Training General Surgery Residents Research Articles

Gamification of robotic simulation to train general surgery residents.

Gamification applies game design elements to non-game contexts in order to engage participation and increase learner motivation. Robotic surgery is gaining popularity in general surgery but requires specialized technical skills. We sought to determine whether gamification of robotic simulation training could increase robotic simulator utilization among general surgery residents. General surgery residents were recruited and sent weekly progress on simulator performance including leaderboards for 4weeksduring the intervention periods. There were also two control periods setup in an ABAB study design. Usage time and mean scores were compared between the control periods and intervention periods. A post-study qualitative assessment interview using semi-structured interviews determined barriers and motivational components of simulator usage. Fifteen general surgery residents enrolled in the study (n = 15). Intervention increased total simulator usage time 9.7-fold from 153 to 1485min. Total simulator days increased threefold from 9 to 27days. Resident participation increased from 33 to 53%. Median average scores were higher during the intervention periods (58.8 and 81.9 vs 44.0). During the first intervention period, median individual-level simulator usage time increased 17min (P = 0.03). However, there was no individual-level increase in median usage minutes or days during the second intervention period. Qualitative assessment determined barriers to be limited time due to clinical duties, and simulator availability while motivational factors included competitive factors such as leaderboards and gaming aspects. Potential improvements were increasing attending visibility of scores to increase recognition of progress by the residents and creating dedicated time for training. Gamification of robotic simulation training increased general surgery resident participation, usage time and scores. Impact was not durable. Instituting dedicated practice time and more attending engagement may increase trainee motivation and performance.

An Innovative Simulation Curriculum to Train General Surgery Residents and Medical Students on Four Commonly Encountered Obstetric and Gynecologic Procedures.

Lack of obstetric and gynecologic (OBGYN) procedure exposure during general surgery residency was recognized as a training gap for military general surgery residents by U.S. Navy trauma and general surgeons serving as simulation leads for the Naval Medical Center Portsmouth general surgery resident program. Program faculty requested the authors develop and implement a recurring simulation curriculum to address this training gap. The primary goal of the simulation curriculum was to increase exposure to and confidence in performing four commonly encountered OBGYN procedures in a deployed setting: spontaneous vaginal delivery (SVD), Bartholin's cyst incision and drainage with Word catheter placement, cesarean delivery, and total abdominal hysterectomy (TAH). We hypothesized that trainees exposed to the new simulation curriculum would demonstrate an increase in knowledge and confidence in these four commonly encountered OBGYN procedures. The study utilized a pre- and postdesign to determine the efficacy of a newly developed simulation curriculum as measured by participants' knowledge and confidence levels. The annual curriculum was 4 hours in duration and included a targeted lecture followed by the administration of the four OBGYN simulation skills stations: SVD, Bartholin's, cesarean delivery, and total abdominal hysterectomy. Proctors for the simulation stations consisted of OBGYN teaching faculty who had at least 5 years of clinical teaching experience and were experienced simulation instructors. Precourse and postcourse knowledge and confidence were self-rated on a 5-point Likert scale. The learners rated the course using the Simulation Design Scale. Likert scale data were analyzed using the paired Wilcoxon rank sum test. Descriptive statistics were reported for the Simulation Design Scale. P < 0.05 was considered to be statistically significant. This project was classified as nonhuman subjects' research by the Naval Medical Center Portsmouth Institutional Review Board. Over the 2 years since curriculum implementation, 34 trainees participated in the curriculum; no trainees have had the curriculum twice. All trainees confirmed training gaps on baseline self-assessment of knowledge and confidence of all four OBGYN procedures with the most confidence reported for SVD (2.83 mean). Self-rated knowledge and confidence levels improved significantly in all four of the simulated procedures for all 34 participants (P < 0.001). Postcurricular surveys (82% response rate, 28/34) indicated a high satisfaction with all areas of the simulation training (4.74/5.0). The implemented curriculum increased general surgery trainees' knowledge and confidence in four commonly encountered OBGYN procedures and demonstrated a high level of learner satisfaction and sustainability. The curriculum exhibits high educational impact and could be a valuable adjunctive training for other non-OBGYN physicians who may need to provide OBGYN care in military environments.

A survey of robotic surgery training curricula in general surgery residency programs: How close are we to a standardized curriculum?

BackgroundRobotic surgery is increasingly adopted into surgical practice, but it remains unclear what level of robotic training general surgery residents receive. The purpose of our study was to assess the variation in robotic surgery training amongst general surgery residency programs in the United States. MethodsA web-based survey was sent to 277 general surgery residency programs to determine characteristics of resident experience and training in robotic surgery. ResultsA total of 114 (41%) programs responded. 92% (n = 105) have residents participating in robotic surgeries; 68%(n = 71) of which have a robotics curriculum, 44%(n = 46) track residents’ robotic experience, and 55%(n = 58) offer formal recognition of training completion. Responses from university-affiliated (n = 83) and independent (n = 31) programs were not significantly different. ConclusionsMany general surgery residencies offer robotic surgery experience, but vary widely in requisite components, formal credentialing, and case tracking. There is a need to adopt a standardized training curriculum and document resident competency.

Challenges of Training General Surgery Residents to Do Urology in the Developing World

The purpose this manuscript is to describe the work of one program in Kenya, East Africa, to train general surgery residents in urology to make available the much needed service to the underserved rural population. People in developing countries continue to face the challenge of accessing surgical care with a ratio of 1 surgeon to 20,000 people. This is due, in part, to the inadequate number of trained surgeons. The availability of specialized surgical care such as urology is even more unlikely due to fewer numbers of specialists in urology. Such disciplines take many years of training before a person qualifies as a specialist. This requires highly motivated and suitable candidates who are willing to spend time in training and acquiring skills as well as proper infrastructure for training. There is an effort to train general surgical residents in enhanced skills to make available urology services to the wider population. This involves equipping them with skills in general urology, basic skills in handling endoscopic equipment, and basic endo-urology procedures such as diagnostic cystoscopy with or without biopsy and direct vision urethrotomy (DVU). The residents are also exposed to visiting faculty through international collaborations, surgical camps, and workshops to enhance their skills and knowledge. Equipping general surgical residents with urology skills will greatly reduce the shortage of these services to the people of developing countries.

Robotic Training in General Surgery Residency: How Early Can We Begin?

Background: The increasing demand for robotics in general surgery has prompted academic institutions to train general surgery residents toward the acquisition of basic robotic skills. Our current robotic training curriculum begins in the PGY-3 year and is based on the use of surgical simulators in a risk-free environment, in which each resident must show proficiency prior to advancing to training on an animate model as PGY-4. Our unpublished data on the curriculum indicates that PGY-3s required additional remediation training on the robotic simulator, suggesting room for improvement in our teaching paradigm [8]. Because of resident duty hour restrictions, we could not provide remediation by simply increasing the number of training sessions.

Perceptions of Program Directors on the Necessity of Hepatopancreaticobiliary Fellowships in Training General Surgery Residents

Perceptions of Program Directors on the Necessity of Hepatopancreaticobiliary Fellowships in Training General Surgery Residents

A Unique Hybrid Simulation Used to Train General Surgery Residents in the Cognitive and Procedural Aspects of Emergency Department Thoracotomy

A Unique Hybrid Simulation Used to Train General Surgery Residents in the Cognitive and Procedural Aspects of Emergency Department Thoracotomy

Why fundamentals of endoscopic surgery (FES)?

As flexible endoscopy has moved into the mainstream, gastroenterologists have embraced many of the skills and techniques particular to this modality of diagnosis and intervention. Their adoption of flexible endoscopic technology and training, and the lack of enthusiasm for endoscopic therapy potentials by surgeons, has left many surgical residents and practicing surgeons deficient in endoscopic skills. As a result, education of surgical residents in flexible endoscopy has lagged and training of surgical residents in flexible endoscopy is increasingly coming under scrutiny and has become an area of debate. The medical literature and practice guidelines are replete with articles from surgeons and gastroenterologists debating the appropriate education and training in flexible endoscopy. Both surgical and gastroenterology professional societies have published guidelines for training in flexible endoscopy. These guidelines are often at odds with each other, citing opposing literature supporting their position on appropriate criteria for training in basic upper and lower endoscopy [1–4]. Flexible endoscopy is a critical element of any general surgeon’s and colorectal surgeon’s practice. In 2007, 74 % of rural surgeons performed more than 50 flexible endoscopic procedures each year, with 42 % of rural surgeons performing more than 200 flexible endoscopic procedures annually [5]. In a 2010 report on rural, under-served areas that lack gastroenterology services, 39.8 % of an American general surgeons’ practice comprises flexible endoscopic procedures [6]. In Canada, surgeons were found to be the primary providers of flexible endoscopic services in smaller urban and rural areas [7]. The American Board of Surgery (ABS) has begun to address the training inequity that exists between general surgery residents and gastroenterology fellows [8]. In an effort to ensure surgical residents are fully trained and competent in flexible endoscopy, the ABS has not only increased the minimum requirements for training general surgery residents in flexible endoscopy but has also undertaken the task of formalizing a flexible endoscopy curriculum for its residents. Currently, the ABS and Residency Review Committee (RRC) recommend 35 upper endoscopic procedures and 50 colonoscopies as the minimum number of procedures to be performed by surgical residents. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the ABS have long espoused that numbers do not ensure competency in surgical or endoscopic procedures. This position is fully supported by data. In 2004, the SAGES esophagogastroduodenoscopy (EGD) Outcomes Study Group prospectively reviewed 3,525 EGDs performed by surgeons, showing a high degree of success with low morbidity. There was no correlation between experience (i.e. number of cases performed) and completion rates or major complications [9]. A similar trial by the SAGES Colonoscopy Study Outcomes Group prospectively reviewed 13,580 colonoscopies performed by surgeons and found no correlation between experience and complications, with an acceptable success rate. The investigators noted that a minimum of 50 colonoscopies with 100 performed annually showed a significant improvement in completion rates Taskforce Members are listed in Appendix.

Training general surgery residents in pediatric surgery: educational value vs time and cost

Background This study evaluated the educational value of pediatric surgery rotations, the likelihood of performing pediatric operations upon completing general surgery (GS) residency, and time and cost of training GS residents in pediatric surgery. Methods A survey was administered to GS residents that evaluated the pediatric surgery rotation and anticipated practice intentions. A retrospective analysis (2005-2006) of operative times for unilateral inguinal hernia repair, bilateral inguinal hernia repair, and umbilical hernia repair was also performed. Procedure times were compared for operations performed by a pediatric surgeon with and without GS residents. Cost analysis was based on time differences. Results General surgery residents (n = 19) considered the pediatric surgery rotation to have high educational value (4.7 ± 0.6 of 5) with extensive teaching (4.6 ± 0.7) and operative experience (4.4 ± 0.8). Residents listed pediatric surgery exposure, operative technique, and observed work ethic as most valuable. Upon graduation, residents expect to perform pediatric operations 2 to 3 times annually. Thirty-seven percent of residents felt competent to perform appendectomy (patients >5 years), 32% appendectomy (3-5 years), 21% gastrostomy (>1 year), and 11% inguinal herniorrhaphy (>1 year). Operative times and costs were significantly higher in operative procedures performed with a GS resident. Conclusion General surgery residents considered pediatric surgery as a valuable educational experience. Residents anticipate performing pediatric operations a few times annually. Training GS residents in pediatric surgery increased operative time and cost. This information may be useful in determining the appropriate setting for resident education as well as budget planning for pediatric surgical practices.

Training General Surgery Residents on the Gastroenterology Service: A Look at the Successes and Challenges

Dr Susan Reid is an associate professor in the Department of Surgery, McMaster University, Hamilton, Ontario, practicing general surgery and critical care

Training general surgery residents to avoid postoperative cardiac events

Background Expertise in cardiac risk assessment takes years to acquire, but unnecessary cardiology consultation delays treatment and consumes scarce resources. Methods A retrospective review was performed of the cardiac work-up and postoperative events during 1 year on a general surgery service. Postgraduate year 1–3 general surgery residents were instructed to obtain a cardiology consult if a patient had any of the following: (1) had undergone coronary artery intervention more than 2 years in the past; (2) was taking an anti-anginal medication (nitroglycerine, Ca channel, or β-blocker); or (3) was symptomatic or had an abnormal electrocardiogram. Whether a patient was symptomatic was to be tempered by the nature of the planned procedure. Results Supervised residents screened 720 unique patients for surgery. Cardiology consultation was obtained in 37. All but 1 (97%) patient referred to cardiology met at least 1 of the earlier-described criteria; with 8 (22%) meeting all 3 criteria. On average, patients referred to the cardiologists were taking 1.4 anti-anginal medications; and 1 patient sustained a fatal myocardial infarction after referral. Cardiac imaging (stress test or catheterization) was performed on 24 (65%) referred patients and was positive in 8 (33%). After minimizing cardiac risk by medication or intervention, the surgery service declined to offer the planned procedure to 11 (30%) of the referred patients and an additional 5 (15%) patients declined surgery. The overall surgical mortality was 2%. None of the patients in this series sustained a postoperative myocardial infarction or cardiac death. Postoperative supraventricular tachycardia was not influenced significantly by cardiology consultation (5% referred patients vs 1% nonreferred). Conclusions Our criteria for obtaining cardiology consultation in general surgery patients appears to appropriately select patients in need of further work-up. Information obtained from a cardiac consultation frequently leads to a re-evaluation of the risks and benefits of surgery by both surgeons and patients.

P177: Training general surgery residents in pediatric surgery: Analysis of time and cost

Background: Resident participation in the pediatric surgery service is essential to their training. The impact with regard to operative time and hospital cost is not well-defined. Hypothesis: Training general surgery residents in pediatric surgery significantly increases operative time and hospital cost. Methods: A retrospective analysis of operative times was performed for three common pediatric operations: unilateral inguinal herniorraphy, bilateral inguinal herniorraphy, and open pyloromyotomy. All cases occured between July 2004 and July 2006. In Group 1 all operations were performed by a single attending pediatric surgeon. Group 2 involved the same attending surgeon directing a 3rd -year general surgery resident through the operations. Operative time was defined as the time from skin incision to placement of the final dressing. Surgery schedules and a cost analysis were also analyzed for the 2 groups. Statistical analysis was performed using student t-test. Results: Demographics between the two groups were similar. Mean operative time was shorter in Group 1 with respect to unilateral and bilateral herniorraphy. Mean operative time for pyloromyotomy was similar between the 2 groups. No perioperative complications or recurrent hernias occured in either group. Surgery schedules (number of operations per day) were similar between the 2 groups. Furthermore, decreased time in performing herniorraphy without surgery residents would not lead to more operative cases performed per day, thus hospital cost and surgeon fees are similar between the 2 groups. Conclusion: Training general surgery residents in pediatric surgery increased operative time with respect to unilateral and bilateral herniorraphy. There was no increase in operative with respect to pyloromyotomy. Increased operative time to train general surgery residents did not influence surgical scheduling, thus there was no increase in cost to the hospital or surgeon. Tabled 1Operative time (minutes) between the 2 groups Group 1 Group 2 p Unilateral herniorraphy 31.2 ± 10.4 (n=41) 40.1 ± 15.2 (n=35) 0.003 Bilateral herniorraphy 44.9 ± 13.4 (n=30) 54.0 ± 16.6 (n=20) 0.04 Pyloromyotomy 32.9 ± 9.6 (n=10) 34.6 ± 7.4 (n=15) 0.61 Open table in a new tab

Training general surgery residents in pediatric surgery: A Canadian survey

Background/Purpose: The training of general surgeons in pediatric surgery is an important educational role of pediatric surgeons (PS). The authored surveyed this training process and the related expectations and perceptions of competence. Methods: The authors surveyed all practicing members of the Canadian Association of Paediatric Surgeons (CAPS) in Canada, all general surgery program directors (PD), and all final year general surgery residents (GS). Questions included exposure to pediatric surgery, expected and perceived competence in managing common pediatric general surgical problems, and trainee practice intentions. Results: Response rate to date was 51% from PS, 69% from PD, and 19% from GS. Sixty-seven percent of PS considered the exposure to pediatric surgery satisfactory, yet only 1 of 7 residents planning on pursuing general surgery felt adequately prepared. Trainees were expected to be competent in the conditions polled by 65% of PS and 74% of PD, yet only 38% of the trainees actually felt competent in them. The largest discrepancies were found for infant hernia, newborn colostomy, and cryptorchidism. Presence of a fellowship program and size of training program had no impact on perceived competence. Conclusions: Training of general surgeons in pediatric surgery varies across Canadian programs. Perceived resident competence often lags behind program and faculty expectations. These data can be used for directing educational priorities in general surgery programs. J Pediatr Surg 36:706-710. Copyright © 2001 by W.B. Saunders Company.