Impact of the 80-hour workweek on surgical case exposure within a general surgery residency program

Mentorship in surgical training: a systematic review

OBJECTIVE

This review systematically examines the literature regarding mentor-mentee relationships in surgery.

BACKGROUND

The usefulness of mentorship in surgical training has been expressed in many articles. However, to date, there has been no systematic review on mentoring surgical trainees. This surgical environment is different from other areas of medicine and requires young surgeons to learn skills not readily available from textbooks. Instead, mentors are a valuable mode of transferring this knowledge to the next generation of surgeons. Thus, mentorship is a worthy area of research and attention.

METHODS

We identified all articles discussing mentorship in surgery between January 1985 and August 2010 using PubMed and ISI Web of Knowledge. Predetermined exclusion and inclusion criteria were used to screen articles by title, abstract, and full text in sequence. We extracted the relevant data, and then analyzed the prevalence of major surgical mentoring themes in the literature.

RESULTS

Of the 1,091 unique articles found during our original literature search, 38 were selected for review. The majority (68%) were commentary/editorial articles. The most discussed themes include the desirable qualities of a surgical mentor, the structure of mentor-mentee relationships, and advice for overcoming barriers to mentoring. Much less discussed themes include the desirable traits in a mentee and the appreciation of generational and cultural differences in mentorship.

CONCLUSIONS

Several barriers to effective surgical mentoring were identified, such as time constraints and a lack of female mentors. By focusing on the positive traits found in this review, for example, developing formal programs to alleviate time constraints, these barriers can be overcome and effective mentor-mentee relationships can be built. Many articles draw attention to the dying art of mentorship in surgical training programs, and currently, the literature on mentorship in surgery is somewhat scarce. These concerns should serve as motivation to revive mentorship in surgery education and to expand the literature regarding underexplored themes and overcoming the current barriers. Although mentorship may not always take on a structured form, it should not be treated casually because proper mentorship is the foundation for training quality surgeons.

The Impact of American College of Surgeons Trauma Center Designation and Outcomes after Early Thoracotomy: A National Trauma Databank Analysis

Trauma centers are designated by the American College of Surgeons (ACS) into four different levels based on resources, volume, and scientific and educational commitment. The purpose of this study was to evaluate the relationship between ACS center designation and outcomes after early thoracotomy for trauma. The National Trauma Databank (v. 7.0) was used to identify all patients who required early thoracotomy. Demographics, clinical data, and outcomes were extracted. Patients were categorized according to ACS trauma center designation. Multivariate logistic regression was used to evaluate the impact of ACS trauma center designation on mortality. From 2002 to 2006, 1834 (77.4%) patients were admitted to a Level I ACS verified trauma center, 474 (20.0%) to a Level II, and 59 (3.6%) to a Level III/IV facility. After adjusting for differences between the groups, there were no significant differences in mortality (overall: 53.3% for Level I, 63.1% for Level II, and 52.5% for Level III/IV, adjusted P = 0.417; or for patients arriving in cardiac arrest: 74.9% vs 87.1% vs 85.0%, P = 0.261). Subgroup analysis did not show any significant difference in survival irrespective of mechanism of injury. Glasgow Coma Scale score # 8, Injury Severity Score >16, no admission systolic blood pressure, time from admission to thoracotomy, and nonteaching hospitals were found to be independent predictors of death. For trauma patients who have sustained injuries requiring early thoracotomy, ACS trauma center designation did not significantly impact mortality. Nonteaching institutions however, were independently associated with poorer outcomes after early thoracotomy. These findings may have important implications in educational commitment of institutions. Further prospective evaluation of these findings is warranted.