Background Several challenges threaten the traditional premise of graduated independence in general surgery training, leading to a lack of readiness in graduating surgeons. The objective of this study was to determine the factors contributing to faculty decisions to grant residents autonomy in the operating room, the barriers to granting this autonomy, and the factors that facilitate entrustment. Study Design An anonymous online survey was distributed to 239 attending surgeons at 7 institutions. Questions consisted of open-ended and structured 5-point Likert scale questions. Descriptive statistics were calculated, and a qualitative analysis of free-text responses was performed to identify emergent themes. Results There were 116 attending surgeons who responded to the survey (49%). Factors most important to increasing resident responsibility and autonomy in the operating room were the resident's observed clinical skill and the attending surgeon's confidence level with the operation. Factors believed to prevent awarding graduated responsibility and autonomy in the operating room included an increased focus on patient outcomes, a desire to increase efficiency and finish operations earlier, and expectations of attending surgeon involvement by the hospital and patients. Among themes discerned in faculty responses to an open-ended question about the greatest challenges in graduate surgical education, 47% of faculty identified work-hour regulations/time restrictions. Fourteen percent pointed to a change to a shift-work mentality and decreased ownership of responsibility for patients by residents; 13% described a lack of resident autonomy due to increased supervision requirements. Conclusions This study identified several factors that attending surgeons report as significant limitations to transitioning autonomy to surgical residents in the operating room. These issues must be addressed in a direct manner if progressive graduated responsibility to independence is to occur in the next era of graduate surgical training.

https://www.journalacs.org/article/S1072-7515(14)00442-6/pdf

Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy

Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP.

Virtual reality simulators and training in laparoscopic surgery.

Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery.

Introduction. Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skil...

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Relevance of Motion-Related Assessment Metrics in Laparoscopic Surgery

Purpose
The laparoscopic suturing task is a complex procedure that requires objective assessment of surgical skills. Analysis of laparoscopic suturing task components was performed to improve current objective assessment tools.

Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment.

Purpose
Laparoscopic techniques have nowadays become a gold standard in many surgical procedures, but they imply a more difficult learning skills process. Simulators have a fundamental role in the formative stage of new surgeons. This paper presents the construct and face validity of SINERGIA laparoscopic virtual reality simulator in order to decide whether it can be considered as an assessment tool.

/pdf/construct-and-face-validity-of-sinergia-laparoscopic-virtual-327259mhiv.pdf

Construct and face validity of SINERGIA laparoscopic virtual reality simulator.

espanolINTRODUCCION: La Urologia necesita de modelos de evaluacion de capacidades, a pesar de que existe una variada oferta de herramientas que no estan integradas en los programas de formacion. Contexto: No existe un criterio universal para medir el nivel de competencia. Los programas de formacion deben proporcionar conocimientos y destrezas, y deben considerar las habilidades cognitivas, la formacion basada sobre simulacion y modelo animal. La validez es un concepto complejo que hace referencia a la capacidad del instrumento de evaluacion, por lo que es necesario establecer varios tipos de validacion para asegurar la capacidad de un metodo, reforzarse con distintos test de fiabilidad y calculo de consistencia interna entre evaluadores. OBJETIVO: A partir de un dossier estructurado de competencias quirurgicas, clasificadas por grupos, se planteo el sistema ESSCOLAP® Basic con 5 ejercicios sobre simulador, para la evaluacion de las competencias basicas en Laparoscopia. Una vez validado, en el CCMIJU, se planteo ampliar el alcance e implementacion del mismo en otras localizaciones. RESULTADOS: Nuestro sistema no ha demostrado aun su validez en el ambito clinico real, porque no presenta una validez predictiva con datos clinicos de resultados en salud. Existe, ademas, un cierto rango de subjetividad, por lo que se requiere establecer criterios claros y definidos para cualquier situacion. El numero de evaluadores y de los ejercicios a evaluar, va a influir en los test de fiabilidad que miden el grado de acuerdo entre evaluadores, de modo que solo obteniendo un elevado numero de casos evaluados, podremos acercarnos a una mayor fiabilidad de nuestro sistema. Por ultimo, asumimos que la incorporacion de este tipo de herramientas implica un coste anadido a cargo de las instituciones publicas y privadas responsables, que solo se considerara rentable cuando se demuestre su trazabilidad real y positiva en resultados sanitarios. CONCLUSIONES: ESSCOLAP® Basic, con capacidad de implementacion rapida y sencilla, ha sido validado y contrastado para la evaluacion de las habilidades tecnicas basicas en laparoscopia. EnglishINTRODUCTION: Urology needs models of competencies assessment, although there is a wide range of tools not yet integrated into the official training programs. CONTEXT: At present, there is no universal framework for measuring surgeons level of competence. Urology training programs should provide and consider knowledge, pyschomotor/cognitive skills, and simulator, cadaver or animal models-based training. Validity is a complex concept that refers to the capacity of the evaluation tool, so it is necessary to demonstrate several types of validation to assure the capacity of a method, reinforced with different reliability tests and calculation of internal consistency between evaluators. OBJECTIVE: Based on a structured dossier of surgical skills, classified by groups, the ESSCOLAP® Basic system was proposed with 5 simulator tasks to evaluate basic laparoscopic skills. Once validated in the JUMISC (Spain), the tool was proposed to extend its scope and implementation in other locations. RESULTS: Our system has not yet demonstrated a full validity in the real clinical setting because a predictive validity needs to be demonstrated on the basis of clinical data. It also suffers from a certain range of subjectivity, thus implying clear and defined criteria for any situation. Factors like the number of evaluators and tasks to assess will influence the reliability tests that measure the degree of agreement between evaluators, so that a higher number of evaluated cases would imply a greater reliability of our system. Finally, we assume that the incorporation of this type of tools implies an added cost, charged to the public and private responsible institutions, which will only be considered cost-effective when it is demonstrated its real and positive traceability in health outcomes. CONCLUSIONS: ESSCOLAP® Basic, of quick and simple implementation capacity, has been validated and calibrated for the evaluation of basic technical skills in laparoscopy.

Silvia Enciso-Sanz

Papers

Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment.

Construct and face validity of SINERGIA laparoscopic virtual reality simulator.

Evaluación de competencias en Urología. Esscolap® basic, como aproximación a la mejora de las capacidades de los urólogos