Impact of fellow compared to resident assistance on outcomes of minimally invasive surgery.

Introduction: As fellowship training after general surgery residency has become increasingly common, the impact on resident education must be considered. Patient safety and procedure outcomes are often used as justification by attendings who favor fellows over residents in certain minimally invasive surgery (MIS) operations. The aim of the present study was to compare the impact of trainee level on the outcomes of selected MIS operations to determine if giving preference to fellows on grounds of outcomes is warranted.

Surgical management of obstructing clot at the jejunojejunostomy after gastric bypass: a single center experience and literature review.

Background: Roux-en-Y gastric bypass is a proven treatment for morbid obesity and its sequelae. Gastric bypass has a safe risk profile, but postoperative complications can be seen. We report on 10 cases of postoperative bleeding causing an obstructing clot at the jejunojejunostomy (JJ) occurring over a 9-year period.

A Structured Mentorship Elective Deepens Personal Connections and Increases Scholarly Achievements of Senior Surgery Residents.

Objectives: Surgery residents have few opportunities to work closely with attending surgeons or conduct research during clinical time. We hypothesized that a mentorship elective with a required research project would benefit residents' career development, including their personal connections with faculty mentors, and would help them build their academic portfolio.

Design: We created a mentorship elective designed as a one-on-one apprenticeship.

Novel Low-Cost, Low-Fidelity Hemorrhoidectomy Task Trainers.

Objective: Develop and describe a set of low-cost hemorrhoidectomy task trainer prototypes in the setting of inadequate junior resident surgical skill preparation for anorectal cases.

Design: This is a study comparing expert and novice performance and opinions. Three task trainers were developed to simulate dissecting, knot-tying, and suturing in a confined space, like the anus.

Oral examinations in undergraduate medical education - What is the 'value added' to evaluation?

Background: Given the long tradition of oral examinations in surgical training, surgical clerkships continue to use oral examinations to evaluate medical students even though the value of oral examination at the post-graduate level has been questioned. The key issue in the context of undergraduate surgical training then is to understand value of the oral examination in assessment. The goal of this study is to clarify what oral examinations do, or appear to, test and how this complements other methods of assessment.

Resident involvement in minimally-invasive vs. open procedures.

Background: The objective of this study was to evaluate the impact of resident involvement on surgical outcomes in laparoscopic compared to open procedures.

Methods: The American College of Surgeons National Surgical Quality Improvement Program 2007-2012 was queried for open and laparoscopic ventral hernia repair (VHR), inguinal hernia repair (IHR), splenectomy, colectomy, or cholecystectomy (CCY). Multivariable regression analyses were performed to assess the impact of resident involvement on surgical outcomes.

Resident-as-Teacher Programs in General Surgery Residency: Context and Characterization.

Objective: Teaching medical students and junior residents are key components of a surgical resident's role. How surgical residents are formally prepared for their teaching role is not well described. The aim of this study was to characterize the status of formal Resident-as-Teacher Programs (RATPs) in U.

Resident-as-teacher programs in general surgery residency - A review of published curricula.

Introduction: The Liaison Committee on Medical Education (LCME) requires that residents are trained to fulfill their educational duties toward medical students. This study reviews the literature on resident-as-teacher programs (RATPs) aimed at surgical residents.

Methods: Literature search with MeSH terms internship, residency, general surgery, teaching, education, and curriculum was performed using PubMed, Embase, Web of Science, and ERIC.

An appraisal of the learning curve in robotic general surgery.

Background: Robotic-assisted surgery is used with increasing frequency in general surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic general surgery to inform adopters of the technology.

An Effort to Develop an Algorithm to Target Abdominal CT Scans for Patients After Gastric Bypass.

Abdominal CT (abdCT) scans are frequently ordered for Roux-en-Y gastric bypass (RYGB) patients presenting to the emergency department (ED) with abdominal pain, but often do not reveal intra-abdominal pathology. We aimed to develop an algorithm for rational ordering of abdCTs. We retrospectively reviewed our institution's RYGB patients presenting acutely with abdominal pain, documenting clinical and laboratory data, and scan results.

What is the BMI threshold for open ventral hernia repair?

Background: Overweight and obese patients are often asked to lose weight prior to ventral hernia repair (VHR). Improved outcomes are the reasons behind this strategy. Data regarding weight loss targets are scant, and it is not known at what body mass index (BMI) threshold postoperative complications increase.

Gastric bypass reversal: a 7-year experience.

Background: After gastric bypass, some patients develop conditions that ultimately require reversal of the bypass. There are currently few publications on the topic to guide clinicians.

Objectives: To describe the indications, techniques, and outcomes for gastric bypass reversal.

Impact of a Surgeon-Led Peripherally Inserted Central Venous Catheter Team on Peripherally Inserted Central Venous Catheter-Related Complications and Costs.

Background: Peripherally inserted central venous catheters (PICCs) are popular for a broad range of indications. As with other forms of central access, PICC use can be associated with serious and potentially costly complications. In 2000, in response to the rising popularity of PICC use, a surgeon-led team was created to steward their placement.

Exploring the Content of Intraoperative Teaching.

Introduction: Much teaching to surgical residents takes place in the operating room (OR). The explicit content of what is taught in the OR, however, has not previously been described. This study investigated the content of what is taught in the OR, specifically during laparoscopic cholecystectomies (LCs), for which a cognitive task analysis (CTA), explicitly delineating individual steps, was available in the literature.

Using spaced education to teach interns about teaching skills.

Background: Despite limited preparation and knowledge base, surgical interns have important teaching responsibilities. Nevertheless, few faculty development programs are aimed at interns.

Methods: Succinct teaching skill content was electronically distributed over time (spaced education) to interns in academic year 2010/2011.

Using an Objective Structured Clinical Examination to test adherence to Joint Commission National Patient Safety Goal--associated behaviors.

Background: A study was conducted at a tertiary care academic medical center to assess a simulation-based, single-station Objective Structured Clinical Examination (OSCE) designed to evaluate intern trainees' familiarity with and adherence to behaviors associated with Joint Commission National Patient Safety Goals and The Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery.

Method: Subjects were interns, from all disciplines, completing basic skills training during intern orientation. The OSCE scenario was designed to assess 13 behaviors associated with four National Patient Safety Goals (1, 2, 3, and 7) from 2009 and 2010 and the Universal Protocol.

Residents can successfully teach basic surgical skills in the simulation center.

Objectives: Basic surgical skills are frequently taught to surgical interns in simulation centers. Faculty recruitment for teaching of these sessions can be difficult. The goal of this study was to determine whether senior surgical residents can effectively teach basic surgical skills to provide an alternative to faculty-led instruction.

Master surgeons' operative teaching philosophies: a qualitative analysis of parallels to learning theory.

Objectives: Practicing within the Halstedian model of surgical education, academic surgeons serve dual roles as physicians to their patients and educators of their trainees. Despite this significant responsibility, few surgeons receive formal training in educational theory to inform their practice. The goal of this work was to gain an understanding of how master surgeons approach teaching uncommon and highly complex operations and to determine the educational constructs that frame their teaching philosophies and approaches.

Spaced education faculty development may not improve faculty teaching performance ratings in a surgery department.

Objectives: To determine the effectiveness of spaced education as a faculty development tool designed to improve teaching skills in a surgery department.

Design: Faculty members were randomized to receive either weekly spaced education e-mails with content designed to improve teaching skills (group A) or no e-mails (group B). Using qualitative and quantitative surveys, we assessed both medical students' perception of faculty members' teaching effectiveness and faculty members' perception of the usefulness of the spaced education e-mails.

Feasibility and impact of a case-based palliative care workshop for general surgery residents.

Background: The American Board of Surgery has emphasized that palliative care education should be included in surgical training. The few formal curricula for teaching palliative care, although effective, are time-intensive and have low longitudinal participation rates. The aim of this project was to design a feasible and effective palliative care intervention for general surgery residency training.

Mini-clinical evaluation exercise as a student assessment tool in a surgery clerkship: lessons learned from a 5-year experience.

Background: The mini-clinical evaluation exercise (mini-CEX) used for clinical skill assessment in internal medicine provides in-depth assessment of single clinical encounters. The goals of this study were to determine the feasibility and value of implementation of the mini-CEX in a surgery clerkship.

Methods: Retrospective review of mini-CEX evaluations collected for surgery clerkship students at our institution between 2005 and 2010.

Preoperative learning goals set by surgical residents and faculty.

Background: The operating room (OR) remains the main teaching venue for surgical trainees. The OR is considered a pure-discovery learning environment; the downsides of this can be putatively overcome when faculty and trainee arrive at a shared understanding of learning. This study aimed to better understand preoperative learning goals to identify areas of commonalities and potential barrier to intraoperative teaching.