Journal of surgical education
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Review Multicenter Study Comparative Study
Relationship Between Technical Errors and Decision-Making Skills in the Junior Resident.
The purpose of this study is to coevaluate resident technical errors and decision-making capabilities during placement of a subclavian central venous catheter (CVC). We hypothesize that there would be significant correlations between scenario-based decision-making skills and technical proficiency in central line insertion. We also predict residents would face problems in anticipating common difficulties and generating solutions associated with line placement. ⋯ Almost half of the surgical residents committed multiple errors while performing subclavian CVC placement. The correlation between technical errors and decision-making skills suggests a critical need to train residents in both technique and error management.
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Although development of trainees' competency in interpersonal communication is essential to high-quality patient-centered surgical care, nontechnical skills present assessment challenges for residency program directors. The Communication Assessment Tool (CAT) demonstrated internal reliability and content validity for general surgery residents, though the tool has not yet been applied in simulation. The study provides validation evidence for using the CAT to assess surgical residents' interpersonal communication skills in simulation scenarios. ⋯ The CAT demonstrates content validity in a simulation environment with former patients acting as SPs. This study provides validation evidence relating the SP-CAT to discrete observations of communication behaviors by a trained, reliable observer as well as residents' self-reported emotional intelligence traits.
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Review Comparative Study
Objective Assessment of General Surgery Residents Followed by Remediation.
Surgical training programs often lack objective assessment strategies. Complicated scheduling characteristics frequently make it difficult for surgical residents to undergo formal assessment; actually having the time and opportunity to remediate poor performance is an even greater problem. We developed a novel methodology of assessment for residents and created an efficient remediation system using a combination of simulation, online learning, and self-assessment options. ⋯ Despite difficulties with training logistics and busy resident schedules, it is feasible to objectively assess most GS trainees and offer opportunities to remediate if performance is poor. Our multifaceted remediation methodology allowed 18 residents to achieve good or stellar performance on each station after deliberate practice. Enticing chief residents to participate in remediation efforts in the spring of their final year of training remains a work in progress.
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The Accreditation Council for Graduate Medical Education requires accredited general surgery residencies to implement competency-based developmental outcomes in resident evaluations. Overall, 16 milestones are evaluated by a clinical competency committee (CCC). The milestones span 8 domains of surgical practice and 6 Accreditation Council for Graduate Medical Education clinical competencies. The highest level suggests preparedness for independent practice. Our objective was to compare self-assessments and committee evaluations within the milestone framework. ⋯ Surgery residents within our program demonstrated adequate self-awareness, with most self-evaluations falling within a half level of the CCC report. This self-awareness was consistent across surgical domains and most clinical competencies. Residents perceived a lower level of medical knowledge than the CCC. Subgroup analysis revealed interesting trends in the effects of sex, postgraduate year level, and academic year timing, which will take additional study to fully delineate.
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To analyze the surgical proficiency and educational quality of YouTube videos demonstrating laparoscopic fundoplication (LF). ⋯ Many videos showing the LF procedure have been uploaded to YouTube with varying degrees of quality. A process for filtering LF videos with high surgical and educational quality is feasible by evaluating the video duration, uploading source, and the views/days online ratio. However, alternative videos platforms aimed at professionals should also be considered for educational purposes.