Nayna A. Lodhia

The Effect of Positive and Negative Verbal Feedback on Surgical Skills Performance and Motivation

There is considerable effort and time invested in providing feedback to medical students and residents during their time in training. However, little effort has been made to measure the effects of positive and negative verbal feedback on skills performance and motivation to learn and practice. To probe these questions, first-year medical students (n = 25) were recruited to perform a peg transfer task on Fundamentals of Laparoscopic Surgery box trainers. Time to completion and number of errors were recorded. The students were then randomized to receive either positive or negative verbal feedback from an expert in the field of laparoscopic surgery. After this delivery of feedback, the students repeated the peg transfer task. Differences in performance pre- and post-feedback and also between the groups who received positive feedback (PF) vs negative feedback (NF) were analyzed. A survey was then completed by all the participants. Baseline task times were similar between groups (PF 209.3 seconds; NF 203 seconds, p = 0.58). The PF group averaged 1.83 first-time errors while the NF group 1 (p = 0.84). Post-feedback task times were significantly decreased for both groups (PF 159.75 seconds, p = 0.05; NF 132.08 seconds, p = 0.002). While the NF group demonstrated a greater improvement in mean time than the PF group, this was not statistically significant. Both groups also made fewer errors (PF 0.33 errors, p = 0.04; NF 0.38 errors, p = 0.23). When surveyed about their responses to standardized feedback scenarios, the students stated that both positive and negative verbal feedback could be potent stimulants for improved performance and motivation. Further research is required to better understand the effects of feedback on learner motivation and the interpersonal dynamic between mentors and their trainees.

Weighing in on bariatric surgery: who and when?

Over two-thirds of the United States is overweight or obese, and over 5% of the country is morbidly obese. Numerous public health preventative measures have been established to help battle this public health epidemic. Surgical obesity treatment, although now gaining popularity, has been an underutilized treatment option for obesity. Patients with a body mass index (BMI) of >40 or >35 kg m−2 with two or more comorbid conditions are eligible for bariatric surgery. Currently, the three most popular bariatric surgeries are Roux-en-y gastric bypass, sleeve gastrectomy and gastric banding procedures, all overwhelmingly performed laparoscopically. The purpose of this article is to discuss the heterogeneity of bariatric surgery. In our practice, among 834 patients operated over a 4-year period (2006–2010), patients were of an average age of 45 years (16–73 years), 80.4% were female patients, 82.5% had private insurance, 61% were White, 17% were Hispanic and 9% were Black. Patients had an average BMI of 46.2 kg m−2 (30.1–75.3 kg m−2), waist circumference of 133.6 cm (68.6–207.8 cm) and four preoperative comorbidities (0–11 comorbidities). Variation exists in surgeon practice patterns for preoperative weight-loss recommendations and complication rates based on surgery case volume. Despite variation in patient, surgeon and hospital characteristics, bariatric surgery outcomes are generally highly safe and effective.

Mo1526 What Motivates Weight Loss Surgery Patients

Background By better understanding patientmotivations, patient education can be individualized for the most effective healthcare possible. The purpose of this study was to evaluate patient motivations for bariatric surgery. Methods Preoperative, three, six and twelve month postoperative data were prospectively obtained for 169 consecutive laparoscopic Roux-en Y gastric bypass surgery patients at a single academic institution. All patients were given a standardized multiple choice questionnaire which asked them about their primary motivations for bariatric surgery preoperatively, then 6 and 12 months postoperatively. Results Better health was the primary motivator preoperatively and at 12 months postoperatively (87, 89%, respectively). A better appearance was a primary motivation for only 15% of patients preoperatively and 20% of patients 12 months postoperative. Within health-related motivations for bariatric surgery, 29% of patients expressed a primary desire to live longer preoperative and, by 12 months postoperatively, this number increased to 38.7% of patients postoperatively. The primary motivation for bariatric surgery from a family perspective was to have more energy with children preoperatively and remained so at 12 months postoperatively (44 to 46%). The second most common familial motivation was to be a healthy role model which did not change from preto post-operatively (29.8 to 29.5%). Preoperatively, 65% of patients thought that diet and exercise would be the most important factor to maintain long-term weight loss; however, by 12 months postoperatively, only 56% of patients thought that diet and exercise would be the most important factor. Patients gave an increasingly greater role to surgery as an important factor for weight loss raising its importance from 45% preop to 58% at one year postoperatively. Observed to patientexpected (O:E) ratios of 12 month percent excess weight loss became more accurate as patients progressed from preop to 6 and 12 months postop (0.60, 0.70, 0.78). Pre-operative O:E Ratios of percent excess weight loss were strongly correlated with 12 postoperative excess weight loss (p<0.001). Conclusions Patients had increasingly, more realistic expectations for surgerys role and ideal weight. Preoperatively, accurate patient expectation of surgical weight loss resulted in better observed post-op weight loss. Patient motivation may be a prime factor for weight loss and should be harnessed for improved outcomes.