Journal of Surgical Education最新文献

{"title":"Mindfulness in Surgical Training (MiST): A Modified Mindfulness Curriculum for Surgical Residents","authors":"Elizabeth Miazga MDLLM ,&nbsp;Brenna E. Swift MD, MSc (HSED), MASc ,&nbsp;Madalina Maxim MD ,&nbsp;Monica Pearl MD ,&nbsp;Anna R. Gagliardi PhD ,&nbsp;Janet Bodley MD Med ,&nbsp;Michèle Farrugia MSc, MD Med ,&nbsp;Hava Starkman MD ,&nbsp;Anna Kobylianskii MD ,&nbsp;Julie Maggi MD ,&nbsp;Carol-Anne Moulton MD, PhD ,&nbsp;Dana Soroka MD ,&nbsp;Andrea N. Simpson MD, MSc","doi":"10.1016/j.jsurg.2024.103351","DOIUrl":"10.1016/j.jsurg.2024.103351","url":null,"abstract":"<div><h3>OBJECTIVES</h3><div>Residents experience numerous work-related and personal stressors that make it difficult to focus in the operating room, negatively impacting learning and surgical performance. Mindfulness-based cognitive therapy decreases anxiety and improves memory and learning. This study aimed to create a feasible and desirable modified mindfulness curriculum for surgical residents.</div></div><div><h3>DESIGN</h3><div>This was a prospective cohort study using multiple methods design to assess a 12-week modified mindfulness curriculum tailored to busy surgical trainees involving a 30 min group session weekly and 15 minutes home practice daily. The main outcomes were program feasibility and desirability. Focus groups explored how mindfulness techniques were used in the operating room. Secondary outcomes were measured in a pre- and post- intervention design assessing surgical performance, anxiety, confidence and burnout using validated assessment scales. Outcome measures were collected at baseline, immediately following the course and at 3 months postintervention.</div></div><div><h3>SETTING</h3><div>Academic obstetrics and gynecology residency program.</div></div><div><h3>PARTICIPANTS</h3><div>Obstetrics and gynecology residents in postgraduate years 2-5 at the University of Toronto were invited to participate in Mindfulness in Surgical Training.</div></div><div><h3>RESULTS</h3><div>Twelve (20%) out of 61 eligible residents enrolled in the program and 8 (67%) completed the course. There was a statistically significant decrease in anxiety (p &lt; 0.001) and increase in surgical confidence (p = 0.007) following the mindfulness curriculum using validated survey tools. There was no change in burnout or surgical performance evaluations. Thematic analysis identified that mindfulness tools were beneficial and regularly utilized by participants in the operating room with sustained use 3 months post intervention. The biggest barrier to participation in the mindfulness curriculum was time. Participants felt the residency program should support ongoing mindfulness training to promote a positive culture shift.</div></div><div><h3>CONCLUSIONS</h3><div>A modified mindfulness curriculum designed for surgical trainees is feasible, desirable, reduces anxiety and increases surgical confidence.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103351"},"PeriodicalIF":2.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of a Resident, Fellow, or Physician Assistant on Operative Time and Complication Rate in Closed Reduction and Percutaneous Pin Fixation of Pediatric Distal Humerus Supracondylar Fractures","authors":"Zachary Quanbeck MD ,&nbsp;Etasha Bhatt MD ,&nbsp;Deborah Quanbeck MD ,&nbsp;Alison Schiffern MD","doi":"10.1016/j.jsurg.2024.103353","DOIUrl":"10.1016/j.jsurg.2024.103353","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>We sought to compare operative times and complications for attending surgeons operating alone or with an assistant including an orthopedic resident, fellow, or physician assistant (PA) for closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures (SCH), an archetypal procedure integral to the education of orthopedic trainees.</div></div><div><h3>DESIGN</h3><div>Using a retrospective database collected following institutional review board approval, a 1-way ANOVA (non-parametric) was used to assess the effect of assistant absence or presence by type of assistant on mean operative time. We analyzed the association between the attending surgeon assistant categories and the complication rate using Fisher's Exact Test.</div></div><div><h3>SETTING</h3><div>The study was performed at Gillette Children's Specialty Healthcare, St. Paul, Minnesota, and Children's Minnesota in St. Paul and Minneapolis. These three affiliated metropolitan hospitals, the last of which is a level 1 trauma facility, all share the same group of orthopedic surgeons, trainees, and physician assistants.</div></div><div><h3>PARTICIPANTS</h3><div>All patients under 14 years of age treated with CRPP for Gartland type 2, 3, 4 and flexion type closed supracondylar fractures between April 2006 and September 2016 were analyzed. Of 1053 patients identified by Current Procedure Terminology code 24358, data was available for 888 patients.</div></div><div><h3>RESULTS</h3><div>Out of the 888 patients, 44.1% were operated on by a surgeon alone, 48.4% with a resident, 4.8% with a fellow and 2.6% with a physician assistant. The ANOVA revealed a statistically significant increase (p &lt; 0.001) in operative times when a resident participated compared to the other categories. The shortest mean surgery time (34.7 minutes) occurred when an attending surgeon and PA were present. The longest mean time (44.3 minutes) occurred with a surgeon and resident. This difference, at 9.6 minutes, constituted 28% more time. There were 40 patients with a complication, a rate of 4.5%. The rate for each of the assistant categories was surgeon alone 5.6%, with a resident 3.3%, with a fellow 4.7%, with a PA 8.7%. The Fisher's Exact Test results showed no statistically significant association between the type or absence of assistant and the complication rate.</div></div><div><h3>CONCLUSION</h3><div>Differences in operative times were observed across assistant categories although the mean time difference was statistically insignificant between the surgeon unassisted versus assisted by the fellow or a PA. The finding of statistically increased operative times with resident participation in this study for this specific procedure is consistent with results for most other reported orthopedic surgeries. Complication rates did not vary based on the participating personnel.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103353"},"PeriodicalIF":2.6,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Simulation-Based Training Tools in Plastic Surgery","authors":"Diego Agustín Abelleyra Lastoria ,&nbsp;Sehrish Rehman ,&nbsp;Farah Ahmed ,&nbsp;Sara Jasionowska ,&nbsp;Andrej Salibi ,&nbsp;Naveen Cavale ,&nbsp;Prokar Dasgupta ,&nbsp;Abdullatif Aydin","doi":"10.1016/j.jsurg.2024.103320","DOIUrl":"10.1016/j.jsurg.2024.103320","url":null,"abstract":"<div><h3>Objectives</h3><div>The recent shift from traditional surgical teaching to the incorporation of simulation training in plastic surgery has resulted in the development of a variety of simulation models and tools. We aimed to assess the validity and establish the effectiveness of all currently available simulators and tools for plastic surgery.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>The PRISMA 2020 checklist was followed. The review protocol was prospectively registered in PROSPERO (CRD42021231546). Published and unpublished literature databases were searched to the 29^th of October 2023. Each model was appraised in accordance with the Messick validity framework, and a rating was given for each section. To determine the effectiveness of each model, the McGaghie model of translational outcomes was used.</div></div><div><h3>Results</h3><div>On screening 1794 articles, 116 were identified to discuss validity and effectiveness of simulation models in plastic surgery. These were hand surgery (6 studies), breast surgery (12 studies), facial surgery (25 studies), cleft lip and palate surgery (29 studies), rhinoplasty (4 studies), hair transplant surgery (1 study), surgery for burns (10 studies), and general skills in plastic surgery (29 studies). Only 1 model achieved an effectiveness level &gt; 3, and no model had a rating &gt; 2 in all aspects of the Messick validity framework.</div></div><div><h3>Conclusion</h3><div>There are limited models enabling the transfer of skills to clinical practice. No models achieved reductions in surgical complications or costs. There must be more validity studies conducted using updated validity frameworks, with an increased emphasis on the applicability of these simulators to improve patient outcomes and surgical technique. More training tools evaluating both technical and non-technical surgical skills are recommended.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103320"},"PeriodicalIF":2.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Feasibility and Efficacy of Video Education with Individual Review in Early Surgical Education","authors":"Danielle Mayorga-Young BS ,&nbsp;Jonnby LaGuardia BS ,&nbsp;Keith Sweitzer MD ,&nbsp;Rishika Chikoti ,&nbsp;James Butterfield MD ,&nbsp;Safi Ali-Khan MD ,&nbsp;Aabra Ahmed MD ,&nbsp;Jonathan Leckenby MBBS, PhD","doi":"10.1016/j.jsurg.2024.103354","DOIUrl":"10.1016/j.jsurg.2024.103354","url":null,"abstract":"<div><h3>Purpose</h3><div>Use of video-based education (VBE) to teach surgical skills has increased rapidly and been shown to accelerate students’ and residents’ time to satisfactory skill acquisition while also improving trainees’ satisfaction. However, its implementation is limited by logistical factors such as: video quality, view obstruction, and excessive motion. We aim to study the feasibility of using VBE to teach medical students basic suturing skills.</div></div><div><h3>Methods</h3><div>Medical students viewed standardized videos to learn multiple suturing techniques, which they performed on a skin model. They recorded and sent their best attempt at subcuticular technique to a plastic surgery resident who provided synchronous, virtual feedback. Following feedback, students re-attempted the technique and again recorded their best attempt. Both videos were graded by a blinded reviewer. A previously-validated grading scale was used to score students on 1) number of completed suturing steps, 2) economy of time and motion, and 3) final rating (proficient or requires practice).</div></div><div><h3>Results</h3><div>All fifteen students agreed that this activity was either “fairly” or “very” useful for their learning. Seven students were rated as proficient prior to feedback and remained proficient following feedback. Of the remaining eight students, five students (62.5%) achieved proficiency following feedback. On average, the students demonstrated significant improvement in number of successfully completed suture steps (4.3 ± 1.10 vs 4.8 ± 1.01 post-feedback, p = 0.028) and economy of time and motion (2.6 ± 1.24 vs 3.2 ± 0.94 post-feedback, p = 0.029). When adjusting for student interest in pursuing a surgical residency, baseline scores were similar, but those who intend to pursue surgery demonstrated greater economy of motion scores following feedback (3.56 ± 0.73 vs 2.67 ± 1.03 among students not interested in surgery, p = 0.035).</div></div><div><h3>Conclusions</h3><div>This pilot study shows that use of VBE is feasible in teaching medical students basic suturing skills. Efficacy may be influenced by career interests.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103354"},"PeriodicalIF":2.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional Intelligence as a Component of Surgical Coaching: A Scoping Review","authors":"MJFX Rickard MMed ,&nbsp;DM Ackermann MPH ,&nbsp;M Schnitzler FRACS ,&nbsp;D Kozlowski PhD","doi":"10.1016/j.jsurg.2024.103316","DOIUrl":"10.1016/j.jsurg.2024.103316","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Surgical coaching has become more widespread and involves both technical and nontechnical skills. Emotional Intelligence (EI) is an important nontechnical skill and is associated with leadership skills, increased job satisfaction and superior nontechnical skills. This scoping review aimed to explore the use of EI as a component of surgical coaching.</div></div><div><h3>DESIGN AND SETTING</h3><div>A scoping review was conducted to map the existing literature. Medline was searched from inception to May 2023. Eligible studies included surgical coaching, which incorporated aspects of emotional intelligence into the non-technical skills component.</div></div><div><h3>RESULTS</h3><div>3206 studies were identified in the initial search. A total of 2117 articles remained after duplicates were removed. 2117 articles were screened by 2 authors (DA and MR). 32 studies were included in the full-text review, and 8 studies were included in the final analysis. Coaching was predominantly delivered by practicing surgeons, although 1 study used external professional coaches. Training methods for coaches vary widely, from short courses to extensive workshops, highlighting the lack of standardized training protocols within the field. The outcomes measured across studies were diverse, encompassing both technical and non-technical skills, as well as emotional intelligence constructs. Non-technical skills were predominantly assessed using the Non-Technical Skills for Surgeons (NOTSS) assessment tool, whereas other outcomes included burnout, resilience, and technical skills. Notably, none of the studies incorporated formal measurements of emotional intelligence, although aspects such as motivation, empathy, self-knowledge, and social skills were addressed in the coaching sessions.</div></div><div><h3>CONCLUSIONS</h3><div>Standardization of coaching protocols and incorporation of emotional intelligence principles represent critical avenues for advancing the field and maximizing the benefits of coaching interventions in surgical practice.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103316"},"PeriodicalIF":2.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Textbooks: Interactive Learning of Biomechanical Principles of Osteosynthesis with an Online Tool for Orthopaedic Residents","authors":"Lionel Llano MD ,&nbsp;Dominic Mischler MSc ,&nbsp;Danilo Taype MD ,&nbsp;Sandipan Chatterjee PhD ,&nbsp;Monica Ghidinelli PhD ,&nbsp;Markku Nousiainen Prof ,&nbsp;Simon Lambert MD ,&nbsp;Peter Varga PhD","doi":"10.1016/j.jsurg.2024.103350","DOIUrl":"10.1016/j.jsurg.2024.103350","url":null,"abstract":"<div><h3>OBJECTIVES</h3><div>This study aimed at evaluating the effectiveness of an online interactive biomechanical teaching tool called OSapp. Our main hypothesis was that through the presentation of appropriate science-based content in an interactive, self-directed learning environment familiar to residents the OSapp could significantly improve the knowledge, comprehension, and retention of clinically relevant biomechanical principles of osteosynthesis.</div></div><div><h3>DESIGN</h3><div>Thirty-one orthopaedic residents from the same institution were enrolled. Their knowledge of basic biomechanical principles of osteosynthesis was assessed using 24 multiple-choice questions, in 3 assessment rounds: at baseline; directly after a 1-week self-directed OSapp-based learning period; and 2 months later to measure retention. Results of the junior (1-3 years) and senior (4-5 years) resident groups were compared.</div></div><div><h3>SETTING</h3><div>Orthopaedics and Traumatology Department, Italian Hospital of Buenos Aires, Argentina.</div></div><div><h3>PARTICIPANTS</h3><div>Orthopaedic residents of the same Department at the time of investigation, including residency years 1 to 5.</div></div><div><h3>RESULTS</h3><div>Twenty-eight participants completed all 3 assessment rounds. Assessment scores significantly improved after the intervention compared to baseline (p &lt; 0.05) and did not decline after 2 months (p &gt; 0.99). Both juniors and seniors showed significant knowledge gain (p &lt; 0.05) that was retained (p &gt; 0.99). Although seniors were better than juniors at baseline (p ≤ 0.01) and postintervention (p &lt; 0.05), after the intervention, juniors reached the level of baseline seniors (p &gt; 0.21). No difference was observed between the 2 groups after 2 months (p &gt; 0.21).</div></div><div><h3>CONCLUSIONS</h3><div>Self-directed learning with the interactive 3D models available in the freely available online tool OSapp led to a significant and sustained improvement of residents’ knowledge and understanding of the biomechanical principles of osteosynthesis. Utilizing OSapp in surgical education could help to improve the efficiency and effectiveness of training and may thus lead to decreased fracture treatment complications including failure of osteosyntheses.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103350"},"PeriodicalIF":2.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Do No Harm?” Moral Distress Among Medical Students During the Surgical Clerkship","authors":"Cara AF Humphrey BS ,&nbsp;R. Evey Aslanian BS ,&nbsp;Sarah E. Bradley PhD,MPH,CPH ,&nbsp;Rija Awan BS ,&nbsp;M. Andrew Millis MD,MPH ,&nbsp;Janice Firn PhD,MSW ,&nbsp;Pasithorn A. Suwanabol MD,MS","doi":"10.1016/j.jsurg.2024.103340","DOIUrl":"10.1016/j.jsurg.2024.103340","url":null,"abstract":"<div><h3>OBJECTIVES</h3><div>Moral distress, reported among healthcare workers across a variety of settings, is associated with negative mental health consequences, burnout, and intention to leave a position. The scant literature exploring medical students’ moral distress does not specifically examine moral distress during the surgical clerkship nor does it characterize the type of moral distress experienced by medical students. Thus, we aimed to explore and characterize medical students' moral distress during the surgical clerkship.</div></div><div><h3>SETTING/PARTICIPANTS</h3><div>This study was conducted at the University of Michigan Medical School evaluating narrative essays written by 3 cohorts of students (2018-19, 2019-20, 2020-21) who completed the surgical clerkship during their third year of medical school.</div></div><div><h3>DESIGN</h3><div>Deductive content analysis was used to evaluate 180 narrative essays for the presence of moral distress using a 5-subcategorization schema developed by Morley et al. (<em>constraint-distress, tension-distress, dilemma-distress, uncertainty-distress, and conflict-distress).</em></div></div><div><h3>RESULTS</h3><div>Four of the 5 sub-categories of moral distress (<em>constraint-distress, tension-distress, dilemma-distress</em> and <em>uncertainty-distress</em>) were identified in medical student essays. There were no examples of <em>conflict-distress</em>.</div></div><div><h3>CONCLUSIONS</h3><div>Medical students described 4 of the 5 sub-types of moral distress during their surgical clerkship. The sub-types of moral distress most often experienced by medical students are different than sub-types of moral distress previously reported among nurses, suggesting the varied roles and responsibilities of the healthcare team impact the scenarios most likely to present moral distress. Additionally, medical students were hesitant to raise concerns with their team when they experienced events discordant with their moral beliefs; they cited their position in the medical hierarchy, fearing implications on their future career, and perceived lack of knowledge and experience as factors limiting their willingness to share. Finally, this study identifies morally distressing scenarios as opportunities for transformative learning for medical students specifically in the realm of professional identity formation.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103340"},"PeriodicalIF":2.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting the Standard for the Future of Cancer Surgery: Utilizing the Operative Standards for Trainees","authors":"Michelle Horowitz MD ,&nbsp;Jack Sample MD ,&nbsp;Sarah Rudasill MD ,&nbsp;Shruti Zaveri MD, MPH ,&nbsp;Amanda Francescatti MS ,&nbsp;Mediget Teshome MD, MPH ,&nbsp;Anthony Villano MD ,&nbsp;Tina Hieken MD ,&nbsp;Matthew Katz MD ,&nbsp;Kelly Hunt MD","doi":"10.1016/j.jsurg.2024.103345","DOIUrl":"10.1016/j.jsurg.2024.103345","url":null,"abstract":"<div><div>The purpose of this editorial is to illustrate how the Operative Standards for Cancer Surgery can be used as a tool to support education of surgical trainees. The three-volume text is a valuable resource not only for learning the scientific principles related to surgical oncology, but also as a technical guide for critical aspects of performing operations and a primer for quality assurance going forward in a surgical career.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103345"},"PeriodicalIF":2.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Focus Group Discussion Study Exploring General Surgery Trainees’ Views on Evidence-Based Medicine Within Their Training Program in the United Kingdom","authors":"Evripidis Tokidis MSc ,&nbsp;Pirashanthie Vivekananda-Schmidt DPhil ,&nbsp;Saba P. Balasubramanian PhD","doi":"10.1016/j.jsurg.2024.103348","DOIUrl":"10.1016/j.jsurg.2024.103348","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Evidence-based Medicine (EBM) is fundamental to modern healthcare and its integration into postgraduate curricula is strongly advocated. Despite its relevance, incorporating EBM in postgraduate training, specifically in general surgery, is fraught with challenges. This study aims to explore the perceptions of general surgical trainees regarding EBM, focusing on the process of achieving competency, assessment and its associated challenges.</div></div><div><h3>METHODS</h3><div>Four semi-structured focus group discussions were conducted, involving participants with varying experience in general surgery. Sessions were audio-recorded, de-identified and transcribed verbatim to facilitate data analysis. Thematic analysis was employed to identify recurring patterns and themes within the dataset, ensuring rigor and reliability in the findings. Saturation was achieved when no new themes or codes emerged from the data.</div></div><div><h3>RESULTS</h3><div>Eighteen trainees at different levels of training, academic experience and from different regions of the UK took part. The discussions were thematically analysed. Four key themes were identified: \"Knowledge and understanding of EBM,\" \"Developing EBM competencies,\" \"Assessment in EBM,\" and \"Barriers for EBM.\" Thematic saturation was achieved by the fourth focus group.</div></div><div><h3>CONCLUSION</h3><div>This study provides insights into the landscape of EBM in general surgery in the United Kingdom. Trainees demonstrated knowledge and understanding of EBM and the process of achieving relevant competencies. EBM assessment was perceived to be part of their training. Nevertheless, systemic barriers and inherent challenges appear to hinder the development of EBM competencies within postgraduate general surgical training. Achieving this requires a participatory approach to engage stakeholders to further develop the existing competency-based curriculum.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103348"},"PeriodicalIF":2.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OrthoACCESS 2.0: Redesigning a National Orthopaedic Surgery Curriculum for Medical Students using a Flipped-Classroom Blended Learning Model","authors":"Tanios Dagher BSE ,&nbsp;Michael Kessler MD ,&nbsp;Adam Levin MD ,&nbsp;Sarah N. Pierrie MD ,&nbsp;Brian Scannell MD ,&nbsp;Tessa Balach MD","doi":"10.1016/j.jsurg.2024.103337","DOIUrl":"10.1016/j.jsurg.2024.103337","url":null,"abstract":"<div><h3>Objective</h3><div>Due to limited musculoskeletal education, students pursuing orthopaedic surgery often feel unprepared for residency. Clinical rotations provide some education; however, prior to the development of the Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills (OrthoACCESS) curriculum in 2019, no standardized didactic curriculum existed. Over time, students desired interactive, case-based learning opportunities. Our objective was to design a flipped-classroom, blended learning curriculum and evaluate its ability to improve medical student orthopaedic knowledge.</div></div><div><h3>Design</h3><div>OrthoACCESS 2.0 is a 16-week, open-access curriculum consisting of didactic lectures, case discussions, and learning resources.</div><div>The curriculum was evaluated using pre-curriculum, post-case discussion, and post-curriculum surveys. Likert-item questions were evaluated with paired Wilcoxon signed-rank analysis. Free text responses were reviewed for emerging themes.</div></div><div><h3>Setting</h3><div>Lectures were presented weekly in-person for students at OrthoACCESS institutions with pre-recorded lectures available for non-rotating students. Faculty-led virtual case discussions consisted of 3 case presentations and breakout rooms for discussion. Learning resources (e.g., Anki Cards, “scut sheets”) were posted to the website.</div></div><div><h3>Participants</h3><div>OrthoACCESS 2.0 was hosted from June to October 2023 with 35 participating institutions. All 226 student registrants completed the pre-curriculum survey and 69 completed the post-curriculum survey. Forty students attended at least 8/16 case discussions.</div></div><div><h3>Results</h3><div>In the post-curriculum survey, 68% of participants reported “quite” or “extremely” strong orthopedic knowledge, compared to 23% beforehand (p &lt; 0.001). Postcase discussion surveys revealed significant increases in knowledge associated with each lecture and case discussion (p &lt; 0.001). The greatest student-reported benefits were the broad coverage of orthopedic topics (n=41) and learning how to think like an orthopaedic surgeon (n=20). The greatest barrier to attendance was clinical obligations during case discussions (n=44).</div></div><div><h3>Conclusions</h3><div>This flipped-classroom, blended learning curriculum has improved medical student foundational orthopaedic knowledge nationally. This model may be valuable for other specialties with limited undergraduate medical exposure.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103337"},"PeriodicalIF":2.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}