Journal of surgical education
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Previously, we identified a positive correlation between administration of regularly structured mock oral examinations and successful first time pass rates on the American Board of Surgery Certifying Examination (ABSCE)/oral boards. In this study, we investigated factors associated with test results to determine whether residents at risk of not passing the ABSCE can be identified a priori. ⋯ Compared with a control group of residents from the same program, residents who passed the ABSCE examination on the first attempt were more likely to have higher USMLE Step 2 and professional communication scores. USMLE Step 1 scores and English as a native language were not associated with certifying examination pass rates. These criteria may offer guidance for residents preparing to take the ABSCE and may aid in the selection of residents for residency programs. Larger studies to validate these findings and to investigate the role of improving communication skills and conducting interventions between the 1st and 2nd attempt are warranted.
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Comparative Study
Proficiency of surgical faculty and residents with ethical dilemmas: is modeling enough?
Professionalism, an Accreditation Commission for Graduate Medical Education (ACGME) competency, embraces the concept of adherence to ethical principles. Despite this, most surgical residencies do not currently include ethics as part of their core curriculum. Further, expertise in effectively managing ethical dilemmas is frequently obtained via modeling after the attending physician. This study evaluated surgical faculty (SF) and residents (SR) on their understanding of basic ethical principles and their overall confidence in translation of these principles into clinical practice. The objective was to determine if there are any differences in the overall levels of knowledge and confidence in ethics between SR and SF. ⋯ While SF are more confident in their ethical decision-making, their fundamental knowledge base in ethics is not different from that of SR. Female SF report greater self-confidence over their male counterparts. In total, SF may not possess the foundation to effectively mentor residents in appropriate ethical principles and their translation to clinical practice. This study supports the need for both SR and SF to engage in an integrated education program in ethics to promote on-going dialogue in this complex topic.
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The time it takes to complete an operation is important. Operating room (OR) time is costly and directly associated with infectious complications and length of stay. Intuitively, procedures take longer when a surgical resident is operating. How much extra time should we take to train residents? We examined the relationship between laparoscopic inguinal hernia repair (IHR) procedure duration and resident participation and its impact on the development of complications and hospital stay. ⋯ Laparoscopic IHR is performed faster by staff surgeons without residents. There was no difference in the complication rate when residents were involved. Teaching and mentoring residents in the OR for laparoscopic IHR is safe and laudable.
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Comparative Study
General surgery vs fellowship: the role of the Independent Academic Medical Center.
To compare career choices of residency graduates from Independent Academic Medical Center (IAMC) and University Academic Medical Center (UAMC) programs and evaluate program directors' perceptions of residents' motivations for pursuing general surgery or fellowships. ⋯ Most general surgery residents undergo fellowship training. Graduates from IAMC and UAMC programs pursue similar specialties, but UAMC programs report more first choice acceptance. IAMC programs may graduate proportionately more general surgeons. Further studies directly evaluating surgical residents' career choices are warranted to understand the influence of independent and university programs in shaping these choices and to develop strategies for reducing the general surgeon shortage.
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To assess if implementing Nighttime Nurse and Physician Paging System (NNAPPS) would improve nurse and physician communication as well as reduce the number of nonurgent pages to residents taking overnight call. ⋯ NNAPPS significantly reduced nonurgent pages, total pages and pages per patient during a night shift compared to services with conventional systems. Streamlined paging systems lead to more efficient communication between providers and decrease the nonurgent pages to residents. NNAPPS continued high standards of patient care and improved sleep patterns for residents.