Papers by Barton Thiessen
Background: The current literature on medical education suggests that integrated curricula can im... more Background: The current literature on medical education suggests that integrated curricula can improve the learning outcomes of medical students. This research project involves the horizontal integration of anesthesia within the surgery clerkship rotation (3rd year) at Memorial University and tests the feasibility of an integrated rotation as a learning experience for perioperative care. Method: Twenty-five students participated in this project and were randomized into integrated (9) and non-integrated (16) groups. Student participation in the integrated group involved: 1) shadowing an anesthetist during a preoperative assessment; 2) attending the surgery; 3) assisting with delivery of the anesthetic; 4) accompanying the patient to the Recovery Room and learning about postoperative care; and, 5) following the patient's recovery on the floor. All students completed pre-and post-rotation surveys to assess their views on anesthesia, its role in the surgical process, and the integrated experience in general. The anesthetists and surgeons involved with the integrated rotation also completed post-rotation surveys to provide feedback on the feasibility of the rotation. Results: Of those students who participated in the integrated group, 89% felt they had a better understanding of the work of an anesthetist after the rotation. Students appreciated the hands-on experience involved in the rotation and the opportunity to learn intubation, IV-placement, arterial line insertions, and ventilating the patient. Students gained a better understanding of the surgical patient and perioperative care through the integrated rotation. However, they also reported that the integrated experience was not long enough and they wanted more clinical anesthesia experience and structure. Conclusions: The integrated anesthesia-surgery clerkship rotation provided students with an introduction to anesthesia which they would not have received unless they did the separate anesthesia selective in their final year of study. Further research is planned to determine the best structure of an integrated anesthesia-surgery rotation at Memorial University.
British Journal of Surgery, 2019
BackgroundThe Clavien–Dindo classification is perhaps the most widely used approach for reporting... more BackgroundThe Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs).MethodsThis was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparin...
European Journal of Surgical Oncology (EJSO), 2017
on behalf the International Surgical Outcomes Study (ISOS) group* *members of study group listed ... more on behalf the International Surgical Outcomes Study (ISOS) group* *members of study group listed in the Supplementary Appendix
British Journal of Anaesthesia, 2016
Background: As global initiatives increase patient access to surgical treatments, there remains a... more Background: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. Results: A total of 474 hospitals in 19 high-, 7 middle-and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low-and middle-income compared with high-income countries. Conclusions: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. Study registration: ISRCTN51817007
Academic Medicine, May 24, 2022
British journal of anaesthesia, 2018
The surgical safety checklist is widely used to improve the quality of perioperative care. Howeve... more The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (1...
Medical Education Scholarship Forum Proceedings, Mar 6, 2015
Canadian journal of anaesthesia = Journal canadien d'anesthésie, 2014
The Guidelines to the Practice of Anesthesia Revised Edition 2014 (the guidelines) were prepared ... more The Guidelines to the Practice of Anesthesia Revised Edition 2014 (the guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2014 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.
Medical Education Scholarship Forum Proceedings, Mar 6, 2015
Purpose: Memorial University does not offer a dedicated anesthesia rotation in the clerkship year... more Purpose: Memorial University does not offer a dedicated anesthesia rotation in the clerkship year. A survey of Canadian medical schools found that 80% offered a dedicated rotation (one-two weeks). No schools at the time of the survey offered an integrated, collaborative surgical/anesthesia program where medical students follow patients throughout the perioperative experience. We designed a pilot program to provide anesthesia experience, provide valuable hands-on learning opportunities, and foster collaborative, inter-professional behavior in medical students. Methods: Six third-year medical students were recruited while on their general and orthopedic surgical rotations at Memorial. Students joined the anesthetist before, during, and after their operations. Students filled out pre-and post-surveys measuring their perceptions, impressions, and value of their anesthesia experience. In addition to learning hands-on skills, students were also provided with an iPad with teaching modules that they reviewed with the anesthetist. Staff surgeons and anesthetists were surveyed regarding their levels of satisfaction and how to improve the program. Results: All students, surgeons, and anesthetists agreed that an integrated program should be introduced during the clerkship year at Memorial. The students' preferred methods of learning were hands-on and one-on-one, which are the primary teaching methods employed in anesthesia. Most students felt iPad modules were helpful in learning core aspects of anesthesia but should be made available on line also. Most students felt the program enhanced their surgical experience. Conclusions: The horizontal integration of anesthesia into the surgical program at Memorial was well accepted by all participants and could enhance the new spiral curriculum with integrated learning experiences centered on hands-on and one-on-one teaching.
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Papers by Barton Thiessen