A theory-based model for teaching and assessing residents in the operating room.

An Emergency Department (ED) is considered the heart of a hospital and in many cities around the world, and especially in developing countries such as Brazil, it is very often the sole source of medical care. Making decisions about hospital resource management is not a trivial activity and incorrect decision-making can have serious consequences on the quality of health care services provided to the community. This paper describes the application of the PROMETHEE II method to support decision-making and resource management in an ED. Multiple Criteria Decision Analysis (MCDA) is especially useful in systems in which decision-making is complex and involves different considerations. PROMETHEE II was chosen for this study because its outranking approach is considered appropriate for the decision context of hospital services. This method was tested and validated with experimental data from a Brazilian public hospital. The ranking showed the best alternatives to be implemented to improve the throughput of patients in the “Blue Room”. Six months after implementing the best alternatives, the waiting time during periods of overcrowding had been reduced by around 70%. The PROMETHEE II method proved to be a rational tool to support the Decision Maker (DM) to choose the best alternative to solve bottlenecks related to overcrowding in an ED. Improving decision-making in hospital departments means taking actions to increase the throughput of patients and reducing the number of patients-in-process.

Improving decision-making and management of hospital resources: An application of the PROMETHEE II method in an Emergency Department

Importance Surgical expertise demands technical and nontechnical skills. Traditionally, surgical trainees acquired these skills in the operating room; however, operative time for residents has decreased with duty hour restrictions. As in other professions, video analysis may help maximize the learning experience. Objective To develop and evaluate a postoperative video-based coaching intervention for residents. Design, Setting, and Participants In this mixed methods analysis, 10 senior (postgraduate year 4 and 5) residents were videorecorded operating with an attending surgeon at an academic tertiary care hospital. Each video formed the basis of a 1-hour one-on-one coaching session conducted by the operative attending; although a coaching framework was provided, participants determined the specific content collaboratively. Teaching points were identified in the operating room and the video-based coaching sessions; iterative inductive coding, followed by thematic analysis, was performed. Main Outcomes and Measures Teaching points made in the operating room were compared with those in the video-based coaching sessions with respect to initiator, content, and teaching technique, adjusting for time. Results Among 10 cases, surgeons made more teaching points per unit time (63.0 vs 102.7 per hour) while coaching. Teaching in the video-based coaching sessions was more resident centered; attendings were more inquisitive about residents’ learning needs (3.30 vs 0.28,P = .04), and residents took more initiative to direct their education (27% [198 of 729 teaching points] vs 17% [331 of 1977 teaching points],P  Conclusions and Relevance Video-based coaching is a novel and feasible modality for supplementing intraoperative learning. Objective evaluation demonstrates that video-based coaching may be particularly useful for teaching higher-level concepts, such as decision making, and for individualizing instruction and feedback to each resident.

/pdf/complementing-operating-room-teaching-with-video-based-e711ltimji.pdf

Complementing Operating Room Teaching With Video-Based Coaching.

Background Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. Methods A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. Results Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. Conclusions This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback.

Perioperative feedback in surgical training: A systematic review.

Surgical education continues to evolve from the master-apprentice model. Newer methods of the process need to be used to manage the dual challenges of educating while providing safe surgical care. This requires integrating adult learning concepts into delivery of practical training and education in busy clinical environments. A narrative review aimed at outlining and integrating adult learning and surgical education theory was undertaken. Additionally, this information was used to relate the practical delivery of surgical training and education in day-to-day surgical practice. Concepts were sourced from reference material. Additional material was found using a PubMed search of the words: 'surgical education theory' and 'adult learning theory medical'. This yielded 1351 abstracts, of which 43 articles with a focus on key concepts in adult education theory were used. Key papers were used to formulate structure and additional cross-referenced papers were included where appropriate. Current concepts within adult learning have a lot to offer when considering how to better deliver surgical education and training. Better integration of adult learning theory can be fruitful. Individual teaching surgical units need to rethink their paradigms and consider how each individual can contribute to the education experience. Up skilling courses for trainers can do much to improve the delivery of surgical education. Understanding adult learning concepts and integrating these into day-to-day teaching can be valuable.

Surgical education and adult learning: Integrating theory into practice.

Background As part of a quality improvement initiative to reduce Emergency Department (ED) length of stay (LOS) for surgical consult patients, we e-mailed performance metrics to key stakeholders on a daily basis. ED and Surgery leadership used these daily metrics to identify and remedy contributing factors for increased ED LOS in patients who received surgical consults. Objective To evaluate whether a quality improvement process driven by a daily performance metric e-mail would be associated with a change in ED LOS for surgical consult patients. Methods Prospective before-after study looking at ED LOS for surgical consult patients after an e-mail intervention at a tertiary academic teaching hospital. All consecutive adult ED patients between July 1, 2010 and October 1, 2010 who received a general surgical consult were enrolled. The primary outcome measure was ED LOS, and secondary outcome measure was time to consultation. Results There were 916 patients who had surgical consults placed during the study period; 459 patients presented before the intervention and 457 patients presented after the intervention. The median LOS decreased 54 min, from 463 min (interquartile range [IQR] 326–617) before the intervention to 409 min (IQR 294.5–528.5) after the intervention ( p p = 0.002). There was no difference in age, severity, number of consults, or disposition. There was also no difference in median LOS for other consultation services or in previous years during the same time period. Conclusions ED LOS and time to consultation were decreased for surgical consult patients after initiation of daily performance metric e-mails.

Prospective evaluation of daily performance metrics to reduce emergency department length of stay for surgical consults

Splenic trauma in a pediatric patient with hereditary spherocytosis.

Perspectives on intraoperative teaching: divergence and convergence between learner and teacher.

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Prospective evaluation of daily performance metrics to reduce emergency department length of stay for surgical consults

Splenic trauma in a pediatric patient with hereditary spherocytosis.

Perspectives on intraoperative teaching: divergence and convergence between learner and teacher.