Canadian Journal of Surgery最新文献

Background: Given the complexity of the transition to competency-based medical education (CBME) and the diversity of systems and learning contexts, the literature has acknowledged the need for principled yet contextual approaches to implementation. There is a need for research that examines these adaptations and their consequences, both intended and unintended.

Methods: We performed a constructivist grounded theory study to explore how the theory of CBME translated to practice in operative settings in a Canadian approach to CBME: Competence by Design (CBD).

Results: Program contexts both enabled and hindered how CBD translated into practice. The operative context was aligned with the principles of competency-focused instruction and allowed for frequent, direct observation and formative feedback. Time, personnel, and technology constraints unique to the patterns of practice in operative settings hindered programmatic assessment.

Conclusion: Adaptations to CBME that are responsive to the context of programs can support the intended conceptual learning conditions of CBME.

Background: Workplace injuries are increasingly recognized as a substantial detriment to surgeon longevity and productivity. Limited data exist on pain and injury prevalence among rectal surgeons. In this epidemiologic study, we aimed to estimate the prevalence of physical discomfort among rectal surgeons in Canada and identify potential causative factors.

Methods: We distributed a web-based survey to rectal surgeons in Canada between January and October 2022. We included colorectal surgeons, surgical oncologists, and colorectal surgery fellows associated with Canadian university hospitals.

Results: Of the 72 surgeons we contacted, 48 participated (67%). More than 98% reported experiencing physical discomfort or pain during rectal surgery, with more than half experiencing these symptoms weekly. Neck, shoulders, and back were common pain or discomfort locations, whether surgeons were performing open surgery or using a minimally invasive platform. Laparoscopic equipment, headlight, and pelvic retractor use were the most common causes. Many surgeons (54%) sought professional treatment and employed risk-reducing strategies such as intraoperative stretching (48%) or after-work strength training exercises (52%). Satisfaction with pain levels during surgery was uncommon (40%). Multivariable analysis showed advancing age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.02-1.23) and larger percentage of minimally invasive surgeries (OR 2.61, 95% CI 1.28-5.33) as significant predictors of increased discomfort. After-work exercise participation was protective in both open (OR 0.14, 95% CI 0.02-0.95) and minimally invasive surgeries (OR 0.60, 95% CI 0.37-0.98).

Conclusion: Rectal surgeons in Canada commonly experience pain and injury during surgery, underscoring the need for improved safety measures to preserve their physical health and career longevity.

Background: Studies have highlighted inadequate exposure to musculoskeletal education and orthopedic surgery in mandatory medical school curricula; thus, the Canadian Orthopaedic Surgery Medical Education Course (COSMEC) was designed to enhance medical education around orthopedic surgery and common musculoskeletal presentations encountered in primary care. We sought to explore the effectiveness of COSMEC in preparing medical students for clinical training and future practice.

Methods: Canadian and international medical students were invited to participate in COSMEC, a 12-week virtual course led by orthopedic faculty and senior residents. Teaching objectives were guided by the musculoskeletal objectives of the Medical Council of Canada Qualifying Examination and expert opinion. We administered pre- and postcourse surveys to assess outcomes related to participant knowledge, confidence, and interest in orthopedic surgery.

Results: A total of 133 medical students registered and completed COSMEC. Of these, we received 84 paired pre- and postcourse surveys. Knowledge scores improved from 7.9 (standard deviation [SD] 2.6) to 9.7 (SD 2.0) out of 14 (p < 0.001). There were significant improvements in participant-reported confidence in performing a history and physical examination, understanding the basic components of fracture management, managing bone and joint emergencies, and describing fracture radiographs (p < 0.001).

Conclusion: Overall, COSMEC enhanced knowledge and confidence in orthopedic and musculoskeletal topics and is an effective extracurricular learning resource for medical students. It can help prepare medical students for future training and practice involving orthopedic and musculoskeletal patient presentations.

Background: Robotic surgery has seen substantial growth over the years and continues to show promise, with recent implementation into orthopedic surgery. There is limited literature available on patient attitudes and comfort level with robotic compared with conventional surgery. We aimed to develop an understanding of patient views on robot-assisted knee replacement to help the development of patient education materials and facilitate successful implementation.

Methods: A qualitative, descriptive methodology was used. Included participants were those who had undergone total knee replacement in the last 5 years. Participants completed an online semistructured interview assessing their past experiences and their fears and assumptions about robotic surgery. An inductive thematic analysis was completed to organize and present the major themes.

Results: Four overarching themes described the areas patients focused on: advancements in surgery, perception of robotic surgery and surgeons, reliability, and patient education materials. Major subthemes included the proven reliability of robots, safety fears, and efficacy. Some participants' fear centred around robot autonomy. Greater comfort with the use of robots would occur if patients were given information about the role of the robot before surgery.

Conclusion: Patient education materials can help alleviate fears and prevent misperceptions about robot-assisted knee replacement. Materials should include themes of surgical advancements and how surgeons interact with these advancements, level of robot autonomy, and the reliability and safety of the robot.

Background: Gender disparities exist in several surgical specialties, particularly in orthopedic surgery. The purpose of this study was to determine the current trends in gender diversity among orthopedic surgical residents in Canada over the last 20 years.

Methods: We analyzed gender distribution data for orthopedic trainees from the Canadian Resident Matching Service (CaRMS) for 2013-2022 and the Canadian Post-MD Education Registry for 2000-2022 using linear and quadratic regressions.

Results: More male (4.7%) than female medical students (1.9%) applied to an orthopedics program (p < 0.001). The proportion of male applicants entering CaRMS who applied to orthopedics followed a quadratic (U-shaped) distribution over time (p = 0.01). The proportion of female applicants remained unchanged from 2013 to 2022 (p > 0.9). However, for matching results, among the applicants who applied to orthopedic surgery, there was no gender effect (men 56.1% matched, women 50.3% matched; p = 0.3). The proportion of residency spots offered to female applicants remained at around 30%, without significant changes over time (p = 0.1). The number of female orthopedic graduates increased linearly from 2000 to 2021 (p < 0.001), projected to reach gender equalization (at 50%) by 2060. Female residents experienced higher attrition in residency (3.4%) than male residents (2.1%; p = 0.05), and this gender difference is decreasing over time (p = 0.03).

Conclusion: Over 2 decades, women have shown consistently lower rates of application to orthopedic surgery programs than their male colleagues. Women who matched experienced higher attrition rates than men, although this appears to be improving over time.