•Academic surgeons are mentors, educators, researchers, and take care of patients.•There is a continuum of scholarly activity that surgeons may participate in.•Research experience during surgical ...residency is an important part of the training.•Surgeons have characteristics that make them well suited for conducting research.•Conducting research helps surgeons keep up and provide state of the art care.
This review aimed to consolidate the existing literature on intraoperative teaching strategies and highlight areas for future research.
The objective is to review the research conducted regarding the ...implementation of various teaching frameworks for surgical learners and to present their feasibility, benefits, and limitations within surgical residencies, as well as areas for future research.
Two independent investigators searched MEDLINE, EMBASE, and ERIC and reviewed articles on intraoperative teaching strategies for surgical resident education.
3050 abstracts were reviewed, and 66 studies (2.2%) were included. The most common study type was single cohort studies (33%), followed by survey studies (17%). The majority of articles were carried out in General Surgery (50%), or a combination of surgical specialties (17%).
The BID model encompasses perioperative teaching time points and suggests a universal organizational approach to intraoperative teaching that would likely be compatible with documented competency assessments for residents.
Display omitted
•Effective teaching in the operating room is crucial for shaping a competent surgeon.•Various models, frameworks, and tools exist to aid with teaching surgical residents.•Goal setting and briefing before an operation is crucial.•Intraoperative teaching helps ensure residents meet exit competencies.•Postoperative debriefing allows time for feedback and reflection.
Since first being described in 1956 by John McCarthy,1 the evolution of artificial intelligence (AI), or technology that models human behavior into algorithms that can perform human tasks,2 has ...progressed rapidly with many novel applications in medicine. Certain AI programs could become capable in writing entire research papers such as systematic reviews.6 In this brief overview, we aim to improve surgeon awareness of this rapidly growing area by summarizing some of the key capabilities and limitations in employing AI to facilitate surgical research (Fig. 1).1 Benefits of AI in surgical research With the growing breadth of surgical knowledge, completing a comprehensive literature search has become increasingly more labor intensive and time-consuming.7 ML and knowledge-based systems in AI programs represent powerful tools that can identify relevant data when an appropriate research question is asked.3,4 ML helps computers build algorithms from data inputs that lead to independent decisions modelling the human decision-making process.6 With ML, AI programs can efficiently and effectively sort through vast amounts of data and summarize the most relevant and critical results,5,7 shortening the amount of time spent performing literature searches.8 A randomized control trial published in 2020 by Schoeb et al. compared the quality of a literature search generated by human researchers to the AI search engine IRIS.AI (IRIS.AI, 2015, Stabekk Norway).8 IRIS.AI generated a more focused literature search compared to the researchers, but the overall quality and number of search results were comparable between the two groups.8 For the inexperienced surgical researcher, it is probable that AI programs may outperform them with regards to the speed, comprehensiveness, and quality of their literature search. Surgical studies can be complicated by a variety of human and medical confounders, which places significant demands on the analytical and problem-solving skills of the clinician. ...a discussion section written by an AI program should be reviewed and revised by an experienced surgeon who has a rich knowledge of the area and who understands the true relevance of the data in its feasibility and potential application in the ‘real world’.6 The expansion of AI programs in research, writing, and generating presentations, creates controversy in AI ethics, law, and authorship.
Hypoparathyroidism (hypoPT) is the most common complication following bilateral thyroid operations. Thyroid surgeons must employ strategies for minimizing and preventing post-thyroidectomy hypoPT. ...The objective of this American Thyroid Association Surgical Affairs Committee Statement is to provide an overview of its diagnosis, prevention, and treatment.
HypoPT occurs when a low intact parathyroid hormone (PTH) level is accompanied by hypocalcemia. Risk factors for post-thyroidectomy hypoPT include bilateral thyroid operations, autoimmune thyroid disease, central neck dissection, substernal goiter, surgeon inexperience, and malabsorptive conditions. Medical and surgical strategies to minimize perioperative hypoPT include optimizing vitamin D levels, preserving parathyroid blood supply, and autotransplanting ischemic parathyroid glands. Measurement of intraoperative or early postoperative intact PTH levels following thyroidectomy can help guide patient management. In general, a postoperative PTH level <15 pg/mL indicates increased risk for acute hypoPT. Effective management of mild to moderate potential or actual postoperative hypoPT can be achieved by administering either empiric/prophylactic oral calcium and vitamin D, selective oral calcium, and vitamin D based on rapid postoperative PTH level(s), or serial serum calcium levels as a guide. Monitoring for rebound hypercalcemia is necessary to avoid metabolic and renal complications. For more severe hypocalcemia, inpatient management may be necessary. Permanent hypoPT has long-term consequences for both objective and subjective well-being, and should be prevented whenever possible.
Guidelines recommend that health-related information for patients should be written at or below the sixth-grade level. We sought to evaluate the readability level and quality of online patient ...education materials regarding epidural and spinal anesthesia.
We evaluated webpages with content written specifically regarding either spinal or epidural anesthesia, identified using 11 relevant search terms, with seven commonly used readability formulas: Flesh-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed the quality of the reading materials using the Brief DISCERN tool.
We analyzed 261 webpages. The mean (standard deviation) readability scores were: FKGL = 8.8 (1.9), GFI = 11.2 (2.2), CLI = 10.3 (1.9), ARI = 8.1 (2.2), SMOG = 11.6 (1.6), FRE = 55.7 (10.8), and NDC = 5.4 (1.0). The mean grade level was higher than the recommended sixth-grade level when calculated with six of the seven readability formulas. The average Brief DISCERN score was 16.0.
Readability levels of online patient education materials pertaining to epidural and spinal anesthesia are higher than recommended. When we evaluated the quality of the information using a validated tool, the materials were found to be just below the threshold of what is considered good quality. Authors of educational materials should provide not only readable but also good-quality information to enhance patient understanding.
Narrative operative reports (NOR) are important for cancer management but often lack key information. This review investigated the efficacy of synoptic operative reports (SORs) for cancer operations ...compared to NORs.
A database search included published studies up to October 31, 2021. Overall report completeness and reporting frequencies of cancer elements were descriptively compared between NORs and SORs.
Among 4353 studies, 32 were included. 47% of studies compared NORs to SORs. Overall completeness favored SORs (80 ± 19%) over NORs (47 ± 18%, p < 0.001). Essential cancer operative report elements including tumor location (NOR: 51 ± 28%, SOR: 89 ± 11%, p < 0.001), presence of metastases (NOR: 36 ± 33%, SOR: 96 ± 5%, p < 0.001), and final resection margins (NOR: 39 ± 30%, SOR: 87 ± 17%, p < 0.001) demonstrated higher mean reporting frequencies in SORs.
Overall completeness and reporting of cancer elements were superior in SORs. Although standardization of SORs requires further research, transition from NORs to SORs may improve the quality of postoperative cancer care.
Display omitted
•Operative reporting has been studied most frequently in rectal and breast cancer.•Synoptic operative reports have better overall reporting completeness.•Most cancer elements are reported more consistently in synoptic operative reports.•Transition to synoptic operative reporting may improve quality of cancer care.
We aim to evaluate the body of evidence reporting on normohormonal primary hyperparathyroidism (NHpHPT) patients to help guide their diagnosis, characterization and treatment.
Normohormonal primary ...hyperparathyroidism is a term used to describe patients with a normal PTH and elevated calcium levels. There is limited understanding regarding the presentation and appropriate management of these patients.
A systematic review was conducted: abstract and full-text screening were independently conducted by 2 investigators. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals were calculated.
Twenty-two studies were identified. Patients with NHpHPT were more likely to present with lower PTH (p < 0.00001) and calcium (p < 0.00001) levels. Intraoperatively, the NHpHPT group was 1.8 times more likely to undergo bilateral neck exploration (BNE) and harbor multigland disease. The rates of surgical cure were 93% in the NHpHPT and 96% in the pHPT groups (p = 0.0003).
Symptomatic patients with NHpHPT benefit from parathyroidectomy with prolonged intraoperative PTH monitoring, and a low threshold for conversion to BNE.
•Patients with NHpHPT present with lower levels of PTH, calcium and higher levels of phosphate, vitamin D, and urine calcium.•NHpHPT patients were significantly more likely to present with nephrolithiasis and osteopenia.•Intraoperatively, NHpHPT cases were twice as likely to harbor multigland disease and undergo a bilateral neck excision.•Rates of cure of patients with NHpHPT after parathyroidectomy were than in classic primary hyperparathyroidism.
Dedicated anatomy educational time in medical schools has decreased significantly, disproportionately affecting surgical residents. In this scoping review, we aim to consolidate existing evidence, ...describe ongoing research, and highlight future directions for surgical anatomy education.
Two independent investigators searched MEDLINE, EMBASE, and the Cochrane library, for educational interventions targeting anatomy knowledge in surgical residents. English articles until October 28, 2021, were reviewed.
1135 abstracts were considered, and 59 (5.2%) included. Agreement on inclusion was excellent (k = 0.90). The majority were single-cohort studies (53%) and prospective cohort studies (17%). The most common disciplines were General Surgery (17%) and Obstetrics and Gynecology (17%).
Cadavers consistently produce positive knowledge gains and are heavily favored by residents. They remain the educational method to which new educational models are compared. New technologies do not yet match cadaver fidelity. Research showing knowledge translation from cadaver labs to patient outcomes remains limited.
•Residents strongly favour cadaver labs to learn anatomy.•Procedure-oriented cadaver labs to teach anatomy are increasingly popular.•Cadaver labs often organized by resident level and/or anatomic region.•New technologies are promising but generally lack cadaver fidelity.•Little data on clinical outcomes and knowledge retention from anatomy interventions.
