Training Model For Residents Research Articles

From Berlin to Brady: Tracing the Origins of the Urology Residency

Introduction Urology was one of the first subspecialties in medicine to employ the training model known today as residency, yet no definitive account currently exists of how urology residency programs came into existence. These events are rarely taught in formal urologic curricula. It is imperative that tomorrow’s urologists understand how today’s system came to be. Sources and Methods We performed a comprehensive review of the literature, referencing primary and secondary sources including journal articles, books, textbook chapters, monographs, bulletins, editorials, and transcribed speeches, to compile sufficient evidence to complete this historical review. Results During the 13th-18th centuries, surgical training was undertaken in small and non-regulated apprenticeships. Napoleon created the first versions of the residency training model in early 1800s France. In Berlin, Bernhard von Langenbeck (1810-1887) devised the most direct early predecessor of the modern system. An early trainee, Theodor Billroth (1829-1894) later mentored American surgeon William Halsted (1852-1922) and passed along the training methods. At Johns Hopkins Hospital, Halsted drew on Billroth’s methods to establish the “pyramidal” training model in 1890. This was later adapted by Edward Churchill (1895-1972) at Massachusetts General Hospital into the “rectangular” structure in the 1930s, which is closer to existing residency programs today. Hugh Hampton Young (1879-1944), the ‘Father of American Urology’, was hired by Halsted at Hopkins and quickly became Chair of the Department of Genitourinary Diseases in 1897. Young informally recommended aspiring urologists to Halsted for appointment in the surgical residency, spawning the beginnings of the urologic specialty. In 1915, the Brady Urological Institute opened at Hopkins via a donation from Young’s patient James Buchanan Brady (1856-1917), and a 7-year training program was designed alongside it. With this, the first formal urology residency in the country was born. Conclusions American urology residency formally began in 1915 at Johns Hopkins Hospital under the direction of Hugh Hampton Young and shares deep roots with the history of surgery itself. Recognizing where this training model originated is a critical context for all who seek to improve how the urologists of tomorrow are trained.

Interdisciplinary problem-based learning model for standardized dental residency training: from theory to practice in dental trauma management.

Enhancing clinical skills and quality of dental residents is critical for standardized training. Conventional standardized training falls short in exposing residents to diverse scenarios and fostering interdisciplinary collaboration, essential for dental trauma management. To address these issues, West China Hospital of Stomatology, Sichuan University introduced an interdisciplinary problem-based learning (IPBL) model to improve residents' professional quality and practical abilities. Based on the specific needs of dental residents, the hospital established a PBL framework supported by an interdisciplinary collaborative teaching team with a focus on dental trauma diagnosis and treatment. A comprehensive assessment followed the IPBL course, which informed subsequent course modifications. In a preliminary study, 134 students voluntarily chose whether to participate in the program. At the end of the study, the scores of both groups were compared. The IPBL model significantly improved the professional ability of dental residents in the diagnosis and treatment of dental trauma, and obtained positive evaluations from residents and mentors. For the quantitative analysis, the Wilcoxon signed-rank test showed an overall improvement in participants' scores after completing the course. This teaching model provides a new way for the standardized training of dental residents, and helps to cultivate dental professionals with high professional and practical abilities.

Simulated spinal durotomy repair for orthopaedic resident training: a perfusion-based porcine cadaveric specimen as an in vitro animal model

BackgroundTraining in delicate spinal dura mater suturing techniques poses significant challenges due to patient safety and medicolegal concerns, driving the need for alternative training methods beyond traditional mentorship models. This study aimed to introduce and validate a training model for orthopaedic residents using perfusion-based porcine spines to simulate intraoperative durotomy and subsequent repair.MethodsNine junior orthopaedic residents were invited to participate. Three attending orthopaedic spine surgeons were included in the control group. Fresh porcine spines were used for the simulation, and a perfusion-based system was implemented to replicate cerebrospinal fluid circulation and apply hydrostatic pressure to the dura. Durotomies were made and mended with 6–0 prolene sutures, and the participants’ performance was assessed across six trials for repair speed and leakage pressure. Additionally, the self-confidence levels of the residents were analyzed before and after the training.ResultsWhile attending surgeons showed consistent performance across trials, residents demonstrated a 70% reduction in mean total time and a 62% increase in mean leakage pressure after training. Residents showed significant improvements in repair speed from Trial 4 and in repair quality from Trial 3 compared with Trial 1 as the baseline. The difference compared with attending surgeons became insignificant in repair speed from Trial 4 and in repair quality from Trial 2, indicating that the residents' performance approached that of the attending surgeons. Residents’ self-confidence increased significantly from a mean pre-training score of 1.1 to a mean post-training score of 4.3.ConclusionsThis simulation model, which utilizes fresh porcine spines and a perfusion-based system, is an accessible, cost-effective, and high-fidelity training method for dural repair during spinal surgery.

Accuracy of O-RADS System in Differentiating Between Benign and Malignant Adnexal Masses Assessed via External Validation by Inexperienced Gynecologists.

Objective: To evaluate the accuracy of the O-RADS system in differentiating between benign and malignant adnexal masses, as assessed by inexperienced gynecologists. Methods: Ten gynecologic residents attended a 20 h training course on the O-RADS system conducted by experienced examiners. Following the training, the residents performed ultrasound examinations on patients admitted with adnexal masses under supervision, recording the data in a database that included videos and still images. The senior author later accessed this ultrasound database and presented the cases offline to ten residents for O-RADS rating, with the raters being blinded to the final diagnosis. The efficacy of the O-RADS system by the residents and inter-observer variability were assessed. Results: A total of 201 adnexal masses meeting the inclusion criteria were evaluated, consisting of 136 (67.7%) benign masses and 65 (32.3%) malignant masses. The diagnostic performance of the O-RADS system showed a sensitivity of 90.8% (95% CI: 82.2-96.2%) and a specificity of 86.8% (95% CI: 80.4-91.8%). Inter-observer variability in scoring was analyzed using multi-rater Fleiss Kappa analysis, yielding Kappa indices of 0.642 (95% CI: 0.641-0.643). The false positive rate was primarily due to the misclassification of solid components in classic benign masses as O-RADS-4 or O-RADS-5. Conclusions: The O-RADS system demonstrates high diagnostic performance in distinguishing benign from malignant adnexal masses, even when used by inexperienced examiners. However, the false positive rate remains relatively high, mainly due to the over-interpretation of solid-appearing components in classic benign lesions. Despite this, inter-observer variability among non-expert raters was substantial. Incorporating O-RADS system training into residency programs is beneficial for inexperienced practitioners. This study could be an educational model for gynecologic residency training for other systems of sonographic features.

Utilizing Relative Citation Ratio to Compare Academic Productivity by Gender in Plastic Surgery

IntroductionThe relative citation ratio (RCR) is a bibliometric index utilized to assess research productivity. Mean relative citation ratio (m-RCR) and weighted relative citation ratio (w-RCR) can be utilized to assess individual research quality as well as career-long productivity, respectively. We sought to determine differences in academic productivity between genders and identify demographic variables associated with increased academic productivity. MethodsA list of Plastic and Reconstructive Surgery residency programs was compiled utilizing the American Council of Academic Plastic Surgeons website. Each program department's website was utilized to generate a list of practicing surgeons and respective demographic information. Both mean and weighted RCR were obtained using the iCite, a National Institutes of Health bibliometric tool. Surgeons were excluded if any demographic or RCR data was not accessible. Chi-squared test, Mann–Whitney U test, Kruskal–Wallis test, and multivariable linear regressions were performed. ResultsA total of 785 academic plastic surgeons met the criteria and were included in the analysis, 186 of whom were women and 599 men. Both academic rank and model of residency training were significantly associated with gender in chi-squared analysis (P < 0.05). Mean relative citation ratio was higher among men in departments. Mean w-RCR was higher among men of assistant professor status, chief/chairperson status, integrated model of residency training, faculty size ≥six and in departments and divisions. Academic rank and faculty size were associated with higher w-RCR upon multivariable linear regression. ConclusionsAlthough differences exist in mean w-RCR between men and women in plastic surgery, gender is not a predictor of increased academic productivity. RCR is an accurate means of assessing gender differences in academic productivity as it comprehensively considers both quality and quantity of research and may be superior to other, older bibliometric indices.

A Model for Formal Residency Training in Interventional Psychiatry.

A Model for Formal Residency Training in Interventional Psychiatry.

Implementation and Validation of a High-fidelity Simulation Model for Surgical Resident Training: Management of Acute Intraoperative Hemorrhage during Robot-assisted Surgery

ObjectivesTo improve our previous simulation-based training module by using sustainable material to mold an anatomically accurate terrain and reproducing major vascular injuries encountered during robot-assisted nephrectomy. MethodsThe simulator was built with a pump, gauge, and valve linked via silicone tubing. Artificial blood was made from cornstarch, water, and red dye, and pumped through 3D-Med artificial vessels with the dimensions of an average renal artery. Silicone was used to emulate the pliability of organic tissue and mold an anatomically accurate terrain. Eight urologic residents participated in the pilot simulation. We employed validated assessment tools including Non-Technical Skills for Surgeons and Objective Structured Assessment of Technical Skills forms to guide debrief sessions moderated by an expert physician after individual performance evaluations. ResultsThe apparatus demonstrated high reproducibility across all simulation scenarios, enhancing resident problem-solving skills. Residents’ pre-simulation surveys revealed significant concern regarding their acute hemorrhage management. Residents’ post-simulation survey demonstrated average realism scores increased from 4.375 to 4.75. Residents also felt the simulator enhanced learning, offering valuable practice and knowledge applicable to their surgical specialty. ConclusionsThe management of acute hemorrhage during robot-assisted surgery remains a space for additional surgical education and training. Our simulation successfully provided a reliable, reproducible training for residents to practice their technical and non-technical skills in managing acute hemorrhage.

An application and exploration of entrustable professional activities in Chinese orthopaedic postgraduate residents training: a pilot study

BackgroundThrough the standardization of residency training in certain Chinese medical education institutions, it was discovered that the current evaluation system falls short in accurately assessing residents’ professional skills in clinical practice. Therefore, we developed the list of Entrustable Professional Activities (EPAs) in orthopaedic residency training to explore a new evaluation system.MethodsThe process of constructing EPAs includes seven steps. 40 orthopaedic residents were randomly assigned to two groups (20 in each). The experimental group used the EPAs evaluation system while the control group employed the traditional Mini Clinical Exercise (Mini-CEX) system. Post-residency, theoretical and practical tests were conducted to measure training effectiveness. Additionally, a survey gauged teaching satisfaction, knowledge mastery, and course engagement in both groups.ResultsThe control group scored an average of 76.05 ± 10.58, while the experimental group achieved 83.30 ± 8.69 (p &amp;lt; 0.05) on the combined theoretical and practical test. Statistically significant differences were observed between the two groups concerning teaching satisfaction, knowledge mastery, and course engagement.ConclusionThe application of EPAs in orthopaedic residency training yielded higher theoretical and practical test scores compared to the traditional formative evaluation system. It also enhanced teaching satisfaction, knowledge mastery, and course engagement. The EPAs present a potential model for national orthopaedic residency training.

A Model for Residency Training: The Small Animal Emergency and Critical Care Residency Program at Purdue University.

Training residents in any specialty is a balancing act between ensuring high-quality education, making certain the resident meets the requirements set forth by the specialty college to achieve credentials and be eligible to take the board certification examination, and fulfilling clinical duties at that institution. For programs such as this one, residents are integral members of the clinical team, working primary emergency receiving shifts in order to allow the service to function; this leads to a need to identify and protect learning time for the residents. Those involved in the Purdue Small Animal Emergency and Critical Care residency program believe that in the chaos that is emergency and critical care, a firm timeline with attainable checkpoints is crucial to resident success. Such a timeline follows goal-setting theory and provides structure and guidance to candidates to navigate their 3-year program and ensure that they complete all requirements during the residency period. Candidates completing the Purdue program successfully finish their credentials, including at least one first author publication, and have at least one scientific presentation to improve their curriculum vitae. This article serves to present the structure and timelines used by the Purdue Small Animal Emergency and Critical Care program to organize its residency program as an example of a successful program.

63. Competency-based, Time Variable Model for Resident Training: A Programmatic Update

63. Competency-based, Time Variable Model for Resident Training: A Programmatic Update

HF01-07 FROM BERLIN TO BRADY: TRACING THE ORIGINS OF UROLOGY RESIDENCY

You have accessJournal of UrologyCME1 Apr 2023HF01-07 FROM BERLIN TO BRADY: TRACING THE ORIGINS OF UROLOGY RESIDENCY Trevor C. Hunt and Ronald Rabinowitz Trevor C. HuntTrevor C. Hunt More articles by this author and Ronald RabinowitzRonald Rabinowitz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urology was one of the first specialties in medicine to employ the training model known today as residency. These events are rarely taught in formal urologic curricula, yet it is imperative that tomorrow’s urologists understand how today’s system came to be. METHODS: We performed a review of the literature, including journal articles, book chapters, and transcribed talks, to compile sufficient evidence to inform this historical review. RESULTS: The residency training model first appeared in the mid-1800s, when German surgeon Bernhard von Langenbeck devised a system where medical graduates would live at the hospital and undertake graduated responsibility in the care of surgical patients. One of his residents—known then as house officers—was Theodor Billroth, who later mentored American surgeon William Halsted in Vienna while he trained throughout Europe from 1878-1880. In 1889, Johns Hopkins Hospital opened and Halsted became one of the founding “Big Four” doctors alongside Welch, Osler, and Kelly. As Chief of Surgery, he drew on Billroth’s methods and established the earliest form of surgical residency as we now know it. Halsted’s model was “pyramidal”, with only one of eight residents advancing each year, and aimed to produce a single outstanding surgeon at the unintentional expense of the others. This remained the gold standard until 1931, when Edward Churchill at Massachusetts General Hospital introduced the more balanced “rectangular” structure which remains the backbone of residency programs today. Halsted hired 25-year-old Hugh Hampton Young to his surgical staff in 1895 and quickly made him Chair of the Department of Genitourinary Diseases in 1897, which he helmed through 1941. In response to the appointment, Young is noted to have said, “This is a great surprise. I know nothing about genitourinary surgery,” to which Halsted replied, “We believe you could learn.” He did indeed learn, and is now widely regarded as the Father of Modern Urology. From 1897-1915, Young was allowed to recommend aspiring urologists to Halsted for appointment in the surgical residency, spawning the beginnings of the urologic specialty as we know it today. In 1915, thanks to a donation from his patient James Buchanan Brady, the Brady Urological Institute opened at Hopkins, and Young designed a 7-year training program to begin alongside it. With this, the first formal urology residency in the country was born. CONCLUSIONS: Urology residency shares deep roots with the history of surgery itself. Recognizing where this model originated is critical context for all who seek to improve how the urologists of tomorrow are trained. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e258 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Trevor C. Hunt More articles by this author Ronald Rabinowitz More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Number ‐ 275: Novel 3D Virtual Reality Simulator Use in Stroke Code Simulation

Introduction Stroke code simulations have gained popularity as an educational model for neurology resident and fellow training in the diagnosis and management of hyperacute stroke. Previous simulations have used live patients or standardized patients as surrogates for learners to interact with in the simulated codes. While these provide high fidelity, there can be significant costs associated with the training and deployment of standardized patients, as well as potential for inconsistencies from encounter to encounter. A novel 3D virtual reality based simulator (Dancing Eyes LLC, Skaneateles, NY) aims to reduce the costs of running stroke code simulations while maintaining high fidelity and encounter consistency. It can also have the additional benefit of being utilized at the convenience of the trainee’s schedule, reducing logistical hurdles for scheduling and organizing simulations. Methods Neurology residents (who have previously experienced live simulation stroke codes with standardized patients) will undergo simulation encounters using the 3D virtual reality‐based simulator. We will enroll 20–25 residents at post graduate year levels (PGY) 2–4. Following the simulated encounter, a debriefing session is conducted for learners to review the case, share their experience, and provide additional feedback. A post‐simulation survey will be comnducted that solicits trainee experience with the VR simulator in defined domains such as comfort, ease of use, fidelity, and overall educational experience and value. Results The VR simulator has been designed to be worn over the face and can be adjusted for trainee comfort. The simulator integrates imaging, labs, the ability to use a virtual NIH‐stroke‐scale booklet, and other neurologic examination tools by virtually grabbing them or selecting them from a panel user interface. The simulated VR patient registers the trainee’s voice and shows the speech that was detected. It then attempts to answer the question or perform the issued command based on variables that have been pre‐programmed for the specific encounter/simulation. Trainees are able to perform a full NIH stroke scale assessment on the simulated patient. We aim to report the results of our study in time for the SVIN Annual Meeting/update deadline prior to the meeting. Conclusions Figure 1 shows a trainee using the VR simulator in a simulated stroke code encounter, as well as a rendering of the simulated patient. The VR simulator aims to serve as a high‐fidelity, low‐cost, convenient and consistent training modality for stroke code simulation and enhance trainees ability and comfort with diagnosis and management of hyperacute stroke.

ENRICHING THE LIVES OF OLDER VETERANS: THE GEROFIT WAY

Abstract Gerofit is a clinical exercise program for Veterans ages 65 years and older with multi-morbidities and functional limitations that place them at elevated risk for institutionalization. It was declared a VHA “Best Practice” in 2017 and was selected for widespread dissemination and implementation, with over 30 Gerofit programs spanning the country. The original Gerofit program consists of supervised, facility-based exercise, offered 3 days per week in a group setting. Each exercise prescription incorporates aerobic training, progressive resistance training, and specialized exercises for balance and physical function. Everything changed in March 2020 when facilities began receiving orders to shut down face to face encounters and social distancing measures were put in place. Within six weeks, all of our sites had transitioned to group-based virtual classes, aptly called Gerofit to Home (GTH). This symposium includes 2 presentations that explore the effect of GTH on physical functioning and health-related quality of life outcomes in veteran participants during the pandemic: one focusing on resilience among GTH adopters vs. non-adopters in patients formerly participating in facility-based Gerofit; and the second focusing on patients enrolled directly in to GTH (no facility-based experience). The third presentation describes differences in physical function and health gains among Gerofit participants with and without peripheral artery disease (PAD). The fourth and fifth presentations describe augmented models of care to enrich the Gerofit experience for a) participants with supplemental nutrition programming and b) advanced physical therapy trainees through a Gerofit resident training model.

The chicken wing training model in cerebrovascular microsurgery for the side-to-side bypass

In the expanding era of endovascular treatment and minimally invasive techniques, the neurosurgical trainees have a steady decrease in the exposure to microsurgical skills. However, there remain a need for neurosurgical trainees to be proficient at such skills, particularly for performing high-stakes interventions such as vascular bypasses. The scarcity of cerebrovascular bypasses coupled with the technical expertise it demands necessitates the presence of a training model for neurosurgical residents and fellows. Regarding the model utilizing the chicken wing for vascular anastomoses, the neurosurgical literature has described many models of bypasses involving the end-to-end and end-to-side anastomoses. The side-to-side anastomosis however is not clearly depicted in these papers. Here we focus on technique, chicken wing anatomy, and donor/recipient vessel diameters to provide a comprehensive guide for trainees. We describe a reproducible and reliable chicken wing model to perform an in-situ side-to-side bypass that incorporates integral elements of a successful bypass surgery.

Septoplasty Training During the COVID-19 Era: Development and Validation of a Novel Low-Cost Simulation Model.

ObjectiveIn a context of increasingly limited surgical exposition, enhanced by the coronavirus disease 2019 (COVID-19) pandemic context, the objective of this article is to explain the development of a novel low-cost and simple replication animal-based septoplasty training model for otolaryngology residents, to assess its face and construct validity, and to validate a specific rating scale for each task.Study DesignExperimental study.SettingSurgical simulation laboratory.MethodsSeptoplasty experts divided the procedure into key tasks. A simulator model to perform tasks was developed using pig ears to imitate human nasal septum cartilage, and a Specific Rating Scale was constructed. Trainees and faculty performed all tasks in the model. The participants were videotaped, and operative time, hand movements, and path length were recorded using a motion sensor device. Two blinded experts evaluated the videos with Global and Specific Rating Scales. All participants answered a satisfaction survey.ResultsFifteen subjects were recruited (7 trainees and 8 faculty). Significantly higher Global Rating Scale score, shorter operative time and path length, and fewer hand movements were observed in the faculty group. The satisfaction survey showed high applicability to a real scenario (mean score of 4.6 out of 5). Specific Rating Scale showed construct and concurrent validity and high reliability.ConclusionThis simulation model and its specific rating scale can be accurately used as a validated surgical assessment tool for endonasal septoplasty skills. Its low cost and simple replicability make it a potentially useful tool in any otolaryngology surgical training program.

Creating Inclusive and Accessible Residency Training programs: Lessons Learned from Establishing a Deaf and American Sign Language Inclusive Model for Residency Training

<h3>Purpose</h3> There is a growing need for a more diverse physician workforce to address gender, racial, and ethnic disparities in medicine. Investigations into vulnerable populations, including African, Native, Hispanic, and rural Americans all have overwhelmingly shown that these groups have diminished access and increased barriers to receiving radiation treatment. Increasing diversity among physicians can help address health care disparities in underserved populations. Accessible and inclusive residency training programs are needed to promote recruitment and retention of underrepresented physician groups. However, limited attention has been given to the potential benefits of training physicians with differences other than gender, race, or ethnicity. Americans with a disability represent about 27% of the population, whereas 1%-3% of physician trainees report having a disability. In 2017, our program matched a Deaf resident who preferentially utilized American Sign Language (ASL) to communicate. However, to date, there had been no published strategies on how to create an ASL inclusive residency training program for Deaf trainees. Herein, we report the development of a Deaf and ASL-inclusive residency program to serve as a model, which can be tailored to meet the needs of other underrepresented physician trainees in radiation oncology. <h3>Methods</h3> In preparation, department leadership engaged key stakeholders and leaders within the university's health system and among the department faculty, residents, and staff as well as the incoming resident, which led to the development and implementation of an inclusive ASL training model for the program. <h3>Results</h3> In this process, 5 important principles and steps were identified. First, the trainee should be directly engaged and involved as a primary and key collaborator as to any cultural, linguistic, or physical needs and preferences. Second, key stakeholders within the institution, including hospital and department leadership, should be engaged early, and involved in implementing and creating strategies. Third, with the trainee's input, efforts should be initiated to utilize resources internal and external to the institution, including institutional ADA officers, disability services, and training consultants. Fourth, cultural and communication expectations should be discussed with faculty and staff with the goal of creating an inclusive training culture for all participants. Finally, workspace accommodations that remove any physical barriers should be addressed based on the trainee's input. <h3>Discussion</h3> Through collaborative efforts, a Deaf and ASL-signing resident was successfully integrated into the residency program. The 5 principles of our model allow for efficient implementation of a similar framework at other institutions seeking to employ similar inclusivity initiatives.

Preparing for a Crowded Cosmetic Market: A Resident Training Model for Minimally Invasive Cosmetic Treatments.

Patient demand for nonsurgical and minimally invasive cosmetic treatments has increased in recent years, resulting in a growing market that is particularly vulnerable to specialty creep. Despite this growing demand, nonsurgical cosmetic training for plastic surgery residents is often inconsistent and challenging. To ensure the continued safe and effective delivery of nonsurgical cosmetic care by board-certified plastic surgeons, it is critical to implement standardized training models for plastic surgery residents. In this Special Topic article, the authors describe their experience with a resident-run clinic training model that incorporates graduated autonomy, volunteer patient recruitment, and grant-based industry support that has been successfully implemented at their institution for the past 6 years. The article provides a framework for a resident educational model and addresses common obstacles in resident cosmetic training. The authors also provide recommendations for patient recruitment, optimizing clinic workflow, and the management of patient complications.

A versatile low-cost, high-fidelity cystoscopy simulation model

The objective of this video is to describe the design of a versatile low-cost, high-fidelity water balloon model for OBGYN resident cystoscopy simulation training. In this video, we present a unique design for a life-like water balloon model for teaching cystoscopy to OBGYN residents. While water balloon models for cystoscopy have been described previously, limitations include: poor water seal, restricted urethral mobility, limited diversity in simulated tasks, and cost. We demonstrate step-by-step instructions on how to construct the model using materials found at most arts and crafts stores, for a total cost of about $46 per model. The design incorporates the use of a large 24-inch water balloon which may be customized to allow for a range of simulation tasks, including: identifying abnormal bladder lesions or markings, identifying presence of ureteral efflux, and practicing ureteral catheterization or stenting (via addition of simulated ureters). Unique to this bladder model, is the use of a foam housing system which stabilizes the water balloon bladder model and allows the trainee to focus on bimanual dexterity in manipulating the cystoscope. This innovative cystoscopy model serves as an easy, affordable way to incorporate cystoscopy simulation training in other OBGYN programs. Benefits of this model include: low cost, unique housing system that stabilizes the bladder model for ease-of-use, enhanced urethral mobility, easy in-out manipulation of the cystoscopy with minimal water leakage, and versatility in creating different training tasks by interchanging balloon models. Future studies will aim to compare the efficacy of this tool to other high-fidelity models in improving resident cystoscopic skills.

Investigating faculty assessment of anesthesia trainees and the failing-to-fail phenomenon: a randomized controlled trial.

A growing body of evidence has shown that supervisors may "fail to fail" trainees even when they have judged their performance unsatisfactory. This has significant implications for the implementation of a nationwide competency-based education model of residency training. The objective of this study was to determine the incidence of "failing to fail" clearly underperforming residents. Study participants were recruited via an email invitation sent to all departments of anesthesia at each of the hospitals affiliated with the University of Toronto. They were randomized into a high-stakes (assessment would affect the resident's progress) or low-stakes (assessment would not affect the resident's progress) group and asked to assess the performance (fail or pass grade) of a struggling resident. Participants assessed a video depicting an actor managing a scripted simulation scenario. It contained several critical clinical mistakes constituting a clear fail performance. The purpose of the study was only disclosed following the assessment. Of the 288 email invitations sent (144 in each group), 158 (54%) participants completed the study, with 93 in the high-stakes group and 65 in the low-stakes group. Twenty-eight participants (17.7%) failed to issue a failing grade, including 23.1% (15/65) in the high-stakes group and 13.9% (13/93) in the low-stakes group (P = 0.14). Though often discussed, this is the first study to quantitatively show that the "failing-to-fail" phenomenon likely occurs during residency training performance evaluations. Passing underperforming learners can potentially affect patient safety and result in severe personal consequences to the learner. The results indicate the need for better performance assessment training for faculty members.

A Novel Transvaginal Cervical Cerclage Model for Resident Training.

IntroductionVaginal suturing can be challenging to teach and learn due to the surgical assistant's limited operative field visualization. Data on resident training and comfort with cerclage placement using models are limited. The aim of this activity was to assess learner satisfaction with practice using a novel model allowing for full visualization during transvaginal cervical cerclage placement.MethodsOB/GYN residents participated in a 1-hour combined lecture and hands-on cerclage training simulation with the novel model. Pre- and postsession survey responses were assessed with descriptive statistics and paired t tests.ResultsTwenty residents with a median of 2 (SD = 1.6) years of residency experience participated. Ninety-five percent reported no prior cerclage simulation training; 60% reported placing cerclages in practice. Pre- and posttest analysis indicated a significant decrease in perceived need for further training (M = 4.05, SD = 1.07, vs. M = 3.45, SD = 0.86; p = .024) and an increase in comfort performing a cerclage placement (M = 2.55, SD = 1.16, vs. M = 3.85, SD = 0.79; p < .001). After the simulation, residents reported more comfort in cerclage placement with decreasing supervision (M = 2.05, SD = 1.02, vs. M = 2.30, SD = 1.01; p = .021); 90% reported that learning to place a cerclage was easy.DiscussionImplementing a novel, low-cost model allowing full operative field visualization significantly improved reported comfort regarding cervical cerclage placement and resulted in high satisfaction amongst residents. Future research should evaluate the training's impact on clinical skills.