All Publications

  • A Novel Blended Curriculum for Communication of Informed Consent With Surgical Interns. Journal of graduate medical education Anderson, T. N., Kaba, A., Gros, E., Schmiederer, I. S., Shi, R., Aalami, L. R., Lin, D. T., Lau, J. N. 2021; 13 (3): 411-416

    Abstract

    Background: Interns often conduct procedural informed consent discussions (ICDs), identified as a core entrustable professional activity. Deficiencies in the training process for ICDs span across specialties.Objective: We provide evidence for a curriculum and assessment designed to standardize the training process and ensure ICD competency in surgical interns.Methods: In March 2019, PowerPoint educational materials were emailed to one academic institution's new surgical interns, who in June participated in an onsite 1-hour role-play "hot seat" group activity (GA) with an untrained simulated patient, and in October completed a single trained simulated patient (real-time raters) verification of proficiency (VOP) assessment. Curriculum evaluation was measured through intern pre-/post-confidence (5-point scale), and the VOP's Cronbach's alpha and test-retest were examined. Data were analyzed with descriptive statistics, paired t tests, and 2-way random effects models.Results: Of 44 new interns, 40 (91%) participated in the remote teaching and live GA and were assessed by the VOP. Pre-/post-GA confidence increased a mean difference of 1.3 (SD = 0.63, P < .001). The VOP's Cronbach's alpha was 0.88 and test-retest was 0.84 (95% CI 0.67-0.93, P < .001), with a 95% pass rate. The 2 first-time fail students required remediation. Time commitment included 1 hour maximum for individual training and implementation and 30 minutes for assessment. The use of volunteers and donated space mitigated additional costs.Conclusions: Remote asynchronous and group skills teaching for new general surgical interns improved their confidence in conducting procedural ICDs. A patient-simulation verification process appeared feasible with preliminary evidence of retest and internal consistency.

    View details for DOI 10.4300/JGME-D-20-01057.1

    View details for PubMedID 34178267

  • In situ interprofessional operating room simulations: Empowering learners in crisis resource management principles. Surgery Gros, E., Shi, R., Hasty, B., Anderson, T., Schmiederer, I., Roman-Micek, T., Merrell, S. B., Lau, J. 2021

    Abstract

    BACKGROUND: Given the multifaceted nature of operating room teams, miscommunication at various perioperative stages leads to lapses in teamwork and communication, which potentiates adverse events. In situ interprofessional operating room simulations are a valuable tool in identifying the possible threats to patient safety in the operating room. Participant confidence may also increase; however, perceived confidence in specific areas of team communication in the clinical environment remains unclear. This research aims to study how in situ interprofessional operating room simulations increase participants' individual confidence in 4 team principles derived from crisis resource management: using effective communication, utilizing resources, establishing role clarity, and using effective situational awareness.METHODS: Over a 2-year period, interdisciplinary operating room team members were assigned to participate in 13 simulated surgical case scenarios, which were chosen based on the volunteer surgeon's specialty. These cases were designed to engage all team members and included a crisis scenario (ie, hemorrhage, airway emergency, arrhythmia, or cardiac arrest). All statistical analyses were performed using RStudio version 1.2.1335 software. We analyzed matched pre- and postsimulation self-assessment of individual confidence using the Wilcoxon signed-rank test for each of the 4 aforementioned constructs of interest derived from crisis resource management training principles. Significance was set at P < .0038, using Bonferroni correction, for all comparisons to account for the multiple comparisons problem.RESULTS: There was a statistically significant shift in the 4-point scale toward greater self-reported confidence from presimulation to postsimulation for each of the 4 team principles: using effective communication (P= .0019, r= 0.18), utilizing resources well (P= .0014, r= 0.18), establishing role clarity (P < .0010, r= 0.22), and using effective situational awareness (P < .0010, r= 0.27).CONCLUSION: In this pilot study, we describe how teaching crisis resource management principles in an in situ operative simulation is an effective way to increase the confidence of communication skills among the members of an interdisciplinary procedure/operative team during crisis scenarios. In situ simulation can be used to evaluate system competence and interdisciplinary dynamics, and to identify latent conditions that predispose to medical error. As we continue to conduct these sessions, we aim to evaluate their impact on individual confidence and the advancement of interdisciplinary efforts to improve patient care.

    View details for DOI 10.1016/j.surg.2021.02.011

    View details for PubMedID 33771356

  • A Generalizable Multimodal Scrub Training Curriculum in Surgical Sterile Technique. MedEdPORTAL : the journal of teaching and learning resources Anderson, T. N., Hasty, B. N., Schmiederer, I. S., Miller, S. E., Shi, R., Aalami, L. R., Huffman, E. M., Choi, J. N., Lau, J. N. 2021; 17: 11077

    Abstract

    Introduction: Recent endeavors from governing bodies such as the AAMC have formally recognized the importance of aseptic technique. AAMC guidelines include activities that all graduating physicians should be able to perform with minimum indirect supervision and were developed to recognize these needs. For example, the skills necessary for aseptic technique include daily safety habits and general physician procedures.Methods: We developed a scrub training curriculum and evaluated the program through a quasi-experimental study with a pre- and posttest design. Questions were developed to examine students' perceived knowledge and skills as related to the objectives of the course and to their anxieties, concerns, and future training needs.Results: Between February 2020 and March 2020, 44 students completed the curriculum. Students indicated that self-efficacy significantly increased in all aspects of the curricular goals following curriculum completion. Students identified understanding OR etiquette as the most anxiety-provoking element associated with scrub training. They felt that more time could be spent elucidating this etiquette. On the other hand, tasks such as surgical hand hygiene were the least anxiety-inducing.Discussion: We share this multimodal scrub training curriculum, mapped to the AAMC's guidelines, to reduce variability in teaching strategies and skills acquisition through a standardized curriculum. Also, we effectively imparted these skills and instilled a sense of confidence in learners as they worked to provide their best in patient care and safety.

    View details for DOI 10.15766/mep_2374-8265.11077

    View details for PubMedID 33553617

  • Well-Being without a Roof: Examining Well-Being among Unhoused Individuals Using Mixed Methods and Propensity Score Matching. International journal of environmental research and public health Ahuja, N. J., Nguyen, A., Winter, S. J., Freeman, M., Shi, R., Rodriguez Espinosa, P., Heaney, C. A. 2020; 17 (19)

    Abstract

    The morbidity and mortality experiences of people who are unhoused have been well-described, but much less is known about the overall well-being of these individuals. In this mixed methods study, housed and unhoused participants completed a multi-faceted 10 domain measure of well-being (the Stanford WELL Survey), and a subset of unhoused participants shared their experiences during qualitative interviews. Using propensity score matching, unhoused participants (n = 51) were matched at a ratio of 1:5 with housed participants (n = 255). The mean overall well-being score of the unhoused participants was significantly lower than that of the matched housed participants (B = -5.022, p = 0.013). Additionally, the two groups differed on some of the constituent domains of well-being, with unhoused participants reporting statistically significantly lower mean scores on social connectedness (B = -1.086, p = 0.000), lifestyle and daily practices (B = -1.219, p = 0.000), stress and resilience (B = -0.493, p = 0.023), experience of emotions (B = -0.632, p = 0.009), physical health (B = -0.944, p = 0.0001), and finances (B = -3.099, p = 0.000). The unhoused participants had a statistically significantly higher mean score for spirituality and religiosity (B = 2.401, p = 0.000) than their matched housed counterparts. The qualitative interviews further highlighted spirituality and religion as a coping mechanism for the unhoused. The results of this study highlight both unexpected strengths exhibited by the unhoused individuals and areas of challenge.

    View details for DOI 10.3390/ijerph17197228

    View details for PubMedID 33023231

  • Interns on the Internet for Resident Readiness: A Successful Option Schmiederer, I. S., Anderson, T., Shi, R., Huffman, E., Phares, A., Naples, R., Choi, J., Lin, D., Lau, J. ELSEVIER SCIENCE INC. 2020: S250–S251

    View details for Web of Science ID 000582792300459

  • Preclinical Surgical Preparatory Course and the NRMP Match: Early Exposure and Surgical Recruitment a 10-Year Follow-Up. Journal of surgical education Anderson, T. N., Shi, R., Schmiederer, I. S., Miller, S. E., Lee, E. W., Hasty, B. N., Lin, D. T., Lau, J. N. 2020

    Abstract

    OBJECTIVE: Many medical students mentally commit to specialties prior to entering clerkships. This is why early preclinical interactions with surgical specialties, through mentorship and/or interest groups, increases the opportunity to nurture enthusiasm for surgery. In 2007, a course providing preclinical medical students with introductory surgical skills training and preparation for the surgical environment ("SURG205") was established at our institution. The course underwent a major revision in 2016, increasing intraoperative mentorship by matching students to surgical attendings and requiring students to scrub into operative cases together. We anticipate that the positive surgical experiences created by the course will lead to further development and enhancement of student interest in surgical specialties-interest that we hypothesized would reflect in their National Resident Matching Program (NRMP) Match outcomes.DESIGN: NRMP results from 2010 to 2019 were cross-referenced with a database of students who participated in the SURG205 course from 2007 to 2016. With this, we examined the correlation between student participation in SURG205 and surgical specialty match. Descriptive statistics were used to review the trends of the NRMP results, and Pearson's correlation was used to determine the relationship and its significance.SETTING: This study was conducted in a single private medical school in California.PARTICIPANTS: Specialties considered "surgical" included: General Surgery, integrated programs-such as Plastic, Thoracic, or Vascular surgery, Obstetrics and Gynecology, Orthopedic Surgery, Otolaryngology, Neurosurgery, and Urology. All other specialties were considered nonsurgical. Students identified as having participated in SURG205 and who then also took part in the NRMP.RESULTS: Seven hundred eighty students underwent the Match process from 2010 to 2019. 144 (18.5%) of these students participated in SURG205 between 2007 and 2016. Each Match class ranged in size from 62 to 91 (median = 77.5, IQR = 14.5) students. (Table 1) Two-hundred and nineteen students (28.1%) matched into a surgical specialty, of which 34 (15.5%) selected general surgery. From 2010 to 2019 the rate of students who matched into surgical specialties averaged 28.1% per year with a slight nonstatistically significantly increasing trend over that time period R2 = 0.30 (p = 0.09; Fig. 1). There was a significant increase in trend in proportion of students who took the course and matched into any specialty between 2010 and 2019 (R2 = 0.85, p = 0.0002; Fig. 2). And, there was a statistically significant positive relationship between students taking the course and matching into a surgical specialty (R2 = 0.63, p = 0.01; Fig. 3).CONCLUSION: Our results highlight the increasing tendency of students who pursue surgical specialties having previously participated in this early exposure courses. Not only is student interest created and encouraged through positive mentorship experiences, but that interest may be associated with increases in application rates and eventual match into the specialty. General surgery training programs might consider these trends when designing courses to ease transitions into first-year residency positions-such as fourth-year surgical boot camps, surgical procedure-based anatomy courses, and mentorship frameworks. This information further justifies the cost and time commitment required to administer these programs for students.

    View details for DOI 10.1016/j.jsurg.2020.05.016

    View details for PubMedID 32522563

  • Operating Room In Situ Interprofessional Simulation for Improving Communication and Teamwork. The Journal of surgical research Shi, R. n., Marin-Nevarez, P. n., Hasty, B. n., Roman-Micek, T. n., Hirx, S. n., Anderson, T. n., Schmiederer, I. n., Fanning, R. n., Goldhaber-Fiebert, S. n., Austin, N. n., Lau, J. N. 2020; 260: 237–44

    Abstract

    Effective teamwork and communication are correlated with improved patient care quality and outcomes. The belief that each team member contributes to excellent patient care in the operating room (OR) leads to a more productive work environment. However, poor teamwork and communication lead to poorer OR outcomes. We qualitatively and quantitatively explored perspectives of three OR professions (nursing, anesthesiology, and surgery) on teamwork and communication in the OR preinterprofessional and postinterprofessional in situ OR simulation.One-on-one semi-structured interviews were conducted; 14 pre-in situ simulations during July-October 2017 (three surgery, four anesthesiology, and six nursing staff), and 10 post-in situ simulations during August-November 2017 (five surgery, four anesthesiology, and one nursing staff). Themes were identified inductively to create a codebook. The codebook was used to consensus code all interviews. This analysis informed the development of a quantitative survey distributed to all contactable interviewees (22).Presimulation and postsimulation interview participants concurred on teamwork and communication importance, believed communication to be key to effective teamwork, and identified barriers to communication: lack of cordiality, lack of engagement from other staff, distractions, role hierarchies, and lack of familiarity with other staff. The large majority of survey participants-all having participated in simulations-believed they could use effective communication in their workplace.Establishing methods for improving and maintaining the ability of OR professionals to communicate with each other is imperative for patient safety. Effective team communication leads to safe and successful outcomes, as well as a productive and supportive OR work environment.

    View details for DOI 10.1016/j.jss.2020.11.051

    View details for PubMedID 33360307