Journal of surgical education
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Team-based training using crisis resource management (CRM) has gained popularity as a strategy to minimize the impact of medical error during critical events. The purpose of this review was to appraise and summarize the design, implementation, and efficacy of peer-reviewed, simulation-based CRM training programs for postgraduate trainees (residents). ⋯ The findings support the utility of CRM programs for residents. A high degree of satisfaction and perceived value reflect robust resident engagement. The iteration of themes from our review provides the basis for the development of best practices in curricula design. A dearth of well-designed, randomized studies preclude the quantification of impact of simulation-based training in the clinical environment.
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In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted limits on duty hours. Residents were restricted to working 80 hours/week and limited to 24 hours of continuous patient care. Effective July 2011, an additional restriction will be instituted for PGY 1 residents limiting continuous duty to 16 hours maximum. ⋯ Residency programs have adapted to the 2003 work-hour restrictions without apparent ill effect. We must study the effects of the July 2011 requirements prospectively as the traditional frontline physicians (PGY 1 residents) will no longer be available for 24-hour duty shifts.
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Comparative Study
Video review using a reliable evaluation metric improves team function in high-fidelity simulated trauma resuscitation.
To demonstrate that instruction of proper team function can occur using high-fidelity simulated trauma resuscitation with video-assisted debriefing and that this process can be integrated rapidly into a standard general surgery curriculum. ⋯ Video review with debriefing is an effective means of teaching team competencies and improving team function in simulated trauma resuscitation. This strategy can be integrated readily into the surgical curriculum analogous to other applications of simulation technology.
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Often, minor complications are not reported in morbidity and mortality (M&M) conference because they are considered insignificant to patient outcome. As part of an effort to improve the quality of the M&M conference, we sought to integrate a specific, focused intervention to improve the reporting of minor complications and to evaluate the perception of its educational value. ⋯ A formal, evidence-based presentation of minor complications can increase both the faculty and residents' perception of the importance of reporting minor complications at an M&M conference. Focused minor complication reporting should be incorporated into M&M curriculum.
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To investigate the degree of variability in perception as related to the service versus education issue in general surgery residency education. ⋯ Considerable variability exists across individuals as well as groups in the interpretation of the types of experiences that represent service, education, or both in general surgery residency training. Arriving at a quantifiable balance in service versus education in general surgery resident education may never be possible given the variability in interpretation of the various activities residents perform. This must be kept in mind in both interpreting the results of the Accreditation Council for Graduate Medical Education (ACGME) survey and also when designing educational activities within a program.