Journal of surgical education
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The purpose of this article is to describe our experience with the incorporation of a proficiency-based laparoscopic skills curriculum in a busy surgical training program that aims to improve the technical proficiency of residents. The curriculum has a cognitive component and a manual skills component and is adjusted to resident training level. It is based on the Fundamentals of Laparoscopic Surgery program and includes basic laparoscopic virtual-reality tasks of the Lap Mentor simulator (Simbionix USA Corp., Cleveland, Ohio). ⋯ Our curriculum has been implemented for several months. Our experience so far suggests that it is imperative to have dedicated supervising personnel and dedicated training time in the busy week of the surgical resident to ensure attendance. Our next step is to incorporate the 20 modules of the new Association of Program Directors in Surgery (ADPS)/American College of Surgeons (ACS) national skills curriculum into our skills training program, to expand its cognitive component by incorporating additional procedural videos, and to adapt scenario-based training on trauma and critical care on human patient simulators.
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The Mount Sinai Surgical Residency program uses physician assistants and nurse practitioners, jointly termed non-physician practitioners (NPPs), to adhere to the 80-hour work-week restrictions implemented by Accreditation Council of Graduate Medical Education (ACGME) resident duty hour requirements initiated in 2003. A survey was performed to determine how the integration of NPPs into the surgical subspecialty teams has affected surgical residents' perceptions of their education and overall residency experience. We review the roles of NPPs within surgical specialty teams as well as our survey findings about NPP and resident impressions about the NPP role. ⋯ We found that at our institution, residents and NPPs agree that they work well together and that NPPs positively contribute to resident education. We recommend a service-specific orientation for the residents with each rotation to clarify NPP responsibilities and functions, thereby maximizing collaboration. With a firm understanding of the various roles of the NPPs, a cohesive, multidisciplinary group can be attained while enhancing surgical education.
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Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons. ⋯ Although general surgical residencies prepare residents well technically, they do not seem to be training residents adequately in the business of medicine. This training can be conducted by attendings, local attorneys, office managers, and past residents with the expectation that job relocations can decrease and surgeon career satisfaction can increase.
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As laparoscopy continues to permeate general surgery, there is an increased need for residents to acquire advanced laparoscopic skills during a surgical training program. To underscore its importance, the Accreditation Council of Graduate Medical Education (ACGME) recently increased the requirements for laparoscopy from 34 to 60 basic cases and from 0 to 25 advanced cases. With this in mind, the purpose of this study is to assess the impact of an organized minimally invasive surgical service on the volume of advanced laparoscopic cases of a general surgery residency program. ⋯ The number of advanced laparoscopic cases per resident in this otherwise stable general surgery residency program substantially increased with the incorporation of a dedicated minimally invasive service led by a fellowship-trained laparoscopic surgeon. These data suggest that the volume increases needed to satisfy ACGME requirements may only be possible by creation of such a training experience dedicated to advanced laparoscopy.
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The study aim was to demonstrate that a new database tool for assessment of surgical resident operative skills discerns predictable progression in those skills over successive residency years for specific index case types. ⋯ Our early results show that the OpRate assessment tool is effective in identifying expected changes in operative performance across successive training years, with a satisfactory level of internal consistency for the test items. As such, the use of this database tool may offer the opportunity to (1) define performance benchmarks for specific levels of training and (2) identify areas where focused training may be required for specific residents.