Trigger videos: a novel application of a tool for surgical faculty development.

BACKGROUND: Trigger videos have occasionally been used in medical education; however, their application to surgical faculty development is novel. We assessed participants' attitudes towards workshops on intraoperative teaching (IOT) that were anchored by trigger videos, and studied whether they could generate discussion-for-learning among surgeons in this workshop setting. METHODS: Surgeons from multiple specialties attended one of six faculty development workshops where IOT trigger videos were shown and discussed during break-out sessions. Participants completed questionnaires to (1) evaluate videos via survey and feedback, and (2) identify adoptable and discardable IOT techniques. Teaching techniques were collated to identify planned IOT changes and survey data and feedback were analyzed. RESULTS: A total of 135 surgeons identified 292 adoptable and 202 discardable IOT techniques based on trigger videos and discussions, and 94% of participants reported that the trigger videos were useful and encouraged them to discuss and consider new IOT techniques in their own practice. CONCLUSIONS: Participants reported that the trigger videos were useful and motivating. Surgeons critically reflected on IOT during the sessions, identifying numerous adoptable and discardable techniques relevant to their own teaching styles. Trigger videos can be a valuable tool for surgical faculty development and can be tailored to other medical specialties.

What Should We Recommend for Colorectal Cancer Screening in Adults Aged 75 and Older?

The current recommendation to stop colorectal cancer screening for older adults is based on a lack of evidence due to systematic exclusion of this population from trials. Older adults are a heterogenous population with many available strategies for patient-centered assessment and decision-making. Evolutions in management strategies for colorectal cancer have made safe and effective options available to older adults, and the rationale to screen for treatable disease more reasonably, especially given the aging Canadian population. In this commentary, we review the current screening guidelines and the evidence upon which they were built, the unique considerations for screening older adults, new treatment options, the risks and benefits of increased screening and potential considerations for the new guidelines.

Mullerian remnants presenting as a pelvic cyst in a young adult with 45X0/46XY mixed gonadal dysgenesis.

A 22-year-old known case of 45XO/46XY mixed gonadal dysgenesis, reared as a male, presented with complaints of suprapubic and left iliac fossa pain for the past 1 month. The patient underwent laparoscopic right orchidectomy (streak) + Mullerian remnant excision + left orchidopexy + first-stage hypospadias repair 10 years back. Contrast-enhanced computed tomography showed a large complex cyst in the left side of the pelvis and rectovesical space. Excision of the cystic structure was done along with left orchidectomy. Histopathological examination revealed features of Mullerian remnants (endometrial glands and cervix) in the cystic structure. The importance of this case report is to emphasize the fact that the Mullerian remnants tend to enlarge in size over time and become symptomatic and may require a surgical removal at a later date as in our case.

Proportion of Female Speakers at Academic Medical Conferences Across Multiple Specialties and Regions.

Importance: Women in medicine have been underrepresented at medical conferences; however, contributing factors have not been well studied. Objective: To examine the distribution of invited conference speakers by gender and factors associated with representation of women as speakers. Design, Setting, and Participants: This cross-sectional analysis used medical conference programs from March 2017 to November 2018 across 20 specialties in 5 regions (Australasia, Canada, Europe, the UK, and the US) that were obtained online or from conference conveners. Exposures: Gender of invited lecturers, panelists, and planning committee members for each conference based on name or picture and publicly available data on compositions of specialties by gender for included regions. Main Outcomes and Measures: Outcomes included the proportion of female speakers (invited lecturers and panelists), the number of single-gender panels, and the proportion of female speakers compared with the specialties' gender composition. Correlations between the gender composition of conference planning committees and the proportion of female speakers were assessed. Multivariable regression models were used to evaluate factors independently associated with the proportion of female speakers at conferences. Results: A total of 8535 sessions (panels and invited lectures) with 23 440 speakers across 98 conferences were identified. Women accounted for 7064 (30.1%) of speakers; 1981 of 5409 panels (36.6%) consisted of men only, and 363 (6.7%) consisted of women only. The proportion of women speakers varied by region and specialty from 5.8% to 74.5%. In general, specialties with low baseline proportions of women (<20%) had a ratio of female speakers to female specialists greater than 1, whereas specialties with high baseline proportions of women (>40%) had a ratio of female speakers to female specialists less that 1. There was a strong positive correlation between the proportion of women on planning committees and conference representation of female speakers (r = 0.67; P < .001). The association remained statistically significant after controlling for other variables, including the regional gender balance of the specialty (odds ratio, 1.10; 95% CI, 1.04-1.15; P < .001 for every 10% increase in the proportion of women on the planning committee). Conclusions and Relevance: In this cross-sectional study, the proportion of female speakers at medical conferences was lower than that of male speakers, and more than one-third of panels were composed of men only. Increasing the number of women on planning committees may help address gender inequities.

Recommendations for the Prescription of Opioids at Discharge After Abdominopelvic Surgery: A Systematic Review.

Importance: The prescription of opioids at discharge after abdominopelvic surgery is variable and often excessive. A lack of guidance for abdominopelvic surgeons may explain the suboptimal nature of current prescribing practices. Objective: To systematically review existing recommendations on the prescription of opioids at discharge, the appropriate disposal of opioids, and the prevention of chronic postsurgical opioid use after abdominopelvic surgery. Evidence Review: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From January 2010 to December 2018, a search of MEDLINE, PsycINFO, HealthSTAR, Embase, and the difficult to locate and unpublished (ie, gray) literature was performed using a peer-reviewed strategy with variations of the terms opioid, surgery, and guideline to identify English-language documents that contained recommendations published by professional societies or health care institutions. The quality of clinical practice guidelines was assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. A descriptive synthesis of results was performed. Findings: Of 5530 citations screened, 41 full-text documents were included in the systematic review. Fifteen clinical practice guidelines were identified. AGREE II domain scores varied substantially. Identified among the 41 included documents were 98 recommended interventions for the prescription of opioids at discharge, 8 interventions for the disposal of opioids, and 8 interventions for the prevention of chronic postsurgical opioid use. Only 13 of 114 interventions (11.4%) were supported by an assessment of strength or level of evidence, and the amount of opioid recommended after specific abdominopelvic surgical procedures varied widely between guidance documents, even for the same procedure. Conclusions and Relevance: Current guidance for the prescription of opioids at discharge after abdominopelvic surgery is heterogeneous and rarely supported by evidence. More research is needed on this topic to guide the development of future recommendations.

Non-technical skills curriculum incorporating simulation-based training improves performance in colonoscopy among novice endoscopists: Randomized controlled trial.

BACKGROUND AND AIMS: Non-technical skills (NTS), involving cognitive, social and interpersonal skills that complement technical skills, are important for the completion of safe and efficient procedures. We investigated the impact of a simulation-based curriculum with dedicated NTS training on novice endoscopists' performance of clinical colonoscopies. METHODS: A single-blinded randomized controlled trial was conducted at a single center. Novice endoscopists were randomized to a control curriculum or a NTS curriculum. The control curriculum involved a didactic session, virtual reality (VR) simulator colonoscopy training, and integrated scenario practice using a VR simulator, a standardized patient, and endoscopy nurse. Feedback and training were provided by experienced endoscopists. The NTS curriculum group received similar training that included a small-group session on NTS, feedback targeting NTS, and access to a self-reflective NTS checklist. The primary outcome was performance during two clinical colonoscopies, assessed using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) tool. RESULTS: Thirty-nine participants completed the study. The NTS group (n = 21) had superior clinical performance during their first (P < 0.001) and second clinical colonoscopies (P < .0.001), compared to the control group (n = 18). The NTS group performed significantly better on the VR simulator (P < 0.05) and in the integrated scenario (P < 0.05). CONCLUSION: Our findings demonstrate that dedicated NTS training led to improved performance of clinical colonoscopies among novices.

A Case of Incomplete Removal of Horseshoe Kidney by Laparoscopic Nephrectomy in an Adult Leading to Urinary Leak: An Eye Opener.

Horseshoe kidney is a common congenital fusion anomaly of the kidneys. It poses a challenge to surgeon because of its very variable anatomy in terms of location and lie, fusion, pelvicalyceal system, and the renal vessels. Here we describe a case of laparoscopic nephrectomy in a horseshoe kidney complicated by incomplete removal because of not realizing the lower and medial extent of pelvicalyceal system across midline to the contralateral side leading to persistent urine leak. The relevant anatomy and the necessary precautions to prevent such complication have been discussed.