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Emerging technologies and research ethics: Developing editorial policy using a scoping review and reference panel
Emerging technologies and societal changes create new ethical concerns and greater need for cross-disciplinary and cross-stakeholder communication on navigating ethics in research. Scholarly articles are the primary mode of communication for researchers, however there are concerns regarding the expression of research ethics in these outputs. If not in these outputs, where should researchers and stakeholders learn about the ethical considerations of research?
Drawing on a scoping review, analysis of policy in a specific disciplinary context (learning and technology), and reference group discussion, we address concerns regarding research ethics, in research involving emerging technologies through developing novel policy that aims to foster learning through the expression of ethical concepts in research.
This paper develops new editorial policy for expression of research ethics in scholarly outputs across disciplines. These guidelines, aimed at authors, reviewers, and editors, are underpinned by: a cross-disciplinary scoping review of existing policy and adherence to these policies;a review of emerging policies, and policies in a specific discipline (learning and technology); and,a collective drafting process undertaken by a reference group of journal editors (the authors of this paper).
Analysis arising from the scoping review indicates gaps in policy across a wide range of journals (54% have no statement regarding reporting of research ethics), and adherence (51% of papers reviewed did not refer to ethics considerations). Analysis of emerging and discipline-specific policies highlights gaps.
Our collective policy development process develops novel materials suitable for cross-disciplinary transfer, to address specific issues of research involving AI, and broader challenges of emerging technologies.
Journal Article
The Fundamentals of Endoscopic Surgery (FES) skills test: factors associated with first-attempt scores and pass rate
BackgroundThe Fundamentals of Endoscopic Surgery (FES) program became required for American Board of Surgery certification as part of the Flexible Endoscopy Curriculum (FEC) for residents graduating in 2018. This study expands prior psychometric investigation of the FES skills test.MethodsWe analyzed de-identified first-attempt skills test scores and self-reported demographic characteristics of 2023 general surgery residents who were required to pass FES.ResultsThe overall pass rate was 83%. “Loop Reduction” was the most difficult sub-task. Subtasks related to one another only modestly (Spearman’s ρ ranging from 0.11 to 0.42; coefficient α = .55). Both upper and lower endoscopic procedural experience had modest positive association with scores (ρ = 0.14 and 0.15) and passing. Examinees who tested on the GI Mentor Express simulator had lower total scores and a lower pass rate than those tested on the GI Mentor II (pass rates = 73% vs. 85%). Removing an Express-specific scoring rule that had been applied eliminated these differences.Gender, glove size, and height were closely related. Women scored lower than men (408- vs. 489-point averages) and had a lower first-attempt pass rate (71% vs. 92%). Glove size correlated positively with score (ρ = 0.31) and pass rate. Finally, height correlated positively with score (r = 0.27) and pass rate. Statistically controlling for glove size and height did not eliminate gender differences, with men still having 3.2 times greater odds of passing.ConclusionsFES skills test scores show both consistencies with the assessment’s validity argument and several remarkable findings. Subtasks reflect distinct skills, so passing standards should perhaps be set for each subtask. The Express simulator-specific scoring penalty should be removed. Differences seen by gender are concerning. We argue those differences do not reflect measurement bias, but rather highlight equity concerns in surgical technology, training, and practice.Graphic abstract
Journal Article
FES exam outcomes in year two of a proficiency-based endoscopic skills curriculum
BackgroundFES certification is required to sit for the ABS Qualifying Exam. Previous work demonstrated a 40% FES pass rate for residents with standard clinical endoscopy training. After implementing a proficiency-based simulation curriculum, our FES pass rate increased to 87%. The purpose of this study was to monitor the success of our curriculum in its second year. We also hypothesized that residents who took the FES exam within 30 days of their clinical endoscopy rotation would have superior pass rates to residents who waited longer.MethodsPGY4 residents (N = 12) underwent flexible endoscopy training including a 1 month clinical rotation plus proficiency-based simulation training using bench-top models (Trus, Operation Targeting Task) and a virtual reality task on the GI Mentor. Residents that passed FES on their first attempt were compared to residents that did not pass based on number of endoscopies logged, hours spent practicing on simulators, and time elapsed between completing their endoscopy rotation and taking the FES exam. FES total scores and section scores were compared to historical controls.ResultsNine residents (75%) passed FES on their first attempt. Overall, 80% of residents who tested within 30 days of their endoscopy rotation (n = 5) passed FES while 71% of residents who waited longer (n = 7) passed FES (p = non-significant). Residents that passed FES were not significantly different from residents who did not pass based on number of endoscopies logged or hours spent practicing on simulators. Compared to historical controls, scores on loop reduction improved significantly with the new curriculum.ConclusionsFES pass rates decreased during the second year of our curriculum. Based on other literature, our trainees would benefit from higher volumes of endoscopy and/or a more robust proficiency-based simulation curriculum. Scheduling the FES exam in the month following the endoscopy rotation did not significantly improve pass rates.
Journal Article
Are you better off than you were 4 years ago? Measuring the impact of the ABS flexible endoscopy curriculum
IntroductionIn 2014, the ABS introduced the Flexible Endoscopy Curriculum (FEC). The FEC did not alter the minimum defined category case volumes for endoscopy; however, it did introduce specific cognitive and technical milestones for endoscopy training. It also mandated that residents pass the Fundamentals of Endoscopic Skills (FES) exam to qualify for board certification. Although significant research has been published regarding residents’ success on the FES exam, very little is known regarding how the FEC has changed the way general surgery programs train their residents in surgical endoscopy. The aim of this study was to quantify changes in flexible endoscopy education at a large academic program in the 4 years since the FEC was published.MethodsWe classified the impact of FEC into four categories: (a) case volume or distribution, (b) clinical rotations, (c) required didactics or simulation exercises, and (d) FES pass rates. For category (a), we reviewed current and historical case logs for all categorical residents from 2013 to 2018. Mann–Whitney U tests were used to compare endoscopy volumes for each PGY level in 2013–2014 to the respective PGY level in 2017–2018 with p < 0.05 considered significant. For categories (b)–(d), we gathered historical records from the residency coordinator and endoscopy rotation director.ResultsComplete data were available for 57 residents in the 2013–2014 academic year and 56 residents in the 2017–2018 academic year. Median total endoscopies performed by PGY2, PGY3, and PGY5 residents all significantly increased during the FEC rollout. Our program’s focus on endoscopy also expanded with absolute increases in endoscopy rotations, didactics, and simulation exercises. These changes translated into significantly increased pass rates on the FES exam from 40 to 100%.ConclusionsImplementation of the FEC at a large academic program led to measurable improvements in clinical experience, program structure, educational programing, and performance on high-stakes assessments.
Journal Article
Proficiency-based preparation significantly improves FES certification performance
BackgroundThe Fundamentals of Endoscopic Surgery (FES) certification has recently been mandated by the American Board of Surgery but best methods for preparing for the exam are lacking. Our previous work demonstrated a 40% pass rate for PGY5 residents in our program. The purpose of this study was to determine the effectiveness of a proficiency-based skills and cognitive curriculum for FES certification.MethodsResidents who agreed to participate (n = 15) underwent an orientation session, followed by skills pre-testing using three previously described models (Trus, Operation targeting task, and Kyoto) as well as the actual FES skills exam (vouchers provided by the FES committee). Participants then trained to proficiency on all three models for the skills curriculum and completed the FES online didactic material for the cognitive curriculum. Finally, participants post-tested on the models and took the actual FES certification exam. Values are mean ± SD; p < 0.05 was considered significant.ResultsOf 15 residents who participated, 8 (53%) passed the FES skills exam at baseline. Participants required 2.7 ± 1.3 h to achieve proficiency on the models and approximately 3 h to complete the cognitive curriculum. At post-test, 14 (93%, vs. pre-test 53%, p = 0.041) passed the FES skills exam. 14 (93%) passed the FES cognitive exam and 13/15 (87%) passed both the skills and cognitive exam and achieved FES certification.ConclusionsOur traditional clinical endoscopy curricula were not sufficient for senior residents to pass the FES exam. Implementation of a proficiency-based flexible endoscopy curriculum using bench-top models and the FES online materials was feasible and effective for the majority of learners. Importantly, with a modest amount of additional training, 87% of our trainees were able to pass the FES examination, which represents a significant improvement for our program. We expect that additional refinements of this curriculum may yield even better results for preparing future residents for the FES examination.
Journal Article
Teacher-Student Dialogue During Classroom Teaching: Does It Really Impact on Student Outcomes?
It is now widely believed that classroom dialogue matters as regards student outcomes, with optimal patterns often regarded as requiring some or all of open questions, elaboration of previous contributions, reasoned discussion of competing viewpoints, linkage and coordination across contributions, metacognitive engagement with dialogue, and high student participation. To date, however, the relevance of such features has been most convincingly examined in relation to small-group interaction among students; little is known about their applicability to teacher-student dialogue. This article reports a large-scale study that permits some rebalancing. The study revolved around 2 lessons (covering 2 of mathematics, literacy, and science) that were video recorded in each of 72 demographically diverse classrooms (students' ages 10-11 years). Key measures of teacher-student dialogue were related to 6 indices of student outcome, which jointly covered curriculum mastery, reasoning, and educationally relevant attitudes. Prior attainment and attitudes were considered in analyses, as were other factors (e.g., student demographics and further aspects of classroom practice) that might confound interpretation of dialogue-outcome relations. So long as students participated extensively, elaboration and querying of previous contributions were found to be positively associated with curriculum mastery, and elaboration was also positively associated with attitudes.
Journal Article
When All Else Fails: A Rare Case of Postoperative Toxic Shock Syndrome Arising from Surgical Site Infection after Decompressive Neurectomy Successfully Treated with Angiotensin-2
Toxic shock syndrome is a serious complication of Streptococcus pyogenes or Staphylococcus aureus infections associated with very high morbidity and mortality. Postoperative toxic shock syndrome is an extremely rare phenomenon which manifests as fevers, diffuse rash, septic shock, and death. We present the first reported case of toxic shock syndrome associated with a surgical site infection from a decompressive neurectomy for refractory migraines in a 41-year-old female as well as the first use of angiotensin-2 vasopressor therapy to treat persistent septic shock from toxic shock syndrome refractory to conventional therapies.
Journal Article
CAN PEER FACILITATION PROMOTE CLASSROOM DIALOGUE AT SCALE?
Teacher professional development (TPD) programs are essential for fostering continuous teacher learning. Facilitators play a central role in these programs, mediating discussions and supporting learning. However, most research has focused on programs led by external professionals; such programs are resource-intensive and difficult to scale. This study reports on a peer-facilitated model designed to promote dialogic teaching in primary mathematics that was implemented in three primary schools in Chile. Peer facilitators implemented a program featuring content-focused sessions and reflective teaching cycles. Perceptions of the facilitator role were explored; the facilitators' actions in professional development meetings were documented and analyzed to characterize the role in detail and discuss its viability and potential. Data included interviews with teachers, facilitators, and school leaders, alongside video recordings of TPD sessions from two schools that completed the program. Findings suggest the peer-facilitator role is viable and has potential for promoting learning under certain conditions. Participants reported positive perceptions of peer facilitation; viability was related to role ownership and decision-making flexibility. Furthermore, facilitators demonstrated a repertoire of actions aimed at guiding the group, fostering a supportive learning environment, and contributing as equals. Facilitators engaged in a variety of practices, with adaptive variations depending on the type of activity at hand. Individual differences and some challenges were identified. This study highlights the potential of peer facilitation in TPD to offer scalable, cost-effective alternatives to traditional expert-led models, emphasizing the importance of context and support mechanisms and noting emerging challenges. The possibilities and limitations of a facilitator who has close ties with participants but is not an expert on the TPD program are discussed in relation to literature on facilitating educational dialogue and scalability. Findings can inform future efforts to design sustainable TPD programs that balance structure with adaptability while promoting local ownership.
Journal Article
Cardiothoracic surgery
Cardiothoracic surgeons provide care to neonates, children, adults, and the elderly with a range of disorders of the heart, lungs, esophagus, and major blood vessels of the chest. The field of cardiothoracic surgery continues to thrive among the transformations in thoracic and cardiovascular medicine. This article is intended to provide a guide to medical students and physicians on the training, certification, research, and funding opportunities as well as societies and journals specific to cardiothoracic surgery.
Journal Article