Date of Award

8-2017

Culminating Project Type

Thesis

Degree Name

Exercise Science: M.S.

Department

Kinesiology

College

School of Health and Human Services

First Advisor

David Bacharach

Second Advisor

Glenn Street

Third Advisor

David Robinson

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Keywords and Subject Headings

Resident training

Abstract

Medical students wanting to be surgeons have a long road of training that only grows with advancing technology and an expanding range of diseases. Faced with duty hour restrictions, today’s residents are experiencing a shift from the traditional training paradigm—instead of learning all basic skills in the operating room (OR), some are being developed with simulation training outside the OR. In order to create a curriculum with an effective blend between operating duties and simulation, it’s important that there’s an understanding of the effect of resident involvement in the OR. Then, a more accurate simulation/education curriculum can be created that will maximize quality and efficiency of training and begin to reduce adverse effects of intraoperative resident involvement (complications, time, and cost). In an effort to determine these effects at the Mayo Clinic, 324 laparoscopic cholecystectomy (gallbladder removal) cases from 2010-2013 were retrospectively reviewed. All cases were performed by one general surgeon with or without a post-graduate year three surgery resident. There were 174 cases with resident involvement and 150 without. Overall, OR time was significantly greater with a resident (88 ± 30 min versus 57 ± 22 min by surgeon only (t(311)=10.33, p2=0.026; p=0.436). Excluding high-risk patients, there were 117 cases with resident involvement and 89 without. Again, operative duration was longer with a resident (88 ± 23 min versus 54 ± 22 min surgeon only (t(192)=8.97, p2=0.102, p=0.370). While a longer operative duration with resident involvement translates into larger costs, no statistically significant difference in complications is quite encouraging. Educators can now modify their simulation/education curriculum to include more laparoscopic fundamentals—potentially reducing the amount of time spent in the OR learning the basics of laparoscopy—as well as adding sessions that include common GS procedures (like LC and laparoscopic appendectomy). The addition of laparoscopic stations in assessments would also be beneficial to ensure residents are meeting competency standards before they can operate. The ultimate goal of these modifications is to create surgeons who are both efficient and effective in the OR: reducing operative duration without risking patient safety.

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