RESUMO
OBJECTIVE: To determine the relationship between race/ethnicity and case volume among graduating surgical residents. BACKGROUND: Racial/ethnic minority individuals face barriers to entry and advancement in surgery; however, no large-scale investigations of the operative experience of racial/ethnic minority residents have been performed. METHODS: A multi-institutional retrospective analysis of the Accreditation Council for Graduate Medical Education case logs of categorical general surgery residents at 20 programs in the US Resident OPerative Experience Consortium database was performed. All residents graduating between 2010 and 2020 were included. The total, surgeon chief, surgeon junior, and teaching assistant case volumes were compared between racial/ethnic groups. RESULTS: The cohort included 1343 residents. There were 211 (15.7%) Asian, 65 (4.8%) Black, 73 (5.4%) Hispanic, 71 (5.3%) "Other" (Native American or Multiple Race), and 923 (68.7%) White residents. On adjusted analysis, Black residents performed 76 fewer total cases (95% CI, -109 to -43, P <0.001) and 69 fewer surgeon junior cases (-98 to -40, P <0.001) than White residents. Comparing adjusted total case volume by graduation year, both Black residents and White residents performed more cases over time; however, there was no difference in the rates of annual increase (10 versus 12 cases per year increase, respectively, P =0.769). Thus, differences in total case volume persisted over the study period. CONCLUSIONS: In this multi-institutional study, Black residents graduated with lower case volume than non-minority residents throughout the previous decade. Reduced operative learning opportunities may negatively impact professional advancement. Systemic interventions are needed to promote equitable operative experience and positive culture change.
Assuntos
Cirurgia Geral , Internato e Residência , Humanos , Estudos Retrospectivos , Etnicidade , Competência Clínica , Grupos Minoritários , Educação de Pós-Graduação em Medicina , Cirurgia Geral/educaçãoRESUMO
OBJECTIVE: To examine differences in resident operative experience between male and female general surgery residents. BACKGROUND: Despite increasing female representation in surgery, sex and gender disparities in residency experience continue to exist. The operative volume of male and female general surgery residents has not been compared on a multi-institutional level. METHODS: Demographic characteristics and case logs were obtained for categorical general surgery graduates between 2010 and 2020 from the US Resident OPerative Experience Consortium database. Univariable, multivariable, and linear regression analyses were performed to compare differences in operative experience between male and female residents. RESULTS: There were 1343 graduates from 20 Accreditation Council for Graduate Medical Education-accredited programs, and 476 (35%) were females. There were no differences in age, race/ethnicity, or proportion pursuing fellowship between groups. Female graduates were less likely to be high-volume residents (27% vs 36%, P < 0.01). On univariable analysis, female graduates performed fewer total cases than male graduates (1140 vs 1177, P < 0.01), largely due to a diminished surgeon junior experience (829 vs 863, P < 0.01). On adjusted multivariable analysis, female sex was negatively associated with being a high-volume resident (OR = 0.74, 95% CI: 0.56 to 0.98, P = 0.03). Over the 11-year study period, the annual total number of cases increased significantly for both groups, but female graduates (+16 cases/year) outpaced male graduates (+13 cases/year, P = 0.02). CONCLUSIONS: Female general surgery graduates performed significantly fewer cases than male graduates. Reassuringly, this gap in operative experience may be narrowing. Further interventions are warranted to promote equitable training opportunities that support and engage female residents.
Assuntos
Cirurgia Geral , Internato e Residência , Cirurgiões , Humanos , Masculino , Feminino , Competência Clínica , Educação de Pós-Graduação em Medicina , Etnicidade , Cirurgia Geral/educaçãoRESUMO
BACKGROUND: The Fundamentals of Endoscopic Surgery (FES) certification has recently been mandated by the American Board of Surgery but best methods for preparing for the exam are lacking. Our previous work demonstrated a 40% pass rate for PGY5 residents in our program. The purpose of this study was to determine the effectiveness of a proficiency-based skills and cognitive curriculum for FES certification. METHODS: Residents who agreed to participate (n = 15) underwent an orientation session, followed by skills pre-testing using three previously described models (Trus, Operation targeting task, and Kyoto) as well as the actual FES skills exam (vouchers provided by the FES committee). Participants then trained to proficiency on all three models for the skills curriculum and completed the FES online didactic material for the cognitive curriculum. Finally, participants post-tested on the models and took the actual FES certification exam. Values are mean ± SD; p < 0.05 was considered significant. RESULTS: Of 15 residents who participated, 8 (53%) passed the FES skills exam at baseline. Participants required 2.7 ± 1.3 h to achieve proficiency on the models and approximately 3 h to complete the cognitive curriculum. At post-test, 14 (93%, vs. pre-test 53%, p = 0.041) passed the FES skills exam. 14 (93%) passed the FES cognitive exam and 13/15 (87%) passed both the skills and cognitive exam and achieved FES certification. CONCLUSIONS: Our traditional clinical endoscopy curricula were not sufficient for senior residents to pass the FES exam. Implementation of a proficiency-based flexible endoscopy curriculum using bench-top models and the FES online materials was feasible and effective for the majority of learners. Importantly, with a modest amount of additional training, 87% of our trainees were able to pass the FES examination, which represents a significant improvement for our program. We expect that additional refinements of this curriculum may yield even better results for preparing future residents for the FES examination.
Assuntos
Certificação/normas , Competência Clínica/normas , Currículo , Endoscopia/educação , Cirurgia Geral/educação , Internato e Residência/métodos , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: The purpose of this study was to assess the adequacy of current surgical residency and gastroenterology (GI) fellowship flexible endoscopy training as measured by performance on the FES examination. METHODS: Fifth-year general surgery residents and GI fellows across six institutions were invited to participate. All general surgery residents had met ACGME/ABS case volume requirements as well as additional institution-specific requirements for endoscopy. All participants completed FES testing at the end of their respective academic year. Procedure volumes were obtained from ACGME case logs. Curricular components for each specialty and institution were recorded. RESULTS: Forty-eight (28 surgery and 20 GI) trainees completed the examination. Average case numbers for residents were 76 ± 26 colonoscopies and 45 ± 12 EGDs. Among GI fellows, PGY4 s (N = 10) reported 99 ± 64 colonoscopies and 147 ± 79 EGDs. PGY5 s (N = 3) reported 462 ± 307 colonoscopies and 411 ± 260 EGDs. PGY6 GI fellows (N = 7) reported 515 ± 111 colonoscopies and 418 ± 146 EGDs. The overall pass rate for all participants was 75 %, with 68 % of residents and 85 % of fellows passing both the cognitive and skills components. For surgery residents, pass rates were 75 % for manual skills and 85.7 % for cognitive. On the skills examination, Task 2 (loop reduction) was associated with the lowest performance. Skills scores correlated with both colonoscopy (r = 0.46, p < 0.001) and EGD experience (r = 0.46, p < 0.001). Receiver operating characteristics curves were examined among the resident cohort. The minimum number of total cases associated with passing the FES skills component was 103. Significant variability existed in curricular components across institutions. DISCUSSION: These data suggest that current flexible endoscopy training may not be sufficient for all trainees to pass the examination. Implementing additional components of the FEC may prove beneficial in achieving more uniform pass rates on the FES examination.
Assuntos
Competência Clínica , Avaliação Educacional , Endoscopia Gastrointestinal/educação , Internato e Residência , Currículo , Bolsas de Estudo , Gastroenterologia/educação , Cirurgia Geral/educação , Humanos , TexasRESUMO
BACKGROUND: Despite numerous efforts to ensure that surgery residents are adequately trained in the areas of laparoscopy and flexible endoscopy, there remain significant concerns that graduates are not comfortable performing many of these procedures. METHODS: Online surveys were sent to surgery residents (98 items, PGY1-5 Categorical) and faculty (78 items, general surgery, and gastrointestinal specialties) at seven institutions. De-identified data were analyzed under an IRB-approved protocol. RESULTS: Ninety-five faculty and 121 residents responded, with response rates of 65 and 52 %, respectively. Seventy-three percent of faculty indicated that competency of their graduating residents were dramatically or slightly worse than previous graduates. Only 29 % of graduating residents felt very comfortable performing advanced laparoscopic (AL) cases and 5 % performing therapeutic endoscopy (TE) cases immediately after graduation. Over half of interns expressed a need for fellowship to feel comfortable performing AL and TE procedures, and this need did not decrease as residents neared graduation. For these procedures, residents receive only "little to some" autonomy, as reported by both faculty and PGY5s. Residents reported that current curricula for laparoscopy and endoscopy consist primarily of clinical experience. Both residents and faculty, though, reported considerable value in other training modalities, including simulations, live animal laboratories, cadavers, and additional didactics. CONCLUSIONS: These data indicate that both residents and faculty perceive significant competency gaps for both laparoscopy and flexible endoscopy, with the most notable shortcomings for advanced and therapeutic cases, respectively. Improvement in resident training methods in these areas is warranted.
Assuntos
Competência Clínica/normas , Endoscopia/normas , Bolsas de Estudo/normas , Cirurgia Geral/educação , Internato e Residência/normas , Laparoscopia/normas , Currículo/normas , HumanosRESUMO
INTRODUCTION: This study aimed to develop a training curriculum to evaluate the basic robotic skills necessary to reach an 80 % preset proficiency score and correlate the level of surgical experience with the overall performance obtained using the da Vinci Surgical Skills simulator. METHODS: Twenty-two participants (4 faculty, 4 senior, and 14 junior residents) were enrolled in a 4-week robotic training curriculum developed at our institution. A set of seven robotic skills were selected based on the manufacturer's exercise primary endpoint. During their pretesting session, participants completed one trial of each of the seven simulated exercises. In two individual sessions over a 2 week period, trainees practiced a different set of exercises that evaluated the same basic robotic skills assessed during pretesting with the objective of reaching an overall score of 80 % on two consecutive attempts. If proficiency was not achieved, then a maximum of six trials per exercise was allowed before advancing to the next skill. During their fourth week of training, participants completed a post-testing session with the same set of exercises used during pretesting. Participants' overall performance and various metrics were recorded in an online database for further analysis. RESULTS: A significant skills gain from pre- to post-test was observed for each of the seven basic robotic skills regardless of participant's level of training (p < .001). Interestingly, participants only achieved an overall score of 80 % or more in only five of the seven exercises. No statistical difference in gain of skills was found between groups suggesting robotic skills development is independent of level of prior surgical expertise. CONCLUSION: A dedicated virtual reality robotic training curriculum significantly improves the seven basic robotic surgical skills necessary to operate the da Vinci Si surgical console. Six training trials appear to be insufficient to reach proficiency levels on more advanced skills.
Assuntos
Simulação por Computador , Currículo , Procedimentos Cirúrgicos Robóticos/educação , Adulto , Feminino , Cirurgia Geral/educação , Humanos , Internato e Residência , Masculino , Texas , Adulto JovemRESUMO
BACKGROUND: Prior analyses of general surgery resident case logs have indicated a decline in the number of endocrine procedures performed during residency. This study aimed to identify factors contributing to the endocrine operative experience of general surgery residents and compare those who matched in endocrine surgery fellowship with those who did not. METHODS: We analyzed the case log data of graduates from 18 general surgery residency programs in the US Resident Operative Experience Consortium over an 11-year period. RESULTS: Of the 1,240 residents we included, 17 (1%) matched into endocrine surgery fellowships. Those who matched treated more total endocrine cases, including more thyroid, parathyroid, and adrenal cases, than those who did not (81 vs 37, respectively, P < .01). Program-level factors associated with increased endocrine volume included endocrine-specific rotations (+10, confidence interval 8-12, P < .01), endocrine-trained faculty (+8, confidence interval 7-10, P < .01), and program co-location with otolaryngology residency (+5, confidence interval 2 -8, P < .01) or endocrine surgery fellowship (+4, confidence interval 2-6, P < .01). Factors associated with decreased endocrine volume included bottom 50th percentile in National Institute of Health funding (-10, confidence interval -12 to -8, P < .01) and endocrine-focused otolaryngologists (-3, confidence interval -4 to -1, P < .01). CONCLUSION: Several characteristics are associated with a robust endocrine experience and pursuit of an endocrine surgery fellowship. Modifiable factors include optimizing the recruitment of dedicated endocrine surgeons and the inclusion of endocrine surgery rotations in general surgery residency.
Assuntos
Procedimentos Cirúrgicos Endócrinos , Cirurgia Geral , Internato e Residência , Cirurgiões , Humanos , Bolsas de Estudo , Cirurgia Geral/educação , Educação de Pós-Graduação em Medicina/métodos , Competência ClínicaRESUMO
BACKGROUND: Certification in fundamentals of laparoscopic surgery (FLS) is required by the American board of surgery for graduating residents. This study aimed to evaluate the feasibility and need for certifying practicing surgeons and to assess proficiency of operating room (OR) personnel. METHODS: Through a patient safety and health care delivery effectiveness grant, investigators at four state medical schools received funding for FLS certification of all attending surgeons and OR personnel credentialed in laparoscopy. Data were voluntarily collected under an institutional review board-approved protocol. Surgeons performed a single repetition of the FLS tasks oriented to the FLS proficiency-based curriculum and online cognitive materials and were encouraged to self-practice. The FLS certification examination was administered 2 months later under standard conditions. Operating room nurses and scrub technicians were enrolled in a curriculum with cognitive materials and a multistation skills practicum. Baseline and completion questionnaires were administered. Performance was assessed using signed-rank and χ(2) analysis. RESULTS: The study aimed to enroll 99 surgeons. Subsequently, 87 surgeons completed at least one portion of the curriculum, 72 completed the entire curriculum (73% compliance), 83 completed the baseline skills assessment, and 27 (33%) failed. The self-reported practice time was 3.7 ± 2.5 h. At certification (n = 76), skills performance had improved from 317 ± 102.9 to 402 ± 54.2 (p < 0.0001). One surgeon (1.3%) failed the skills certification, and nine (11.8%) failed the cognitive exam. Remediation was completed by six surgeons. Of the 64 enrolled OR personnel, 22 completed the curriculum (34% compliance). All achieved proficiency at skills, and 60% passed the cognitive exam. CONCLUSIONS: This study demonstrated that FLS certification for practicing surgeons and proficiency verification for OR personnel are feasible. A baseline skills failure rate of 33% and a certification failure rate of 13% suggest that FLS certification may be necessary to ensure surgeon competency. Fortunately, with only moderate practice, significant improvement can be achieved.
Assuntos
Certificação , Competência Clínica/normas , Educação Médica Continuada/métodos , Cirurgia Geral/educação , Laparoscopia/educação , Corpo Clínico Hospitalar/educação , Atitude do Pessoal de Saúde , Educação Baseada em Competências/métodos , Estudos de Viabilidade , Feminino , Cirurgia Geral/normas , Humanos , Laparoscopia/normas , Masculino , Corpo Clínico Hospitalar/normas , Pessoa de Meia-Idade , Salas Cirúrgicas , TexasRESUMO
OBJECTIVES: The Oxford English Dictionary defines "intern" as "a student or trainee who works, sometimes without pay, at a trade or occupation in order to gain work experience." In the medical realm, the label "intern" may introduce confusion as well as implicit and explicit bias. In this study, we sought to examine the general public's perception of the label "intern" compared to the more accurate label "first-year resident." DESIGN: We developed 2 forms of a 9-item survey that assessed an individual's level of comfort with surgical trainees' participation in various aspects of surgical care and knowledge of medical education and work environment. One form used the label "intern" and the other used "first-year resident." SETTING: San Antonio, TX. PARTICIPANTS: A total of 148 adults in the general population at 3 local parks on 3 separate occasions. RESULTS: A total of 148 individuals completed the survey (74 per form). Respondents who did not work in the medical field reported less comfort with interns vs first-year residents participating in various aspects of their care. Only 36% of respondents were able to correctly identify which surgical team members have completed a medical degree. Directly assessing perceptual incongruity between the labels "intern" and "first-year resident," 43% of respondents said interns have a medical degree compared to 59% for first-year residents (pâ¯=â¯0.008), 88% stated that interns work full-time in the hospital compared to 100% for first-year residents (pâ¯=â¯0.041), and 82% stated that interns get paid for their work in the hospital compared to 97% for first-year residents (pâ¯=â¯0.047). CONCLUSIONS: The label "intern" may confuse patients, family members, and perhaps other healthcare professionals regarding the level of experience and knowledge of first-year residents. We advocate for abolishing the term "intern" and replacing it with "first-year resident" or simply "resident."
Assuntos
Educação Médica , Internato e Residência , Estudantes de Medicina , Adulto , Humanos , Hospitais , Inquéritos e QuestionáriosAssuntos
Anastomose Cirúrgica/educação , Competência Clínica/estatística & dados numéricos , Educação Baseada em Competências , Microcirurgia/educação , Microvasos/cirurgia , Treinamento por Simulação , Procedimentos Cirúrgicos Vasculares/educação , Currículo , Humanos , Internato e Residência , Reprodutibilidade dos Testes , Silicones , Treinamento por Simulação/métodos , Técnicas de Sutura , Análise e Desempenho de Tarefas , Procedimentos Cirúrgicos Vasculares/normasRESUMO
INTRODUCTION: We explored the impact of implementing structured interviews and associated interviewer education on interrater agreement within a large academic residency program. METHODS: Faculty and senior resident interviewers from a large academic residency program participated in a 3-hour structured interview course. Before and after the course, participants completed a 15-item assessment pertaining to the characteristics, logistics, and guidelines associated with structured interviews. Along with interviewer training, interview day logistics also changed from an unstructured format (no specific questions, one overall 1-9 rating scale) to a structured interview format, including incorporation of behavioral-based competency questions that would be asked of every applicant and behavioral anchored rating scales (1-10; 10â¯=â¯highest). Interrater agreement was assessed via intraclass correlation coefficients (ICC1) for the 2 years before and 2 years after incorporation of the structured interview format. RESULTS: A total of 45 faculty and resident interviewers participated in the course in 2018. Participant knowledge significantly increased from an average of 36% to 79% after the course (p < 0.01). Prior to the intervention, overall interrater agreement was "poor" to "fair," with an ICC1 of 0.51 in 2016 and 0.49 in 2017. After the structured interview intervention, overall agreement increased to the "good" level with an ICC1 of 0.71 in 2018 and 0.66 in 2019. The proportion of applicants who received interview scores with at least 2 ratings more than 2 points apart significantly decreased from 59% to 47% after the intervention (p < 0.01). CONCLUSIONS: Incorporating an interviewer educational session and a structured interview format into residency selection can help increase agreement in ratings between interviewers. However, these data suggest that ongoing refresher trainings may be needed to maintain acceptable levels of interrater agreement.
Assuntos
Internato e Residência , Humanos , Educação de Pós-Graduação em MedicinaRESUMO
Background: Leaders in surgery have posited that passion for the surgery profession is diminishing among entering trainees, and that its scarcity is related to the high levels of attrition observed in general surgery training. This study explores trends in passion for the profession among applicants to general surgery training. Methods: Applicants to a large midwestern academic general surgery program were invited to complete a voluntary, anonymous 12-item Passion for Surgery Index (PSI) as part of their supplementary application package during the 2020-2021 and 2021-2022 residency selection seasons. The PSI is adapted from a generic work-related passion index and is based on the dualistic model of passion, organizing scores into harmonious passion and consuming passion. Applicants completed the index on a stand-alone website which automatically generated results pertaining to overall passion, harmonious passion, and consuming passion for the surgery profession. Applicants were provided with their results and provided feedback. Results: Sixty-one percent (871/1428) of invited applicants completed the PSI. Approximately 67.4% (N = 587) of these applicants reported an overall high level of passion for surgery, while 31.1% (N = 271) reported a moderate level and the remaining 1.5% (N = 13) reported a low level. When comparing the two different types of passion, the vast majority of applicants (92.8%; N = 808) reported a high level of harmonious passion and only 7.1% (N = 62) reported a moderate level of harmonious passion. The results for consuming passion were much more varied, with 36.9% (N = 321) reporting a high level, 47.5% (N = 414) reporting a moderate level, and 15.6% (N = 136) reporting a low level of consuming passion for the profession. Discussion: These results suggest that there is substantial variation in passion for the profession among those pursuing a career in surgery. While the majority of applicants reported a high level of harmonious passion for surgery, less than half of applicants reported a high level of consuming passion for surgery. This variability in consuming passion among entering trainees is concerning, as individuals with low or only moderate passion for the profession may not have the motivation or drive to persist in demanding training environments.
RESUMO
OBJECTIVE: As USMLE Step 1 moves to pass/fail, residency programs are seeking alternate interview selection processes. Attrition in general surgery is reported as high as 26%. Thus, it is important to ensure that programs are selecting and matching applicants with shared values. Situational judgment tests (SJTs) measure educational and cultural values by posing ambiguous situations and individuals rate the effectiveness of possible reactions. SJTs have previously been shown to identify job applicants with shared values while promoting diversity. Scoring categories are high, moderate, or low values congruence. We sought to explore predictive validity of the SJT relative to program attrition. DESIGN: Residents who matched into our program between 2018 and 2021 completed the SJT. We tracked attrition. SETTING: UT Health San Antonio, Texas PARTICIPANTS: Fifty-six categorical general surgery residents RESULTS: Per SJT ratings, the numbers of residents who had high, moderate, and low values congruence were 27, 16, and 13, respectively. Attrition numbers for residents who scored high and moderate congruence were similar, indicating that these ratings were indistinguishable. As such, we combined those 2 categories to create a 2â¯×â¯2 matrix and used signal detection theory as a framework for analysis. Overall attrition was 16.1% (9/56). Of the 43 residents who scored high or moderate congruence, 90.7% remained in the program. There was a 9.3% chance of attrition for these residents. Of the 13 residents who scored low congruence, 38.5% attrited. While scoring as low congruence on the SJT does not definitively indicate attrition, it does indicate that attrition is 4.14 times more likely for these residents (chi-square, p = 0.0121). CONCLUSIONS: One of the most important aspects of residency applicant selection and interviewing is mitigating risk by identifying applicants who carry a high risk of attrition. The SJT significantly identifies at-risk applicants.
Assuntos
Internato e Residência , Humanos , Julgamento , Pesquisa , Escolaridade , TexasRESUMO
INTRODUCTION: Training programs are now more than ever seeking ways to promote recruitment and retention of a diverse resident workforce. The goal of this study was to examine how gender and ethnic identities affect applicant attraction to surgery training programs. METHODS: Applicants to general surgery residency in 2018 to 2019 completed a 31-item assessment measuring preferences for training program characteristics and attributes. Differences in preferences across candidate gender and ethnicity were investigated. Factor analyses and analysis of variance (ANOVA) were used to explore these differences. RESULTS: 1491 unique applicants to 7 residency programs completed the assessment, representing 67% of all applicants to general surgery during the 2018 to 2019 season. Women preferred training programs that had high levels of social support (p < 0.001), were less traditional (p < 0.001), and with less turbulence (p < 0.05). Non-white candidates reported greater preference for programs with higher levels of established academics (p < 0.001), clinical experiences (p < 0.001), social support (p < 0.05), traditionalism (p < 0.001), flexibility (p < 0.001), and innovation (p < 0.001). CONCLUSIONS: Organizational efforts to attract and retain a diverse workforce may benefit from considering the aspects of work that align with female and underrepresented minority preferences.
Assuntos
Internato e Residência , Beleza , Etnicidade , Feminino , Humanos , Grupos Minoritários , Recursos HumanosRESUMO
BACKGROUND: There is concern regarding the competency of today's general surgery graduates as a large proportion defer independent practice in favor of additional fellowship training. Little is known about the graduates who directly enter general surgery practice and if their operative experiences during residency differ from graduates who pursue fellowship. METHODS: Nineteen Accreditation Council for Graduate Medical Education-accredited general surgery programs from the US Resident OPerative Experience Consortium were included. Demographics, career choice, and case logs from graduates between 2010 to 2020 were analyzed. RESULTS: There were 1,264 general surgery residents who graduated over the 11-year period. A total of 248 (19.6%) went directly into practice and 1,016 (80.4%) pursued fellowship. Graduates directly entering practice were more likely to be a high-volume resident (43.1% vs 30.5%, P < .01) and graduate from a high-volume program (49.2% vs 33.0%, P < .01). Direct-to-practice graduates performed 53 more cases compared with fellowship-bound graduates (1,203 vs 1,150, P < .01). On multivariable analysis, entering directly into practice was positively associated with total surgeon chief case volume (odds ratio = 1.47, 95% confidence interval 1.18-1.84, P < .01) and graduating from a US medical school (odds ratio = 2.54, 95% confidence interval 1.45-4.44, P < .01) while negatively associated with completing a dedicated research experience (odds ratio = 0.31, 95% confidence interval 0.22-0.45, P < .01). CONCLUSION: This is the first multi-institutional study exploring resident operative experience and career choice. These data suggest residents who desire immediate practice can tailor their experience with less research time and increased operative volume. These data may be helpful for programs when designing their experience for residents with different career goals.
Assuntos
Internato e Residência , Acreditação , Escolha da Profissão , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Humanos , Estados UnidosRESUMO
PURPOSE: Use of the United States Medical Licensing Examination (USMLE) for residency selection has been criticized for its inability to predict clinical performance and potential bias against underrepresented minorities (URMs). This study explored the impact of altering traditional USMLE cutoffs and adopting more evidence-based applicant screening tools on inclusion of URMs in the surgical residency selection process. METHOD: Multimethod job analyses were conducted at 7 U.S. general surgical residency programs during the 2018-2019 application cycle to gather validity evidence for developing selection assessments. Unique situational judgment tests (SJTs) and scoring algorithms were created to assess applicant competencies and fit. Programs lowered their traditional USMLE Step 1 cutoffs and invited candidates to take their unique SJT. URM status (woman, racial/ethnic minority) of candidates who would have been considered for interview using traditional USMLE Step 1 cutoffs was compared with the candidate pool considered based on SJT performance. RESULTS: A total of 2,742 general surgery applicants were invited to take an online SJT by at least 1 of the 7 programs. Approximately 35% of applicants who were invited to take the SJT would not have met traditional USMLE Step 1 cutoffs. Comparison of USMLE-driven versus SJT-driven assessment results demonstrated statistically different percentages of URMs recommended, and including the SJT allowed an average of 8% more URMs offered an interview invitation (P < .01). CONCLUSIONS: Reliance on USMLE Step 1 as a primary screening tool precludes URMs from being considered for residency positions at higher rate than non-URMs. Developing screening tools to measure a wider array of candidate competencies can help create a more equitable surgical workforce.
Assuntos
Diversidade Cultural , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Seleção de Pacientes , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Cirurgia Geral/estatística & dados numéricos , Humanos , Internato e Residência/métodos , Internato e Residência/normas , Internato e Residência/tendências , Licenciamento em Medicina/tendências , Estados UnidosRESUMO
BACKGROUND: General surgery is the fastest growing field in the adoption of robotic assisted laparoscopic surgery. Here, we present the results of one institution's experience in training surgical residents in robotic assisted transabdominal preperitoneal inguinal hernia repairs. METHODS: Data were prospectively collected on patients undergoing robotic assisted laparoscopic inguinal hernia repair with residents. Data points included patient age, gender, complications, hernia difficulty, resident technical competency as measured by GEARS, Zwisch scores, operative time, and the number of robotic console cases reported by residents as primary surgeon. RESULTS: Residents who performed >30 robotic cases had significantly higher mean modified GEARS scores (pâ¯≤â¯.002). Residents who completed 10 or fewer robotic cases achieved significantly lower mean modified GEARS and Zwisch scores than those who completed 11 or more (pâ¯<â¯.001). CONCLUSIONS: Resident competency and autonomy improve with increasing total robotic case load. Attending surgeons grant more autonomy to residents with higher competency scores.
Assuntos
Competência Clínica , Hérnia Inguinal/cirurgia , Herniorrafia/educação , Autonomia Profissional , Procedimentos Cirúrgicos Robóticos/educação , Adulto , Análise de Variância , Bases de Dados Factuais , Educação de Pós-Graduação em Medicina/métodos , Feminino , Herniorrafia/métodos , Humanos , Internato e Residência/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Estatísticas não Paramétricas , Telas Cirúrgicas , Resultado do TratamentoRESUMO
INTRODUCTION: We describe a multimethod, multi-institutional approach documenting future competencies required for entry into surgery training. METHODS: Five residency programs involved in a statewide collaborative each provided 12 to 15 subject matter experts (SMEs) to participate. These SMEs participated in a 1-hour semistructured interview with organizational psychologists to discuss program culture and expectations, and rated the importance of 20 core competencies derived from the literature for candidates entering general surgery training within the next 3 to 5 years (1â¯=â¯importance decreases significantly; 3â¯=â¯importance stays the same; 5â¯=â¯importance increases significantly). RESULTS: Seventy-three SMEs across 5 programs were interviewed (77% faculty; 23% resident). All competencies were rated to be more important in the next 3 to 5 years, with team orientation (3.87 ± 0.81), communication (3.82 ± 0.79), team leadership (3.81 ± 0.82), feedback receptivity (3.79 ± 0.76), and professionalism (3.76 ± 0.89) rated most highly. CONCLUSIONS: These findings suggest that the competencies desired and required among future surgery residents are likely to change in the near future.
Assuntos
Cirurgia Geral , Internato e Residência , Competência Clínica , Avaliação Educacional , Retroalimentação , Cirurgia Geral/educação , MotivaçãoRESUMO
OBJECTIVE: Determine whether an educational video can improve surgical inpatients' attitudes toward resident participation in their care. METHODS: Patients admitted to the Trauma/Emergency General Surgery Service at University Hospital (San Antonio, Texas) were randomly divided into control and intervention groups. Patients in the intervention group viewed a short educational video about the role and responsibilities of medical students, residents, and attending surgeons. All patients then completed a previously published survey. RESULTS: A total of 140 patients responded to the survey (controlâ¯=â¯81 and interventionâ¯=â¯59 patients). Overall, 86.4% of patients were welcoming of resident participation. Patients who were expecting residents to be involved in their care had attitudes that are more favorable on almost all survey questions regardless of their study condition. However, patients in the intervention group who expected resident involvement in their care had more favorable attitudes about senior residents (postgraduate year 3-5) assisting in routine or complicated surgery than those in the control group who were expecting resident involvement (both p ≤ 0.001). This same group of patients also had more favorable attitudes about surgical outcomes and overall surgical health when residents are involved (pâ¯=â¯0.004, pâ¯=â¯0.001, respectively). Most patients (79%) said they had no residents previously involved in their care, or they were unsure if residents were previously involved. CONCLUSIONS: Patient expectation of resident involvement is one of the most important factors influencing perceptions of inpatients about resident participation in surgery. Our goal should be early and frequent discussion with patients about resident involvement in order to foster an atmosphere of trust, including full transparency regarding resident involvement in surgical procedures. An educational video may help introduce the roles of trainees and attending surgeons but should not be used in lieu of direct discussion with patients.
Assuntos
Cirurgia Geral , Internato e Residência , Atitude , Educação de Pós-Graduação em Medicina , Cirurgia Geral/educação , Humanos , Pacientes Internados , Motivação , TexasRESUMO
OBJECTIVE: Describe an online system used to collect data, compute statistics, and provide reports for mock oral examinations. DESIGN: Forty general surgery residents, program directors, and faculty serving as examiners completed a survey regarding their experiences with the online mock oral examination system. SETTING: General surgery residency programs and national surgical conferences. PARTICIPANTS: General surgery residents, program directors, and faculty. RESULTS: System users had very positive attitudes toward the online system in terms of usability and reporting functions. CONCLUSIONS: The mock oral exam management online system is a useful tool that eases the burden of managing a mock oral exam session.