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1.
Am Surg ; 89(5): 1974-1979, 2023 May.
Article in English | MEDLINE | ID: mdl-34766513

ABSTRACT

The senior year of undergraduate medical education has been scrutinized for lacking emphasis from educators and value for students. Surgical residency program directors and medical students have reported different sets of perceived weaknesses as surgical trainees enter residency. With this in mind, we developed a novel rotation for senior medical students pursuing surgical residency. The rotation incorporates practical didactics, robust skill and simulation training, and an enriching anatomy experience that entails dissections and operations on embalmed and fresh tissue cadavers. To our knowledge, this is the first reported formal training experience for medical students that involves working with fresh tissue cadavers, which have been described as effective models for live human tissue in the operating room. We describe our multifaceted curriculum in detail, discuss its organization, and elaborate on its potential value. We also provide detailed explanations of the curriculum components so that other surgical educators may consider adopting them.


Subject(s)
Anatomy , Education, Medical, Undergraduate , Internship and Residency , Students, Medical , Humans , Curriculum , Education, Medical, Graduate , Cadaver , Clinical Competence
3.
Curr Surg Rep ; 9(12): 27, 2021.
Article in English | MEDLINE | ID: mdl-34729254

ABSTRACT

PURPOSE OF REVIEW: The objective of general surgery residency is to produce competent surgeons. At a minimum this requires being procedurally and clinically capable and able to pass the board exams. Recruitment is designed to select those residents who can successfully do so. But there is more to being a successful resident than that. In this review, we attempt to define a "successful resident" and how to attract them to your program. RECENT FINDINGS: Resident applicants are still most concerned with matching to a program that will prepare them for a surgery career. Though there is variation of importance for different applicants, resident life, comradery, and relationships with faculty or mentors do factor into residency ranking. The program website remains the most utilized resource for applicants. However, social media (SM) has an increasing role in applicants' evaluation of a program. SM and the preinterview gathering seem to expose the subjective aspects of a program most effectively. Additional assessments evaluating personality, grit or career goals may assist in screening applicants for good "fit." SUMMARY: In order to recruit successful residents, it is necessary to determine which applicant attributes are important to the program. Additionally, a program must maintain an updated website with clearly delineated resident expectations and program strengths. The screening and interview process must be maximized to target residents with career goals complimentary to available program opportunities. If SM is utilized, post should be frequent with relevant information pertaining to both resident life and educational or clinical opportunities.

5.
J Surg Res ; 267: 167-171, 2021 11.
Article in English | MEDLINE | ID: mdl-34153559

ABSTRACT

BACKGROUND: Undergraduate and graduate medical education offerings continue to create opportunities for medical students to pursue MD+ degree education. These educational endeavors provide formal education in fields related to surgery, which gives trainees and surgeons diverse perspectives on surgical care. This study sought to assess current prevalence of additional advanced degrees among leaders in academic surgery to assess the relationship between dual degree attainment and holding various leadership positions within surgical departments. METHODS: The Association for Program Directors in Surgery database was used to identify academic surgical programs, which comprised our study population. Each department of surgery website in the APDS database was interrogated for departmental leaders and their reported academic degrees. RESULTS: Among 3223 identified surgeon leaders, 14.6% (470/3223) were found to possess MD+ degrees. Most common degrees possessed included MBA, MPH, and PhD. In comparing different types of surgeon leaders such as chairs, program directors, and division chiefs, no group was found to have a significantly higher prevalence of MD+ degrees than others. CONCLUSION: Prevalence of MD+ degrees among current academic surgery leaders is low, and the lack of an advanced degree should not be considered a barrier to entry into leadership positions. We hypothesize that these findings are likely to evolve as larger proportions of trainees obtain MD+ degrees during medical school and academic development time throughout residency.


Subject(s)
Internship and Residency , Surgeons , Faculty, Medical , Humans , Leadership , Schools, Medical
6.
Am Surg ; 86(9): 1057-1061, 2020 Sep.
Article in English | MEDLINE | ID: mdl-33049163

ABSTRACT

BACKGROUND: Timely access to emergency general surgery services, including trauma, is a critical aspect of patient care. This study looks to identify resource availability at small rural hospitals in order to improve the quality of surgical care. METHODS: Forty-five nonteaching hospitals in West Virginia were divided into large community hospitals with multiple specialties (LCHs), small community hospitals with fewer specialties (SCHs), and critical access hospitals (CAHs). A 58-question survey on optimal resources for surgery was completed by 1 representative surgeon at each hospital. There were 8 LCHs, 18 SCHs, and 19 CAHs with survey response rates of 100%, 83%, and 89%, respectively. RESULTS: One hundred percent of hospitals surveyed had respiratory therapy and ventilator support, computerized tomography (CT) scanner and ultrasound, certified operating rooms, lab support, packed red blood cells (PRBC), and FFP accessible 24/7. Availability of cryoprecipitate, platelets, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) decreased from LCHs to CAHs. The majority had board-certified general surgeons; however, only 86% LCHs, 53% SCHs, and 50% CAHs had advanced trauma life support (ATLS) certification. One hundred percent of LCHs had operating room (OR) crew on call within 30 minutes, emergency cardiovascular equipment, critical care nursing, on-site pathologist, and biologic/synthetic mesh, whereas fewer SCHs and CAHs had these resources. One hundred percent of LCHs and SCHs had anesthesia availability 24/7 compared to 78% of CAHs. DISCUSSION: Improving access to the aforementioned resources is of utmost importance to patient outcomes. This will enhance rural surgical care and decrease emergency surgical transfers. Further education and research are necessary to support and improve rural trauma systems.


Subject(s)
Health Resources/organization & administration , Health Services Accessibility/organization & administration , Hospitals, Rural/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Humans , Surveys and Questionnaires , United States , West Virginia
7.
J Surg Educ ; 77(4): 905-910, 2020.
Article in English | MEDLINE | ID: mdl-32107161

ABSTRACT

OBJECTIVE: There exists significant variation in the approach to and execution of morbidity and mortality conference (M&MC). Faculty attendance remains a working challenge. We sought to change our department's M&MC and hypothesized improved educational value and attendance. DESIGN: Complications were submitted in Clavien-Dindo format. A designated M&MC moderator facilitated discussion. A teaching point (TP) was assigned to each complication intended to be the focus of discussion. Presentations followed a structured 6-slide PowerPoint template. A web-based tool using Google Forms was developed and distributed as an "App" for tracking of attendance. An anonymous online survey was distributed to participants to elucidate perception of M&MC following the intervention. SETTING: Academic medical center. PARTICIPANTS: Postgraduate year-1 to 5 surgery residents and faculty at West Virginia University, Morgantown. RESULTS: Forty-eight of sixty-three surveys were returned (response rate 76%). Twenty-five faculty (70%) and 23 residents (82%) responded. A predetermined TP was viewed as the most favorable change made by both faculty and residents. 65% of faculty and residents acknowledged improved educational value, 58% found a single moderator to help streamline Morbidity and Mortality (M&M) presentations and 71% felt that a standard PowerPoint template improved quality of presentations. Both residents (96%) and faculty (68%) believed a predetermined TP improved the educational value of the conference and medical knowledge during preparation. More residents (43%) than faculty (16%) believed that changes to the department's M&MC format allowed better identification of quality improvement issues. Furthermore, the majority of residents (83%) believed that changes to the department's M&M format allowed better identification of system factors compared to faculty (32%), p = 0.003. Faculty participation increased from 60% to 80% after changes (p = 0.03). CONCLUSIONS: The educational value of M&MC and attendance can be improved with simple changes, but faculty and residents may have different expectations and perceptions.


Subject(s)
Internship and Residency , Academic Medical Centers , Faculty, Medical , Humans , Morbidity , Quality Improvement
8.
Am J Surg ; 220(4): 899-904, 2020 10.
Article in English | MEDLINE | ID: mdl-32087987

ABSTRACT

BACKGROUND: Use of minimally invasive techniques for management of common bile duct (CBD) stones has led to declining number of CBD explorations (CBDE) performed at teaching and non-teaching institutions. We evaluate the impact of this decline on surgery training in bile duct procedures. STUDY DESIGN: National operative data for general surgery residents (GSR) were examined from 2000 to 2018. Biliary operations including, cholecystectomy open and laparoscopic, and CBDE open and laparoscopic were evaluated for mean number of cases per graduating GSR. RESULTS: Despite increases in number of GSR, case numbers for laparoscopic cholecystectomy increased 39% from 84 to 117, p < .00001, per GSR. Mean number of cases for open CBDE, however, decreased 74% from 2.7 to 0.7, p < .00001, per GSR and laparoscopic CBDE declined 22% from 0.9 to 0.7 per resident. CONCLUSION: GSR operative case volume in CBDE has declined significantly creating a training deficiency for this complex skill. Novel simulation, including fresh cadavers, may offer the best option with high-fidelity, dynamic training to mitigate the loss of low volume, high acuity procedures.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy/statistics & numerical data , Common Bile Duct/surgery , Gallstones/diagnosis , Gallstones/surgery , General Surgery/education , Internship and Residency , Laparoscopy/statistics & numerical data , Humans
9.
Case Rep Surg ; 2019: 2479267, 2019.
Article in English | MEDLINE | ID: mdl-31263622

ABSTRACT

INTRODUCTION: The Angelchik prosthesis (AP) is a historic antireflux device which consists of a C-shaped silicone ring placed around the gastroesophageal junction (GEJ) and secured by Dacron tape. We present a rare experience with an AP and its impact on bariatric surgical outcomes. CASE: Our patient is a 66-year-old woman who had an open antireflux procedure with an AP in 1987. She presented to a bariatric clinic for consideration of bariatric surgery for the treatment of morbid obesity and associated comorbidities. She also reported significant problems with reflux and dysphagia. After an appropriate work-up, an AP was identified at her GEJ. She was taken to the operating room for laparoscopic removal with planned interval laparoscopic sleeve gastrectomy. Intraoperatively, the AP was identified around the GEJ; after extensive adhesiolysis, the prosthesis was removed. Postoperatively, in order to determine if the AP had caused any lasting esophageal motility problems, the patient underwent a high-resolution esophageal manometry which demonstrated normal esophageal motility. Interval laparoscopic sleeve gastrectomy was performed safely 9 weeks later. CONCLUSION: Although rarely used, it is still possible to encounter an Angelchik prosthesis in practice. General and bariatric surgeons need to be aware of this rare device and understand how to manage its related complications.

10.
Am J Surg ; 215(2): 326-330, 2018 02.
Article in English | MEDLINE | ID: mdl-29132645

ABSTRACT

BACKGROUND: The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts. METHODS: Questionnaire response rates were 76% for residents (N = 291) and 71% for faculty (N = 279) in 13 general surgery residency programs. Results include means, percentage in agreement, and statistical tests for 15 questionnaire items. Semi-structured interviews conducted with 39 residents and 43 faculty were analyzed for main themes. RESULTS: Few view the intern shift limit as a positive change. Views differ (P < 0.01) for residents and faculty on 12 of 15 item means and across PGY levels on all 15 items. Interviews indicate concerns about losses with respect to education and professional development, difficulties when interns transition to their second year, and how intern shifts may be more fatiguing than expected. CONCLUSIONS: The 16-h limit on intern shifts has remained a source of concern and an educational challenge for residents and faculty.


Subject(s)
Attitude of Health Personnel , General Surgery/education , Internship and Residency/standards , Personnel Staffing and Scheduling/standards , Work Schedule Tolerance/psychology , Workload/standards , Faculty, Medical/psychology , Fatigue/etiology , Humans , Internship and Residency/methods , Interviews as Topic , Students, Medical/psychology , Surveys and Questionnaires , Time Factors , United States , Workload/psychology
11.
Am J Surg ; 215(2): 222-226, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29137723

ABSTRACT

BACKGROUND: Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems. METHODS: General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns. RESULTS: NPPs reduce faculty and resident workloads and teach residents. NPPs also reduce resident exposure to educationally valuable activities, and faculty sometimes round, make decisions, and operate with NPPs instead of residents. Interviews indicate that NPPs can overly reduce resident involvement in patient care, diminish resident responsibility and decision making, disrupt team dynamics, and compete for procedures. CONCLUSIONS: NPPs both enhance and hinder surgical education and highlight the need to more clearly articulate learning outcomes for residents and activities necessary to achieve those outcomes.


Subject(s)
Faculty, Medical/organization & administration , General Surgery/education , Internship and Residency/methods , Nurse Practitioners/organization & administration , Physician Assistants/organization & administration , Physicians/organization & administration , Attitude of Health Personnel , Humans , Internship and Residency/organization & administration , Professional Role , Professional-Patient Relations , Surveys and Questionnaires , United States
12.
J Surg Educ ; 75(3): 697-701, 2018.
Article in English | MEDLINE | ID: mdl-29079108

ABSTRACT

BACKGROUND: There exists an acute need to recruit and train general surgeons for rural communities. To assist medical students interested in rural surgery, the American College of Surgeons (ACS) website lists general surgery residencies, which are tailored to train the rural surgeon by providing exposure to endoscopy, gynecology, urology, orthopedics, and otolaryngology. Another available reference is the American Medical Association Fellowship and Residency Electronic Database (FREIDA). FREIDA allows programs to indicate availability of a rural training scheme. This is an effort to identify programs which demonstrate a commitment to training rural surgeons and evaluate accessibility of this information to medical students. METHODS: Each ACGME general surgery residency program in the United States and Canada received an electronic survey. They were queried on commitment to training rural surgeons and their ability to provide 3 to 12 months of subspecialty training. RESULTS: Of the 261 programs surveyed, 52 (19.9%) responses were obtained; 11 had established rural tracks and 15 were willing to customize a program. We identified 14 additional rural training programs not identified by either the ACS website or FREIDA. In total, 44 programs identified by ACS, FREIDA, and our survey indicate they can accommodate the rural surgical resident. CONCLUSIONS: For a medical student interested in rural surgery, several obstacles must be overcome to find the appropriate residency program. A complete and updated list of established tracks or customizable training schemes does not exist. Review of the ACS website and FREIDA online in addition to our survey has identified 44 of 261 (16.9%) ACGME accredited programs either with an existing rural surgical track or willing to customize their program accommodate a resident. To facilitate the recruitment of medical students into rural surgery, we support the maintenance of a complete and routinely updated list that identifies available training programs.


Subject(s)
Career Choice , General Surgery/education , Rural Health Services/organization & administration , Students, Medical/statistics & numerical data , Surveys and Questionnaires , Awareness , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Personnel Selection , United States , Young Adult
13.
Acad Med ; 91(11 Association of American Medical Colleges Learn Serve Lead: Proceedings of the 55th Annual Research in Medical Education Sessions): S31-S36, 2016 11.
Article in English | MEDLINE | ID: mdl-27779507

ABSTRACT

PURPOSE: Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism. METHOD: Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews. RESULTS: A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient. CONCLUSIONS: Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.


Subject(s)
Education, Medical, Graduate , General Surgery/education , Professionalism , Students, Medical/psychology , Work Schedule Tolerance/psychology , Workload/psychology , Humans , Internship and Residency , Patient Handoff , Surveys and Questionnaires , United States
15.
Am J Surg ; 212(3): 451-4, 2016 Sep.
Article in English | MEDLINE | ID: mdl-26867479

ABSTRACT

BACKGROUND: Our system uses a hub and spoke approach to provide surgical care for our rural population. Patients access care anywhere in the system but are transferred centrally for surgical care. We sought to determine if surgical outcome differed depending on where initial care occurred. We chose acute appendicitis (AA) to investigate our care model. METHODS: We identified patients admitted with the diagnosis of AA. Patients were divided into 2 groups, Bassett Medical Center presentation and satellite center (SAT) presentation. Demographics were compared and, time from system access to surgery, time of surgery, and clinical information associated with care. RESULTS: There were no differences regarding any clinically relevant factor. SAT patients had longer mean surgery times, 60.7 minutes vs 51.5 (P=.008). Time to surgery, LOS, and complications were similar. CONCLUSIONS: It is safe to care for AA patients with a hub and spoke approach without putting SAT patients at a disadvantage.


Subject(s)
Appendectomy , Appendicitis/surgery , Disease Management , Rural Population , Acute Disease , Adult , Appendicitis/epidemiology , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Male , Morbidity/trends , New York/epidemiology , Retrospective Studies
16.
Am J Surg ; 208(1): 136-42, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24815526

ABSTRACT

BACKGROUND: Rural surgeons have unique learning needs not easily met by traditional continuing medical education courses. METHODS: A multidisciplinary team developed and implemented a skills curriculum focused on leadership and communication, advanced endoscopy, emergency urology, emergency gynecology, facial plastic surgery, ultrasound, and management of fingertip amputations. RESULTS: Twenty-five of 30 (89%) rural surgeons who completed a follow-up course evaluation reported that the knowledge acquired during the course had improved their practice and/or the quality of patient care, particularly by refining commonly used skills and expanding the care options they could offer to their patients. The surgeons reported incorporating changes in their communication and interaction with colleagues. CONCLUSIONS: This course was successful, from participants' perspectives, in providing hands-on mentored training for a variety of skills that reflect the broad scope of practice of surgeons in rural areas. Attendees felt that their participation resulted in important behavior and practice changes.


Subject(s)
Clinical Competence , Education, Medical, Continuing/methods , General Surgery/education , Rural Health Services , Attitude of Health Personnel , Communication , Curriculum , Follow-Up Studies , Humans , Interprofessional Relations , Leadership , Practice Patterns, Physicians' , Program Development , Program Evaluation , Self-Assessment , United States
17.
J Am Coll Surg ; 217(5): 919-23, 2013 Nov.
Article in English | MEDLINE | ID: mdl-24041561

ABSTRACT

BACKGROUND: As new technology is developed and scientific evidence demonstrates strategies to improve the quality of care, it is essential that surgeons keep current with their skills. Rural surgeons need efficient and targeted continuing medical education that matches their broader scope of practice. Developing such a program begins with an assessment of the learning needs of the rural surgeon. The aim of this study was to assess the learning needs considered most important to surgeons practicing in rural areas. STUDY DESIGN: A needs assessment questionnaire was administered to surgeons practicing in rural areas. An additional gap analysis questionnaire was administered to registrants of a skills course for rural surgeons. RESULTS: Seventy-one needs assessment questionnaires were completed. The self-reported procedures most commonly performed included laparoscopic cholecystectomy (n = 44), hernia repair (n = 42), endoscopy (n = 43), breast surgery (n = 23), appendectomy (n = 20), and colon resection (n = 18). Respondents indicated that they would most like to learn more skills related to laparoscopic colon resection (n = 16), laparoscopic antireflux procedures (n = 6), laparoscopic common bile duct exploration/ERCP (n = 5), colonoscopy/advanced techniques and esophagogastroscopy (n = 4), and breast surgery (n = 4). Ultrasound, hand surgery, and leadership and communication were additional topics rated as useful by the respondents. Skills course participants indicated varying levels of experience and confidence with breast ultrasound, ultrasound for central line insertion, hand injury, and facial soft tissue injury. CONCLUSIONS: Our results demonstrated that surgeons practicing in rural areas have a strong interest in acquiring additional skills in a variety of general and subspecialty surgical procedures. The information obtained in this study may be used to guide curriculum development of further postgraduate skills courses targeted to rural surgeons.


Subject(s)
Clinical Competence , Needs Assessment , Rural Health Services/standards , Specialties, Surgical/standards , Humans , Rural Population , Surveys and Questionnaires , United States
19.
Surg Clin North Am ; 89(6): 1321-3, viii-ix, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19944814

ABSTRACT

The surgical training at Bassett is naturally broader than in many university settings, with a survey showing that nearly 70% of graduates who practice general surgery remain in a rurally designated area. Rural surgery experience falls into 3 categories: undergraduate, graduate, and postgraduate. The general surgery training program has no competing fellowships or subspecialty residencies; residents get significant experience with endoscopy; ear, nose, and throat; plastic and hand surgery; and obstetrics and gynecology. The rural setting lifestyle is valued by the students, residents, and fellows alike. It provides an ideal setting for recognizing the specific nuances of small-town American life, with a high-quality education and surgical experience.


Subject(s)
Education, Medical, Graduate/organization & administration , General Surgery/education , Internship and Residency , Models, Educational , Rural Health Services , Career Choice , Clinical Competence , Curriculum , Humans , Life Style , New York , Physicians/supply & distribution , Program Development , Program Evaluation , Workforce
20.
J Surg Educ ; 66(1): 3-7, 2009.
Article in English | MEDLINE | ID: mdl-19215889

ABSTRACT

INTRODUCTION: Practice-Based Learning and Improvement (PBLI) is 1 of 6 integral competencies required by the Accreditation Council for Graduate Medical Education (ACGME) for proof of adequate resident training and accreditation of residency programs. Moreover, the Outcome Project of the ACGME is beginning to enforce the provision of documented, objective evidence of resident PBLI. Current assessment tools, such as resident portfolios and performance evaluations, by faculty tend to be qualitative in nature. However, few objective, outcome-based, and quantitative evaluation tools have been developed. METHODS: A web-based application was designed to assess every consultation performed by senior residents at a university-affiliated general surgery residency. In real time, residents documented patient presentations along with their initial impression and plan. As patient outcomes became available, they were also documented into this application, which allowed residents to self-assess whether their impressions and plans were correct. A running "batting average" (BA) is then calculated based on percentage correct. RESULTS: Seven senior residents participated in this study, which included a total of 459 consults: 222 documented by PGY4 residents and 237 documented by PGY5 residents. The average BA of PGY4 residents in their first 3 months was 82.9%, which was followed by 85.9%, 88.7%, and 94.3% for each of the next 3 quarters. For PGY5 residents, the corresponding results were 96.4%, 94.4%, 93.8%, and 96.4% respectively. CONCLUSIONS: A web-based outcome-tracking program is useful for conducting rapid and ongoing evaluation of residents' practice-based learning, generating data for analysis of individual resident knowledge gaps, stimulating self-assessment and targeted learning, as well as providing objective data of PBLI for accreditation purposes.


Subject(s)
Clinical Competence , Educational Measurement , General Surgery/education , Internet , Internship and Residency , Humans
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