Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience

Prystowsky, Jay B.; Bordage, Georges; Feinglass, Joseph

doi:10.1067/msy.2002.127550

Cited by 212 publications

(153 citation statements)

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“…Prystowsky et al [8] reported that American Board of Surgery certification was associated with reduced mortality and morbidity for colorectal resection. Pearce et al [9] found that surgeons with a subspecialty certification had better outcomes for carotid endarterectomy and abdominal aortic aneurysm repair.…”

Section: Discussionmentioning

confidence: 99%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

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Background Laparoscopy-assisted gastrectomy (LAG) is an advanced surgery that requires the mastery of complex surgical skills. We evaluate the feasibility of LAG with systemic lymph node dissection when participating surgeons have sufficient knowledge and experience to conduct open surgery for gastric cancer and basic laparoscopic skills. Methods All operations were performed by two Japan Surgical Society board-certified attending surgeons who had performed over 50 conventional gastrectomies and 30 laparoscopic cholecystectomies. The surgeons went through an established program, including training at the wet and dry laboratories. In addition, surgeries for the first 10 cases were assisted by an expert surgeon with experience of [300 cases. To be eligible for the LAG procedure, patients had to have a preoperative diagnosis of T1, N0 and M0 gastric carcinoma. The morbidity rate was used as the study endpoint. Variables such as operating time, intraoperative blood loss and number of retrieved lymph nodes were evaluated as complementary surgical endpoints. These variables were compared between the first 25 cases and the latter 25 cases.Results A total of 50 patients who were scheduled to undergo LAG were prospectively enrolled between 2005 and 2008. Morbidity rate was 4% (2/50), with one case due to intestinal injury and one case due to an intra-abdominal abscess. Complications related to laparoscopy were observed in 2% (1/50), with one case of mesenteric injury. The conversion rate to laparotomy was 6% (3/50). However, there were no serious consequences in converted cases. The operating time was 263.7 ± 45.0 min. The intraoperative blood loss was 94.5 ± 106.5 g. The total number of regional lymph nodes retrieved was 34.7 ± 12.2. A significant improvement in the blood loss was only noted after the first 25 procedures. All patients are alive and disease-free after a median follow-up of 38.8 months. Conclusion An adequate training program, including site visits by expert surgeons, in conjunction with basic laparoscopy skills and solid backgrounds in open gastrectomy from the perspective of the trainees are currently key to the successful and safe implementation of LAG. Whether the procedure is oncologically feasible remains to be confirmed by long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

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“…[5][6][7] Certification examination scores correlate with training factors (type of medical school and residency program) 9,10 and assessments of competency by program directors, 11 and recertification scores discriminate between individuals with and without subspecialty content expertise. 12 A growing body of evidence demonstrates relationships between certification status and quality of care including outcomes following acute MI, [13][14][15] colorectal surgery, 16 diabetes care, 17 mammography screening, 17 and other preventive services. 18 Unfortunately, unrelenting time pressures in clinical practice have made it increasingly difficult for physicians to maintain habits of lifelong learning, 19,20 resulting in decrements in medical knowledge over time.…”

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confidence: 99%

Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores

et al. 2012

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BACKGROUND: Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine. METHODS: We conducted a cross-sectional study of 3,958 United States physicians who took the Internal Medicine Maintenance of Certification Examination (IM-MOCE) between January 1, 2006 and December 31, 2008, and who held individual licenses to one or both of two large electronic knowledge resource programs. We examined associations between physicians' IM-MOCE scores and their days of electronic resource use, practice type (private practice, residency teaching clinic, inpatient, nursing home), practice model (single or multispecialty), sex, age, and medical school location. RESULTS: In the 365 days prior to the IM-MOCE, physicians used electronic resources on a mean (SD, range) of 20.3 (36.5, 0-265) days. In multivariate analyses, the number of days of resource use was independently associated with increased IM-MOCE scores (0.07-point increase per day of use, p=0.02). Increased age was associated with decreased IM-MOCE scores (1.8-point decrease per year of age, p< 0.001). Relative to physicians working in private practice settings, physicians working in residency teaching clinics and hospital inpatient practices had higher IM-MOCE scores by 29.1 and 20.0 points, respectively (both p<0.001). CONCLUSIONS: Frequent use of electronic resources was associated with modestly enhanced IM-MOCE performance. Physicians involved in residency education clinics and hospital inpatient practices had higher IM-MOCE scores than physicians working in private practice settings.

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“…1 The public is also keenly interested in the certification status of physicians because certification is a measure of a physician's medical knowledge in his or her specialty area. 2 Though considerable evidence exists that correlates physician performance on these examinations with desirable physician behaviors and patient outcomes, [3][4][5][6][7][8][9][10][11] limited information exists regarding the influence of test-taking skills on the ability to suc-cessfully pass the examination and thus become certified. This is largely because of experimental design issues in isolating test-taking skills from ability.…”

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confidence: 99%

Performance on the American Board of Family Medicine (ABFM) Certification Examination: Are Superior Test-Taking Skills Alone Sufficient to Pass?

O'Neill

Royal²,

Puffer³

2011

The Journal of the American Board of Family Medicine

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Introduction: Certification examinations used by American specialty boards have been the sine qua non for demonstrating the knowledge sufficient for attainment of board certification in the United States for more than 75 years. Some people contend that the examination is predominantly a test of superior test-taking skills rather than of family medicine decision-making ability. In an effort to explore the validity of this assertion, we administered the American Board of Family Medicine (ABFM) Certification to examinees who had demonstrated proficiency in taking standardized tests but had limited medical knowledge.Methods: Four nonphysician experts in the field of measurement and testing were administered one version of the 2009 ABFM certification examination. Scaled scores were calculated for each examinee, and psychometric analyses were performed on the examinees responses to examination items and compared with the performance of physicians who took the same examination.Results: The minimum passing threshold for the examination was a scaled score of 390, corresponding to 57.7% to 61.0% of questions answered correctly, depending on the version of the examination. The 4 nonphysician examinees performed poorly, with scaled scores that ranged from 20 to 160 (mean, 87.5; SD, 57.4). The number of questions answered correctly ranged from 24.0% to 35.1% (mean, 29.2%; SD, 0.05%). Rasch analyses of the examination items revealed that the nonphysician examinees were more likely to use guessing strategies in an effort to answer questions correctly. Distracter analysis suggest near-complete randomness in the nonphysician responses.Conclusions: Though all 4 nonphysician examinees performed better than would have been predicted by chance alone, none performed well enough to even fall within 8 SE below the passing thresholds; their performance was far below that of almost all physicians who completed the examination. Given that the nonphysicians relied heavily on the identifying cues in the phrasing of items and the manner in which response options were presented, the results affirm the notion that the ABFM certification examination is not primarily a measure of generic test-taking ability but measures information critical to the estimation of a family physician's knowledge sufficient for certification. Item analysis confirmed that items were well written, provided minimal cueing, and required medical knowledge to answer correctly. (J Am Board Fam Med 2011;24:175-180.)

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Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience

Cited by 212 publications

References 13 publications

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores

Performance on the American Board of Family Medicine (ABFM) Certification Examination: Are Superior Test-Taking Skills Alone Sufficient to Pass?

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