Donald A. Risucci

In-hospital cardiopulmonary resuscitation: patient, arrest and resuscitation factors associated with survival

Data on 470 adults with single in-hospital cardiac arrest resuscitations were analyzed to determine 24-h and discharge survival rates and to identify significant correlates of survival. One hundred fifty-three (33%) patients were alive 24 h after initiation of cardiopulmonary resuscitation; 69 (45% of 24-h survivors, 15% of all patients) were discharged alive. Logit analysis identified the following independently significant correlates of 24-h survival: arrest locations other than emergency room or cardiac care unit, CPR duration less than 15 min, non-cardiac primary diagnosis, non-asystolic dysrhythmia, less than one intravenous and one drip-administered inotrope and absence of pacemaker insertion and defibrillation. Fifty-one (94%) of 54 patients with all of these characteristics were alive 24 h after initiation of CPR. The same variables, as well as age less than 68 years and absence of intubation were statistically associated with discharge survival. Nine (64%) of 14 patients with all of these characteristics were discharged alive. Increased intervention was generally associated with increased mortality. Overall survival rates replicate previous reports and may reflect the effects of diagnosis-related groups policies on the average illness severity of the in-patient population, rather than failure of current CPR methods to improve the probability of survival. Use of the data as baseline for future studies and as a source of hypotheses for research on decision making are discussed.

Effectiveness of a CD-ROM multimedia tutorial in transferring cognitive knowledge essential for laparoscopic skill training

BACKGROUND Computer-assisted instruction (CAI) can benefit surgical education by improving efficiency, effectiveness, standardization, and access. This study compares knowledge gains for laparoscopic skill acquisition following a standardized tutorial delivered via CD-ROM versus live instructor. METHODS A standardized tutorial was written and subsequently converted to multimedia CD-ROM format by its author (JR). During a laparoscopic development course, experienced US-trained surgeons (n = 52) participated in the tutorial delivered live by the author. The CD-ROM tutorial replaced the instructor for the following groups: (1) experienced US-trained surgeons (n = 27); (2) US-trained surgical residents (n = 59); and (3) Greek surgeons (n = 63). A 51-item knowledge test was administered before and after tutorial instruction. RESULTS The mean increase in scores between pretest and posttest was significant (P <0.01) and of similar magnitude in each group, with nonsignificant posttest mean differences among US-trained groups. CONCLUSIONS The CD-ROM tutorial effectively transfers cognitive information necessary for skill development. Distance learning modes of this tutorial program may be feasible.

Effects of morbid obesity and diabetes mellitus on risk of coronary artery bypass grafting

Abstract Obesity has been identified as an independent risk factor for cardiovascular disease 1–4 and the occurrence of complications of coronary artery bypass grafting (CABG). 5,6 A study was designed to determine if the risks associated with morbid obesity should alter the indications for CABG, the operative strategy or the postoperative care.

Reliability and accuracy of resident evaluations of surgical faculty.

This study examines the reliability and accuracy of ratings by general surgery residents of surgical faculty. Twenty-three of 33 residents anonymously and voluntarily evaluated 62 surgeons in June, 1988; 24 of 28 residents evaluated 64 surgeons in June, 1989. Each resident rated each surgeon on a 5-point scale for each of 10 areas ofperformance: technical ability, basic science knowledge, clinical knowledge, judgment, peer relations, patient relations, reliability, industry, personal appearance, and reaction to pressure. Reliability analyses evaluated internal consistency and interrater correlation. Accuracy analyses evaluated halo error, leniency/severity, central tendency, and range restriction. Ratings had high internal consistency (coefficient alpha = 0. 97). Interrater correlations were moderately high (average Pearson correlation = 0.63 among raters). Ratings were generally accurate, with halo error most prevalent and some evidence of leniency. Ratings by chief residents had the least halo. Results were generally replicable across the two academic years. We conclude that anonymous ratings of surgical faculty by groups of residents can provide a reliable and accurate evaluation method, ratings by chief residents are most accurate, and halo error may pose the greatest threat to accuracy, pointing to the needfor greater definition of evaluation items and scale points.

Resident evaluation of surgical faculty

This study examines the association between resident evaluations of surgical faculty and measures of teaching activity and practice characteristics. Twenty-three of 33 general surgery residents, anonymously and voluntarily rated 62 faculty surgeons in 10 areas of performance. This was repeated 1 year later with 24 of 28 residents and 64 surgeons. Ratings were reliable (test-retest on overall mean rating, r = 0.91, P less than 0.01). Factor analysis of ratings by residents in postgraduate year (PGY) 5 extracted a judgment factor and an interpersonal skills factor. Ratings by other PGYs were unidimensional. Faculty subgroups that performed more than two major procedures per week at the hospital (P less than 0.01) attended the weekly Mortality and Morbidity conference more than once per month (P less than 0.05) and/or published one or more research reports (P less than 0.05) received higher ratings than those who did not. Among general surgeons (n = 35), ratings of interpersonal skill by PGY 5 residents correlated inversely with complication rate (r = -0.41, P less than 0.05) and overall ratings by PGYs 3 and 4 correlated inversely with mean patient length-of-stay (LOS; r = -0.44, P less than 0.05). These remained significant after statistical adjustment for case mix differences and differences in the amount of contact with residents. Resident ratings were unrelated to mean patient age, the mean number of diagnoses per patient, and the mean number of procedures per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of blinded interviews in the assessment of surgical residency candidates

BACKGROUND Interview assessments of surgical residency candidates may be biased by prior knowledge of objective data. METHODS Each candidate (site 1: n = 88; site 2: n = 44) underwent two interviews, one by faculty members informed only of a candidates medical school, the second with prior knowledge of the complete application. Interviewers (site 1: n = 28; site 2: n = 14) independently rated candidates overall and on nine qualitative characteristics. RESULTS At site 1 only, overall ratings were significantly more favorable for unblinded than blinded interviews (23.0 +/- 17.7 versus 32.6 +/- 23.1, P < 0.01). Blinded and unblinded overall ratings correlated -0.01 (P = 0.90) and 0.31 (P = 0.05) at sites 1 and 2, respectively. At site 1 only, overall ratings correlated significantly with USMLE scores, but in opposite directions for blinded (r = 0.32, P = 0.003) versus unblinded interviews (r = -0.32, P = 0.003). CONCLUSION Interview assessments may be influenced by objective data, and faculty and program variables. The value of blinded interviewing may vary as a function of individual program characteristics.

Student perceptions of skills acquisition during the surgical clerkship: Differences across academic quarters and deviations from faculty expectation

Background: Individual and experiential factors, as well as the timing of the surgical clerkship, may influence knowledge and/or skills acquisition. Purpose: To examine differences across academic quarters in student perceptions of skills acquisition; differences between student perceptions and faculty expectations; and the association between perceptions and grades, student evaluations of the program, and their own career interests. Methods: Each of 61 students evaluated postclerkship acquisition of 33 procedural and 12 clinical skills. Each of 14 faculty surgeons indicated expectations for skills acquisition. Results: Faculty expectations were significantly higher (p < .01) than first quarter (Q1) student perceptions for most skills. Ql student perceptions were significantly lower than those of third quarter (Q3) students for most skills. Perceptions of skills acquisition were associated with preclinical desire for a surgical career, number of procedures performed, number of workups completed, and clini...

Reliability and Accuracy of Surgical Resident Peer Ratings

The reliability and accuracy of peer ratings by general surgery residents were examined. Thirty-two residents anonymously and voluntarily evaluated their peers on ten areas of perfor mance in 1988; twenty-eight residents were evaluated in 1989, and thirty-three were evaluated in 1990. Resident peer ratings were found highly reliable, with no evidence of serious restriction of range or leniency effects. The results indicated a high level of test-retest reliability replicated across three academic years. Halo effects appear to pose the greatest threat to rater accuracy. There was some evidence that chief residents exhibit less halo effect than junior residents when rating peers.