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Escobar-Domingo MJ, Mahmoud AA, Lee D, Taritsa I, Foppiani J, Hernandez Alvarez A, Schuster K, Lin SJ, Lee BT. Representation of Racial Diversity on US Plastic Surgery Websites: A Cross-sectional Study: Racial Diversity on Plastic Surgery Websites. Ann Plast Surg 2024:00000637-990000000-00496. [PMID: 38980944 DOI: 10.1097/sap.0000000000004051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
BACKGROUND The racial diversity portrayed in plastic and reconstructive surgery (PRS) media is an important indicator of an inclusive environment for potential patients. To evaluate the degree to which PRS websites demonstrate inclusivity, we assessed the racial composition of both patients and plastic surgeons depicted on the most visited academic and private PRS websites to determine the extent to which racial diversity is represented. METHODS A cross-sectional study was conducted in September 2023. The 10 most visited websites in each state were identified. Sociodemographic characteristics including race and sex of patients and plastic surgeons, as well as the type of practice, were collected. Race was classified according to individuals' Fitzpatrick Phototypes into White and non-White. Differences in patient and surgeon representation were compared to the 2020 US Census and the 2020 ASPS demographics using χ2 tests. Subgroup analyses were conducted to identify differences by type of practice and region. RESULTS We analyzed a total of 2,752 patients from 462 websites belonging to 930 plastic surgeons. PRS websites were predominantly from private practices (93%). Regarding patient representation, 92.6% were female, 7.4% were male, 87.6% were White, and 12.4% were non-White. The surgeon population on the studied webpages was 75.1% male, 92.1% White, and 7.8% non-White. Statistically significant differences were found in the patient population when compared to the 2020 national (P < 0.001) and regional (P < 0.001) US Census demographics and the 2020 ASPS Statistics Report (P < 0.001). Although minority representation was significantly higher on academic websites compared to private practice (22.9% vs. 12.1%; P = 0.007), both were significantly lower than the percentage of minority patients undergoing PRS. CONCLUSIONS This study illuminates racial disparities in the representation of racial groups among patients and plastic surgeons in the most frequented plastic surgery websites. Moreover, it underscores the imperative to bolster racial diversity within the digital content of both private and academic PRS websites. Greater racial representation can foster a more inclusive perception of the plastic surgery field, which may potentially broaden access to care and enrich the professional landscape.
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Affiliation(s)
- Maria J Escobar-Domingo
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Swanson E. Diversity, Equity, and Inclusion in Plastic Surgery: A Systematic Review. Ann Plast Surg 2024; 92:353-366. [PMID: 38527336 DOI: 10.1097/sap.0000000000003936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The number of publications on the subject of diversity, equity, and inclusion has surged in the last 5 years. However, a systematic review of this topic has not been published. METHOD Six top plastic surgery journals were queried from 2018 to 2023 using the search term "diversity." Methods, conclusions, and recommendations were tabulated. RESULTS A total of 138 publications were identified; 68 studies presented data suitable for analysis. All studies were retrospective. Currently, over 40% of plastic surgery residency applicants are women. The proportion of women in integrated plastic surgery residents is now 43%. In 2021 and 2022, the percentage of female first-year residents exceeded men. The percentage of female presenters at meetings (34%) is double the number in the workforce (17%). Twenty-five percent of academic faculty positions and 22% of program director positions are now held by women. Underrepresented minorities account for fewer than 10% of applicants to integrated plastic surgery residencies. DISCUSSION The proportion of Black and Hispanic applicants to integrated plastic surgery residencies (6% and 8%, respectively) mirrors the proportion of Black and Hispanic medical students (7% and 6%, respectively). Numerous recommendations have been made to increase the proportion of underrepresented minorities in plastic surgery programs. CONCLUSIONS The representation of women in plastic surgery has increased dramatically. A lack of Hispanics and Blacks reflects a small pool of applicants, as opposed to a "leaky pipeline."
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Oberoi MK, Reghunathan M, Aref Y, Dinis JJ, Balumuka D, Gosman A. Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training. Ann Plast Surg 2023; 90:S281-S286. [PMID: 36752557 DOI: 10.1097/sap.0000000000003403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows. METHODS Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population. RESULTS Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons. CONCLUSION This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.
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Affiliation(s)
- Michelle K Oberoi
- From the Division of Plastic Surgery, Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center College of Medicine, Temple, TX
| | - Meera Reghunathan
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | - Youssef Aref
- California University of Science and Medicine, Colton, CA
| | - Jacob J Dinis
- Frank H. Netter MD School of Medicine, North Haven, CT
| | - Darius Balumuka
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Amanda Gosman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
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Cevallos P, Amakiri UO, Johnstone T, Kim TSE, Maheta B, Nazerali R, Sheckter C. Is Plastic Surgery Training Equitable? An Analysis of Health Equity across US Plastic Surgery Residency Programs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4900. [PMID: 37035124 PMCID: PMC10079348 DOI: 10.1097/gox.0000000000004900] [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] [Received: 12/09/2022] [Accepted: 02/09/2023] [Indexed: 04/11/2023]
Abstract
Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies. Methods The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES. Results The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) (P = 0.03). The number of safety net hospitals per program was associated with higher MES (P = 0.02). Conclusions Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.
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Affiliation(s)
- Priscila Cevallos
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
- Geisel School of Medicine, Dartmouth University, Hanover, N.H
| | | | - Thomas Johnstone
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Trudy Sea-Eun Kim
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Bhagvat Maheta
- College of Medicine, California Northstate University, Elk Grove, Calif
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Clifford Sheckter
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
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Knoedler L, Oezdemir B, Moog P, Prantl L, Broer PN, Knoedler C, Rieger UM, Perl M, von Isenburg S, Gassner UM, Obed D, Haug V, Panayi AC, Knoedler S. Thinking like a Lawyer-Human Rights and Their Association with the Plastic Surgeon of Today. Aesthetic Plast Surg 2023; 47:490-497. [PMID: 35922668 PMCID: PMC9944724 DOI: 10.1007/s00266-022-02990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022]
Abstract
Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR). 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 www.springer.com/00266 ."
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Berkin Oezdemir
- Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Moog
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - P Niclas Broer
- Department of Plastic, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Christoph Knoedler
- Faculty of Applied Social and Health Sciences, Regensburg University of Applied Sciences, Regensburg, Germany
| | - Ulrich M Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Academic Teaching Hospital of the J.W. Goethe University, Frankfurt am Main, Germany
| | - Markus Perl
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA
| | - Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA
| | - Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
- Department of Surgery, Division of Plastic Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, USA.
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Sinclair MK, Chhabra AB. Recruiting, Supporting and Retaining Diversity in Hand Surgery. Hand Clin 2023; 39:33-42. [PMID: 36402524 DOI: 10.1016/j.hcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
All surgical fields that lead to a career in Hand Surgery have a stark lack of diversity of sex/gender and race, at every level of the workforce, from trainees to practicing physicians. Despite consistent statistics in publications on lack of diversity in surgical fields, a guide to effective recruitment and retention is lacking. Although we recognize that a strategy cannot be applied in all practices, this article provides actionable items to consider in the commitment and work toward a more just and equitable practice of Hand Surgery.
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Affiliation(s)
- Micah K Sinclair
- Department of Orthopaedic Surgery & Musculoskeletal Medicine, Children's Mercy Hospital, University of Missouri Kansas City, University of Kansas Medical Center, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, Hand Surgery, University of Virginia Health, PO Box 800159, Charlottesville, VA 22908-0159, USA
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Kalmar CL, Zapatero ZD, Kosyk MS, Bartlett SP, Taylor JA. Geographic Financial Analysis of Craniosynostosis Surgery in the United States. J Craniofac Surg 2022; 33:1282-1287. [PMID: 35275858 DOI: 10.1097/scs.0000000000008627] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the financial implications of demographic and socioeconomic factors upon the cost of surgical procedures for craniosynostosis. METHODS A retrospective cohort study was conducted of admissions for craniosynostosis surgery in the United States from 2015 through 2020 using the Pediatric Health Information System. Patient demographics, case volume, and surgical approach were analyzed in context of hospital charges. RESULTS During the study interval, 3869 patients were admitted for surgery for craniosynostosis. In multivariate regression accounting for demographic and socioeconomic factors, hospital admission charges were significantly higher in patients with longer hospital length of stay (P < 0.001), longer ICU length of stay (P < 0.001), living in an underserved area (P = 0.046), preoperative risk factors (P = 0.016), and those undergoing open procedures (P < 0.001); hospital admission charges were significantly lower in patients with White race (P = 0.020) and those treated at high-volume centers (P < 0.001). In multivariate regression, ICU length of stay was significantly higher in patients with preoperative risk factors (P < 0.001), undergoing open procedures (P < 0.001), government insurance (P = 0.018), and not treated at high-volume centers (P = 0.005). There were significant differences in admission charges (P < 0.001), charge-to-cost ratios (P < 0.001), and likelihood of being treated at high-volume craniofacial centers (P < 0.001) across geographic regions of the country. CONCLUSIONS In the United States, there is significant sociodemographic variability in charges for craniosynostosis care, with increased hospital charges independently associated with non-White race, preoperative risk factors, and living in an underserved area.
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Affiliation(s)
- Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia PA
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Boulom V, Hasanadka R, Ochoa L, Brown OW, McDevitt D, Singh TM. Importance of diversity, equity, and inclusion in the community practice setting. J Vasc Surg 2021; 74:118S-124S. [PMID: 34303451 DOI: 10.1016/j.jvs.2021.03.051] [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: 11/18/2020] [Accepted: 03/13/2021] [Indexed: 10/20/2022]
Abstract
Vascular surgeons of all backgrounds play an important role in providing high quality vascular surgical care in their communities. In America, with our diverse population and communities, patients presenting with vascular disease are very common and could pattern the community demographic. Often faced with the challenges of community hospital politics and demand, the vascular surgical workforce has continued to be active members in their communities, focusing on their strengths to lead vascular surgery healthcare in an environment of high patient demand. Having a varied vascular surgery workforce provides all patients afflicted by vascular disease a comfortable opportunity for compassionate and empathic vascular care. This is a significant strength of vascular care when diversity, equity, and inclusion are supported by the leadership.
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Affiliation(s)
- Valy Boulom
- BASS Medical Group, El Camino Hospital, Los Gatos, Calif
| | - Ravishankar Hasanadka
- Cardiovascular Institute, Carle Illinois College of Medicine/OSF HealthCare, Urbana, Ill
| | - Lyssa Ochoa
- San Antonio Vascular and Endovascular Clinic, San Antonio, Tex
| | - O William Brown
- Section of Vascular Surgery, William Beaumont Hospital, Oakland, Mich; Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Mich
| | - Daniel McDevitt
- Peachtree Vascular Specialist, Department of Vascular Surgery, Stockbridge, Ga
| | - Tej M Singh
- Palo Alto Medical Foundation, El Camino Hospital, Mountain View, Calif.
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Butler PD, Morris MP, Momoh AO. Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation. Ann Surg Oncol 2021; 28:6099-6108. [PMID: 34287788 DOI: 10.1245/s10434-021-10487-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
For many women, breast reconstruction is an essential component of the breast cancer care continuum after mastectomy. Despite postmastectomy breast reconstruction now being a standard of care, numerous studies over the past decade have documented persistent racial disparities in breast reconstruction rates, physician referral patterns, and patient knowledge of their reconstructive options. These disparities have disproportionately impacted women of color-most specifically, African American women. Recent data have revealed racial differences in patient comorbidities, informed decision-making satisfaction, and clinical outcomes after breast reconstruction. Explicitly, African American women have significantly more risk factors for complications and less baseline knowledge regarding reconstructive options than white women. With a recent heightened attention focused on social determinants of health, studies designed to improve these racial differences have demonstrated promising results through educational outreach to underserved communities, implementation of tailored legislation promoting inclusion, diversity, and equity, and encouragement of additional recruitment of ethnically underrepresented-in-medicine surgeons. This study uses a targeted review of the literature to provide a summary of racial disparities in breast reconstruction for African American women, with our perspective on opportunities for improvement.
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Affiliation(s)
- Paris D Butler
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Martin P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Stewart JH, Butler PD, Tseng JF, Kennard AC, Mellinger JD, Buyske J. Acknowledgment, Reflection, and Action: The American Board of Surgery Leans into Antiracism. Ann Surg 2021; 273:619-622. [PMID: 33351484 DOI: 10.1097/sla.0000000000004684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- John H Stewart
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Paris D Butler
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jennifer F Tseng
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | | | - John D Mellinger
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jo Buyske
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- American Board of Surgery, Philadelphia, Pennsylvania
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