Day case laparoscopic herniorraphy

Lim, Michael; OBoyle, Colm; Royston, C. M. S.; Sedman, Peter

doi:10.1007/s00464-004-2265-5

Cited by 12 publications

(3 citation statements)

References 20 publications

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“…Although we systematically assessed articles before assigning them into categories, categorization is always subject to discussion. However, only seven articles additionally reported on subjects of a category other than the one they were placed in [42,50,59,71,73,91,100]. Nonetheless, the results of these studies were consistent with the conclusions we drew for the categories they were not placed in.…”

Section: Discussionsupporting

confidence: 58%

“…The remaining five studies were conducted in radiology [90,91], family medicine [92,93] and anesthesiology [94]. Thirty-one studies reported no statistically significant differences between faculty and residents on a wide variety of outcomes including mortality, morbidity and length of stay [52,54,56-58,61,63,67-69,73-90,92-94]. Although patient outcomes were similar, 12 of these 31 studies did report a significantly longer operation time for residents [61,67,69,74,77,78,81,83,84,87-89].…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies highlight the need for supervision by showing similar patient outcomes for supervised residents [52,54,56-58,68,73,75,76,79,80,85,86,90,94] or worse patient outcomes for unsupervised residents [60,84]. Many studies compared faculty with residents in small settings with small sample sizes.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

145

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BackgroundResidents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.MethodsThe literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.ResultsNinety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.ConclusionsThe majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.

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