Operative Experience of Residents in US General Surgery Programs

Biester, Thomas W.; Tabuenca, Arnold; Rhodes, Robert S.; Cofer, Joseph B.; Britt, L. D.; Lewis, Frank R.

doi:10.1097/sla.0b013e3181a38e59

Cited by 390 publications

(220 citation statements)

References 12 publications

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“…An example of the effort to develop a standardized curriculum is the work of the Surgical Council on Resident Education (SCORE) [4], in which stakeholders in general surgery education developed a list of conditions and procedures to form the basis of a standardized curriculum. One crucial advantage of such a curriculum is that the performance of programs in exposing their trainees to components of the standard curriculum can be evaluated [7,13]. Gaps and variations in exposure are thus uncovered and can be corrected in order to have trainees meet the uniform standard of exposure to curricular components [7,13].…”

Section: Discussionmentioning

confidence: 99%

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

Aliu

Chung

2014

Hand (New York, N,Y.)

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Background We examined the fellowship experience of hand surgeons in the USA to identify gaps and variations in exposure to essential skills and knowledge during hand fellowship. Methods We conducted a web-based survey of the entire American Society for Surgery of the Hand and American Association for Hand Surgery membership. We inquired about the level of exposure received to 170 knowledge topics and procedures during fellowship. We used factor analysis to group the knowledge topics and procedures into 79 scales of related items and calculated mean exposure ratings for each scale. We compared the ratings between graduates of plastic surgery (PS) and orthopedic surgery (OS) Residency Review Committee (RRC)-accredited fellowships. Results Our response rate was 21 % (n=562). Plastic surgery RRC-accredited fellowship graduates reported inadequate exposure for proficiency in 22 % (17/79) of the knowledge topic and procedure scales whereas graduates of OS RRCaccredited fellowships reported inadequate exposure for proficiency in 10 % (8/79) of the scales. Moreover, 11 and 21 % of graduates from PS RRC-accredited fellowships reported receiving no exposure in distal radius/ulna and forearm conditions, respectively, whereas only 1 and 2 % of graduates from OS RRC-accredited fellowships reported receiving no exposure in the same domains, respectively.

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Section: Discussionmentioning

confidence: 99%

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

Aliu

Chung

2014

Hand (New York, N,Y.)

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“…As shown in this study and others, reliance on clinical experience alone is insufficient to achieve competence. 31 Use of the mastery model is 1 way to boost clinical skills to high achievement levels. In mastery learning, training time varies, whereas education outcomes are uniform.…”

Section: Discussionmentioning

confidence: 99%

Internal Medicine Postgraduate Training and Assessment of Patient Handoff Skills

Didwania¹,

Kriss²,

Cohen³

et al. 2013

Journal of Graduate Medical Education

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Background Effective communication during patient care transitions is essential for high-quality patient care. Objective The purpose of this study was (1) to objectively assess patient handoff skills of internal medicine residents, and (2) to evaluate correlations between clinical experience and patient handoff skill self-assessment with directly observed skill. Methods We studied simulated patient handoffs in postgraduate year (PGY)-1 and PGY-2 residents between July 2011 and September 2011, using a standardized scenario in an observed structured handoff exam (OSHE). Our design was a posttest-only, with nonequivalent groups. Assessment used a previously published checklist for evaluating handoff skills. Residents were asked about clinical experience with patient handoffs and about their self-confidence in performing a patient handoff independently. We evaluated between-group differences on OSHE checklist performance, patient handoff experience, and self-confidence and used multiple regression analyses to assess the association between performance, experience, and confidence. Results Forty-seven PGY-1 residents and 38 PGY-2 residents completed the study. Interrater reliability was substantial (intraclass correlation = 0.68). There was no significant difference in OSHE performance by PGY-1 residents (mean = 79%, SD = 4.6) and PGY-2 residents (mean = 82%; SD = 7.6; P = .07). The PGY-2 residents were significantly more experienced (P < .001) and confident (P < .001) than PGY-1 residents were, yet clinical experience and self-confidence did not significantly predict OSHE performance. Conclusions Clinical experience and self-assessment do not predict skills in simulated patient handoffs, and residents with substantial clinical experience still benefit from further skills development.

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“…Under limited duty hours, United States surgical programs have sought to preserve procedural volumepotentially at the expense of continuity and involvement of residents in postoperative decision-making and patient management. 69,70 Informal reports from pediatrics suggest that residents in programs with higher total hours of clinical learning performed better on the board certification exam. A Support for the importance of research into the educational effects of duty hour limits comes from studies showing reduced competence in graduates trained under the more restrictive European standards, 33,34 and from Canadian research that surgical graduates lack confidence in their skills at completion of residency.…”

Section: Duty Hour Limits and The Acquisition Of Competencementioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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Operative Experience of Residents in US General Surgery Programs

Cited by 390 publications

References 12 publications

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

A Role Delineation Study of Hand Surgery in the USA: Assessing Variations in Fellowship Training and Clinical Practice

Internal Medicine Postgraduate Training and Assessment of Patient Handoff Skills

Review article: Closing the research gap at the interface of learning and clinical practice

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