Journal of Surgical Education最新文献

{"title":"Correlation of Performance on the ENTRUST Assessment Platform With Other Variables in Competency-Based Surgical Education","authors":"Lye-Yeng Wong MD ,&nbsp;Nathan Lam BS ,&nbsp;Yewon Ashley Son BS ,&nbsp;Hyrum Eddington BS ,&nbsp;Katherine D. Arnow MS ,&nbsp;Jason Tsai MS ,&nbsp;Ananya Anand MD ,&nbsp;Fatyma C. Peralta MS ,&nbsp;Samuel Shields MS ,&nbsp;Edward F. Melcer PhD ,&nbsp;Dana T. Lin MD, FACS ,&nbsp;Cara A. Liebert MD, FACS","doi":"10.1016/j.jsurg.2024.09.012","DOIUrl":"10.1016/j.jsurg.2024.09.012","url":null,"abstract":"<div><h3>Objective</h3><div>With the implementation of American Board of Surgery (ABS) Entrustable Professional Activities (EPAs), there is continued need for objective, evidence-based assessment tools to augment existing microassessments and inform readiness for entrustment. The ENTRUST Assessment Platform is an online virtual-patient simulation platform to assess trainees’ surgical decision-making competence across preoperative, intraoperative, and postoperative phases of care. This study collects additional validity evidence for the ENTRUST platform in its relationship to other established variables in competency-based surgical education.</div></div><div><h3>Design</h3><div>This is a prospective analysis of surgical resident performance on the ENTRUST Right Lower Quadrant (RLQ) pain/Appendicitis EPA Assessment. ENTRUST scores were analyzed by PGY-level and correlations with Accreditation Council for Graduate Medical Education (ACGME) Case Logs, ACGME Surgery Milestones, and ABS In-Service Training Examination (ABSITE) scores were evaluated. Bivariate analyses were performed using Spearman rank correlations.</div></div><div><h3>Setting</h3><div>This study was conducted at a tertiary academic center (Stanford University, Palo Alto, CA) in a proctored exam setting.</div></div><div><h3>Participants</h3><div>Thirty-two PGY-1 though PGY-5 general surgery residents completed the ENTRUST RLQ Pain/Appendicitis EPA Assessment containing four case scenarios which were iteratively developed and scored by expert consensus and aligned with ABS EPA definitions.</div></div><div><h3>Results</h3><div>ENTRUST grand total score was positively correlated with PGY-level (rho = 0.57, p = 0.001), ACGME appendectomy case log volume (rho = 0.55, p = 0.002), and ABSITE raw score (rho = 0.66, p = 0.0004). ENTRUST performance was significantly correlated with all eighteen ACGME Surgery Milestones (rho = 0.43 to rho = 0.54, all p≤0.01), with the strongest correlation seen for PC1 (Patient Evaluation and Decision Making) (rho = 0.54, p = 0.006).</div></div><div><h3>Conclusions</h3><div>Performance on ENTRUST was significantly correlated with established variables in surgical training, including ACGME Appendectomy Case Logs, ABSITE, and ACGME Surgery Milestones. This study strengthens existing validity evidence for the ENTRUST Assessment Platform as an objective assessment of clinical decision-making. ENTRUST is an assessment tool which can augment microassessments and support competency-based medical education.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103293"},"PeriodicalIF":2.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635273","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":"Readiness of Graduating General Surgery Residents To Perform Common Pediatric Surgery Procedures","authors":"Rebecca Moreci MD, MS ,&nbsp;Alyssa Pradarelli MD ,&nbsp;Kayla Marcotte MS ,&nbsp;Chia Chye Yee PhD ,&nbsp;Andrew Krumm PhD ,&nbsp;Brian C. George MD, MAEd ,&nbsp;Benjamin Zendejas MD, MSc","doi":"10.1016/j.jsurg.2024.103318","DOIUrl":"10.1016/j.jsurg.2024.103318","url":null,"abstract":"<div><h3>Objective</h3><div>Up to 40% of pediatric surgery procedures occur at adult hospitals. We aim to evaluate how competent graduating general surgery residents are to perform common pediatric surgery procedures.</div></div><div><h3>Design</h3><div>Pediatric and adult inguinal (IH) and umbilical (UH) hernia operative evaluations were collected. Ratings were analyzed using Bayesian generalized linear mixed models. The primary outcome was graduating residents’ estimated probability of being competent to perform an IH or UH repair.</div></div><div><h3>Setting</h3><div>This study was conducted using operative assessment data from general surgery programs in the Society for Improving Medical and Professional Learning (SIMPL) collaborative.</div></div><div><h3>Participants</h3><div>113,621 evaluations (2,924 UH, 5,555 IH) from 7,032 categorical general surgery residents were analyzed from 2015-2023.</div></div><div><h3>Results</h3><div>Graduating residents had an adjusted probability of being competent to perform an adult IH of 94.3% (Interquartile Range [IQR] 83.4%-98.3%). In contrast, competence probabilities were 79.5% (IQR 52.7%-93.3%) for a &lt;6 month old, 89.6% (IQR 72.1%-96.9%) for a 6 month to 5 year old, and 89.9% (IQR 71.9%-96.9%) for a &gt;5 year old. For UH repairs, competence probabilities were similar for adult (97.6%, IQR 92.4%-99.3%) and pediatric procedures (97.3% for &lt;5 years old [IQR 91.4%-99.2%]; 97.6% for &gt;5 years old [IQR 92.3%-99.3%]).</div></div><div><h3>Conclusions</h3><div>Nearly all graduating general surgery residents are competent to perform pediatric UH repairs. However, there is variability in competence of general surgery residents performing pediatric IH repairs, especially in children &lt;6 months old.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103318"},"PeriodicalIF":2.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635274","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":"Validation of the Objective Structured assessment of Technical Skill (OSATS) in China","authors":"Thibault Tricard MD, PhD ,&nbsp;JiaHua Pan MD, PhD ,&nbsp;QiXiang Song MD ,&nbsp;YiHong Lu MD ,&nbsp;GuangYao Ye MD, PhD ,&nbsp;ZhengQian Bian MD, PhD","doi":"10.1016/j.jsurg.2024.103304","DOIUrl":"10.1016/j.jsurg.2024.103304","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to perform a cross-cultural adaptation of the Objective Structured assessment of Technical Skill (OSATS) tool into Chinese and to determine its reproducibility and validity in China.</div></div><div><h3>Methods</h3><div>A Chinese version of OSATS was created through a process of translation, back-translation, expert panel evaluation, pilot testing and then its validation. 59 candidates were included in the study in an international Chinese simulation center including medical students (5th year of medical studies), surgical fellow, attending surgeons, attending professors and professors of surgery. Two exercises performed on synthetic protheses (latex balloons) were designed and filmed: separate suture (3 points) and a circular anastomosis. Each candidate technical competencies were established according to the score by 3 experts. The results of the different scores were correlated against the theoretical background (TB) of the candidates (1 to 5), for each exercise.</div></div><div><h3>Results</h3><div>A Chinese version of OSATS was produced and validated through a back-translation process. The average professors’ residents’ and students’ scores were 35 (± 0.2), 28 (± 0.4) and 18 (± 0.3) respectively. For the objective score cnOSATS on simple sutures, the mean increases from one TB level to the next was 1.63 (0.90-2.37), p &lt; 0.001. For the objective score cnOSATS on running sutures, the mean increases from one TB level to the next was 1.99 (1.22 – 2.77), p &lt; 0.001.</div></div><div><h3>Conclusion</h3><div><u>:</u> This study suggests that the Chinese version of OSATS can reliably and validly assess surgical skills in China.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103304"},"PeriodicalIF":2.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635277","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":"Artificial Intelligence Compared to Manual Selection of Prospective Surgical Residents","authors":"Monalisa Hassan MD ,&nbsp;Marco Ayad MD ,&nbsp;Christine Nembhard MD ,&nbsp;Andrea Hayes-Dixon MD ,&nbsp;Anna Lin MD ,&nbsp;Mahin Janjua MBBS ,&nbsp;Jan Franko MD, PhD, MMM ,&nbsp;May Tee MD, MPH, FACS","doi":"10.1016/j.jsurg.2024.103308","DOIUrl":"10.1016/j.jsurg.2024.103308","url":null,"abstract":"<div><h3>Background</h3><div>Artificial Intelligence (AI) in the selection of residency program applicants is a new tool that is gaining traction, with the aim of screening high numbers of applicants while introducing objectivity and mitigating bias in a traditionally subjective process. This study aims to compare applicants screened by an AI software to a single Program Director (PD) for interview selection.</div></div><div><h3>Methods</h3><div>A single PD at an ACGME-accredited, academic general surgery program screened applicants. A parallel screen by AI software, programmed by the same PD, was conducted on the same pool of applicants. Weighted preferences were assigned in the following order: personal statement, research, medical school rankings, letters of recommendation, personal qualities, board scores, graduate degree, geographic preference, past experiences, program signal, honor society membership, and multilingualism. Statistical analyses were conducted by chi-square, ANOVA, and independent two-sided t-tests.</div></div><div><h3>Results</h3><div>Out of 1235 applications, 144 applications were PD-selected and 150 AI-selected (294 top applications). Twenty applications (7.3%) were both PD and AI selected for a total analysis cohort of 274 prospective residents. We performed two analyses: 1) PD-selected vs. AI-selected vs. Both and 2) PD-selected vs. AI-selected with the overlapping applicants censored. For the first analysis, AI selected significantly: more White/Hispanic applicants (p &lt; 0.001), less signals (p &lt; 0.001), more AOA honors society (p = 0.016), and more publications (p &lt; 0.001). When censoring overlapping PD and AI selection, AI selected significantly: more White/Hispanic applicants (p &lt; 0.001), less signals (p &lt; 0.001), more US medical graduates (p = 0.027), less applicants needing visa sponsorship (p = 0.01), younger applicants (p = 0.024), higher USMLE Step 2 CK scores (p &lt; 0.001), and more publications (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>There was only a 7% overlap between PD-selected and AI-selected applicants for interview screening in the same applicant pool. Despite the same PD educating the AI software, the 2 application pools differed significantly. In its present state, AI may be utilized as a tool in resident application selection but should not completely replace human review. We recommend careful analysis of the performance of each AI model in the respective environment of each institution applying it, as it may alter the group of interviewees.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103308"},"PeriodicalIF":2.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592801","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":"“Plastic Surgery Program Leadership Perspectives on Wellness and Professional Development Curricula–Where are we Now?”","authors":"Rachel A. Guest MD,&nbsp;Anne M. Meyer MD,&nbsp;James A. Butterworth MBBS,&nbsp;Richard A. Korentager MD,&nbsp;Meredith S. Collins MD","doi":"10.1016/j.jsurg.2024.103319","DOIUrl":"10.1016/j.jsurg.2024.103319","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Burnout is common amongst surgical trainees and its consequences can be detrimental to both mental health and patient care. As such, wellness and professional development have moved to the forefront of discussion in surgical education. The purpose of this study is to describe the current landscape of wellness and professional development education, as well as barriers to initiation of dedicated curricula.</div></div><div><h3>METHODS</h3><div>Electronic surveys were distributed to 115 publicly available program director (PD) or coordinator emails for integrated and independent plastic surgery programs.</div></div><div><h3>RESULTS</h3><div>The survey response rate was 40%. Burnout was a problem within 28.6% of respondent's programs. An additional 50% reported “they had dealt with burnout, but it was not a problem.” Thus, 78.6% of respondents reported burnout issues amongst their trainees. While all respondents believed that prioritizing resident wellness was 1 of their many roles, 78.6% felt that this role should be shared. Forty percent of programs did not have wellness programming with 84.2% indicating that the addition of a dedicated curriculum would benefit their trainees. Common barriers to implementation included: lack of interest, impingement upon free time, lack of resources, onerous initiation, and concern regarding a shift from academic focus. Eighty three percent of respondents would be interested in adopting curricula from another program.</div></div><div><h3>CONCLUSIONS</h3><div>Burnout remains a major issue, affecting over 75% of plastic surgery programs; however, the current landscape of wellness and professional development curricula is highly variable. Adopting curricula from other programs may address commonly cited barriers.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103319"},"PeriodicalIF":2.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592216","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":"How I do it: Meeting Milestones Through a Communication Coaching Program","authors":"Lauren DeCaporale-Ryan,&nbsp;Holly Weldon,&nbsp;Yanjie Qi,&nbsp;Rabih Salloum,&nbsp;Susan McDaniel","doi":"10.1016/j.jsurg.2024.103323","DOIUrl":"10.1016/j.jsurg.2024.103323","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>An existing communication coaching program was adapted to address an educational gap to enhance the communication skills of surgical residents.</div></div><div><h3>DESIGN</h3><div>Expert communication coaches observe surgical residents in various clinical settings and provide detailed feedback and recommendations for improvement.</div></div><div><h3>SETTING</h3><div>Observations occur across diverse clinical environments, including inpatient and outpatient settings, peri-operative contexts, team meetings, and skills labs.</div></div><div><h3>PARTICIPANTS</h3><div>Participants include general surgery and integrated residents, with an initial focus on chief residents, later expanding to include all levels of surgical trainees.</div></div><div><h3>RESULTS</h3><div>Residents reflected that: this is not a domain about which they otherwise receive direct feedback; they appreciate having space to explore their approach to complex interactions; and they experience increased confidence in their interactions with patients, families, peers, and staff. The program adapts easily to various clinical settings, allowing for comprehensive evaluation and individualized feedback. It addresses both personal and systemic factors affecting communication.</div></div><div><h3>CONCLUSIONS</h3><div>This communication coaching program was effectively tailored to the needs and demands of a surgical training program. The program's success underscores the importance of having real-life, direct observation and personalized feedback regarding communication training as part of surgical education. Effective communication skills are an important foundation for creating the most effective future surgical leaders.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103323"},"PeriodicalIF":2.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578076","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":"The Impact of Virtual Interviews on Satisfaction and Diversity in the Orthopedic Surgery Residency Match","authors":"Youssef M. Khalafallah MD ,&nbsp;Aaron Singh BA ,&nbsp;Jacob Scioscia BS ,&nbsp;Abdullah Ghali MD ,&nbsp;Melvyn Harrington MD","doi":"10.1016/j.jsurg.2024.103315","DOIUrl":"10.1016/j.jsurg.2024.103315","url":null,"abstract":"<div><h3>Introduction</h3><div>The recent pandemic necessitated virtual interviews for residency applications. While the travel restrictions have eased, the future of virtual interviews remains uncertain, and more information is needed regarding their impact. The purpose of this study was to assess the impact of virtual interviews on both matched applicants’ and program directors’ satisfaction with match outcomes. Secondarily, we assessed the impact of virtual interviews on resident diversity.</div></div><div><h3>Methods</h3><div>This study received endorsement from COERG (Collaborative Orthopedic Education and Research Group). It consisted of surveys distributed to 24 orthopedic surgery residency program directors and residents in their programs, administered at the midpoint of their second year of residency. The surveys were conducted in 2 rounds: the first round targeted the class of 2025, who completed all interviews in person and served as the control group. The second round, conducted the following year, targeted the class of 2026, who underwent all interviews virtually. Each round involved 2 similar surveys to the ones conducted the year before, 1 for program directors and one for residents. Demographics, including resident race and socioeconomic measures, were also collected along with these surveys. Satisfaction was rated on a scale of 1 to 5, and mean satisfaction scores were calculated. Mann-Whitney U-test was performed for statistical analysis.</div></div><div><h3>Results</h3><div>We received a total of 96 responses from residents, 60 in-person and 36 virtual interviewees. Of the 24 residency program directors who received surveys, 23 responded to the first-round survey (95.8%), while 18 responded to the second-round survey (75%), resulting in an overall response rate of 85.4%. Residents who interviewed virtually reported lower overall satisfaction with their residency program (p &lt; 0.01), less satisfaction with a good fit between the applicant and the program (p &lt; 0.01), faculty feedback (p &lt; 0.05), research opportunities (p &lt; 0.05), and the educational curriculum at their program (p &lt; 0.01). Program directors were less satisfied with the timeliness of residents from the virtual cohort (p &lt; 0.05) and the knowledge of the virtual cohort (p &lt; 0.05). We found no significant difference in resident diversity between the 2 cohorts of matched residents.</div></div><div><h3>Conclusion</h3><div>Virtual interviews were associated with a reduction in both resident and program director satisfaction with match outcomes. Further, virtual interviews did not significantly increase residency diversity. These findings do not support the use of virtual interviews in the orthopedic surgery match process.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103315"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569891","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":"General Surgery Versus Integrated Surgical Sub-specialties: Predictors for Residency Match and Interview Invites Among Surgical Candidates","authors":"Yoshiko Iwai MD, MS ,&nbsp;Kelsey R. Landrum MS ,&nbsp;J. Nathaniel Diehl MD, PhD ,&nbsp;Audrey L. Khoury MD, MPH ,&nbsp;Angela P. Mihalic MD ,&nbsp;Luigi Pascarella MD, FACS ,&nbsp;Lynn A. Damitz MD, FACS ,&nbsp;Karyn B. Stitzenberg MD, MPH, FACS ,&nbsp;Chris B. Agala PhD ,&nbsp;Jason M. Long MD, MPH, FACS","doi":"10.1016/j.jsurg.2024.103314","DOIUrl":"10.1016/j.jsurg.2024.103314","url":null,"abstract":"<div><h3>Objective</h3><div>The goal of this study was to assess predictive factors for receiving interviews and matching in general surgery (GS), cardiothoracic surgery (TS), vascular surgery (VS), and plastic surgery (PS).</div></div><div><h3>Design</h3><div>The Texas Seeking Transparency in Applications to Residency (STAR) survey was analyzed for match years 2018-2023. Chi-Square Tests of Independence were used to assess differences among participants who received ≥16 vs &lt;16 interviews and, separately, participants who matched vs went unmatched. Odds ratios (OR) for matching were adjusted for board scores, home region, publications, and honors in applicant specialty.</div></div><div><h3>Setting</h3><div>All US medical schools participating in the Texas STAR survey from 2018-2023.</div></div><div><h3>Participants</h3><div>All fourth-year students who completed the survey during the study period.</div></div><div><h3>Results</h3><div>Of the 2,687 individuals included, 78.15% applied in GS, 13.58% in PS, 4.43% in VS, and 3.82% in TS. Participants had higher odds of receiving ≥16 interviews when having &gt;240 step 1 score vs ≤239 (OR 1.76 (95% CI 1.46-2.12); p &lt; 0.001), &gt;250 step 2 score vs ≤249 (2.42 (2.00-2.91); p &lt; 0.001), honors in their specialty (1.48 (1.21-1.80); p &lt; 0.001), and &gt;5 publications vs ≤4 (1.46 (1.16-1.83); p = 0.001). Odds of matching were lower among PS (0.50 (0.36-0.69); p &lt; 0.001) and TS (0.2 (0.13-0.31); &lt;0.001) compared to GS applicants. Participants had higher odds of matching when having &gt;240 step 1 score vs ≤239 (1.33 (1.04-1.70); p = 0.026), &gt;250 step 2 score vs ≤249 (1.52 (1.20-1.92); p &lt; 0.001), and were more likely to match at a program where they indicated a geographic preference (5.49 (2.58-11.66); p &lt; 0.0001) or program signal (3.87 (1.85-8.11); p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The novel geographic preferencing and program signal functions were associated with increased match success. More studies are needed to assess the generalizability of these findings.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103314"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569887","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":"Conflict Competence Among Resident Physicians: Knowledge and Perception","authors":"Chinedu Okoli MBBS, MSc ,&nbsp;Bridget Olsen MD, MPH ,&nbsp;Carolyne Falank PhD ,&nbsp;Amelia Denney ,&nbsp;Bryan Morse MD, MS ,&nbsp;Jaswin Sawhney MD","doi":"10.1016/j.jsurg.2024.103310","DOIUrl":"10.1016/j.jsurg.2024.103310","url":null,"abstract":"<div><h3>Background</h3><div>The hospital environment is a complex and unpredictable workplace where different providers share the responsibility of patient care. Differences in opinions, values, and experiences between resident physicians and other care team members may trigger conflicts that affect the safety and quality of patient care. Thus, developing conflict competencies may help to negotiate the complexities of different conflict situations and resolve these conflicts. However, the extent of the knowledge and perception of conflict competence among resident physicians remains to be determined.</div></div><div><h3>Methods</h3><div>A survey and qualitative semi-structured interviews of resident physicians were conducted. Participants were recruited voluntarily. Survey results were analyzed using SPSS 21, and MAXQDA 24 was used to evaluate the interview transcripts with thematic analysis.</div></div><div><h3>Results</h3><div>Sixty-five resident physicians completed the survey, and 15 resident physicians were interviewed. 61.5% of the survey respondents identified as female, 76.9% were Caucasian, 35.4% of the respondents were from surgical specialties, and 43.1% of the residents were in their second year of training. 53.8% of the participants reported witnessing or experiencing conflicts weekly, with 44.6% reporting resident physician-nurse conflicts. 63.1% of the conflicts were reported as unresolved, with 16.9% reporting that the conflict affected future working relationships, 25.5% of the conflicts were due to failure of communication, 75.4%residents did not have any form of prior training on conflict management, and 83.1% of them reported interest in conflict competence training. Conflicts mainly affected the quality of care (87.3%) compared to patient safety concerns (12.3%). Participants with prior training in conflict competence were more likely to resolve their reported conflict (p = 0.047). The interviews highlighted 5 main themes: sources of conflict, awareness of conflict resolution styles, addressing conflict and outcomes, and the effect on patient care. Sources of conflict included hierarchy and different priorities. 52.2% of the respondents did not know any style of conflict resolution. Addressing conflict included collaboration, avoidance, competition, and prevention. Avoidance was the most common style used by interviewees, followed by collaboration. While most felt that the conflicts affected the quality of patient care, 1 interviewee reported severe adverse events on the patient.</div></div><div><h3>Conclusion</h3><div>Conflicts are rife in the hospital environment and can affect patient care when unresolved. Resident physicians' knowledge of conflict competence is low and does not reflect the complexity of their working environment. Future training in conflict competence and resolution is warranted.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"81 12","pages":"Article 103310"},"PeriodicalIF":2.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549843","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":"Consequences of Legal Infractions on the General Surgery Residency Application Process","authors":"John T. McCarthy Med ,&nbsp;Brett H. Waibel MD ,&nbsp;Paul J. Schenarts MD","doi":"10.1016/j.jsurg.2024.103303","DOIUrl":"10.1016/j.jsurg.2024.103303","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Alcohol and drug-related legal infractions are common among college and medical students. The objective of this work is to quantify the influence of these legal infractions on program directors (PDs) when making decisions on applicants to general surgery residencies.</div></div><div><h3>DESIGN</h3><div>A convenience sample of 72 PDs with publicly accessible email addresses were electronically sent a previously piloted survey tool. Data collected included demographic information about the PD, and the legal status of recreational marijuana in their state. A 5-point Likert scale (No influence – Would not select) was used to quantify the influence of various alcohol and drug-related legal infractions on an applicants’ ability to match into their general surgery residency.</div></div><div><h3>SETTING</h3><div>American general surgery PDs</div></div><div><h3>PARTICIPANTS</h3><div>61 general surgery PDs.</div></div><div><h3>RESULTS</h3><div>Response rate was 84% or 18.4% of all accredited general surgery residencies. The consequences of legal infractions were more significant for medical students than college students, this included drunk and disorderly (p &lt; 0.001), driving under the influence (DUI) (p &lt; 0.001), possession of marijuana (p &lt; 0.001), cocaine (p &lt; 0.001), fentanyl (p = 0.003), and methamphetamine (p = 0.004). For both college and medical students, infractions distribute into 3 tiers of severity. The lowest tier is for drunk and disorderly and marijuana. These have minimal negative impact and are not different from each other. DUI is the second tier and is significantly more negative than the first tier infractions (p = 0.002, p &lt; 0.001). Infractions involving cocaine, fentanyl, and methamphetamine, have the most negative impact; with each being significantly worse than tier 1 offenses (p &lt; 0.001 for each) and DUI (p &lt; 0.001 for each). For residencies located in states where marijuana was illegal, arrest for possession of marijuana as a medical student has a greater negative influence (p = 0.033), than where it is legal.</div></div><div><h3>CONCLUSIONS</h3><div>Legal infractions occurring during college are less consequential than those in medical school. Regardless of the timing, being arrested for drunk and disorderly or marijuana possession had less impact than a DUI, possession of cocaine, methamphetamine or fentanyl.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 1","pages":"Article 103303"},"PeriodicalIF":2.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549845","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}