Orthopaedic Trauma Surgery Performed by Unsupervised and Supervised Trainees: Complication Rates Compared

Harris, IA; Lin, Chin Shien

doi:10.1177/230949900701500302

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…Of the other four studies, two compared their outcomes to results in the literature [62,65], one did not formally train their residents [71] and another study reported the negative impact of residents' assistance in laparoscopic gastric bypass surgery compared with fellow or attending level assistance [66]. Three studies reported negative outcomes for faculty cases, likely caused by selection bias [64,70,72]. …”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

138

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BackgroundResidents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.MethodsThe literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.ResultsNinety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.ConclusionsThe majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

138

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“…There is much experience but little evidence on how teaching in operation theatres can be performed effectively and safely. Although orthopaedic trauma surgery performed by supervised and unsupervised trainees does not seem to have different complication rates [3], the most common method of teaching is to allow residents to perform operative procedures under the supervision of an attending surgeon.…”

Section: Discussionmentioning

confidence: 99%

Is proximal femoral nailing a good procedure for teaching in orthogeriatrics?

Biber

Grüninger

Singler

et al. 2012

Arch Orthop Trauma Surg

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“…In an Australian study, where more than 6000 orthopedic trauma procedures were studied, 59% were unsupervised. 13 Surprisingly, complications such as hardware failure and malunion were more frequent in the supervised group. In contrast to these studies, two more recent studies do not support these conclusions.…”

Section: Discussionmentioning

confidence: 92%

Outcome of femoral fractures care as a measure of trauma care between level I and level II trauma systems in Israel

Khoury

Weil

Liebergall

et al. 2016

Trauma Surg Acute Care Open

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BackgroundOur hypothesis in this study was that the outcome of patients with femur fractures would be favorable in a level I trauma center (LITC).MethodsA prospective multicenter cohort study. 5 LITC and 6 regional (level II) trauma centers (RTCs) were enrolled to participate in the study. A total of 238 patients suffering from a femoral fracture were recruited to the study. 125 patients were treated in LITCs and 113 in RTCs. Data were extracted from the emergency medical services ambulances, emergency department records, patient hospitalization and discharge records, operating room records, and the national trauma registry (for LITCs). A study questionnaire was administered to all participating patients at discharge, 6 weeks and 6 months postoperatively. The following parameters were studied: mechanism of injury, time from injury to the hospital, Injury Severity Score, classification of femoral fracture, additional injuries, medical history, time to surgery, implant type, skill level of the surgical team, type of anesthesia, length of stay and intensive care unit (ICU) stay, postoperative and intraoperative complications and mortality.ResultsThere was a significant difference in the modality of patient transfer between the 2 study groups—with the LITC receiving more patients transported by helicopters or medical intensive care. Time to surgery from admission was shorter in the LITC. Length of stay, ICU stay, and mortality were similar. In the LITCs, 47% of the procedures were performed by residents without the supervision of an attending surgeon, and in the RTCs 79% of the procedures were performed with an senior orthopaedic surgeon. Intraoperative and immediate complication rates were similar among the 2 groups.ConclusionsA femoral shaft fracture can be successfully treated in an LITC and RTC in the state of Israel. Both research and policy implementation works are required. Also, a more detailed outcome analysis and triage criteria for emergency are desired.Level of evidenceII.

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Orthopaedic Trauma Surgery Performed by Unsupervised and Supervised Trainees: Complication Rates Compared

Abstract: The complication rate was not higher for operations performed by unsupervised trainees than those performed in the presence of a consultant.

Cited by 8 publications

References 8 publications

A systematic review of the effects of residency training on patient outcomes

A systematic review of the effects of residency training on patient outcomes

Is proximal femoral nailing a good procedure for teaching in orthogeriatrics?

Outcome of femoral fractures care as a measure of trauma care between level I and level II trauma systems in Israel

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