Effect of trainee level on surgical time and postoperative complications of anterior cruciate ligament reconstruction

PURPOSE: The objective of this study was to investigate the association between trainee level and surgical time and postoperative complications of anterior cruciate ligament reconstruction (ACLR). METHODS: A retrospective chart review of patients who underwent ACLR at an academic orthopaedic ambulatory surgery center collected demographic and clinical information, including the number of trainees present and trainee level. Unadjusted and adjusted regression analyses assessed the association between trainee number and level with surgical time (time from skin incision to closure) and postoperative complications. RESULTS: Of 799 patients in this study operated on by one of five academic sports surgeons, 87% had at least one trainee involved. The average surgical time overall was 93 ± 21 minutes and by trainee level was 99.7 (junior resident), 88.5 (senior residents), 96.6 (fellows), and 95.6 (no trainees). Trainee level was significantly associated with surgical time (P = 0.0008), with increased surgical time in cases involving fellows (0.0011). Fifteen complications (1.9%) were observed within 90 days of surgery. No notable risk factors of postoperative complications were identified. CONCLUSION: Resident trainee level does not have a notable effect on surgical time or postoperative complications for ACLR at an ambulatory surgery center, although cases involving fellows had longer surgical times. Trainee level was not associated with risk of postoperative complications

The Parallel Encounter: An Alternative to the Traditional Serial Trainee–Attending Patient Evaluation Model

BackgroundThe emergency department environment requires the clinician‐educator to use adaptive teaching strategies to balance education with efficiency and patient care. Recently, alternative approaches to the traditional serial trainee–attending patient evaluation model have emerged in the literature.MethodsThe parallel encounter involves the attending physician and resident seeing the patient independently. Instead of the trainee delivering a traditional oral case presentation, the trainee does not present the history and examination to the attending physician. Rather, the attending and trainee come together following their independent evaluations to jointly discuss and formulate the assessment and plan.ResultsThe parallel encounter has the potential to enhance the teaching encounter by emphasizing clinical reasoning, reduce cognitive bias by integrating two independent assessments of the same patient, increase attending workflow flexibility and efficiency, and improve patient satisfaction and outcomes by reducing time to initial provider contact. The attending must be mindful of protecting resident autonomy. This model tends to work better for more senior learners.ConclusionsThe parallel encounter represents a novel approach to the traditional serial trainee–attending patient evaluation model that may enhance the teaching encounter and improve patient care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163487/2/aet210491_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163487/1/aet210491.pd

Development and Implementation of a Resident Training Tracking Tool Targeted to Documentation of Milestone Fulfillment

Purpose and Background: Despite adoption of the 2015 Accreditation Council for Graduate Medical Education (ACGME) and American Board of Pathology (ABP) Milestones for assessment of resident education, no tool is available to organize longitudinal collection of residency program trainee tracking data relevant to the milestones. With the goal of being able to efficiently and accurately convert resident accomplishment data into milestone scores during biannual resident evaluations, we devised a user-friendly tracking tool to collect, display and map this data to relevant ACGME milestones

The Ideal Psychiatry Training Program: A Resident\u27s Viewpoint

The journey between medical school graduation and specialty board certification in one\u27s chosen field of medicine may comprise the most challenging, exciting and important times of a young professional\u27s life. This journey is called residency education. While the most obvious objectives are cognitive education and practice in the field, trainees also face fundamental life challenges such as developing identity, intimacy and a direction for their own generative goals in the world. Psychiatry residency should be viewed as a personal as well as professional developmental process (1). It contains all of the turbulence of adolescence revisited (2), where normative crises (3) can be expected to occur. This journey through fundamental stages of emotional development actually begins long before one enters residency (4), but dealing with disorders of thought, behavior and action will constitute a major challenge to the trainee\u27s identity. Yager (5) contends that some degree of identity crisis may in fact be beneficial to growth, but that training programs should identify and control factors which magnify this crisis unnecessarily. Taintor et al (6) discussed specific stress factors and their contributions to personal and professional growth. An excellent paper by Lindy (7) presented a training director\u27s perspective on a phase-specific model for psychiatric training based on maturational steps

Using an Audience Response System Smartphone App to Improve Resident Education in the Pediatric Intensive Care Unit.

In the Pediatric Intensive Care Unit (PICU), most teaching occurs during bedside rounds, but technology now provides new opportunities to enhance education. Specifically, smartphone apps allow rapid communication between instructor and student. We hypothesized that using an audience response system (ARS) app can identify resident knowledge gaps, guide teaching, and enhance education in the PICU. Third-year pediatric residents rotating through the PICU participated in ARS-based education or received traditional teaching. Before rounds, experimental subjects completed an ARS quiz using the Socrative app. Concomitantly, the fellow leading rounds predicted quiz performance. Then, discussion points based on the incorrect answers were used to guide instruction. Scores on the pre-rotation test were similar between groups. On the post-rotation examination, ARS participants did not increase their scores more than controls. The fellow's prediction of performance was poor. Residents felt that the method enhanced their education whereas fellows reported that it improved their teaching efficiency. Although there was no measurable increase in knowledge using the ARS app, it may still be a useful tool to rapidly assess learners and help instructors provide learner-centered education

Effective feedback: an indispensable tool for improvement in quality of medical education

Feedback in medical education is an integral and important constituent of teaching as it encourages and enhances the learners' knowledge, skills and professional performance. Feedback has to be delivered in an appropriate setting; it should focus on the performance and not on the individual; should be clear and specific; delivered in non-judgmental language; should emphasize positive aspects; be descriptive rather than evaluative; and should suggest measures for improvement. An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline and Google Scholar. Keywords used in the search include feedback, constructivism and medical education. Constructive feedback is defined as the act of giving information to a trainee through the description of his/her performance in the observed situation. It emphasizes the strengths of the session and areas which require improvement. The processes of giving and receiving feedback are skills that can be acquired only with practice. To integrate the concept of feedback in medical education, training of the trainers pertaining to techniques of adult learning and how to give feedback to trainees are foremost requirements. Interactive feedback is indispensable in bringing about professional development and overall improvement in doctors

For Our Information, May & June 1954, Vol. VI, no. 10-11

An official publication of the ILR School, Cornell University, “for the information of all faculty, staff and students