Recruitment of Young Medical Apprentices (RYOMA) Project: A Comprehensive Surgical Education Program at a Local Academic Institute in Japan

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Scientific Poster Presentations: 2016 Clinical Congress

(pre- and post-course 5-point Likert surveys), knowledge (net performance on pre- and post-course multiple choice exams), and resident perception of the curriculum (post-course 5-point Likert survey). Data were analyzed using ANOVA paired t-tests and Wilcoxon signed rank sum test. RESULTS: Resident knowledge improved overall by 10.9% from 58.9% to 69.8% of questions correct. Junior residents demonstrated significant improvement by 11.9% (p¼0.007). Senior resident knowledge improved but was not significant. Self-efficacy/confidence demonstrated a significant improvement in junior residents with the median confidence level increasing from 2 to 3 (p<0.001); however, senior residents did not report a significant improvement in confidence. Residents scored the overall curriculum usefulness as a median 4/5, the videos 4.5/5, and the readings 4/5. CONCLUSIONS: We demonstrate an improvement in knowledge and self-efficacy/confidence in general surgery residents after a multimedia cadaver lab curriculum. The course was feasible and successfully incorporated into the didactics curriculum. Maternal and Fetal Delivery Outcomes in Pregnancies after Bariatric Surgery: A Meta-Analysis of the Literature Brittanie Young, Samantha Drew, Aliu Sunni, Christopher Ibikunle, MD, FACS Georgia SurgiCare, Loganville, GA INTRODUCTION: Bariatric surgery has become an increasingly common method of weight reduction among obese women. Obesity carries potential pregnancy and postnatal complications. This study aims to evaluate maternal and fetal outcomes after pregnancies after bariatric surgery as compared to the general population obese mothers. METHODS: A systematic review was conducted using studies from Pub Med (2000-2016) with comparative data on the maternal and fetal delivery outcomes following bariatric surgery. The primary outcome analyzed was the rate of Cesarean deliveries. Other outcomes included SGA (small for gestational age), LGA (large for gestational age), macrosomia (>4000g at birth), assisted vaginal delivery, and preterm delivery. The results are expressed as standard difference in means with standard error. Statistical analysis was done using fixed-effects meta-analysis (Comprehensive MetaAnalysis Version 3.3.070 software; Biostat Inc, Englewood, NJ). RESULTS: Five out of 47 studies were assessed for meta-analysis; 4,329 Cesarean sections were recorded in 10,811 post-bariatric women and 133,533 Cesarean sections in 223,573 obese women. The need for Cesarean sections in post-bariatric surgery women was found to be significantly lower when compared to obese women (-0.3800.011, p<0.001). The incidence of LGA (0.5270.114, p<0.001), macrosomia (0.4180.245, p<0.001), SGA (0.4520.116, p<0.0001) and assisted vaginal delivery (-0.0950.039, p<0.014) were significantly reduced in the postbariatric surgery group of women. The incidence of preterm delivery (-0.0400.021, p>0.05) were similar in both groups.

J Am Coll Surg

CONCLUSIONS: Bariatric surgery places the expectant mother at a lower risk of delivery by Cesarean section and excellent fetal outcomes when compared to the general population obese mothers. Prevalence and Causes of Attrition Among Surgical Residents: A Systemic Review and Meta-Analysis Zeyad Khoushhal, MBBS, MPH, Mohamad A Hussain, MD, Elisa F Greco, MD, FRCSC, Andrea Tricco, PhD, Muhammad Mamdani, MPH, PhD, Ori D Rotstein, MD, FACS, Najma A Ahmed, MD, FACS, Moha Al-Omran, MD Applied Health Research Centre, St Michael’s Hospital, Toronto, ON INTRODUCTION: Previous studies suggest wide discrepancies in the rates and causes of attrition among surgical residents. Our aim was to examine the prevalence and drivers of attrition in surgical residency programs. METHODS: We systematically searched Medline, EMBASE, Cochrane, PsycINFO, and ERIC databases for studies reporting on rates and causes of attrition in surgical residents, and the characteristics and destinations of residents that left their training program. Two reviewers independently reviewed the studies and collected the data. We calculated pooled estimates using random effects meta-analyses where appropriate. RESULTS: Overall, we included 31 studies that reported on residents from general surgery (n¼22), obstetrics/gynecology (n¼4), neurosurgery (n¼2), ophthalmology (n¼1), otolaryngology (n¼1) and orthopedic (n¼1) programs. The pooled estimate for the overall attrition rate among general surgery residents was 16% (95% CI, 14%-19%), with significant between-study variation (I2¼96.3%; p<0.001). Attrition was higher among female general surgery residents (25% [95% CI, 16%-34%]) compared to male (15% [95% CI, 11-20%]), and most residents left after their first postgraduate year (49% [95% CI, 40%-58%]). Departing residents often relocated to another general surgery program (20% [95% CI, 15%24%]) or switched into anesthesia (13% [95% CI, 11%-16%]). The most common reported causes of attrition were uncontrollable lifestyle and transferring to another specialty. No conclusions were drawn about other surgical specialties due to a paucity of data. CONCLUSIONS: General surgery programs have relatively high attrition, with females more likely to leave their training programs than males. Residents most often relocate or switch to another specialty after the first postgraduate year due to lifestyle-related issues. Recruitment of Young Medical Apprentices (RYOMA) Project: A Comprehensive Surgical Education Program at a Local Academic Institute in Japan Atsushi Nanashima, MD Nagasaki University, Nagasaki, Japan, University of Miyazaki, Miyazaki, Japan

Vol. 223, No. 4S2, October 2016

INTRODUCTION: The number of young surgeons in Japan has significantly decreased, which may lead to future proble. Comprehensive training programs for young surgeons are needed. We developed a locally specific education program called the Recruitment of Young Medical Apprentices (RYOMA) project. METHODS: We performed this project between January 2008 and 2013 on fourth to sixth year medical students and internship doctors. RYOMA project included step-by-step surgical education programs on open and scopic procedures as dry, wet, and animal laboratory training. Our goal was to increase the number of young and specialist surgeons. RESULTS: Based on an interview questionnaire answered by 90 medical students, most young students were interested in surgical training. The most positive opinions regarding the field of surgery were the impressive results achieved with surgery, while negative opinions included the difficulty of the surgical skill, physical concerns related to difficult work environments, and severity of surgical procedures. The present program began to resolve negative opinions through adequate training or simulations. Of the 19 medical students and internship doctors who attended the RYOMA project in 2008, 17 trainees (90%) were satisfied with this special surgical program and 16 (88%) showed interest in becoming surgeons. The number of participants considering the field of surgery increased between 2008 and 2013. Nineteen of 23 participants (83%) had a positive opinion of the program after the training. CONCLUSIONS: Gaining experience in surgical training from an early stage in medical school and step-by-step authorized education by teaching staff are important for recruiting students and increasing the number of young surgeons.

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composition. Both groups felt that electronic resources were “very” or “extremely useful” (76.5% vs 85%, p¼0.61). There was no difference in preference of electronic vs print resources over time (p¼0.28). Smartphone usefulness increased from 60.8% to 65% (p¼0.02). A majority (55%) also felt that electronic usage increased. While the average total time online was unchanged (p¼0.09), there was a significant increase in time spent online for academic purposes (283 vs 161 minutes, p¼0.046). CONCLUSIONS: Surgical residents perceive electronic educational resources to be as useful as printed materials. Department-sponsored 24-hour access to these resources results in increased utilization. The impact of electronic versus print materials on academic and clinical performance remains to be determined.

Impact of Resident Participation on Surgical Efficiency and Outcomes in General Surgery Kelli Aibel, Jared A Blau, Scott T Hollenbeck, MD, FACS Duke University, Durham, NC INTRODUCTION: Our goal is to evaluate the growing pressures for surgeons to be efficient, decrease complications, and teach residents. METHODS: The American College of Surgeons (ACS)-NSQIP database was queried to identify 4 isolated surgical procedures by CPT code. These were laparoscopic cholecystectomy (LC), inguinal hernia (IH), carotid endarterectomy (CE) and right hemicolectomy (RH). Cases were categorized based on presence or absence of a resident. Means and proportions were compared using the t-test with p<0.05 representing a significance.

Textbook or E-book? Role of Electronic Resources in Surgical Education Lindsay Hessler, MD, Sarwat B Ahmad, MD, Rami Kantar, MD, Stephen M Kavic, MD, FACS University of Maryland Medical Center, Baltimore, MD, University of Maryland School of Medicine, Baltimore, MD

RESULTS: A total of 13,870 cases met inclusion criteria. Patient demographics did not significantly differ in 15 of the 20 parameters tested. For LC, IH, and CE operative times were significantly different. For RH there was no significant difference in operative times based on resident participation. The rate of complications differed based on resident participation in 3 of the 4 selected cases (Table).

INTRODUCTION: In the current electronic era, surgical residents have a wide range of educational resources at their disposal. Whether the availability of online tools has improved surgical education is unknown. We hypothesize that access to electronic educational resources is useful and academically beneficial for surgical residents.

Table. OP Time and Complications

Procedure

METHODS: During the 2014-2015 academic year, 24-hour access to online general surgery textbooks and other educational materials was provided to surgical residents at a single institution. During pre- and post-electronic access periods, residents were asked to report frequency of resource utilization, study preferences, and time spent in online study. Data were analyzed on 10-point Likert scales using chi-square and independent sample t-tests. RESULTS: Surveys from 51 pre-electronic access residents (58.8% male, 51% PGY 1-2) were compared to 20 responders 1-year post-electronic access with similar sex (p¼0.7) and PGY (p¼0.6)

LC e resident LC e resident + IH e resident IH e resident + CE e resident CE e resident + RH e resident RH e resident +

Complications OP Time (% of patients (Mean) p Value* with) p Value*

60.6 76.1 54.2 66.5 108.2 131.2 125.5 131.4

<0.0001 <0.0001 <0.0001 0.62

1.02% 4.5% 5.4% 1.6% 6.9% 13.2% 37.5% 65.0%

0.02 0.008 0.13 0.008

(-) ¼ no resident in the case, (+) ¼ resident participated in the case. *T-test where p<0.05 represents statistical significance.