Resident Involvement Research Articles

Quality Improvement of Quality Improvement (P13-2.005)

<h3>Objective:</h3> To increase resident participation in quality improvement (QI) in a large New York City neurology residency program within a one-year academic period. <h3>Background:</h3> The ACGME requires that neurology residents receive training and experience in quality improvement processes (QI). QI involves investigating root cause analysis and systems thinking. As part of preparing future clinical leaders, residency programs educate residents on ways to analyze the care they provide, investigate system process, and understand their roles within the larger health care system. There is a need to guide residency programs to further develop and improve resources to encourage resident involvement in QI. We present a possible solution to increase QI education and participation among our neurology residents. <h3>Design/Methods:</h3> Well-established QI tools including driver diagrams, cause and effect diagrams and GEMBA walks were utilized to identify barriers and tests of change. We then designed and implemented a multifaceted approach to achieve our objective including (1) creation of a database tracking ongoing projects, (2) establishment of a department mandate regarding resident participation in quality improvement, (3) administration of QI didactic lectures, and (4) increased visibility of QI projects through departmental social media and grand round QI presentations. Resident project participation was our primary outcome measure, and tracked through the database. <h3>Results:</h3> Second year neurology resident QI project participation increased from 36% to 100%, third year resident participation increased from 70% to 90%, and fourth year residents maintained their high level of participation with 88% participating in QI and two residents were exempt. <h3>Conclusions:</h3> Our approach to increasing neurology resident participation in quality improvement projects was successful. At our institution, QI has gained recognition as a critical component of our residents’ scholarly activity. <b>Disclosure:</b> Dr. Monohan has nothing to disclose. Dr. Angulo Castro has nothing to disclose. Dr. Sivakumar has nothing to disclose. Dr. Perk has nothing to disclose. Dr. O’Kula has nothing to disclose. Dr. Law has nothing to disclose.

Improving resident well-being: a narrative review of wellness curricula.

To improve wellness among residents, many graduate medical education programs have implemented formal wellness curricula. Curricular development has recently shifted focus from drivers of burnout to promotion of wellness. The specific components of successful wellness curricula, however, are not yet well defined. To review the published literature assessing core components of wellness curricula in graduate medical education programs. Searches were conducted through June 2020 in PubMed, Education Resources Information Center, Google Scholar and Web of Science using the search terms wellness curricula, wellness programs, well-being and graduate medical education. Additional articles were identified from reference lists. Curricula from primarily undergraduate medical education, singular interventions, non-peer-reviewed studies and non-English language studies were excluded. Eighteen articles were selected and reviewed by three authors. Critical drivers of success included support from program leadership and opportunities for resident involvement in the curriculum implementation. Most curricula included interventions related to both physical and mental health. Curricula including challenging components of professionalisation, such as critical conversations, medical errors and boundary setting, seemed to foster increased resident buy-in. The most frequently used curricular assessment tools were the Maslach Burnout Inventory and resident satisfaction surveys. Different specialties have different wellness needs. A resource or 'toolbox' that includes a variety of general as well as specialty-specific wellness components might allow institutions and programs to select interventions that best suit their individual needs. Assessment of wellness curricula is still in its infancy and is largely limited to single institution experiences.

MP18-11 DOES LEVEL OF TRAINEE INVOLVEMENT HAVE AN IMPACT ON HYPOSPADIAS TIP REPAIR OUTCOME?

You have accessJournal of UrologyCME1 Apr 2023MP18-11 DOES LEVEL OF TRAINEE INVOLVEMENT HAVE AN IMPACT ON HYPOSPADIAS TIP REPAIR OUTCOME? Vinaya Bhatia, Rocio Goodman, Maria Jabbour, and Walid Farhat Vinaya BhatiaVinaya Bhatia More articles by this author , Rocio GoodmanRocio Goodman More articles by this author , Maria JabbourMaria Jabbour More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Teaching hypospadias repair to trainees is a major component of pediatric urology fellowship training but is not a focus of training junior residents. Herein, we reviewed outcomes of distal hypospadias repairs performed by a single surgeon in the proficiency stage of practice in a residency program and compared these outcomes to those for the same surgeon in the same stage in a fellowship program. METHODS: We reviewed all distal tubularized incised plate repairs performed by a single surgeon from 2019-2021. Data included age, meatal location, presence of curvature, operative time, occurrence of complications, and follow-up duration. Of note, resident involvement comprised mainly assisting in penile degloving urethroplasty and included skin closure under direct supervision. Our outcomes were compared to previously published data using descriptive statistics and Fisher’s exact tests, in which a p<0.05 was designated as statistically significant. RESULTS: A total of 52 patients met our inclusion criteria. A total of 5 patients had a megameatus, 6 had a glanular hypospadias, and 34 had a distal shaft hypospadias. The median age at surgery was 0.72 months (IQR 0.75 months). All patients did have an indwelling stent post-operatively. One patient (3.3%) was found to have complications, which were fistulae and meatal stenosis (Table 1). The time to complication for this patient was 6 months. When comparing previous data to the current data, the overall complication rates were lower (p=0.03), with overall complication rates of 15% (29/187) versus 3% (1/52). CONCLUSIONS: This is the first study directly comparing hypospadias surgical outcomes for the same surgeon in a different practice setting, specifically fellowship and residency programs. Though the detailed role of fellows in hypospadias repair might not be well delineated, it did entail autonomy and delegation, while residents only assisted or performed skin closure under supervision. Our data suggest that fellowship training programs might need to determine key steps for hypospadias repair they teach or delegate. This process should be delivered in a gradual manner gauged to the level of trainees to ensure that outcomes are improved. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e227 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vinaya Bhatia More articles by this author Rocio Goodman More articles by this author Maria Jabbour More articles by this author Walid Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...

O.10.4 - Resident and caregiver involvement in the medicines’ pathway: healthcare professionals’ perspectives: Presenter(s): Amber Damiaens, KU Leuven, Belgium

O.10.4 - Resident and caregiver involvement in the medicines’ pathway: healthcare professionals’ perspectives: Presenter(s): Amber Damiaens, KU Leuven, Belgium

Resident involvement in cataract surgery at the Veterans Health Administration: complications, case complexity, and the role of experience.

To characterize intraoperative complications, case complexity, and changes in complication rates with surgical experience for cataract surgeries involving residents at the Veterans Health Administration (VHA). All VHA facilities where cataract surgery was performed. Multicenter, retrospective cohort study. A retrospective review of all cataract surgeries within the VHA between July 2010 and June 2021 was conducted. Several parameters, including resident involvement, intraoperative complications, and case complexity as determined by Current Procedural Terminology codes, and use of pupil expansion or capsular support devices, were collected. Complication rates were compared between residents and attendings. Of 392 428 cataract surgeries completed across 108 VHA facilities, 90 504 were performed by attendings alone, while 301 924 involved a resident. Of these, 10 244 (11.3%) of attending cases were complex compared with 32 446 (10.7%) of resident cases. Pupil expansion devices were required in 8191 of attending cases (9.05%) and 31 659 (10.5%) of cases involving residents ( P < .001). Similarly, cases involving residents were more likely than attending-only cases to require a capsular support device (0.835% vs 0.586%, P < .001). Cases involving residents were more likely to have posterior capsular rupture (4.75% vs 2.58%, P < .001) and dropped nucleus (0.338% vs 0.198%, P < .001). Higher resident case volumes were associated with significantly lower complication rates for posterior capsular rupture, dropped nucleus, zonular loss, and suprachoroidal hemorrhage. Although residents had higher intraoperative complication rates than attendings, these rates were reduced with surgical experience. Residents were involved in a similar number of complex surgical cases as attendings.

Antecedents of Community Support for Local Tourism Development: A Spotlight on Residents’ Participation in North Cyprus

The effectiveness of tourist development at community-level destinations depends on resident involvement. Through a case study of Esentepe Tourist Village in North Cyprus, this study investigates the impact of residents' engagement on their support for tourist growth at the community level. This study discovered that residents' attitudes toward development are significantly influenced by participation in tourism development using the structural equation model (SEM), which included the variables of community attachment, economic dependence, perceived positive impacts, perceived negative impacts, and attitude toward tourism development. Participation by locals has a direct impact on their attitudes toward tourism development as well as indirect effects by enhancing their favorable image of it. Empirical findings show the importance of resident involvement in tourist development, particularly for regional and local attractions.

Evaluating the Impact of ACGME Resident Duty Hour Restrictions on Patient Outcomes for Bilateral Breast Reductions.

Bilateral breast reductions performed in the 3 years before and after each reform were collected from the National Inpatient Sample database: pre-duty hours (2000-2002), duty hours (2006-2008), and extended duty hours (2012-2014). Multivariable logistic regression models were constructed to investigate the association between ACGME duty hour restrictions on medical and surgical complications. Overall, 19,423 bilateral breast reductions were identified. Medical and surgical complication rates in these patients increased with each successive iteration of duty hour restrictions (P < 0.001). The 2003 duty-hour restriction independently associated with increased surgical (OR = 1.51, P < 0.001) and medical complications (OR = 1.85, P < 0.001). The 2011 extended duty-hour restriction was independently associated with increased surgical complications (OR = 1.39, P < 0.001). ACGME duty-hour restrictions do not seem associated with better patient outcomes for bilateral breast reduction although there are multiple factors involved. These considerations and consequences should be considered in decisions that affect resident quality of life, education, and patient safety.

Preventive Behaviors and Influencing Factors among Thai Residents in Endemic Areas during the Highest Epidemic Peak of the COVID-19 Outbreak.

This research aims to investigate COVID-19 preventive behavior and influencing factors among Thai residents during the highest epidemic peak of COVID-19. Nine hundred and forty-six residents in five districts with high COVID-19 infection cases in Thailand were systematically included in this cross-sectional survey. The results showed that 87.2% and 65.2% of the residents had a high level of general knowledge and preventive measures, respectively. As to COVID-19 attitudes, poor levels of attitude among Thai residents were found in risk perception (53.6%) and mistrust issues (70.4%). Moreover, this study presents good preventive behavior (77.0%) among Thai residents. Multiple logistic regression showed that the influence factors of COVID-19 preventive behavior were the young age group (AOR 2.97, 95% CI 1.68-5.25), high income (AOR 1.38, 95% CI 1.03-1.86), and high level of general COVID-19 knowledge (AOR 2.21, 95% CI 1.64-2.96). The conclusion was that providing information on COVID-19 via social media was the key mechanism of policy action for increasing the level of COVID-19 preventive behavior during the highest epidemic peak in Thailand. In addition, the pandemic preparedness and response policy, with resident participation and involvement, could be recommended for the resilience of pandemic preparedness.

How do patients perceive resident participation in facial cosmetic treatment?

The main objective of this study was to determine patient attitudes toward resident participation in their facial cosmetic treatment. The study design was a cross-sectional study which consisted of an anonymous questionnaire regarding the patient's opinion of resident involvement in their care. Patients who presented to a single academic center seeking facial cosmetic care were surveyed over a period of 10 months. The primary outcome variables were degree of training, analysis of resident involvement impacting quality of care, and resident gender. Fifty patients were surveyed. All participants agreed that they would be comfortable if a resident observed their consultation or treatment and 94% agreed they would be comfortable if a resident interviewed and examined before meeting with the surgeon (n=47). When asked if they would prefer a resident to be far along in their training if they were involved in the surgical care, the majority, 68% (n=34), agreed. Only 18% (n=9) of the patients reported feeling a resident's involvement in their surgery may lower the quality of their care. Patient perception of resident participation in their cosmetic treatment is favorable, but it appears patients do prefer that residents be well into their training years.

Betrokken bewoners in het verpleeghuis: dilemma’s, knelpunten en kansen

In the residential care sector we have witnessed throughout the previous decades a development from a rather paternalistic approach towards a more democratic way of care giving. In many care organizations, however, residents are still rarely involved in the daily routine. In a participatory study on a somatic care unit in the Netherlands, we examined the challenges around the involvement of residents in the care residence. We organized two homogeneous group sessions, with staff and residents separately; reflected on new ways for involving residents; and concluded with a heterogeneous focus group, bringing staff and residents together. Both staff and residents recognized the importance of resident involvement in daily care. However, the difference in perspective on what this should look like created challenges. We found three dilemmas that made the engagement of residents challenging: autonomy versus dependence, personal experiences versus privacy, and happiness versus honesty. We found different ways staff and residents dealt with these dilemmas in practice and defined them in terms of bottlenecks and opportunities. Attention to these dilemmas, pitfalls, and potentials, promotes mutual understanding and ultimately resident involvement in daily care.

Do Plastic Surgery Residents Get Sued? An Analysis of Malpractice Lawsuits.

Using the LexisNexis database, verdicts and settlements from appellate state and federal cases between February 1988 and 2020 were queried. A nonrepresentative sample of 300 cases was compiled. During a 32-year period, 21 lawsuits involving plastic surgery trainees were identified. Of these, 14 (66.67%) involved claims when a trainee was directly named as a defendant. Eighteen (85.7%) cases were due to procedural-related adverse outcomes, while three (14.3%) cases were associated with clinical or diagnostic-related adverse outcomes. Of the procedure-related cases, five (27.8%) occurred when the trainee was the lead surgeon. Allegations included lack of informed consent of procedure complications (11, 52.4%), procedural error (11, 52.4%), failure to supervise trainee (11, 52.4%), inexperience of trainee (eight, 38.1%), incorrect diagnosis or treatment (five, 23.8%), delay in evaluation (three, 14.3%), lack of awareness of resident involvement (three, 14.3%), lack of follow-up (three, 14.3%), and prolonged operative time (one, 4.8%). Median time from injury to lawsuit resolution was 3.8 years [interquartile range (IQR), 3-5 years]. Verdicts were ruled in favor of the defense in eight (38.1%) cases and for plaintiff in six (28.6%) cases. A settlement was made in seven (33.3%) cases. Median payout for plaintiff-won cases was $5,100,000 (IQR, $1,530,000-$17,500,000); the median settlement was $2,500,000 (IQR, $262,500-$4,410,000). Procedural error, improper informed consent, improper trainee supervision, and resident inexperience were the most common allegations. These factors can lead to financial and psychological burdens early in a physician's career.

Supporting a culture of patient safety: Resident-led patient safety event reviews in a pathology residency training program

Patient safety is a critical component of quality patient care at any healthcare institution. In order to support a culture of patient safety, and in the context of a hospital-wide patient safety initiative at our institution, we have created and implemented a new patient safety curriculum within our training program. The curriculum is embedded in an introductory course for first-year residents, in which residents gain an understanding of the multifaceted role of the pathologist in patient care. The patient safety curriculum is a resident-centered event review process and includes 1) identification and reporting of a patient safety event, 2) event investigation and review, and 3) presentation of findings to the residency program including core faculty and safety champions for the consideration of implementation of the identified systems solution. Here we discuss the development of our patient safety curriculum, which was trialed over a series of seven event reviews conducted between January 2021 and June 2022. Resident involvement in patient safety event reporting and patient safety event review outcomes were measured. All event reviews conducted thus far have resulted in the implementation of the solutions discussed during event review presentations based on cause analysis and identification of strong action items. Ultimately this pilot will serve as the basis by which we implement a sustainable curriculum in our pathology residency training program centered on supporting a culture of patient safety, and in line with ACGME requirements.

Комплексная оценка уровня комфортности (качества) городских многофункциональных парков севера Москвы

The article discusses the issues and methods for assessing the level of parking comfort for five years, the use in the northern and central administrative districts of Moscow. The main characteristics have been identified, an expert assessment of multifunctional parking lots has been carried out in dynamics over several years. Get involved and referrals. Keywords: COMPARATIVE ASSESSMENT, CITY PARK, METHODOLOGY, LANDSCAPING, MONITORING, URBAN ENVIRONMENT, RESIDENT INVOLVEMENT, COMFORT INDICATORS, EVALUATION CRITERIA

Variation in Resident Operative Autonomy at Veterans Affairs Hospitals

This cohort study examines resident involvement in the care of US veterans who underwent noncardiac surgery.

Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

IntroductionPoor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings.MethodsAs part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021. ResultsFollowing analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints.ConclusionsThere are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity.

An Interval Look at the Transplant Surgery Pipeline: Insights from General Surgery Residents’ Operative Experience Using ACGME Operative Logs from 2000 to 2021

Given the declining number of US graduates pursuing transplant surgery as well as regulatory changes regarding transplant rotations for surgical residents, this study examined the transplant surgery operative volume of residents over the past 20 years. Retrospective analysis of the ACGME database of general surgery operative logs from academic year (AY) 1999-2000 to AY 2020-2021; data was categorized into time periods relative to regulatory changes: Period 1 (1999-2010) and Period 2 (2011-2021). All ACGME-accredited general surgery residency programs in the US. On average, the proportion of transplant cases to all total major cases was about 1% and did not change during the study period (p=0.61). Each graduating resident completed an average of 10.0 ± 11.0 cases during Period 1 and 10.8 ± 12.0 cases during Period 2, representing a statistically but unlikely clinically significant increase (p=0.008). Renal transplants comprised more than 50% of each resident's operative experience in transplant surgery. The proportion of resident involvement in all renal and liver transplantations nationally did not change during the study period, ranging from 34.5-42.9% for renal and 13.8-22.4% for liver. Resident volume in transplant surgery has largely remained consistent over the past 20 years, suggesting that changes in operative volume are unlikely driving declining interest in transplant surgery fellowship among US trainees.

Cost analysis of training residents in robotic-assisted surgery.

Use of robotic-assisted surgery is increasing, and resident involvement may lead to higher costs. We investigated whether senior resident involvement in noncomplex robotic cholecystectomy (RC) and inguinal hernia (RIH) would take more time and cost more when compared to non-robotic cholecystectomy (NRC) and inguinal hernia repair (NRIH). We extracted surgery duration and total cost of NRC, NRIH, RC, and RIH from 7/2016 to 6/2020 with senior resident (PGY4-5) involvement. We excluded complex cases as well as prisoner cases and those with new faculty and research residents. We assessed differences between robotic and non-robotic cases in surgery duration and total cost per minute, using one-way ANOVA. We included 1608 cases (non-robotic 1145 vs. robotic 463). On average, RC cases with a senior resident took less time than NRC (179.4 < 185.8, p = 0.401); surgery duration of RIH cases was similar with NRIH cases. The total cost per minute of RC cases with a senior resident on average was $9.30 higher than NRC cases for each minute incurred in the operating room but did not lead to a significant change in overall cost. RIH cases, on the other hand, cost less per minute than NRIH cases (114.1 < 126.5, p = 0.399). Training in robotic surgery is important. Noncomplex RC and RIH involving senior residents were not significantly longer nor did they incur significantly more cost than non-robotic procedures. Senior resident training in noncomplex robotic surgery can be efficient and can be included in the residency curriculum.

Participatory environmental health research: A tool to explore the socio-exposome in a major european industrial zone

ObjectivesWe show that participatory research approaches can be a useful tool across disciplines and data collection methods to explore the socio-exposome near one of the largest industrial harbors in Europe. We analyzed resident involvement in each project and their capacity to affect structural changes. MethodsLongitudinal participatory environmental monitoring studies on lichens, petunias, aquatic systems and groundwater were conducted under the program VOCE (Volunteers for the Citizens' Observation of the Environment), which mobilized nearly 100 volunteers to collect and report data. A community-based participatory health survey, Fos EPSEAL was also carried out during the same period. We describe citizens' involvement in each study following Davis and Ramirez-Andreotta's (2021) ‘best practice’ grid. We also use residents' insights to refine understanding of the socio-exposome. ResultsThe region is significantly impacted by industrial pollution and fenceline communities are disproportionately exposed. The community-based participatory health survey documented negative health outcomes among the residents, including a higher prevalence of chronic symptoms and diabetes (e.g., 11.9%) in the Fos-Berre Lagoon region than in other communities. This methodology shows the benefits of the co-production of knowledge in environmental health: not only does it enable epistemological transformations favorable to the vulnerable population, but it also triggered public action (i.e., media and public authorities’ attention leading to official expertise reports, filing of collective complaints before the courts). ConclusionThis body of multiple participatory research studies over time is a useful approach to better understand the socio-exposome and health issues in an industrial zone.

Park renovation for and with Children. - Activities at the Arima Fuji Park in Hyogo Prefecture to create diverse resident involvement -

Park renovation for and with Children. - Activities at the Arima Fuji Park in Hyogo Prefecture to create diverse resident involvement -

Comparison of Robotic, Laparoscopic, and Open Unilateral Repair of Non-recurrent Inguinal Hernia.

There is a paucity of data comparing open, robotic, and laparoscopic approaches on unilateral, non-recurrent inguinal hernias. Our study presents a large, retrospective triple-arm outcome analysis between robotic, laparoscopic, and open unilateral, non-recurrent inguinal hernia repairs at a single institution. 706 patients who underwent elective, non-recurrent inguinal hernia repair performed by 8 general surgeons at a single institution from 2016 to 2019 were reviewed retrospectively. Patient baseline characteristics, operative times, resident involvement, and postoperative outcomes were analyzed for all repair types. A cost analysis of the different procedures was performed. There were 305 laparoscopic repairs, 207 robotic repairs, and 194 open repairs. Open and laparoscopic repairs were performed on patients who were older (p =< .001) and with a higher Charlson Comorbidity Index (p =< .001). Patient BMI was higher in minimally invasive repair than open repair (P = .021). There were no significant differences in complication rates on pairwise analysis. Robotic and open repairs had significantly longer operative times than laparoscopic repairs (P < .001). There was less resident involvement in robotic repair than with the other approaches (P < .001). Resident involvement was associated with shorter OR times (P = .001) and no significant difference in postoperative complications. There was a trend over the study period toward faster operative times and more robotic repair. Robotic repair is the most expensive repair, followed by laparoscopic and open repairs. All 3 repair techniques can be performed without significant differences in outcomes. The technique utilized should be based on surgeon preference and patient characteristics.