Resident Skills Research Articles

A structured curriculum for the acquisition of basic surgical endoscopic skills for surgical residents and quantification of skills improvement

IntroductionNew strategies and methods are needed to ensure that new generations can train and acquire surgical skills in a safe environment. Materials and methodsFrom January 2020 to October 2020, we performed a single centre, prospective observational cohort study. 19 participants (15 students, 4 residents) enrolled and 16 participants (13 students, 3 residents) successfully completed the curriculum. We performed a quantitative data analysis to evaluate its effectiveness in gaining and improving basic surgical endoscopic skills. ResultsThe time for single knot tying pre-, mid-, and post-training was reduced significantly, the average time (sec) decreased by 79.5 % (p < 0.001), the total linear distance (cm) by 74.5 % (p < 0.001) and the total angular distance (rad) by 71.7 % (p < 0.001). The average acceleration (mm/s2) increased by 20 % (p = 0.041). Additionally, the average speed increased by 23.5 % (p < 0.001), while motion smoothness (m/s3) increased by 20.4 % (p = 0.02). ConclusionThe obtained performance scores showed a significant increase in participants improving their basic surgical performance skills on the endoscopic simulator. This curriculum can be easily implemented in any surgical specialty as part of the residency training curriculum before first exposure in the operation room. All 16 participants recommended the implementation of such simulator training in their surgical training curriculum.

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

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

Simulation-guided auscultatory training before graduation is associated with better auscultatory skills in residents.

A growing body of scientific evidence shows that simulation-guided auscultatory training can significantly improve the skills of medical students. Nevertheless, it remains to be elucidated if this training has any long-term impact on auscultatory skills. We sought to ascertain whether there were differences in heart and lung auscultation among residents who received simulation-guided auscultatory training before graduation vs. those who did not. A total of 43 residents were included in the study; 20 of them entered into Cardiology specialty school (C) and 23 of them entered into Internal and Occupational Medicine specialty schools (M) at the University of Trieste. Based on the history of simulation-guided auscultatory training before graduation (yes = Y; no = N), four groups were formed: CY, CN, MY, and MN. Residents were evaluated in terms of their ability to recognize six heart and five lung sounds, which were reproduced in a random order with the Kyoto-Kagaku patient simulator. Associations between history of simulation training, specialty choice and auscultatory skills were evaluated with Kruskal-Wallis test and logistic regression analysis. Auscultatory skills of residents were associated with simulation-guided training before graduation, regardless of the specialty chosen. Simulation-guided training had a higher impact on residents in Medicine. Overall, heart and lung sounds were correctly recognized in 41% of cases. Logistic regression analysis showed that simulation-guided training was associated with recognition of aortic stenosis, S2 wide split, fine crackles, and pleural rubs. Specialty choice was associated with recognition of aortic stenosis as well as aortic and mitral regurgitation. History of simulation-guided auscultatory training was associated with better auscultatory performance in residents, regardless of the medical specialty chosen. Choice of Cardiology was associated with better scores in aortic stenosis as well as aortic and mitral regurgitation. Nevertheless, overall auscultatory proficiency was quite poor, which suggests that simulation-guided training may help but is probably still too short.

Procedure-Focused Escape Room: A Pilot Study on Teaching High-Stakes Technical Skills in Anesthesia Residents

Procedure-Focused Escape Room: A Pilot Study on Teaching High-Stakes Technical Skills in Anesthesia Residents

The Impact and Opportunities of Digital Economy on Rural Revitalization

This study explores how the digital economy influences and provides opportunities for the rejuvenation of rural areas. Positioned as a crucial element in the contemporary global economy, the digital economy opens up fresh possibilities for the growth and revitalization of rural regions. The research reveals that the extensive application of digital technologies has transformed the operational methods in various sectors of rural economies, education, healthcare, finance, and agriculture. Digital technologies, such as rural e-commerce and smart agriculture, have provided rural residents with new economic opportunities, fostering economic growth and the sale of agricultural products. Remote education and digital skills training contribute to elevating the knowledge and skills of rural residents, thereby increasing employment prospects. Digital financial services enhance financial inclusivity in rural areas, aiding rural residents in better financial management. Furthermore, the development of digital healthcare services improves rural healthcare by providing opportunities for remote medical consultations and diagnoses. The digital economy's influence contributes to the enhancement of living standards among rural residents, fosters the development of rural infrastructure, and improves governance within rural communities. Digital technologies also contribute to enhancing the environmental sustainability of rural regions, reducing resource wastage and environmental pollution. These opportunities provide new impetus for rural revitalization and are expected to assist rural areas in achieving their sustainable development objectives. However, the digital economy also presents challenges, including the digital divide, privacy and security issues, barriers to technology adoption, knowledge and skill disparities, as well as social, cultural, navigating through these challenges demands thorough policies and strategies, aiming to optimize the digital economy's potential while guaranteeing that rural residents fully capitalize on the opportunities it offers. To sum up, the digital economy provides extensive possibilities for rejuvenating rural areas, enhancing living standards, fostering economic growth, and fostering sustainable development in rural communities. However, fully realizing these opportunities necessitates overcoming a series of challenges, devising appropriate policies, and enhancing the adoption and application of digital technologies. This will aid in attaining the objectives of rural rejuvenation and advancing sustainable development in rural areas.

OSABSS: An authentic examination for assessing basic surgical skills in surgical residents

ObjectivesThis study aimed to develop and validate the OSABSS (Objective Structured Assessment of Basic Surgical Skills), a modified Objective Structured Clinical Examination (OSCE), to assess basic surgical skills in residents. DesignA developmental study conducted in two phases. Basic skills were identified through literature review and gap analysis. The OSABSS was then designed as a modified OSCE. SettingThis study took place at Alborz University of Medical Sciences in Iran. InterventionsThe OSABSS was created using Harden's OSCE (Objective Structured Clinical Examination) methodology. Scenarios, checklists, and station configurations were developed through expert panels. The exam was piloted and implemented with residents as participants and faculty as evaluators. Participants32 surgical residents in gynecology, general surgery, orthopedics, and neurosurgery participated. 22 faculty members were evaluators. Primary and secondary outcome measuresThe primary outcome was OSABSS exam scores. Secondary outcomes were written exam scores, and national residency entrance ranks. Main resultsThe mean OSABSS score was 16.59 ± 0.19 across all stations. Criterion validity was demonstrated through correlations between OSABSS scores, written scores and entrance ranks. Reliability was high, with a Cronbach's alpha of 0.87. No significant inter-rater score differences were found. ConclusionsThe rigorous OSABSS development process produced an exam demonstrating strong validity and reliability for assessing basic surgical skills. The comprehensive station variety evaluates diverse technical and non-technical competencies. Further research should expand participant samples across surgical disciplines.

Applying a Competency-Based Medical Education Framework to Development of Residents' Feedback Skills.

Feedback is a critically important tool in medical education. This pilot program applies and evaluates a competency-based approach to develop residents' skills in providing feedback to medical students. In 2018-2019, a competency-based resident feedback skills program incorporating videorecording of skills, multi-source feedback using assessment tools with validity evidence, and sequential deliberate practice was piloted in a single-center, prospective study at the University of Rochester. Study participants included eight second-year psychiatry residents and 23 third-year clerkship students. After an introduction to foundational feedback concepts in didactic sessions, residents were videorecorded providing feedback to medical students. Recordings were reviewed with a faculty member for feedback. Skills were assessed by students who had received resident feedback, residents, and faculty utilizing a tool with validity evidence. Observations were repeated a total of three times. Mean feedback scores increased from 2.70 at the first feedback observation, to 2.77 at the second feedback observation, to 2.89 at the third feedback observation (maximum 3.00 points). The differences between the first and third sessions (0.19) and second and third sessions (0.12) were statistically significant (p values were < .001 and .007, with SE of 0.4 and 0.4, respectively). The observed competency-based feedback skills training program for residents using sequential, multi-source review and feedback was feasible and effective. Direct observation is a key component of high-quality feedback, and videorecording is an efficient methodology for observations, enabling both direct observation by the assessor and opportunity for enhanced self-assessment by residents viewing themselves in the feedback encounter.

Scientific Communication Initiative at a Medical Military Library

Implementation of new scholarly communication library service in the digital age is characterized by the competitive forces between the old library information services and the ambiguity of future information services. This research analyzes the development process of scientific initiative and collaborative partnership in the military medical library environment aimed to enhance the quality of scientific communication and information skills in military residents and clinicians. The hindering internal and external forces and facilitators of developing and implementing scientific initiative service in the military medical library are evaluated. The environmental analysis was conducted to determine the scholarly communication needs in the scholarly military medical environment. The ambassador-based model was used for the development of scientific communication initiative (SCI) at the military medical library. The SCI consisted of two components: library information communication and scientific communication. This implementation in the military medical environment enhanced scholarly communication, research skills development, and information education. A collaborative Scientific Hub, and liaison partnerships with military graduate medical education program directors and clinicians enhanced the scientific communication and information skills in residents. The Ambassador model, used in the development of scientific initiative in academic and military environments, was valuable for developing and implementing specialized interdisciplinary and multidisciplinary information services in the academic and military environment. Higher education hierarchy, educational needs, organizational hierarchy, academic culture, and educational environment influence the implementation of information services in academic and military environments.

Evaluation of the one-minute preceptor as a teaching method for family medicine residents

Background and objective: Health professionals struggle to appropriately train resident doctors in overcrowded medical centers. The one-minute preceptor teaching approach is an effective teaching model that provides a solution to the problem. This study aims to determine the effectiveness of a one-minute preceptor in improving the clinical teaching skills of supervisors and the critical thinking skills of residents and to assess the residents' and supervisors’ attitudes toward a one-minute preceptor. Methods: From October 1, 2021, to February 28, 2022, a cross-sectional study was conducted in the Family Medicine department at Hawler Medical University, in Erbil, Iraq. Eight family medicine supervisors and 30 resident doctors at the specialized Family Medicine Health Center were involved in the study. Pre-and-post assessment questions were administered to the supervisors before and after one-minute preceptor training to assess their knowledge. Kirkpatrick's evaluation model was used to evaluate supervisors’ knowledge and application of skills after training, and to assess whether intended outcomes occurred with the residents. Results: All supervisors agreed that this approach to teaching should be incorporated into medical education (50% agreed and 50% strongly agreed) and improved their teaching skills (75% agreed, 25% strongly agreed). More than half of the residents agreed that this new teaching method should be incorporated into medical education. (50% agreed and 10% strongly agreed) Conclusion: The one-minute preceptor teaching model intends to provide doctors with an effective framework to improve their instructional effectiveness.

Virtual patients versus standardized patients for improving clinical reasoning skills in ophthalmology residents. A randomized controlled trial

BackgroundHistory taking and clinical reasoning are important skills that require knowledge, cognition and meta-cognition. It is important that a trainee must experience multiple encounters with different patients to practice these skills. However, patient safety is also important, and trainees are not allowed to handle critically ill patients. To address this issue, a randomized controlled trial was conducted to determine the effectiveness of using Virtual Patients (VP) versus Standardized Patients (SP) in acquiring clinical reasoning skills in ophthalmology postgraduate residents.MethodsPostgraduate residents from two hospitals in Lahore, Pakistan, were randomized to either the VP group or the SP group and were exposed to clinical reasoning exercise via the VP or SP for 30 min after the pretest. This was followed by a posttest. One month after this activity, a follow-up posttest was conducted. The data were collected and analysed using IBM-SPSS version 25. Repeated measures ANOVA was used to track the effect of learning skills over time.ResultsThe mean age of the residents was 28.5 ± 3 years. The male to female ratio was 1:1.1. For the SP group, the mean scores were 12.6 ± 3.08, 16.39 ± 3.01 and 15.39 ± 2.95, and for the VP group, the mean scores were 12.7 ± 3.84, 16.30 ± 3.19 and 15.65 ± 3.18 for the pretest, posttest and follow-up posttest, respectively (p value < 0.00). However, the difference between the VP and SP groups was not statistically significant (p = 0.896). Moreover, there was no statistically significant difference between the VP and SP groups regarding the retention of clinical reasoning ability. In terms of learning gain, compared with the VP group, the SP group had a score of 51.46% immediately after clinical reasoning exercise as compared to VP group, in which it was 49.1%. After one month, it was 38.01 in SP and 40.12% in VP group.ConclusionVPs can be used for learning clinical reasoning skills in postgraduate ophthalmology residents in a safe environment. These devices can be used repeatedly without any risk to the real patient. Although similarly useful, SP is limited by its nonavailability for repeated exercises.

Empowerment of coffee farmers in Gunung Manik Village through intercropping of honey bee (apis mellifera)

The potential for utilizing the natural resources of Gunung Manik Village remains largely untapped. Abundant natural commodities such as coffee, cloves, cardamom, and others are available. Utilizing land through intercropping in coffee plantations provides dual benefits for farmers, including beekeeping of Apis Mellifera species. The goal of community empowerment is to develop the natural potential through honey cultivation found in the forests of Gunung Manik Village. The method used involves workshops for training in beekeeping management, honey harvesting, and the transfer of Apis Mellifera forest bee colonies into honey bee cultivation boxes in coffee plantations. The outcome of this activity is an increase in the understanding and skills of residents in harvesting forest honey and transferring bee colonies into cultivation boxes.

Readiness For Household Scale Waste Composting: Waste-Knowledge Management

The Surakarta City Government faces many obstacles in implementing the waste management system, especially household waste. These problems include waste management sites that are no longer able to accommodate waste (overload), low public awareness of clean and healthy living behavior (PHBS), weak sanitation management institutions and human resource capabilities. This research was conducted to determine the basic knowledge of the Surakarta City community regarding household waste management so that it can become a benchmark for waste handling in the future. The method used is descriptive and analytical and the respondents are 100 residents from five districts in Surakarta City. Data was collected through interviews with a questionnaire guide, observation, and recording, followed by analysis using descriptive statistics. The readiness level of 59.8% indicates that the people in Surakarta are ready to adapt to the conditions needed to achieve Knowledge Management readiness in household-scale composting. Counseling to improve waste processing skills for Surakarta residents can be carried out as an option to reduce waste from the main source of waste engagement.

PORTE FOLIO DES COMPETENCES PRATIQUES DU RESIDENT EN CHIRURGIE PLASTIQUE AU MAROC

In Morocco, plastic surgery is a comprehensive specialty that encompasses various domains. The training is lengthy and rigorous, involving residents in a extensive curriculum with both theoretical education and practical hospital training. The study aims to assess residents skills, define mastered procedures, and collect feedback to enhance the quality of education.A secondary objective is to create a portfolio using digital support: https://sites.google.com/view/comptencespratiqueduresident/accueil. To enable residents to track their progress and make informed decisions about their career in plastic surgery. We hope this educational tool will find its rightful place in the training of plastic surgery residents.

Strategies for CO2 Laser Use in Laryngeal Microsurgery: A Systematic Review.

We aim to systematically review the literature addressing perioperative practices for optimal use of the CO2 laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety. A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO2 laser in laryngeal TOLMS was conducted. Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software. Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO2 laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO2 TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up). The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.

Analisis Potensi Sumber Daya Manusia Dalam Bisnis Akomodasi Pondok Wisata Di Desa Wisata Besani

This research analyzes the potential of human resources in the accommodation business of pondok wisata or homestays in Besani Tourism Village, Blado District, Batang Regency, Central Java. Cottage tourism is a form of accommodation that offers more intimate lodging close to local communities, providing a different and satisfying experience for travelers seeking authenticity and togetherness in their journeys. The village stands out due to its concept of Javanese-Chinese cultural acculturation and attractive natural tourism potential. Through qualitative approaches and case studies, involving stakeholders as respondents, and utilizing primary data from interviews and observations, as well as secondary data from scientific literature and official documents. The SOAR approach is used to identify internal strengths, external opportunities, aspirations, and desired outcomes in accommodation business development. The analysis highlights the traditional skills of residents, significant tourism demand, and support from local government and companies. Human resource development strategies are recommended, including business management skills training, group-based cottage tourism development, service standard enhancement, income diversification, and local cultural promotion. This study provides insights into the potential of human resources to enhance competitiveness and sustainability in the tourism sector in Besani Tourism Village.

Peningkatan Pengetahuan dan Keterampilan Warga Desa Babakan melalui Pelatihan Pembuatan Cookies Spirulina

Cookies are dry cakes made with flour as the primary baking ingredient. Spirulina platensis was rich in protein, amino acids, glycoproteins, essential fatty acids, polysaccharides, and beta-carotene. Therefore, using sago flour combined with spirulina and seaweed in cookies can increase the nutritional value and produce gluten-free cakes. This training aims to increase knowledge about spirulina, packaging, and product marketing strategies and the skills of Babakan village residents by providing training on making spirulina cookies. This community service activity was conducted by counseling and training on making spirulina cookies in Babakan Village, Dramaga. Counseling activities were carried out to increase knowledge about the potential of spirulina, good packaging, and product marketing strategies, as well as training on making spirulina cookies to improve the skills of Babakan village residents. There were 18 training participants: Family Welfare Empowerment administrators and members. Pre-tests and post-tests were carried out before and after the training activities regarding the topic provided by the speakers. The achievements of the training activities were seen from an increase in post-test results, which was 60% answered correctly compared to only 40% for the pre-test. The evaluation results of the participant's acceptance of training topics and training speakers had an average of 58 to 69%, respectively, perfect. While the participants's assessment of the training facilities and consumption had an average of 50%, they were good.

Measures of Clinical Performance and Communication Skills of EM Residents on Simulated Resuscitations are not Correlated

Measures of Clinical Performance and Communication Skills of EM Residents on Simulated Resuscitations are not Correlated

Integrating education for clinical practice change.

Children with chronic medical conditions and their families have significant emotional health concerns, yet paediatricians are often ill-equipped to address these needs. The American Board of Pediatrics launched the Roadmap Project to better support emotional health as part of routine care. We present pilot work in paediatric training programmes to test educational approaches and explore lessons learned. Four institutions implemented Roadmap tools into their paediatric training programmes, either incorporating them into existing educational structures or embedding them into the clinical workplace. One programme utilised an existing longitudinal curriculum, and another incorporated into a block rotation. Two programmes embedded training for residents into a larger programme for the healthcare team within the clinical space, one in outpatient clinics and one in an inpatient service. Evaluation strategies at each site matched the intended outcomes. Sites working within education programmes evaluated learners, demonstrating increases in resident skills and confidence on pre-/post-self-assessments. Sites embedding tools into the practice context measured changes in the clinical practice of the healthcare team. Despite variability in implementation, all approaches improved trainee skills; sites embedding education into a clinical setting saw greater changes in clinical practice. Our pilot provided structure yet allowed for flexibility, and all sites improved trainee skills. Engaging the entire healthcare team within practice settings appears advantageous, thus embedding education into clinical practice may be preferable to a separate education programme. Similar to outcomes found in interprofessional education (IPE), educating clinical teams together may be more impactful for cultural shifts needed for changing clinical practice.

Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills

BackgroundProximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study’s objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients.Materials and methodsTwenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated.ResultsIntraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention.ConclusionsFewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims.Level of evidenceLevel I, prospective randomized case–control study.

Improved tracheostomy-dependent patient outcomes after implementation of the Pediatric Resident Education in Pulmonary (PREP) Boot Camp.

Children with tracheostomies are high risk for morbidity and mortality. Pediatric resident physicians are not routinely taught skills to care for this vulnerable patient population. Few reports link educational interventions to improved patient outcomes. This study evaluates the impact of an intensive educational training program on pediatric residents' observed skills and tracheostomy-dependent patient outcomes. Pediatric post-graduate year 2 (PGY2) resident physicians rotating through the inpatient pediatric pulmonology month at Children's Hospital Colorado July 2018-2019 participated in the Pediatric Resident Education in Pulmonary (PREP) Boot Camp, an intensive educational program with an interactive lecture and simulation experience on patients with tracheostomy-dependence. PGY2s who partook in PREP and PGY3s who rotated before PREP initiation were invited to be studied. Primary outcomes included: (1) resident skills assessed by direct observation during simulation encounters and (2) rates of intensive care unit (ICU) transfers in tracheostomy-dependent patients following acute events before and after introduction of PREP. We hypothesized that increased education would enhance resident skills and improve patient outcomes by decreasing the rate of ICU transfers. PGY2 residents retained skills learned during PREP up to 11 months following initial participation, and significantly outperformed their PGY3 counterparts. There was a significant decrease in ICU transfer rate in patients with tracheostomies admitted to the pulmonary team during the 19 months following initiation of PREP. Enhanced early education may improve resident physicians' ability to care for complex patients with tracheostomies and could improve outcomes in this high-risk population.