Readiness of US General Surgery Residents for Independent Practice

George, Brian C.; Bohnen, Jordan D.; Williams, Reed G.; Meyerson, Shari L.; Schuller, Mary C.; Clark, Michael; Meier, Andreas H.; Torbeck, Laura; Mandell, Samuel P.; Mullen, John; Smink, Douglas S.; Scully, Rebecca E.; Chipman, Jeffrey G.; Auyang, Edward D.; Terhune, Kyla P.; Wise, Paul E.; Choi, Jennifer; Foley, Eugene F.; Dimick, Justin B.; Choti, Michael A.; Soper, Nathaniel J.; Lillemoe, Keith D.; Zwischenberger, Joseph B.; Dunnington, Gary L.; DaRosa, Debra A.; Fryer, Jonathan P.

doi:10.1097/sla.0000000000002414

Cited by 280 publications

(161 citation statements)

References 35 publications

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“…"The American Board of Surgery has designated 132 procedures as being core to the practice of general surgery" [16]. "General surgery residents are expected to be able to safely and independently perform those designated procedures by the time they graduate/are board certified" [16]. "There is increasing concern though that perhaps some general surgery residents are not competent to enter independent practice" [16].…”

Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

“…"General surgery residents are expected to be able to safely and independently perform those designated procedures by the time they graduate/are board certified" [16]. "There is increasing concern though that perhaps some general surgery residents are not competent to enter independent practice" [16]. In a study from a US university hospital approximately 40% of the faculty members expressed that trainees were not independently capable of performing inguinal hernia repair at any stage of their training [55].…”

Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

“…"For example, the UK demands 1600 procedures by completion of training and the USA requires 750" [15]. In addition to appendectomy, cholecystectomy and partial colectomy, inguinal/femoral and ventral hernia repairs are listed as part of the core procedures in general surgery training [16].…”

Section: Introductionmentioning

confidence: 99%

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The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia-or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique).Other hernia-and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special int...

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Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

See 1 more Smart Citation

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

View full text Add to dashboard Cite

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“…In recent decades, competency‐based programmes, formative feedback and structural assessments have reshaped the traditional strategy of ‘learning by doing’ in the OR . Nowadays restrictions on working hours and gaps in autonomous task performance force surgical trainees to learn more in less time . One strategy that allows surgical trainees to master clinical skills and improve individual learning strategies may involve self‐regulated learning (SRL) .…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15] Nowadays restrictions on working hours and gaps in autonomous task performance force surgical trainees to learn more in less time. [16][17][18] One strategy that allows surgical trainees to master clinical skills and improve individual learning strategies may involve selfregulated learning (SRL). 19,20 According to the theories of SRL, learners can deliberately develop and adapt their cognitive strategies, behaviour and interactions with the learning environment to maximise the benefits of the learning moment.…”

mentioning

confidence: 99%

Recruiting expertise: how surgical trainees engage supervisors for learning in the operating room

et al. 2019

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Context For centuries now, the operating room (OR) has been the environment in which surgical trainees come to master procedures. Restricted working hours and insufficient levels of autonomy at the end of their training necessitate a shift towards alternative effective learning strategies. Self‐regulated learning is a promising strategy by which surgical trainees can learn more with fewer exposures. However, the challenge is to understand how surgical trainees regulate their learning in the clinical context of the OR. Objectives The purpose of this study is to identify and understand the strategies of surgical trainees in engaging their supervisors for learning purposes and how these strategies contribute to effective learning. Methods Total hip replacement procedures performed by four surgical trainees and their supervisors were videotaped. Using the iterative inductive process of conversation analysis, each verbal initiative to engage the supervisor was identified, analysed (‘why that now’) and categorised. Results Surgical trainees used a range of practices to engage supervisors and recruit expertise, ranging from explicit recruitment to implicit hints. We identified four major categories. Surgical trainees: (i) invite the supervisor to provide an evaluation of the ongoing task; (ii) express an evaluation of the ongoing task and then explicitly invite the supervisor to provide an evaluation; (iii) express an evaluation of the ongoing task and then invite the supervisor to provide confirmation, and (iv) express an evaluation of the ongoing task without engaging the supervisor. Conclusions Surgical trainees recruit expertise from supervisors using practices of four different categories. Trainees’ actions are provoked by the moment at which they experience insufficient expertise and are focused on the task at hand in the immediate present. Supervisors can and do elaborate on these requests to provide explicit teaching. Insight into these practices provides tools for reflection on OR learning, proficiency assessment and deliberation to adapt guidance in the real time of the procedure.

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