PubMed Health⌕ Search

Biomedical subjects

Daniel W Birch

Publications and source records attributed to Daniel W Birch.

10 recordsLinked to original sources
PubMed2006

Undergraduate surgical training: variations in program objectives and curriculum implementation across Canada.

BACKGROUND: Although nationally recognized learning objectives for undergraduate surgical education exist, the extent to which Canadian medical schools follow these guidelines has never been established. METHODS: We distributed a survey to all program directors and clinical-teaching-unit coordinators for undergraduate surgery at Canada's 16 medical schools, and subsequently assessed the perceived emphasis placed on learning objectives and student performance, and the impact of instructional tools and teaching locations. RESULTS: Program directors in 15 medical schools responded to the survey. We identified a wide variation in the emphasis placed on basic learning objectives as well as specialty specific learning objectives. The length of rotations, methods of instruction and tools used to grade student performance also varied widely. CONCLUSIONS: Our findings suggest significant variation in the design and implementation of undergraduate surgical education in Canada. This study may serve as a basis for reassessing learning objectives in Canadian undergraduate surgical education.

Canada↗
PubMed2006

Practice patterns for deep vein thrombosis prophylaxis in minimal-access surgery.

BACKGROUND: There are no comprehensive evidence-based guidelines for deep vein thrombosis (DVT) prophylaxis in patients undergoing minimal-access surgery (MAS). METHODS: We completed a cross-sectional survey of general surgeons practising in Ontario, in order to establish current practice patterns for DVT prophylaxis for MAS procedures. RESULTS: The mean duration of practice of respondents was 15.4 years, with most (67.0%) practising outside an academic centre. For minor MAS, most surgeons do not give DVT prophylaxis (73.8% in laparoscopic cholecystectomy and 63.7% in laparoscopic inguinal hernia repair). For major MAS, a minority of surgeons do not give DVT prophylaxis (4.1% in laparoscopic colorectal surgery and 13.6% in laparoscopic splenectomy). However, there remains considerable variation in the mechanism (pharmacological, mechanical), approach and duration (perioperative, postoperative) of DVT prophylaxis among respondents in all case scenarios evaluated. Academic surgeons and surgeons in practice for 15 years or less are more aggressive with preoperative heparin administration. CONCLUSIONS: There is substantial and important variability in the current practice of general surgeons with respect to DVT prophylaxis for MAS. Considerable benefit will be derived from clinical trials that provide data to establish appropriate DVT prophylaxis guidelines for MAS.

Follow-Up Studies↗
PubMed2006

A needs assessment study of undergraduate surgical education.

BACKGROUND: There is compelling evidence to suggest that undergraduate surgical education may fail to provide appropriate instruction in basic surgical principles and skills. METHODS: We completed a descriptive, cross-sectional survey of stakeholder groups (surgeon educators and recent medical school graduates) to assess the perceived relevance and learning for surgical principles, surgical skills, teaching environments and teaching interventions. RESULTS: Graduates returned 123 surveys, and surgeons returned 55 surveys (response rates: graduates 46%, surgeons 45%). Both graduates and surgeons considered 8 of 10 surgical principles highly relevant to current medical practice. Despite this, the surgical clerkship seemed to enable proficiency in far fewer principles (graduates: 3, surgeons: 5). Graduates believed that each of the 15 basic surgical skills is relevant to current medical practice, whereas surgeons indicated that more invasive skills (i.e., central venous lines, thoracentesis) are much less relevant. Graduates and surgeons indicated that medical students will achieve proficiency in only 3 basic skills areas as a result of the surgical clerkship. Graduates and surgeons considered each surgical specialty relevant and effective in undergraduate surgical education. According to graduates and surgeons, the most effective teaching environments are outpatient settings (emergency department, outpatient clinics). Graduates and surgeons ranked resident teaching as the most effective teaching intervention, and traditional interventions (grand rounds, formal rounds) and electronic resources (computer-assisted learning, web-based learning) were ranked the least effective. CONCLUSIONS: In this study, we assessed the learning needs of contemporary medical students in surgery. The results suggest that respondent graduate students and surgeons believe that the level of proficiency achieved in surgical principles and basic skills through undergraduate surgical educations is much less than anticipated. Outpatient settings and resident teaching are believed to provide the most effective teaching for medical students. Information from this study has important implications for Canadian undergraduate surgery programs and curricula.

Canada↗
PubMed2005

The impact of latency on surgical precision and task completion during robotic-assisted remote telepresence surgery.

OBJECTIVE: It has been suggested that robotic-assisted remote telepresence surgery with a signal transmission latency of greater than 300 ms may not be possible. METHODS: We evaluated the impact of four different latencies of up to 500 ms on task completion and error rate in five surgeons after completion of three different surgical tasks. RESULTS: The surgeons were able to complete all tasks with a latency of 500 ms. However, higher latency was associated with higher error rates and task completion time (TCT). There were significant variations between surgeons and different tasks. CONCLUSION: Surgeons are able to complete tasks with a signal transmission latency of up to 500 ms. The clinical impact of slower TCT and increased error rates encountered at higher latency needs to be established.

Clinical Competence↗
PubMed2004

The feasibility of adopting laparoscopic incisional hernia repair in general surgery practice: early outcomes in an unselected series of patients.

A laparoscopic approach to incisional hernia repair has been shown to be safe and effective in selected patients. We report our early outcomes following laparoscopic ventral/incisional hernia repair (LVHR) in an unselected series of patients encountered in general surgery practice. All patients referred with incisional hernia were offered a laparoscopic repair using prosthetic mesh. Patients were not excluded from laparoscopic approach on the basis of age, previous surgery, defect size, intraperitoneal mesh, body mass index (BMI), comorbidities, or abdominal wall stomas. We followed 28 consecutive patients who underwent LVHR (17 primary, 11 recurrent hernias). Laparoscopic repair was completed in 27 patients with a mean operative time of 141.6 +/- 11.9 minutes. There were no intraoperative complications. The mean size of the abdominal wall defects was 153.4 +/- 27.5 cm and the mean mesh size was 349.2 +/- 59.1 cm. The mean hospital stay was 3.7 +/- 0.3 days. Nine patients developed large wound seromas; all spontaneously resolved. Our experience suggests that LVHR is feasible as a primary approach to most incisional hernias encountered in general surgery practice.

Feasibility Studies↗
PubMed2004

Robotic-assisted laparoscopic colorectal surgery.

Robotic assistance provides a number of potential benefits for laparoscopic surgery by addressing several inherent limitations. However, its utility in colorectal surgery has not been determined. This is a report of our initial experience with robot-assisted colon resections. We prospectively followed 10 patients who underwent robotic-assisted laparoscopic colorectal surgery using Zeus Microwrist System. Surgical outcomes were compared with those of 10 consecutive patients who underwent laparoscopic colorectal surgery in the same institution for similar indications prior to the start of robotic-assisted surgery. Six patients in each group had surgery for colorectal malignancy. All 10 robotic-assisted procedures were completed with no intraoperative complications, conversions, or mortality. The average blood loss was less than 150 mL in all cases. Morbidity and hospital stay were comparable to those for the patients undergoing standard laparoscopic procedures. Robotic surgery was associated with a significant increase in operative time of almost 1 hour. This time was reduced significantly after the first 4 cases. The value of robotic assistance in colorectal surgery needs to be further evaluated in a larger comparative study.

Aged↗