Lillemoe Heather A, Stonko David P, George Brian C, Schuller Mary C, Fryer Jonathan P, Sullivan Maura E, Terhune Kyla P, Geevarghese Sunil K
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Vanderbilt University School of Medicine, Nashville, Tennessee.
J Surg Educ. 2020 Jan-Feb;77(1):18-26. doi: 10.1016/j.jsurg.2019.07.004. Epub 2019 Jul 18.
The purpose of this study was to assess the impact of a preoperative Educational Time-Out (ETO) with structured postoperative feedback on resident preoperative goal-setting and the educational experience of a clinical rotation.
A preoperative ETO was developed during which trainees and faculty jointly identified an operative goal and discussed the trainee's operative autonomy. Postoperative feedback with a smartphone application was encouraged. From November 2016 to October 2017, the intervention was piloted with 1 surgical service. Outcomes included ETO completion rate, goal setting rate, and subjects' perception of the impact of the ETO on identification of performance deficits, trainee autonomy, and receipt of feedback. Data were analyzed using descriptive statistics.
This study was performed in an institutional hospital setting.
Third-year general surgery residents and surgical faculty in the Department of Hepatobiliary Surgery and Liver Transplantation at Vanderbilt University Medical Center took part in the intervention.
Seven residents and 7 attending surgeons participated in this study. Residents performed a median of 15 procurements during an average of 6.5 weeks each on service. The ETO completion rate was 83%. Resident-reported preoperative goal setting increased after the intervention (from 36% to 78%, p = 0.015). Subjects reported a positive impact of the intervention, with high resident agreement that the ETO helped identify deficits (82% median agreement), increased autonomy (82% median agreement), and increased receipt of feedback (84% median agreement). Residents and attendings agreed that the educational experience was stronger due to the ETO (median 81% and 77%, respectively).
The ETO intervention improved rates of resident preoperative goal setting and strengthened perceived educational experiences. Resident participants also reported improvements in autonomy and rates of postoperative feedback. Broader implementation of this brief preoperative pause is an easy way to emphasize procedural education in the operating room.
本研究旨在评估术前教育暂停（ETO）结合结构化术后反馈对住院医师术前目标设定及临床轮转教育体验的影响。
制定了术前ETO，在此期间，学员和教员共同确定手术目标并讨论学员的手术自主权。鼓励使用智能手机应用程序进行术后反馈。2016年11月至2017年10月，在1个外科服务部门进行了该干预试点。结果包括ETO完成率、目标设定率以及受试者对ETO对识别绩效缺陷、学员自主权和反馈接收影响的认知。使用描述性统计分析数据。
本研究在一家机构医院环境中进行。
范德比尔特大学医学中心肝胆外科和肝移植科的三年级普通外科住院医师和外科教员参与了该干预。
7名住院医师和7名主治外科医生参与了本研究。住院医师在平均每人6.5周的服务期间平均进行了15次手术。ETO完成率为83%。干预后，住院医师报告的术前目标设定有所增加（从36%增至78%，p = 0.015）。受试者报告该干预有积极影响，住院医师高度认同ETO有助于识别缺陷（中位认同率82%）、增加自主权（中位认同率82%）以及增加反馈接收（中位认同率84%）。住院医师和主治医生一致认为，由于ETO，教育体验更强（中位认同率分别为81%和77%）。
ETO干预提高了住院医师术前目标设定率，并增强了感知到的教育体验。参与研究的住院医师还报告了自主权和术后反馈率的改善。广泛实施这种简短的术前暂停是在手术室强调程序教育的一种简便方法。
