Journal of surgical education
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The scope of patient management increasingly crosses the defined lines of multiple medical specialties and services to meet patient needs. Concurrently, many hospitals and health-care systems have adapted new multidisciplinary team structures that provide patient-centric care as opposed to the more traditional discipline-centered delivery of care. As health care continues to evolve, the use of teams becomes even more critical in allowing interdependence between multiple disciplines to provide excellent care delivery and ongoing patient management. ⋯ Most importantly, we wish to emphasize that health care, both philosophically and practically, is delivered best through high-performance teams. For such teams to perform properly, the organizational environment must support the team concept tangibly. In concert, we believe the best manner in which to cultivate knowledge and performance of the health-care organizational mission and goals is by using such teams.
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Much is still to be learned about the assessment of simulation-based surgical skills training. However, assessing surgery skills through simulation is a new horizon in medical education. ⋯ Using simulators (both warm and cold) as a means to assess trainees has been established. However, also problems concerning the validity and reliability of such simulation-based assessment tools exist, particularly in surgery, that may need to be investigated even more to decide whether to use them as a tool for assessing the performance of surgical residents.
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The Mount Sinai Surgical Residency program uses physician assistants and nurse practitioners, jointly termed non-physician practitioners (NPPs), to adhere to the 80-hour work-week restrictions implemented by Accreditation Council of Graduate Medical Education (ACGME) resident duty hour requirements initiated in 2003. A survey was performed to determine how the integration of NPPs into the surgical subspecialty teams has affected surgical residents' perceptions of their education and overall residency experience. We review the roles of NPPs within surgical specialty teams as well as our survey findings about NPP and resident impressions about the NPP role. ⋯ We found that at our institution, residents and NPPs agree that they work well together and that NPPs positively contribute to resident education. We recommend a service-specific orientation for the residents with each rotation to clarify NPP responsibilities and functions, thereby maximizing collaboration. With a firm understanding of the various roles of the NPPs, a cohesive, multidisciplinary group can be attained while enhancing surgical education.
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Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons. ⋯ Although general surgical residencies prepare residents well technically, they do not seem to be training residents adequately in the business of medicine. This training can be conducted by attendings, local attorneys, office managers, and past residents with the expectation that job relocations can decrease and surgeon career satisfaction can increase.