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Benson RM, Khedr S, Riccardi J, Gore A, Sifri ZC. Unveiling the Lasting Impact: A 15-Year Follow-Up of Short-Term Surgical Mission Experiences. J Surg Res 2024; 302:662-668. [PMID: 39208491 DOI: 10.1016/j.jss.2024.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/08/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Resident interest in global surgery has increased over recent years. Incorporating short-term surgical missions (STSMs) into training improves Accreditation Council for Graduate Medical Education (ACGME) competencies and aids in understanding of global health infrastructure. We aim to investigate the impact of STSM participation during residency on the desire for participation after residency, and barriers in doing so. METHODS Eighteen general surgery residents who participated in STSM with the International Surgical Health Initiative from 2009 to 2017 were surveyed. An 18-question survey encompassing demographics, mission-specific data, ACGME competencies, current perspectives, barriers, and areas for improvement was distributed. RESULTS The group averaged 5.4 y out of residency and 89% (n = 16) completed the survey. Mean age was 38.5 y with a female predominance (62.5%). During residency, 10 (62.5%) participated in ≥ two STSMs and six (37.5%) participated in one STSM. On average, each resident performed 24 cases per mission. All reported that after their resident STSM experience, they were more inclined to participate as an attending. Twenty-five percent (n = 4) participated in STSMs after residency. Vacation, scheduling, and family factors were ranked the highest barriers. All ACGME competencies were felt to be significantly improved by STSMs. CONCLUSIONS This is the first long-term follow-up study of general surgery residents who participated in STSMs confirming that resident involvement increases desire for continued participation. Although 100% of residents wanted to participate as attendings, only 25% were successful in doing so. While operative experience is salient in surgical residency, there are other valuable experiences to be gained. Further work should focus on enhancing experiences and mitigation of barriers to continued participation in global humanitarian initiatives.
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Affiliation(s)
- Ryan M Benson
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Shahenda Khedr
- Department of Surgery, New York Presbyterian Queens, Queens, New York
| | - Julia Riccardi
- Department of Surgery, University of California Davis, Sacramento, California
| | - Amy Gore
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Goulas S, Karamitros G. The Perceived Impact of COVID-19 on Graduate Medical Education and Recommendations for Bridging the Educational Gap. J Surg Res 2024; 299:237-248. [PMID: 38781733 DOI: 10.1016/j.jss.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION COVID-19 generated a system-wide shock causing an unbalanced equilibrium between producing adequately trained physicians and meeting extraordinary operational needs. Previous studies report the experience of surgical residents during COVID-19 at a regional level. This study measures the learning losses related with the redeployment of highly specialized medical professionals to the care of COVID-19 patients, while we systematically investigate proposed remedial strategies. METHODS We administered an online cross-sectional survey in 67 countries capturing training inputs (i.e., surgeries and seminars residents participated in) before and during the pandemic and retrieved residents' expected learning outputs, career prospects and recommended remedial measures for learning losses. We compared responses of residents working in (treatment group) and out (control group) of hospitals with COVID-19 patients. RESULTS The analysis included 432 plastic surgery residents who were in training during the pandemic. Most of the learning losses were found in COVID-19 hospitals with 37% and 16% loss of surgeries and seminars, respectively, per week. Moreover, 74%, 44%, and 55% of residents expected their surgical skill, scientific knowledge, and overall competence, respectively, to be lower than those of residents who graduated before COVID. Residents in COVID-19 hospitals reported participating in significantly (P < 0.001) fewer surgeries and having significantly (P < 0.001) lower surgical skill relative to those not in COVID-19 hospitals. CONCLUSIONS The perceived lower competence and the fall-off in surgical skill and scientific knowledge among future surgeons suggest that health-care systems globally may have limited capacity to perform specialized and costly procedures in the future.
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Affiliation(s)
- Sofoklis Goulas
- Economic Studies Program, Brookings Institution, Washington, District of Columbia; World Bank, Washington, District of Columbia; Aletheia Research Institution, Palo Alto, California; Hoover Institution, Stanford University, Stanford, California
| | - Georgios Karamitros
- Medical School, University of Ioannina, Ioannina, Greece; Department of Plastic Surgery, University Hospital of Ioannina, Ioannina, Greece.
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Rojas-Miliano C, Aperrigue-Lira S, Barriga-Chambi F, Huamani-Merma E, Taype-Rondan A. Assessment of professional competencies of Peruvian physicians: A scoping review of published studies. PLoS One 2024; 19:e0299465. [PMID: 38781143 PMCID: PMC11115292 DOI: 10.1371/journal.pone.0299465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/09/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Evaluating the professional competencies of Peruvian doctors is crucial for proposing necessary improvements. However, there is a lack of knowledge regarding the specific characteristics and competencies that are assessed in these studies. OBJECTIVE The objective of this study is to characterize published studies focusing on the assessment of professional competencies among physicians in Peru. METHODS A comprehensive scoping review was conducted, encompassing scientific journal publications that evaluated the professional competencies of physicians in Peru. The search was performed in PubMed, Google Scholar, Scopus, and SciELO, with the review period extending until 2022. The identified competencies were classified using the Accreditation Council for Graduate Medical Education (ACGME) and the Ministry of Health of Peru (MINSA) frameworks. The findings were presented using absolute and relative frequency measures. RESULTS A total of forty-nine studies focused on the assessment of professional competencies among physicians were identified, indicating an upward trend over the years. The primary focus of these studies was on evaluating competencies related to medical knowledge (79.6% according to ACGME classification) and the treatment of health problems (57.1% according to MINSA classification). However, there was a noticeable lack of emphasis on assessing behavioral competencies such as ethics, professionalism, and communication. Most of the included studies (65.3%) were exclusively conducted in Lima. Among the studies that disclosed their funding sources, 61% were self-funded. CONCLUSION Most studies primarily concentrated on evaluating knowledge-based competencies, specifically in the areas of diagnosis and treatment. There is a scarcity of studies assessing other important competencies. Additionally, centralization and limited funding appear to be areas that require improvement in the evaluation of professional competencies among Peruvian physicians.
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Affiliation(s)
- Cristhian Rojas-Miliano
- Sociedad Científica de Estudiantes de Medicina del Centro, Universidad Nacional del Centro del Perú, Huancayo, Peru
| | - Shalom Aperrigue-Lira
- Sociedad Científica de Estudiantes de Medicina Agustinos, SOCIEMA; Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | - Fernanda Barriga-Chambi
- Sociedad Científica de Estudiantes de Medicina Agustinos, SOCIEMA; Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | - Edson Huamani-Merma
- Asociación Científica de Estudiantes de Medicina Humana del Cusco, ASOCIEMH CUSCO, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- EviSalud–Evidencias en Salud, Lima, Peru
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Mloka D, Tarimo E, Mselle L, Mshana S, Sirili N, Rogathi J, Msuya L, Rugarabamu P, Mteta A, Moshi M, Kwesigabo G, Lyamuya E, Bartlett J, Martin-Holland J, O'Sullivan P, Macfarlane S, Kaaya E. The process of harmonizing competency-based curricula for medicine and nursing degree programmes: A Multi-institutional and multi-professional experience from Tanzania. MEDICAL TEACHER 2023; 45:740-751. [PMID: 36622865 DOI: 10.1080/0142159x.2022.2158066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In many low- and middle-income countries, there seems to be a mismatch between graduate skills and healthcare industry requirements due to variability in curricula. With the current increased global demand for competent health profession graduates, harmonizing competency-based curricula (CBC) is necessary to address this mismatch. This paper describes how three health professions training universities in Tanzania and their two long-standing United States partners embarked on developing harmonized CBC for undergraduate medicine and nursing degrees. The main goal of the activity was to develop templates to harmonize curricula that would support graduates to acquire mandatory national Graduate Minimum Essential Competencies (GMEC) irrespective of the institution of their training. The paper describes the processes of engaging multiple institutions, the professions of medicine and nursing and various stakeholders to develop mandatory curricula generic competencies, creating milestones for assessing competencies, training faculty at each of the three partnering institutions in curriculum delivery and assessments, resulting in the adoption of the curricula by the University leadership at each institution. Ultimately the Tanzania Commission for Universities (TCU) a regulatory body required all schools of medicine and nursing in the country to adopt the curricula, thus creating a harmonized national standard for teaching medicine and nursing beginning October 2022.
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Affiliation(s)
- Doreen Mloka
- Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edith Tarimo
- Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lillian Mselle
- Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen Mshana
- Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Nathaniel Sirili
- Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jane Rogathi
- Community Health Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Levina Msuya
- Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Pascahilis Rugarabamu
- Anatomy and Histology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alfred Mteta
- Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mainen Moshi
- Biological and Preclinical Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eligius Lyamuya
- Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John Bartlett
- Global Health and Nursing, Duke University, Durham, United States of America
| | - Judy Martin-Holland
- Physiological Nursing, University of San Francisco California, San Francisco, United States of America
| | - Patricia O'Sullivan
- Office of Research and Development in Medical Education, University of San Francisco California, San Francisco, United States of America
| | - Sarah Macfarlane
- Global Health Sciences, University of San Francisco California, San Francisco, United States of America
| | - Ephata Kaaya
- Pathology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Necknig U, Leyh H, Waidelich R, Gernhold L, Kiesewetter J, Weidenbusch M. MatricS-A novel tool for monitoring professional role development in surgical disciplines. Front Surg 2022; 9:1009391. [PMID: 36311925 PMCID: PMC9614066 DOI: 10.3389/fsurg.2022.1009391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Mentoring is an effective method for human resource development. Monitoring the process is important for individual mentee/mentor pairs as well as for program directors. Due to individual personality differences of both mentees and mentors and their respective interactions, it is challenging to monitor the individual development process of mentees in a structured manner. This study investigates to what extent a novel instrument, the mentee-based assessment tool for role development of interpersonal competencies in surgical professions (MatricS) can adequately monitor the professional role development process of residents during an established mentoring program. Material and methods In a prospective longitudinal study, the competence development of 31 mentees in two subsequent cohorts was assessed by a modified role matrix based on Canadian Medical Education Directives for Specialists. The evaluation focused on three defined roles (D, developer; N, networker; M, multiplicator) at three levels (private, employer-related, national/international) with four stages of development. For validation of mentee self-assessments, the assessments of the respective mentors were recorded alongside. For correlation analyses, Pearson coefficients were calculated, pre-post-comparisons were done by paired t-tests; significance was assumed at p < 0.05, respectively. Results Mentee self-assessments overall correlated well with the objective mentor assessments (Pearson's r 0.8, p < 0.001). Significant correlations of this magnitude were found for both individual cohorts as well as for all individual roles. The mentees acquired competencies in all roles indicated by significant increases of corresponding MatricS scores. The largest competency gains (mean ± SD) were found in the role D (start: 1.30 ± 0.77, end: 2.13 ± 0.83, p < 0.001). The majority of mentees achieved the prespecified target competency level in >75% of all roles and levels. Conclusion The role development process during mentoring can be reliably monitored by using MatricS. MatricS scores highly correlate between mentees and mentors, indicating that mentee self-assessments are suitable and sufficient for monitoring. These findings help to lessen the work burden on senior surgeons and thus can help to increase the acceptance of mentoring programs in surgical disciplines.
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Affiliation(s)
- U. Necknig
- Urologische Praxis Lindenberg, Lindenberg, Germany,Deutsche Gesellschaft für Urologie, Junior Akademie, Düsseldorf, Germany,Urologische Klinik und Poliklinik, LMU University Hospital, Munich, Germany,Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - H. Leyh
- Deutsche Gesellschaft für Urologie, Junior Akademie, Düsseldorf, Germany
| | - R. Waidelich
- Urologische Klinik und Poliklinik, LMU University Hospital, Munich, Germany
| | - L. Gernhold
- Urologische Klinik und Poliklinik, LMU University Hospital, Munich, Germany
| | - J. Kiesewetter
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - M. Weidenbusch
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
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Zivanov CN, Joseph J, Pereira DE, MacLeod JBA, Kauffmann RM. Qualitative Analysis of the Host-Perceived Impact of Unidirectional Global Surgery Training in Kijabe, Kenya: Benefits, Challenges, and a Desire for Bidirectional Exchange. World J Surg 2022; 46:2570-2584. [PMID: 35976431 PMCID: PMC9383670 DOI: 10.1007/s00268-022-06692-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
Background As globalization of surgical training increases, growing evidence demonstrates a positive impact of global surgery experiences on trainees from high-income countries (HIC). However, few studies have assessed the impact of these largely unidirectional experiences from the perspectives of host surgical personnel from low- and middle-income countries (LMIC). This study aimed to assess the impact of unidirectional visitor involvement from the perspectives of host surgical personnel in Kijabe, Kenya. Methods Voluntary semi-structured interviews were conducted with 43 host surgical personnel at a tertiary referral hospital in Kijabe, Kenya. Qualitative analysis was used to identify salient and recurring themes related to host experiences with visiting surgical personnel. Perceived benefits and challenges of HIC involvement and host interest in bidirectional exchange were assessed. Results Benefits of visitor involvement included positive learning experiences (95.3%), capacity building (83.7%), exposure to diverse practices and perspectives (74.4%), improved work ethic (51.2%), shared workload (44.2%), access to resources (41.9%), visitor contributions to patient care (41.9%), and mentorship opportunities (37.2%). Challenges included short stays (86.0%), visitor adaptation and integration (83.7%), cultural differences (67.4%), visitors with problematic behaviors (53.5%), learner saturation (34.9%), language barriers (32.6%), and perceived power imbalances between HIC and LMIC personnel (27.9%). Nearly half of host participants expressed concerns about the lack of balanced exchange between HIC and LMIC programs (48.8%). Almost all (96.9%) host trainees expressed interest in a bidirectional exchange program. Conclusion As the field of global surgery continues to evolve, further assessment and representation of host perspectives is necessary to identify and address challenges and promote equitable, mutually beneficial partnerships between surgical programs in HIC and LMIC.
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Affiliation(s)
- Catherine N Zivanov
- Eskind Family Biomedical Library and Learning Center, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
| | - James Joseph
- Department of Surgery, Africa Inland Church Kijabe Hospital, Kijabe, Kenya
| | - Daniel E Pereira
- Eskind Family Biomedical Library and Learning Center, Vanderbilt University School of Medicine, 2209 Garland Avenue, Nashville, TN, 37240, USA
| | - Jana B A MacLeod
- Department of Surgery, Africa Inland Church Kijabe Hospital, Kijabe, Kenya.,Department of Surgery and Orthopedics, Kenyatta University School of Medicine, Nairobi, Kenya
| | - Rondi M Kauffmann
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, 597 Preston Research Building, 2220 Pierce Ave, Nashville, TN, 37232, USA.
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Bale AG, Sifri ZC. Does Global Surgery Interest Influence the Choice of Surgical Residency Program? JOURNAL OF SURGICAL EDUCATION 2021; 78:e137-e144. [PMID: 34548262 DOI: 10.1016/j.jsurg.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Medical students actively seek global health opportunities. Surgical residents also show great enthusiasm for international missions, rotations and global surgery. Unfortunately, only 18% to 34% of all surgery residency programs offer such international opportunities. We surveyed fourth year medical students applying for surgery residency to determine if international surgery opportunities offered by a program would influence their match rank list. DESIGN A 20 question survey was given to interviewees at our surgery residency program. Survey was optional and anonymous. We queried prior volunteerism, interest in global surgery and importance of international opportunities offered during residency. SETTING Hackensack University Medical Center, Hackensack New Jersey PARTICIPANTS: All candidates interviewing for general surgery residency at Hackensack University Medical Center from October 2019 to January 2020. RESULTS A total of 97 fourth year medical students interviewed, with a 66% response rate to the survey. Mean age was 27 years. 92% of students had volunteered during college and/or medical school. 41% of students had volunteered internationally. Majority of students were interested in a surgery residency program offering international opportunity. 78% of students planned to volunteer internationally after residency, and two-thirds planned to include global surgery in future career. Half of the students reported they would rank a residency program higher if it offered an international opportunity. Students who were immigrants were significantly more likely to rank a program higher in the match if an international opportunity was offered, compared to students born in the US (p < 0.05). CONCLUSIONS There is great interest in global surgery and international volunteer opportunities amongst fourth year medical students who apply for surgery residency. The majority of applicants have prior volunteer experience either locally or abroad. Majority of students plan to volunteer internationally after residency and are interested in academic global surgery careers. Students will rank surgery residency programs that offer international opportunities higher in the match.
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Affiliation(s)
- Asha G Bale
- Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey.
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Gutnik LA, Petroze RT. Optimizing US surgical trainees for global engagement. Am J Surg 2021; 223:222-223. [PMID: 34535291 DOI: 10.1016/j.amjsurg.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lily A Gutnik
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Robin T Petroze
- Department of Surgery, University of Florida, Gainesville, Fl, USA
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Abbott KL, Kwakye G, Kim GJ, Luckoski JL, Krumm AE, Clark M, Chen X, Gupta T, Weiser TG, George BC. US general surgical trainee performance for representative global surgery procedures. Am J Surg 2021; 223:224-228. [PMID: 34119330 DOI: 10.1016/j.amjsurg.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many US general surgery residents are interested in global surgery, but their competence with key procedures is unknown. METHODS Using a registry managed by the Society for Improving Medical Professional Learning (SIMPL), we extracted longitudinal operative performance ratings data for a national cohort of US general surgery residents. Operative performance at the time of graduation was estimated via a Bayesian generalized linear mixed model. RESULTS Operative performance ratings for 12,976 procedures performed by 1584 residents in 52 general surgery programs were analyzed. These spanned 17 of 31 (55%) procedures deemed important for global surgical practice. For these procedures, the probability of a graduating resident being deemed competent to perform a procedure was 0.95 (95% confidence interval 0.86-1.00) but was less than 0.9 for 3 observed procedures. CONCLUSION Our results highlight gaps in the preparedness of US general surgery trainees to perform procedures deemed most important for global surgery settings.
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Affiliation(s)
- Kenneth L Abbott
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gifty Kwakye
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Grace J Kim
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - John L Luckoski
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew E Krumm
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Michael Clark
- Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, MI, USA
| | - Xilin Chen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanvi Gupta
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas G Weiser
- Stanford University School of Medicine, Department of Surgery, Division of General Surgery, Section of Trauma & Critical Care, Stanford, CA, USA; Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Frange A, Duffy S, Al-Rousan T, Evensen A, Nelson BD. Trainee Perspectives Regarding Advanced Clinical Global Health Fellowships in North America. Am J Trop Med Hyg 2021; 104:2286-2292. [PMID: 33872209 PMCID: PMC8176480 DOI: 10.4269/ajtmh.20-1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
Postgraduate clinical global health (GH) training is a rapidly evolving field. To understand and improve training opportunities, we sought the perspectives of current and former trainees related to their advanced clinical training or global health fellowships and the anticipated impact on their careers. Clinical GH fellowships across North America were identified through websites and previous studies. An e-mail was sent to program directors to invite all current and former GH fellows to complete a web-based questionnaire. We contacted 100 GH fellowship programs. Fifty-two fellows from 10 different specialties completed the survey. The median fellowship length was 23.3 months, with an annual median of 4.8 months spent in low-income and middle-income countries, which was less than their reported ideal of 6 months. The majority reported satisfaction, the anticipation of career benefits, and that they would recommend fellowship training to others. Challenges included insufficient funding, mentorship, and formal curricula. Conducting research in high-income countries was a significant negative predictor of fellowship satisfaction. Most fellows (73.1%) were not at all or only a little concerned about the absence of fellowship accreditation, with only 17.3% desiring accreditation. Survey respondents were largely satisfied with their training and valued program flexibility and educational opportunities, including advanced tropical medicine certificates or diplomas. However, to improve fellowship training, improvements are needed in mentorship, standardized curricula, institutional support, and funding. For GH fellowship training to be effective and sustainable, institutions will need to balance the needs of fellows, training programs, and the communities (low-, middle-, and high-income countries) where the fellows serve.
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Affiliation(s)
- Adam Frange
- 1Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean Duffy
- 2Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tala Al-Rousan
- 3University of California San Diego Herbert Wertheim School of Public Health, La Jolla, California
| | - Ann Evensen
- 2Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brett D Nelson
- 1Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- 4Divisions of Global Health and Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- 5Harvard Medical School, Boston, Massachusetts
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Meng X, Hao C, Tan H, Sun B, Xue D, Bo H. Competency-based medical education for postgraduates in the minimally invasive surgery department during the COVID-19 pandemic. Postgrad Med J 2021; 98:e187-e188. [PMID: 33637638 DOI: 10.1136/postgradmedj-2021-139771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Xianzhi Meng
- Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Chenjun Hao
- Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongtao Tan
- Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bei Sun
- Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Dongbo Xue
- Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hong Bo
- Department of Educational Affairs, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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12
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Riccardi J, Padmanaban V, Padberg FT, Shapiro ME, Sifri ZC. A Pilot Study of Surgical Trainee Participation in Humanitarian Surgeries. J Surg Res 2021; 262:175-180. [PMID: 33588294 DOI: 10.1016/j.jss.2020.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The impact of general surgery resident participation on operative case time and postoperative complications has been broadly studied in the United States. Although surgical trainee involvement in international humanitarian surgical care is escalating, there is limited information as to how this participation affects care rendered. This study examines the impact of trainee involvement on case length and immediate postoperative complications with regard to operations in low- and middle-income settings. METHODS A retrospective chart review was conducted of humanitarian surgeries completed during annual short-term surgical missions performed by the International Surgical Health Initiative to Ghana and Peru. Between 2017 and 2019, procedures included inguinal hernia repairs and total abdominal hysterectomies (TAHs). Operative records were reviewed for case type, duration, and immediate postoperative complications. Cases were categorized as involving two attending co-surgeons (AA) or one attending and resident assistant (RA). RESULTS There were 135 operative cases between 2017 and 2019; the majority (82%) involved a resident assistant. There were no statistically significant differences in case times between the attending assistant (AA) and resident assistant (RA) cohorts in both case types. All 23 postoperative complications were classified as Clavien-Dindo Grade I. In addition, resident assistance did not lead to a statistically significant increase in complication rate; 26% in the AA cohort versus 74% in the RA cohort (P = 0.3). CONCLUSIONS This pilot study examining 135 operative cases over 2 y of humanitarian surgeries demonstrates that there were no differences in operative duration or complication rates between the AA and RA cohorts. We propose that surgical trainee involvement in low- and middle-income settings do not adversely impact operative case times or postoperative complications.
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Affiliation(s)
- Julia Riccardi
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vennila Padmanaban
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Frank T Padberg
- Division of Vascular Surgery, Rutgers New Jersey Medical School, VA New Jersey Healthcare System, East Orange, New Jersey
| | - Michael E Shapiro
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Abraham PJ, Abraham MN, Corey BL, Lindeman B, Chen H. Cross-Sectional Analysis of Global Surgery Opportunities Among General Surgery Residency Programs. JOURNAL OF SURGICAL EDUCATION 2020; 77:1179-1185. [PMID: 32709570 DOI: 10.1016/j.jsurg.2020.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/02/2020] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Global surgery is a rising field within academic surgery. With the publication of recent landmark papers highlighting the need for increased global efforts to combat surgical disease, many general surgery residents seek opportunities to gain clinical, research, and educational experience related to global surgery during residency. This study aims to quantify the global surgery opportunities that are publicly available to residents training in Accreditation Council for Graduate Medical Education (ACGME)-accredited general surgery programs. METHODS The websites of all ACGME-accredited general surgery residency programs were surveyed for mention of global surgery training opportunities. Each opportunity was recorded in a database and categorized based on type. Recorded categories include international clinical rotations, international surgical research opportunities, and formal tracks or training pathways for global surgery. RESULTS Of the 299 ACGME-accredited general surgery training programs, 52 (17%) mention some form of international surgical opportunity on their website. Among these programs, 11 (21%) note both clinical and research opportunities, 28 (54%) mention only clinical opportunities, and 13 (25%) list only research opportunities. The large majority of global surgery opportunities were based in training programs at academic medical centers (n = 50, 96%). There was no significant difference in the percentage of global surgery programs when evaluated by program region (p = 0.154) CONCLUSIONS: Few general surgery residency programs mention international training opportunities on their program websites. For those programs that do offer global surgery opportunities, these are typically international rotations offered as electives for upper-level residents. Expanding access to global surgery opportunities may be beneficial to meet the desires of residents wishing to pursue academic global surgery.
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Affiliation(s)
- Peter J Abraham
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mackenzie N Abraham
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Britney L Corey
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery, Birmingham Veteran's Affairs Medical Center, Birmingham, Alabama
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Sherif YA, Davis RW. Formal Training of the Global Surgeon. Oral Maxillofac Surg Clin North Am 2020; 32:447-455. [DOI: 10.1016/j.coms.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Improving plastic surgery resident education and quality of care with outcomes feedback using the surgery report card: An initial experience. J Plast Reconstr Aesthet Surg 2020; 73:1338-1347. [PMID: 32241736 DOI: 10.1016/j.bjps.2020.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/19/2019] [Accepted: 02/09/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The practice of tracking and analyzing surgical outcomes is essential to becoming better surgeons. However, this feedback system is largely absent in residency training programs. Thus, we developed a Surgery Report Card (SRC) for residents performing tissue expander (TE)-based breast reconstruction and report our initial experience with its implementation. METHODS We performed a systematic review and meta-analysis for TE-based breast reconstructions and compared outcomes to our retrospective cohort. The primary outcome was overall complications. The SRC compares patient and complication statistics for resident-led teams to the meta-analysis. RESULTS The meta-analysis included 12 studies, with 2093 patients (2982 breasts) that underwent TE-based reconstruction. The pooled complication rate was 26.9%; infection was most common (8.3%); failure rate was 5.9%. Our cohort included 144 patients (245 breasts) among 13 resident-led teams. Overall complication rate was 31.8%; infections were most frequent (17.6%) and failure rate was 7.3%. Our cohort had significantly higher BMIs (29.7 vs 25.4, p<0.0001) more diabetics (6.9% vs. 3.2%, p = 0.02), and more patients receiving adjuvant radiation therapy (41.4 vs 26.3%, p<0.0001). Every 3 months, residents receive a customized SRC of their cases, with the meta-analysis used as a benchmark. A survey demonstrated the SRC made residents reconsider surgical technique and more conscientious surgeons, and would like it implemented for other procedures during residency. CONCLUSIONS The implementation of our SRC for TE-based breast reconstruction establishes a baseline for surgical performance comparison for residents, demonstrates that residents can safely perform the procedure, and allows for critiquing of surgical techniques to improve patient care.
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Deora H, Garg K, Tripathi M, Mishra S, Chaurasia B. Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education. Neurosurg Focus 2020; 48:E11. [DOI: 10.3171/2019.12.focus19852] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe evolution of the neurosurgical specialty in lower-middle-income countries is uniformly a narrative of continuous struggle for recognition and resource allocation. Therefore, it is not surprising that neurosurgical education and residency training in these countries is relatively nascent. Dr. Harvey Cushing in 1901 declared that he would specialize in neurosurgery and gave his greatest contribution to the advancement of neurosurgical education by laying the foundations of a structured residency training program. Similar efforts in lower-middle-income countries have been impeded by economic instability and the lack of well-established medical education paradigms. The authors sought to evaluate the residency programs in these nations by conducting a survey among the biggest stakeholders in these educational programs: the neurosurgical residents.METHODSA questionnaire addressing various aspects of the residency program from a resident’s perspective was prepared with Google Forms and circulated among neurosurgery residents through social media and email groups. Where applicable, a 5-point Likert scale was used to grade the responses to the questions. Responses were collected from May to October 2019 and analyzed using descriptive statistics. Complete anonymity of the respondents was ensured to keep the responses unbiased.RESULTSA total of 195 responses were received, with 189 of them from lower-middle-income countries (LMICs). The majority of these were from India (75%), followed by Brazil and Pakistan. An abiding concern among residents was lack of work hour regulations, inadequate exposure to emerging subspecialties, and the need for better hands-on training (> 60% each). Of the training institutions represented, 89% were offering more than 500 major neurosurgical surgeries per year, and 40% of the respondents never got exposure to any subspecialty. The popularity of electronic learning resources was discernible and most residents seemed to be satisfied with the existent system of evaluation. Significant differences (p < 0.05) among responses from India compared with those from other countries were found in terms of work hour regulations and subspecialty exposure.CONCLUSIONSIt is prudent that concerned authorities in LMICs recognize and address the deficiencies perceived by neurosurgery residents in their training programs. A determined effort in this direction would be endorsed and assisted by a host of international neurosurgical societies when it is felt that domestic resources may not be adequate. Quality control and close scrutiny of training programs should ensure that the interests of neurosurgical trainees are best served.
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Affiliation(s)
- Harsh Deora
- 1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Kanwaljeet Garg
- 2Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjul Tripathi
- 3Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India; and
| | - Shashwat Mishra
- 2Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bipin Chaurasia
- 4Department of Neurosurgery, Bangladesh State Medical University, Dhaka, Bangladesh
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Munabi NCO, Durnwald L, Nagengast ES, Ntirenganya F, Magee Iii WP. Long-Term Impact of a Mission-Based Surgical Training Rotation on Plastic Surgery Capacity Building in Rwanda. JOURNAL OF SURGICAL EDUCATION 2020; 77:124-130. [PMID: 31492640 DOI: 10.1016/j.jsurg.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/13/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Short-term, high-volume surgical training experiences can lead to successful skills transfer and be an effective method of training surgical providers in low-resource settings. However, immediate skills acquisition does not guarantee long-term performance of surgical procedures by trainees. This study aims to determine the long-term impact of a short-term plastic surgery training rotation (STR) on general surgeon contribution to plastic surgery capacity building in Rwanda. DESIGN A retrospective survey study was conducted. Surveys were distributed to credentialed general surgeons who previously participated in the Operation Smile STR in Rwanda. Questions focused on exposure to procedures during the rotation and current practice demographics. The percentage of current practice volumes dedicated to plastic surgery was mapped to demonstrate participant contribution to plastic surgery capacity in the country. SETTING Surveys were distributed remotely. Surgeon respondents previously participated in the STR at the Rwinkwavu District Hospital, a primary level hospital in eastern Rwanda. PARTICIPANTS All 8 prior participants of the STR who completed residency and are currently practicing as general surgeons in Rwanda were included. RESULTS Six out of 8 prior participants completed the survey (75.0%). All respondents work as general surgeons in governmental hospitals around the country. Up to 75% of surgeon caseloads are dedicated to plastic surgery procedures. Half of respondents work in regions without a credentialed plastic surgeon. Exposure to cleft and congenital hand surgery during the rotation did not lead to durable performance in practice. All participants felt the rotation improved their performance in multiple core competencies. CONCLUSION Participation in a short-term plastic surgery training experience in Rwanda was associated with increased long-term surgical capacity in the country through a task-sharing model. A mission-based rotation may provide sufficient exposure for basic plastic surgery procedures, but does not provide enough volume or time to durably teach more complicated surgeries such as cleft repair. Further studies are needed to determine how longer durations of training exposure impacts long-term performance of plastic surgery procedures.
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Affiliation(s)
- Naikhoba C O Munabi
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Operation Smile, Inc., Virginia Beach, Virginia
| | | | - Eric S Nagengast
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Operation Smile, Inc., Virginia Beach, Virginia
| | - Faustin Ntirenganya
- Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - William P Magee Iii
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, California; Division of Plastic Surgery, Shriner's Hospital, Los Angeles, California.
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Kryspin M, Wyrzykowsk D. Outcomes of Open and Laparoscopic Appendectomy With Single Endoloop Stump Closure. JSLS 2019; 22:JSLS.2018.00062. [PMID: 30607104 PMCID: PMC6305067 DOI: 10.4293/jsls.2018.00062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: Although laparoscopic appendectomy (LA) has been used for 35 years, the open approach (OA) is preferred worldwide. Widespread access to instrumentation in a number of centers has reduced economic and logistical obstacles. The aim of this work is to compare the results for patients with suspected appendicitis treated using an OA versus patients treated using LA. Methods: A retrospective study of all patients (N = 290) who underwent operation due to suspected appendicitis in the General Surgery Department from 2014 to 2017 was conducted. LA was performed in 91 patients, and OA was performed in 199 patients. Results: Average surgery duration was 67.8 minutes in the LA group and 62.9 minutes in the OA group (P =.082). It was necessary to perform 3 conversions (3.3%) from LA to OA. Wound infections occurred in 2.2% of patients in the LA group and in 12.6% of patients in the OA group (P = .007). A reduced duration of hospitalization was noted in the LA group (3.3 days) compared with the OA group (4.7 days) (P < .001). Conclusion: The duration of LA is not considerably longer than that of OA. LA in patients with suspected appendicitis reduces the number of operation site infections compared with OA. LA with single endoloop stump closure is a safe method and may be recommended for wider applications.
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Affiliation(s)
- Mitura Kryspin
- General Surgery Department, Siedlce Hospital, Siedlce, Poland
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Babb DE, Salerno TA. Commentary: Setting the standard: The necessity of internationalizing residency training programs. J Thorac Cardiovasc Surg 2018; 157:2547-2548. [PMID: 30503735 DOI: 10.1016/j.jtcvs.2018.10.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Danielle E Babb
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Jackson Memorial Hospital and the University of Miami Miller School of Medicine, Miami, Fla
| | - Tomás A Salerno
- Division of Cardiothoracic Surgery, Jackson Memorial Hospital and the University of Miami Miller School of Medicine, Miami, Fla.
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