Resident Involvement Research Articles

Operative Time for Minimally Invasive Sacrocolpopexy: Comparison of Conventional Laparoscopy versus Robotic Platform

To evaluate the operative time for minimally invasive sacrocolpopexy using conventional laparoscopy vs robotic assistance. In addition, we sought to compare intraoperative complications, mesh complications, anatomic prolapse recurrence, and retreatment. Retrospective cohort study. Academic hospital. All 142 women who underwent minimally invasive sacrocolpopexy between January 1, 2019, and December 31, 2019. We compared operative time between laparoscopic and robotic-assisted sacrocolpopexies. A total of 142 women were included. Mean age was 61.8 ± 9.6 years and mean body mass index 27.1 ± 4.4 kg/m2. A total of 86 (60.6%) sacrocolpopexies were performed laparoscopically and 56 (39.4%) with robotic assistance. There were no significant differences in baseline demographic variables. A higher proportion of concomitant hysterectomies were performed with robotic assistance as compared with laparoscopic cases (n=42, 73.7% robotic vs n=43, 50.6% laparoscopic; p <.01). Mean operative times were significantly different between robotic and laparoscopic groups (176.3 ± 45.5 minutes and 195.0 ± 45.4 minutes, p = .02). On linear regression, the variables predicting significant change in operative time were robotic assistance, concomitant hysterectomy, age, body mass index, and no resident involvement. There were no differences in intraoperative bladder or bowel injury, anatomic recurrence beyond the hymen, retreatment, or mesh complications (all p >.05). Contrary to previous research, the use of robotic assistance does not appear to increase operative time for patients undergoing minimally invasive sacrocolpopexy in a large academic practice.

MP10-03 SURGICAL AUTONOMY OF UROLOGY RESIDENTS WITHIN THE VETERANS AFFAIRS HEALTHCARE SYSTEM

You have accessJournal of UrologyCME1 May 2022MP10-03 SURGICAL AUTONOMY OF UROLOGY RESIDENTS WITHIN THE VETERANS AFFAIRS HEALTHCARE SYSTEM Janmejay Hingu, Anh Nguyen, Kunj Jain, Devashish Anjaria, Joseph Oliver, and Hossein Sadeghi-Nejad Janmejay HinguJanmejay Hingu More articles by this author , Anh NguyenAnh Nguyen More articles by this author , Kunj JainKunj Jain More articles by this author , Devashish AnjariaDevashish Anjaria More articles by this author , Joseph OliverJoseph Oliver More articles by this author , and Hossein Sadeghi-NejadHossein Sadeghi-Nejad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical resident autonomy in procedures has been eroding over time due to factors such as duty hour restrictions, focus on operating time, complication rates, and trust among supervising physicians. This study examines whether urology residents at the Department of Veterans Affairs hospitals (VA) have experienced decreased surgical autonomy and what factors may contribute. METHODS: The VA Surgical Quality Improvement Program (VASQIP) was queried for the most common urologic procedures between 2004 to 2019 with resident involvement. The cases were stratified by resident involvement: attending as primary (AP), attending and resident (AR), resident as primary (RP). RESULTS: 127,757 urology cases were identified from 2004 to 2019. The most frequent surgeries were transurethral resection of prostate (TURP); transurethral resection of small, medium, or large tumor (TURBT); GreenLight laser of prostate (GLL); hydrocelectomy; and ureteral stent placement. These procedures accounted for 76.5% of all cases. The percentage of RP cases decreased from 31.3% of cases to 18.6%. Reduction in RP cases was seen in all seven top urology cases, particularly in ureteral stent placement which has declined from 44% RP in 2004 to 18% in 2019. Cases with resident involvement had patients with more cardiovascular, pulmonary, and infectious comorbidities. Mean operative times in all cases were not significantly different. The 30-day composite complications and 30-day return to operating room were greatest for AR. Postoperative complications of bleeding, infection, DVT, embolism, renal failure, wound dehiscence, and 30 day all-cause mortality were not significantly different. CONCLUSIONS: Urology resident autonomy has decreased within the VA healthcare system over the past 15 years. Mean operative times and postoperative complications are not inferior in cases that involve residents as the primary surgeon. Increased focus on resident education and surgical autonomy in the operating theater is vital for training the next generation of surgeons. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e146 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Janmejay Hingu More articles by this author Anh Nguyen More articles by this author Kunj Jain More articles by this author Devashish Anjaria More articles by this author Joseph Oliver More articles by this author Hossein Sadeghi-Nejad More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP19-05 LANDSCAPE ANALYSIS OF THE USE OF HOLISTIC REVIEW IN THE UROLOGY RESIDENCY MATCH PROCESS

You have accessJournal of UrologyCME1 May 2022MP19-05 LANDSCAPE ANALYSIS OF THE USE OF HOLISTIC REVIEW IN THE UROLOGY RESIDENCY MATCH PROCESS Efe Chantal Ghanney Simons, Parris A. Diaz, Rebecca Takele, Serena Does, Nicholas J. Jackson, Samuel L. Washington, Benjamin N. Breyer, Tracy M. Downs, and Christopher Saigal Efe Chantal Ghanney SimonsEfe Chantal Ghanney Simons More articles by this author , Parris A. DiazParris A. Diaz More articles by this author , Rebecca TakeleRebecca Takele More articles by this author , Serena DoesSerena Does More articles by this author , Nicholas J. JacksonNicholas J. Jackson More articles by this author , Samuel L. WashingtonSamuel L. Washington More articles by this author , Benjamin N. BreyerBenjamin N. Breyer More articles by this author , Tracy M. DownsTracy M. Downs More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Association of American Medical Colleges calls on residency program leadership to adopt Holistic Review in the selection of applicants when screening, interviewing and creating rank order lists however the method of implementation is at the discretion of individual programs. Other specialties have employed blinding recruiters to standardized and increasing the diversity of their recruitment teams. In this work, we aimed to first describe the use of blinding of academic performance metrics at each stage of the urology match process and second, to describe the diversity of individuals involved in the screening of applicants to invite for interview during the Urology Residency Match process. METHODS: A cross-sectional survey of program leadership at the 144 accredited urology residency programs in the US was distributed January 29, 2021 to March 4, 2021 via the Society of Academic Urologists mailing list. Descriptive statistics were performed to determine the proportion of urology residency programs blinding academic performance metrics including USMLE Step 1 and 2 scores, GPA, class rank, honors during screening, interviewing and ranking of urology applicants. RESULTS: We received responses from 130 urology (associate) program directors representing 112 programs (112/144 = 78%). In the 2020-2021 urology residency application cycle, 9%, 16% and 9% of urology residency programs blinded their recruitment team to academic performance metrics at the screening, interviewing and ranking steps respectively. An equal proportion of programs report having a female faculty screen applications as those that report having male faculty (39%). Fewer programs report having Under-Represented in Medicine (URiM) faculty screen applications (21%) vs those that report non-URiM faculty involvement in screening (27%). Few programs report having resident involvement in screening and only 7% of programs include URiM residents. CONCLUSIONS: A minority of urology residency programs currently employ blinding of scores as part of Holistic review. Fewer programs involve URiM faculty or URiM residents in the screening process. An understanding of the current practices of residency programs can inform strategies for optimizing equity, diversity and inclusion in the urology match process. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e308 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Efe Chantal Ghanney Simons More articles by this author Parris A. Diaz More articles by this author Rebecca Takele More articles by this author Serena Does More articles by this author Nicholas J. Jackson More articles by this author Samuel L. Washington More articles by this author Benjamin N. Breyer More articles by this author Tracy M. Downs More articles by this author Christopher Saigal More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD60-05 A 20 YEAR FOLLOW-UP STUDY OF ONCOLOGIC OUTCOMES, QUALITY OF LIFE AND COMPLICATIONS IN PATIENTS UNDERGOING ROBOTIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 May 2022PD60-05 A 20 YEAR FOLLOW-UP STUDY OF ONCOLOGIC OUTCOMES, QUALITY OF LIFE AND COMPLICATIONS IN PATIENTS UNDERGOING ROBOTIC RADICAL PROSTATECTOMY Alexander Bandin, Ilene Staff, Joseph Tortora, Kevin Pinto, Tara McLaughlin, Rosa Negron, Laura OlivoValintin, Caner Dinlenc, and Joseph Wagner Alexander BandinAlexander Bandin More articles by this author , Ilene StaffIlene Staff More articles by this author , Joseph TortoraJoseph Tortora More articles by this author , Kevin PintoKevin Pinto More articles by this author , Tara McLaughlinTara McLaughlin More articles by this author , Rosa NegronRosa Negron More articles by this author , Laura OlivoValintinLaura OlivoValintin More articles by this author , Caner DinlencCaner Dinlenc More articles by this author , and Joseph WagnerJoseph Wagner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002645.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Within 10 years of its approval, surgeons were using the Da Vinci surgical robot for the majority of prostatectomies in the USA. Here we evaluate a single surgeon’s 20 year experience with robotic radical prostatectomy. METHODS: Patients were identified via an IRB approved prospectively maintained prostate cancer database. Perioperative variables such as operative time were recorded at time of surgery. EPIC 26 and/or UCLA Prostate Cancer Index scores were collected preoperatively and at each postoperative visit. PSAs, salvage and adjuvant treatment, and complications were prospectively collected. Continence was defined as 0 pads or 1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks. Biochemical recurrence was defined as a PSA >0.2 or a hypersensitive PSA resulting in early salvage therapy. All surgeries were performed by a single surgeon; the initial 74 cases were performed as a co-surgeon with another fellowship trained minimally invasive urologic surgeon. Patients were divided into five year cohorts (Cohort A 2001-2005; cohort B 2006-2010; cohort C 2011-2015; Cohort D 2016-2021) and we evaluated group differences in perioperative, quality of life, and oncologic outcomes over time. RESULTS: 3152 patients met criteria for inclusion (Table 1). ≥Clavien 3 complication rates decreased from 16.0% to 3.6%, p <0.001. 1 year continence rates improved from 74.8% to greater than 92%, p <0.001. Operative times dropped from Cohort A to B (199 min v 167 min, p <0.001) and then began to gradually increase with increased resident and fellow involvement. There was considerable grade and stage migration between 2001 and 2021, p <0.001. CONCLUSIONS: In this 20 year review of our experience with robotic prostatectomy, complication rates and continence improved over time. Confounding factors such as grade/stage migration, changes in prostate cancer screening, level of resident/fellow involvement, the advent of hypersensitive PSA, and changing recommendations for adjuvant/salvage therapy certainly influenced outcomes such as operative time, BCR, and margin status. Nonetheless, this study provides insight into the changing landscape of prostate cancer treatment over the past two decades. Source of Funding: Unfunded © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1026 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Bandin More articles by this author Ilene Staff More articles by this author Joseph Tortora More articles by this author Kevin Pinto More articles by this author Tara McLaughlin More articles by this author Rosa Negron More articles by this author Laura OlivoValintin More articles by this author Caner Dinlenc More articles by this author Joseph Wagner More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD28-07 UROLOGY RESIDENT AUTONOMY IN PERFORMING PENILE PROSTHESES IN THE VETERANS AFFAIRS (VA) HOSPITALS

You have accessJournal of UrologyCME1 May 2022PD28-07 UROLOGY RESIDENT AUTONOMY IN PERFORMING PENILE PROSTHESES IN THE VETERANS AFFAIRS (VA) HOSPITALS Anh Nguyen, Jacob Veliky, John Fastenau, Devashish Anjaria, Joseph Oliver, and Hossein Sadeghi-Nejad Anh NguyenAnh Nguyen More articles by this author , Jacob VelikyJacob Veliky More articles by this author , John FastenauJohn Fastenau More articles by this author , Devashish AnjariaDevashish Anjaria More articles by this author , Joseph OliverJoseph Oliver More articles by this author , and Hossein Sadeghi-NejadHossein Sadeghi-Nejad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical resident autonomy is critical for transition to confidence and transition to independent practice post training. This study examines the degree of urology resident autonomy at the VA hospitals in performing penile prosthetic surgery. METHODS: The VA Surgical Quality Improvement Program (VASQIP) was queried for penile prosthesis insertion and removal procedures between 2004 to 2019 at teaching VA hospitals. VASQIP does not track all penile prosthetic procedures. This data was then compared with the five most commonly resident performed non-penile prostheses cases within the database (transurethral resection of prostate, transurethral resection (small, medium, or large tumor), GreenLight laser of prostate, hydrocelectomy, and ureteral stent placement). The cases were stratified by attending supervision: attending as primary surgeon (AP), attending and resident (AR), resident as primary surgeon with the attending not scrubbed (RP). Primary outcome was rate of resident involvement. Secondary outcomes were 30-day mortality and morbidity within the prosthetic procedures by supervision categories. Statistics was performing using Pearson’s Chi Squared. RESULTS: 881 penile prosthesis implantation and removal cases were identified from 2004 to 2019. Of these, 13.2% were AP, 78.5% were AR, and 8.3% were RP compared to the most common procedures (n=127,757) which showed that 33.7% were AP, 40.6% were AR, and 25.7% were RP (p < 0.001). Comparison of AP, AR, and RP penile prostheses demonstrated no statistically significant increase in 30-day all-cause mortality or complications (Table 1). CONCLUSIONS: Within VA hospitals, penile prostheses surgeries are performed by residents without an attending scrubbed less frequently than the most commonly performed urological surgeries. The sensitive and costly nature of implanting prostheses and the higher stakes of post-surgical infection may influence this trend. The latter may affect the residents’ comfort level independently performing these operations after graduation. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e501 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anh Nguyen More articles by this author Jacob Veliky More articles by this author John Fastenau More articles by this author Devashish Anjaria More articles by this author Joseph Oliver More articles by this author Hossein Sadeghi-Nejad More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP10-02 UROLOGY RESIDENT AUTONOMY COMPARED TO GENERAL SURGERY RESIDENT AUTONOMY

You have accessJournal of UrologyCME1 May 2022MP10-02 UROLOGY RESIDENT AUTONOMY COMPARED TO GENERAL SURGERY RESIDENT AUTONOMY Kunj Jain, Janmejay Hingu, Anh Nguyen, Devashish Anjaria, Joseph B. Oliver, and Hossein Sadeghi-Nejad Kunj JainKunj Jain More articles by this author , Janmejay HinguJanmejay Hingu More articles by this author , Anh NguyenAnh Nguyen More articles by this author , Devashish AnjariaDevashish Anjaria More articles by this author , Joseph B. OliverJoseph B. Oliver More articles by this author , and Hossein Sadeghi-NejadHossein Sadeghi-Nejad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urology and general surgery resident autonomy in the operating room has been declining in recent years. This may be due to perceptions of poorer outcomes, complications, and operating time. Residents and faculty have expressed decreased preparedness as independent surgeons due to inadequate autonomy during residency. We sought to compare resident involvement for general surgery and urology residents and evaluated the associated outcomes. METHODS: This study is a retrospective study from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. All operative cases from July 1, 2004 to September 30, 2019 in the VASQIP database were included in the study. Patients who underwent a urologic surgical procedure were identified based on the code of the surgeon’s specialty and stratified based on CPT codes. The cases were coded based on the level of supervision by an attending physician: AP- attending as primary surgeon, RP- resident as primary surgeon, AR- attending and resident as primary surgeons. Logistic regression and ANOVA analysis was performed. RESULTS: The VASQIP database included 127,757 patients who underwent urologic surgery over the 15 year time frame. There was decline in resident primary surgeon (RP) cases from 31.3% in 2004 to 18.6% in 2019 with an increase in total cases (p <0.01). The number of urology RP cases is higher compared to general surgery/vascular surgery RP cases which decreased from 15% to 5% in the same period. Urology and general surgery AR cases had increased operating times, but RP surgeries did not have significantly increased operating times when compared to AP surgeries. There was no increase in mortality with RP or AR urology cases. However, the 30-day return to OR was significantly increased compared to AP cases. There was no difference in mortality between RP or AP general surgery cases, but AP general surgery cases had an increased rate of complications. CONCLUSIONS: Residents in urology and general surgery have had a major decline in resident autonomy between 2004 and 2019. Although urology has had better autonomy maintenance compared to general surgery, both specialties have seen a decline that is not warranted based on operating time, complications, and patient outcomes. There is a need for increased efforts to expand resident autonomy to create prepared and independent future surgeons. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e146 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kunj Jain More articles by this author Janmejay Hingu More articles by this author Anh Nguyen More articles by this author Devashish Anjaria More articles by this author Joseph B. Oliver More articles by this author Hossein Sadeghi-Nejad More articles by this author Expand All Advertisement PDF DownloadLoading ...

Empirical Study on Local Residents’ Participation in Endogenous Tourism Development

Purpose: The present paper endeavors to explore the three-pronged approach; to identify the local residents’ attitude, to investigate the local residents’ participation in planning and implementing the endogenous tourism development project, as well to investigate the influence of local residents’ participation upon perception caused by the socio-economical and cultural impact of endogenous tourism. Methodology: This research study is explorative by nature adopting both descriptive and analytical methods. The research process involves the sampling technique. Field interview has been initiated to collect the data for the purposive sampling method. An open-ended questionnaire has been prepared for the random sampling to obtain the data from the respondents. Findings: The research study explores the impact of local residents’ participation in endogenous tourism development projects. For this reason, one way ANOVA has been conducted that reveal a value of less than 0.05 which signifies local residents’ participation impacts on the tourism planning and implementation. Practical Implications: The participation has increased the positive attitude among the residents resulting in the sustainable approach towards endogenous tourism development. Local residents’ participation in the implementation of endogenous tourism projects has enhanced their quality of life in terms of socio-economic and cultural development. Originality: The primary purpose of the endogenous tourism project in Pipli and Raghurajpur village of Odisha is the inclusive development through active resident participation and involvement. Endogenous tourism development project has also intensified the infrastructure development of the region, hence tourism policymakers and planners should think of deriving the maximum benefits by encouraging residents to a greater extent.

Unpacking notions of residents' responsibility in flood risk governance

AbstractEnvironmental disasters, and especially floods, are among today's biggest sustainability challenges. The number and intensity of floods are increasing, challenging current governance approaches. Governments worldwide are looking to diversify their flood risk management and adaptation strategies, among others, by increasing resident involvement in flood risk governance. Such involvement of individuals shifts responsibilities from public to private actors. A clear understanding of the extent and implications of this shift is difficult to reach as theoretical perspectives on the concept of responsibility vary. Similarly, grounds for attributing responsibility for flood preparedness and response differ across countries. This lack of analytical and empirical clarity complicates academic and policy discourses on what it actually means to ‘be responsible’. The current article systematises these different approaches to responsibility in flood risk governance. To improve current knowledge on residents' responsibilities in flood risk governance, we present a conceptual framework that distinguishes among four theoretical notions of responsibility: legal responsibility, accountability, perceived responsibility, and moral responsibility. These notions are elucidated with the help of examples of flood risk governance practices in the United States, Germany and the Netherlands. We find that the four notions are closely intertwined. In addition, this article documents divergences between what individuals perceive as their own responsibility in flood risk management and the responsibilities that governments assume. We conclude with a discussion on the tensions between perceived responsibilities and the other three notions. Explicit, transparent and open discussion on these tensions is needed to allow attribution of responsibility in flood risk governance and to reconsider residents' roles in particular.

The Impact of Resident Involvement on Outcomes and Costs in Elective Hand and Upper Extremity Surgery

The purpose of this study was to assess the impact of resident involvement on periprocedural outcomes and costs after common procedures performed at an academic hand surgical practice. A retrospective review was performed in all patients undergoing 7 common elective upper extremity procedures between January 2008 and December 2018: carpal tunnel release, distal radius open reduction and internal fixation (ORIF), trigger finger release, thumb carpometacarpal arthroplasty, phalanx closed reduction and percutaneous pinning, cubital tunnel release, and olecranon ORIF. The medical record was reviewed to determine the impact of surgical assistants (resident, fellow, or physician assistant) on periprocedural outcomes, periprocedural costs, and 1-year postoperative outcomes. The involvement of surgical trainees operating under direct supervision was compared with the entire operation performed by the attending surgeon with a physician assistant present. A total of 396 procedures met the inclusion criteria. Analysis of the whole study sample revealed low rates of intraoperative complications, wound complications, medical complications, readmissions, and mortality. Subgroup analysis of carpal tunnel releases revealed significantly greater tourniquet times for residents compared with physician assistants (7 ± 2 min, 6 ± 1 min), as well as longer overall operating room times for residents compared to fellows or physician assistants (17 ± 5 min, 13 ± 3 min, 12 ± 3 min). Operating room times for distal radius ORIF were significantly greater among residents compared to fellows or physician assistants (68 ± 19 min, 57 ± 17 min, 56 ± 14 min). There were no differences in any other perioperative metrics or periprocedural costs for the trigger finger release or cubital tunnel release cohorts. Resident involvement in select upper extremity procedures can lengthen operative times but does not have an impact on blood loss or operating room costs. Surgeons should be aware that having a resident assistant slightly increases operative times in elective hand surgery.

Patient Perceptions of Resident Involvement in Surgery: A Qualitative Study Using Surgical Video

To improve patient-centered perioperative informed consent, this study used real surgical footage to identify key topics which might be discussed with patients regarding resident involvement in surgery. We conducted semi-structured qualitative interviews with 27 participants. The interviews included a video showing an attending and resident performing a procedure together. Questions focused on comfort with resident involvement and preferences regarding preoperative informed consent. Participants also described residents' participation in their own words. Participants were recruited from the infusion room of the allergy clinic and the treatment room of the dialysis clinic at a tertiary care facility in Nashville, TN (Vanderbilt University Medical Center). Adult medical patients were recruited via periodic verbal announcements by the interviewer in the waiting rooms. Purposive sampling was used to increase demographic diversity. Participants with training in the clinical health professions (i.e., physicians, nurses, and medical assistants) were excluded. Before watching the video, roughly half of participants imagined the resident to have a passive, bystander role, while the remaining imagined a more active role. Despite these differences, most participants found the video of attending-resident teamwork to be a reassuring depiction of resident involvement. When asked the best way to describe resident participation depicted in the video to patients, participants emphasized the need to focus on attending supervision, teamwork, reassurance, as well as resident presence, specific activities, and experience. Although patients have varying perceptions regarding the role of trainees in surgery, most participants were comfortable with teamwork between an attending and resident, as depicted in the video. Our participants provided multiple practical ways to transparently articulate resident involvement for testing in future research.

New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications

ABSTRACT Introduction Inflatable penile prosthesis (IPP) placement is a critical component of urology residency education. Resident trainees are useful in IPP cases, but resident assistance is not always available to prosthetic urologists. Registered Nurse First Assistants (RNFAs) can also serve as capable assistants during IPP procedures. We reviewed our data to compare intraoperative and postoperative complications in IPP cases with residents or RNFAs as assistants. We also compared the differences in the surgical procedures with either type of assistant. Objective Comparing the influence of different assistants on perioperative complications of Inflatable Penile Prosthesis Methods Medical records of patients who underwent IPP placement by a single surgeon between 2017 and 2020 were retrospectively reviewed with IRB approval. Baseline patient characteristics, details of surgical procedure, and outcomes were collected. A logistic regression model was used to identify predictors of complications. Student's T test was used to examine for differences in total OR time between different assistants. Results A total of 210 patients who underwent IPP surgery were identified, among which 168 (80%) placements were assisted by RNFAs, and 42 (20%) by urology residents. Complications were reported in 37 (17.6%) patients. Clavien-Dindo complications were grades V (1%, n=2), IIIb (11%, n=23), II (0.5%, n=1), and I (7%, n=14). There was no significant difference in the rate of complications for IPP placement assisted by a resident or RNFA (OR 0.95, CI 0.35 – 2.31) but this was limited by the overall power in assessing complications. Resident-assisted IPP placements were found to be associated with longer operative time than those assisted by RNFAs (86.2 ± 23.1 min vs 72.9 ± 35.5 min, p&amp;lt;0.01). Patient factors including new IPP, BMI&amp;gt;30, DM, and positive urine culture were also not associated with increased complication rate. Current smokers were noted to have more complications (OR 2.51, CI 0.94 – 6.30), although this was not statistically significant. Patients were followed for 12.2 ± 10.8 months postoperatively. Conclusions Resident-assisted IPP placement with a high-volume surgeon is not associated with observable increase rate of complications comparing to those assisted by RNFAs. Moreover, resident involvement is only associated with slight increase in operative time compared to RNFA-assisted IPP placement. Overall complications were low in this series. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

Perspectives of residents on shared decision making in medication management: A qualitative study.

Shared decision making is the process in which the person, their representative, and health care professional share information with each other, participate in the decision-making process, and agree on a course of action. At present, very little is known about shared decision making (SDM) in medication management from the perspective of long-term care facility residents. The objective of this study was to identify residents' beliefs, motivation, and aspects of the environment that facilitate or impede SDM. A qualitative study was conducted using face-to-face semi-structured interviews, and data analysis was carried out using a thematic approach. Six long-term care facilities in Sydney, Australia. Thirty-one residents. Enablers to resident involvement in SDM were resident beliefs in exercising their right to take part in medication-related decisions, preference to maintain control over decisions, and motivation to raise concern about medication. Residents were not motivated to be involved in SDM if they believed they had no control over life circumstance, perceived that medications were necessary, or experienced no problems with their medications. Participation in SDM was hindered by limitations in opportunities for resident involvement, engagement with staff and primary care physician to discuss issues related to medications, and continuity of care with their regular physician. This study highlights that the residents' beliefs in control over decisions and concerns about medication are a significant function of the SDM process. It is important that residents are given the choice to take part in SDM, their beliefs and values regarding SDM are understood, and the culture of the care facility respects residents' right to participate in SDM.

The effects of organizations engaging residents in greening vacant lots: Insights from a United States national survey

BackgroundAs vacant lot inventories expand in cities across the U.S., vacant land management organizations require strategies that optimize their functioning while ensuring community benefit. Resident engagement in programs to green vacant land may be one helpful strategy. While resident engagement is often required for vacant land management organizations, few researchers have examined how these organizations engage residents and the effect of these practices on their functioning. We hypothesized that more intensive engagement such as involving residents in planning and implementing greening would be more predictive of organizational functioning than lower level engagement. MethodsWe analyzed data from a national survey of vacant land management organizations from 27 states (N = 68). We assessed three areas of organizational functioning including networking, programmatic, and resource capacity. We used hierarchical regression to test the additive effects of the resident engagement predictor variables including communication, input, involvement in planning, and involvement in implementation on organizational functioning. ResultsLess intensive engagement forms such as communicating and soliciting input were the most popular methods, but our final model indicated that the highest functioning organizations reported the most resident involvement in planning and implementing greening. ConclusionsOur results support policies and practices that expand resident involvement in greening.

Increasing Patient Safety Event Reporting Among Pediatric Residents.

Background and objectiveDespite their role as frontline providers, resident physicians often underreport adverse patient events or safety issues they encounter. The objective of this study was to increase the number of patient safety events (PSE) reported at our institution through the implementation of a longitudinal, multi-pronged approach.MethodsWe designed and implemented a series of interventions focused on increasing patient safety events reported by resident physicians from October 2018 to April 2021. Interventions consisted of formal didactic sessions, increasing awareness among organizational leaders about the integral role of residents, implementing a direct feedback process to residents regarding the events, and encouraging them to develop solutions to their PSE that were associated with a financial incentive. We collected the rates of reports every month to assess the impact of our interventions.ResultsThe mean number of PSEs submitted monthly increased from zero to two reports at baseline to 10.4 during the study period. The mean number of PSE increased to 5.8 (range: 2-11) at the end of the first intervention. Following the third intervention, the average number of reported PSE was 12.3 (range: 5-18). There was a continued increase in the number of events reported across the study period, which was sustained. The outcome of interest was not achieved after intervention 1 but was achieved in 27% and 62% of months following interventions two and three. By theend of the study period, our goal of >13 PSEs per month was consistently met. The most significant increase in reporting occurred when residents received positive timely feedback regarding their reports.ConclusionsThe number of patient safety events reported by pediatric residents increased at our institution following the implementation of a multi-pronged approach including enhanced education, recognition of the residents as frontline reporters among institutional stakeholders, and direct feedback regarding submissions. Our strategies may be replicated at other residency programs seeking to establish resident involvement in safety initiatives. Further work is necessary to ensure residents gain an understanding of how patient safety events are addressed and prevented at an organizational level.

Emergency medicine resident clinical experience vs. in-training examination content: A national database study.

Emergency medicine (EM) residents take the In-Training Examination (ITE) annually to assess medical knowledge. Question content is derived from the Model of Clinical Practice of Emergency Medicine (EM Model), but it is unknown how well clinical encounters reflect the EM Model. The objective of this study was to compare the content of resident patient encounters from 2016-2018 to the content of the EM Model represented by the ITE Blueprint. This was a retrospective cross-sectional study utilizing the National Hospital Ambulatory Medical Care Survey (NHAMCS). Reason for visit (RFV) codes were matched to the 20 categories of the American Board of Emergency Medicine (ABEM) ITE Blueprint. All analyses were done with weighted methodology. The proportion of visits in each of the 20 content categories and 5 acuity levels were compared to the proportion in the ITE Blueprint using 95% confidence intervals (CIs). Both resident and nonresident patient visits demonstrated content differences from the ITE Blueprint. The most common EM Model category were visits with only RFV codes related to signs, symptoms, and presentations regardless of resident involvement. Musculoskeletal disorders (nontraumatic), psychobehavioral disorders, and traumatic disorders categories were overrepresented in resident encounters. Cardiovascular disorders and systemic infectious diseases were underrepresented. When residents were involved with patient care, visits had a higher proportion of RFV codes in the emergent and urgent acuity categories compared to those without a resident. Resident physicians see higher acuity patients with varied patient presentations, but the distribution of encounters differ in content category than those represented by the ITE Blueprint.

Supporting surgical residents learning clinical palliative care: Insights from multi-disciplinary focus groups

BackgroundA shortage of palliative care (PC) sub-specialists highlights the need for quality PC provided by treating surgeons, although no established curriculum exists to teach surgical residents PC skills. To guide curriculum development, we sought to determine what modifiable factors contribute to surgical residents successfully providing PC. MethodsEight focus groups with 34 participants were conducted. Semi-structured interviews were recorded, transcribed, and de-identified. Inductive thematic analysis was utilized to encode, identify, and categorize emergent themes. ResultsBarriers to resident involvement in PC included: Limited Knowledge/Inexperience, Communication Difficulties, Time Constraints, and Burnout. Factors supporting resident involvement included: Patient Relationship/Rapport, Expertise Guiding PC Discussions, and Institutional Support. Communication skills that support successful PC delivery include establishing rapport, managing conflicts, avoiding bias, and acknowledging personal/scientific limitations. DiscussionThis work identifies modifiable factors that support surgical residents providing PC. Faculty and institutional support, resident education on PC principles, and expanding clinical experience with PC may be the most modifiable from a programmatic perspective. Curriculum and process development focused on these areas will help optimize surgical resident's success delivering PC.

Resident and Non-resident Father Involvement, Coparenting, and the Development of Children's Self-Regulation Among Families Facing Economic Hardship.

Self-regulation, or the ability to effectively manage emotions and behavior, is a critical skill to develop in early childhood. Children living in a context of economic hardship are at an increased risk for developing self-regulation difficulties. However, few studies have comprehensively examined how multiple aspects of the caregiving environment, including fathers’ parenting and coparenting quality, may contribute to child self-regulation. Thus, this study applied a family systems perspective to examine whether coparenting and resident and non-resident fathers’ reports of parenting quantity and quality were associated with observations of children’s self-regulation. Participants were drawn from the Embedded Developmental Study (n = 257) of the Three-City Study, a longitudinal study of children and families facing economic hardship. At Wave 1, when children were 2–4 years old, reports of parenting (i.e., quantity and quality) and coparenting (i.e., support) were obtained. At Wave 2, when children were 3–6 years old, children participated in a snack delay and gift wrap task, which assessed their self-regulation. Multi-group path analyses indicated that resident fathers’ harsh parenting at Wave 1 predicted decreased levels of self-regulation at Wave 2. Non-resident fathers’ reported hours of involvement at Wave 1 predicted greater levels of self-regulation at Wave 2. Additionally, supportive coparenting among families with a non-resident father predicted greater self-regulation. Supportive coparenting was not associated with child self-regulation in families with a resident father. The implications for research focused on facilitating positive father–child relationships in diverse family contexts are discussed.

A Systematic Review on the Implementation and Educational Value of Resident Aesthetic Clinics.

Resident aesthetic clinics (RACs) provide plastic surgery residents with hands-on aesthetic surgery training. Although RACs have demonstrated successful surgical outcomes without compromising patient care, few studies have evaluated the efficacy or educational value of RACs to increase resident confidence and competence in procedures. In addition, clinic structures vary widely among institutions, with each clinic offering a unique patient volume, caseload, and degree of resident autonomy that impacts the clinic's educational value. This systematic review identifies existing RAC practices, compares clinic structures, and proposes a curriculum framework to maximize educational value for residents. Following PRISMA guidelines, we performed a systematic review of plastic surgery residency training program RACs. We queried PubMed, Embase, and Web of Science from January 2000 to April 2020. Eligible articles were original articles that discussed RAC structure and educational value. Data abstracted included details on clinic structure (eg, volume, location, cost, clinic operations) and trainee-perceived educational value (eg, resident satisfaction, resident confidence in procedures). Of 1199 identified publications, 10 met the inclusion criteria: 6 single-site studies and 4 national survey studies. Among the single-site studies, annual volumes ranged from 22 to 68 patients/year and 35 to 81 cases/year. Resident aesthetic clinics were all staffed by full-time academic faculty (100%); one-third also were staffed by adjunct faculty and 17% also by community plastic surgeons. Resident involvement varied by hours in clinic and degree of autonomy. The survey studies found that RACs increase resident confidence and competence in performing aesthetic procedures and identified critical challenges to RAC implementation (eg, financial viability, continuity of care) that limited RAC educational value. Based on this review's findings, we propose a 6-step RAC curriculum framework for training programs seeking to establish an RAC and maximize the clinic's educational value. Resident aesthetic clinics are increasingly important for providing plastic surgery residents with aesthetic training. Patient and case volume, degree of resident autonomy, and clinic attending physicians are critical determinants of the educational value of RACs. We hope our findings can aid plastic surgery training programs in better organizing educational and sustainable RACs.

Feasibility of Smartphone Application in Plastic Surgery Operative Assessments.

Background:The evaluation model of operative competence is based on aggregate tabulations of procedures and end-of-rotation feedback from faculty members. Procedural tabulations do not detail the level of resident involvement in the case, and end of rotation feedback is infrequent and inaccurate due to the necessity of long-term recall. Smart phone-based evaluation systems provide residents with immediate and permanent feedback for surgical encounters. In this study, we examine the feasibility of smart phone-based evaluations in plastic surgery residency.Methods:This was a 6-month prospective, single institution pilot study at three teaching hospitals, assessing all PGY levels. We utilized our department mobile application (Wayne State University Surgery Department application), which includes intraoperative evaluations based on the Zwisch scale. Prestudy and poststudy surveys were conducted. An unstructured interview of the Clinical Competency Committee provided feedback for the new evaluation tool against the previous evaluation forms.Results:Eleven physicians participated in the study, resulting in 126 encounters and 184 procedures. A 10-question prestudy survey was given with answers ranging from 1 (strongly disagree) to 5 (strongly agree). The Clinical Competency Committee faculty ranked the prestudy resident assessment tool 2.82 of 5, whereas the poststudy survey scored 4.64 of 5.Conclusions:Residents and faculty both rated the smartphone application as a useful tool for evaluating residents. The success of the application proves its feasibility within plastic surgery residency and may play an important role in rating resident operative competency in the future.

Resident and informal caregiver involvement in medication-related decision-making and the medicines\u2019 pathway in nursing homes: experiences and perceived opportunities of healthcare professionals

BackgroundPerson-centered care has been shown to be beneficial for nursing home residents. The know-how and attitude of healthcare professionals, however, can make its implementation difficult. Also, research on person-centered care with regard to medication decision-making and the medicines’ pathway in nursing homes is lacking. This study aimed to provide an understanding of healthcare professionals’ attitudes and perspectives on current resident and informal caregiver involvement in medication decision-making and the medicines’ pathway in nursing homes.MethodsA qualitative, explorative study using semi-structured interviews with a sample of 25 healthcare professionals from four different nursing homes was performed. Interview transcripts were analyzed by means of an inductive thematic framework.ResultsThree overarching domains were identified: 1) features of, 2) drivers and barriers for, and 3) perceived consequences of resident and informal caregiver involvement in medication decision-making and the medicines’ pathway. Involvement was mainly initiated by residents and informal caregivers themselves, pointing towards information and participation needs among both groups. Nevertheless, actions of healthcare professionals towards resident and informal caregiver involvement were mainly reactive and fragmentary. Their actions were influenced by the perception of residents and informal caregivers’ desire and capabilities to be involved, the perception of their own professional role, but also by organizational factors such as the nursing home’s philosophy. Furthermore, organizational concerns tempered the motivation to provide residents and informal caregivers with more medication-related responsibilities.ConclusionsResident and informal caregiver involvement in medication decision-making and the medicines’ pathway remains limited in nursing homes. Information and participation needs of residents and informal caregivers were not fully acknowledged by healthcare professionals. As such, we can conclude that there is a need for initiatives, both on an individual and on an organizational level, to create and improve awareness on opportunities to improve resident and informal caregiver involvement in medication decision-making and the medicines’ pathway.