Trainee autonomy and surgical outcomes after emergency gastrointestinal surgery

Parker, Robert K.; Otoki, Kemunto; Sylvester, Kimutai; Roberts, Luke; Many, Heath R.; Mwachiro, Michael; Parker, Andrea S.

doi:10.1016/j.surg.2023.04.050

Cited by 4 publications

(2 citation statements)

References 36 publications

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“…While higher case volumes have been positively correlated with patient outcomes [ 22 – 25 ], procedural numbers do not always correlate with trainee autonomy and learning [ 26 ]. The development of autonomy in the operating room is critical to creating competent, safe, and independent surgeons while not compromising patient safety [ 27 , 28 ]. In the future, adopting entrustable professional activities for evaluation may limit the role and focus on specific case minimums [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Mwachiro,

Yankunze,

Bachheta

et al. 2023

World j. surg.

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Background Operative experience is a necessary part of surgical training. The College of Surgeons of East, Central, and Southern Africa (COSECSA), which oversees general surgery training programs in the region, has implemented guidelines for the minimum necessary case volumes upon completion of two (Membership) and five (Fellowship) years of surgical training. We aimed to review trainee experience to determine whether guidelines are being met and examine the variation of cases between countries. Methods Operative procedures were categorized from a cohort of COSECSA general surgery trainees and compared to the guideline minimum case volumes for Membership and Fellowship levels. The primary and secondary outcomes were total observed case volumes and cases within defined categories. Variations by country and development indices were explored. Results One hundred ninety-four trainees performed 69,283 unique procedures related to general surgery training. The review included 70 accredited hospitals and sixteen countries within Africa. Eighty percent of MCS trainees met the guideline minimum of 200 overall cases; however, numerous trainees did not meet the guideline minimum for each procedure. All FCS trainees met the volume target for total cases and orthopedics; however, many did not meet the guideline minimums for other categories, especially breast, head and neck, urology, and vascular surgery. The operative experience of trainees varied significantly by location and national income level. Conclusions Surgical trainees in East, Central, and Southern Africa have diverse operative training experience. Most trainees fulfill the overall case volume requirements; however, further exploration of how to meet the demands of specific categories and procedures is necessary.

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Section: Discussionmentioning

confidence: 99%

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Mwachiro,

Yankunze,

Bachheta

et al. 2023

World j. surg.

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“…Since 2008, the hospital has had a five‐year surgical training program with two to three residents each year. Meaningful operative autonomy is safely granted to residents with increasing progression throughout residency training [12]. Prior to the implementation of SIMPL, the resident training program encouraged use of information feedback conversations using the Zwisch scale, which was posted on operating room doors in 2016 [13].…”

Section: Methodsmentioning

confidence: 99%

Implementation of a Smartphone‐Based Platform for Operative Feedback at Tenwek Hospital in Kenya: A Mixed Methods Study

Bidwell,

Gates,

Mwachiro

et al. 2023

World j. surg.

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Background The SIMPL operative feedback tool is used in many U.S. surgical residency programs. However, the challenges of implementation and benefits of the web-based platform in low-and middle-income countries are unknown. The aim of this study was to evaluate implementation of SIMPL in a general surgery residency training program in Kenya. Methods SIMPL was pilot tested at Tenwek Hospital from January through December 2021. Participant perspectives of SIMPL were elicited through a survey and semi-structured interviews. Descriptive statistics were used to analyze survey data. Inductive qualitative content analysis of interview responses was performed by two independent researchers. Results Fourteen residents and six faculty (100% response rate) were included in the study and completed over 600 operative assessments. All respondents reported numerical evaluations and dictated feedback were useful. Respondents felt that SIMPL was easy to use, improved quality and frequency of feedback, helped refine surgical skills, and increased resident autonomy. Barriers to use included participants forgetting to complete evaluations, junior residents not submitting evaluations when minimally involved in cases, and technological challenges. Suggestions for improvement included expansion of SIMPL to surgical subspecialties and allowing senior residents to provide feedback to juniors. All respondents wanted to continue using SIMPL, and 90% recommended use at other programs. Conclusion Residents and faculty at Tenwek Hospital believed SIMPL were a positive addition to their training program. There were a few barriers to use and suggestions for improvement specific to the training environment in Kenya, but this study demonstrates it is feasible to use SIMPL in settings outside the U.S. with the appropriate resources.

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Laparoscopy experience in East, Central, and Southern Africa: insights from operative case volume analysis

Yankunze,

Mwachiro,

Lando

et al. 2024

Surg Endosc

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Background With the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied. Methods We conducted an extensive review of COSECSA general surgery trainees' operative case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization. Results Among 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001). Conclusions The study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques.

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Trainee autonomy and surgical outcomes after emergency gastrointestinal surgery

Cited by 4 publications

References 36 publications

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa

Implementation of a Smartphone‐Based Platform for Operative Feedback at Tenwek Hospital in Kenya: A Mixed Methods Study

Laparoscopy experience in East, Central, and Southern Africa: insights from operative case volume analysis

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