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Formal Didactic Training Improves Resident Understanding and Communication of Brain Death
Vol. 225, No. 4S2, October 2017
polytrauma criteria, have been reviewed. One hundred and twenty eight patients were excluded from statistical analysis (incomplete folder, missed values of ISS or imagistic findings, unmentioned maneuvers in ICU or omitted autopsy protocol) and finally from 362 patients remained we retained 47 deaths (13% of patients included). RESULTS: Twelve patients (3.3% admissions) had recognized errors in care that contributed to their death. Important errors patterns included: delayed control of abdominal and intra-thoracic hemorrhage or inadequate recognition (6.3%), failure to secure or protect airway (4.2%), inappropriate management of unstable patients in 8.5% of deaths (long operative procedures, unstable patients sent to CT or to interhospital transfer), missed or delayed diagnoses (4.2%), and inadequate DVT prophylaxis (2.1%). By the internal processing classification of causes, 25% were input errors, 41.7% were intentions errors and 33.3% were execution errors. By phase of trauma management, 16.6% of errors occurred in the ED, 25% during the secondary survey and initial diagnostic, 33.3% during surgery, 16.6% during transport to CT or interhospital transfer, and 8.3% in the ICU stay. CONCLUSIONS: This study combines contemporary understanding of error causation, classification and proposes their remediation with a specific process and protocols. Failure to Graduate from Surgical Residency: A 10-Year Analysis Charalampos Siotos, MD, Rachael M Payne, Scott D Lifchez, MD, FACS, Damon Cooney, MD, Gedge D Rosson, MD, Carisa M Cooney, MPH Johns Hopkins University, Baltimore, MD INTRODUCTION: General surgery and surgical subspecialty residents account for nearly 19% of residents overall; however, little information exists regarding residents who are accepted for surgical residency but never graduate. We sought to evaluate graduation failure rates and associated factors for surgical residents. METHODS: We evaluated information provided by the Accreditation Council for Graduate Medical Education on residents in surgery and surgical subspecialties during the 2007 to 2016 academic years. We extracted total number of graduating residents per year, total number of residents who failed to graduate per year, and reasons for discontinuation of residency. Ratios and proportions were calculated to estimate potential differences among failure-to-graduate rates. RESULTS: When assessing all residents and specialties, an average of one out of every 14.3 residents will not graduate. The ratio is lower for surgical specialties (1:9, range 7.6:1-11.2:1), indicating that surgical residents are less likely to complete residency. From 2007-2015, the greatest decrease in ratio (47%) was shown in general surgery while the greatest increase was in otolaryngology (158%). In cases when reason was known, more than 51% of surgical residents withdrew, 38% transferred to different programs, and 9% were dismissed. CONCLUSIONS: Our findings indicate that surgical residents are more likely to discontinue training prior to completion than
Scientific Poster Presentations: 2017 Clinical Congress
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residents in medical specialties. General surgeons were the most likely and otolaryngology residents the least likely to discontinue training. Additional ratios among subspecialties vary, possibly reflecting differences in residency duration and/or associated burn-out rates. Further studies are required to investigate possible barriers to completing surgical residencies. Formal Didactic Training Improves Resident Understanding and Communication of Brain Death Jeanette Zhang, MD, Andrea L Lubitz, MD, Gweneth D O’Shaughnessy, Andrea Reynolds, Amy J Goldberg, MD, FACS Temple University Hospital, Gift of Life Donor Program, Philadelphia, PA INTRODUCTION: Understanding brain death is crucial in the organ donation process for families and physicians. This will become more vital as the discrepancy between people awaiting transplantation and available donors continues to grow. We hypothesized that formal didactic training will improve residents’ understanding of and comfort in communicating brain death. METHODS: A total of 722 residents in general surgery, internal medicine, neurology, pediatrics and emergency medicine at 10 academic medical centers completed a didactic program followed by simulation on communicating brain death. Resident knowledge and comfort were evaluated in pre- and post-didactic assessments. RESULTS: Sixty-nine percent of trainees had taken care of at least one patient with traumatic brain injury leading to brain death prior to the didactic program. However, 42 percent reported never receiving instruction on how to explain brain death. Residents’ knowledge of the definition of brain death improved after the educational session. More trainees indicated in the post-assessment that conversations about donation should occur after pronouncement and after the family has achieved understanding of brain death as death (94% vs 55%, p<0.05). Participants also reported feeling more comfortable and confident discussing brain death after the didactic. On subset analysis, the improvement in responses was not significantly different between surgical and non-surgical residents. CONCLUSIONS: Residents across specialties reported improved knowledge and comfort in communicating about brain death, and better understanding of the organ donation process after completing our didactic training. Standardized educational programs will become increasingly essential as the need for donors continues to grow. Hemangiomas and Vascular Malformation of Head and Neck: When to Operate? Andre´s C Limardo, Luis Blanco, Adrı´an Ortega, Rube´n Padı´n Hospital Prof A Posadas, El Palomar, Argentina INTRODUCTION: Hemangiomas and vascular malformations are different congenital anomalies in pathogenesis, evolution and
polytrauma criteria, have been reviewed. One hundred and twenty eight patients were excluded from statistical analysis (incomplete folder, missed values of ISS or imagistic findings, unmentioned maneuvers in ICU or omitted autopsy protocol) and finally from 362 patients remained we retained 47 deaths (13% of patients included). RESULTS: Twelve patients (3.3% admissions) had recognized errors in care that contributed to their death. Important errors patterns included: delayed control of abdominal and intra-thoracic hemorrhage or inadequate recognition (6.3%), failure to secure or protect airway (4.2%), inappropriate management of unstable patients in 8.5% of deaths (long operative procedures, unstable patients sent to CT or to interhospital transfer), missed or delayed diagnoses (4.2%), and inadequate DVT prophylaxis (2.1%). By the internal processing classification of causes, 25% were input errors, 41.7% were intentions errors and 33.3% were execution errors. By phase of trauma management, 16.6% of errors occurred in the ED, 25% during the secondary survey and initial diagnostic, 33.3% during surgery, 16.6% during transport to CT or interhospital transfer, and 8.3% in the ICU stay. CONCLUSIONS: This study combines contemporary understanding of error causation, classification and proposes their remediation with a specific process and protocols. Failure to Graduate from Surgical Residency: A 10-Year Analysis Charalampos Siotos, MD, Rachael M Payne, Scott D Lifchez, MD, FACS, Damon Cooney, MD, Gedge D Rosson, MD, Carisa M Cooney, MPH Johns Hopkins University, Baltimore, MD INTRODUCTION: General surgery and surgical subspecialty residents account for nearly 19% of residents overall; however, little information exists regarding residents who are accepted for surgical residency but never graduate. We sought to evaluate graduation failure rates and associated factors for surgical residents. METHODS: We evaluated information provided by the Accreditation Council for Graduate Medical Education on residents in surgery and surgical subspecialties during the 2007 to 2016 academic years. We extracted total number of graduating residents per year, total number of residents who failed to graduate per year, and reasons for discontinuation of residency. Ratios and proportions were calculated to estimate potential differences among failure-to-graduate rates. RESULTS: When assessing all residents and specialties, an average of one out of every 14.3 residents will not graduate. The ratio is lower for surgical specialties (1:9, range 7.6:1-11.2:1), indicating that surgical residents are less likely to complete residency. From 2007-2015, the greatest decrease in ratio (47%) was shown in general surgery while the greatest increase was in otolaryngology (158%). In cases when reason was known, more than 51% of surgical residents withdrew, 38% transferred to different programs, and 9% were dismissed. CONCLUSIONS: Our findings indicate that surgical residents are more likely to discontinue training prior to completion than
Scientific Poster Presentations: 2017 Clinical Congress
e153
residents in medical specialties. General surgeons were the most likely and otolaryngology residents the least likely to discontinue training. Additional ratios among subspecialties vary, possibly reflecting differences in residency duration and/or associated burn-out rates. Further studies are required to investigate possible barriers to completing surgical residencies. Formal Didactic Training Improves Resident Understanding and Communication of Brain Death Jeanette Zhang, MD, Andrea L Lubitz, MD, Gweneth D O’Shaughnessy, Andrea Reynolds, Amy J Goldberg, MD, FACS Temple University Hospital, Gift of Life Donor Program, Philadelphia, PA INTRODUCTION: Understanding brain death is crucial in the organ donation process for families and physicians. This will become more vital as the discrepancy between people awaiting transplantation and available donors continues to grow. We hypothesized that formal didactic training will improve residents’ understanding of and comfort in communicating brain death. METHODS: A total of 722 residents in general surgery, internal medicine, neurology, pediatrics and emergency medicine at 10 academic medical centers completed a didactic program followed by simulation on communicating brain death. Resident knowledge and comfort were evaluated in pre- and post-didactic assessments. RESULTS: Sixty-nine percent of trainees had taken care of at least one patient with traumatic brain injury leading to brain death prior to the didactic program. However, 42 percent reported never receiving instruction on how to explain brain death. Residents’ knowledge of the definition of brain death improved after the educational session. More trainees indicated in the post-assessment that conversations about donation should occur after pronouncement and after the family has achieved understanding of brain death as death (94% vs 55%, p<0.05). Participants also reported feeling more comfortable and confident discussing brain death after the didactic. On subset analysis, the improvement in responses was not significantly different between surgical and non-surgical residents. CONCLUSIONS: Residents across specialties reported improved knowledge and comfort in communicating about brain death, and better understanding of the organ donation process after completing our didactic training. Standardized educational programs will become increasingly essential as the need for donors continues to grow. Hemangiomas and Vascular Malformation of Head and Neck: When to Operate? Andre´s C Limardo, Luis Blanco, Adrı´an Ortega, Rube´n Padı´n Hospital Prof A Posadas, El Palomar, Argentina INTRODUCTION: Hemangiomas and vascular malformations are different congenital anomalies in pathogenesis, evolution and