Journal of surgical education
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Comparative Study
Teamwork training improves the clinical care of trauma patients.
We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes? ⋯ Structured trauma resuscitation team training augmented by simulation improves team performance, resulting in improved efficiency of patient care in the trauma bay. We propose that formal teamwork training augmented by simulation be included in surgery residency training as well as Advanced Trauma Life Support (ATLS).
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To examine the relationship between and predictive nature of United States Medical Licensing Examination(®) (USMLE) Step 1, Step 2, and American Board of Surgery In-Training Examination (ABSITE) postgraduate year (PGY) 1-5 scores from 2 general surgery programs from 1999-2009, with a goal of discerning how Step 1 and Step 2 scores should be used in resident selection and screening. ⋯ USMLE Step 1 scores showed limited utility in predicting later ABSITE scores whereas Step 2 scores were more predictive of all years of ABSITE scores. These findings should prompt additional research into the relationship between examination performances at different points along the general surgery education continuum. In the mean time, general surgery program directors and faculty might do well to examine the relationships between Step 1 and Step 2 scores and ABSITE scores in their own programs to evaluate the usefulness of considering either score when ranking potential residents for selection into a program.
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Comparative Study
Teaching first or teaching last: does the timing matter in simulation-based surgical scenarios?
The optimal timing of instruction in simulation-based scenarios remains unclear. We sought to determine how varying the timing of instruction, either before (teaching first) or after (teaching last) the simulation, affects knowledge outcomes of surgical trainees. ⋯ Participants who received instruction after simulated scenarios achieved higher mean knowledge scores than those who received instruction before simulated scenarios. Cognitive overload, stress, or activation of prior knowledge could all be involved as causal mechanisms.
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The Accreditation Council for Graduate Medical Education (ACGME) uses the resident/fellow survey to assess residency programs compliance with ACGME work hours regulations. Survey results can have significant consequences for residency programs including ACGME letters of warning, shortened program accreditation cycle, immediate full program and institutional site visits, or administrative withdrawal of a program's accreditation. Survey validity was assessed by direct query of general surgery residents who answer the survey each year. ⋯ One hundred thirty-three residents (14%) admitted to not answering the questions truthfully while 352 (37%) of residents felt that the survey did not provide an accurate evaluation of their work hours in residency training. An evaluation tool in which 1 in 7 residents admit to answering the questions falsely and 1 in 5 residents had difficulty interpreting the questions may not be a valid method to evaluate compliance with work hours regulations. Evaluation of work hours regulations compliance should be based on actual work hours data rather than an anonymous survey.
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Simulated patient care has gained acceptance as a medical education tool but is underused in surgical training. To improve resident clinical management in critical situations relevant to the surgical patient, high-fidelity full patient simulation training was instituted at Baystate Medical Center in 2005 and developed during successive years. We define surgical patient simulation as clinical management performed in a high fidelity environment using a manikin simulator. This technique is intended to be specifically modeled experiential learning related to the knowledge, skills, and behaviors that are fundamental to patient care. We report 3 academic years' use of a patient simulation curriculum. ⋯ Patient simulation training was implemented successfully with good compliance in this medium-sized surgical residency training program, but clear challenges were encountered with issues related to the number and range of experiences available per resident, competition with other educational activities, and fidelity and realism. Initial experience suggests that the associated assessment methods can detect predictable improvements in patient management skills across successive residency years, as well as potentially deficient management. Additional work is required to determine the educational effect of this training on resident clinical competency.