A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. A total of 135 articles met inclusion criteria. In surgery, recent RDH changes are not consistently associated with improved resident well-being and may have negative impacts on patient outcomes and education.

No abstract

Effective trauma resuscitation requires the coordinated effort of an interdisciplinary team. Medical error is common during trauma resuscitations, occurring even in well-resourced settings with experienced practitioners. The majority of errors are nontechnical in nature, stemming from ineffective team leadership, nonstandardized communication among team members, lack of global situational awareness, poor use of resources and inappropriate triage and prioritization. Lessons from high-hazard, highreliability industries have therefore informed the development of medical and surgical crisis resource management (CRM) principles and team training applications to address local and domain-specific needs. There is currently no formally derived or systematically evaluated nontechnical skills curriculum for Canadian surgical trainees. Simulation-based CRM training provides an opportunity for focused instruction, deliberate practice, feedback and assessment on the communicator, collaborator and manager roles espoused by the CanMEDS framework in a manner that is consistent and reproducible and poses no threat to patients. We describe the development, piloting and multi level evaluation of a novel, interprofessional, simulation-based trauma team training curriculum for Canadian surgical trainees: Trauma NonTechnical Training (TNT-2).The TNT-2 currirulum was piloted as a prospective, 2-phase, single blinded education study and was informed by a Best Evidence Medical Education systematic review 1 and a focused literature review by the authors. 2The strength of the TNT-2 study stems from the multilevel curriculum assessment, with objective assessment of team performance as the primary study outcome. The course was held at the Allen Waters Family Simulation Centre at St. Michael's Hospital in Toronto, Ont., and used SimMan (Laerdal), an operator-controlled, full-sized human patient simulator. The "health" of SimMan can be interactively manipulated on the basis of management decisions. The simulation theatre was set up to resemble a trauma room, and teams had access to equipment and diagnostic test results in real time. Two confederates were trained to respond in a standardized fashion according to scenario scripts. A single experienced operator controlled all scenarios, and teams were video-recorded for subsequent blinded evaluation.

Diagnostic study, level III.