residency training

住院医师培训
  • 文章类型: Journal Article
    增强现实(AR)和虚拟现实(VR)是强大的技术,具有成熟的实用性和巨大的潜力。脊柱手术,特别是,可能会受益于这些发展中的住院医师培训技术,对患者进行术前教育,手术计划和执行,病人康复。在这次审查中,历史,当前应用,挑战,研究了AR/VR在脊柱手术中的未来。
    Augmented reality (AR) and virtual reality (VR) are powerful technologies with proven utility and tremendous potential. Spine surgery, in particular, may benefit from these developing technologies for resident training, preoperative education for patients, surgical planning and execution, and patient rehabilitation. In this review, the history, current applications, challenges, and future of AR/VR in spine surgery are examined.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    这项研究着眼于COVID-19如何影响全球神经外科住院医师的入学和培训。
    从2019年到2021年,我们审查了多个数据库(即,谷歌学者,科学直接,PubMed,和Hinari)评估COVID-19大流行对中低收入国家(LMICs)和高收入国家(HICs)神经外科住院医师培训和入学的影响。然后,我们使用Wilcoxon符号秩检验来评估两个LMIC/HIC之间的差异,并使用Levene检验来评估方差的同质性。
    有58项研究符合我们的纳入标准;48项(72.4%)在HIC中进行,16项(27.6%)在LMIC中进行。由于COVID-19,2019年至2021年,HIC(31.7%;n=13)和LMIC(25%;n=4)大多取消了新居民的入学。学习方式更改为主要包括视频会议(即,94.7%[n=54]的病例)。Further,神经外科手术主要限于急诊病例(79.6%[n=39]),只有12.2%(n=6)的选择性病例。结果是住院医师外科培训明显减少(即,LMIC为66.7%[n=10],HIC为62.9%[n=22]),尽管在(即,LMIC[37.4%;n=6]和HIC[35.7%;n=15])。这归因于分配给每个居民的手术患者数量显着减少(即,LMIC[87.5%;n=14]高于HIC[83.3%;n=35])。
    COVID-19大流行明显扰乱了全球神经外科教育。尽管LMIC和HIC培训之间存在差异,神经外科病例负荷和外科手术的减少对神经外科培训产生了重大影响。问题仍然存在,这种“经验的丧失”如何在未来得到纠正?
    UNASSIGNED: This study looks at how COVID-19 affected the admission and training of neurosurgical residents worldwide.
    UNASSIGNED: From 2019 to 2021, we reviewed multiple databases (i.e., Google Scholar, Science Direct, PubMed, and Hinari) to evaluate the impact of the COVID-19 pandemic on neurosurgery resident training and admission in low middle-income countries (LMICs) and high-income countries (HICs). We then utilized a Wilcoxon signed-rank test to evaluate the difference between the two LMIC/HICs and employed Levene\'s test to assess the homogeneity of variances.
    UNASSIGNED: There were 58 studies that met our inclusion criteria; 48 (72.4%) were conducted in HIC and 16 (27.6%) in LMIC. The admission of new residents was mostly canceled in HIC (31.7%; n = 13) and in LMIC (25%; n = 4) from 2019 to 2021 due to COVID-19. Learning modalities changed to include predominantly video conferencing (i.e., 94.7% [n = 54] of cases). Further, neurosurgery was largely restricted to emergency cases alone (79.6% [n = 39]), with only 12.2% (n = 6) elective cases. The result was a marked reduction in resident surgical training (i.e., 66.7% [n = 10] in LMIC and 62.9% [n = 22] in HIC), despite increased workloads in (i.e., LMIC [37.4%; n = 6] and HIC [35.7%; n = 15]). This was attributed to the marked reduction in the number of surgical patients allotted to each resident (i.e., LMIC [87.5%; n = 14] than HIC [83.3%; n = 35]).
    UNASSIGNED: The COVID-19 pandemic markedly disrupted neurosurgical education globally. Although differences have been found between LMICs and HICs training, the reduction of neurosurgical case-loads and surgical procedures has significantly impacted neurosurgical training. The question remains, how can this \"loss of experience\" be redressed in the future?
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  • 文章类型: Journal Article
    背景:对孕妇和新生儿的护理必须通过大流行继续进行。为了保持护理质量,在严重急性呼吸系统综合症相关冠状病毒-2(SARS-CoV2)大流行期间尽量减少身体接触,医院和国际组织发布了关于产妇和新生儿护理分娩以及临床和学术服务重组的建议。在大流行的早期,建议依赖于专家意见,并提供了一套一刀切的指导方针。我们的目的是研究这些建议,并提供指导临床医生的理由和背景,管理员,教育工作者,和研究人员,关于如何在大流行期间适应产妇和新生儿服务,不管管辖权。
    方法:我们最初的数据库搜索使用了与冠状病毒感染相关的医学主题标题和自由文本搜索词,妊娠和新生儿学,并总结了国际社会准则的相关建议。随后的针对性搜索至2020年12月30日,包括一般医学和产科期刊上的相关出版物,和更新的社会建议。
    结果:我们确定了846个标题和摘要,其中105份英文出版物符合资格标准并被纳入我们的研究.一个多学科团队代表来自不同学科的临床医生,学者,管理人员和培训计划主管批判性地评估了文献,以整理多个司法管辖区的建议,包括一家加拿大四级医院,为可行的选择提供背景和理由。
    结论:关于产科和新生儿服务的有效做法有不同的思想流派。我们的严格审查提出了有效修改服务的理由,根据大流行的阶段,人群中的感染率,和资源可用性。
    BACKGROUND: The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction.
    METHODS: Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations.
    RESULTS: We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options.
    CONCLUSIONS: There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability.
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  • 文章类型: Journal Article
    神经外科培训传统上是基于学徒模式。然而,对临床暴露的限制减少了受训者的手术经验。仿真模型可以允许更有效的,可行,和及时有效的技能获取。我们的目标是用面子,内容,并构建效度,以回顾模拟模型在神经外科教育中的应用。
    PubMed,WebofScience,和Scopus被查询为符合条件的研究。排除重复项之后,对1204项研究进行了筛选。18项研究包括在最终审查中。
    评估的神经外科技能包括动脉瘤夹闭术(n=6),开颅术和钻孔钻孔(n=2),肿瘤切除(n=4),和血管缝合(n=3)。所有研究都评估了面部效度,11评估内容,和6个评估的结构效度。动物模型(n=5),合成模型(n=7),和VR模型(n=6)进行评估。在面部验证中,所有研究对视觉现实主义的评价都很好,但是触觉现实主义是关键的限制。与其他模型相比,合成模型的触觉真实感中位数较高(5个中的4个)。对内容有效性的评估显示了对解剖和程序教育的积极发现,但是这些模型为新手提供了比有经验的组更多的好处。研究参与者认为尸体模型在解剖学上是最现实的。结构效度显示,在所有模式下,与高级组相比,初级组的熟练程度在统计上显着提高。
    我们的综述强调了在神经外科培训中实施模拟模型的可行性证据。研究应包括预测有效性,以评估将对其进行相同程序的个体的未来技能。这项研究表明,未来的神经外科培训系统需要手术模拟和客观验证的模型。
    Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees\' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education.
    PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review.
    Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities.
    Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.
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  • 文章类型: Journal Article
    BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and clinical teachers. The aim of this study was to understand the effect of the COVID-19 pandemic comprehensively through a systematic review and analysis of related published articles.
    METHODS: A systematic review was conducted based on a predesigned protocol. We searched MEDLINE and EMBASE databases until November 30, 2020, for eligible articles. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed.
    RESULTS: In total, 53 original articles that investigated the effect of the COVID-19 pandemic on residency training were included. Studies from various regions were included in the research, with the largest percentage from the United States (n = 25, 47.2%). Most of these original articles were questionnaire-based studies (n = 44, 83%), and the research target groups included residents (79.55%), program directors (13.64%), or both (6.82%). The majority of the articles (n = 37, 84.0%) were published in countries severely affected by the pandemic. Surgery (n = 36, 67.92%) was the most commonly studied field.
    CONCLUSIONS: The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns. Further studies should be conducted with a focus on the learning outcomes of residency training during the pandemic and the effectiveness of assisted teaching methods.
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  • 文章类型: Journal Article
    The demand for minimally invasive cosmetic procedures is rising, and the public and other physicians deem dermatologists as top providers of these services. Given these expectations, dermatologic residency training must equip resident physician trainees to care for the growing population of patients with aesthetic concerns. As stands, formal hands-on cosmetic dermatology training in residency is lacking specific structure. Educational, cultural, time, and monetary barriers exist, among others, which restrict residents from attaining proficiency in cosmetic dermatology procedures prior to graduation. This may adversely impact patient safety and deter graduates from offering aesthetic procedures. The standardization of core residency competencies in minimally invasive cosmetic procedures is fundamental to guarantee patient safety and satisfaction while ensuring practitioner competence. The balance between these elements is essential for optimal patient care. We review and debate for modifying and strengthening the current curriculum requirements while presenting means to overcome barriers.
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  • 文章类型: Journal Article
    BACKGROUND: There is a lack of understanding of the scope and purpose of teaching assistant cases, impact on patients and safety, as well as the facilitators or barriers to resident participation in these cases.
    METHODS: Four databases (PubMed, Embase, Web of Science, and the Education Resources Information Center), were searched. The references of identified resources were additionally hand-searched. 10 articles were identified and considered in the literature review.
    RESULTS: The TA case literature focuses on case numbers and safety. The discussions of papers allude to perceived benefits of TA cases. The literature review reveals that residents are more likely to be granted TA opportunities if they show themselves worthy of entrustment.
    CONCLUSIONS: The work elucidates aspects of TA cases that have not previously been emphasized or highlighted. The literature review can serve to inform attending surgeons and trainees how to optimize the opportunities teaching assistant cases can afford.
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  • 文章类型: Journal Article
    Phenomenon: There is currently a move to provide residency programs with accurate competency-based assessments of their candidates, yet there is a gap in knowledge regarding the role and effectiveness of interventions in easing the transition to residency. The impact of key stakeholder engagement, learner-centeredness, intrinsic competencies, and assessment on the efficacy of this process has not been examined. The objective of this scoping review was to explore the nature of the existing scholarship on programs that aim to facilitate the transition from medical school to residency. Approach: We searched MEDLINE and EMBASE from inception to April 2020. Programs were included if they were aimed at medical students completing undergraduate medical training or first year residents and an evaluative component. Two authors independently screened all abstracts and full text articles in duplicate. Data were extracted and categorized by type of program, study design, learner-centeredness, key stakeholder engagement, the extent of information sharing about the learner to facilitate the transition to residency, and specific program elements including participants, and program outcomes. We also extracted data on intrinsic (non-Medical Expert) competencies, as defined by the CanMEDS competency framework. Findings: Of the 1,006 studies identified, 55 met the criteria for inclusion in this review. The majority of the articles that were eligible for inclusion were from the United States (n = 31, 57%). Most of the studies (n = 47, 85%) employed quantitative, or mixed method research designs. Positive outcomes that were commonly reported included increased self-confidence, competence in being prepared for residency, and satisfaction with the transition program. While a variety of learner-centered programs that focus on specific intrinsic competencies have been implemented, many (n = 29, 52%) did not report engaging learners as key stakeholders in program development. Insights: While programs that aim to ease the transition from medical school to residency can enhance both Medical Expert and other intrinsic competencies, there is much room for novel transition programs to define their goals more broadly and to incorporate multiple areas of professional development. The existing literature highlights various gaps in approaches to easing the transition from medical school to residency, particularly with respect to key stakeholder engagement, addressing intrinsic CanMEDS competencies, and focusing on individual learners\' needs.
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  • 文章类型: Journal Article
    A significant number of residents in postgraduate training programs pursue dedicated research training. Currently, no formal curricula exist to transition residents back into clinical roles following dedicated research leave. This scoping review aims to determine what literature exists on the challenges faced by trainees who interrupt their clinical training for extended periods of time for research leave. The Pubmed and Medline databases were searched for all study designs related to postgraduate trainees taking academic or research leave. A three-step selection process including title, abstract and full-article review was employed to identify articles that mentioned decay of knowledge, skill or competence. A narrative review of the literature was generated to present key themes identified within the studies. The search yielded 174 articles of which five investigated resident skill decay during research leave. The five studies included for analysis were cohort studies that used general surgery residents\' self-perception and faculty members\' perception of residents\' skill decay as a measure. Residents and faculty perceived decay of residents\' technical skills, leadership skills and knowledge following dedicated research leave. The greatest decay perceived was in technical skills, specifically with more complex tasks and longer periods of non-use. This review identified that residents and faculty perceive a decay of resident skills following dedicated research training. To provide the necessary support to limit this potential decay, as well as to assist in the transition back into clinical training, the needs of and challenges faced by research residents and postgraduate programs must be better understood.
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