Coding Education in Residency and in Practice Improves Accuracy of Coding in Orthopedic Surgery.

Construct Validity of a Simple Laparoscopic Ovarian Cystectomy Model Using a Validated Objective Structured Assessment of Technical Skills

Measuring Surgical Trainee Perceptions to Assess the Operating Room Educational Environment

Exploring Entrustment: Housestaff Autonomy and Patient Readmission

Can an Orthopedic Hip Fracture Simulator Advance Orthopedic Residents’ Hip Fracture Fixation Skills to an Expert Level?

There are currently few data regarding the rate of learning for medical students and residents during a single clinical rotation. In this study, learner knowledge acquisition for medical students, and junior and senior residents, was evaluated during a single rotation in a surgical intensive care unit. Multiple-choice and short-answer question examinations (n = 261) were administered to students, and junior and senior residents (n = 103) at variable times during their rotation, over a period of 3 years. Results demonstrated that examination scores improved as ICU experience increased, in both students and junior residents, but not in senior residents. The learning curve in juniors reached a plateau after 7 weeks' experience. Post-call status had no impact on examination results. The plateau in examination scores in juniors and the lack of increase in senior residents have implications regarding planning the length of rotations during residency education.

A Needs Assessment of Video-based Education Resources Among General Surgery Residents

Ultrasound (US) is fast becoming an extension of the physical examination in most surgical settings. Unfortunately, few residency programs offer a formal US training curriculum to their general surgical residents. This study aimed to assess the efficacy of a formal US training module for general surgery residents. We studied the degree of improvement observed between junior and senior residents. A training-based study was conducted to evaluate baseline knowledge and skills. Subsequently, a formal didactic and practical training program for our surgery residents was instituted. Residents were then scored in various categories. A total of 18 surgical residents comprising 10 junior and 8 senior residents completed our US training module. There was no significant improvement in the scores of the senior resident group. In the junior group, the written test, image detection, optimization, and interpretation categories improved significantly after completion of the training module. Comparison of improvement in scores between junior and senior residents revealed a significantly better improvement in the junior group than in the senior group. Early training of surgical residents can significantly improve US performance in junior residents. This early training has the benefit of increased utilization of bedside US for diagnostic and procedural purposes. Interestingly, even without formal training, skill acquisition of senior residents is noted to occur during modern surgical training.

Perioperative Reflection: An Understudied Yet Common Practice Among Surgical Residents

Wound construction is a critical step in phacoemulsification. Using anterior segment optical coherence tomography (AS-OCT), we compared the morphological features and complications of main incisions made by junior or senior residents during phacoemulsification. This cross-sectional comparative study included eyes with senile cataracts that underwent uneventful phacoemulsification with a clear corneal incision made by seven senior and eight junior ophthalmology residents. All eyes underwent postoperative image acquisition using AS-OCT on day one and at three months, examining for morphological features and potential complications of the main incision. We included 50 eyes of 50 patients with a male-to-female ratio of 22 (44%) to 28 (56%); 26 (52%) were operated on by junior residents and 24 (48%) by seniors. The mean geometric features of the main incisions and the frequency of early and late wound complications were comparable between the two groups (all P > 0.05). A significant correlation was found between the incision length and angle with the superior (r = + 0.80; P < 0.001 and r = - 0.63; P < 0.001, respectively) and inferior (r = + 0.84; P < 0.001 and r = - 0.68; P < 0.001, respectively) areas of the incision, as well as between the length and angle of incision (r = - 0.74; P < 0.001). The number of planes in the wound architecture was not significantly different according to senior or junior resident status (P > 0.05). Although the number of eyes with stromal hydration was significantly greater for junior residents than for seniors (P < 0.001), the corneal thickness at the entrance to the cornea or the anterior chamber, presence of endothelial wound gaping, and Descemet's membrane detachment were comparable between eyes with and without stromal hydration (all P > 0.05). At three months, 29 (58%) patients returned for examination, in whom seven (24%) had late wound complications. This study found no significant differences in the performances of junior and senior residents in terms of wound construction or its associated complications. However, considering the overall rate of some observed wound-related complications, we recommended revision of the resident educational curriculum concerning the structure and complications of the main incision.

How much guidance is given in the operating room? Factors influencing faculty self-reports, resident perceptions, and faculty/resident agreement

The rates of opioid abuse and overdose in America have risen in parallel with the rates of opioid prescribing by physicians. As such, we sought to examine the prescribing practices among plastic surgery attendings and trainees to determine the need for more thorough education. A survey was distributed to all ACGME-accredited plastic surgery residency programs and included questions regarding opioid-prescribing practices and self-rated ability pertaining to opioid management. Trends in prescribing practices based on prescriber position were analyzed using cumulative odds ordinal logistic regression with proportional odds and Chi-squared tests for ordinal and nominal variables, respectively. We received 78 responses with a wide geographical representation from plastic surgery residency programs: 59% of respondents were male and 39.7% female, 29.5% were attendings, 26.9% senior residents, 29.5% junior residents, and 14.1% interns. Compared with attendings, interns prescribe fewer pills (p < 0.05) and were significantly more likely to prescribe oxycodone (p < 0.03). Junior residents were 4.49 times more likely (p = 0.012) and senior residents 3.65 times more likely (p = 0.029) to prescribe additional opioids to avoid phone calls and follow-up visits. Interns and senior residents were significantly less comfortable than attendings in managing patients requesting additional opioids (p < 0.02). The results of this survey demonstrate that knowledge deficits do exist among trainees, and that trainees are significantly less comfortable than their attending counterparts with opioid prescribing and patient management. Therefore, the implementation of a thorough postoperative pain management education in residency may be a cogent strategy in mitigating the opioid crisis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

We tested whether residents would improve in fluoroscopy knowledge and ability after using an inexpensive novel pelvis model and educational website. Twenty-four orthopaedic residents were recruited from three United States residency programs and randomised into two groups with equal numbers of juniors and seniors. The OrthoAcademy group received educational materials from a website ( www.theorthoacademy.com ), whereas the control group did not. Survey scores, radiograph scores, number of fluoroscopic images taken, and overall radiation exposure were compared (1) between control and OrthoAcademy groups and (2) between junior and senior residents. Both groups had higher radiograph scores at the second round of testing than at the first (P =.004). The OrthoAcademy group had higher post-test than pre-test knowledge survey scores (P =.045), whereas the control group did not (P =.54). However, the OrthoAcademy group did not have higher radiograph scores between tests (P =.15), whereas the control group did (P =.01). Junior residents had higher second-round than first-round radiograph scores (P =.005) and survey scores (P =.006), whereas senior residents did not (P =.24 radiograph scores) (P =.30 survey scores). Testing residents with this novel pelvis model improved the quality of the fluoroscopic images obtained by the residents, especially juniors. This study highlighted the need for more accessible resources for residents to learn about obtaining these images.

Using Concurrent Complication Reporting to Evaluate Resident Critical Thinking and Enhance Adult Learning

Grantsmanship Refined: Evaluation and Training of Efficacy in Residents (Greater Study).

The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.