What are the primary concerns of recently graduated surgeons and how do they differ from those of the residency training years?

Study protocol of a systematic review and metaanalysis of stress and burnout among general surgery residents

Introduction

Chronic workplace stress and burnout are impediments to physicians' professional fulfillment, healthcare organizations' efficiency, and patient care quality/safety. General surgery residents are especially at risk due to the complexity of their training. We report the protocol of a metaanalysis of chronic stress and burnout among Accreditation Council for Graduate Medical Education (ACGME)-affiliated general surgery residents in the era after duty-hour reforms, plus downstream effects on their health and clinical performance.

Methods

The proposed systematic review and metaanalysis (PROSPERO registration CRD42021277626) will synthesize/pool data from studies of chronic stress and burnout among general surgery residents at ACGME-affiliated programs. The timeframe under review is subdivided into three intervals: (a) after the 2003 duty-hour restrictions but before 2011 reforms, (b) after the 2011 reforms but before the coronavirus pandemic, and (c) the first 3 years after the pandemic's outbreak. Only studies reporting outcomes based on validated instruments will be included. Qualitative studies, commentaries/editorials, narrative reviews, and studies not published in English will be excluded. Multivariable analyses will adjust for sample characteristics and the methodological quality of included studies.

Conclusions

The metaanalysis will yield evidence reflecting experiences of North American-based general surgery residents in the years after ACGME-mandated duty-hour restructuring.

National Institutes of Health Career Development (K) Awards to Young Surgeons: An Academic Milestone or One-hit Wonder?

OBJECTIVE

To assess contemporary trends in the National Institutes of Health (NIH) Career Development (K) Awards within the Departments of Surgery and its impact on the likelihood of achieving independent R01 grants.

BACKGROUND

The NIH provides K-type Career Development Awards to nurture young clinicians toward a productive academic career, thereby maintaining a pipeline of physician-scientists. However, the impact of K awards on career trajectory of surgeons remains unclear.

METHODS

The NIH grant data was queried for all new K08/K23 grants awarded to Departments of Surgery (1999-2019). Principal Investigators' data and grant-related information was obtained.

RESULTS

The NIH awarded 298 K08/23 surgical grants ($41,893,170) over the last 2 decades. Median budget increased from $116,370 to $167,508 (P<0.001). Of grantees, 83.2% were MDs, 15.1% MD/PhD, and 1.7% PhDs, with 25.2% being women. Principal Investigators' were mostly practicing surgeons (91.1%) with fellowship training (82.4%) and young in their careers {4 [interquartile ranges (IQR) 4] years of experience}. Vascular surgery (15.9%), Complex General Surgical Oncology (15.1%), and Trauma/Critical Care (14.6%) were the most frequent specialties. Awards were associated with 3,336 publications [median 8/project (IQR 13)]. The majority of K grantees (77.2%) currently hold an academic faculty position. Only 32.2% of awardees received independent R01 grant funding, at a median of 5.5 years (IQR 5) after their K awards. Sex (P = 0.71), previous fellowship training (P = 0.63), type of surgical specialty (P = 0.72), or MD/PhD degree (P = 0.75) were not associated with increased likelihood of achieving a subsequent R01 award.

CONCLUSION

Although the majority of K awardees maintain an academic career, only a limited number of grantees progress to obtain NIH R01 funding. Increased mentorship, financial support, and infrastructure are needed to facilitate career development awardees opportunities to enhance their ability to achieve independent funding.

Satisfaction From Plastic Surgery Residency: A National Survey

BACKGROUND

Plastic surgery residency programs in Israel have undergone several changes over the years, but the perspectives and satisfaction of the residents have not been investigated.

METHODS

An anonymous national survey of plastic surgery residents in Israel was performed. Demographic, professional, and education variables were summarized using descriptive statistics, and findings were related to self-reported satisfaction levels using univariate analysis.

RESULTS

The response rate was 75.9%. Response rates to surgery and education-related items were as follows: 60% performed 5 to 15 surgeries/month; 60.3% performed fewer than 5 surgeries/month as the primary surgeon; 57.3% and 77.8%, respectively, received surgical and academic instruction from fewer than half the attending physicians; 33.9% and 32.3%, respectively, had little or no in-hospital exposure to aesthetic surgeries. The average overall satisfaction rate was 3.33/5. Ten variables were significantly associated with increased satisfaction: total number of surgeries performed (P = 0.01); active participation in complex procedures (P = 0.0009); performing preoperative and postoperative management for one's patients (P = 0.016); marking one's patients preoperatively (P = 0.037); managing complications of one's patients (P = 0.0027); receipt of surgical instruction (P = 0.0035); receipt of academic medical instruction (P < 0.0001); sense that the training will provide the proper professional level (P < 0.0001) and independence (P = 0.0002); and subjective correspondence between demands and capabilities (P = 0.0004).

CONCLUSIONS

This study identifies several factors associated with plastic surgery resident satisfaction. It highlights factors that warrant changes by plastic surgery departments and faculty to improve resident training and increase their satisfaction. The questionnaire can also serve as a diagnostic and follow-up tool.

Identifying Sources of Stress Across Years of General Surgery Residency

Stressors during surgical residency training are common and can contribute to impaired technical performance, medical errors, health problems, physician burnout, and career turnover. This survey of general surgery recent graduates and chief residents examined threats to resident health and well-being. An electronic survey composed of multiple-choice, checkbox, dropdown, and open-ended questions was developed to determine the most stressful general surgery residency year, sources of the stress, and potential interventions to manage resident well-being. The survey was sent to five program directors across the United States to be forwarded to chief residents and recent graduates less than five years from graduation. Twenty-three residents and recent graduates responded to the survey. Seventy percent reported they "never" got enough sleep, and 39% reported they did not have a healthy lifestyle. Financial concerns were the most frequently cited source of stress. During post-graduate-years (PGY) 1 and 2, residents were most likely to fear hurting a patient or being "in over their head." In PGY-3, residents were most likely to consider leaving the residency program. The current findings suggest that each year of general surgery residency is linked with certain stressors, and no year is particularly stressful relative to the other years. There can be more research and efforts to focus on additional PGY-specific training and supervision, as well as added general measures to promote resident health and financial stability throughout all years. Regarding stress mitigation, residents may benefit from faculty, peer, and community interaction rather than from formal professional counseling.

Influence of Trainee Experience on Choice of Orthopaedic Subspecialty Fellowship

INTRODUCTION

Most orthopaedic surgery residents elect to pursue additional subspecialty training; however, factors influencing the choice of subspecialty and the ways that these factors change during training are not well understood. The aim of this investigation was to determine, on the basis of a trainee's postgraduate year (PGY), whether variability exists in factors valued when choosing a specific subspecialty.

METHODS

We emailed an online survey (intended for distribution to current trainees) to a list of orthopaedic surgery residency program coordinators in the United States. The survey queried demographic information, PGY level, and the importance of 14 discrete factors in the selection of fellowship specialty according to a Likert scale rating from 1 to 4.

RESULTS

There were 359 respondents representing an even distribution of PGY levels. Junior trainees assigned greater relative value to geographic location, on-call responsibilities, financial compensation, and the tradition of the residency program, whereas senior trainees assigned greater relative value to variety of cases and intellectual stimulation (all P < 0.05).

DISCUSSION

The differences seen in factors valued based on trainee experience may highlight the relative importance of greater exposure to the breadth of orthopaedic surgical practice during training and increasing awareness of clinical competencies and responsibilities.

CONCLUSIONS

When deciding on orthopaedic subspecialty choice, junior trainees value lifestyle factors relatively more than do senior trainees, whereas senior trainees value case variety and stimulation relatively more than junior trainees do.

Factors Influencing Orthopedic Surgery Residents' Choice of Subspecialty Fellowship

In the setting of increasing student debt, a rapidly changing health care system, and growing transparency in the age of outcome reporting, residents have many factors to consider when determining which fellowship to pursue. An institutional review board-approved link to an online survey was emailed to orthopedic surgery trainees across the United States. Demographics were collected, and 14 fellowship influences were assessed using a Likert scale. A total of 360 responses were received. Of the respondents, 85.5% (n=308) were male and 14.5% (n=52) were female. Responses were received from every region of the United States and from every postgraduate year. Respondents represented the gamut of relationship status and indebtedness. Respondents were interested in all of the current major subspecialties. Pursuit of an intellectually stimulating subspecialty had the highest average Likert score (3.38), followed by variety of cases (3.26). The lowest scores were for residency program with a strong tradition of placing into a particular subspecialty (2.08) and potential to conduct research in that subspecialty (2.09). Marital status, number of children, and level of debt did not significantly affect the importance of factors in selecting a fellowship. Choice of subspecialty did influence the level of importance of various factors. Intellectual stimulation and a strong mentor were the most influential factors in the decision to pursue a given fellowship. Because fellowship is now the norm, it is important to understand the motives behind young orthopedic surgeons' career aspirations. [Orthopedics. 2017; 40(5):e820-e824.].

A multi-institutional survey of newer surgery faculty on the impacts of education debt and debt repayment strategies

BACKGROUND

The cost associated with becoming a physician is significant, and studies have shown that surgeons, in particular, accrue higher debts than matched controls from other specialties, and the public. These findings, along with the current era of economic turmoil, prompted our investigation into the effects of educational debt on the career, family and lifestyle choices of recently graduated surgeons. Our goal was to query young surgical faculty about the education debt carried, the burden it presents as they embark on a career, and the financial management strategies employed to pay down their debt.

STUDY DESIGN

This study is a one-time, cross-sectional survey of regular and adjunct faculty from the University of Minnesota and the Mayo Clinic-Rochester. Participation was voluntary and responses were collected anonymously via SurveyMonkey. Respondents were sorted into two groups: those with and without education debt at the time of residency graduation. We compared these groups on a number of variables.

RESULTS

Of the 111 respondents (111/152, 73% response rate), 69 (62.2%) carried debt at the time of graduation from residency. The median educational debt at graduation was $100,000, and surgeons with educational debt carried a significantly higher burden of consumer and total debt than those without educational debt at graduation (p < 0.001). This continued after graduation with 74% (51/69) of residents with debt at graduation falling below the benchmark 36% debt-to-income ratio, and 45% (17/32) of those without debt at graduation in this same high risk financial situation.

CONCLUSIONS

Educational debt places a large financial responsibility on the shoulders of most newer faculty. The debt-to-income ratio demonstrated through our results was considerable for both study groups, and unwise according to financial literature. This is of utmost importance to leaders in academe, as salaries are generally lower than private practice colleagues. This can begin in residency with explicit and practical information on surgeon reimbursement, income ranges, and revenue sources (faculty, clinical), debt repayment strategies, and overall training on financial matters early in their residency.

What determines the selection of undergraduate medical students to the specialty of their future careers?

BACKGROUND

It is important to understand the factors that influence the undergraduate medical students' specialties choice for the post-graduation.

OBJECTIVES

To identify the number of undergraduate medical students who decided their post-graduate specialty career, factors that may influence their decision to select a particular specialty, and their career specialties preference.

METHODS

A self-administered questionnaire was used to achieve the objectives.

RESULTS

Less than half of the students (40.2%) showed a future specialty preference. Senior students and having background about specialties were the significant factors for career choices. General Surgery (27.4%), ENT-Ophthalmology (24.6%) and Internal Medicine (22%) were preferred specialties. Male students preferred General Surgery (15.7%), Internal Medicine (15%), ENT-Ophthalmology (12%) and Orthopedics (9.1%). Female students showed interest in ENT-Ophthalmology (12.1%), Surgery (11.7%), Pediatrics (10.8%) and Dermatology (8.2%). The least popular specialties were Community Medicine, (6.6%), Anesthesia, (6%) and Forensic Medicine (4.6%). Obstetrics and Gynecology (Ob/Gyne) was a less popular branch even in female students.

CONCLUSIONS

General Surgery, ENT-Ophthalmology and Internal Medicine were the most preferred specialties, while Community Medicine, Forensic and Ob/Gyne, even for female students were least selected specialties. Proper information and counseling should be offered to students about the challenges and opportunities to select their future careers.

Resident career planning needs in internal medicine: a qualitative assessment

BACKGROUND

Few residency programs have centralized resources for career planning. As a consequence, little is known about residents' informational needs regarding career planning.

OBJECTIVE

To examine career preparation stressors, practical needs, and information that residents wished they were privy to when applying.

METHODS

In 2007 and 2008, we surveyed 163 recent graduates or graduating residents from 10 Yale-based and Yale-affiliated hospitals' internal medicine programs regarding their experiences with applying for positions after residency. We included questions about demographics, mentorship, stress of finding a job or fellowship, and open-ended questions to assess barriers and frustrations. Qualitative data were coded independently and a classification scheme was negotiated by consensus.

RESULTS

A total of 89 residents or recent graduates responded, and 75% of them found career planning during residency training at least somewhat stressful. Themes regarding the application process included (1) knowledge about the process, (2) knowledge about career paths and opportunities, (3) time factors, (4) importance of adequate personal guidance and mentorship, and (5) self-knowledge regarding priorities and the desired outcome. Residents identified the following advice as most important: (1) start the process as early as possible and with a clear knowledge of the process timeline, (2) be clear about personal goals and priorities, and (3) be well-informed about a prospective employer and what that employer is looking for. Most residents felt career planning should be structured into the curriculum and should occur in the first year or throughout residency.

CONCLUSIONS

This study highlights residents' desire for structured dissemination of information and counseling with regard to career planning during residency. Our data suggest that exposure to such resources may be beneficial as early as the first year of training.

Will the clinicians support the researchers and teachers? Results of a salary satisfaction survey of 947 academic surgeons

OBJECTIVE

To determine whether academic surgeons are satisfied with their salaries, and if they are willing to forego some compensation to support departmental academic endeavors.

BACKGROUND

Increasing financial constraints have led many academic surgery departments to rely on increasingly on clinical revenue generation for the cross-subsidization of research and teach missions.

METHODS

Members of 3 academic surgical societies (n = 3059) were surveyed on practice characteristics and attitudes about financial compensation. Univariate and multivariate logistic regression analyses were performed to identify determinants of salary satisfaction and willingness to forego compensation to support academic missions.

RESULTS

One thousand thirty-eight (33.9%) surgeons responded to our survey, 947 of whom maintain an academic practice. Of these academic surgeons, 49.7% expressed satisfaction with their compensation. Length of career, administrative responsibility for compensation and membership in the American Surgical Association or the Society of University Surgeons were predictive of salary satisfaction on univariate analysis. Frequent emergency call duty, increased clinical activity, and greater perceived difference between academic and private practice compensation were predictive of salary dissatisfaction. On multivariate analysis, increased clinical activity was inversely associated with both salary satisfaction (adjusted odds ratio [AOR], 0.77; [95% CI: 0.64, 0.94]; P = 0.009) and amount of compensation willingly killed for an academic practice (AOR, 0.71; [0.61, 0.83]; P < 0.0005).

CONCLUSIONS

Increasing reliance on clinical revenue to subsidize nonclinical academic missions is disaffecting many academic surgeons. Redefined mission priorities, enhanced nonfinancial rewards, utilization of nonclinical revenue sources (eg, philanthropy, grants), increased efficiency of business practices and/or redesign of fund flows may be necessary to sustain recruitment and retention of young academic surgeons.

Instability of fellowship intentions during general surgery residencies

PURPOSE

To determine whether PGY-1 future fellowship preferences are stable during progression through residency.

METHODS

Residents who took the American Board of Surgery In-Training Examination (ABSITE) were surveyed about fellowships. Three data files were created: categorical and nondesignated preliminary trainees at all postgraduate years (PGY); categorical PGY-1 and chief residents; and individual categorical residents with paired PGY-1 and PGY-5 responses. Gender was self-reported; residency characteristics were retrieved via program identifier codes. Annual frequency distributions were generated by specialty and for other, any fellowship (AF), and no fellowship (NF).

RESULTS

Categorical plus contains more than 80,000 responses. Undecided leads PGY-1 intentions at all times, which reached 55% by 2007 and decreased near linearly as PGY level advances. The AF rates increase by PGY level in a decelerating curve. The other rates accelerate at PGY-3 and beyond. The NF rates are low for PGY-1 and 2, nearly double from PGY-3 to 4, and double again from PGY-4 to 5. The categorical group contains more than 20,000 residents with their demographics. The undecided group predominates for both genders, but more women were undecided by 2003. Specialty distribution varies with gender; women were overrepresented in oncology, pediatric, plastic, and other. The undecided group leads choices of university and independent PGY-1 residents, with university overrepresentation in all areas except colorectal, plastic, and no fellowship. Small, medium, and large program PGY-1 residents all choose undecided first but diverge thereafter. Over 12,000 paired categorical PGY-1 and PGY-5 responses reveal that most PGY-1 residents (78%) change future specialties by PGY-5. Undecided residents most often choose no fellowship (25%), vascular (12%), or other (12%).

CONCLUSION

PGY-1 residents are increasingly unsure about future fellowships. PGY-1 preferences are unstable whether examined in groups or as individuals. Gender and residency characteristics are linked to differing selection patterns. PGY-1 residents rarely predict accurately their PGY-5 fellowship choices. Early specialization paradigms may disadvantage some residents and residency groups and risk greater attrition rates.

Factors in fellowship selection: effect of services and fellows

PURPOSE

General Surgery residents are increasingly pursuing fellowships. We examine whether perceived subspecialty content, dedicated services, and fellows impact fellowship choices.

METHODS

Specialty content was assessed through a survey linking 228 operations to 9 content areas. The presence of dedicated services and fellows and the post-residency activities of graduates 1997-2006 were collected from 2 program directors.

RESULTS

A total of 75% of residents (26 University of Mississippi, UM; 22 Vanderbilt University, VU) completed surveys. Five dedicated services and 2 fellowships at UM and VU were identical; VU had an additional 4 services and 3 fellowships. UM and VU residents similarly associated 184 operations (81%) with General Surgery. Agreement was not linked to services or fellows. A total of 44% of UM graduates and 68% of VU graduates pursued fellowships. The top choice at UM was Plastic/Hand (14%, versus 6% VU) and Oncology/Endocrine at VU (19%, versus 2% UM). Differences in specialties selected could not be linked consistently to dedicated services or fellows.

CONCLUSION

Dedicated services and fellows appear to have little impact on fellowship specialty selection by chief residents. There may be a generic effect of dedicated services favoring fellowship versus no fellowship. Differential faculty mentoring skills may influence specific fellowship choices.

Employment and satisfaction trends among general surgery residents from a community hospital

BACKGROUND

Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons.

PURPOSE

To review employment patterns and job satisfaction among general surgery residents from a single university-affiliated institution.

METHODS

All general surgery residents graduating from 1986 to 2006, inclusive, were mailed an Institutional Review Board-approved survey, which was then returned anonymously. Information on demographics, fellowship training, practice characteristics, job satisfaction and change, and perceived shortcomings in residency training was collected.

RESULTS

A total of 31 of 34 surveys were returned (91%). Most of those surveyed were male (94%) and Caucasian (87%). Sixty-one percent of residents applied for a fellowship, and all but 1 were successful in obtaining their chosen fellowship. The most frequent fellowship chosen was plastic surgery, followed by minimally invasive surgery. Seventy-one percent of residents who applied for fellowship felt that the program improved their competitiveness for a fellowship. Most of the sample is in private practice, and of those, 44% are in groups with more than 4 partners. Ninety percent work less than 80 hours per week. Only 27% practice in small towns (population <50,000). Of the 18 graduates who practice general surgery, 94% perform advanced laparoscopy. Sixty-seven percent of our total sample cover trauma, and 55% of the general surgeons perform endoscopy. These graduates wish they had more training in pancreatic, hepatobiliary, and thoracic surgery. Eighty-three percent agreed that they would again choose a general surgery residency, 94% of those who completed a fellowship would again choose that fellowship, and 90% would again choose their current job. Twenty-three percent agreed that they had difficulty finding their first job, and 30% had fewer job offers than expected. Thirty-five percent of the graduates have changed jobs: 29% of the residents have changed jobs once, and 6% have changed jobs at least twice since completing training. Reasons for leaving a job included colleague issues (82%), financial issues (82%), inadequate referrals (64%), excessive trauma (64%), and marriage or family reasons (55% and 55%, respectively). One half to three fourths of the graduates wished they had more teaching on postresidency business and financial issues, review of contracts, and suggestions for a timeline for finding a job.

CONCLUSIONS

Although general surgical residencies prepare residents well technically, they do not seem to be training residents adequately in the business of medicine. This training can be conducted by attendings, local attorneys, office managers, and past residents with the expectation that job relocations can decrease and surgeon career satisfaction can increase.

Financial impact of emergency hand trauma on the health care system

BACKGROUND

The US has a crisis of insufficient emergency coverage for hand trauma. One of the problems is the perceived financial loss associated with caring for this population. We evaluated the financial impact of treating emergency hand trauma patients on an academic medical practice and health care system.

STUDY DESIGN

We examined billing records for 2,632 hand patients seen in the emergency department in 2005 at the University of Michigan. Financial data were separated into inpatient professional and facility revenues and costs. Professional net revenue was calculated by applying actual collection rates to procedural charges. Facility revenue was calculated by applying actual collection rates to the following downstream charge categories: inpatient/operating room (including nursing, anesthesia, and pharmacy), clinic facility, radiology, and occupational therapy.

RESULTS

The payer mix for this analysis was 60.7% private insurance, 15.3% Medicare, 4.2% uninsured, 8.3% Medicaid, and 11.5% other. The net professional revenue and total costs for physician salary, malpractice, and benefits allocated to hand patients were $698,578 and $574,880, respectively, for a net profit margin of $123,698 (18%). Net health system facility revenue and total costs were $2,420,899 and $2,389,901, respectively, for a net profit margin of $30,998 (1%).

CONCLUSIONS

Hand trauma at this academic medical center is fiscally advantageous for the surgical department and marginally advantageous for the health care system. Providing access to hand trauma patients may be fiscally advantageous in certain settings when the proportion of nonreimbursed care can be controlled.

The new training paradigms and the unfilled match positions of 2004: Will history repeat itself?

OBJECTIVE

The new millennium has seen an increase in vascular residency vacancies. The American Board of Vascular Surgery recently proposed new training paradigms, but their impact on recruitment remains unknown. We surveyed vascular fellows regarding factors and timing of career decisions to determine an optimal strategy for recruitment.

METHODS

Surveys were sent electronically to vascular residents for completion. Data were analyzed using SPSS software. Additional data were obtained from the National Resident Matching Program.

RESULTS

Of the 90 fellows that responded, 84% committed to vascular surgery during residency. Of these, 18% decided during postgraduate year 1, 54% by year 2, 84% by year three, and 95% by year 4. Sixteen percent of all trainees decided in medical school. Seventy-three percent of residents performed a minimum of 20 to 50 cases before reaching a decision. Among the group deciding between years 2 to 4 of residency, there was a significant difference in the number of vascular rotations before career commitment (P = .0001). In the 2004 Match, 21% of vascular residency positions were unfilled, up from 12% in 2003, 9% in 2002, and 4% in 2001.

CONCLUSIONS

Leaders in the field of vascular surgery have proposed focused training through the new paradigms. The incline in unmatched vascular residency positions over the past 4 years highlights the importance of a strategic plan to optimize recruitment. Few current trainees decided early in training about career choice, and volume appears critical to the decision process. Utilizing the current matching system (an 18-month process) and without any proactive change in recruitment, an integrated program after medical school would be reasonable for only 16% of applicants, or the 3+3 option for 54% of residents. For the new paradigms to be successful and to prevent more unfilled positions, increased medical student integration into vascular rotations and early active exposure to endovascular and open procedures during general surgical training will be necessary across the country.

Gender differences in general surgical careers: results of a post-residency survey

BACKGROUND

This study's purpose was to gain perspective regarding general surgery career choices while examining gender differences.

METHODS

Graduates of a general surgery residency (n = 189) received surveys addressing fellowship training, practice type, case composition, work hours, academic involvement, income, residency, and career satisfaction.

RESULTS

Several gender differences were identified. Most men (64%) listed general surgery as their primary work type, whereas women most commonly reported breast surgery (38%, P < .001). More women worked <40 hours per week (25% versus 9%, P = .049). There was no gender difference in income for fellowship-trained surgeons, but a disparity in income >200,000 dollars favored non-fellowship-trained men (74% versus 36%, P = .0031). Both genders reduced work hours. Women reduced them exclusively for personal/family demands. Both genders reported satisfaction with their surgical careers (93%).

CONCLUSIONS

Some gender differences in surgery were identified. However, both genders maintain a high level of satisfaction with their career choice.

Predictors of surgery resident satisfaction with teaching by attendings: a national survey

OBJECTIVE

To identify factors that predict fourth- and fifth-year surgical resident satisfaction of attending teaching quality.

SUMMARY BACKGROUND DATA

With the training of surgical residents undergoing major changes, a key issue facing surgical educators is whether high-quality surgeons can still be produced. Innovative techniques (eg, computer simulation surgery) are being developed to substitute partially for conventional teaching methods. However, an aspect of training that cannot be so easily replaced is the faculty-resident interaction. This study investigates resident perceptions of attending teaching quality and the factors associated with this faculty-resident interaction to identify predictors of resident educational satisfaction.

METHODS

A national survey of clinical fourth- and fifth-year surgery residents in 125 academically affiliated general surgery training programs was performed. The survey contained 67 questions and addressed demographics, hospital, and service characteristics, as well as surgery, education, and clinical care-related factors. Univariate analyses were performed to describe the characteristics of the sample; multivariate analyses were performed to evaluate the factors associated with resident educational satisfaction.

RESULTS

The response rate was 61.5% (n = 756). Average age was 32 years; most were male (79%), white (72%), and married (69%); 42% had children. Ninety-five percent of respondents graduated from U.S. medical schools, and the average debt was $80,307. Of 20 potentially mutable factors, 6 variables had positive associations with resident education satisfaction and 7 had negative associations. Positive factors included the resident being the operating surgeon in major surgeries, substantial citing of evidence-based literature by the attending, attending physicians giving spontaneous or unplanned presentations, increasing the continuity of care, clinical teaching aimed at the chief resident level, and having clinical decisions made together by both the attending and resident. There were 7 negative factors such as overly supervising in surgery, being interrupted so much that teaching was ineffective, and attending physicians being rushed and/or eager to finish rounds.

CONCLUSION

This study identifies several factors that were associated with resident educational satisfaction. It offers the perspective of the learners (ie, residents) and, importantly, highlights mutable factors that surgery faculty (and departments) may consider changing to improve surgery resident education and satisfaction. Improving such satisfaction may help to produce a better product.

Recent trends in the funding and utilization of NIH career development awards by surgical faculty

INTRODUCTION

Career development awards (K-awards) from the National Institutes of Health comprise the most significant mechanism of research funding for junior faculty. This study compared the funding success rates and utilization of these awards between faculty from surgical departments and those from nonsurgical departments.

METHODS

Success rates for major career development awards were obtained from the National Institutes of Health and compared between departments of surgery and four other clinical departments during 1992 to 2002. The number of faculty associated with these departments was obtained from the American Association of Medical Colleges and used to compare K-award utilization between groups during 1998 to 2002.

RESULTS

Success rates for award proposals designed for clinical scientists were consistently lower when originating from departments of surgery compared with other clinical departments (combined K08, K23, and K24 pool: Surgery 41.3%; range of nonsurgery 46.7-57.5%, P = .009 vs nonsurgical group). Nonsurgeons were 2.5 times (range 2.0-7.8) more likely to apply for any type of career development award compared with surgeons (P < .01 for all awards).

CONCLUSIONS

Surgeons are less likely to apply for career development awards, and those who do are less likely to be successful compared with their nonsurgical peers. Innovative strategies are needed to increase the number and success of career development proposals submitted by surgical faculty.

Factors influencing residents' decisions to pursue a career in hand surgery: a national survey

PURPOSE

The number of programs offering hand surgery fellowships has remained approximately the same over a 6-year period while the number of fellows within these programs has decreased by 46%. This study aimed to identify factors that persuaded or dissuaded orthopedic and plastic surgery residents in choosing hand surgery as a career.

METHODS

We conducted a national survey of final-year orthopedic (n = 600) and plastic surgery (n = 177) residents. We developed an internet questionnaire based on literature review and focus group discussions. A Web site link was sent via e-mail to program directors of accredited orthopedic and plastic surgery programs for distribution of this anonymous survey to the residents. Factor analysis combined items into an "intellectual issues" category and a "lifestyle issues" category. Logistic regression was used to evaluate factors that predict an outcome of entering a hand surgery fellowship.

RESULTS

We achieved a 30% response rate. Respondents and nonrespondents were not significantly different in terms of gender and race. After controlling for age, gender, marital status, and specialty, residents who enjoyed the intellectual issues of the hand surgery field were more likely to pursue a hand surgery fellowship (odds ratio = 10.1; 95% confidence interval = 3.3-30.8). Although a positive attitude toward lifestyle issues of the hand surgery field tended to be associated with pursuit of a hand surgery fellowship, the relationship was much weaker (odds ratio = 2.5; 95% confidence interval = 0.8-7.3).

CONCLUSIONS

Lifestyle issues associated with a career in hand surgery such as low reimbursement and long hours were not the most important factors to residents when considering a career in the field. Residents pursued hand surgery primarily because of factors such as interest in and exposure to this field. To prevent a potential shortfall of hand surgeons, both orthopedic and plastic surgery programs must strengthen residents' exposure to hand surgery education in their training.

Operative Surgical Education: Results of a Society of Surgical Oncology Fellowship Survey and Proposal for an Operative Database

BACKGROUND

Preparation of surgical trainees for oncological operative procedures is challenging. The purpose of this survey was to focus on identifying methods and resources used by trainees to prepare for procedures and to ascess the need for additional educational tools.

METHODS

A 34-item survey was mailed electronically to 97 surgical oncology fellows at 14 Society of Surgical Oncology-approved training programs. General surgery residents at an affiliate training program (n = 65) and residents attending an American Board of Surgery In-Training Examination review course (n = 129) were polled via hard-copy mailings. The survey was distributed with the Dillman method. Self-education practices, factors influencing operative education, and strengths/weaknesses of available resources were identified.

RESULTS

Response rates were 56% and 78% for fellows and residents, respectively. Trainees prepare for more than 50% of cases they perform (82%; 169 of 205), devoting up to 1 hour (87%; 178 of 205) in review the evening before a procedure (64%; 131 of 205). Time availability and attending of record were dominant factors influencing resident preparation, whereas case complexity was the most important variable motivating fellows. Surgical atlases, texts, anatomical references, and case discussion with attending staff were the most useful and available resources rated by trainees. Skills stations were recognized as the least valuable. Critical assessment of six educational resources identified no one particular area for improvement.

CONCLUSIONS

There is a need for contemporary operative educational tools, incorporating time-sensitive and procedure-specific needs of surgical trainees preparing for oncological operative procedures.

A Study of Prospective Ophthalmology Residents' Career Perceptions

OBJECTIVES

The purpose of this study was to identify differences in ophthalmology resident candidates and practicing ophthalmologists' career perceptions. A secondary aim was to evaluate specific demographic factors (e.g., gender, ethnicity, career interests, etc.) among residency candidates regarding their career perceptions.

METHODS

A survey instrument (Critical factors in Career Perceptions) was sent by e-mail to prospective residents (n= 122). Group differences were calculated using a one sample t-test analysis.

RESULTS

Compared to practicing ophthalmologists (n = 56), residency candidates were more likely (p < 0.05) to expect greater professional job satisfaction from a number of career factors (e.g., time with patients, physician teamwork, etc.); family-personal factors (e.g., diversity of job skills, sole professional responsibility, etc.); and financial factors (i.e., income and security) than those in practice. Gender differences between candidates revealed that women were more interested in spending time with patients and in computer technology applications.

CONCLUSIONS

These results suggest that medical school and residency program leaders to consider specific factors ophthalmologists encounter in their profession so that residency candidates have a more realistic view of their chosen profession. Several recommendations for resident recruitment and curriculum development are provided.

Factors influencing career choice among medical students interested in surgery

PURPOSE

The number of applicants to general surgery programs has recently declined. We set out to determine factors that influence career choice among medical students.

METHODS

DESIGN

survey;

SETTING

university medical center;

PARTICIPANTS

fourth-year medical students;

INTERVENTION

distribution and completion of the survey. PARTICIPANTS ranked 18 items coded on a Likert scale from 1 (not important) to 8 (very important). These factors were career opportunities, academic opportunities, experience on core rotation/subinternship, role model(s) in that specialty (mentors), length of training required, lifestyle during residency, work hours during residency, ability to obtain residency position, concern about loans/debt, call schedule, lifestyle after training, work hours after training, financial rewards after training, intellectual challenge, patient relationships/interaction, prestige, future patient demographics, and gender distribution in the specialty. Students were asked to provide gender, career choice, number of programs they applied to, and the number of programs at which they were interviewed.

RESULTS

A total of 111 of the 160 surveys distributed were returned (69%). A total of 48 of the students were men, 31 were women, and 32 did not identify their gender. Nineteen students were interested in pursuing a career in surgery or a surgical subspecialty. Factors predicting surgery as a career choice were career opportunities (p < 0.04) and prestige (p < 0.003). Lifestyle during residency (p < 0.0007), work hours during residency (p < 0.008), and quality of patient/physician relationships (p < 0.05) were all significantly negatively correlated with the choice of a surgical career. Students pursuing a surgical career applied to greater than 31 programs compared with 11 to 15 for the nonsurgical students (p < 0.0001).

CONCLUSIONS

Prestige and career opportunities are more important to students seeking surgical residencies. Concerns about lifestyle and work hours during residency and perceived quality of patient/physician relationships were deterrents to surgery as a career choice. These issues may need to be addressed to increase the number of applicants to surgical programs.