Journal of surgical education
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The existing methods for evaluating resident operative performance interrupt the workflow of the attending physician, are resource intensive, and are often completed well after the end of the procedure in question. These limitations lead to low faculty compliance and potential significant recall bias. In this study, we deployed a smartphone-based system, the Procedural Autonomy and Supervisions System, to facilitate assessment of resident performance according to the Zwisch scale with minimal workflow disruption. We aimed to demonstrate that this is a reliable, valid, and feasible method of measuring resident operative autonomy. ⋯ The Zwisch scale can be used to make reliable and valid measurements of faculty guidance and resident autonomy. Our data also suggest that Zwisch ratings may be used to infer resident operative performance. Deployed on an automated smartphone-based system, it can be used to feasibly record evaluations for most operations performed by residents. This information can be used to council individual residents, modify programmatic curricula, and potentially inform national training guidelines.
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The spectrum of the surgeon-scientist ranges from a clinician who participates in the occasional research collaboration to the predominantly academic scientist with no involvement in clinical work. Training surgeon-scientists can involve resource-intense and lengthy training programs, including Masters and PhD degrees. Despite high enrollment rates in such programs, limited data exist regarding their outcome. The aim of the study was to investigate the scientific productivity of general surgeons who completed Masters or PhD graduate training compared with those who completed clinical residency training only. ⋯ The volume and impact of research publication of PhD-trained surgeon-scientists are significantly higher than those having clinical-only and Masters training. The additional 1 or 2 years of training to obtain a PhD over a Masters degree significantly nurtures trainees to hone research skills within a supervised environment and should be encouraged for research-inclined residents.
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Although designed as a low-stakes formative examination, the American Board of Surgery In-Training Examination (ABSITE) is often used in high-stakes decisions such as promotion, remediation, and retention owing to its perceived ability to predict the outcome of board certification. Because of the discrepancy between intent and use, the ability of ABSITE scores to predict passing the American Board of Surgery certification examinations was analyzed. ⋯ ABSITE scores are a useful predictor of QE scores and outcomes but do not predict passing the CE. Although scoring well on the ABSITE is highly predictive of QE success, using low ABSITE scores to predict QE failure results in frequent decision errors. Program directors and other evaluators should use additional sources of information when making high-stakes decisions about resident performance.
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Development and maintenance of scholarly activity is a challenge for small community-based surgical training programs. The current Accreditation Council for Graduate Medical Education Program Requirements in General Surgery states that, "Residents should participate in scholarly activity," and "The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities." We adopted a program designed to improve the quality of research projects pursued by surgical residents and to increase the number of projects submitted for both presentation and publication. ⋯ A structured scholarly activity program positively affects the number of clinical projects produced by a small community-based surgical training program. Familiarity with project design and biostatistics, plus one-on-one mentoring improves the quality of research produced. A potential additional benefit is the ability to involve private surgical faculty with the residents' projects.
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Cigarette smoking is the leading cause of preventable death in North America and a major contributor to surgically treated diseases and operative complications. Counseling by residents can be an effective means of helping patients to quit smoking, and with the introduction of the Accreditation Council for Graduate Medical Education and CanMEDS competency frameworks, health promotion is a required component of residency training. However, past studies have found that smoking cessation counseling by residents, and in particular surgical residents, is lacking. In light of the introduction of health promotion as a core competency in residency training, this study was designed to examine the attitudes and practices of residents at our institution regarding smoking cessation counseling, comparing surgical and nonsurgical residents and seeking to identify barriers to resident counseling. ⋯ Residents, and surgical residents in particular, are missing opportunities to help their patients quit smoking and improve their health. Given their positive attitudes toward counseling, it may be possible to improve their counseling practices through simple means. By identifying obstacles to counseling and tools that may increase residents׳ tendency to perform counseling, this study can help to guide training programs aimed at improving resident competency in health promotion.