A systematic review of the effects of residency training on patient outcomes

<p>Abstract</p> <p>Background</p> <p>Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.</p> <p>Methods</p> <p>The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.</p> <p>Results</p> <p>Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design.Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.</p> <p>Conclusions</p> <p>The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.</p

Comparison of early postoperative enteral nutrients versus chow on colonic anastomotic healing in normal animals

We aimed to clarify the effects of different enteral nutrients ( normal chow, complete balanced nutrition, elemental nutrition enriched with glutamine, immune-enhancing diet and fiber) on colonic anastomotic healing in the stress-free metabolic state. The study was carried out with 50 male Balb-C mice in five groups of 10 animals each. After transverse colon anastomosis, animals were fed with early enteral nutrients using normal chow (group 1), Ensure(R) (group 2), Alitraq(R) (group 3), Impact(R) ( group 4), and Benefiber Resource(R) orange juice drink ( group 5) for 7 days. There were no significant differences among the groups in bursting pressure (p > 0.05). There was no statistical difference in terms of hydroxyproline level among groups 1 - 3. The hydroxyproline levels of groups 4 and 5 were statistically higher than that of the control group ( p < 0.05 for both comparisons). Under normal conditions without stress, we could not demonstrate the superior effects of early enteral feeding with specialized enteral preparations over normal diets on colonic anastomoses when the bursting pressures were compared. Copyright (C) 2004 S. Karger AG, Basel

Importance of identifying the course of the recurrent laryngeal nerve in total and near-total thyroid lobectomies

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery

A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies

Purpose. Recurrent laryngeal nerve palsy and hypoparathyroidism are the most common and serious complications after thyroid operations. Surgeon experience has been defined as a significant factor in the number of complications occurring in thyroid surgery. There has so far been no prospective randomized study that compares the complication rates between residents and the attending surgeon in statistically similar patient groups in which all of the patients undergo the same type of thyroid surgery by the same surgical team. In this prospective study the performances of residents and attending surgeons were evaluated and compared according to the complication rates in near-total thyroidectomies. Methods. One hundred and fifty-two patients underwent near-total thyroidectomies between April 2001 and May 2003. The number of randomly selected patients operated on by residents at the level of postgraduate year two, under the direct supervision of an attending surgeon, and the number of patients operated on by attending surgeons were 78 and 74, respectively. All patients had preoperative and postoperative videolaryngostroboscopic examinations of the vocal cords and serum calcium level evaluation. Results. The rates of temporary vocal cord paralysis with respect to the nerves at risk for residents and attending surgeons were 3.7% and 2.7%, respectively. The temporary hypoparathyroidism rate was 8.1% for attending surgeons, whereas it was found to be 6.4% for residents. Neither any cases of permanent vocal cord paralysis nor permanent hypoparathyroidism were detected. Conclusion. Our results indicate that the complication rates in near-total thyroidectomies performed by residents and attending surgeons are similar. Thyroid surgery can therefore be safely and effectively performed by residents under close supervision

Fade or fate - Seroma in laparoscopic inguinal hernia repair

WOS: 000235059700029PubMed: 16333536Background: Postoperative fluid collection in the space left behind the dissected hernia sac in laparoscopic herniorraphy puts the surgeon in a dilemma as to whether it is a recurrence or a seroma, and it is not always easily judged only by physical examination (PE). Another important issue is what kind of seroma can be accepted as a complication of surgery. Methods: Thirty patients with unilateral inguinal hernia who had a hernia sac of > 4 cm were operated on with transabdominal preperitoneal hernia repair (TAPP) technique and the collection at the hernia site was followed by PE and superficial ultrasonography (USG) postoperatively on the first day, first week, first month, and third month. Results: USG detected seroma in 20 patients, while 17 could be noticed by PE on the first postoperative day. At the end of the third month, seromas resolved by 90%, and could only be detected by USG in two patients. Pain or complication rates attributable to seroma in patients were not determined (p > 0.05) in the statistical analyses between the groups. Conclusions: Superficial USG is a beneficial tool in differentiating early recurrence or seroma In patients. It should not be intervened with as a complication until the patient has complaints attributable to seroma

Experimental bile-duct ligation resulted in accumulation of oxidized low-density lipoproteins in BALB/c mice liver

Background and Aim: Oxidized low-density lipoproteins (LDL), which are produced during oxidative stress by the process of lipid peroxidation, have also been proposed to have complex roles in many other immuno-inflammatory mechanisms. It has been shown that bile-duct ligation results in oxidative stress in the liver of animals. The aim of this study was to investigate if oxidized LDL are produced in the liver tissues of bile-duct-ligated mice. Methods: Obstructive jaundice was induced in BALB/c mice by the ligation and division of the common bile duct. Liver concentrations of glutathione and malondialdehyde were measured in the sham-operated (n = 10) and bile-duct-ligated (n = 10) mice on the 10th day of obstructive jaundice. The presence of oxidized LDL in the liver tissue sections was evaluated using a special, novel immunofluorescent staining method. The final step was to explore the existence of oxidized LDL under fluorescent microscopy. Results: Compared with sham-operated mice, jaundiced mice showed significantly higher levels of malondialdehyde and lower concentrations of reduced glutathione in the liver. While there was no staining in the sham-operated group, bile-duct ligation resulted in positive oxidized LDL staining in the liver tissues of mice. The present study testifies that bile-duct ligation results in oxidative stress and enhanced lipid peroxidation in the hepatic tissues of BALB/c mice and moreover, that oxidized LDL accumulate in the liver of mice with experimental obstructive jaundice. Conclusion: Oxidized LDL may be an important and direct indicator of ongoing oxidative stress and enhanced lipid peroxidation in obstructive jaundice. The potential roles of this finding were also discussed, briefly. © 2004 Blackwell Publishing Asia Pty Ltd