Resident Proficiency Research Articles

Strengthening anaesthesia training: The role of wet lab anatomy in resident education

Wet lab anatomy plays a vital role in enhancing the clinical proficiency of anaesthesiology residents by providing a hands-on learning experience that complements theoretical knowledge. Anaesthesiologists rely heavily on an accurate understanding of anatomical relationships for critical procedures such as airway management, regional anaesthesia, and vascular access. Conventional teaching methods often fail to convey the complexity and variability of human anatomy, leaving trainees less confident in applying their knowledge to real-life situations. Wet lab sessions, utilizing cadavers and preserved specimens, allow residents to explore anatomical structures in a realistic and tactile setting, significantly improving their procedural accuracy and understanding. Recent developments, such as the use of virtual reality (VR) and augmented reality (AR) tools alongside traditional cadaveric studies, have made learning more interactive and effective. These tools enable residents to visualize anatomical structures dynamically and practice techniques repeatedly without patient risk. However, challenges such as ethical concerns, limited availability of cadavers, and high costs associated with wet lab facilities limit its widespread use. This review examines the importance of wet lab anatomy in anaesthesia training, discusses modern advancements that enhance its value, and explores strategies for overcoming barriers to its implementation. Through structured application and innovative approaches, wet lab anatomy has the potential to significantly improve the competency and confidence of anaesthesia residents, ultimately leading to better patient outcomes.

Effective Use of Laparoscopic Simulators in Gynecological Training.

This study aims to assess the effectiveness of a haptic-enabled laparoscopic simulator in improving the surgical proficiency of residents across different experience levels. This prospective study was conducted to evaluate the effectiveness of a haptic laparoscopic simulator (LAP Mentor) for gynecological procedures among residents. Participants were divided into three groups based on experience: senior, midlevel, and junior residents, and completed simulations of bilateral tubal ligation and prophylactic oophorectomy, with performance metrics including time taken and instrument movements recorded. While group 1 generally scored higher, no statistically significant differences were found between groups. Major bleeding incidents were rare, occurring once in group 2 during tubal ligation and twice in group 3 during prophylactic oophorectomy. Within-group analysis revealed improvements for group 2, which showed reduced duration (P = .006), left-hand movements (P = .009), and right-hand movements (P = .002) and group 3 also achieved statistically significant decreases in duration (P = .004), left-hand movements (P = .001), and right-hand movements (P = .003), indicating skill development over time. Limited but regular access to advanced simulators-offered two or three times annually-could empower residency programs to meet contemporary surgical training standards without incurring prohibitive costs, ensuring broader access to high-quality skills development.

Radiology resident proficiency in identifying misplaced lines, tubes, and devices: a simulation-based study using WIDI SIM.

Accurate placement of medical devices is crucial in critical care to prevent severe complications. This study aims to evaluate radiology residents' proficiency in identifying four specific critical misplacements of medical devices using the Wisdom in Diagnostic Imaging Simulation (WIDI SIM). A retrospective analysis was conducted on 1,102 responses from radiology residents who participated in the WIDI SIM between 2010 and 2022. The majority were first- and second-year residents from multiple institutions. The simulation presented four specific cases featuring misplacements of an endotracheal tube in the esophagus, an intrauterine device embedded in the myometrium, a peripherally inserted central catheter in the right internal jugular vein, and an umbilical venous catheter in the splenic vein. Residents provided free-text interpretations scored on a 0-10 scale by subspecialty radiologists. Errors were categorized as observational (failure to identify misplacement) or interpretive (misinterpretation of identified misplacement). Statistical analyses were performed using Kruskal-Wallis and Dunn's multiple comparisons tests. Across all cases, residents' average scores did not meet the acceptable standard of 7 points. Observational errors were predominant, indicating a failure to recognize these specific device misplacements. Effective report rates were low: 58% for the endotracheal tube case, 35% for the intrauterine device, 19% for the peripherally inserted central catheter, and 25% for the umbilical venous catheter. Significant performance improvements were observed between first- and second-year residents in three of the four cases (p-values ranging from < 0.0001 to 0.0238), but overall proficiency remained suboptimal even among senior residents. This study reveals gaps in radiology residents' ability to identify these specific misplaced lines, tubes, and devices accurately. The consistent pattern of underperformance, primarily due to observational errors, suggests a need for targeted educational interventions to improve resident proficiency in this aspect of emergency radiology.

Radiology resident proficiency in pediatric trauma cases: a comparative analysis based on trauma center status using the WIDI SIM exam.

To investigate the correlation between pediatric and adult trauma center status and radiology resident performance on pediatric trauma cases using the WIDI SIM exam. The WIDI SIM is a validated computer-aided simulation that assesses radiology residents' preparedness for independent call duty. It includes 65 cases across various imaging modalities derived from actual patient encounters. Faculty score free-text responses using a standardized 0-10 scale rubric. We analyzed 8,488 WIDI SIM exam scores from 35 pediatric trauma cases across 52 programs. A negative binomial regression model adjusting for resident level, imaging modality, and case specialty was employed to evaluate the impact of pediatric and adult trauma center status on resident performance. Both pediatric trauma center status (p = 0.0005) and adult trauma center status (p = 0.0003) were significant predictors of higher resident scores. Resident level was also significant, with higher-level residents performing better than first-year residents (p < 0.001). Residents performed worse on MR and US modalities compared to CT, and performance varied by case specialty. Radiology residents' pediatric trauma imaging skills are significantly linked to pediatric and adult trauma center status. Given most pediatric traumas occur outside pediatric trauma centers, targeted training strategies should be considered to ensure residents develop essential diagnostic skills.

Improving Resident Comfort With Peripartum Cesarean Hysterectomy Through the Use of Low-Fidelity Simulation Models.

Introduction Cesarean hysterectomy is a relatively rarely performed, complex, life-saving procedure considered during post-partum hemorrhage and other obstetric complications. This multi-site study aimed at validating a low-cost, low-fidelity cesarean hysterectomy model to support resident proficiency and increase their confidence in performing this critical procedure. Materials and methods We developed a low-fidelity, anatomically representative model for cesarean hysterectomy simulation purposes. Obstetrics and Gynecology residents at two residency programs were offered a simulation experience using the model, with a performance assessment via two validated assessment tools. The clinical case involved a 38 y/o woman with a delivery complicated by postpartum hemorrhage who failed conservative therapy and required a peripartum hysterectomy. Participants included 26 residents, postgraduate year (PGY)1 through PGY4, at two midwestern university-based obstetrics and gynecology residency programs. Results The median resident scores on the Task Specific Checklist (TSC) and Global Rating Scale (GRS) correlated with increasing PGY levels. The combined TSC+GRS score was a median of 40 out of 49 total for the PGY4 class, while the PGY1 class had a median combined TSC+GRS score of 12 of 49. The PGY2 and -3 classes had TSC+GRS scores of 14 and 28, respectively. The simulation model was well-received with a median 4/5 rating for improving comfort level with cesarean hysterectomy and a median 4/5 rating for model realism. Conclusion This study validated a cost-effective, easily reproducible model that highlights the vital anatomy relevant to a cesarean hysterectomy. The model and simulation offer a way to introduce cesarean hysterectomies to residents while in training, particularly at sites that may not perform a substantial number of these procedures.

The Impact of Simulator Training of Vascular Anastomosis and Video Assessment for Surgical Residents

The Impact of Simulator Training of Vascular Anastomosis and Video Assessment for Surgical Residents

Co-Existing Vascular Surgery Integrated Residencies are Associated with Increased General Surgery Resident Proficiency and Autonomy in Vascular Cases

Co-Existing Vascular Surgery Integrated Residencies are Associated with Increased General Surgery Resident Proficiency and Autonomy in Vascular Cases

Shifting the Curve: Mastery Learning to Teach Nerve Conduction Studies in Physical Medicine and Rehabilitation Residency.

Nerve conduction studies are a commonly performed procedure and a core competency for physical medicine and rehabilitation residents. Nerve conduction studies are complex to learn and no standardized training protocols exist across physical medicine and rehabilitation programs. The aims of this study are to standardize training and assessment of resident proficiency in nerve conduction studies skills and to evaluate the impact of an educational intervention on skills development. This was a repeated measures design wherein 36 physical medicine and rehabilitation residents underwent a pretest, followed by a mastery learning-based intervention, including deliberate practice. Residents were then expected to meet or exceed a minimum passing score at posttest. Performance improved from a median score of 4.5/66 on the pretest to a median score of 63/66 on the posttest. Thirty-three of 36 residents achieved the minimum passing score on the first attempt; three residents required additional deliberate practice and met the minimum passing score on the second attempt. A curriculum featuring deliberate practice dramatically increased checklist scores of residents performing nerve conduction studies. This mastery learning program shows a reliable and reproducible method to achieve procedural competency within a physical medicine and rehabilitation residency program and can shift the curve to allow residents to immediately start performing nerve conduction studies at the start of their clinical experience.

Mastering Sedation and Associated Respiratory Events through Simulation-Based Training: A Randomised Controlled Trial Involving Non-Anaesthesiology Residents.

Non-anaesthetists commonly administer procedural sedation worldwide, posing the risk of respiratory events that can lead to severe complications. This study aimed to evaluate whether simulation-based learning could lead to enhancements in the clinical proficiency of non-anaesthesiology residents in managing sedation and related respiratory complications. Following the evaluation of baseline clinical performance through a pre-test simulation, 34 residents were randomly allocated to either participate in an innovative simulation-based learning module (intervention group) or view a brief self-learning video (control group). After a one-month period, their clinical performance was assessed again in a post-test simulation involving respiratory arrest during procedural sedation. Two independent assessors rated each resident's performance using video recordings and a scoring tool with scores ranging from 0 to 19/19. The two assessments were averaged for each performance, and the pre- to post-test change was calculated for each resident. While baseline clinical performance was similar, mean (SD) increase in clinical performance was significantly greater in the intervention group than in the control group (+2.4 (1.6) points versus +0.8 (1.3) points, respectively; p = 0.002). Our simulation-based learning sedation module resulted in the enhanced management of sedation-related complications compared to baseline and minimal self-learning. Simulation-based medical education may offer an effective approach for equipping non-anaesthesiology residents with essential skills to mitigate risks associated with sedation. (ClinicalTrials.gov identifier: NCT02722226).

Quality Improvement Curriculum for Intensive Care Unit Upgrades.

Patients admitted to the hospital ward from the emergency department (ED) occasionally decompensate and require transfer to the intensive care unit (ICU). An emergency medicine (EM) curriculum focused on review of these ICU upgrade cases could improve resident knowledge related to patient acuity, critical illness, and appropriate disposition. Furthermore, initial identification of critical pathology in the ED and earlier admission to the ICU could reduce delays in care and improve patient outcomes. We performed a retrospective analysis to determine the effectiveness of a resident quality improvement curriculum evaluating cases where patients require transfer from the inpatient floor to the ICU within 12 hours of admission from the ED. We compared postgraduate year 2 (PGY-2) EM residents who participated in the ICU upgrades curriculum during their first year to PGY-2 EM residents who did not participate in the curriculum. Analysis of the 242 qualifying ICU upgrade cases from July 2019-October 2021 showed post-curriculum residents were responsible for an average of 1.0 upgrades per resident compared to an average of 1.54 upgrades per resident (P = 0.12) for pre-curriculum residents. Although there was no statistically significant difference in ICU upgrades between the groups, there was a trend toward decreased ICU upgrade cases for residents who participated in the curriculum. Common reasons for ICU upgrade included worsening respiratory distress requiring higher level of respiratory support, recurrent hypotension after initial intravenous fluid resuscitation requiring vasopressor support, and declining mental status. This retrospective study showed no significant difference in the number of ICU upgrades for residents who completed the ICU upgrades curriculum compared to residents who were not enrolled in the course. However, the study was likely underpowered to detect a significant difference in the groups, and there was a trend toward reduced ICU upgrades for residents who completed the curriculum. ICU upgrade cases were frequently associated with worsening respiratory status, hypotension, and mental status. These findings highlight the importance of reassessment of vital signs and mental status prior to determining disposition from the ED. Additional, larger studies are needed to better determine the curriculum's impact on resident proficiency in recognizing critical illness and reducing ICU upgrades.

Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study

Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study

Confronting new challenges: Faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape

BackgroundOpportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to identify laparoscopic surgeons' perceptions of gaps in current laparoscopic skills in general surgery, obstetrics-gynecology, and urology residency programs. MethodsLaparoscopic surgeons who operate with residents participated in semi-structured interviews. Questions addressed expectations for resident proficiency, deficits in laparoscopic surgical skills, and barriers to learning and teaching. Two authors independently coded de-identified transcripts followed by a conventional content analysis. ResultsFourteen faculty members from thirteen subspecialties participated. Faculty identified three main areas to improve laparoscopic training across specialties: foundational knowledge, technical skills, and cognitive skills. They also recognized an overarching opportunity to address faculty development. ConclusionsThis qualitative study highlighted key deficiencies in laparoscopic training that have emerged in the current, changing era of minimally invasive surgery. Key messageThis qualitative study identified laparoscopic educators' perceptions of deficiencies in laparoscopic training. Findings emphasized the importance of incorporating high quality educational practices to optimize training in the current changing landscape of laparoscopic surgery.

Does language make people more prosocial? The influence of Mandarin proficiency on donation behavior.

Both the effects of language proficiency on individual outcomes, and the influencing factors of individual donation arouse wide concern, but researchers have hardly probed into the relationship between language proficiency and donation behavior. Using the data from the 2012 China General Social Survey (CGSS) and the binary logistic regression model as the benchmark model, this study empirically examines the influence and mechanism of language proficiency on donation behavior. It is revealed that Mandarin proficiency has significant positive influence on individual donation behavior. According to the results of the variable substitution practice and the instrumental variable regression based on the two-stage least square model, the above conclusion remains robust. The heterogeneity test shows that Mandarin proficiency of male, southern and rural residents has more obvious impact on donation behavior. The multiple intermediary effect test indicates that perceived social responsibility and subjective social status partially mediate the relationship between Mandarin proficiency and donation behavior. Therefore, it indicates that language proficiency has a prosocial effect, which makes people more prosocial. This study contributes to the literature on donation behavior by examining the influencing mechanism of Mandarin proficiency on individual donation, and further the effects of language proficiency on individual outcomes, thereby providing theoretical and empirical support for the formulation of policies for the promotion of Mandarin and social donation in China.

Using QI Methodology to Improve a Program’s QI Curriculum: An Educational Improvement Project

Introduction:Quality improvement (QI) as a method of obtaining meaningful change is increasingly valued. A few comprehensive, longitudinal curricula demonstrate efficacy, patient impact, and behavior change over time. This educational improvement study aimed to create a curriculum that increased resident proficiency in practicing QI principles, score on the QI Knowledge Application Tool-Revised, and QI projects completing at least 2 plan-do-study-act (PDSA) cycles in 5 years.Methods:We utilized The Model for Improvement and sequential PDSA cycles, testing curricular components for improvement. Measures were analyzed annually (2014−2020). The curriculum includes modules and didactic workshops for foundational knowledge, rapid personal improvement projects for putting knowledge into practice, and experiential learning through developing and leading QI projects.Results:Graduating residents reporting proficiency in practicing QI principles increased from 4 (44%) to 11 (100%). The average QI Knowledge Application Tool-Revised score increased from 50% to 94% (95% CI, 37–51). Resident QI projects completing at least 2 PDSA cycles increased from 30% (n = 3) to 100% (n = 4), P = 0.0005, while projects achieving improvement increased from 40% (n = 4) to 100% (n = 3), P = 0.002. Patients were also positively impacted, with 63% (n = 3) of clinical QI projects that measured patient-centered outcomes achieving improvement and 69% (n = 11) of clinical QI projects improving clinical processes.Conclusions:This study developed a curriculum that successfully prepares residents to practice QI principles and lead multidisciplinary QI projects while demonstrating patient impact and behavior change. It offers an example of curriculum development and evaluation aided by QI science.

Determinants of satisfaction and self-perceived proficiency of trainees in surgical residency programs at a single institution

BackgroundWe aimed to identify factors contributing to training program satisfaction and self-perceived proficiency of residents in 5 integrated surgical residency programs within the same referral institution.MethodsWe conducted a cross-sectional survey including all senior surgical residents in all integrated sub-specialty and general surgery residency programs at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Training programs were assessed on 6 educational components including operative case volume and diversity, intra-operative hands-on training, morning teaching sessions, seminars, ward rounds, and research opportunities.ResultsOf 82 eligible residents, 69 (84.1%) responded to the survey. Overall resident satisfaction (rated from 0–10) varied between the 5 training programs, from a mean of 6.03 to 7.89 (overall p = 0.03). The percentage of residents who agreed they would be proficient by the end of their training ranged from 44.2%-88.9%. General surgery residents had the lowest overall satisfaction score, and lowest scores in all educational components except seminar teaching. In multivariable analysis, operative case volume and diversity (AOR 3.67; 95% CI, 1.24–10.83; P = 0.019), and hands-on training (AOR 4.15; 95% CI, 1.27–13.5; P = 0.018) were significantly associated with overall resident satisfaction. In ordinal logistic regression, hands-on training (OR 3.94, 95% CI, 1.69–9.2; P = 0.001), and seminar sessions (OR 2.43, 95% CI, 1.11–5.33; P = 0.028) were significantly associated with self-perceived proficiency.ConclusionDifferent surgical residency training programs within the same institution had divergent resident satisfaction scores and proficiency scores. Operative case volume and diversity, and intraoperative hands-on training are the most important predictors of resident satisfaction while hands-on training and seminar sessions independently predicted self-perceived proficiency. Attention to these key components of resident education is likely to have a strong effect on training outcomes.

Deliberate practice-based surgical curriculum leads to enhanced technical proficiency among dermatology residents.

Deliberate practice-based medical education has demonstrated superiority in trainee acquisition and maintenance of skills in several surgical subspecialties. In an effort to highlight the impact of a deliberate practice-based surgical curriculum on the technical proficiency of dermatology residents, a prospective cohort study including first- and second-year dermatology residents was performed. A total of 87.5% (7 of 8) first-year dermatology residents completed three hands-on simulations at 6-week intervals. Additionally, six of eight (75.0%) second-year dermatology residents at the same institution were evaluated at a single point-in-time session without accessing the surgical curriculum prior. A 5-point global rating scale (GRS) was used to assess resident performance on six core surgical techniques. Nonparametric ANOVA statistical methods using the Kruskal-Wallis test was performed. The residents' overall GRS increased from a median of 1-2.75 after completion of the curriculum (p < 0.01). There was a significant improvement in the median scores of each tested surgical technique. The first-year residents had a greater overall GRS after completion of the curriculum compared to the second-year residents (median of 2.13 versus 1.88, p < 0.001). Limitations include the small sample size and lack of a synchronized control group. Our study highlights the use of deliberate practice-based strategies as an effective modality in teaching surgical skills to dermatology residents.

How We Do It: Remediation Pathways in a Surgical Simulation Curriculum for Competency Improvement.

Validated assessment of procedural knowledge and skills with formative remediation is a foundational part of achieving surgical competency. High-fidelity simulation programs provide a unique area to assess resident proficiency and independence, as well as to assist in identifying residents in need of further practice. While several studies have validated the use of simulation to attain proficiency of specific technical skills, few have validated remediation pathways for their trainees objectively. In this descriptive analysis, we review 2 remediation pathways within our simulation training curricula and how these are used in assessments of resident proficiency. Two methods of remediation were formulated for use in high-fidelity simulation labs. One remediation pathway was a summative process, where ultimate judgment of resident competency was assessed through intra-operative assessments of a holistic skill set. The second remediation pathway was a formative "coaching" process, where feedback is given at several intervals along the pathway towards a specific technical skills competence. All general surgery residents are enrolled in the longitudinal, simulation curricula. Approximately one-third of surgical residents entered into a remediation pathway for either of the high-fidelity simulation curricula. Both residents and faculty expressed support for the summative and formative remediation pathways as constructed. Residents who entered remediation pathways believed it was a beneficial exercise, and the most common feedback was that remediation principles should be expanded to all residents. Interestingly, faculty demonstrated stronger support for the formative coaching feedback model than the summative assessment model. Through the complementary use of both formative and summative remediation pathways, resident competence can be enriched in a constructive, nonpunitive method for self-directed performance improvement. Both trainees and faculty express high satisfaction with programs explicitly organized to ensure that skills are rated through a standardized process.

Safety in training for ultrasound guided internal jugular vein CVC placement: a propensity score analysis

BackgroundCentral venous catheter (CVC) placement is a routine procedure but is potentially associated with severe complications. Relatively small studies investigated if the use of ultrasound is effective in bridging the skill gap between proficient and not proficient operators, while patient safety during training remains a controversial topic. The first aim of this study was to evaluate if resident proficiency affects the failure rate in CVC positioning under ultrasound guidance. In addition, it aimed to investigate the different rate of complications between proficient and non proficient residents.MethodsWe conducted a cohort study including CVC placed by residents at the University Hospital of Padova, from November 1, 2012 to July 9, 2020 comparing proficient and non proficient residents. To avoid bias the two cohorts were matched using propensity score.ResultsA total of 356 residents positioned 2310 CVC during the 8 year study period. Among them, two groups of 1060 CVCs each were matched with a propensity score analysis. There was no difference in the failure rate among the groups (2.8 vs 2.7%, p-value 0.895).Moreover, cohorts had the same rate of hematomas, catheter tip malposition, arterial puncture and pneumothorax. No cases of hemothorax were reported.ConclusionsWe found the same rate of success and incidence of adverse complications among cohorts, meaning that the process of skill acquisition is safe as long as appropriate training and direct supervision by a senior consultant are available.

Downward Trend in Resident Myringotomy and Tympanostomy Tube Experience.

Historically, myringotomy, and the insertion of tympanostomy tubes has served as one of the initial surgical training experiences for residents. Resident experience with this procedure since the introduction of pneumococcal conjugate vaccines has not been well described in the literature. The objective of this study was to identify trends in resident training experience with chronic otitis media-related surgeries, such as myringotomy and tympanostomy tube placement. While multiple factors influence resident experience, we hypothesize that resident experience has decreased since the introduction of the pneumococcal 13-valent conjugate vaccine (PCV13). In a retrospective review of Accreditation Council for Graduate Medical Education (ACGME) National Data Reports, mean number of myringotomy and tympanostomy tube cases logged in the Resident Case Log System from 2006 to 2019 were collated and plotted against years to identify monotonic trends. Mann-Whitney U test was used to compare pre-PCV13 era and post-PCV13 era data. Since the introduction of PCV13, there is a national decreasing trend in the myringotomy and tympanostomy tube placement by otolaryngology residents (P = .001). Otologic surgeries are an important part of resident education and historically have served as one of the initial surgical training experiences for residents. There has been a significant reduction in the number of myringotomy and tympanostomy procedures performed by otolaryngology residents in the past decade. While multiple factors influence resident experience, it is possible that introduction of PCV13 has impacted resident exposure to myringotomy and tympanostomy tube placement. Resident proficiency with this procedure has likely not been affected by introduction of PCV13. Data should be reassessed in 5 years to determine if an impact of the PCV13 vaccine on resident training is evident.

Structured Training for Laparoscopic Appendectomy for Residents (STAR Trial)–A Randomized Pilot Study

Structured Training for Laparoscopic Appendectomy for Residents (STAR Trial)–A Randomized Pilot Study