Estimation of Population Average Treatment Effects in the <scp>FIRST</scp> Trial: Application of a Propensity Score‐Based Stratification Approach

Chung, Jeanette W.; Bilimoria, M.S.C.I. Karl Y.; Stulberg, Jonah J.; Quinn, Christopher; Hedges, Larry V.

doi:10.1111/1475-6773.12752

Cited by 3 publications

(3 citation statements)

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“…Fourth, our interview data were obtained only from sites participating in the FIRST trial. Previous work has shown that these sites do not differ substantially from nonparticipating residencies; thus, we expect our findings to be representative of all general surgery residencies . Finally, our analysis of preparation is limited to those factors measured in the ABSITE survey.…”

Section: Discussionmentioning

confidence: 96%

“…Previous work has shown that these sites do not differ substantially from nonparticipating residencies; thus, we expect our findings to be representative of all general surgery residencies. 33 Finally, our analysis of preparation is limited to those factors measured in the ABSITE survey. We acknowledge that other unmeasured factors such as experience before medical school, mentorship, and other preparatory courses may also influence preparation for residency.…”

Section: Limitationsmentioning

confidence: 99%

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A National Mixed-Methods Evaluation of Preparedness for General Surgery Residency and the Association With Resident Burnout

et al. 2020

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IMPORTANCE Differences in medical school experiences may affect how prepared residents feel themselves to be as they enter general surgery residency and may contribute to resident burnout.OBJECTIVES To assess preparedness for surgical residency, to identify factors associated with preparedness, to examine the association between preparedness and burnout, and to explore resident and faculty perspectives on resident preparedness. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used convergent mixed-methods analysis of data from a survey of US general surgery residents delivered at the time of the 2017 American Board of Surgery In-Training Examination (January 26 to 31, 2017) in conjunction with qualitative interviews of residents and program directors conducted as part of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial. A total of 262 Accreditation Council for Graduate Medical Education-approved US general surgery residency programs participated. Survey data were collected from 3693 postgraduate year (PGY) 1 and PGY2 surgical residents (response rate, 99%) and 98 interviews were conducted with residents and faculty from September 1 to

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Section: Discussionmentioning

confidence: 96%

Section: Limitationsmentioning

confidence: 99%

A National Mixed-Methods Evaluation of Preparedness for General Surgery Residency and the Association With Resident Burnout

et al. 2020

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“…Using a PSM approach, Lai et al [ 10 ] compared the results of patients treated with SXC monotherapy from both real world and RCT cohorts and found that SXC monotherapy is at least as effective in real-world settings as within the RCT. Similarly, Chung et al [ 11 ] used propensity score-based poststratification to generalize the results of the Flexibility in Duty Hour Requirements for Surgical Trainees Trial to the nonrepresentative samples. In addition, Godley et al [ 12 ] used propensity score based methods to assess the impact of dosage levels of Volunteer Recovery Support for Adolescents across measures such as frequency of substance used and emotional problems.…”

Section: Use Of Propensity Score Matching In Randomized Controlled Tr...mentioning

confidence: 99%

Can propensity score matching replace randomized controlled trials?

Liau,

Toh,

Muhamed

et al. 2024

World J Methodol

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Randomized controlled trials (RCTs) have long been recognized as the gold standard for establishing causal relationships in clinical research. Despite that, various limitations of RCTs prevent its widespread implementation, ranging from the ethicality of withholding potentially-lifesaving treatment from a group to relatively poor external validity due to stringent inclusion criteria, amongst others. However, with the introduction of propensity score matching (PSM) as a retrospective statistical tool, new frontiers in establishing causation in clinical research were opened up. PSM predicts treatment effects using observational data from existing sources such as registries or electronic health records, to create a matched sample of participants who received or did not receive the intervention based on their propensity scores, which takes into account characteristics such as age, gender and comorbidities. Given its retrospective nature and its use of observational data from existing sources, PSM circumvents the aforementioned ethical issues faced by RCTs. Majority of RCTs exclude elderly, pregnant women and young children; thus, evidence of therapy efficacy is rarely proven by robust clinical research for this population. On the other hand, by matching study patient characteristics to that of the population of interest, including the elderly, pregnant women and young children, PSM allows for generalization of results to the wider population and hence greatly increases the external validity. Instead of replacing RCTs with PSM, the synergistic integration of PSM into RCTs stands to provide better research outcomes with both methods complementing each other. For example, in an RCT investigating the impact of mannitol on outcomes among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial, the baseline characteristics of comorbidities and current medications between treatment and control arms were significantly different despite the randomization protocol. Therefore, PSM was incorporated in its analysis to create samples from the treatment and control arms that were matched in terms of these baseline characteristics, thus providing a fairer comparison for the impact of mannitol. This literature review reports the applications, advantages, and considerations of using PSM with RCTs, illustrating its utility in refining randomization, improving external validity, and accounting for non-compliance to protocol. Future research should consider integrating the use of PSM in RCTs to better generalize outcomes to target populations for clinical practice and thereby benefit a wider range of patients, while maintaining the robustness of randomization offered by RCTs.

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Applicability of Transcatheter Aortic Valve Replacement Trials to Real-World Clinical Practice

Butala

Secemsky

Kazi

et al. 2021

JACC: Cardiovascular Interventions

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Estimation of Population Average Treatment Effects in the FIRST Trial: Application of a Propensity Score‐Based Stratification Approach

Abstract: Propensity score-based poststratification can be valuable tools to address trial generalizability but may yield imprecise estimates of PATE when sparse strata exist.

Cited by 3 publications

References 54 publications

A National Mixed-Methods Evaluation of Preparedness for General Surgery Residency and the Association With Resident Burnout

A National Mixed-Methods Evaluation of Preparedness for General Surgery Residency and the Association With Resident Burnout

Can propensity score matching replace randomized controlled trials?

Applicability of Transcatheter Aortic Valve Replacement Trials to Real-World Clinical Practice

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