***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objectives : The purpose of this study was to quantify the effect of training on outcomes following colorectal cancer resections in a District General Hospital . Patients and methods : Data on 102 consecutive elective colorectal cancer resections performed at a District General Hospital over a three-year period were prospect ively collated . The proportion of cases performed by trainees was recorded and the seniority of the operating surgeon was related to pre-operative morbidity , operative time and postoperative outcome . Results : Consultants , staff grade s and registrars performed 46 , 35 and 21 procedures respectively . Of the cases performed by registrars , consultant supervision was provided in seven cases , with staff grade s providing supervision in 14 cases . As compared with consultants , registrars were less likely to undertake anterior resection ( p = 0.001 ) . However , the mean operating times of trainees ( 145 ± 8 mins ) and consultants ( 135 ± 6 mins ) were similar . There were no significant differences between the groups with respect to postoperative mortality or morbidity . There was a trend towards more advanced disease in consultant cases , and consultants had a significantly poorer freedom from death or recurrence at two years as compared with trainees ( p = 0.03 ) . Conclusions : In our unit , trainees performed 21 % of all elective colorectal resections with no detrimental effect on length of hospital stay , overall hospital costs and early and late patient outcomes . Major colorectal procedures can be successfully accomplished in a District General setting by trainees , with the training burden shared between consultants and staff grade surgeons OBJECTIVES The purpose of this study was to investigate the operative time , surgical complications and patient outcomes of the TOT surgery performed by an experienced surgeon compared to those performed by a senior resident under proper supervision by a senior surgeon . PATIENTS AND METHODS A prospect i ve , open label , r and omized study was conducted at the department of urogynecology of the Ministry of Health Ankara Etlik Maternity and Women 's Health Teaching Research Hospital between June 2003-June 2004 . The study included 60 women who had stress urinary incontinence . Patients were r and omly allocated to either the TOT surgery performed by an experienced surgeon group ( Group 1 , n=30 ) or the TOT surgery performed by a senior resident under proper supervision by a senior surgeon group ( Group 2 , n=30 ) . The operative time , intraoperative and postoperative complications , intraoperative blood loss and the effectivity of the TOT procedure were recorded by a senior surgeon who did not participate to the operation . RESULTS The study was completed by 55 women . Baseline characteristics were comparable between the two groups . The mean operative time was significantly long in Group 2 compared with Group 1 ( 27 min [ 15 - 48 ] ; 13 min [ 7 - 22 ] , respectively ) . There was no difference between the Groups 1 and 2 in terms of the intraoperative and postoperative complications . No bladder injury was noted in Group 1 . One bladder injury was observed in Group 2 and the bladder was repaired in the usual form by the assisting senior surgeon . Urinary retention was observed in two patients in Group 2 and the tapes were cut 7 days after the operation . Both of the patients have been dry since the intervention . The mean follow up period was 30 months . After the follow up period , there were no statistically significant differences in terms of cure , partial recovery and failure between two groups . CONCLUSION There is no difference in the outcome when TOT is performed by residents under proper supervision Background — We investigated the association between  trainees performing supervised operations  and late outcomes of patients undergoing cardiac surgery .  Methods and Results — Data were prospect ively collected on patients who underwent coronary artery bypass graft surgery , aortic valve replacement , or a combination of these between 1998 and 2005 at the Maritime Heart Center , Halifax , Canada .  In-hospital mortality and a composite outcome of in-hospital mortality , stroke , bleeding , intra-aortic balloon pump insertion , renal failure , and sternal infection was compared between teaching ( n=1054 ) and nonteaching cases ( n=5877 ) .  Late survival and cardiovascular hospital readmissions were also examined . To adjust for baseline risk disparities , we used logistic regression for dichotomous in-hospital outcomes and Cox proportional hazards regression for survival data . Resident cases were significantly more likely to have high-risk features such as depressed ventricular function , redo operation , and urgent or emergent procedure . Resident as primary operator was not independently associated with in-hospital mortality ( OR , 1.09 ; 95 % CI , 0.75 to 1.58 ; P=0.66 ) or with the composite outcome ( OR , 1.01 ; 95 % , CI 0.82 to 1.26 ; P=0.90 ) . The Kaplan-Meier event-free survival of the 2 groups was equivalent at 1 , 3 , and 5 years ( log-rank P=0.06 ) . By Cox regression , resident cases were not associated with late death or cardiovascular rehospitalization ( hazard ratio , 1.05 ; 95 % CI , 0.94 to 1.17 ; P=0.42 ) . Conclusions — Cases performed by senior-level cardiac surgery residents were more likely to have greater acuity and complexity than staff surgeon-performed cases . However , clinical outcomes were similar in the short- and long-term . Allowing residents to perform cardiac surgery is not associated with adverse patient outcomes OBJECTIVE To study whether surgical trainees can perform  arteriovenous fistula ( AVF ) surgery  to a st and ard comparable to consultants . PATIENTS AND METHODS Retrospective study of all vascular access surgery over a three year period at a single centre . The operating surgeon was identified from theatre log books and categorised by grade . Fistula patency was used as the primary outcome measure and was determined from patients ' case-notes and from a prospect ively collected electronic record of dialysis sessions . Patency was defined as " used for dialysis " if the AVF was used for dialysis for at least 6 consecutive sessions . RESULTS One hundred and eighty six cases were used for analysis . In 60 cases ( 32 % ) the operating surgeon was the consultant , in 53 cases ( 29 % ) a trainee was supervised by a consultant , in 56 cases ( 30 % ) a trainee performed the operation independently and in 17 cases ( 9 % ) the grade of the operating surgeon could not be established . Primary and primary assisted patency rates by operating surgeon did not differ significantly ( P-values 0.25 and 0.16 respectively ) . Age of the patient was the only predictor of patency failure in a multivariate model . Grade of operating surgeon ( logrank test chi(2)=3.1 , p=0.38 ) and type of fistula ( logrank test chi(2)=2.3 , p=0.52 ) were not significantly related to the primary survival of the fistula . CONCLUSIONS This study showed no significant differences in AVF patency rates between trainee and consultant surgeons . Allocation of appropriate cases can result in trainees obtaining similar outcomes as consultants , demonstrating that dialysis access surgery can provide good training opportunities for junior doctors without detriment to patient care Background : Little is known about the effect of surgical training on outcomes in thoracic surgery . The impact of surgeon training on outcomes following lung resection was examined , focusing on lobectomy as a marker operation . Methods : 328 consecutive patients who underwent lobectomy at our institution between 1 October 2001 and 30 June 2003 were studied . Data were collected prospect ively during the patient ’s admission as part of routine clinical practice and vali date d by a design ated audit officer . Patient characteristics and postoperative outcomes were compared between trainee led and consultant led operations . Results : In 115 cases ( 35.1 % ) the operation was performed by a trainee thoracic surgeon as the first operator . There were no significant differences in patient characteristics between the two groups . In-hospital mortality was similar for operations led by trainees and consultants ( 3.5 % and 2.8 % , respectively ; p>0.99 ) . Outcomes in the two groups did not differ significantly with respect to respiratory , cardiovascular , renal , neurological , chest infection , bleeding , and gastrointestinal complications . Survival rates at 1 year were 82.6 % for procedures led by trainees compared with 81.7 % for procedures led by consultants ( p = 0.83 ) . Conclusions : With appropriate supervision , trainee thoracic surgeons can perform lobectomies safely without compromising short or intermediate term patient outcome BACKGROUND Because surgical residents ' level of experience may be at its nadir early in the academic year , academic seasonality-or the " July effect"-could affect cardiac surgical outcomes . METHODS Prospect ively collected data from the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program were used to identify 70,616 consecutive cardiac surgical procedures performed between October 1997 and October 2007 .  Morbidity and mortality rates were compared between early ( July 1 to August 31 , n = 11,975 ) and late ( September 1 to June 30 , n = 58,641 ) periods in the academic year . A prediction model was constructed by using stepwise logistic regression modeling . RESULTS The two patient groups had similar demographic and risk variables . Isolated coronary artery bypass grafting accounted for 76.7 % of early-period procedures and 75.8 % of later-period procedures ( p = 0.03 ) . Morbidity rates did not differ significantly between the early ( 14.0 % ) and later periods ( 14.2 % ; odds ratio [ OR ] , 1.01 ; 95 % confidence interval [ CI ] , 0.96 to 1.07 ; p = 0.67 ) and operative mortality was similar , 3.7 % vs 3.9 % ( OR , 0.99 ; 95 % CI , 0.89 to 1.11 ; p = 0.90 ) . The early portion of the year was associated with longer cardiac ischemia times ( 84 + /- 40 vs 83 + /- 42 minutes ) , cardiopulmonary bypass times ( 126 + /-52 vs 124 + /-56 minutes ) , and total surgical times ( 295 + /- 90 vs 288 + /- 90 minutes ; p < 0.05 for all ) . CONCLUSIONS The early part of the academic year was associated with slightly longer operative times ; however , risk-adjusted outcomes were similar in both periods . This finding should lessen concerns about the quality of cardiac surgical care at the beginning of the academic year Background and Purpose Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training . Meanwhile , the importance of transfer of communication skills to the workplace has not been sufficiently studied . This study aims to assess the efficacy of a 40-hour training program design ed to improve patients ' satisfaction and residents ' communication skills during their daily clinical rounds . Methods Residents were r and omly assigned to the training program or to a waiting list .  Patients ' satisfaction was assessed with a visual analog scale after each visit . Transfer of residents ' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round . Transcripted audiotapes were analyzed using content analysis software ( LaComm ) . Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models . Results Eighty-eight residents were included . First , patients interacting with trained residents reported a higher satisfaction with residents ' communication ( Median = 92 ) compared to patients interacting with untrained residents ( Median = 88 ) ( p = .046 ) . Second , trained residents used more assessment utterances ( Relative Risk ( RR ) = 1.17 ; 95 % Confidence intervals ( 95%CI ) = 1.02–1.34 ; p = .023 ) . Third , transfer was also observed when residents ' training attendance was considered : residents ' use of assessment utterances ( RR = 1.01 ; 95%CI = 1.01–1.02 ; p = .018 ) and supportive utterances ( RR = 0.99 ; 95%CI = 0.98–1.00 ; p = .042 ) ( respectively 1.15 ( RR ) , 1.08–1.23 ( 95%CI ) , p<.001 for empathy and 0.95 ( RR ) , 0.92–0.99 ( 95%CI ) , p = .012 for reassurance ) was proportional to the number of hours of training attendance . Conclusion The training program improved patients ' satisfaction and allowed the transfer of residents ' communication skills learning to the workplace . Transfer was directly related to training attendance but remained limited . Future studies should therefore focus on the improvement of the efficacy of communication skills training in order to ensure a more important training effect size on transfer BACKGROUND The effect of the time of the academic year on cardiac surgical outcomes is unknown . METHODS Using prospect ively collected data , we identified all ( n = 1,673 ) cardiac surgical procedures performed at our institution between October 1997 and April 2007 .  Morbidity and mortality rates were compared between 2 periods of the academic year , one early ( July 1-August 31 , n = 242 ) and one later in the year ( September 1-June 30 , n = 1,431 ) . A prediction model was constructed by using stepwise logistic regression modeling . RESULTS Morbidity rates did 
    Output:
    
In this study , training programs were ranked by complication rates of their graduates , thus linking patient outcomes back to where physicians were trained .
Conclusions The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents .
A minority of results pointed to some negative patient outcomes from the involvement of residents .
Adequate supervision , room for extra operation time , and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes .