Abstract:
Importance:Surgical patient outcomes are related to surgeon skills. Objective:To measure resident surgeon technical and nontechnical skills for trauma core competencies before and after training and up to 18 months later and to compare resident performance with the performance of expert traumatologists. Design, Setting, and Participants:This longitudinal study performed from May 1, 2013, through February 29, 2016, at Maryland State Anatomy Board cadaver laboratories included 40 surgical residents and 10 expert traumatologists. Interventions:Performance was measured during extremity vascular exposures and lower extremity fasciotomy in fresh cadavers before and after taking the Advanced Surgical Skills for Exposure in Trauma (ASSET) course. Main Outcomes and Measures:The primary outcome variable was individual procedure score (IPS), with secondary outcomes of IPSs on 5 components of technical and nontechnical skills, Global Rating Scale scores, errors, and time to complete the procedure. Two trained evaluators located in the same laboratory evaluated performance with a standardized script and mobile touch-screen data collection. Results:Thirty-eight (95%) of 40 surgical residents (mean [SD] age, 31 [2.9] years) who were evaluated before and within 4 weeks of ASSET training completed follow-up evaluations 12 to 18 months later (mean [SD], 14 [2.7] months). The experts (mean [SD] age, 52 [10.0] years) were significantly older and had a longer (mean [SD], 46 [16.3] months) interval since taking the ASSET course (both P < .001). Overall resident cohort performance improved with increased anatomy knowledge, correct procedural steps, and decreased errors from 60% to 19% after the ASSET course regardless of clinical year of training (P < .001). For 21 of 40 residents (52%), correct vascular procedural steps plotted against anatomy knowledge (the 2 IPS components most improved with training) indicates the resident's performance was within 1 nearest-neighbor classifier of experts after ASSET training. Five residents had no improvement with training. The Trauma Readiness Index for experts (mean [SD], 74 [4]) was significantly different compared with the trained residents (mean [SD], 48 [7] before training vs 63 [7] after training [P = .004] and vs 64 [6] 14 months later [P = .002]). Critical errors that might lead to patient death were identified by pretraining IPS decile of less than 0.5. At follow-up, frequency of resident critical errors was no different from experts. The IPSs ranged from 31.6% to 76.9% among residents for core trauma competency procedures. Modeling revealed that interval experience, rather than time since training, affected skill retention up to 18 months later. Only 4 experts and 16 residents (40%) adequately decompressed and confirmed entry into all 4 lower extremity compartments. Conclusions and Relevance:This study found that ASSET training improved resident procedural skills for up to 18 months. Performance was highly variable. Interval experience after training affected performance. Pretraining skill identified competency of residents vs experts. Extremity vascular and fasciotomy performance evaluations suggest the need for specific anatomical training interventions in residents with IPS deciles less than 0.5.
journal_name
JAMA Surgjournal_title
JAMA surgeryauthors
Mackenzie CF,Garofalo E,Puche A,Chen H,Pugh K,Shackelford S,Tisherman S,Henry S,Bowyer MW,Retention and Assessment of Surgical Performance (RASP) Group of Investigators.doi
10.1001/jamasurg.2017.0092subject
Has Abstractpub_date
2017-06-01 00:00:00pages
581-588issue
6eissn
2168-6254issn
2168-6262pii
2606980journal_volume
152pub_type
杂志文章相关文献
JAMA Surgery文献大全abstract:IMPORTANCE:Although prospective randomized data are available to guide the multidisciplinary management of soft tissue sarcoma (STS) of the extremities, controversy exists regarding adjuvant chemotherapy and radiation therapy. OBJECTIVE:To determine if clinical specialty introduces bias in recommendations for multimod...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.113
更新日期:2013-07-01 00:00:00
abstract:IMPORTANCE:In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending. OBJECTIVE:To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.3618
更新日期:2016-02-01 00:00:00
abstract:IMPORTANCE:Revisional laparoscopic surgery after Roux-en-Y gastric bypass (RYGB) has been linked to substantial complications and morbidity. OBJECTIVE:To investigate the safety and effectiveness of endoscopic gastric plication with the StomaphyX device vs a sham procedure for revisional surgery in RYGB patients to red...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamasurg.2013.4051
更新日期:2014-04-01 00:00:00
abstract:IMPORTANCE:Research has been limited on the incidence, mechanisms, etiology, and treatment of symptoms that require palliation in patients with terminal cancer. Bowel obstruction (BO) is a common complication of advanced abdominal cancer, including colon cancer, for which small, single-institution studies have suggeste...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.1
更新日期:2013-08-01 00:00:00
abstract:Importance:Identification of the tumor margin during surgery is important for precise minimal resection of lung tumors. Intravenous injection of indocyanine green (ICG) has several limitations when used for intraoperative visualization of lung cancer. Objectives:To describe a technique for intraoperative visualization...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.1314
更新日期:2020-06-24 00:00:00
abstract:IMPORTANCE:A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems. OBJECTIVE:To use human factors engineering to redesign the trauma process based on previously identified impediments to care related to coordination problems, c...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1208
更新日期:2014-09-01 00:00:00
abstract:IMPORTANCE:Total hip replacement is a commonly performed orthopedic procedure for the treatment of painful arthritis, osteonecrosis, or fracture. OBJECTIVE:To develop and verify a scale for predicting readmission rates for total hip replacement patients and allow for the development and implementation of readmission r...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.0020
更新日期:2016-08-01 00:00:00
abstract:Importance:Living kidney donation is associated with increased long-term risk of end-stage renal disease (ESRD). An early postdonation marker of ESRD risk could improve postdonation risk assessment and counseling for kidney donors and allow early intervention for donors at increased risk. Objective:To determine the as...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.5472
更新日期:2020-03-01 00:00:00
abstract:IMPORTANCE:Laparoscopic ventral hernia repair (LVHR) using mesh is a well-established intervention for ventral hernia, but pain control can be challenging. OBJECTIVE:To determine whether instillation of a long-acting local anesthetic between the mesh and the peritoneum after LVHR reduces pain or narcotic requirements....
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2015.1530
更新日期:2015-09-01 00:00:00
abstract:Importance:Chemotherapy is the recommended induction strategy in borderline resectable and locally advanced pancreatic ductal adenocarcinoma. However, the associated results on an intention-to-treat basis are poorly understood. Objective:To investigate pragmatically the treatment compliance, conversion to surgery, and...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.2277
更新日期:2019-10-01 00:00:00
abstract:Importance:Adhesive small-bowel obstruction (aSBO) is a potentially chronic, recurring surgical illness. Although guidelines suggest trials of nonoperative management, the long-term association of this approach with recurrence is poorly understood. Objective:To compare the incidence of recurrence of aSBO in patients u...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.5248
更新日期:2019-05-01 00:00:00
abstract:Importance:Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted car...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.5674
更新日期:2017-06-01 00:00:00
abstract:Importance:Surgical and medical device manufacturers have a cooperative relationship with clinicians. When evaluating published works, one should assess the integrity and academic credentials of the authors, who serve as putative experts. A relationship with a relevant manufacturer may increase the potential risk for b...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.2576
更新日期:2018-11-01 00:00:00
abstract:UNLABELLED:IMPORTANCE It is not known whether hospital and surgeon volumes have an association with readmission among patients undergoing pancreatoduodenectomy. OBJECTIVE:To evaluate patient-, surgeon-, and hospital-level factors associated with readmission. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort stud...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.2509
更新日期:2013-12-01 00:00:00
abstract:IMPORTANCE:Among patients presenting with critical lower extremity ischemia, it has been previously documented that white individuals are more likely to undergo revascularization than nonwhite individuals, with the disparity largely attributed to differences in resources and access to care. OBJECTIVE:To investigate th...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.1436
更新日期:2013-07-01 00:00:00
abstract:IMPORTANCE:Morphometric assessment has emerged as a strong predictor of postoperative morbidity and mortality. However, a gap exists in translating this knowledge to bedside decision making. We introduced a novel measure of patient-centered surgical risk assessment: morphometric age. OBJECTIVE:To investigate the relat...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.4823
更新日期:2014-04-01 00:00:00
abstract:Importance:Liposomal bupivacaine is a novel extended-duration anesthetic that has recently been used for local infiltration in total knee arthroplasty (TKA). Athough liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. Objective:To evaluate ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.3474
更新日期:2017-01-01 00:00:00
abstract:Importance:Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an innovative procedure in the treatment of noncompressible truncal hemorrhage. However, readily available fluoroscopy remains a limiting factor in its widespread implementation. Several methods have been proposed to perform REBOA without f...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4757
更新日期:2017-04-01 00:00:00
abstract:IMPORTANCE:Endovascular technology has become ubiquitous in the modern care of abdominal aortic aneurysm (AAA), yet broad estimates of its efficacy among variable hospital and regional settings is not known. OBJECTIVE:To perform a preliminary analysis of hospital effects on mortality following open AAA repair (OAR) an...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2014.3871
更新日期:2015-07-01 00:00:00
abstract:Importance:Military and civilian trauma experts initiated a collaborative effort to develop an integrated learning trauma system to reduce preventable morbidity and mortality. Because the Department of Defense does not currently have recommended guidelines and standard operating procedures to perform military preventab...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2017.6105
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the performance of 3-dimensional (3D) virtual neck exploration (VNE) as a modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism and assess the feasibility of using augmented reality to guide parathyroidectomy as a step toward minimally invasive imageguided s...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.739
更新日期:2013-03-01 00:00:00
abstract:Importance:Older adults are disproportionately affected by trauma and accounted for 47% of trauma fatalities in 2016. In many populations and disease processes, described risk factors for poor clinical outcomes include sarcopenia and brain atrophy, but these remain to be fully characterized in older trauma patients. Sa...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.0988
更新日期:2019-08-01 00:00:00
abstract:Importance:Radical cystectomy is the guidelines-recommended treatment of muscle-invasive bladder cancer, but a resurgence of trimodal therapy has occurred. Limited comparative data are available on outcomes and costs attributable to these 2 treatments. Objective:To compare the survival outcomes and costs between trimo...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.1680
更新日期:2018-10-01 00:00:00
abstract:IMPORTANCE:Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators. OBJECTIVE:To determine the change in hospital profit due to SSIs. DESIGN:Retrospective study of data from January 1, 2007, to December 31, 2010. SETTI...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2013.2246
更新日期:2013-10-01 00:00:00
abstract:Importance:Surgical options for weight loss vary considerably in risks and benefits, but the relative importance of procedure-associated characteristics in patient decision making is largely unknown. Objective:To identify patient preferences for risks, benefits, and other attributes of treatment options available to i...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2018.4375
更新日期:2019-01-01 00:00:00
abstract:Importance:Opioid overdose is the leading cause of injury-related death in the United States. Several studies have shown that surgeons overprescribe opioids, and guidelines for appropriate opioid prescribing are available. Concern about patient-reported satisfaction scores may be a barrier to surgeons adopting guidelin...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.2875
更新日期:2019-11-01 00:00:00
abstract::Over the past decade, minimally invasive surgery has been introduced as a means to allow manipulation of delicate tissues with outstanding visualization of the surgical field. The purpose of this article is to review the available literature regarding early postoperative outcomes and the technical challenges of minima...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2013.366
更新日期:2013-12-01 00:00:00
abstract:Importance:Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide compl...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4604
更新日期:2017-02-15 00:00:00
abstract:IMPORTANCE:Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE:To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complicated appendicitis. DE...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.4236
更新日期:2016-04-01 00:00:00
abstract:IMPORTANCE:Postoperative pulmonary complications can be a devastating consequence of surgery. Validated strategies to reduce these adverse outcomes are needed. OBJECTIVES:To design, implement, and determine the efficacy of a suite of interventions for reducing postoperative pulmonary complications. DESIGN:A before-af...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.358
更新日期:2013-08-01 00:00:00