Ajit K. Sachdeva

Support for Simulation-based Surgical Education through American College of Surgeons – Accredited Education Institutes

The American College of Surgeons (ACS) recently launched a new program to provide regional support for simulation-based surgical education through the establishment of a consortium of accredited education institutes. The goals of the program are to enhance surgical patient safety, support efforts of surgeons to meet the requirements for Maintenance of Certification, address the core competencies that all surgeons and surgical residents need to achieve and demonstrate, and enhance access to contemporary surgical education. The ACS-accredited institutes will comprehensively address the needs of a broad spectrum of learners and advance the science of simulation-based surgical education. Accreditation is being offered at two levels—Level I (Comprehensive) and Level II (Basic)—based on three standards that focus on the learners served, the curricula offered, and the technological support and resources available. Initial plans of the consortium of ACS-accredited Education Institutes include development and dissemination of innovative curricula, peer review of new educational programs and products, sharing of limited educational resources, and pursuit of collaborative research and development. This program should be of great value in supporting the professional activities of surgeons, surgical residents, medical students, and members of the surgical team, and in delivering surgical care of the highest quality.

Effective faculty preceptoring and mentoring during reorganization of an academic medical center

The experience and lessons learned in the design, implementation and initial evaluation of a demonstration faculty-to-faculty mentoring program, during a time of major institutional reorganization, are described. The question addressed was: Can a voluntary mentoring program be established with minimal resources and be effective in the context of major organizational change? Key design elements included two-tiered programs (one year preceptoring and multi-year mentoring), voluntary participation, and selection of senior faculty members by the junior faculty members. A total of 20% of junior faculty and 30% of senior faculty participated. Faculty indicated the program was worth the time invested, had a positive impact on their professional life and increased productivity. There was high satisfaction with the mentoring relationship, especially the psychosocial mentoring functions, and a trend toward increased retention of minority faculty. Within two years, the program was institutionalized into the Office for Faculty Affairs, and faculty approved a mentoring policy. It is concluded that voluntary mentoring programs can have a positive impact on junior and senior faculty satisfaction, reinvigorate the collegial culture, and improve productivity and retention even during a time of reorganization and minimal resources.

Technique of ultrasonic detection and mapping of abdominal wall adhesions

SummaryA technique for noninvasive ultrasound examination to detect and map abdominal wall adhesions is described. The examination is based on the demonstration of movement of abdominal viscera during real-time imaging. This movement is called viscera slide and either occurs spontaneously as a result of respiratory movement or may be induced by manual compression. Abdominal wall adhesions produce a restriction of viscera slide. Ultrasonic demonstration of restricted viscera slide has been used for the precise localization and mapping of abdominal wall adhesions prior to abdominal surgery. The technique may be particularly useful in providing safe initial access in patients undergoing laparoscopy who are at increased risk for trocar injury of viscera due to abdominal wall adhesions resulting from previous surgery or peritonitis.

Use of effective feedback to facilitate adult learning

Effective feedback plays a critical role in helping adult learners achieve their educational goals and reach their maximum potential. It should be an integral part of every adult education program. Both formal and informal feedback should be provided by teachers, based on the underpinnings of effective feedback techniques. The feedback source, message, and recipient exert influences on the process and must be considered in this context. For maximum impact, the source of feedback must be considered credible and trustworthy by the recipient. The message should provide clear information about performance standards and the performance of the student, in order to elucidate any differences. Positive information should be shared before negative information, and the feedback should be specific, objective, consistent, and timely. The environment in which feedback is provided must be supportive, and should encourage an open dialog between the teacher and the student. Both parties should discuss various items in a spirit of collaboration, and clearly define the goals that need to be achieved. A plan for follow-up and ongoing reinforcement must be developed and implemented. In addition to oral and written feedback, other modes of providing feedback, such as computers, audiotapes, and videotapes, should be considered, and used as appropriate. Skills of faculty members in providing effective feedback may be enhanced through faculty-development programs, such as workshops and self-study modules.

Establishing a simulation center for surgical skills : what to do and how to do it

1 Department of Surgery, Section of Minimally Invasive Surgery and Bariatrics, Penn State University, Penn State College of Medicine, P.O. Box 850 MC H149, Hershey, PA, 17033, USA 2 University of Washington, 1959 NE Pacific Street, Seattle, WA, USA 3 Adair Family of Surgical Education, McGill University, 1650 Cedar Avenue, Montreal, QC, Canada 4 CEO, Verefi Technologies, Inc., 246 S. Market Street, Elizabethtown, PA, 17022, USA 5 NCA Medical Simulation Center, Uniformed Services University, 4301 Jones Bridges Road, Bethesda, MD, USA 6 American College of Surgeons, 633 N. Saint Claire Street, Chicago, IL, 60611, USA 7 Department of Surgery, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA 8 University of New Mexico, Albuquerque, NM, USA 9 West Virginia University, Morgantown, USA 10 Steinberg-Bernstein chair of Minimally Invasive Surgery and Innovation McGill University Health Centre Hospitals, 1650 Cedar Avenue, L9.309, Montreal, QC, H3G1A4, Canada

Professionalism in surgery

Russell L Gruen, MBBS, Jyoti Arya, MD, Ellen M Cosgrove, MD, Richard L Cruess, MD, Sylvia R Cruess, MD, A Brent Eastman, MD, FACS, P Jeffrey Fabri, MD, FACS, Paul Friedman, MD, FACS, Thomas D Kirksey, MD, FACS, Ira J Kodner, MD, FACS, Frank R Lewis, MD, FACS, Kathleen R Liscum, MD, FACS, Claude H Organ, MD, FACS, Joel C Rosenfeld, MD, FACS, Thomas R Russell, MD, FACS, Ajit K Sachdeva, MD, FACS, Elvin G Zook, MD, FACS, Alden H Harken, MD, FACS

Women in Surgery Residency Programs: Evolving Trends from a National Perspective

BACKGROUND Similar numbers of men and women are currently graduating from United States (US) medical schools; therefore, surgery residency programs need to attract graduates of both genders. This study compared gender distributions of allopathic US medical graduates (USMG) from academic years 1999-2000 through 2004-2005. In addition, the gender distributions of USMG and international medical graduates (IMG; analyzed separately) entering accredited general surgery (GS) programs and USMG entering other surgical specialty programs were compared across academic years 2000-2001 through 2005-2006. STUDY DESIGN Data were extracted from the American College of Surgeons Resident Master File and the Association of American Medical Colleges FACTS Website and Data Warehouse. Chi-square statistics compared gender distributions across years for all USMG graduating and applying to GS programs each year between 1999-2000 and 2004-2005 and for USMG and IMG entering training between 2000-2001 and 2005-2006. RESULTS During the study period, the proportion of women increased significantly (p < 0.001) among USMG (43% to 47%), USMG applying to GS programs (27% to 33%), and USMG entering GS residencies (32% to 40%); the percentages of women among IMG entering GS residencies ranged from 11% to 18%, with no apparent linear increase. Proportions of women among USMG entering training increased in most surgical specialties examined. CONCLUSIONS The gender gap among USMG entering GS training appears to be closing, concurrent with that of USMG overall during the study period. Surgery programs must continue to recruit and retain women to attract the best and brightest trainees.

Expectations of and for Clerkship Directors: A Collaborative Statement from the Alliance for Clinical Education

Purpose: The clerkship director (CD) is an essential leader in the education of medical students on clinical rotations. This article represents a collaborative effort of the national clerkship organizations that comprise the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE suggests that selection of a CD be regarded as an implied contract between the CD and the department chair that each will take the steps to ensure the success of the clerkship and of the CD. This article sets standards for what should be expected of a CD and provides guidelines for the resources and support to be provided to the person selected for leadership of the clerkship. Summary: In their roles as CDs, educators engage in three principal activities: administration, teaching, and scholarly activity, such as educational research. This article describes (a) the work products that are the primary responsibility of the CD; (b) the qualifications to be considered in selection of a CD; (c) the support structure, resources, and personnel that are necessary for the CD to accomplish his or her responsibilities; (d) incentives and career development for the CD; and (e) the dedicated time that should be provided for the clerkship and the CD to succeed. Studies by several CD organizations conclude that 25% should be considered a minimum estimate of time for the administrative aspects of running a clerkship. With the added teaching and scholarly activities undertaken by a CD, a minimum of 50% of an full-time equivalent has been recognized as appropriate. The complexity and the need for timeliness in the cyclic and often repetitive tasks of the clerkship require that a full-time administrative assistant be part of the structure dedicated to running the clerkship. Conclusion: ACE recommends that institutions have clear standards for what is expected of the director of a clinical clerkship and have correspondingly clear guidelines as to what should be expected for CDs in their career development and in the support they are given.

Impact of a standardized patient intervention to teach breast and abdominal examination skills to third-year medical students at two institutions.

BACKGROUND This study examined whether a single intervention with standardized patients (SPs) as a supplement to traditional teaching during the surgery clerkship would enhance the breast and abdominal examination skills of third-year medical students. METHODS During the academic year 1994-1995, 153 students from two institutions were assigned to control or experimental groups. At institution A, all students underwent pretests and posttests with SPs; at institution B, no pretest was conducted. All experimental students received group and one-to-one instruction with SPs during the intervention session. RESULTS At posttest, the experimental group performed better than the control group on breast examination (P = 0.002), professionalism during this examination (P <0.001), abdominal examination (P <0.001), and professionalism during the latter examination (P = 0.050). The improvement from pretest to posttest at institution A was significantly greater in the experimental group than the control group for the breast examination (P = 0.036) and the abdominal examination (P <0.001). Analyses on a variety of specific tasks within each examination were also performed. CONCLUSION A single intervention with SPs teaching breast and abdominal examinations resulted in significant enhancement of these clinical skills.

Talking with Patients about Other Clinicians' Errors

The authors discuss the challenges facing a clinician who discovers that her patient has been harmed by another health care workers medical error. They provide guidance to help clinicians and institutions disclose such errors to patients.