninety-five percent of survey participants matched into otolaryngology (n = 62). A sub-analysis of match preference among matching applicants revealed 63% of participants with HP matched to their first choice compared to 56% (staff) and 14% (none) (P = .058). Match rate between those with any staff (HP or staff) versus those without was statistically significant (P = .037). Applicants without HPs went on more away rotations than students with HPs (mean: 2.5 ± 0.5 vs 1.7 ± 0.07, P = .0002). No statistical significance was seen between applicants with/without HP in regards to USMLE scores, publications, or number of interviews. CONCLUSION: Applicants applying to otolaryngology residency without HPs are as competitive as those who have HPs. However, without HPs, applicants tend to participate in more away rotations and are less likely to match at their top choice.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Otolaringologia/educação , Estudantes de Medicina , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos
15.
J Pediatr Orthop ; 40(1): e6-e13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30969197

RESUMO

BACKGROUND: Most distal radius fractures can be treated with closed reduction and casting in pediatric patients. These skills are traditionally developed treating real patients, however, there is growing interest in the use of simulation training to supplement traditional learning strategies. METHODS: Seventy-eight children with distal radius fractures that underwent closed reduction and casting by novice orthopaedic surgery residents were retrospectively reviewed. Radiographic measures of patients treated by simulation-trained residents were compared with patients treated by residents without simulation training. RESULTS: Patients treated by simulation-trained residents had less residual angulation in the anteroposterior radiograph (3.7 vs. 6.3 degrees, P=0.006) and translation on the lateral (14% vs. 21%, P=0.040) and anteroposterior radiograph (10% vs. 16%, P=0.029). Patients treated by simulation-trained residents also had lower rates of redisplacement (50% vs. 79%, P=0.016). CONCLUSIONS: Loss of reduction is common, particularly when novice trainees perform their first independent reductions. Residents who underwent simulation training had lower rates of loss of reduction, thus simulation training has potential as a supplement to the traditional apprentice model of medical education. LEVEL OF EVIDENCE: Level III.


Assuntos
Redução Fechada/educação , Internato e Residência/métodos , Ortopedia/educação , Fraturas do Rádio/cirurgia , Treinamento por Simulação , Moldes Cirúrgicos , Criança , Feminino , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
16.
Am J Surg ; 219(1): 191-196, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31208624

RESUMO

BACKGROUND: With the rapid growth of robotic-assisted surgery, surgical educators recognize the need to develop appropriate curriculum for trainees. However, the unique robotic learning environment challenges educators to determine the most appropriate ways to instruct surgical residents. The purpose of this study was to characterize the instructional techniques used in the robotic teaching environment by observing attending surgeon's language and behaviors during resident robotic dissection. STUDY DESIGN: Attending robotic surgeons guided senior residents through robotic dissection of live porcine tissue. Three observers documented the language, gestures and behaviors occurring at three different stations, and at a fourth station, they obtained video and audio recordings of the instructional interaction. Afterwards, instructors and residents met in separate focus groups. The authors used qualitative content analysis to summarize the type and frequency of teaching behaviors and focus group information to clarify the analysis. We compared the frequency of the behaviors to an existing taxonomy of 16 operative teaching behaviors in open and laparoscopic surgery. RESULTS: Robotic instructors used 11 of the 16 behaviors previously described for surgical instruction. Frequency of use differed in the robotic environment due to relevance and application of new techniques. New, unique robotic teaching behaviors involved disengaging the resident from the operative console for either onscreen direction or for gesturing with verbal instruction. Focus group participants highlighted these behaviors as essential. CONCLUSION: Robotic instruction uses a different set of instructional approaches compared to open and laparoscopic surgery. New teaching behaviors emerged driven by physical separation within the robotic environment. Robotic faculty development should emphasize these unique features.


Assuntos
Internato e Residência/métodos , Procedimentos Cirúrgicos Robóticos/educação , Especialidades Cirúrgicas/educação
18.
Plast Reconstr Surg ; 144(5): 1227-1236, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688771

RESUMO

BACKGROUND: Plastic surgery trainees who wish to start a family face challenges. This is the first study to collect data directly from residents and fellows to understand issues surrounding childbearing and to propose solutions. METHODS: Following institutional review board approval, an anonymous survey was distributed to all current plastic surgery residents and fellows in the United States. Data regarding demographics, obstetrical complications, parental leave, breastfeeding, and use of assisted reproductive technology were collected. RESULTS: The survey was completed by 307 trainees, for a resident response rate of 27.0 percent. Mean age of the respondents was 31.7 ± 3.8 years, 58.6 percent were married, and 35.3 percent reported at least one pregnancy for themselves or for their partner. Both male (67.4 percent) and female (76.5 percent) respondents intentionally postponed having children because of career. Women were significantly more likely to report negative stigma attached to pregnancy (70.4 percent versus 51.1 percent; p = 0.003) and plan to delay childbearing until after training. Fifty-six percent of female trainees reported an obstetrical complication. Assisted reproductive technology was used by 19.6 percent of trainees. Mean maternity leave was 5.5 weeks, with 44.4 percent taking less than 6 weeks. Mean paternity leave was 1.2 weeks. Sixty-two percent of women and 51.4 percent of men reported dissatisfaction with leave. Sixty-one percent of female trainees breastfed for 6 months and 19.5 percent continued for 12 months. Lactation facilities were available near operating rooms for 29.4 percent of respondents. CONCLUSIONS: Plastic surgery training may negatively impact fertility, obstetrical health, and breastfeeding practices. The data presented in this article provide the groundwork for identifying areas of concern and potential solutions.


Assuntos
Escolha da Profissão , Educação de Pós-Graduação em Medicina/organização & administração , Serviços de Planejamento Familiar/métodos , Licença Parental/normas , Médicas/estatística & dados numéricos , Cirurgia Plástica/educação , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Internato e Residência/métodos , Masculino , Saúde Materna , Determinação de Necessidades de Cuidados de Saúde , Licença Parental/tendências , Gravidez , Fatores de Risco , Fatores de Tempo , Estados Unidos
19.
West J Emerg Med ; 20(6): 893-902, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31738716

RESUMO

INTRODUCTION: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. METHODS: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. RESULTS: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. CONCLUSION: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.


Assuntos
Educação de Graduação em Medicina/métodos , Medicina de Emergência/educação , Serviço Hospitalar de Emergência , Internato e Residência/métodos , Desempenho de Papéis , Treinamento por Simulação/métodos , Revelação da Verdade , Adulto , Comunicação , Currículo , Feminino , Humanos , Masculino , Relações Profissional-Família , Autoeficácia , Método Simples-Cego
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