Articles: medical-knowledge.
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Review Comparative Study
Operative experience of surgery residents: trends and challenges.
To evaluate trends in operative experience and to determine the effect of establishing the Surgical Council on Resident Education (SCORE) operative classification system on changes in operative volume among graduating surgery residents. ⋯ The operative volume of graduating surgical residents has increased by 21% since 2005; however, the number of operations done 10 times or greater has not changed. Although open cavitary procedures continue to decline, there has been a large increase in endoscopy, complex laparoscopic, and other major operations. Some essential-common operations continue to be performed infrequently. These results suggest that education in the operating room must improve and alternate methods for teaching infrequently performed procedures are needed.
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A mechanism for more effective and comprehensive assessment of surgical residents' performance in the operating room (OR) is needed, especially in light of the new requirements issued by the American Board of Surgery. Furthermore, there is an increased awareness that assessments need to be more meaningful by including not only procedure-specific and general technical skills, but also nontechnical skills (NOTECHS), such as teamwork and communication skills. Our aims were to develop a methodology and create a tool that comprehensively assesses residents' operative performance. ⋯ This is a feasible, valid, and reliable assessment tool for the comprehensive evaluation of resident performance in the OR. We plan to use this tool to assess resident operative skill development and to improve direct resident feedback.
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Comparative Study
Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents' case logs from 2000 to 2011.
Since the introduction of laparoscopic surgery for cholecystectomy in 1989, the growth of minimally invasive surgery (MIS) has increased significantly in the United States. There is a growing concern that the pendulum has now shifted too far toward MIS and that current general surgery residents' exposure to open abdominal procedures is lacking. ⋯ The performance of open procedures in general surgery residency has declined significantly in the past 12 years. The effect of the decline in open cases in surgical training and practice remains to be determined.
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Our general surgery residency (46 residents, graduating 6 categoricals per year) offers the opportunity for 2 categorical residents at the end of their second year to choose a 2-year research track. Academic productivity for the remaining categorical residents was dependent on personal interest and time investment. To increase academic productivity within the residency, a mandatory research requirement was implemented in July 2010. We sought to examine the effect of this annual individual requirement. ⋯ The institution of a mandatory research requirement resulted in a 3-fold increase in scientific presentations in our surgical residency. We believe that the mandatory nature of the program is a key component to its success. We expect to see an increase in the number of publications as a result of this research requirement in the next several years.
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Comparative Study
A comparison of unguided vs guided case-based instruction on the surgery clerkship.
Guided case-based instruction is an effective and efficient means of learning for third year medical students on the surgery clerkship. Compared with an unguided format for teaching biliary disease, we observed greater student satisfaction as well as a more efficient utilization of student as well as faculty time with the guided instruction. ⋯ G-CBI is more suited for the surgery clerkship than the UG-CBI utilized during the first 2 years of medical school. Lack of a clinical knowledge base among the students rotating on the surgery clerkship as well as time limitations for both the student and clinical faculty favor this more efficient means of learning.