Journal of surgical education
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Simulated patient care has gained acceptance as a medical education tool but is underused in surgical training. To improve resident clinical management in critical situations relevant to the surgical patient, high-fidelity full patient simulation training was instituted at Baystate Medical Center in 2005 and developed during successive years. We define surgical patient simulation as clinical management performed in a high fidelity environment using a manikin simulator. This technique is intended to be specifically modeled experiential learning related to the knowledge, skills, and behaviors that are fundamental to patient care. We report 3 academic years' use of a patient simulation curriculum. ⋯ Patient simulation training was implemented successfully with good compliance in this medium-sized surgical residency training program, but clear challenges were encountered with issues related to the number and range of experiences available per resident, competition with other educational activities, and fidelity and realism. Initial experience suggests that the associated assessment methods can detect predictable improvements in patient management skills across successive residency years, as well as potentially deficient management. Additional work is required to determine the educational effect of this training on resident clinical competency.
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Comparative Study
Teamwork training improves the clinical care of trauma patients.
We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes? ⋯ Structured trauma resuscitation team training augmented by simulation improves team performance, resulting in improved efficiency of patient care in the trauma bay. We propose that formal teamwork training augmented by simulation be included in surgery residency training as well as Advanced Trauma Life Support (ATLS).
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Comparative Study
Teaching first or teaching last: does the timing matter in simulation-based surgical scenarios?
The optimal timing of instruction in simulation-based scenarios remains unclear. We sought to determine how varying the timing of instruction, either before (teaching first) or after (teaching last) the simulation, affects knowledge outcomes of surgical trainees. ⋯ Participants who received instruction after simulated scenarios achieved higher mean knowledge scores than those who received instruction before simulated scenarios. Cognitive overload, stress, or activation of prior knowledge could all be involved as causal mechanisms.
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Comparative Study
How accurate is the Accreditation Council for Graduate Medical Education (ACGME) Resident survey? Comparison between ACGME and in-house GME survey.
Increasing importance is being assigned to the annual Accreditation Council for Graduate Medical Education (ACGME) Resident/Fellow survey. In certain circumstances, the survey has prompted site visits for programs with significant areas of noncompliance. However, the dichotomous "yes/no" responses available for most questions on the ACGME survey limit the range of resident responses. Our Graduate Medical Education (GME) department administers an annual survey similar in content to the ACGME survey but with answers using a 5-point Likert scale. The purpose of the current study was to compare the responses obtained on the ACGME survey with our in-house GME survey. ⋯ The results of the current study suggest that responses obtained on the ACGME survey may inaccurately reflect the magnitude of noncompliance found in certain areas. We propose that this discrepancy may be a result of the limited range of responses available on the ACGME survey.
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Comparative Study
Disparity between actual case volume and the perceptions of case volume needed to train competent general surgeons.
Variances between resident expectations and faculty expectations may create conflict and/or dissatisfaction. The objective of this study was to determine if resident expectations of case requirements differed significantly from faculty expectations and/or national and program averages. ⋯ Resident and faculty perceptions of the number of cases needed for a competent graduating general surgery resident differ substantially from each other as well as from actual means. Improved education of each group to better align expectations with reality may improve satisfaction during training and confidence upon completion of training.