Christine Fahim

Otolaryngology residency education: a scoping review on the shift towards competency-based medical education.

Residency training programmes worldwide are experiencing a shift from the traditional time‐based curriculum to competency‐based medical education (CBME), due to changes in the healthcare system that have impacted clinical learning opportunities. Otolaryngology–Head and Neck Surgery (OTL‐HNS) programmes are one of the first North American surgical specialties to adopt the new CBME curriculum.

The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A Comprehensive Systematic Review

The primary objective of this study is to systematically review all pertinent literature related to robotic-assisted lung resection. Robotic-assisted thoracic surgery (RATS) case series and studies comparing RATS with video-assisted thoracoscopic surgery (VATS) or thoracotomy were included in the search. In accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, 2 independent reviewers performed the search and review of resulting titles and abstracts. Following full-text screening, a total of 20 articles met the inclusion criteria and are presented in the review. Amenable results were pooled and presented as a single outcome, and meta-analyses were performed for outcomes having more than 3 comparative analyses. Data are presented in the following 4 categories: technical outcomes, perioperative outcomes, oncological outcomes, and cost comparison. RATS was associated with longer operative time, but did not result in a greater rate of conversion to thoracotomy than VATS. RATS was superior to thoracotomy and equivalent to VATS for the incidence of prolonged air leak and hospital length-of-stay. Oncological outcomes like nodal upstaging and survival were no different between VATS and RATS. RATS was more costly than VATS, with most of the costs attributed to capital and disposable expenses of the robotic platform. Although limited by a lack of prospective analysis, lung resection via RATS compares favorably with thoracotomy and appears to be no different than VATS. Prospective studies are required to determine if there are outcome differences between RATS and VATS.

Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI

Introduction In our model of comprehensive clinical staging (CCS) for lung cancer, patients with a computerized tomography scan of the chest and upper abdomen not showing distant metastases will then routinely undergo whole body positron emission tomography/computerized tomography and magnetic resonance imaging (MRI) of the brain before any therapeutic decision. Our aim was to determine the accuracy of CCS and the value of brain MRI in this population. Methods A retrospective analysis of a prospectively entered database was performed for all patients who underwent lung cancer resection from January 2012 to June 2014. Demographics, clinical and pathological stage (seventh edition of the American Joint Committee on Cancer/Union for International Cancer Control tumor, node, and metastasis staging manual), and costs of staging were collected. Correlation between clinical and pathological stage was determined. Results Of 315 patients with primary lung cancer, 55.6% were female and the mean age was 70 ± 9.6 years. When correlation was analyzed without consideration for substages A and B, 49.8% of patients (158 of 315) were staged accurately, 39.7% (125 of 315) were overstaged, and 10.5% (32 of 315) were understaged. Only 4.7% of patients (15 of 315) underwent surgery without appropriate neoadjuvant treatment. Preoperative brain MRI detected asymptomatic metastases in four of 315 patients (1.3%). At a median postoperative follow‐up of 19 months (range 6–43), symptomatic brain metastases developed in seven additional patients. The total cost of CCS in Canadian dollars was

Examining the barriers to meaningful assessment and feedback in medical training

367,292 over the study period, with

Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series

117,272 (31.9%) going toward brain MRI. Conclusion CCS is effective for patients with resectable lung cancer, with less than 5% of patients being denied appropriate systemic treatment before surgery. Brain MRI is a low‐yield and high‐cost intervention in this population, and its routine use should be questioned.

‘It's not the form; it's the process’: a phenomenological study on the use of creative professional development workshops to improve teamwork and communication skills

BACKGROUND Recent reports from both accreditation bodies in North America highlight problems with current assessment practices in postgraduate medical training. Previous work has shown that educators might be reluctant to report poor performance or fail underperforming trainees. This study explores the barriers perceived by medical educators to providing more meaningful assessment and feedback to trainees. METHODS Semistructured interviews were conducted with 22 physician educators. Interviews were audiotaped and transcribed verbatim. Three researchers analyzed the transcripts using a grounded theory approach. RESULTS Participants expressed a reluctance to provide poor assessments or feedback to trainees. Fifty-five percent of the participants reported passing trainees who could have benefited from additional training. Our data revealed a number of barriers which may account for these findings. Implementing more frequent formative assessments could help educators more effectively evaluate trainees and provide feedback, although a shift in the culture of medicine may be required. CONCLUSION It is imperative that the barriers to effective assessment and feedback identified in this study be addressed to improve postgraduate medical training and enhance patient care.

Robotic Versus Video-Assisted Thoracoscopic Lung Resection During Early Program Development

Background Robotic surgery was introduced as a platform for minimally invasive lung resection in Canada in October 2011. We present the first Canadian series of robotic pulmonary resection for lung cancer. Methods Prospective databases at 2 institutions were queried for patients who underwent robotic resection for lung cancer between October 2011 and June 2015. To examine the effect of learning curves on patient and process outcomes, data were organized into 3 temporal tertiles, stratified by surgeon. Results A total of 167 consecutive patients were included in the study. Median age was 66 (range 27–88) years, and 46.1% (n = 77) of patients were men. The majority of patients (n = 141, 84%) underwent robotic lobectomy. Median duration of surgery was 270 (interquartile range [IQR] 233–326) minutes, and median length of stay (LOS) was 4 (IQR 3–6) days. Twelve patients (7%) were converted to thoracotomy. Total duration of surgery and console time decreased significantly (p < 0.001) across tertiles, with a steady decline until case 20, followed by a plateau effect. Across tertiles, there was no significant difference in LOS, number of lymph node stations removed, or perioperative complications. Conclusion The results of this case series are comparable to those reported in the literature. A prospective study to examine the outcomes and cost of robotic pulmonary resection compared with video-assisted thoracoscopic surgery should be done in the context of the Canadian health care system. We have presented the first consecutive case series of robotic lobectomy in Canada. Outcomes compare favourably to other series in the literature.