American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Daily Highlights: Tuesday, October 6

Scudder Oration: I’m not comfortable with this

Too often, clinicians hide behind the words "I'm not comfortable" during challenging patient situations, according to Dr. Gregory Jurkovich, who presented this year's Scudder Oration on Trauma. Dr. Naveen Sangji talks to him about key takeaways from the lecture, including navigating the discomfort of the COVID-19 era and the importance of training and quality programs to ensure trauma surgeons attain comfort and confidence in their field.

Watch the full session, NL07: Scudder Oration on Trauma: I'm Not Comfortable with This, on the virtual ACS Clinical Congress site.

A community surgeon's guide to treating acute limb ischemia

Community and rural surgeons are often called on to manage patients with acute limb ischemia when comprehensive vascular surgical expertise is not available. Drs. J.P. Walker, Tyler Hughes, and Chris DuCoin talk about how to ensure your practice is prepared to properly diagnose and treat patients to ensure optimal outcomes can be achieved.

Watch the full session, PS446: Acute Limb Ischemia: A Practical Approach for the Community Surgeon, on the virtual ACS Clinical Congress site.

How to manage the pediatric open abdomen

Whether it's needed for trauma damage control, a second-look operation, or to treat abdominal compartment syndrome, managing the open abdomen in pediatric patients presents unique challenges. Drs. Nilda Garcia and Marshall Schwartz discuss how the adult and pediatric surgical practices can inform one another, and key takeaways for pediatric surgeons including when to operate, options for closing the abdomen, and managing factors such as fluid loss, transport, and patient size.

Watch the full session, PS466: The Pediatric Open Abdomen: Controversy, Standards, and Lessons Learned, on the virtual ACS Clinical Congress site.

The importance of colorectal cancer screening guidelines

Colorectal cancer screening guidelines continue to be refined based on age, family, and personal history, as well as newer testing methods. In addition, a broader group of patients have comorbidities that may alter their screening options. Drs. Matthew Kalady, Steve Wexner, and Amalia Stefanou talk about the latest updates, including younger screening ages, options such as Cologuard, and other considerations.

Watch the full session, PS482: Screening for Colorectal Cancer: Updated Guidelines, Tests, and Considerations, on the virtual ACS Clinical Congress site.

Clinical support staff improve surgical residency experience    

Effective use of clinical support staff linked to improved residency experience

Clinical support staff, such as advanced practice providers and social workers, have become increasingly common members of the surgical team, and their presence has been shown to improve patient safety, continuity of care, and compliance with duty-hour regulations. Some have proposed increasing the use of support staff in order to better achieve an appropriate balance between resident education and service responsibilities. However, the association between the use of support staff and surgical trainee education and wellness has not been well described. A new study suggests that effective use of clinical support staff positively impacts trainees in both respects.

The study carried out by Tarik K. Yuce, MD, MS, Feinberg School of Medicine at Northwestern University, Chicago, IL, and colleagues, is based on a survey of residents in 301 Accreditation Council for Graduate Medical Education-accredited general surgery programs following the 2019 American Board of Surgery In-Training Examination (ABSITE). 

Of 6,415 respondents, 63 percent felt support staff were used effectively by their surgical residency program, with considerable variation in the proportion of residents reporting effective use of clinical support staff between programs. There was a significant correlation between effective use of support staff and residents reporting better wellness and more satisfaction with education. "Residents who reported effective use of support staff were more likely to be satisfied with the OR time, clinical autonomy and time available for direct patient care, and they were less likely to report burnout or thoughts of leaving the program," said Dr. Yuce.

Men were more likely than women to report effective use of support staff, researchers found. Senior author Yue-Yung Hu, MD, MPH, Feinberg School of Medicine at Northwestern University, Chicago, IL, commented, "The fact that women less often reported effective use of support staff likely reflects continued gender bias in the learning and working environment. As departments continue to increase their support staff, recognition and training of explicit, implicit, and internalized biases could prevent gender disparities in training from widening."

According to Dr. Yuce, the use of support staff within surgical training programs may prove beneficial. However, the integration of clinical support staff must be conducted thoughtfully to ensure training programs maintain their clinical and educational missions.

Future studies will aim to collect more detailed information on number and type of support staff within residency programs, as well as specific roles and their implementation. The new analysis was conducted by the Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) Trial research team, a collaborative effort of 212 surgical residency programs coordinated by the Surgical Outcomes and Quality Improvement Center at Northwestern. The SECOND Trial team seeks to identify and leverage the innovations and best practices of high-performing surgical programs to drive improvement in resident wellness across the country.

Watch the full presentation, Impact of Clinical Support Staff on General Surgery Residents' Education and Wellness, during session SF185: General Surgery IV on the virtual ACS Clinical Congress site.