Journal of surgical education
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Comparative Study
Teaching first or teaching last: does the timing matter in simulation-based surgical scenarios?
The optimal timing of instruction in simulation-based scenarios remains unclear. We sought to determine how varying the timing of instruction, either before (teaching first) or after (teaching last) the simulation, affects knowledge outcomes of surgical trainees. ⋯ Participants who received instruction after simulated scenarios achieved higher mean knowledge scores than those who received instruction before simulated scenarios. Cognitive overload, stress, or activation of prior knowledge could all be involved as causal mechanisms.
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The Accreditation Council for Graduate Medical Education (ACGME) uses the resident/fellow survey to assess residency programs compliance with ACGME work hours regulations. Survey results can have significant consequences for residency programs including ACGME letters of warning, shortened program accreditation cycle, immediate full program and institutional site visits, or administrative withdrawal of a program's accreditation. Survey validity was assessed by direct query of general surgery residents who answer the survey each year. ⋯ One hundred thirty-three residents (14%) admitted to not answering the questions truthfully while 352 (37%) of residents felt that the survey did not provide an accurate evaluation of their work hours in residency training. An evaluation tool in which 1 in 7 residents admit to answering the questions falsely and 1 in 5 residents had difficulty interpreting the questions may not be a valid method to evaluate compliance with work hours regulations. Evaluation of work hours regulations compliance should be based on actual work hours data rather than an anonymous survey.
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Simulated patient care has gained acceptance as a medical education tool but is underused in surgical training. To improve resident clinical management in critical situations relevant to the surgical patient, high-fidelity full patient simulation training was instituted at Baystate Medical Center in 2005 and developed during successive years. We define surgical patient simulation as clinical management performed in a high fidelity environment using a manikin simulator. This technique is intended to be specifically modeled experiential learning related to the knowledge, skills, and behaviors that are fundamental to patient care. We report 3 academic years' use of a patient simulation curriculum. ⋯ Patient simulation training was implemented successfully with good compliance in this medium-sized surgical residency training program, but clear challenges were encountered with issues related to the number and range of experiences available per resident, competition with other educational activities, and fidelity and realism. Initial experience suggests that the associated assessment methods can detect predictable improvements in patient management skills across successive residency years, as well as potentially deficient management. Additional work is required to determine the educational effect of this training on resident clinical competency.
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Comparative Study
Teamwork training improves the clinical care of trauma patients.
We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes? ⋯ Structured trauma resuscitation team training augmented by simulation improves team performance, resulting in improved efficiency of patient care in the trauma bay. We propose that formal teamwork training augmented by simulation be included in surgery residency training as well as Advanced Trauma Life Support (ATLS).
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Comparative Study
How accurate is the Accreditation Council for Graduate Medical Education (ACGME) Resident survey? Comparison between ACGME and in-house GME survey.
Increasing importance is being assigned to the annual Accreditation Council for Graduate Medical Education (ACGME) Resident/Fellow survey. In certain circumstances, the survey has prompted site visits for programs with significant areas of noncompliance. However, the dichotomous "yes/no" responses available for most questions on the ACGME survey limit the range of resident responses. Our Graduate Medical Education (GME) department administers an annual survey similar in content to the ACGME survey but with answers using a 5-point Likert scale. The purpose of the current study was to compare the responses obtained on the ACGME survey with our in-house GME survey. ⋯ The results of the current study suggest that responses obtained on the ACGME survey may inaccurately reflect the magnitude of noncompliance found in certain areas. We propose that this discrepancy may be a result of the limited range of responses available on the ACGME survey.