Supervision of Surgical Trainees During Operative Procedures: Implementation of a Formal Preoperative Surgical Checklist (original) (raw)
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ANZ Journal of Surgery, 2007
Traditionally, surgical trainees have acquired their technical skills whilst working in the operating theatre alongside more senior surgeons in an apprenticeship model. Recently, changes in surgical practice have challenged this traditional approach, including reduced working hours, decreased availability of operating theatre time, increased cost of operating theatre time and increasing complexity of surgical procedures. Most importantly, public opinion is increasingly resistant to having patients used as teaching material. Moving forward in the 21st century, we need to develop a new model of technical skills acquisition. Surgical simulation offers a means of practicing surgical skills in a laboratory environment with no risk to patients. Simulators range from simple bench models, which are relatively inexpensive, to high tech virtual reality simulators. The Royal College of Surgeons in Ireland has developed a syllabus for operative surgery which is based on simulation and all trainees attend the National Surgical Training Centre on a regular recurrent basis, six times each year, for concentrated skills training. Simulation allows the standardisation of teaching technical skills and, most importantly, standardisation of assessment of technical skills. Furthermore, simulation offers trainees "permission to make mistakes" -a valuable learning exercise. Our trainees are assessed in the laboratory setting and must demonstrate proficiency before moving to the next stage of training (proficiency based progression). Simulation has played a key role in this process.
Journal of Surgical Education, 2009
BACKGROUND: We developed a convenient mechanism, Surgical Training and Assessment Tool (STAT), to accomplish detailed, continuous analysis of surgical trainees' operative abilities, and a simple method, Quality Based Surgical Training (QBST) for implementing it. METHODS: Using a web-accessed computer program, attending physicians and trainees independently assessed the trainee's operative performance after every operative (training) case. Global attributes of surgical knowledge, skill, and independence were assessed as well as the key technical maneuvers of each operation. A system of hierarchical, expandable menus specific to each of hundreds of different surgical procedures allowed the assessments to be made as detailed or as general as the users felt were necessary. In addition, freehand, unscripted commentary was recorded via an optional "remarks" box feature. Finally, an independently chosen, "overall" grade scaled F through Aϩ concluded each assessment. RESULTS: Over a 31 month period, 72 different users (52 trainees, 20 attending physicians) submitted 3849 performance assessments on 2424 cases, including 132 different case types and amassing 68,260 distinct data points. The mean number of data points per trainee was 1313; the median time spent per assessment was 60 seconds. Graphic displays allowed formative review of individual cases in real time, and summative review of long term trends. Appraisals of knowledge, skill, and independence were strongly correlated with and independently predic-tive of the overall competency grade (model r 2 ϭ 0.68; test of predictive significance p Ͻ 0.001 for each rating). Trainee and attending physician scores were highly correlated (Ͼ 0.7) with one another. CONCLUSIONS: QBST/STAT achieves detailed, continuous analysis of surgical trainees' operative abilities, and facilitates timely, specific, and thorough feedback regarding their performance in theater. QBST/STAT promotes trainee selfreflection and generation of continuous, transparent, iterative training goals.
Identifying quality indicators of surgical training: A national survey
The Laryngoscope, 2015
Evidence shows a positive association between quality of surgical training received and patient outcomes. Traditionally, improved patient outcomes are linked with increased operative volume. However, generalizing this finding to surgeons in training is unclear. In addition, reduced exposure due to work-hour restrictions calls for alternative methods to determine the quality of training. The purpose of this study was to identify the indicators of high-quality training by surveying the trainees and trainers. A questionnaire was developed based on input from faculty and previous studies. The survey was divided into three sections asking about the indicators of quality training, methods to measure them, and interventions for improvement. The questionnaire was administered to program directors (PDs) and senior residents of otolaryngology training programs nationwide. The strongest indicators of quality training that were agreed upon by both residents and PDs were having faculty developme...
Workplace-based assessment: assessing technical skill throughout the continuum of surgical training
ANZ Journal of Surgery, 2009
The Royal Colleges of Surgeons and Surgical Specialty Associations in the UK have introduced competence-based syllabi and curricula for surgical training. The syllabi of the Intercollegiate Surgical Curriculum Programme (ISCP) and Orthopaedic Curriculum and Assessment Programme (OCAP) define the core competencies, that is, the observable and measureable behaviours required of a surgical trainee. The curricula define when, where and how these will be assessed. Procedure-based assessment (PBA) has been adopted as the principal method of assessing surgical skills. It combines competencies specific to the procedure with generic competencies such as safe handling of instruments. It covers the entire procedure, including preoperative and postoperative planning. A global summary of the level at which the trainee performed the assessed elements of the procedure is also included. The form has been designed to be completed quickly by the assessor (clinical supervisor) and fed-back to the trainee between operations.
Evidence in surgical training – a review
Innovative Surgical Sciences, 2019
The first residency programs for surgical training were introduced in Germany in the late 1880s and adopted in 1889 by William Halsted in the United States [Cameron JL. William Stewart Halsted. Our surgical heritage. Ann Surg 1997;225:445–58.]. Since then, surgical education has evolved from a sheer volume of exposure to structured curricula, and at the moment, due to work time restrictions, surgical education is discussed on an international level. The reported effect of limited working hours on operative case volume has been variable [McKendy KM, Watanabe Y, Lee L, Bilgic E, Enani G, Feldman LS, et al. Perioperative feedback in surgical training: a systematic review. Am J Surg 2017;214:117–26.]. Experienced surgeons fear that residents do not have sufficient exposure to standard procedures. This may reduce the residents’ responsibility for the treatment of the patient and even lead to a reduced autonomy at the end of the residency. Surgical education does not only require learning...
International Journal of Surgery, 2014
The WHO Surgical Safety Checklist aims to reduce the risk of surgery by targeting non-technical skills in the operating theatre. Pilot studies have already demonstrated the impact that the checklist has had on patient outcomes. This study aims to further analyze the benefits of implementing the checklist, specifically looking at patient safety. In doing so, reasons for poor outcomes following checklist use have also been identified. The WHO Surgical Safety Checklist has been shown to significantly improve patient outcomes subsequent to surgery.
What is Known About the Attributes of a Successful Surgical Trainer? A Systematic Review
Journal of surgical education, 2017
Surgical training has been subject to significant upheaval in recent years with an increasingly rigorous assessment regimen for trainees. The assessment of surgical trainers is less well evolved by comparison. Recent proposals from the Royal College of Surgeons of England recommend "professionalising the trainers." However, they do not suggest any accepted or validated methods of trainer assessment, nor do they indicate how these might be implemented and monitored in a real-world training program to determine their effect on trainee outcomes. To determine what is known about the attributes of successful surgical trainers. We conducted a systematic review of the scientific literature using the preferred reporting items for systematic reviews and meta-analyses and Cochrane guidelines of the Medline database using specific search criteria. The qualitative analysis involved grouping trainer attributes together into "themes" within 4 "super-themes." Each the...
2021
BackgroundSurgical education evolves through time, and it's related to the number and type of procedures that residents are exposed to. Hour regulations in resident training affect learning curves, and recording surgical exposure remains to be an effective method to assess and keep track of surgical training. Web-based logbooks have proven to be useful to monitor and follow surgical training in general surgery residents. This study aims to evaluate surgical proficiency in general surgery residents by quantifying their operative exposure and experience by using data collected in a web-based logbook.MethodsA retrospective study from a prospectively collected data base between September 2018 to September 2019 was performed. All surgery residents were surveyed.ResultsA total of 13160 surgical procedures were performed by residents. Laparoscopic cholecystectomy was the most frequent procedure performed 7404 times (52,6%), followed by open appendectomy in 34,6%. Trauma context procedu...