Dr. Nassar is board certified in General Surgery and Critical Care in both the USA and Canada. Dr. Nassar has five years of clinical experience in tertiary care referral academic health centers in Canada prior to joining Stanford University in surgery, trauma, and critical care. His clinical interests are emergency and elective surgery in addition to trauma and critical care medicine. He is also a skilled endoscopist performing both upper and lower gastrointestinal endoscopy. His research interests are varied and include developing assessment tools for trainees and burnout among physicians and other healthcare professionals. In addition, he is especially interested in training trainees in simulation-based medical education with a focus on perioperative inter-professional collaboration and patient safety. He is a true clinician-educator and is a certified simulation educator as well as an ATLS course director. Dr. Nassar has also earned an MSc degree in Health Science Education from McMaster University, Canada.
- General Surgery
- Acute Care Surgery
- Critical Care
- Abdominal wall reconstruction
- EGD and Colonoscopy
Clinical Assistant Professor, Surgery - General Surgery
Surgical Subcoucil lead, Stanford Health Care (2020 - Present)
Program Director, Surgical Critical Care fellowship, Stanford University (2019 - Present)
Director, Surgery Coaching Program, Stanford Healthcare (2019 - Present)
Unit Medical Director, Trauma K7 ward, Stanford Healthcare (2019 - Present)
Associate Program Director, Surgical Critical Care, Stanford University (2018 - 2019)
Honors & Awards
Arthur L. Bloomfield Award in Recognition of Excellence in the Teaching of Clinical Medicine,, Stanford School of Medicine (2022)
CSRP (Cost Savings Reinvestment Program) recognition award, Stanford Health Care (2020)
Staff Award for Outstanding Contribution as Relationship-centered Communication Leader, Stanford Healthcare (2019)
Boards, Advisory Committees, Professional Organizations
Education Technology Committee Member, Association for Surgical Education (2022 - Present)
Graduate Surgical Education Committee Member, Association for Surgical Education (2022 - Present)
Simulation Committee Member, Association for Surgical Education (2022 - Present)
Critical Care Committee Member, American Association for the Surgery of Trauma (AAST) (2022 - Present)
Board Certification: American Board of Surgery, Surgical Critical Care (2021)
Board Certification, American Board of Surgery, Surgical Critical Care (2021)
Fellowship: McMaster University Michael G DeGroote School of Medicine Registrar (2012) Canada
Residency: McMaster University Michael G DeGroote School of Medicine Registrar (2011) Canada
Board Certification: American Board of Surgery, General Surgery (2011)
MSc, McMaster University, Hamilton, ON, Canada, Health Science Education (2015)
Board Certification: Royal College of Physicians and Surgeons of Canada, Critical Care Medicine (2012)
Board Certification, American Board of Surgery, General Surgery (2011)
Board Certification: Royal College of Physicians and Surgeons of Canada, General Surgery (2011)
O-IMG Clerkship, McMaster University, Hamilton, ON, Canada, Clerkship Undergraduate program (2006)
- Labeled Surgical Caps: A Tool to Improve Perioperative Communication. Anesthesiology 2022
Education research - Understanding the factors involved in inpatient communication for orthopedic trainees.
Annals of medicine and surgery (2012)
2021; 72: 103079
Background: "Interpersonal and Communication Skills" (ICS) is a core competency set forth by the ACGME. No structured curriculum exists to train orthopedics residents in ICS.Methods: Twenty-four out of thirty-five orthopedics residents completed the survey (69%). The survey had the following domains:  Demographics,  Communication Needs/Goals, and  Communication Barriers.Results: Eighty-three percent of respondents wanted to improve their communication skills and their patient's experience. Interns-PGY4s wanted to improve on similar specific communication skills. All residents desired training in conflict management.Conclusion: There is a need among orthopedics residents for a communication skills curriculum early in residency training, specifically in conflict management.
View details for DOI 10.1016/j.amsu.2021.103079
View details for PubMedID 34876980
- Virtual reality (VR) as a simulation modality for technical skills acquisition ANNALS OF MEDICINE AND SURGERY 2021; 71
Burnout among Academic Clinicians as It Correlates with Workload and Demographic Variables.
Behavioral sciences (Basel, Switzerland)
2020; 10 (6)
Burnout syndrome (BOS) in academic physicians is a psychological state resulting from prolonged exposure to job stressors. It leads to a decline in overall job performance, which could result in misjudgment and serious clinical errors. The current study identifies the prevalence, as well as the potential demographic and workload variables that contribute significantly to BOS in academic clinicians. We distributed a modified version of the Maslach Burnout Inventory (MBI) scale to the academic clinicians in our institution; 326/900 responded, with 56.21% male and 43.46% female. The MBI scale comprised of three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Higher scores in EE and DP and lower scores in PA were associated with a higher risk for burnout. In considering the work-life of academic clinicians, this study used a modified version of the MBI to reflect three hypothesized sources of burnout: interactions with students/trainees, interactions with patients, and interactions with administration, as reflected in these three dimensions. Along both the EE and DP dimensions of the MBI, burnout was highest for interactions with administration (51% and 44.8%), moderate for interactions with patients (26.4% and 34.5%), and lowest for interactions with students (11.7% and 9.8%). The highest scores along the personal accomplishment component was found for interactions with students and patients (33.7% and 33.4%). Regression analyses identified several factors associated with higher scores on the EE and DP scales: younger age, surgical specialty, low academic rank, academic main practice, female gender, numerous night shifts, and living alone. Furthermore, higher patient volume contributed significantly to the increasing PA. This study suggests that administrative interaction contributes significantly to burnout amongst physicians, followed by patient care and trainees. Furthermore, surgeons, females, single, early career, and younger faculty staff members are at higher risk of suffering from burnout. Further studies are needed to characterize the nature of administrative interactions that contribute to burnout and to solidify other contributing variables.
View details for DOI 10.3390/bs10060094
View details for PubMedID 32471265
Mobile application-based guidelines to enhance patient care and provider education in trauma and acute care surgery.
Trauma surgery & acute care open
2020; 5 (1): e000479
Providing up-to-date, universally accessible care guidelines and education within a quaternary care center is challenging. At our institution, trauma and acute care surgery guidelines have historically been published using a paper-based format. Mobile application-based guidelines were developed to address the shortcomings of paper-based guidelines.We assessed the utility, usability, and satisfaction of healthcare providers towards paper-based versus mobile application-based guidelines. A survey was administered to providers within the emergency department and intensive care unit.Fifty of 137 providers responded (36.5% response rate). Nearly half (47.4%, 9 of 19) of those who received a copy of the paper-based guidelines lost the guidelines at least once. Regarding usage of the mobile application-based guidelines, 92.6% (25 of 27) were aware of the application; 92.6% (25 of 27) considered the application comprehensive, 85.2% (23 of 27) thought the application was organized, and 66.7% (18 of 27) thought the application was easy to use. Additionally, 88.9% (24 of 27) found the application moderately, very, or extremely helpful and 85.2% (23 of 27) judged the application moderately, very, or extremely necessary. Overall, 88.9% (24 of 27) were satisfied with the application and indicated likeliness to recommend to a colleague. Seventeen of 27 (63.0%) agreed or strongly agreed that the application improved their provision of trauma and acute care.This survey demonstrates positive usability, utility, and satisfaction among trauma healthcare providers with the mobile application-based guidelines. Additionally, this quality improvement initiative highlights the importance of having comprehensive, organized, and easy-to-use trauma and acute care surgery guidelines and targeted educational materials available on demand. The successful transition from paper to mobile application-based guidelines serves as a model for other institutions to modernize and improve patient care and provider education.IV.
View details for DOI 10.1136/tsaco-2020-000479
View details for PubMedID 32760809
View details for PubMedCentralID PMC7380731
A National Evaluation of Emergency General Surgery Outcomes Among Hospitalized Cardiac Patients.
The Journal of surgical research
2022; 283: 24-32
INTRODUCTION: Emergency general surgery among cardiac surgery patients is increasingly common and consequential. We sought to characterize the true burden of emergency general surgery among hospitalized complex cardiac patients.METHODS: We performed a retrospective analysis of the 2016-2017 National Inpatient Sample. We included adult patients with a primary diagnosis of complex cardiac disease. We then compared patients who underwent emergency general surgery (GS-OR) with those who did not (non-GS-OR). The primary outcome was mortality; secondary outcomes included length of stay and hospitalization costs.RESULTS: We identified 10.2 million patients with a primary diagnosis of complex cardiac disease, of which 148,309 (1.4%) underwent GS-OR. Mortality rates were significantly higher in the GS-OR group (11.0% versus 5.0%, P<0.001). Among all cardiac patients, GS-OR was associated with 2.2 times increased odds of death (aOR: 2.2, P<0.001). GS-OR patients also had longer length of stays (14.1 versus 5.8d, P<0.001). Among all cardiac patients, GS-OR was associated with an 8.1-day longer length of stay (P<0.001). GS-OR patients were less often routinely discharged home (31.7% versus 45.3%, P<0.001) and incurred higher inpatient costs ($46,136 versus $16,303, P<0.001). Among all cardiac patients, GS-OR patients incurred $30,102 higher hospitalization costs (P<0.001).CONCLUSIONS: Emergency general surgery among cardiac surgery patients is associated with a greater than two-fold increase in mortality, longer length of stays, higher rates of nonroutine discharge, and higher hospitalization costs. Emergency general surgery complications account for 4.0% of total inpatient costs of cardiac surgery patients and merit further study.
View details for DOI 10.1016/j.jss.2022.10.016
View details for PubMedID 36368272
Firearm-Related Injuries and the US Opioid Epidemic: A Nationwide Evaluation of Emergency Department Encounters
LIPPINCOTT WILLIAMS & WILKINS. 2022: S45-S46
View details for Web of Science ID 000867877000114
Faculty Lead Coaching as a Method to Enhance Feedback Culture and Communication Skills Development in Surgical Education-Needs Assessment (Study in Progress)
LIPPINCOTT WILLIAMS & WILKINS. 2022: S74
View details for Web of Science ID 000867877000185
- Introducing advanced surgical tasks simulation for surgical training ANNALS OF MEDICINE AND SURGERY 2022; 77
Introducing advanced surgical tasks simulation for surgical training.
Annals of medicine and surgery (2012)
2022; 77: 103568
Acquiring surgical skills is one of the major objectives of surgical training. Trainees face increasing challenges to meet the continuously evolving surgical techniques and approaches during the limited time course of their surgical training. The limited availability of training tools for teaching advanced surgical skills is an additional barrier. Educators have increasingly used simulation tools for surgical skills training around the globe. However, current simulation training modules and curricula focus mainly on basic surgical skills. Hence, the development of advanced virtual simulation modules offers a precious laparoscopic training opportunity. This article provides an educational technology-based review and proposal (with selected examples) of simulation training modules on advanced surgical skills that can be used for advanced surgical training approaches.
View details for DOI 10.1016/j.amsu.2022.103568
View details for PubMedID 35637992
View details for PubMedCentralID PMC9142373
The educational value of an audience response system use in an Iraqi medical school.
BMC medical education
2022; 22 (1): 319
BACKGROUND: Medical education is continually evolving particularly through the modern implementation of educational technology. Enhancing interactive learning in the classroom or lecture settings is one of the growing uses of educational technology. The role and potential benefits of such technology may not be as evident in developing educational systems like the one in Iraq. The purpose of this study was to examine the effect and perception of the use of an audience response system (ARS) on interactive medical education in Iraq. A mixed quantitative and qualitative research methodology approach was used to study the effects and users' perceptions (both student and tutor) of the ARS.METHOD: The study was conducted in an Iraqi medical school in the Head and Neck course during the spring semester for third-year medical students. The course involved fifteen one-hour lectures over fifteen weeks. Users' perceptions were evaluated by survey and focus group discussions (FGD). Descriptive statistics were used for quantitative measures and thematic analysis for the qualitative data. An ARS system was installed and integrated into the course lectures throughout the course period of three months to enhance interactive learning. Three to five interactive questions were used in each lecture. Anonymous participation and answers were maintained. The appropriate discussion was initiated when pertinent depending on students' answers.RESULT: Most students (77% of survey, 85% of FGD) perceived the use of ARS as impactful on their learning. They found the ARS engaging (70%), motivating (76%), promoting interactions (73%), and augment learning through better understanding and remembering (81%). Through the FGD, students expressed improved focus, enhanced thinking and reflection, and joyful learning. The educator perceived the ARS use as practical, interactive, thinking-stimulator, and reflective of student's understanding. The required technology skills were reasonable; however, it demanded extra non-insignificant time to learn the use.CONCLUSION: The perception of the ARS in this study was overall positive, providing encouragement for wide application of this technology in medical education in the developing world. Further studies are needed to validate and prioritize ARS usage in medical education in Iraq.
View details for DOI 10.1186/s12909-022-03381-z
View details for PubMedID 35473705
Building a Trainee-led Research Community to Propel Academic Productivity in Health Services Research.
Journal of surgical education
Academic productivity is an increasingly important asset for trainees pursuing academic careers. Medical schools and graduate medical education programs offer structured research programs, but providing longitudinal and individualized health services research education remains challenging. Whereas in basic science research, members at multiple training levels support each other within a dedicated community (the laboratory), health services research projects frequently occur within individual faculty-trainee relationships. An optimal match of expertise, availability, and interest may be elusive for an individual mentor-mentee pair. We aimed to share our experience building Surgeons Writing about Trauma (SWAT), a trainee-led research community that propels academic productivity by facilitating peer collaboration and opportunities to transition into independent researchers. We highlight challenges of health services research for trainees, present how structured mentorship and a peer community can address this challenge, and detail SWAT's operational structure to guide replication at peer institutions.
View details for DOI 10.1016/j.jsurg.2022.02.008
View details for PubMedID 35272969
Virtual reality (VR) as a simulation modality for technical skills acquisition.
Annals of medicine and surgery (2012)
2021; 71: 102945
Efforts continue to facilitate surgical skills training and provide accessible and safe training opportunities. Educational technology has played an essential role in minimizing the challenges facing traditional surgical training and providing feasible training opportunities. Simulation and virtual reality (VR) offer an important innovative training approach to enhance and supplement both technical and non-technical skills acquisition and overcome the many training challenges facing surgical training programs. To maximize the effectiveness of simulation modalities, an in-depth understanding of the cognitive learning theory is necessary. Knowing the stages and mental processes of skills acquisition when integrated with simulation applications can help trainees achieve maximal learning outcomes. This article aims to review important literature related to VR effectiveness and discuss the leading theories of technical skills acquisition related to VR simulation technologies.
View details for DOI 10.1016/j.amsu.2021.102945
View details for PubMedID 34840738
View details for PubMedCentralID PMC8606692
Applying Bloom's taxonomy in clinical surgery: Practical examples.
Annals of medicine and surgery (2012)
2021; 69: 102656
Bloom's cognitive learning taxonomy is widely used in medical education. The revised taxonomy published by David Kathwohl (1956) and his group describes the levels in action forms: Remember, Understand, Apply, Analyze, Evaluate, and Innovate. The taxonomy has been commonly used to design and structure educational goals and objectives. However, most uses occur at the course or program curriculum level, as was originally described. Whereas applying the taxonomy at the level of individual educational activities remained limited for different reasons. Hence, the aim of this article is to promote applying the taxonomy in daily clinical teaching by providing practical clinical examples in a simplified way.
View details for DOI 10.1016/j.amsu.2021.102656
View details for PubMedID 34429945
Actions to enhance interactive learning in surgery.
Annals of medicine and surgery (2012)
2021; 64: 102256
Introduction: Many educational institutions and academic organizations provide concise and highly organized educational material for the trainees and training programs, while others do not. The role of interactive technology-enhanced learning in surgical education is not entirely explored and disseminated despite common knowledge of such interactive educational technology. Utilizing such technology in the place of textbooks could replace a peer trainee and a teacher examiner.Evidence: Maximizing involvement, participation, and interactivity from both surgical trainees and their faculty has been shown to improve the quality and outcomes of surgical education. Given that there is an increasing trend towards shifting from traditional unidirectional teaching to learner-centered interactive teaching. Improving the educational activities setting from the traditional - didactic unidirectional lecture to multi-directional, interactive, engaging, and stimulating activity can enhance learners' educational outcomes. With the advent of educational technology, interactive and shared learning became more feasible and creative. Various educational technology platforms, instructional designs, and tools serve different educational purposes guided by educational activity's objective. Educational systems have integrated numerous widely technologies such as smartphones, tablets, and cloud-based services that greatly facilitate instructional strategies and teaching methods. Many institutions and programs have embraced the new technologies to enhance the overall learning process. Educational technology offers new concepts and applications in learning beyond faster communication or storage of digital resources. Furthermore, active and interactive learning in surgical education has been found to carry a strong and implied impact depending on how it is structured. To enhance and promote interactive surgical education on a broad scale, the following initiatives will be reviewed; interactive adult learning worldwide, wide sharing of knowledge and skills, and use of educational technology where it is pertinent.Conclusion: Residents and surgical training programs need assistance with the process of learning amid ongoing technological innovations. This guidance would leverage the training programs' educational efforts toward effective surgery training. Interactive educational learning technology is expected to fulfill this need by promoting knowledge sharing, skills learning to enhance educational outcomes.
View details for DOI 10.1016/j.amsu.2021.102256
View details for PubMedID 33889404
Students and faculty perception of distance medical education outcomes in resource-constrained system during COVID-19 pandemic. A cross-sectional study.
Annals of medicine and surgery (2012)
2021; 62: 377–82
Introduction: The COVID-19 pandemic has imposed significant challenges on medical education worldwide, particularly in experience- and resource-limited regions of the world. Collaborative efforts of educators and academic institutions are necessary to facilitate the adaptation to the new educational reality. In this study, challenges and outcomes of a newly implemented distance education curriculum are examined to share findings and provide recommendations.Methods: An alternative distance education curriculum with online resources and virtual lectures was developed and implemented in February 2020at the Wasit University College of Medicine in Iraq. A post-implementation survey was developed for both faculty instructors and students to evaluate the program's effectiveness and perception. Results were compared between both groups. The study was approved by the University's Dean and exempted by the research committee for anonymity.Results: A total of 636 students and 81 instructors were surveyed. Approximately 33% of students and 51% of instructors found online education equivalent or superior to traditional face-to-face teaching methods. Almost 69% of students and 51% of instructors reported increased difficulties with virtual learning, primarily due to challenges with the available technology, unreliable internet connectivity, as well as perceive fatigue when listening to online lectures.Conclusions: Distance education provides a worthwhile alternative during the COVID-19 pandemic, including in regions of limited experience. Adequate preparation, good quality audio-visuals and Internet, and student engagement activities are recommended to improve the quality of education.
View details for DOI 10.1016/j.amsu.2021.01.073
View details for PubMedID 33552498
- The impact of trauma systems on patient outcomes. Current problems in surgery 2021; 58 (1): 100840
Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study.
BMC medical education
2021; 21 (1): 513
Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual).We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed.Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future.In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.
View details for DOI 10.1186/s12909-021-02936-w
View details for PubMedID 34583691
COVID-19 Impact on Surgical Resident Education and Coping.
The Journal of surgical research
2021; 264: 534–43
Healthcare systems and surgical residency training programs have been significantly affected by the novel coronavirus disease 2019 (COVID-19) pandemic. A shelter-in-place and social distancing mandate went into effect in our county on March 16, 2020, considerably altering clinical and educational operations. Along with the suspension of elective procedures, resident academic curricula transitioned to an entirely virtual platform. We aimed to evaluate the impact of these modifications on surgical training and resident concerns about COVID-19.We surveyed residents and fellows from all eight surgical specialties at our institution regarding their COVID-19 experiences from March to May 2020. Residents completed the survey via a secure Qualtrics link. A total of 38 questions addressed demographic information and perspectives regarding the impact of the COVID-19 pandemic on surgical training, education, and general coping during the pandemic.Of 256 eligible participants across surgical specialties, 146 completed the survey (57.0%). Junior residents comprised 43.6% (n = 61), compared to seniors 37.1% (n = 52) and fellows 19.3% (n = 27). Most participants, 97.9% (n = 138), anticipated being able to complete their academic year on time, and 75.2% (n = 100) perceived virtual learning to be the same as or better than in-person didactic sessions. Participants were most concerned about their ability to have sufficient knowledge and skills to care for patients with COVID-19, and the possibility of exposure to COVID-19.Although COVID-19 impacted residents' overall teaching and clinical volume, residency programs may identify novel virtual opportunities to meet their educational and research milestones during these challenging times.
View details for DOI 10.1016/j.jss.2021.01.017
View details for PubMedID 33862581
- Situating Artificial Intelligence in Surgery A Focus on Disease Severity ANNALS OF SURGERY 2020; 272 (3): 523–28
Situating Artificial Intelligence in Surgery: A Focus on Disease Severity.
Annals of surgery
2020; 272 (3): 523-528
Artificial intelligence (AI) has numerous applications in surgical quality assurance. We assessed AI accuracy in evaluating the critical view of safety (CVS) and intraoperative events during laparoscopic cholecystectomy. We hypothesized that AI accuracy and intraoperative events are associated with disease severity.One thousand fifty-one laparoscopic cholecystectomy videos were annotated by AI for disease severity (Parkland Scale), CVS achievement (Strasberg Criteria), and intraoperative events. Surgeons performed focused video review on procedures with ≥1 intraoperative events (n = 335). AI versus surgeon annotation of CVS components and intraoperative events were compared. For all cases (n = 1051), intraoperative-event association with CVS achievement and severity was examined using ordinal logistic regression.Using AI annotation, surgeons reviewed 50 videos/hr. CVS was achieved in ≤10% of cases. Hepatocystic triangle and cystic plate visualization was achieved more often in low-severity cases (P < 0.03). AI-surgeon agreement for all CVS components exceeded 75%, with higher agreement in high-severity cases (P < 0.03). Surgeons agreed with 99% of AI-annotated intraoperative events. AI-annotated intraoperative events were associated with both disease severity and number of CVS components not achieved. Intraoperative events occurred more frequently in high-severity versus low-severity cases (0.98 vs 0.40 events/case, P < 0.001).AI annotation allows for efficient video review and is a promising quality assurance tool. Disease severity may limit its use and surgeon oversight is still required, especially in complex cases. Continued refinement may improve AI applicability and allow for automated assessment.
View details for DOI 10.1097/SLA.0000000000004207
View details for PubMedID 33759839
Enterocutaneous Fistula: A Simplified Clinical Approach.
2020; 12 (4): e7789
A "fistula" is an abnormal connection between two epithelial surfaces. Fistulae are named based on the two surfaces or lumens they connect to. Fistulae form due to loss of wall integrity from an underlying insult, leading to the penetrance of an adjacent organ or epithelized surface. Common causes of small bowel fistulae include sequelae of surgical intervention, foreign body, bowel diverticula, Crohn's disease, malignancy, radiation, and infection. A histopathological analysis displays acute and/or chronic inflammation due to the underlying pathology. A thorough history and physical examination are important components of patient evaluation. Generally, patients will present with non-specific constitutional symptoms in addition to local symptoms attributed to the fistula. In rare instances, symptoms may be severe and life-threatening. Initial laboratory workup includes complete blood count, comprehensive metabolic panel, and lactate level. Radiologic imaging is useful for definitive diagnosis and helps delineate anatomy. In practice, computed tomography (CT) is the initial imaging modality. The addition of intravenous or enteric contrast may be helpful in certain situations. Magnetic resonance imaging (MRI) may also be used in special circumstances. Invasive procedures, such as endoscopy, can assist in the evaluation of mucosal surfaces to diagnose pathology such as inflammatory processes. Appropriate management should include optimizing nutritional status, delineating fistulous tract anatomy, skincare, and managing the underlying disease. A non-operative approach is generally accepted as the initial approach especially in the acute/subacute setting. However, operative intervention is indicated in the setting of failed non-operative management. Successful management of small bowel fistulae requires a multidisciplinary team approach. To conclude, a small bowel fistula is a complex clinical disease, with surgical intervention being the most common cause in developed countries. The non-operative approach should be trialed before an operative approach is considered.
View details for DOI 10.7759/cureus.7789
View details for PubMedID 32461860
View details for PubMedCentralID PMC7243661
- Enterocutaneous Fistula: A Simplified Clinical Approach CUREUS 2020; 12 (4)
Motivators and Stressors for Canadian Research Coordinators in Critical Care: The MOTIVATE Survey.
American journal of critical care : an official publication, American Association of Critical-Care Nurses
2020; 29 (1): 41–48
BACKGROUND: Critical care research coordinators implement study protocols in intensive care units, yet little is known about their experiences.OBJECTIVE: To identify the responsibilities, stressors, motivators, and job satisfaction of critical care research coordinators in Canada.METHODS: Responses to a self-administered survey were collected in order to identify and understand factors that motivate and stress research coordinators and enhance their job satisfaction. Items were generated in 5 domains (demographics, job responsibilities, stressors, motivators, and satisfaction). Face validity pretesting was conducted and clinical sensibility was evaluated. Items were rated on 5-point Likert scales. Descriptive analyses were used to report results.RESULTS: The response rate was 78% (66 of 85). Most critical care research coordinators (71%) were employed full time; they were engaged in 9 studies (7 academic, 2 industry); and 49% were nurses. Of 30 work responsibilities, the most frequently cited were submitting ethics applications (89%), performing data entry (89%), and attending meetings (87%). Highest-rated stressors were unrealistic workload and weekend/holiday screening; highest-rated motivators were a positive work environment and team spirit. Overall, 26% were "very satisfied" and 53% were "satisfied" with their jobs.CONCLUSIONS: Critical care research coordinators in Canada indicate that, despite significant work responsibilities, they are satisfied with their jobs thanks to positive work environments and team spirit.
View details for DOI 10.4037/ajcc2020627
View details for PubMedID 31968081
Precautions for Operating Room Team Members during the COVID-19 Pandemic.
Journal of the American College of Surgeons
The novel corona virus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE).An interventional platform (operating room, interventional suites, and endoscopy) PPE taskforce was convened by the hospital and medical school leadership and tasked with developing a common algorithm for PPE use, to be used throughout the interventional platform. In conjunction with our infection disease experts, we developed our guidelines based upon potential patterns of spread, risk of exposure and conservation of PPE.A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on urgency of operation, anticipated viral burden at the surgical site, opportunity for a procedure to aerosolize virus, and likelihood a patient could be infected based on symptoms and testing.Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision tree algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.
View details for DOI 10.1016/j.jamcollsurg.2020.03.030
View details for PubMedID 32247836
Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions.
Trauma surgery & acute care open
2020; 5 (1): e000552
Emergency general surgery (EGS) conditions encompass a variety of diseases treated by acute care surgeons. The heterogeneity of these diseases limits infrastructure to facilitate EGS-specific quality improvement (QI) and research. A uniform anatomic severity grading system for EGS conditions was recently developed to fill this need. We integrated this system into our clinical workflow and examined its impact on research, surgical training, communication, and patient care.The grading system was integrated into our clinical workflow in a phased fashion through formal education and a written handbook. A documentation template was also deployed in our electronic medical record to prospectively assign severity scores at the time of patient evaluation. Mixed methods including a quantitative survey and qualitative interviews of trainees and attending surgeons were used to evaluate the impact of the new workflow and to identify obstacles to its adoption.We identified 2291 patients presenting with EGS conditions during our study period. The most common diagnoses were small bowel obstruction (n=470, 20.5%), acute cholecystitis (n=384, 16.8%), and appendicitis (n=370, 16.1%). A total of 21 qualitative interviews were conducted. Twenty interviewees (95.2%) had a positive impression of the clinical workflow, citing enhanced patient care and research opportunities. Fifteen interviewees (75.0%) reported the severity grading system was a useful framework for clinical management, with five participants (25.0%) indicating the system was useful to facilitate clinical communication. Participants identified solutions to overcome barriers to adoption of the clinical workflow.The uniform anatomic severity grading system can be readily integrated into a clinical workflow to facilitate prospective data collection for QI and research. The system is perceived as valuable by users. Educational initiatives that focus on increasing familiarity with the system and its benefits will likely improve adoption of the classification system and the clinical workflow that uses it.Level III.
View details for DOI 10.1136/tsaco-2020-000552
View details for PubMedID 32953998
View details for PubMedCentralID PMC7481073
The impact of trauma systems on patient outcomes
Current Problems in Surgery
View details for DOI 10.1016/j.cpsurg.2020.100849
- Using a virtual platform for personal protective equipment education and training. Medical education 2020
Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure: A Systematic Review and Meta-analysis.
Annals of internal medicine
Background: Optic nerve ultrasonography (optic nerve sheath diameter sonography) has been proposed as a noninvasive, quick method for diagnosing increased intracranial pressure.Purpose: To examine the accuracy of optic nerve ultrasonography for diagnosing increased intracranial pressure in children and adults.Data Sources: 13 databases from inception through May 2019, reference lists, and meeting proceedings.Study Selection: Prospective optic nerve ultrasonography diagnostic accuracy studies, published in any language, involving any age group or reference standard.Data Extraction: 3 reviewers independently abstracted data and performed quality assessment.Data Synthesis: Of 71 eligible studies involving 4551 patients, 61 included adults, and 35 were rated as having low risk of bias. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of optic nerve ultrasonography in patients with traumatic brain injury were 97% (95% CI, 92% to 99%), 86% (CI, 74% to 93%), 6.93 (CI, 3.55 to 13.54), and 0.04 (CI, 0.02 to 0.10), respectively. Respective estimates in patients with nontraumatic brain injury were 92% (CI, 86% to 96%), 86% (CI, 77% to 92%), 6.39 (CI, 3.77 to 10.84), and 0.09 (CI, 0.05 to 0.17). Accuracy estimates were similar among studies stratified by patient age, operator specialty and training level, reference standard, sonographer blinding status, and cutoff value. The optimal cutoff for optic nerve sheath dilatation on ultrasonography was 5.0 mm.Limitation: Small studies, imprecise summary estimates, possible publication bias, and no evaluation of effect on clinical outcomes.Conclusion: Optic nerve ultrasonography can help diagnose increased intracranial pressure. A normal sheath diameter measurement has high sensitivity and a low negative likelihood ratio that may rule out increased intracranial pressure, whereas an elevated measurement, characterized by a high specificity and positive likelihood ratio, may indicate increased intracranial pressure and the need for additional confirmatory tests.Primary Funding Source: None. (PROSPERO: CRD42017055485).
View details for DOI 10.7326/M19-0812
View details for PubMedID 31739316
Academic Clinicians' Workload Challenges and Burnout Analysis.
2019; 11 (11): e6108
Academic clinicians have high expectations to meet in their academic institutions. Accomplishments are to be expected in multiple domains for their positions' sustainability and promotions. In addition to excelling in their clinical practice, they are expected to maintain productive scholarly activities and meet the required educational and administrative responsibilities. Striking a balance between clinical, educational, research, and administrative duties is highly challenging and could lead to emotional exhaustion and burnout. Lately, the ever-growing patient population, competitive academic environment, and resident work hour restrictions have led to increased strain and demand on academic physicians and predisposing them to burnout. Despite the numerous studies looking at burnout in various professions, fewer studies have looked at burnout, specifically in clinical faculty members. Little is known about academic job satisfaction, stress, and rates of burnout, or how these factors affect scholarly success and productivity. Clinician faculty educators may be at significant risk of burnout. There is some evidence that clinically burned-out faculty had less confidence in their teaching skills and had fewer life-long learning habits. These results suggest that burnout may influence not only the quality of care but also the quality of training provided to others.
View details for DOI 10.7759/cureus.6108
View details for PubMedID 31886048
View details for PubMedCentralID PMC6901369
- Academic Clinicians' Workload Challenges and Burnout Analysis CUREUS 2019; 11 (11)
Developing an Inpatient Relationship-Centered Communication Curriculum for Surgical Teams: Pilot Study
ELSEVIER SCIENCE INC. 2019: E48
View details for Web of Science ID 000492749600102
The MacTRAUMA TTL Assessment Tool: Developing a Novel Tool for Assessing Performance of Trauma Trainees: Initial Reliability Testing
Journal of Surgical Education
View details for DOI 10.1016/j.jsurg.2016.05.013
- BURNOUT AMONG ACADEMIC CLINICIANS AS IT CORRELATES WITH WORKLOAD AND DEMOGRAPHIC VARIABLES macsphere.mcmaster.ca. Canada. 2015
- A novel use of high fidelity simulation to test inter-rater reliability of a TTL assessment tool Simulation Summit Royal College of Physicians and Surgeons of Canada. 2014: 56
- BURNOUT AMONG CRITICAL CARE WORKERS Canadian Critical Care Forum Canadian Critical Care Forum. 2014
- MOTIVATORS AND STRESSORS FOR CANADIAN RESEARCH COORDINATORS IN CRITICAL CARE: THE MOTIVATE SURVEY Canadian Critical Care Forum Canadian Critical Care Forum. 2014
The Effect of General Surgery Clerkship Rotation on the Attitude of Medical Students Towards General Surgery as a Future Career
JOURNAL OF SURGICAL EDUCATION
2012; 69 (4): 544-549
Literature suggests declining interest in General Surgery (GS) and other surgical specialties, with fewer Canadian medical residency applicants identifying a surgical specialty as their first choice. Although perceptions of surgical careers may begin before enrollment in clerkship, clerkship itself provides the most concentrated environment for perceptions to evolve. Most students develop perceptions about specialties during their clinical clerkships. This study examines the immediate impact of GS clerkship on student attitudes toward GS as a career, and on preferences towards GS compared with other specialties.A pre-post design involved 61 McMaster clinical clerks. Two instruments were used to collect data from students over the course of clerkship (2008-2009). Paired comparison (PC) compared ranking of career choices before and after clerkship. Semantic differential (SD) measured attitudes toward GS and variables that may have affected attitudes before and after clerkship. Analyses used SPSS 16.0 (SPSS Inc., Chicago, IL).Clerks ranked preferences for GS changed substantially after clerkship, moving from the 10th to the 5th position compared with other specialties. Ranks of surgical subspecialties also changed, though GS demonstrated the largest improvement. SD results were consistent with PC, showing improved attitudes after rotation, with differences both statistically and practically significant (t = 3.81, p < 0.000, effect size = 0.23). Results indicated that attitudes toward all areas related to GS clerkship (attending physicians, surgical residents, ward nurses, scrub nurses, workload, knowledge achieved, technical skills acquired) improved significantly except attitude toward technical skills acquired.Clinical clerkship at McMaster was a positive experience and significantly enhanced preferences towards GS and attitudes towards GS as a career. Medical schools should foster positive interaction between clinical clerks and staff (including attending surgeons and nurses), ensure that teaching hospital staff provide a positive experience for clerks, and should provide opportunities to learn basic technical skills during GS clerkship.
View details for DOI 10.1016/j.jsurg.2012.04.005
View details for Web of Science ID 000305366200018
View details for PubMedID 22677595
Burnout Among Academic Surgeons
Canadian Surgery Forum
View details for DOI 10.1503/cjs.008615
- Developing a tool to evaluate trauma team leader performance: initial reliability testing. The Trauma Association of Canada Annual Scientific Meeting 2014: S76
- The mactrauma TTL assessment tool: developing a novel tool for assessing performance of trauma trainees Trauma Association of Canada 2013: S13