Factors influencing amount of guidance in the operating room during laparoscopic cases

Hoops, Heather E.; Haley, Caleb; Cook, Mackenzie R.; Lopez, Olga; Dewey, Elizabeth; Brasel, Karen J.; Spight, Donn; Király, László

doi:10.1016/j.amjsurg.2019.03.019

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…In the operating room (OR), the surgeon educator is constantly faced with the critical balance between supervision, appropriate trainee autonomy, and most importantly patient safety. Studies on factors influencing the level of trainee autonomy in the operating theatre have consistently ranked surgical competency and perception as a "safe proceduralist" as features that would garner sufficient trust for the surgeon to allow the resident to continue with the procedure [8,[19][20][21]. Therefore, the onus lies on the trainee to place themselves in such favourable positions.…”

Section: Will Prepare and Someday My Chance Will Comementioning

confidence: 99%

“…However, caution should be exercised in the choice of videos, as there is a clear absence of peer-review process and quality control on most open-source video streaming sites [25]. Trainees should instead be directed towards instructional video 3 Case Reports in Obstetrics and Gynecology tutorials from accredited surgical societies [21]. Finally, to develop psychomotor and visuospatial skills involved in core laparoscopic skills, hands-on deliberate practice is indispensable; short of being in the OR and "practicing" on patients, this can be achieved through simulation training [26].…”

Section: Will Prepare and Someday My Chance Will Comementioning

confidence: 99%

See 1 more Smart Citation

Cultivating the Apprentice-Mentor Model for Minimally Invasive Gynaecology in the Era of Surgically Scarce Training: A Case Report of Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy by a Trainee

Listijono¹,

Rosen²,

Choi³

et al. 2021

Case Reports in Obstetrics and Gynecology

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Over the last few years, there is an apparent growing concern amongst O&G trainees of the inadequacy in exposure to minimally invasive gynaecology surgical training, which has been inadvertently compounded by the more stringent working hour regulations and disproportionately increasing number of trainees relative to surgical volume. Therefore, it is vitally important for trainees to maximise opportunities in the operating theatre and develop autonomy in carrying out more complex surgical procedures. This case report outlines the step-by-step approach of laparoscopic excision of a cornual ectopic pregnancy performed by a trainee under the supervision of a surgical mentor. This manuscript highlights key characteristic traits of a trainee that serve to foster surgical trust and simple but effective steps to foster surgical preparedness.

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Section: Will Prepare and Someday My Chance Will Comementioning

confidence: 99%

Section: Will Prepare and Someday My Chance Will Comementioning

confidence: 99%

Cultivating the Apprentice-Mentor Model for Minimally Invasive Gynaecology in the Era of Surgically Scarce Training: A Case Report of Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy by a Trainee

Listijono¹,

Rosen²,

Choi³

et al. 2021

Case Reports in Obstetrics and Gynecology

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Design of a new competency-based entrustment scale for the evaluation of resident performance

et al. 2023

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Purpose Recent changes in the design and evaluation of residents to a more competency or mastery-based framework requires frequent observation, evaluation and documentation of residents by busy clinician teachers. Evaluating and determining competent performance is essential for formative evaluation and must be defensible and sound for summative purposes. We sought out experienced Faculty perspectives regarding: (1) important resident performance markers for demonstrating competent attainment of an EPA; (2) the standard of performance expected of graduating residents; (3) evidence for the validity of our purposed entrustment scale; and (4) necessary components required to provide feedback to residents in guiding the development of competent performance of an EPA. Methods We surveyed Canadian 172 neurosurgical Faculty who had publicly available email addresses and received 67 questionnaire responses, 52 of which were complete responses regarding resident performance markers and our proposed entrustment scale (ES) which consisted of five levels of graded achievement focused on resident performance. Results Being able to “perform safely” was consistently rated as the most important element of competence that Faculty stated was the critical marker of competence that should be rated, and was found in the D and E Levels of our scale. Our scale does not include any commentary on “performing without supervision” which was rated as the least important marker of performance. For the graduating neurosurgical resident, 90.4% of Faculty indicated that residents should be capable of adapting performance or decisions in response to contextual complexities of the activity independently and safely (Level E) (67.3%) or being able to perform a procedure safely without complexities independently (level D) (21.3%). Eighty percent indicated that the descriptions of competence levels described in our ES (Level A through Level E) represent the appropriate progression of entrustment required demonstrating competent attainment of an EPA. Forty-four percent of Faculty had considerable concern about liability issues with certification of competence based on an ES that is based on descriptions of decreased or no supervision of residents. “Documenting a few weaknesses,” “providing contextual comments of the case,” “providing suggestions for future learning,” and “providing a global assessment for an EPA with one-rating” were rated as the most necessary components in providing effective feedback. Conclusion Our proposed entrustment global rating scale is easily understood by Faculty who indicate that its graded levels of competence reflect appropriate surgical resident progression in a feasible way. Faculty clearly indicated that the standard of a graduating resident should reflect the ability to perform safely beyond simply performing a case and be able to apply clinical judgments to be able to respond and alter behaviour in response to the clinical and contextual complexities of a case. Our scale focuses on evaluation of resident performance, rather than assessing the supervisor’s degree of involvement. This study has implications for the certification of competence of surgeons and physicians.

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Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review

Sevestre,

Dochez,

Souron

et al. 2024

Journal of Surgical Education

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Factors influencing amount of guidance in the operating room during laparoscopic cases

Cited by 3 publications

References 21 publications

Cultivating the Apprentice-Mentor Model for Minimally Invasive Gynaecology in the Era of Surgically Scarce Training: A Case Report of Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy by a Trainee

Cultivating the Apprentice-Mentor Model for Minimally Invasive Gynaecology in the Era of Surgically Scarce Training: A Case Report of Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy by a Trainee

Design of a new competency-based entrustment scale for the evaluation of resident performance

Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review

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