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Role of Video Documentation and Video Portfolios for Surgical Trainees
S180
Scientific Forum Abstracts
J Am Coll Surg
motherhood in surgery, 4) importance of greater program/institutional support for breastfeeding and childcare, 5) wish for stronger mentorship on work-family integration. CONCLUSIONS: Childbearing is challenging for surgical residents. Elicited obstacles include strenuous workloads during pregnancy, short and inflexible maternity leaves, and childcare and lactation supports that are not aligned with the work environment of residency. Fear of negative stigma and perceptions of bias are sources of anxiety during pregnancy and after return to work. These findings demonstrate areas in which targeted interventions may reduce the burden of childbearing on surgery residents. Proficiency-Based Education in Robotic Inguinal Hernia Repair Using Simulation Raghavendra Rao, MD, Robert C Caskey, MD, Noel N Williams, MD, FRCSI, Jon B Morris, MD, FACS, Daniel T Dempsey, MD, FACS, Kristoffel R Dumon, MD, Ian Soriano, MD, FACS University of Pennsylvania, Philadelphia, PA CONCLUSIONS: This pilot study shows wide variability in opioid prescribing practices and attitudes toward pain management among surgical trainees, illustrating the potential utility of formal education in pain management and effective prescribing of these medications. A broader assessment of surgical trainees’ knowledge and perception of opioid prescribing practices is warranted to facilitate the development of such a program. Pregnancy and Motherhood During Surgical Training: A Qualitative Assessment Manuel Castillo-Angeles, MD, MPH, Douglas S Smink, MD, MPH, FACS, Marguerite Changala, Gifty Kwakye, MD, Gerard M Doherty, MD, FACS, Adil H Haider, MBBS, FACS, Erika Rangel, MD, FACS Brigham and Women’s Hospital, Boston, MA INTRODUCTION: Although more women are beginning families during surgical residency, few studies have directly assessed the perspectives of surgeons who were pregnant during residency. METHODS: A 74-question survey was sent to women who were pregnant, had 1 child during general surgery residency, and graduated after 2006. The survey was distributed by the Association of Women Surgeons, the Association of Program Directors in Surgery, and social media platforms (Twitter and closed Facebook groups). Qualitative information was obtained from 2 open-ended questions inquiring about the experience of childbearing during residency. Three reviewers analyzed the transcripts using a grounded theory approach until thematic saturation was reached. Coded data were analyzed to identify emergent themes. RESULTS: There were 327 participants who completed the survey and 218 (67%) responded to the open-ended questions. Multiple themes emerged: 1) desire for work modifications during the late stages of pregnancy due to health concerns, 2) inadequate duration of maternity leave, 3) perceived stigma of pregnancy and
INTRODUCTION: The superior ability for intracorporeal suturing, better dissection under 3D vision, and ability to work up toward the abdominal wall have led to adoption of the da Vinci platform in several centers for inguinal hernia repair. METHODS: Five intermediate level (PGY2-3) residents underwent training on an in-house developed laparoscopic inguinal hernia model. The training consisted of 4 components: initial orientation by faculty to laparoscopic inguinal anatomy along with watching video of a faculty member performing robotic transabdominal pre-peritoneal (TAPP) hernia repair on the simulation model, pre-mentorship attempt with scoring, faculty mentoring and practice on standardized tasks (around the world and upside down defect closure, which are standardized by Intuitive Surgical), followed by a post-mentorship attempt with scoring. Scoring was based on times for the 4 components for hernia repair, namely, peritoneal incision, sac reduction, mesh placement, and peritoneal closure. Benchmarks were set by experienced faculty. The residents were evaluated with GEARS (Global Evaluative Assessment for Robotic Skills) by faculty. The DaVinci-Si robot with clinical-grade instrumentation was utilized. RESULTS: The mean GEARS score improved from 14.8 to 20.2 after training (p < 0.001). All residents rated the model as realistic, educational, and useful for clinical practice. Few residents failed to attain proficiency in certain steps, and remediation with repeat operation on the model will be done. CONCLUSIONS: This model can be used to attain proficiency in basic steps of a robotic TAPP inguinal hernia repair. Role of Video Documentation and Video Portfolios for Surgical Trainees Courtney A Green, MD, Patricia O’Sullivan, Edward Kim, MD, Hueylan Chern, MD University of California, San Francisco, San Francisco, CA
Vol. 225, No. 4S1, October 2017
INTRODUCTION: Program directors in general and subspecialty surgery must assess resident progression toward competency in surgical skills. This study investigated the perception of usefulness of video for documenting basic surgical skill competency in general surgery and surgical specialties. METHODS: Program and assistant program directors at our institution in ophthalmology, orthopaedics, otolaryngology, urology, oral and maxillofacial, general, and plastic surgery received an anonymous 8-item survey, including an example video clip of an intern completing a vertical mattress suture. Respondents answered questions about how various basic skills pertained to their specific specialties, potential benefits of video documentation as demonstrated in the example clip, and current practices for documenting skill competency. RESULTS: Response rate was 88% (14/16), and all felt skills highlighted in the video, such as needle handling and knot tying, were “somewhat” or “very” relevant to their subspecialty. Respondents agreed (64% to 79%) that competency in 2-handed tie, 1-handed tie, tie without tension, subcuticular suture, horizontal suture, and vertical suture was relevant to their specialty. Sixty-four percent valued video documentation of interns’ skills. They endorsed these potential uses of videos: ongoing documentation (78%), tailoring residents’ operative experience (64%), and developing remediation plans (64%). No documentation of resident skill prior to operating room exposure was reported by 79%. Written comments were positive about video documentation. CONCLUSIONS: This study suggests that surgical knot tying and suturing skills are relevant, and portfolios with videos of these skills may be useful to demonstrate progression toward competency. Future employers may request these portfolios to evaluate surgeons’ qualifications. Studying the Interactions Between Teams and Individuals in the Operating Room: A Pilot Study Andras B Fecso, MD, Sebnem S Kuzulugil, PhD, Ceni Babaoglu, PhD, Ayse B Bener, PhD, Teodor P Grantcharov, MD, FACS University of Toronto, Toronto, ON INTRODUCTION: The operating room is a unique environment with complex team interactions that may affect technical performance and patient outcomes. The relationship between technical and nontechnical performances, however, remains underinvestigated. Therefore, the purpose of this study was to explore the relationship between intraoperative technical and nontechnical performances of the surgical and nursing teams. METHODS: A prospective, single center observational study was conducted at a tertiary academic medical center. All patients who underwent a laparoscopic Roux-en-Y gastric bypass (LRYGB) operation and had their procedure captured using the OR Black Box platform were included in the study.
Scientific Forum Abstracts
S181
Technical assessment was performed using OSATS (Objective Structured Assessments of Technical Skills) and GERT (Generic Error Rating Tool). For nontechnical assessment NOTSS (Non-Technical Skills for Surgeons) and SPLINTS (Scrub Practitioners’ List of Intraoperative Non-Technical Skills) were used. Spearman’s rank-order correlation and Ngram statistics were conducted. RESULTS: Fifty-six patients were included in the study and 90 procedural steps (gastro-jejunostomy and jejuno-jejunostomy) were analyzed. There was a moderate to strong correlation between intraoperative events (rs ¼ 0.417e0.687), rectifications (rs ¼ 0.380e0.768), and NOTSS and SPLINTS. Ngram (Bi-gram) statistics showed that post error, post event, and prior to rectification the 2 main contributors to team dynamics are the surgeon and the scrub nurse, regardless of the training level of the operator. CONCLUSIONS: Technical and nontechnical performances are strongly related. The 2 main contributors to team dynamics are the surgeon and the scrub nurse. Studying this environment is promising and future work should include more participants and diverse operations. Surgical Resident Cash Flow: Are Residents on the Edge of Financial Crisis? Sarah Tevis, MD, Andrew L Rogers, MD, Eugene F Foley, MD, FACS, Evie Carchman, MD, FACS, Bruce A Harms, MD, FACS University of Wisconsin, Madison, WI INTRODUCTION: The cost of medical education continues to rise, with >80% of residents reporting educational debt. We sought to assess surgical resident monthly cash flow to determine if residents are overleveraged and at excessive financial risk. METHODS: A survey administered to surgery residents assessed debt, assets, income, expenditures, and resident perceptions about finances. Liquidity ratios (LR) were calculated for each resident, where LR ¼ liquid assets (savings, investments)/monthly expenditures (mortgage payment, rent, car payment). High risk liquidity ratio was defined as <3. Descriptive statistics were performed to evaluate patterns of income and spending. Chi-square analysis was performed to identify predictors of high risk LR. All statistics were performed in SPSS 24 and p values <0.05 were considered significant. RESULTS: The survey was completed by 105 residents (80% response rate). Resident monthly income ranged from $4,200 to $16,700 (average $7,300), while monthly expenditures were $200 to $7,500 (average $2,600). Fifty-five percent were found to have high risk LR (<3, Figure). These residents did not have liquid assets to finance monthly expenditures for 0 to 3 months. Resident characteristics, financial knowledge, and concern about debt did not predict high risk LR. Residents with low total debt were less likely to have high risk LR than residents with high total debt (23% vs 100%, p < 0.001).
Scientific Forum Abstracts
J Am Coll Surg
motherhood in surgery, 4) importance of greater program/institutional support for breastfeeding and childcare, 5) wish for stronger mentorship on work-family integration. CONCLUSIONS: Childbearing is challenging for surgical residents. Elicited obstacles include strenuous workloads during pregnancy, short and inflexible maternity leaves, and childcare and lactation supports that are not aligned with the work environment of residency. Fear of negative stigma and perceptions of bias are sources of anxiety during pregnancy and after return to work. These findings demonstrate areas in which targeted interventions may reduce the burden of childbearing on surgery residents. Proficiency-Based Education in Robotic Inguinal Hernia Repair Using Simulation Raghavendra Rao, MD, Robert C Caskey, MD, Noel N Williams, MD, FRCSI, Jon B Morris, MD, FACS, Daniel T Dempsey, MD, FACS, Kristoffel R Dumon, MD, Ian Soriano, MD, FACS University of Pennsylvania, Philadelphia, PA CONCLUSIONS: This pilot study shows wide variability in opioid prescribing practices and attitudes toward pain management among surgical trainees, illustrating the potential utility of formal education in pain management and effective prescribing of these medications. A broader assessment of surgical trainees’ knowledge and perception of opioid prescribing practices is warranted to facilitate the development of such a program. Pregnancy and Motherhood During Surgical Training: A Qualitative Assessment Manuel Castillo-Angeles, MD, MPH, Douglas S Smink, MD, MPH, FACS, Marguerite Changala, Gifty Kwakye, MD, Gerard M Doherty, MD, FACS, Adil H Haider, MBBS, FACS, Erika Rangel, MD, FACS Brigham and Women’s Hospital, Boston, MA INTRODUCTION: Although more women are beginning families during surgical residency, few studies have directly assessed the perspectives of surgeons who were pregnant during residency. METHODS: A 74-question survey was sent to women who were pregnant, had 1 child during general surgery residency, and graduated after 2006. The survey was distributed by the Association of Women Surgeons, the Association of Program Directors in Surgery, and social media platforms (Twitter and closed Facebook groups). Qualitative information was obtained from 2 open-ended questions inquiring about the experience of childbearing during residency. Three reviewers analyzed the transcripts using a grounded theory approach until thematic saturation was reached. Coded data were analyzed to identify emergent themes. RESULTS: There were 327 participants who completed the survey and 218 (67%) responded to the open-ended questions. Multiple themes emerged: 1) desire for work modifications during the late stages of pregnancy due to health concerns, 2) inadequate duration of maternity leave, 3) perceived stigma of pregnancy and
INTRODUCTION: The superior ability for intracorporeal suturing, better dissection under 3D vision, and ability to work up toward the abdominal wall have led to adoption of the da Vinci platform in several centers for inguinal hernia repair. METHODS: Five intermediate level (PGY2-3) residents underwent training on an in-house developed laparoscopic inguinal hernia model. The training consisted of 4 components: initial orientation by faculty to laparoscopic inguinal anatomy along with watching video of a faculty member performing robotic transabdominal pre-peritoneal (TAPP) hernia repair on the simulation model, pre-mentorship attempt with scoring, faculty mentoring and practice on standardized tasks (around the world and upside down defect closure, which are standardized by Intuitive Surgical), followed by a post-mentorship attempt with scoring. Scoring was based on times for the 4 components for hernia repair, namely, peritoneal incision, sac reduction, mesh placement, and peritoneal closure. Benchmarks were set by experienced faculty. The residents were evaluated with GEARS (Global Evaluative Assessment for Robotic Skills) by faculty. The DaVinci-Si robot with clinical-grade instrumentation was utilized. RESULTS: The mean GEARS score improved from 14.8 to 20.2 after training (p < 0.001). All residents rated the model as realistic, educational, and useful for clinical practice. Few residents failed to attain proficiency in certain steps, and remediation with repeat operation on the model will be done. CONCLUSIONS: This model can be used to attain proficiency in basic steps of a robotic TAPP inguinal hernia repair. Role of Video Documentation and Video Portfolios for Surgical Trainees Courtney A Green, MD, Patricia O’Sullivan, Edward Kim, MD, Hueylan Chern, MD University of California, San Francisco, San Francisco, CA
Vol. 225, No. 4S1, October 2017
INTRODUCTION: Program directors in general and subspecialty surgery must assess resident progression toward competency in surgical skills. This study investigated the perception of usefulness of video for documenting basic surgical skill competency in general surgery and surgical specialties. METHODS: Program and assistant program directors at our institution in ophthalmology, orthopaedics, otolaryngology, urology, oral and maxillofacial, general, and plastic surgery received an anonymous 8-item survey, including an example video clip of an intern completing a vertical mattress suture. Respondents answered questions about how various basic skills pertained to their specific specialties, potential benefits of video documentation as demonstrated in the example clip, and current practices for documenting skill competency. RESULTS: Response rate was 88% (14/16), and all felt skills highlighted in the video, such as needle handling and knot tying, were “somewhat” or “very” relevant to their subspecialty. Respondents agreed (64% to 79%) that competency in 2-handed tie, 1-handed tie, tie without tension, subcuticular suture, horizontal suture, and vertical suture was relevant to their specialty. Sixty-four percent valued video documentation of interns’ skills. They endorsed these potential uses of videos: ongoing documentation (78%), tailoring residents’ operative experience (64%), and developing remediation plans (64%). No documentation of resident skill prior to operating room exposure was reported by 79%. Written comments were positive about video documentation. CONCLUSIONS: This study suggests that surgical knot tying and suturing skills are relevant, and portfolios with videos of these skills may be useful to demonstrate progression toward competency. Future employers may request these portfolios to evaluate surgeons’ qualifications. Studying the Interactions Between Teams and Individuals in the Operating Room: A Pilot Study Andras B Fecso, MD, Sebnem S Kuzulugil, PhD, Ceni Babaoglu, PhD, Ayse B Bener, PhD, Teodor P Grantcharov, MD, FACS University of Toronto, Toronto, ON INTRODUCTION: The operating room is a unique environment with complex team interactions that may affect technical performance and patient outcomes. The relationship between technical and nontechnical performances, however, remains underinvestigated. Therefore, the purpose of this study was to explore the relationship between intraoperative technical and nontechnical performances of the surgical and nursing teams. METHODS: A prospective, single center observational study was conducted at a tertiary academic medical center. All patients who underwent a laparoscopic Roux-en-Y gastric bypass (LRYGB) operation and had their procedure captured using the OR Black Box platform were included in the study.
Scientific Forum Abstracts
S181
Technical assessment was performed using OSATS (Objective Structured Assessments of Technical Skills) and GERT (Generic Error Rating Tool). For nontechnical assessment NOTSS (Non-Technical Skills for Surgeons) and SPLINTS (Scrub Practitioners’ List of Intraoperative Non-Technical Skills) were used. Spearman’s rank-order correlation and Ngram statistics were conducted. RESULTS: Fifty-six patients were included in the study and 90 procedural steps (gastro-jejunostomy and jejuno-jejunostomy) were analyzed. There was a moderate to strong correlation between intraoperative events (rs ¼ 0.417e0.687), rectifications (rs ¼ 0.380e0.768), and NOTSS and SPLINTS. Ngram (Bi-gram) statistics showed that post error, post event, and prior to rectification the 2 main contributors to team dynamics are the surgeon and the scrub nurse, regardless of the training level of the operator. CONCLUSIONS: Technical and nontechnical performances are strongly related. The 2 main contributors to team dynamics are the surgeon and the scrub nurse. Studying this environment is promising and future work should include more participants and diverse operations. Surgical Resident Cash Flow: Are Residents on the Edge of Financial Crisis? Sarah Tevis, MD, Andrew L Rogers, MD, Eugene F Foley, MD, FACS, Evie Carchman, MD, FACS, Bruce A Harms, MD, FACS University of Wisconsin, Madison, WI INTRODUCTION: The cost of medical education continues to rise, with >80% of residents reporting educational debt. We sought to assess surgical resident monthly cash flow to determine if residents are overleveraged and at excessive financial risk. METHODS: A survey administered to surgery residents assessed debt, assets, income, expenditures, and resident perceptions about finances. Liquidity ratios (LR) were calculated for each resident, where LR ¼ liquid assets (savings, investments)/monthly expenditures (mortgage payment, rent, car payment). High risk liquidity ratio was defined as <3. Descriptive statistics were performed to evaluate patterns of income and spending. Chi-square analysis was performed to identify predictors of high risk LR. All statistics were performed in SPSS 24 and p values <0.05 were considered significant. RESULTS: The survey was completed by 105 residents (80% response rate). Resident monthly income ranged from $4,200 to $16,700 (average $7,300), while monthly expenditures were $200 to $7,500 (average $2,600). Fifty-five percent were found to have high risk LR (<3, Figure). These residents did not have liquid assets to finance monthly expenditures for 0 to 3 months. Resident characteristics, financial knowledge, and concern about debt did not predict high risk LR. Residents with low total debt were less likely to have high risk LR than residents with high total debt (23% vs 100%, p < 0.001).