ANZ journal of surgery
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ANZ journal of surgery · Dec 2017
Comparative StudyFactors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution.
Laparoscopic distal pancreatectomy (LDP) is increasingly adopted today. This study aims to determine factors associated with and consequences of open conversion after LDP. ⋯ Splenectomy, institution experience and individual surgeon volume were the factors associated with open conversion after LDP.
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ANZ journal of surgery · Dec 2017
General surgery primary operator rates: a guide to achieving future competency.
Competency in surgical training is a topic of much recent discussion, with concern regarding the adequacy of current training schemes to achieve competency. Most programmes use caseload and primary operator rates to assess trainee progression. Some trainees still lack technical competence even when recommended procedural numbers are met. It is possible that current measures of individual's capabilities used in surgical education are outdated. ⋯ General surgical trainees accumulate operative experience with progression through the surgical education and training programme, highlighting expected technical progression and competency of trainees for common procedures. For less common or more complicated procedures, the use of entrustable professional activities and accompanying simulation training could be used to achieve the necessary technical expertise.
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ANZ journal of surgery · Dec 2017
Implementing entrustable professional activities: the yellow brick road towards competency-based training?
We describe implementation of competency-based postgraduate surgical training, using an entrustable professional activities (EPAs) programme. The programme aims to improve patient outcomes by optimizing supervision of surgical trainees, creating opportunities for additional teaching and feedback. The curriculum was designed to maximize feasibility for implementation within a colorectal surgical department. ⋯ There are perceived benefits and problems evident in the EPA model at this early stage of implementation. The programme should result in an increase in the number of formative assessments and feedback opportunities for trainees. The assessment process is familiar to supervisors, which should facilitate implementation of the curriculum. There is concern that supervisors may require further training to ensure the assessment process is objective and reproducible. The EPA programme could make the process of delegating patient care to trainees more transparent, but we have not identified a method of widely disseminating trainee assessment data without the potential to prejudice trainees unfairly.
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ANZ journal of surgery · Dec 2017
Comparative StudyImpact of sex on prognostic host factors in surgical patients with lung cancer.
Lung cancer has markedly poorer survival in men. Recognized important prognostic factors are divided into host, tumour and environmental factors. Traditional staging systems that use only tumour factors to predict prognosis are of limited accuracy. By examining sex-based patterns of disease-specific survival in non-small cell lung cancer patients, we determined the effect of sex on the prognostic value of additional host factors. ⋯ Sex differences in non-small cell lung cancer are important irrespective of age, ethnicity, smoking, performance status and tumour, node and metastasis stage. Epidemiological findings such as these should be translated into research and clinical paradigms to determine the factors that influence the survival disadvantage experienced by men.