Identifying and Eliminating Deficiencies in the General Surgery Resident Core Competency Curriculum

Tapia, Nicole M.; Milewicz, Allen L.; Whitney, Stephen; Liang, Mike K.; Braxton, Carla C.

doi:10.1001/jamasurg.2013.4406

Cited by 31 publications

(17 citation statements)

References 18 publications

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“…Most of the fellows perceived their performance in the exercise as good, despite the majority not addressing the hostile environment. This is similar to other fields where self-assessment surveys from surgery residents also show a high level of confidence from trainees in their leadership skills; 69% of surgery residents felt comfortable with negotiation and conflict resolution and 75% were confident in their team building and management[13]. …”

Section: Discussionsupporting

confidence: 79%

Disruptive behavior in the workplace: Challenges for gastroenterology fellows

Srisarajivakul

Lucero

Wang

et al. 2017

WJG

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AIMTo assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).METHODSTwo OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment survey.RESULTSTwelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s guidance.CONCLUSIONFellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.

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Section: Discussionsupporting

confidence: 79%

Disruptive behavior in the workplace: Challenges for gastroenterology fellows

Srisarajivakul

Lucero

Wang

et al. 2017

WJG

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“…These conflicts take on more prominence and urgency when they occur in critical situations, where actions taken, or lack thereof, can create irreversible consequences for patients . Further complicating a clinical conflict is the effect of hierarchy, authority gradients, and intimidation on the human psyche, which can hinder or fully prevent time‐critical information exchange between decision makers and team members . The onus to create fertile ground for effective 2‐way communication in the operational environment falls squarely on the shoulders of clinical team leaders (eg, surgeon, code team leader, charge nurse, hospitalist).…”

Section: Rationalementioning

confidence: 99%

Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork

Sculli¹,

Fore²,

Sine³

et al. 2015

J of Healthc Risk Manag

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In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.

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“…In response, ensuring the safety of patient care became an important objective for resident education, with links to all 6 Accreditation Council for Graduate Medical Education (ACGME) compencies. [2][3][4][5][6][7] There have been efforts to assess the safety of patient care within and across disciplines. 3,8,9 When surveys have been conducted to seek their perspective on the safety of care in teaching settings, residents have reported multiple errors and threats to patient safety, including a lack of procedural training, inadequate sign-outs, teamwork problems, supervision issues, technology interface glitches, and long work hours.…”

Section: Introductionmentioning

confidence: 99%

Residents' Perspectives on Patient Safety in University and Community Teaching Hospitals

Jones¹

2014

Journal of Graduate Medical Education

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Background Patient safety is an important concept in resident education. To date, few studies have assessed resident perceptions of patient safety across different specialties. Objective The study explored residents' views on patient safety across the specialties of internal medicine, general surgery, and diagnostic radiology, focusing on common themes and differences. Methods In fall 2012, interviews of small groups of senior residents in internal medicine, general surgery, and diagnostic radiology were conducted at 3 academic medical centers and 3 community teaching hospitals in 3 major US metropolitan areas. In total, 33 residents were interviewed. Interviews used interactive discussion to explore multiple facets of patient safety. Results Residents identified lack of information, common errors, volume and acuity of patients, and inadequate supervision as major risks to patient safety. Specific threats to patient safety included communication problems, transitions of care, information technology interface issues, time constraints, and work flow. Residents disclosed that reporting safety issues was viewed as burdensome and carrying some degree of risk. There was variability as to whether residents would report safety threats they encountered. Conclusions Residents are aware of threats to patient safety and have a unique perspective compared with other health care professionals. Transitions of care and communication problems were the most common safety threats identified by the residents interviewed.

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Identifying and Eliminating Deficiencies in the General Surgery Resident Core Competency Curriculum

Cited by 31 publications

References 18 publications

Disruptive behavior in the workplace: Challenges for gastroenterology fellows

Disruptive behavior in the workplace: Challenges for gastroenterology fellows

Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork

Residents' Perspectives on Patient Safety in University and Community Teaching Hospitals

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