Journal of surgical education
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Timely debriefing following a simulated event supports learners in critically reflecting on their performance and areas for improvement. Content of debriefing has been shown to affect learner skill acquisition and retention. The use of good judgment statements from debriefing facilitators is considered superior to judgmental or nonjudgmental statements. Ideally, the majority of the conversation will consist of learner self-reflection and focused facilitation rather than directive performance feedback. We hypothesized that the introduction of a written tool to help facilitate high-quality debriefing techniques could improve the ratio of judgmental, nonjudgmental, and good judgment statements from facilitators, as well as shift the percentage of talk in the debrief away from directive performance feedback and toward self-assessment and focused facilitation. ⋯ The discourse in our interprofessional trauma simulation debriefings unaided by a written debriefing tool skewed heavily toward direct performance feedback, with a preponderance of nonjudgmental statements. After introduction of the tool, dialogue shifted significantly toward learner self-assessment, and there was a large increase in utilization of debriefing with good judgment. This shift toward higher quality debriefing styles demonstrates the utility of such a tool in the debriefing of interprofessional simulations.
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We aimed to assess surgical residents' communication confidence and skills, analyze resident feedback on our ongoing communication curriculum, and report feedback-driven updates. ⋯ We assessed and analyzed surgical residents' communication skills and confidence over 17 months; both showed significant increase over the course of the communication curriculum. We adapted our curriculum using resident feedback and engagement. Our results suggest that communication training can be an effective tool to improve non-technical skills.
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Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error. It was conducted as part of the formal undergraduate medical education curriculum at this institution. ⋯ The combination of web tool implementation and protocol refinement decreased the combined triage error rate by over 50% (from 16.7%-7.9%). We developed and tested a web tool that improved triage accuracy, and provided a sustainable method to enact future quality improvement. This web tool and QI framework would be easily expandable to other hospitals.
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The purpose of this effort was to create an educational experience that provided learners a realistic disclosure experience and improved resident confidence discussing an adverse outcome with a patient and family. ⋯ Residents received important skills practice in our disclosure training; disclosure confidence increased after participation. Residents scored high on completion of disclosure tasks and low on comfort and proficiency of those tasks. The Checklist provided a useful set of tasks to review and complete in the exercise. Separating residents by PGY level enabled senior residents to experience a more complex scenario and junior residents extra time to practice.
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Comparative Study
Can Deficiencies in Performance Be Identified Earlier in Surgical Residency? An Initial Report of a Surgical Trainee Assessment of Readiness Exam.
Identifying gaps in medical knowledge, patient management, and procedural competence is difficult early in surgical residency. We designed and implemented an end-of-year examination for our postgraduate year 1 residents, entitled Surgical Trainee Assessment of Readiness (STAR). Our objective in this study was to determine whether STAR scores correlated with other available indicators of resident performance, such as the American Board of Surgery in-training exam (ABSITE) and Milestone scores, and if they provided evidence of additional discriminatory value. ⋯ We have created a multifaceted standardized STAR exam, which correlates with performance on the ABSITE and early milestone scores. It also appears to discriminate resident performance where milestone assessments do not. Further evaluation of the STAR exam with longer term follow-up is needed to confirm these initial findings.