Human Capital and Productivity in Plastic Surgery Research Across Nations

Evaluating the Internet as a Source of Information for Patients With Hidradenitis Suppurativa: A Review of Websites' Content, Insights Into Engagement, and Access

BACKGROUND

The Internet has become the primary information source for patients, with most turning to online resources before seeking medical advice.

OBJECTIVE

The aim of this study is to evaluate the quality of online information on hidradenitis suppurativa available to patients.

METHODS

The authors performed an Internet search using the search terms "hidradenitis suppurativa," "hidradenitis suppurativa treatment," "hidradenitis suppurativa surgery," and "acne inversa." They identified the initial 100 websites from Google, Yahoo, and Bing. Websites were evaluated based on the modified Ensuring Quality Information for Patients instrument.

RESULTS

Of the 300 websites, 95 (31.7%) were incorporated after accounting for the exclusion criteria: duplicate entries, websites not pertinent to the subject matter, websites inaccessible due to location restrictions or necessitating user accounts for access, websites in languages other than English, and websites originating from scientific publications directed at a scientific audience rather than the general population. Ensuring Quality Information for Patients scores ranged from 5 to 30/36, with a median of 17.

CONCLUSION

This analysis unveils a diverse array of websites that could confound patients navigating toward high-caliber resources. These barriers may hinder the access to top-tier online patient information and magnify disparities in referral rates, patient engagement, treatment satisfaction, and quality of life.

Evaluating the web as a source of information for patients with chest wall deformities: insights into engagement and disparities

BACKGROUND

Recent data highlight the internet's pivotal role as the primary information source for patients. In this study, we emulate a patient's/caregiver's quest for online information concerning chest deformities and assess the quality of available information.

METHODS

We conducted an internet search using combination of the terms "pectus excavatum," "pectus excavatum surgery," "funnel chest," "pectus excavatum repair" and identified the first 100 relevant websites from the three most popular search engines: Google, Yahoo, and Bing. These websites were evaluated using the modified Ensuring Quality Information for Patients (EQIP) instrument.

RESULTS

Of the 300 websites generated, 140 (46.7%) were included in our evaluation after elimination of duplicates, non-English websites, and those targeting medical professionals. The EQIP scores in the final sample ranged from 8 to 32/36, with a median score of 22. Most of the evaluated websites (32.8%) originated from hospitals, yet none met all 36 EQIP criteria.

DISCUSSION

None of the evaluated websites pertaining to pectus excavatum achieved a flawless "content quality" score. The diverse array of websites potentially complicates patients' efforts to navigate toward high-quality resources. Barriers in accessing high-quality online patient information may contribute to disparities in referral, patient engagement, treatment satisfaction, and overall quality of life.

LEVEL OF EVIDENCE

IV.

The State of Surgical Research in Sub-Saharan Africa: An Urgent Call for Surgical Research Trainers

Background

Surgery in low- and middle-income countries (LMICs) is poorly developed because of years of neglect. Sustained research on global surgery led to its recognition as an indivisible and indispensable part of primary healthcare in 2015. However, this has had little visible effect on surgical ecosystems within LMICs, especially in sub-Saharan Africa (SSA). SSA surgical research systems strengthening, which includes skills transfer, with local priority setting driving the research agenda, is needed to propel global surgery into the future.

Methods

The authors performed a literature review of the state of surgical research within SSA and also report the initial efforts of two research training nonprofits to empower young African surgeons with research skills.

Results

Surgical research in SSA is disadvantaged even before it is birthed, facing monumental challenges at every stage of development, from research agenda determination to funding, study execution, and publication. Compared with a global output of 17.49 publications per 100,000 population, SSA produces 0.9 (P < 0.0001). The Surgeons in Humanitarian Alliance for Reconstructive, Research, and Education and Enabling Africa Clinical Health Research programs are involved in the longitudinal research mentorship of surgical residents within SSA; the improved quality of research and successful publications by participants suggest nascent steps in growing young surgical scientists.

Conclusions

In the absence of an existing surgical research infrastructure within LMICs, global surgery research trainers should link up and collaborate to help develop a surgical research community that will provide the local data required to help transform the SSA surgical ecosystem.

Independent Plastic Surgery Match Regional Trends Comparing In-person and Virtual Interview Cycles

Background

There is a trend toward matching in a different region than previous training for the independent plastic surgery match cycles from 2019 to 2021, which differs from the trend to match within the same region for integrated plastic surgery programs. Notably, residency interviews transitioned from in-person to virtual in 2020 due to the coronavirus pandemic. Therefore, we compared in-person versus virtual interview match trends from 2019 to 2023.

Methods

Zip codes and regions of each successfully matched plastic surgery applicant's medical school, residency, and plastic surgery program were gathered from publicly available data for the 2019 and 2020 in-person interview cycles and 2021, 2022, and 2023 virtual interview cycles.

Results

Although regions did not differ significantly in the proportions of positions each year (P = 0.85), there was a trend toward fewer positions in each region from 2019 to 2022. Overall, applicants were more likely to match in a different region as their medical school or residency during virtual compared with in-person interviews (P = 0.002 and P = 0.04). Applicants matched to programs further from their medical school zip code in virtual interview years (P = 0.02). There was no significant difference in distance between surgical residencies and plastic surgery residencies between the two time periods (P = 0.51).

Conclusions

Trends toward matching into a different region than prior training after the switch to virtual interviews could be attributed to applicant accessibility to interview broadly. However, this could also be due to the decreased number of independent residency positions over the years, requiring applicants to move regions and travel further from where they began their training.

The Impact of a Centralized Plastic Surgery Research Infrastructure on Scholarly Productivity and Output

Although research and innovation is a key within the field of plastic and reconstructive surgery, the impact of team structure, interpersonal dynamics, and/or standardized infrastructure on scholarly output has been infrequently studied. In this work, we present the formation and implementation of a novel plastic surgery research program that aims to unite previously disparate clinical and translational research efforts at our institution to facilitate critical inquiry. From July 2022 to June 2023, our department launched a pilot research program based on three pillars: (1) formalization of a research curriculum (monthly research meetings for agenda setting and discussion for project honing, formal research leadership for meeting facilitation and workflow regulation), (2) development of a centralized database to compile ongoing research (Google Drive repository to house all ongoing research documents, facilitate real-time editing, and provide resources/templates for assisting in the research process), and (3) bolstering of a core research identity built on mentorship and collaboration (more frequent interactions to shift previously siloed faculty-student mentorship into a robust milieu of intercollaboration). During the first year, we saw an increased number of publications and presentations, as well as robust participation and contribution from faculty, residents, and medical students. Future directions will focus on addressing resource limitation, such as project idea availability and funding, to sustain the success and growth of this novel research infrastructure.

Depression, Anxiety, Body Dissatisfaction, and Eating Disorders in Plastic Surgery Patients

Background

This study aimed to identify and describe indicators of depression, anxiety, body dissatisfaction, and risk of an eating disorder in patients who undergo plastic surgery.

Methods

The sample was made up of 90 patients from a private clinic in Lima, Peru, with ages between 20 and 50 years. The participants were asked to answer the Aaron Beck Depression Inventory (BDI-II), the Aaron Beck Anxiety Inventory, the Body Shape Questionnaire, and the Abbreviated and Modified Eating Attitudes Scale (EAT - 26M).

Results

Through data analysis with the SPSS statistical program, it was found that 80% of patients who access plastic surgery are women, and the average age is 32.4 years. Likewise, of the total sample, no anxiety traits have been identified; however, 3.3% present traits of moderate depression, pathological body discomfort, and risk of an eating disorder.

Conclusion

The presurgical psychological evaluation in plastic surgery patients is crucial because it allows for the identification of predisposing factors to mental health problems and proposes support if needed.

Modern Machiavelli? The illusion of ChatGPT-generated patient reviews in plastic and aesthetic surgery based on 9000 review classifications

BACKGROUND

Online patient reviews are crucial in guiding individuals who seek plastic surgery, but artificial chatbots pose a threat of disseminating fake reviews. This study aimed to compare real patient feedback with ChatGPT-generated reviews for the top five US plastic surgery procedures.

METHODS

Thirty real patient reviews on rhinoplasty, blepharoplasty, facelift, liposuction, and breast augmentation were collected from RealSelf and used as templates for ChatGPT to generate matching patient reviews. Prolific users (n = 30) assessed 150 pairs of reviews to identify human-written and artificial intelligence (AI)-generated reviews. Patient reviews were further assessed using AI content detector software (Copyleaks AI).

RESULTS

Among the 9000 classification tasks, 64.3% and 35.7% of reviews were classified as authentic and fake, respectively. On an average, the author (human versus machine) was correctly identified in 59.6% of cases, and this poor classification performance was consistent across all procedures. Patients with prior aesthetic treatment showed poorer classification performance than those without (p < 0.05). The mean character count in human-written reviews was significantly higher (p < 0.001) that that in AI-generated reviews, with a significant correlation between character count and participants' accuracy rate (p < 0.001). Emotional timbre of reviews differed significantly with "happiness" being more prevalent in human-written reviews (p < 0.001), and "disappointment" being more prevalent in AI reviews (p = 0.005). Copyleaks AI correctly classified 96.7% and 69.3% of human-written and ChatGPT-generated reviews, respectively.

CONCLUSION

ChatGPT convincingly replicates authentic patient reviews, even deceiving commercial AI detection software. Analyzing emotional tone and review length can help differentiate real from fake reviews, underscoring the need to educate both patients and physicians to prevent misinformation and mistrust.

The Impact of COVID-19 on Plastic Surgery Residents Across the World: A Country-, Region-, and Income-level Analysis

BACKGROUND

The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world.

METHODS

We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons.

RESULTS

The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006).

CONCLUSIONS

Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .