Experienced Supervision Research Articles

Big five personality traits of medical students and workplace performance in the final clerkship year using an EPA framework

BackgroundThe qualities of trainees play a key role in entrustment decisions by clinical supervisors for the assignments of professional tasks and levels of supervision. A recent body of qualitative research has shown that in addition to knowledge and skills, a number of personality traits are relevant in the workplace; however, the relevance of these traits has not been investigated empirically. The aim of this study was to analyse the workplace performance of final-year medical students using an Entrustable Professional Activity (EPA) framework in relation to their personality traits.MethodsMedical students at the end of their final clerkship year were invited to participate in an online survey-based, cross-sectional field study. In the survey, the workplace performance was captured using a framework consisting of levels of experienced supervision and a defined set of 12 end-of-undergraduate medical training EPAs. The Big Five personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness) of the participating medical students were measured using the Big Five Inventory-SOEP (BFI-S), which consists of 15 items that are rated on a seven-point Likert scale. The data were analysed using descriptive and inferential statistics.ResultsThe study included 880 final-year medical students (mean age: 27.2 years, SD = 3.0; 65% female). The levels of supervision under which the final-year clerkship students carried out the EPAs varied considerably. Significant correlations were found between the levels of experienced supervision and all Big Five dimensions The correlations with the dimensions of extraversion, agreeableness, conscientiousness and openness were positive, and that for the neuroticism dimension was negative (range r = 0.17 to r = − 0.23). Multiple regression analyses showed that the combination of the Big Five personality traits accounted for 0.8–7.5% of the variance in supervision levels on individual EPAs.ConclusionsUsing the BFI-S, we found that the levels of supervision on a set of end-of-undergraduate medical training EPAs were related to the personality traits of final-year medical students. The results of this study confirm the existing body of research on the role of conscientiousness and extraversion in entrustment decision-making and, in particular, add the personality trait of neuroticism as a new and relevant trainee quality to be considered.

Simulating Surgical Skills in Animals: Systematic Review, Costs & Acceptance Analyses.

Background: Modern surgery demands high-quality and reproducibility. Due to new working directives, resident duty hours have been restricted and evidence exists that pure on-the-job training provides insufficient exposure. We hypothesize that supplemental simulations in animal models provide a realistic training to augment clinical experiences. This study reviews surgical training models, their costs and survey results illustrating academic acceptance.Methods: Animal models were identified by literature research. Costs were analyzed from multiple German and Austrian training programs. A survey on their acceptance was conducted among faculty and medical students.Results: 915 articles were analyzed, thereof 91 studies described in-vivo animal training models, predominantly for laparoscopy (30%) and microsurgery (24%). Cost-analysis revealed single-training costs between 307€ and 5,861€ depending on model and discipline. Survey results illustrated that 69% of the participants had no experience, but 66% would attend training under experienced supervision. Perceived public acceptance was rated intermediate by medical staff and students (4.26; 1–low, 10 high).Conclusion: Training in animals is well-established and was rated worth attending in a majority of a representative cohort to acquire key surgical skills, in light of reduced clinical exposure. Animal models may therefore supplement the training of tomorrow's surgeons to overcome limited hands-on experience until virtual simulations can provide such educational tools.

Lessons in Public Health Leadership

Abstract Background The UK Faculty of Public Health (FPH) is a world leader in developing a dynamic competency-based curriculum and delivering high quality training and professional development of a multidisciplinary public health specialist workforce in the UK. This includes capacity building and shaping tomorrow's public health leaders. Objectives Strong Leadership is increasingly the need of the day to deal with the complex public health challenges in a rapidly evolving and shifting global landscape. Can a public health curriculum and training (like that of the FPH) provide the framework for the knowledge, skills, attitudes and behaviours required for producing world class public health systems leaders? Body of the session Key principles of developing systems leadership include providing an enabling environment, developing the right skill mix, acquiring relevant knowledge, framing placements with experienced supervision and appropriate coaching and mentoring are some of the elements built into the training opportunities for public health registrars, their supervisors and new consultants. This presentation will give an overview of some lessons in public health leadership, the skills and knowledge base required to perform effectively as a public health systems leader and explore some of the challenges faced by the world of public health. The panel will encourage interactive discussion to share the learning from other countries and systems required to develop the next generation of public health leaders. Conclusions Public health, of all specialties, lends itself best to lead across and beyond organisational boundaries, lead without authority and create change whilst not being in charge. It is imperative that systems are put in place to train, develop and build public health leaders for tomorrow.

Preliminary results of robotic inguinal hernia repair following its introduction in a single-center trial.

AimRobotic surgery using the da Vinci system has markedly increased worldwide. However, robotic inguinal hernia repair remains unpopular outside the United States. We introduced and evaluated a robotic transabdominal preperitoneal repair (R‐TAPP) technique for inguinal hernia in our hospital.MethodsFirst, we designed a task protocol according to the surgical results of 388 laparoscopic TAPP (L‐TAPP) procedures performed during the 4 years prior to introducing R‐TAPP. Our task protocol included several time limitations during a step‐wise procedure: creating the peritoneal flap (<60 minutes), mesh placement with fixation (<30 minutes), and peritoneal suture closure (<30 minutes) under experienced supervision. We investigated the preliminary clinical results of R‐TAPP performed by a single operator between December 2018 and January 2020.ResultsWe identified 27 lesions in 20 patients (unilateral in 13 and bilateral in seven). According to the Japan Hernia Society Classification, our cohort included eight type I, five type II, and seven bilateral hernias (nine type I, four type II, and one type IV). The median operation time was 124 minutes (range, 81‐164 minutes), and the median console operation time was 85 minutes (range, 50‐132). The median time required for the peritoneal incision was 30 minutes (range, 18‐54 minutes), that for mesh placement (including tucking) was 13 minutes (range, 7‐27 minutes), and that for peritoneal suturing was 9 minutes (range, 3‐20 minutes).ConclusionOur preliminary results suggest that our task protocol for R‐TAPP is feasible. However, refinement of our task protocol is essential for standardization.

Managing Risk or Supporting Desistance? A Longitudinal Study on the Nature and Perceptions of Parole Supervision in the Netherlands

PurposeLittle is known about how ex-prisoners’ parole supervision experiences support or hinder the process of desistance. The aim of this article is to analyse the nature of parole supervision of Dutch (ex-)long-term prisoners in terms of official conditions, as well as the way in which parole officers (POs) and ex-prisoners navigate these conditions. The focus is particularly on the experienced supervision style and how this interacts with different dimensions of efforts at desistance.MethodsTwenty-three Dutch parolees were interviewed in depth at three waves starting in prison up to one year after their release from prison. A thematic analysis was undertaken to analyse the 69 interviews. In addition, the parole files of these ex-prisoners were examined containing information about conditions, violations and sanctions.ResultsParole files revealed the practice of highly engaged parole officers, who worked with parolees to strengthen factors known to foster desistance and tried to accommodate the difficulties of navigating ‘life outside’ after a relatively long prison sentence. However, the interviews showed that most parolees found their parole experience predominantly surveillance-oriented and not very helpful for desistance. Parole was experienced as most beneficial when parole officers were viewed as social workers or mentors and used their discretionary power to adjust conditions creating ‘space’ for trial-and-error.ConclusionsThis longitudinal study suggests that a policy culture and discourse of risk management do not necessarily preclude desistance support in parole supervision in the Netherlands, due to discretionary power of parole officers.

Improvement of well-being in cancer patients by yoga training

Background: Cancer patients frequently suffer from a reduced physical activity. Non-pharmacological interventions, such as yoga, provide opportunities to deal with these symptoms. The aim of this study is to evaluate the effect of yoga on the well-being of cancer patients.Methods: Between 2015 and 2017, we analyzed the effects of yoga on the well-being of cancer patients. Fifty-one patients received yoga training specifically designed to address cancer-related problems. Before the start (SoS) and after the end (EoS) of training, the WHO-5 well-being index was used to evaluate patients’ perception.Results: WHO-5 scores significantly improved from 47.1±21.4 at SoS to 69.7±15.1 at EoS. Patients in the middle age group (EoS–SoS: 28.0±20.6) showed a significantly higher benefit (p&lt;0.005) compared with age groups &lt;40 years (EoS–SoS: 10.7±15.4) and &gt;60 years (EoS–SoS: 16.0±12.1). Patients with low initial scores benefited most from yoga.Conclusion: Our study showed that yoga training under experienced supervision could serve as a beneficial complementary treatment in cancer patients. Best effects were observed in patients with highly reduced well-being and 40–60-year-old patients.

The resident's point of view in the learning curve of thymic MIS: why should I learn it?

Minimally invasive surgery (MIS) in thoracic surgery became quite popular during the last years. The aim of introducing and performing more MIS is to reduce surgical trauma, pain and complications in patients. Training in MIS increases operative time and thus cost in theatre but thus improves with experience. For a resident, the cases should be well selected with experienced supervision in a suitable setting with supporting staff and optimal instruments. Understanding the anatomy of the lung, using simulators, and attending workshops makes the learning curve shorter.

Incidence and risk factors for adverse events during anesthesiologist-led sedation or anesthesia for diagnostic imaging in children: a prospective, observational cohort study

Abstract Background Pediatric sedation for diagnostic radiological procedures remains the mainstay for adequate imaging quality. Objectives To clarify the risk of adverse events during anesthesiologist-led sedation or anesthesia for diagnostic radiological procedures in children in order to improve quality of care. Methods We enrolled children aged &lt;15 years given sedation or anesthesia by an anesthesiologist and scheduled for computed tomography, magnetic resonance imaging, or nuclear medicine imaging November 2010-September 2014. We recorded adverse events occurring in the first 24 h. Results Of 1,042 patients enrolled, adverse events were recorded in 254 (24.4%, 95% confidence interval [CI] 21.9 to 27.1). Adverse respiratory events occurred in 31 (3.0%), cardiovascular events in 7 (0.7%), sedation was prolonged in 165 (15.8%), there was one case of contrast allergy (0.01%), and there were 50 other minor complications (4.9%). Of the respiratory complications, there were 14 of airway obstruction (1.3%), 2 of apnea (0.2%), 14 of oxygen desaturation (1.3%), and one of laryngospasm (0.01%). There were no life threatening complications or consequences. Age &lt;1 year (adjusted odds ratio [adjusted OR] 2.5, 95% CI 1.2 to 5.3) and American Society of Anesthesiologists (ASA) physical status classification 2 and 3 (adjusted OR 4.6, 95% CI 1.1 to 19.8, and adjusted OR 6.3, 95% CI 1.3 to 30.9, respectively) were risk factors for respiratory complications. Conclusions Adverse events were common during sedation or anesthesia, but no life threatening or sentinel events occurred under experienced supervision. Caution should be exercised in children &lt;1 year or with an ASA classification &gt;1.

Resident training in single-incision laparoscopic colectomy

Single-incision laparoscopic colectomy (SLC) is touted as an improved approach to minimally invasive surgery, although no data currently exist regarding the acquisition of this technique. The aim of this study was to evaluate resident performance and outcomes in patients undergoing SLC performed by residents vs. staff colorectal surgeons. A retrospective case-control study was conducted, including 220 patients who underwent elective surgical intervention with multiport laparoscopic colectomy (MLC, n=141) or SLC (n=79) for colon cancer over a 24-month period at Yao Municipal Hospital (Yao, Japan). Data on patient demographics, operative data, oncological outcomes and short-term outcomes were evaluated for statistical significance. To investigate issues regarding the surgical procedures, the entire operation was recorded on video for all patients and was divided into 6 procedures, with each procedure measured in seconds. Senior-level residents were able to safely perform MLC under appropriate experienced supervision. For SLC, 1 case required conversion to an open procedure. No case required additional trocar placement. The mean operative times were similar for the staff and resident groups for total colon cancer (192.5 and 217.5 min, respectively; P=0.88), whereas the operative times of the staff group for right-sided colon cancer were significantly longer, and the operative times of the resident group for left-sided colon cancer were significantly longer. In addition, the overall perioperative outcomes, including blood loss, number of harvested lymph nodes, length of the surgical margin and complications, were similar between the two groups. When video recordings were evaluated by dividing the surgical process for the right colon into 4 procedures and that for the left colon into 6 procedures, the results demonstrated that the residents required more time to close the mesenteric margin for the left colon compared with the staff performing the same procedure (3,470.1±1,258.5 vs. 5,218.6±2,341.2 sec; P=0.01). Therefore, senior-level residents were able to safely perform SLC under appropriate experienced supervision. For the left colon, the main challenge for the residents appeared to be the closure of the mesenteric margin. Our data support that it is possible to train senior residents to complete a SLC safely and with the same efficacy as staff surgeons.

Training in laparoscopic total extra-peritoneal hernia repair: Safe under experienced supervision with significant performance improvement

Training in laparoscopic total extra-peritoneal hernia repair: Safe under experienced supervision with significant performance improvement

Single-incision laparoscopic colectomy: training the next generation

Single-incision laparoscopic colectomy (SILC) is touted to be an improved approach for minimally invasive surgery although no data currently exists regarding the acquisition of skills for the safe performance of this technique. The authors report their early experience with proctoring of surgical residents in SILC by experienced colorectal surgeons. Data regarding patient demographics, operative data, and short-term outcomes were prospectively collected at two surgical training hospitals. Residents and staff independently rated individual components of this technique to compare them with learning standard multiport colectomy (MP). A total of 31 SILC cases (15 men; mean age 53 years) were managed. The average BMI was 26.5 kg/m(2) (range 16-39 kg/m(2)). The surgical indications included cancer (n = 13), polyps (n = 8), diverticular disease (n = 4), Crohn's disease (n = 2), familial adenomatous polyposis (n = 2), volvulus (n = 1), and rectal prolapse (n = 1). The average operative time was 164 ± 86 min, and the mean blood loss was 80 ± 83 mL. The mean incision length was 4.1 ± 1.1 cm. One case required additional trocar placement (stoma creation), and three cases required conversion to open procedure because of failure to progress, difficult colorectal anastomosis, or poor visualization. The median hospital stay was 5.7 ± 1.3 days. The 30-day morbidity included minor wound infections (9.7 %), ileus (6.5 %), blood transfusion (3.2 %), and intraabdominal abscess (3.2 %). No deaths occurred. Residents rated vascular pedicle isolation, mobilization, critical structure exposure, instrument conflict/handling, and ergonomics as significantly more difficult with SILC. Senior-level residents can safely perform SILC under appropriate experienced supervision. The required advanced skills reflect complex laparoscopic training occurring during residency. Opportunities exist for better preparation and training of surgical residents to perform this complex surgery independently and safely at completion of residency.

Pain management in the rehabilitation of stiff shoulder: Prospective multicenter comparative study of 193 cases

The present study investigated the impact of respecting pain threshold on clinical recovery in stiff shoulder. A prospective multicenter comparative study followed up 193 cases of shoulder stiffness for a mean 12-month period (range, 8-31 months) after four different treatment protocols: (1) conventional sub-pain-threshold rehabilitation (58 cases); (2) self-rehabilitation exceeding the pain threshold (59 cases); (3) supervised suprathreshold rehabilitation (31 cases); and (4) capsulotomy with sub-threshold rehabilitation (45 cases). Follow-up was daily for the first 6 weeks then weekly for the next 6; each session included assessment of the painfulness, feasibility and duration of each rehabilitation and self-rehabilitation exercise and of pain status, disability and psychological status. The surgeon followed patients up at 6 weeks, 3 months, 6 months, 1 year and at last follow-up. Sub-threshold rehabilitation provided progressive results, limited in time (P<0.05). Suprathreshold self-rehabilitation provided reduced pain (P<0.05) as of the first days, with nocturnal pain ceasing after 7 days' rehabilitation in 43% of cases. Supervision of self-rehabilitation exercises optimized the clinical result (P<0.05). Capsulotomy did not influence pain evolution over the first 8 weeks, but then improved it. Failure (at 1 year, 14-17%; last follow-up, 3.5%) correlated directly with the number of exercises performed by the patient (P<0.05). The dogma of respecting the pain threshold is dated: pain inflicted on a passive patient impairs clinical evolution, but pain managed by an informed active patient under experienced supervision provides rapid recovery of function and pain-free status.

Rethinking resident supervision to improve safety: From hierarchical to interprofessional models

Inadequate supervision is a significant contributing factor to medical errors involving trainees, but supervision in high-risk settings such as the intensive care unit (ICU) is not well studied. We explored how residents in the ICU experienced supervision related to medication safety, not only from supervising physicians but also from other professionals. DESIGN, SETTING, MEASUREMENTS: Using qualitative methods, we examined in-depth interviews with 17 residents working in ICUs of three tertiary-care hospitals. We analyzed residents' perspectives on receiving and initiating supervision from physicians within the traditional medical hierarchy, and from other professionals, including nurses, staff pharmacists, and clinical pharmacists ("interprofessional supervision"). While initiating their own supervision within the traditional hierarchy, residents believed in seeking assistance from fellows and attendings, and articulated rules of thumb for doing so; however, they also experienced difficulties. Some residents were concerned that their questions would reflect poorly on them; others were embarrassed by their mistaken decisions. Conversely, residents described receiving interprofessional supervision from nurses and pharmacists, who proactively monitored, intervened in, and guided residents' decisions. Residents relied on nurses and pharmacists for nonjudgmental answers to their queries, especially after-hours. To enhance both types of supervision, residents emphasized the importance of improving interpersonal communication skills. Residents depended on interprofessional supervision when making decisions regarding medications in the ICU. Improving interprofessional supervision, which thus far has been underrecognized and underemphasized in graduate medical education, can potentially improve medication safety in high-risk settings.

Comparison of two percutaneous pinning methods for the treatment of the pediatric type III supracondylar humerus fractures.

Fifty-nine surgically treated cases of type III supracondylar humeral fractures were retrospectively evaluated. Fracture fixation was performed by either crossed K-wires in 35 patients (group I) or lateral K-wires in 24 patients (group II). The reoperation rates and neural injury rates as major complications were similar in the two groups and all neural injuries except one had full recovery. At the last follow-up exam six patients in group I (17%) and four patients in the group II (16%) had apparent cosmetic deformities. No major differences were found between the results of each group. In order to reduce complications an experienced supervision is necessary during surgery of these seemingly benign fractures.

Comparison of two percutaneous pinning methods for the treatment of the pediatric type III supracondylar humerus fractures

Fifty-nine surgically treated cases of type III supracondylar humeral fractures were retrospectively evaluated. Fracture fixation was performed by either crossed K-wires in 35 patients (group I) or lateral K-wires in 24 patients (group II). The reoperation rates and neural injury rates as major complications were similar in the two groups and all neural injuries except one had full recovery. At the last follow-up exam six patients in group I (17%) and four patients in the group II(16%) had apparent cosmetic deformities. No major differences were found between the results of each group. In order to reduce complications an experienced supervision is necessary during surgery of these seemingly benign fractures.

Experience in group analytic psychotherapy

The Royal College of Psychiatrists classifies group psychotherapy as required experience for psychotherapy training as part of general psychiatric training (Grant et al, 1993). This is defined as group experience in in-patient and/or out-patient settings, with an experienced co-therapist and/or supervision. Previous surveys estimate that the percentage of trainees gaining such experience ranges from only 9% (Arnott et al, 1993) to 58% (Hwang &amp; Drummond, 1996). The limited duration of psychiatric training does not allow experience in all types of psychotherapy and trainees must therefore be selective in respect to their own training, depending on what is available.

Laparoscopic appendicectomy: diagnosis and resection of acute and perforated appendices

Laparoscopic appendicectomy for acute appendicitis has been promulgated in many European countries during the 1980s. The introduction of the microchip camera and visual assistance on a monitor has increased the appeal of laparoscopic appendiceal resection. It carries a unique appeal in that the extent of inflammation and the presence of other pathological conditions are readily identified. This approach does not prevent the surgeon proceeding to open surgery if appropriate, and will aid in defining the site of incision. Prospective analyses ( McAnena et al, 1992; Attwood et al, 1992) have shown that this approach shortens hospital stay, decreases wound infection rates and provides excellent cosmetic results. It also hastens return to full activity. It requires experience and, as with cholecystectomy, the option of converting to an open procedure should not be considered a failure of the approach. Details of approaches to the inflamed appendix are described. Caution in the use of diathermy is needed (particularly at the base of the appendix), as it may cause necrosis of the caecum or dissolution of the ties at the appendix base. Control of the appendicular artery by clip ligation is preferable to diathermy. The training of surgical residents will be enhanced rather than diminished if, under close, experienced supervision, they are taught to perform appendicectomy laparoscopically, as the essentials of anatomic dissection of the appendix are perhaps better appreciated on a video screen than at open surgery through a small incision.

Homoseksuelle overgrep i psykoterapiforhold

Albretsen CS, Ikdahl S, Vanberg M. Homoseksuelle overgrep i psykoterapiforhold.Homosexual exploitation of patients in a psychotherapy setting is rarely reported in the psychiatric literature. Two cases are reported here. In the first case a female therapist exploits a young woman who consults her concerning problems related to incest. In the second case a male therapist regularly masturbates his male patient, who turns into psychosis. Administrative and therapeutic managements are discussed, and the need for experienced supervision and theoretical background is stressed.Homosexuality, Incest, Psychotherapy, Sexuality

A Critical Assessment of the Induction and Maintenance of Labour Using the Cardiff Infusion System, Mark II

Summary: A series of patients in whom labour was induced by amniotomy and Syntocinon administration by the Cardiff Infusion System (C.I.S.) is presented. The problems of this equipment, both mechanical and technical, are discussed. Induction is more effective in terms of the reduced amniotomy‐established labour and ammotomy‐delivery intervals, but experienced supervision is required once labour is established. There is some evidence that the duration of labour may be increased by the use of oxytocin, this probably being related to the type of contraction induced by oxytocin administration.