Catalytic Leadership in Food & Fitness Community Partnerships.

Catalytic leadership is a type of multidimensional leadership that facilitates cross-sector collaboration to enact systems and policy changes within communities. Catalytic leaders provide opportunities for stakeholders to partner and merge their efforts to create new opportunities for their work. Catalytic leaders are individuals, organizations, and collaborative partnerships that stimulate partnership alliances. Additionally, catalytic partnerships facilitate the process of collaboration through encouraging and supporting stakeholders to work together effectively and successfully. This article provides examples of catalytic leadership roles that emerged from the Food & Fitness community partnerships. These partnerships were funded by the W.K. Kellogg Foundation to increase access to locally grown food and safe places to play for children and families through systems and policy changes in communities throughout the United States. Key strategies and types of support (i.e., informational and instrumental support) provided through Food & Fitness catalytic leadership that sustained the work of these partnerships was discussed. Based on catalytic leadership strategies identified and types of support provided, outcomes that emerged from this work were also described. We conclude with key recommendations for community partnerships interested in serving as catalytic leaders for large-scale initiatives in their communities.

Creating Integrated Strategies for Increasing Access to Healthy Affordable Food in Urban Communities: A Case Study of Intersecting Food Initiatives.

In New York and other cities, substantial evidence documents that community food environments interact with inequitable allocation of power, wealth, and services to shape the distribution of diet-related diseases and food insecurity. This case study shows how one Central Brooklyn community organization, Bedford Stuyvesant Restoration Corporation, has launched multiple coordinated food initiatives in order to reduce the burden of food-related health problems and boost community development. The report used standard case study methods to document the implementation of the New York City Food and Fitness Partnership in Central Brooklyn. The case study shows how two distinct strands of activities, a Farm to Early Care Program that ultimately brought fresh food to 30 child care centers, and a food hub that sought to make fresh local food more available in Central Brooklyn, intersected and reinforced each other. It also shows how organizational, community, and municipal resources and policies in some cases supported these initiatives and in others served as obstacles. Finally, the case study shows that multiple coordinated strategies have the potential to empower low-income Black and Latino communities to act to make local food environments healthier and more equitable.

Training outcomes of preliminary surgical residents in a university and Veterans Affairs surgical residency.

IMPORTANCE: Nearly 1400 medical students enter preliminary surgical residency each year; placing some of these students into categorical surgical training is an important component of building the future surgical workforce. OBJECTIVES: To examine the training outcomes of preliminary residents in a university and Veterans Affairs surgical residency and to test the hypothesis that characteristics of these residents could be identified that would predict successful placement into categorical general surgical residency. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort of 66 nondesignated preliminary surgical residents who entered a research-intensive, university-based surgical training program with significant Veterans Affairs hospital experience between 2004 and 2012. MAIN OUTCOMES AND MEASURES: Placement of preliminary residents into a categorical general surgical residency. RESULTS: Of 66 nondesignated preliminary residents enrolled in our program during the study period, 57 completed a postgraduate year (PGY) 1 and 22 completed a PGY-2. A total of 21 residents (32%) secured categorical general surgical positions, 8 of 57 (14%) after PGY-1 and 13 of 22 (59%) after PGY-2, a significantly different rate (P < .001). Predictors of success in obtaining a categorical position included a PGY-2, United States Medical Licensing Examination step 2 score, year 1 American Board of Surgery In-Training Examination score, class rank, and prior graduate medical education. By multivariable analysis, only the PGY-2 was significant (P < .03). Residents who obtained categorical surgical positions after 1 preliminary year had significantly higher United States Medical Licensing Examination scores (mean [SD] step 1 score, 235.4 [23.5] vs 206.3 [16.2]; P < .02; step 2 score, 239.3 [21.2] vs 218.5 [16.1]; P < .05) but did not have higher year 1 American Board of Surgery In-Training Examination percentiles (mean [SD], 63.3 [33.3] vs 47.3 [30.8]; P < .34). CONCLUSIONS AND RELEVANCE: Performing a PGY-2 preliminary year increases the chance for a preliminary surgical resident to obtain a place in a categorical surgical residency. Programs that offer preliminary positions should consider offering both PGY-1 and PGY-2 positions, because the PGY-2 increases the categorical surgical placement rate, especially for residents with lower test scores.

Use of collapsible box trainer as a module for resident education.

BACKGROUND AND OBJECTIVES: We sought to determine whether training with a simple collapsible mobile box trainer leads to improved performance of fundamental laparoscopic skills (FLSs) during a 6-month interval versus validated laparoscopic box trainers and virtual-reality trainers, only accessible at a simulation training center. METHODS: With institutional review board approval, 20 first- and second-year general surgery residents were randomized to scheduled training sessions in a surgical simulation laboratory or training in the use of a portable, collapsible Train Anywhere Skill Kit (TASKit) (Ethicon Endo-Surgery Cincinnati, OH, USA) trainer. Training was geared toward the FLS set for a skill assessment examination at a 6-month interval. RESULTS: The residents who trained with the TASKit performed the peg-transfer, pattern-cut exercise, Endoloop, and intracorporeal knot-tying FLS tasks statistically more efficiently during their 6-month assessment versus their initial evaluation as compared with the group randomized to the simulation laboratory training. CONCLUSIONS: Using a simple collapsible mobile box trainer such as the TASKit can be a cost-effective method of training and preparing residents for FLS tasks considering the current cost associated with virtual and highdefinition surgical trainers. This mode of surgical training allows residents to practice in their own time by removing barriers associated with simulation centers.

Changing the student clerkship from traditional lectures to small group case-based sessions benefits the student and the faculty.

BACKGROUND: Attempts to improve the third year surgery clerkship led to the implementation of faculty-led small group teaching instead of large group lecture-style dissemination of the general surgical curriculum. The intent was to facilitate better faculty-to-student relationships, provide more favorable balance between classroom and clinical surgery, and enhance overall surgical education. METHODS: Didactic student sessions were reduced from 33 lectures to 8 small group sessions and surgical specialty lectures. A case-based surgical curriculum was utilized and students were organized into small groups led by assigned faculty members. A uniform schedule of topics was prearranged to ensure continuity and avoid duplication of material. The National Board of Medical Examiners (NBME) surgery subject examination raw score and percentile rank assignments were analyzed for 1 medical graduating class taught using the traditional method and compared with the subsequent class taught in small groups. A survey was administered to assess student and faculty regarding the new format. RESULTS: Average NBME percentile rank score for students educated in small groups versus lecture-only groups improved significantly (61.2 vs 55.9, p = 0.04, Student t test). The students reported increased time spent preparing for small group over lecture and more satisfaction with the small group teaching environment. Faculty members reported an increase in time needed to deliver the session but otherwise gave strong positive feedback. CONCLUSIONS: Concerns that student performance on standardized testing would suffer from the proposed change were not substantiated as performance on NBME subject examinations actually improved. Additional preparation time, method preference, favorable balance of classroom to clinical exposure, and direct interactions with faculty may be responsible for the observed increase in NBME examination percentile scores. Faculty members were overwhelmingly in favor of the new model and the additional direct contact with students may prove beneficial in junior faculty promotion and career development.

A multidisciplinary systems-based practice learning experience and its impact on surgical residency education.

OBJECTIVE: To design and implement a multidisciplinary systems-based practice learning experience that is focused on improving and standardizing the preoperative quality of care for general surgical patients. DESIGN: Four parameters of preoperative care were designated as quality assessment variables, including bowel preparation, perioperative beta-blockade, prophylactic antibiotic use, and deep venous thrombosis prevention. Four groups of general surgery residents (PGY I-V), each led by 1 chief resident, were assigned a quality parameter, performed an evidence-based current literature review, and formulated a standardized management approach based on the level of evidence and recommendations available. Because preoperative preparation includes anesthetic care and operating room preparation, we presented our findings at the Department of Surgery Grand Rounds in a multidisciplinary format that included presentations by each resident group, the Department of Anesthesia, the Department of Medicine, and the Department of Nursing. The aim of the multidisciplinary quality assurance conference was to present the evidence-based literature findings in order to determine how standardization of preoperative care would alter anesthetic and nursing care, and to obtain feedback about management protocols. To determine the educational impact of this model of integrated systems-based practice quality assessment on the teaching experience, residents were queried regarding the value of this educational venue and responses were rated on a Likert scale. RESULTS: Resident participation was excellent. The residents garnered valuable information by performing a literature review and evaluating the best preoperative preparation given each parameter. Furthermore, integration of their findings into systems-based practice including anesthesia and nursing care provided an appreciation of the complexities of care as well as the associated need for appropriate medical knowledge, communication, and professionalism. The derivation of treatment protocols included an opportunity to incorporate several competencies across multiple disciplines. The residents evaluated 5 questions and deemed the educational exercise an effective model to enrich surgical resident education while simultaneously improving patient care. The residents also strongly agreed that they would participate in similar projects in the future as well as recommend this educational exercise to other residents. A finalized preoperative order set was created and distributed to all residents for use in the preoperative care of general surgery patients. CONCLUSIONS: Our multidisciplinary systems-based practice learning experience focused on improving and standardizing the preoperative quality of care for patients, and general surgery residents were pivotal participants in that process. This exercise had a positive impact on our general surgery residency education program and proved to be a valuable model of systems-based practice competency.