The Impact of a Frailty Education Module on Surgical Resident Estimates of Lobectomy Risk

Abstract

Background Frailty is a risk factor for adverse events after surgery. Residents’ ability to recognize frailty is underdeveloped. We assessed the influence of a frailty education module on surgical residents’ estimates of lobectomy risk. Methods Traditional track cardiothoracic surgery residents were randomized to take an on-line short course on frailty (experimental group) or to receive no training (control group). Residents read a clinical vignette, made an initial risk estimate of major complications for lobectomy, and rated clinical factors on their importance to their estimates. They viewed a video of a standardized patient portraying the patient in the vignette, randomly selected to exhibit either vigorous or frail behavior, and provided a final risk estimate. After rating 5 vignettes, they completed a test on their frailty knowledge. Results Forty-one residents participated (20 in the experimental group). Initial risk estimates were similar between the groups. The experimental group rated clinical factors as “very important” in their initial risk estimates more often than did the control group (47.6% vs 38.5%; p<0.001). Viewing videos resulted in a significant change from initial to final risk estimates (frail: 50±75% increase, p=0.008; vigorous: 14±32% decrease, p=0.043). The magnitude of change in risk estimates was greater for the experimental group (10.0±8.1 vs 5.1±7.7; p<0.001). The experimental group answered more frailty test questions correctly (93.7% vs 75.2%; p<0.001). Conclusions A frailty education module improved resident knowledge of frailty and influenced surgical risk estimates. Training in frailty may help educate residents in frailty recognition and surgical risk assessment.

What do we know about frailty in the acute care setting? A scoping review

“…1 ). Table 1 shows the descriptive characteristics of the articles that measured frailty (33%, n = 204) [ 18 – 221 ], whereas Additional file 1 : Table S3 shows the descriptive characteristics of the articles that did not include a frailty measurement.…”

“…The Frailty Index was the most popular measure used in emergency departments ( n = 7/33; 21%) [ 93 , 106 , 125 , 131 , 163 , 165 , 195 ] and orthopedics ( n = 4/18; 22%) [ 126 , 189 , 219 , 220 ] (Table 3 ), in Italy ( n = 5/19; 26%) [ 93 , 104 , 106 , 133 ] and Denmark ( n = 3/8; 38%) [ 189 , 219 , 220 ], and in experimental articles ( n = 6/32; 19%) [ 50 , 62 , 166 , 189 , 219 , 220 ]. The Frailty Phenotype was the most popular measure used in cardiology ( n = 6/24; 25%) [ 45 , 89 , 90 , 112 , 172 , 208 ] and surgery ( n = 2/10; 20%) [ 184 , 221 ] (Table 3 ), and in Spain ( n = 4/10; 40%) [ 90 , 112 , 172 , 174 ] and Sweden ( n = 2/6, 33%) [ 92 , 119 ]. Among the 122 articles that reported the prevalence of frailty, the median prevalence was 49%.…”

<p>Frailty syndrome: implications and challenges for health care policy</p>

“…104 A US educational interventional study involving cardiothoracic surgery residents showed that online short courses on frailty significantly improved residents' knowledge of frailty and influenced surgical risk estimates. 105 Finally, frailty research may have evolved without taking into account the patient perspective. Frailty can be considered as a highly negative term and being labeled as frail may affect negatively the most vulnerable individuals in various ways.…”

Physician Gender Differences in Processing Surgical Risk Features in Videos of Standardized Patients

“…Data from this study were taken from Institutional Review Board-approved prior studies at our institution (The University of Chicago, Chicago, Illinois) [10,11], and this protocol was approved by our Institutional Review Board (IRB17-0448). In these studies, thoracic surgeons and cardiothoracic surgeons in training were recruited to participate from a list provided by the Thoracic Surgery Directors Association, as previously described [10,11]. Anonymized clinical vignettes were developed from patients 60 to 69 years of age who previously underwent lobectomy for lung cancer.…”