Senior surgical resident autonomy and teaching assistant cases: A prospective observational study.

Autor: Do WS; Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA. Electronic address: woosongdo@gmail.com., Sheldon RR; Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA. Electronic address: rowan.sheldon@gmail.com., Phillips CJ; Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA. Electronic address: cjphillips10@gmail.com., Eckert MJ; Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA. Electronic address: matteckert1@gmail.com., Sohn VY; Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA. Electronic address: vancesohn@gmail.com., Martin MJ; Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA. Electronic address: traumadoc22@gmail.com.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2020 May; Vol. 219 (5), pp. 846-850. Date of Electronic Publication: 2020 Feb 26.
DOI: 10.1016/j.amjsurg.2020.02.039
Abstrakt: Introduction: Teaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision.
Methods: Prospective observational study of operative cases where a SR served as the TA between 7/2014-6/2017 (n = 161). Patient/operative characteristics, 30-day outcomes, and SR survey data were compared by level of supervision.
Results: Case mix included 68 laparoscopic appendectomies (42%), 49 laparoscopic cholecystectomies (30%), 10 I&Ds (6%), 10 umbilical hernia repairs (6%), 4 port placements (3%), and 11 others. Indirectly supervised cases were shorter (61 vs. 76 min, p < 0.01), with less blood loss (11 vs. 24 ml, p < 0.05), and lower conversion rates (0% vs. 5.7%, p < 0.05). Perceived difficulty was high in 20% of cases with indirect vs. 49% with direct supervision (p < 0.01). Mean SR comfort was high (4.4 vs. 4.6 out of 5) regardless of level of staff supervision. 30-day complications did not differ for indirect vs. direct supervision (all p = NS).
Discussion: Carefully selected TA cases offer SRs opportunities to practice autonomy without sacrificing operative time or patient safety.
Competing Interests: Declaration of competing interest The views expressed are those of the authors and do not reflect the official policy or position of the Army, the Department of Defense, or the US Government.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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