Search

Background Lack of transparency and meaningful assessment in surgical residency has led to inconsistent intraoperative entrustment and highly variable trainee competence at graduation. The relationship between faculty entrustment and resident entrustability on clinical competency remains unclear. We sought to evaluate the dynamic between entrustment/entrustability and clinical competency in general surgery residency. Methods Intraoperative observations were conducted across a 22-month period at an academic tertiary center. Entrustment/entrustability were measured using OpTrust. Clinical competencies were appraised via ACGME Milestones and Objective Structured Assessment of Technical Skill (OSATS) scores. Mixed effects linear regression was used to investigate the relationship among overall ACGME Milestone scores, OSATS domain scores, and overall OpTrust scores. Results Overall OpTrust scores significantly correlated with overall Milestone scores and multiple OSATS score domains. Conclusions OpTrust demonstrated a positive association between ACGME general surgery Milestones and OSATS scores. Overall, OpTrust may help optimize intraoperative faculty entrustment and resident entrustability, facilitating surgical trainee success during residency.

Background Changes in the surgical training landscape have sparked an interest in developing new educational models anchored on entrustment assessment. We sought to optimize the validated OpTrust entrustment assessment tool by comparing ratings from short-course video reviews to previously validated intraoperative assessments. Methods Entrustment assessment scores for video-based and 1-h (short-course) observations were compared to previously validated intraoperative assessment scores. Faculty and residents were surveyed for their perceptions related to operative observation. Results There was a strong association between entrustment scores when comparing in-person to video-based observations (R2 = 0.76–0.84, p 97%) felt observation did not negatively impact operative experience. Conclusions Assessment of entrustment behaviors using short-course video review provides a feasible approach to intraoperative assessment. This latest application of OpTrust allows for the tool to be incorporated into surgical training programs across a variety of environments.

Background Increasing focus on more granular assessment in medical education has led to more lengthy instruments, with concern that the increased complexity undermines the utility of these tools. This study evaluated the relative contribution of individual questions in an assessment of resident performance and a faculty performance evaluation by residents. Methods The authors performed factor analysis on the individual items in the resident assessment instrument (3,009 assessments of 71 residents) and faculty evaluations (7,328 evaluations of 61 faculty) collected from 2006 to 2012. Results Factor analysis of the resident assessment tool revealed that 1 component was responsible for 96.6% of the variance. This component encompassed each question from the assessment form, and could also be termed "overall resident competency." Factor analysis of the attending evaluation form revealed 2 unique components, representing "clinical care" and "interpersonal skills," which accounted for 89.9% of variance. Conclusions Three components accounted for 90% to 97% of the observed variance in our analysis. Factor analysis represents a useful strategy for analyzing the utility of data obtained from individual items in the assessment and evaluation instruments.

Background The present study was undertaken to determine if psychomotor and visual-spatial abilities improve as a result of surgical training or are enhanced at baseline in those individuals choosing a surgical career. Methods Medical students entering a surgical field and practicing surgeons performed a series of neuropsychologic tests. Performance was compared between surgeon groups, as well as with normative aged-matched controls. Results An age-related decline was noted in the performance of all exercises, with the medical student group outperforming the midcareer surgeons, who in turn outperformed the senior surgeons. Interestingly, however, all 3 groups significantly outperformed their normative control groups on some or all tasks. Conclusions Improved visual memory and psychomotor performance compared with normative controls appears to be present at baseline rather than resulting from surgical training. Decline in performance with age is observed, however, and this should be considered when an older surgeon is learning new visually complex procedures.

Background Computer-aided simulators may increase the safety and efficiency of training in laparoscopic surgery. Before implementation of the Immersion LapSim (Gaithersburg, MD) simulator in our training curriculum, we wished to determine its construct validity (ie, whether the simulator could differentiate laparoscopic novices from trainees with greater experience). Methods Subjects were medical students (MS), residents (RES), and laparoscopic faculty (FAC). Subjects performed 10 repetitions of 6 LapSim tasks. The LapSim measured performance in 6 to 10 parameters per task, and performance was compared between groups. Post hoc t tests were used to make pair-wise comparisons among the 3 groups using the Bonferroni technique. Statistical significance was set at P Results The degree of prior laparoscopic experience was reflected in performance on at least 1 parameter for each task. Several patterns of performance between MS, RES, and FAC were observed. Conclusions The LapSim has performance parameters that reliably differentiate between subjects with varying laparoscopic experience. However, some performance parameters do not differentiate between groups. To accurately measure a trainee's skill level, only parameters that sensitively measure the true level of performance should be used.

Background: Recurrent and complex bilateral inguinal hernias are associated with a high recurrence rate. This study evaluates prospectively the efficacy and safety of giant prosthetic reinforcement of the visceral sac (GPRVS) in a group of patients at high risk for recurrence. Methods: Sixty-four patients with 124 inguinal hernias (60 bilateral and 4 unilateral) underwent repair using a large polyester mesh based on Stoppa’s preperitoneal technique. Mean age was 61 years (63 men and 1 woman), and 69% had one or more comorbid medical conditions. Results: Factors predicating a high risk for recurrence included large hernia size (≥5 cm; 31%, 20 of 64), failure of one or more previous repairs (39%, 25 of 64), and chronic obstructive pulmonary disease (28%, 18 of 64). Mean operative time was 115 minutes (range 45 to 235). Mean length of stay was 3 ± 3 days. There were 2 major and 15 minor complications, no mesh infections, and no death. Follow-up was obtained in 95% (61 of 64). After a mean follow-up of 24 months, the recurrence rate was 1% (1 of 124) per inguinal hernia repaired or 2% (1 of 64) per patient. Conclusion: GPRVS is a safe and effective addition to the surgeon’s armamentarium to treat selected patients with recurrent or complex bilateral inguinal hernias.