Tracking operative autonomy and performance in otolaryngology training using smartphone technology: A single institution pilot study.
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ABSTRACT:
SUBMITTER: Chen JX
PROVIDER: S-EPMC6929585 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
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Tracking operative autonomy and performance in otolaryngology training using smartphone technology: A single institution pilot study.
Chen Jenny X JX Kozin Elliott E Bohnen Jordan J George Brian B Deschler Daniel D Emerick Kevin K Gray Stacey T ST
Laryngoscope investigative otolaryngology 20191111 6
<h4>Background</h4>In the era of duty hour restrictions, otolaryngology residents may not gain the operative experience necessary to function autonomously by the end of training. This study quantifies residents' autonomy during key indicator cases, defined by the Accreditation Council for Graduate Medical Education.<h4>Study design</h4>Prospective cohort study.<h4>Methods</h4>Faculty and residents at a large academic institution were surveyed on the surgical autonomy trainees should achieve for ...[more]
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Project description:ObjectiveSurgical education is changing in an era of new regulations and evolving training cultures. We sought to understand the factors that affect operative experiences during otolaryngology residency.MethodsFrom December 2019 to December 2020, five otolaryngology training programs used the SIMPL OR smartphone application to evaluate residents after each operation. Residents and attendings rated the trainee's autonomy on a 4-level Zwisch scale, performance on a 5-level scale, and case complexity on a 3-level scale. We examined associations between ratings of autonomy and performance with variables including postgraduate year (PGY), case complexity, gender, week of the academic year (AY), and whether multiple procedures were logged.Results78 attendings and 92 residents logged 2984 evaluations. PGY level and week of the AY were positively associated with attending ratings of autonomy and performance (PGY3 vs. PGY2: B = 0.63, p < .001 for autonomy and B = 1.05, p < .001 for performance; week of the AY: B = 0.013, p = .002 for autonomy; B = 0.025, p < .001 for performance). Multiple procedures logged and increasing case complexity were negatively associated with attending ratings (multiple procedures: B = -0.19, p = .04 for autonomy and B = -0.48, p < .001 for performance; hardest vs. easiest 1/3 of cases: B = -1.01, p < .001 for autonomy and B = -0.59, p < .001 for performance). Attending and trainee genders were not associated with attending ratings of autonomy or performance.ConclusionResident autonomy and performance were positively associated with PGY level and week of the academic year, and negatively associated with case complexity and multiple procedures. These findings highlight the need to align training level with case complexity to promote quality operative experiences.Level of evidence2.
| S-EPMC9008171 | biostudies-literature
Project description:ObjectivesTo determine the operative experience of UK general surgery trainees and assess the changing procedural supervision and acquisition of competency assessments through the course of training.BackgroundCompetency assessment is changing with concepts of trainee autonomy decisions (termed entrustment decisions) being introduced to surgical training.MethodsData from the Intercollegiate Surgical Curriculum Programme and the eLogbook databases for all UK General Surgery trainees registered from August 1, 2007 who had completed training were used. Total and index procedures (IP) were counted and variation by year of training assessed. Recorded supervision codes and competency assessment outcomes for IPs were assessed by year of training.ResultsWe identified 311 trainees with complete data. Appendicectomy was the most frequently undertaken IP during first year of training [mean procedures (mp) = 26] and emergency laparotomy during final year of training (mp = 27). The proportion of all IPs recorded as unsupervised increased through training (P < 0.05) and varied between IPs with 91.2% of appendicectomies (mp = 20), 40.6% of emergency laparotomies (mp = 27), and 17.4% of segmental colectomies (mp = 15) recorded as unsupervised during the final year of training. Acquisition of competency assessments increased through training and varied by IP.ConclusionsThe changing autonomy of trainees through the course of an entire training scheme, alongside formal competency assessments, may provide evidence of changing entrustment decisions made by trainers for different key procedures. Other countries utilizing electronic logbooks could adopt similar techniques to further understanding of competency attainment amongst their surgical trainees.
| S-EPMC6369871 | biostudies-literature
Project description:ObjectiveSurgeon-performed head and neck ultrasound (US) is increasingly used among otolaryngologists in office-based and surgical settings. However, it is unknown how formal US training affects otolaryngology residents' diagnostic workup of patients with cervical pathology. This study examined how a formal US course for residents affected their outpatient clinic US performance and diagnostic accuracy.MethodsWe conducted a randomized cross-over trial, where 13 otolaryngology residents participated in a 6-h formal US course. Participants were randomized to perform head and neck US on four patient cases before and after completing the course. Eight patients with and without neck pathology were invited to participate as test cases. The ultrasound examinations were video recorded and anonymized before two consultants rated the US performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. Otolaryngology residents wrote an ultrasound report with a diagnosis based on their US examination, which was used to calculate the specificity and sensitivity.ResultsWe found a statistically significant difference in the OSAUS score before compared to after the hands-on training (p = .035). The diagnostic accuracy also increased from 62% before the course to 75% after the course (p = .02). Specificity increased from 54% prior to the course to 62% following the course, and sensitivity increased from 64% prior to the course to 79% following the course. The intraclass correlation coefficient with "absolute agreement" was 0.63.ConclusionThis study demonstrates that short, formal ultrasound training can improve otolaryngology residents' ultrasound skills and diagnostic accuracy in an outpatient clinic setting.Lay summaryThis study looks at the change of otolaryngology residents' diagnostic workup of patients after they take a formal ultrasound course and shows that they get better at using ultrasound and make more accurate diagnoses if they take a formal course.Level of evidenceLevel 2.
| S-EPMC10866603 | biostudies-literature
Project description:BACKGROUND:The majority of middle-aged to older patients with chronic conditions report forgetting to take medications as prescribed. The promotion of patients' smartphone medication reminder app (SMRA) use shows promise as a feasible and cost-effective way to support their medication adherence. Providing training on SMRA use, guided by the technology acceptance model (TAM), could be a promising intervention to promote patients' app use. OBJECTIVE:The aim of this pilot study was to (1) assess the feasibility of an SMRA training session designed to increase patients' intention to use the app through targeting perceived usefulness of app, perceived ease of app use, and positive subjective norm regarding app use and (2) understand the ways to improve the design and implementation of the training session in a hospital setting. METHODS:A two-group design was employed. A total of 11 patients older than 40 years (median=58, SD=9.55) and taking 3 or more prescribed medications took part in the study on one of two different dates as participants in either the training group (n=5) or nontraining group (n=6). The training group received an approximately 2-hour intervention training session designed to target TAM variables regarding one popular SMRA, the Medisafe app. The nontraining group received an approximately 2-hour control training session where the participants individually explored Medisafe app features. Each training session was concluded with a one-time survey and a one-time focus group. RESULTS:Mann-Whitney U tests revealed that the level of perceived ease of use (P=.13) and the level of intention to use an SMRA (P=.33) were higher in the training group (median=7.00, median=6.67, respectively) than in the nontraining group (median=6.25, median=5.83). However, the level of perceived usefulness (U=4.50, Z=-1.99, P=.05) and the level of positive subjective norm (P=.25) were lower in the training group (median=6.50, median=4.29) than in the nontraining group (median=6.92, median=4.50). Focus groups revealed the following participants' perceptions of SMRA use in the real-world setting that the intervention training session would need to emphasize in targeting perceived usefulness and positive subjective norm: (1) the participants would find an SMRA to be useful if they thought the app could help address specific struggles in medication adherence in their lives and (2) the participants think that their family members (or health care providers) might view positively the participants' SMRA use in primary care settings (or during routine medical checkups). CONCLUSIONS:Intervention training session, guided by TAM, appeared feasible in targeting patients' perceived ease of use and, thereby, increasing intention to use an SMRA. Emphasizing the real-world utility of SMRA, the training session could better target patients' perceived usefulness and positive subjective norm that are also important in increasing their intention to use the app.
| S-EPMC6334682 | biostudies-literature
Project description:Background The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. Objective We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents. Methods The SAP tracks resident progression and guides teaching in neurosurgery. Surgeries are divided into zones of proximal development (opening, exposure, critical portion, and closure). Postoperatively, resident autonomy is rated on a 4-point scale by the resident and the attending for each part of the case, or zone. We utilized data from July 2017 to February 2024 from 8 institutions. Ordinal regression was used to evaluate the odds of self- and attending-evaluated autonomy, accounting for gender, training year, case difficulty, and institution. Differences between attending assessment and self-assessment were calculated across time. Chi-square analyses were used to measure any differences in feedback given to men and women. Results From 128 residents (32 women, 25%), 11894 cases were included. Women were granted less autonomy (OR 0.81; 95% CI 0.74-0.89; P<.001) and self-evaluated as having less autonomy (OR 0.73; 95% CI 0.67-0.80; P<.001). The odds of women operating at higher autonomy were similar to the odds of operating on a hard case compared to average difficulty (OR 0.77; 95% CI 0.71-0.84; P<.001). Men's and women's self-assessment became closer to attending assessment over time, with women improving more quickly for the critical portions of surgeries. Women residents received meaningful postoperative feedback on fewer cases (women: 74.2%, men: 80.5%; X2=31.929; P<.001). Conclusions Women operated with lower autonomy by both attending and self-assessment, but the assessment gap between genders decreased over time. Women also received less feedback from their attendings.
| S-EPMC11475442 | biostudies-literature
Project description:Impaired balance is a key symptom following acute concussion. Unfortunately, the recommended clinical balance assessment lacks sensitivity and discriminative ability, relying on the experience of the clinician for interpretation. The aim of this pilot study is to explore smartphone technology to remotely assess balance impairment in people with acute concussion. A smartphone app was developed to allow the clinician to connect remotely using their personal web browser to the participant's smartphone and collect motion data while instructing the participant to perform the following balance tests: standing on firm and foam surface with eyes opened and closed (FIRMEO, FIRMEC, FOAMEO, and FOAMEC). Outcome measures were processed from the raw acceleration to calculate the average acceleration magnitude from the mean and the root-mean square, with greater values indicating more sway. Eleven healthy controls (HCs) and 11 people with concussion (CON) participated. In all sway measurements, the CON group had significantly (p < 0.05) greater values when standing on a firm surface. In the FOAMEC condition, the CON group had significantly (p < 0.05) greater sway measures only in the AP direction, while significantly greater sway in all directions were found in the CON group in the FOAMEO condition. This study shows that remote balance assessment using a smartphone can discriminate between healthy controls and people with acute concussion. This technology could play an important role in concussion management to assist with determining recovery from concussions and the optimal timing for return to sport.
| S-EPMC11548566 | biostudies-literature
Project description:ImportanceResident operative autonomy has been steadily decreasing. Whether this reduction in autonomy has been associated with changes in patient outcomes is unclear.ObjectiveTo assess whether surgical procedures performed by residents without an attending surgeon scrubbed are associated with differences in patient outcomes compared with procedures performed by attending surgeons alone or by residents with the assistance of attending surgeons.Design, setting, and participantsThis retrospective propensity score-matched cohort study analyzed 30-day outcomes among patients who received operations at US Veterans Affairs (VA) medical centers and were recorded within the VA Surgical Quality Improvement Program (VASQIP) database from July 1, 2004, to September 30, 2019. Among 1 797 056 operations recorded in the VASQIP during that period, 1 319 020 were eligible for inclusion. Operations performed by a surgical resident without an attending surgeon scrubbed (resident primary) were propensity score matched on a 1:1 ratio (based on year of procedure and patient age, race, sex, American Society of Anesthesiologists physical status classification, functional status, emergency status, inpatient status, presence of multiple comorbidities, and Current Procedural Terminology code) to operations performed by an attending surgeon only (surgeon primary) and operations performed by a resident with assistance from an attending surgeon (resident plus surgeon).ExposuresLevel of resident involvement.Main outcomes and measuresThirty-day adjusted all-cause mortality.ResultsAmong 1 319 020 surgical procedures included, 138 750 were performed by residents only, 308 724 were performed by surgeons only, and 871 546 were performed by residents and surgeons. For the 1 319 020 total cases, patients' mean (SD) age was 61.6 (12.9) years; 1 223 051 patients (92.7%) were male; and 212 315 (16.1%) were Black or African American, 63 817 (4.9%) were Hispanic, 830 704 (63.0%) were White, and 212 814 (16.1%) were of other or unknown race and ethnicity. Propensity score matching produced 101 130 pairs of resident-primary and surgeon-primary procedures and 137 749 pairs of resident-primary and resident plus surgeon procedures. Patient all-cause mortality and morbidity were no different among those who received surgeon-primary procedures (mortality: odds ratio [OR], 1.03 [95% CI, 0.95-1.12]; morbidity: OR, 1.01 [95% CI, 0.97-1.05]) vs resident plus surgeon procedures (mortality: OR, 1.03 [95% CI, 0.97-1.11]; all-cause morbidity: OR, 0.97 [95% CI, 0.95-1.00]). Resident-primary procedures had longer operative times than surgeon-primary procedures (median, 80 minutes [IQR, 50-123 minutes] vs 70 minutes [IQR, 41-114 minutes], respectively; P < .001) but shorter operative times than resident plus surgeon procedures (median, 71 minutes [IQR, 43-113 minutes] vs 73 minutes [IQR, 45-115 minutes]; P < .001). Hospital length of stay was unchanged among resident-primary vs surgeon-primary procedures (median, 4 days [IQR, 2-10 days] vs 4 days [IQR, 2-9 days]; P = .08) and statistically significantly shorter than resident plus surgeon procedures (median, 4 days [IQR, 1-9 days] vs 4 days [IQR, 2-10 days]; P < .001).Conclusions and relevanceIn this cohort study, surgical procedures performed by residents alone were not associated with any changes in all-cause mortality or composite morbidity compared with those performed by attending surgeons alone or by residents with the assistance of attending surgeons. Given these findings and the importance of operative autonomy to prepare surgical residents for independent practice, efforts to increase autonomy are both safe and needed.
| S-EPMC8696685 | biostudies-literature
Project description:Background:Neurobiological studies suggest that deficits in emotion recognition are common phenomena in alexithymia. Thus, effective treatments for alexithymia often include skills training in the domain of emotion recognition. Given that smartphone-based interventions (SBIs) offering skills training have been shown to be promising adjuncts to psychological treatments, a blended SBI facilitating the training of emotional skills might be effective in reducing alexithymia. Methods:In this pilot trial, N?=?29 individuals reporting elevated alexithymia levels were randomly assigned to a blended SBI including a psychoeducation session and 14?days of training with the mindtastic alexithymia app (MT-ALEX) or a psychoeducation-only control condition. Primary outcome was emotion recognition skills as assessed in a computer-based two-choice task paradigm. Results:On average, participating in the SBI was associated with a significant increase in computer-assessed emotion recognition skills compared to the control condition (d?=?0.97). Conclusions:Study findings provide preliminary evidence that SBIs can improve emotion recognition skills in alexithymic individuals. Research using larger samples and targeting clinical populations is necessary to further evaluate the potential of MT-ALEX.
| S-EPMC6510700 | biostudies-literature
Project description:ObjectivesEye-tracking technology has emerged as a potentially useful learner assessment tool in several medical specialties. In the fields of general surgery and anesthesiology, it has been shown to reliably differentiate between different levels of expertise in procedural skills. In the field of radiology, it has been shown to be a valid assessment tool for diagnostic test interpretation. Current methods of competency assessment in point-of-care ultrasound (POCUS) remain a challenge, because they require significant direct observation time by an instructor. The purpose of this study was to determine if eye-tracking technology can accurately distinguish between novice and experts in the interpretation of POCUS clips, specifically of the focused assessment using sonography in trauma (FAST) scan.MethodsA convenience sample of medical students, residents, and emergency physicians from a single academic emergency department were invited to participate. Participants included both novices and experts in POCUS. Each participant completed a baseline questionnaire and viewed 16 video clips of a FAST ultrasound examination while their gaze patterns were recorded by a commercially available eye-tracking device. The primary outcome was total gaze time on the area of interest (AOI). Secondary outcomes included total time to fixation, mean number of fixations, and mean duration of first fixation on the AOI.ResultsFifteen novices and 15 experts completed this study. For total gaze time on the AOI, experts fixated their gaze significantly longer than novices (75.8 ± 16.2 seconds vs. 56.6 ± 12.8 seconds, p = 0.001). Similarly, experts were significantly faster to fixate on the AOI and had a higher fixation count on the AOI (8.5 ± 4.0 seconds vs. 15.1 ± 6.8 seconds, p = 0.003; and 170 ± 30 vs. 143 ± 28 seconds, p = 0.016). There were no differences on the mean duration of first fixation on the AOI (0.42 ± 0.12 seconds vs. 0.39 ± 0.09 seconds, p = 0.467).ConclusionEye-tracking technology shows the potential to differentiate between experts and novices by their gaze patterns on video clips of FAST examinations. The total gaze time on the AOI may be a useful metric to help in the assessment of competency in POCUS image interpretation. In addition, the evaluation of gaze patterns may help educators identify causes of interpretation errors. Future studies are needed to further validate these metrics in a larger cohort.
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Project description:This study investigates pilot perspectives on the use of Flight Simulation Training Devices (FSTDs) in Canada's general aviation (GA) sector, which, despite their longstanding adoption, remain underutilized. It also examines pilot perspectives on the potential of Augmented Reality (AR) technology as an assistive tool in GA pilot training. An online survey gathered views on FSTD use for routine flight operations and emergency training, as well as AR's potential to support learning. Responses from 197 participants show a strong interest (average rating above 4 on a 5-point scale) in incorporating FSTDs and AR technology into the GA pilot training framework. The findings suggest that immersive, technology-driven training environments have the potential to better address modern aviation demands and enhance pilot proficiency.
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