Mentorship: concepts and application to plastic surgery training programs

Surgery Mentorship for Medical Students: A Pilot Study

INTRODUCTION

Mentorship plays a valuable role in medical education by helping students navigate significant career decisions and cultivate enhanced professional networks. We sought to implement and evaluate a surgical mentorship program for medical students.

MATERIALS AND METHODS

Student members of the Surgery Interest Group and faculty surgeons were invited to participate in a mentorship program. Mentees were randomly paired with a mentor and instructed to schedule three meetings with their mentor and attend four structured group sessions. Pre-program and post-program surveys were administered and were standardized using a five-point Likert scale. Post-program interviews were conducted with willing participants.

RESULTS

Forty three mentees and 21 mentors were enrolled. Thirty two mentees (74.4%) and nine mentors (42.9%) completed both pre-surveys and post-surveys. In pre-surveys, strong communication was rated as a top factor of importance by mentors and mentees (76.2% versus 95.3%, P = 0.03). In post-surveys, seven mentors (77.8%) and 20 mentees (62.5%) found communication with their mentee or mentor to be effective. Seven mentors (77.8%) and 17 mentees (53.1%) gained a connection with a mentee or mentor. Mentees critiqued mentor communication in comments (9, 28.2%) and interviews (2, 33.3%). Mentors critiqued student communication and initiative in comments (4, 44.4%) and interviews (2, 66.7%).

CONCLUSIONS

Our findings suggest a semi-structured mentorship program can provide meaningful network connections to medical students interested in pursuing surgery. However, it is critical to ensure adequate communication and sufficient commitment from mentees and mentors.

Evolution of a Plastic Surgery Summer Research Program: Lessons Learned from Programmatic Evaluation and Quality Enhancement

Early surgical exposure and research fellowships can influence medical students' specialty choice, increase academic productivity, and impact residency match. However, to our knowledge, there is no published guidance on the programmatic evaluation and quality enhancement necessary for the sustainability of formal plastic surgery summer research programs for first year medical students. We present seven years (2013-2020) of institutional experience in an effort to inform program development at other institutions.

Methods

From 2013 to 2016, a sole basic science research arm existed. In 2017, a clinical research arm was introduced, with several supplemental activities, including surgical skills curriculum. A formalized selection process was instituted in 2014. Participant feedback was analyzed annually. Long-term outcomes included continued research commitment, productivity, and residency match.

Results

The applicant pool reached 96 applicants in 2019, with 85% from outside institutions. Acceptance rate reached 7% in 2020. With adherence to a scoring rubric for applicant evaluation, good to excellent interrater reliability was achieved (intraclass correlation coefficient = 0.75). Long-term outcomes showed that on average per year, 28% of participants continued involvement in departmental research and 29% returned for dedicated research. Upon finishing medical school, participants had a mean of 7 ± 4 peer-reviewed publications. In total, 62% of participants matched into a surgical residency program, with 54% in integrated plastic surgery.

Conclusions

A research program designed for first year medical students interested in plastic surgery can achieve academic goals. Students are provided with mentorship, networking opportunities, and tools for self-guided learning and career development.

What Do Medical Students Want From a Mentor?

Introduction

The medical education literature lacks a uniform definition of mentoring. Mentoring relationships benefit the mentor and mentee. Mentoring roles include coach, advisor, teacher, counselor, and sponsor in the setting of mutual trust toward impacting psychosocial and career functions for the mentee. Mentoring helps improve underrepresented minority medical student performance. Medical students value mentoring relationships. Student mentees note a positive influence on career planning and research and saw mentors as counselors, idea providers, and role models. Medical students' varied goals and development call for personalized, flexible mentoring.

Methods

This study sought to expand the current understanding of medical student mentoring. We emailed a voluntary Qualtrics survey to second-, third-, and fourth-year medical students at the Florida International University (FIU) Herbert Wertheim College of Medicine asking, "What do you want from a mentor (choose all that apply)?" Multiple choice options were constructed based upon literature search. We conducted one-way analysis of variance and Tukey's test to identify whether mentoring preferences differed by student academic year.

Results

Of 363 students, 171 responded (47% response rate). Top-rated responses included honest feedback, responsiveness, and professional connections or networking opportunities.

Discussion

Student desire for honest feedback from mentors was prioritized, affirming the lack of need for impression management in the mentoring relationship. This investigation will be useful for specific mentoring relationships, helping to trigger discussion regarding specific mentoring hopes and training mentors.

The Importance of Mentorship in Shaping the Careers of Academic Leaders in Plastic Surgery

BACKGROUND

The majority of successful academic physicians cite mentorship as a critical element of their achievements. The goal of this study was to survey established leaders in plastic surgery to identify the importance that mentorship played in their career development, and to identify common themes that enabled them to "pay it forward" in helping to develop the next generation of leaders in plastic surgery.

METHODS

The authors performed a qualitative survey of 14 established leaders in plastic surgery (mentors) in the United States with a strong reputation for mentorship. The authors asked each to identify a key mentor (senior mentor) and mentee, grouping them in triads of a senior mentor, mentor, and mentee. The authors then submitted a similar survey to the mentee.

RESULTS

Thirteen mentor-mentee pairs for which both members had responded were included. After reviewing responses to these questions, the authors elicited a number of recurring themes. All respondents emphasized the importance of mentorship to their success in academic plastic surgery. Additional themes included encouraging mentees to find their passion, leading by example, discussing complex cases with residents/students, and using research time as an opportunity.

CONCLUSIONS

Strong patterns of mentorship are highlighted among the careers of leaders in academic plastic surgery. The authors advocate for formation of mentorship relationships within training programs and more national mentorship programs such as those emerging through the American Society of Plastic Surgeons and the Plastic Surgery Research Council for interested medical students, residents, and junior faculty.

Medical Students' Exposure to Plastic Surgery: A Cross-sectional Review of Scholarly and Academic Opportunities

Specialty exposure is most influential in a medical student's decision to pursue plastic surgery training. We aimed to understand what opportunities exist for students through national plastic surgery organizations.

Methods

The American Board of Plastic Surgery, American Society of Plastic Surgeons, and The Aesthetic Society provide online lists of related organizations. Cross-referencing lists yielded 47 unique organizations. Screening for presence of annual meeting and relevance to student and resident education yielded 14 organizations. Bylaws/web-domains were reviewed for information related to the annual meeting, leadership opportunities, membership, grants, and travel scholarships. If available, previrtual/in-person and virtual meeting prices were collected. Lastly, discrepancies between webpage information and phone/email correspondence were noted.

Results

All (100%) organizations welcomed students at annual meetings. Eleven promoted student presentation/submission. Average student registration fee was $109.3 ± SD$136.5 compared with $181.20 ± SD$157.20 for residents. Of organizations providing previrtual and virtual pricing (n = 10, 71.4%), there was an average price reduction in student registration of $92 (range: $0-375). Average student membership was $31.70/year ± SD $45.50 compared with $38.80 per year ± SD $65.90 for residents. The percentages of organizations offering student research grants, travel scholarships, and national student leadership were 21.4% (n = 3), 35.8% (n = 5), and 28.6% (n = 4) respectively. No organizations had student chapters/committees. All organizations (100%) contained at least one discrepancy between webpage/bylaw and email/phone.

Conclusions

Our results suggest that although national opportunities seem to be limited, a role exists for further engagement, with interested students eager to take the initiative. Virtual conferences present a lower-cost alternative for students and residents.

The Accreditation Council for Graduate Medical Education Milestones in Integrated Plastic Surgery Programs: How Competency-Based Assessment Has Been Implemented

BACKGROUND

The plastic surgery milestones are a central component of resident assessment. The authors performed a survey to evaluate how milestones have been implemented across integrated plastic surgery programs and how faculty perceive the Milestones Project has impacted their program.

METHODS

A 25-question survey was directed to the head of the clinical competency committee of all 82 integrated plastic surgery programs through the American Council of Academic Plastic Surgeons. The survey queried the composition of the committee, how ratings are generated, and the data used in generating these ratings.

RESULTS

Committee leaders from 57 programs (69.5 percent) responded to the survey. For most programs (73 percent), one faculty member completed milestone ratings for each resident and reviewed them with the residents. To determine milestone ratings, 92 percent utilized resident assessment after every rotation, and 63 percent utilized in-service examination scores. For documented resident assessment overall, 96 percent of programs assess residents after every rotation; 37 percent asses after every procedure. Feedback is most frequently provided to residents after every rotation (52 percent), rather than only during committee reviews (32 percent) or after every documented assessment (16 percent). Sixty-four percent of respondents did not believe that milestones have helped in the mentorship role.

CONCLUSIONS

Implementation of the milestones has varied among integrated plastic surgery programs. Structured training for core faculty directed to methods of assessment will make milestones a more effective a tool by which to improve resident evaluation and education. These findings provide a key data set by which to revise the milestones for their second iteration.

Demonstrating Excellence in Plastic Surgery Residency

Background:

Residents can achieve distinction by discerning which areas of achievement are worth additional focus at each stage in training. Our survey examines the perspectives of faculty members affiliated with Accreditation Council for Graduation Medical Education–accredited plastic surgery residency programs regarding qualities indicative of resident excellence.

Methods:

A survey including Likert scales and rank-ordering was distributed to plastic surgery program directors and faculty with the intent to assess perspectives regarding resident excellence at each stage of training. Responses were analyzed using marginal homogeneity tests and summary tables.

Results:

In total, 90 respondents completed the survey. An estimated 94.5% believe it is possible for residents to achieve excellence at any stage of clinical training, and 87.7% report their definition of excellence differs by training level. Top three metrics indicative of resident excellence for interns and junior residents were preparation for operative cases, bedside manner, and personality. For seniors: preparation for operative cases, leadership capability, and bedside manner. For chief residents: preparation for operative cases, leadership capability, and technical operative expertise.

Conclusions:

A resident who displays excellence inspires mentorship, which can propel future career success. Faculty agree excellence can be achieved by residents of any stage, although the qualities that define this evolve by training year. Preparation for operative cases is considered a critical component of resident performance at all levels. Bedside manner and personality are ways intern and junior level residents excel, whereas leadership ability and technical expertise in the operating room become significant in senior and chief trainees.

Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery

BACKGROUND

Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery.

OBJECTIVE

This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field.

DESIGN

A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy.

RESULTS

134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%).

CONCLUSION

The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.

Evaluation of Research Opportunities and Limitations for Plastic Surgery Residents: An International Survey

BACKGROUND

Conducting research during specialty training provides an opportunity to develop critical thinking and leadership skills along with a better understanding of the scientific literature. However, trainees often find it difficult to undertake research, in the context of labor-intensive surgical training. The aim of this study is to evaluate the research output and limitations of plastic surgery residents in different countries.

METHODS

An international cross-sectional study involving plastic surgery trainees and recent postgraduates from Brazil, Chile, Germany, and the United Kingdom was conducted. A survey inquiring into academic productivity, limitations to conducting research, and working-hours patterns was distributed among eligible participants.

RESULTS

From September to December 2019, 106 surveys were retrieved. Most respondents declared having participated in at least 1 project that resulted in a presentation or publication during their training (90.6% in national presentations, 68% international presentations, 67% in national publications, and 66% international publications). Having completed a previous research fellowship was associated with a statistically higher academic output (P < 0.05). Seventy-nine percent of respondents felt that their participation in research activities would have been greater if limiting factors had been addressed, including lack of time (72.5%) and insufficient supervision and mentoring (55%).

CONCLUSIONS

Optimizing plastic surgery trainees' participation in scientific research is beneficial both for residents and their mentors. Research fellowships can provide an opportunity for academically oriented trainees to further develop their research skills. Protected time and adequate mentoring can help not only to increase residents' research output, but also to recruit the next generation of academic plastic surgeons.

Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery

BACKGROUND

Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery.

OBJECTIVE

This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field.

DESIGN

A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy.

RESULTS

134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%).

CONCLUSION

The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.

Mentorship in Plastic Surgery: A Critical Appraisal of Where We Stand and What We Can Do Better

SUMMARY

Mentorship is a critical tool for professional development and career success. In academic surgery, supportive mentorship affords higher job satisfaction, academic productivity, and diversity and inclusion. It protects against burnout and increasing academic surgery attrition rates. Women, underrepresented minorities, and junior plastic surgeons report lower job satisfaction and fewer mentorship opportunities. Given the unique challenges these groups face in a constantly changing health care system, the importance of mentorship cannot be overstated. Through a survey of American Society of Plastic Surgeons members, this study evaluated different aspects of mentorship to describe the current state in plastic surgery. Despite 94.05 percent of plastic surgeons believing that mentorship is valuable, only 15.16 percent reported a structured mentorship system, often without evaluation. Male and female participants agree that mentorship is needed for both professional (clinical judgment) and personal (work-life balance) development. Interestingly, women plastic surgeons felt it was important for mentees to have gender and race/ethnicity concordance to their mentors (p < 0.001). There was no agreement regarding the most effective method to implement mentorship programs, highlighting the challenges of this problem. Through thoughtful planning and commitment, mentorship programs can be instituted to benefit not just the mentee, but the mentor as well.

Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia

Graduates of medical school must choose a specific specialty as a life-long practice from a large pool of medical specialties. This decision stands out as one of the most memorable and critical in their lifetimes. To reach such a decision with satisfaction, medical school graduates consider a variety of factors. This is the first study to explore the influential factors on pursuing plastic surgery as a career in Saudi Arabia.

Women in Leadership and Their Influence on the Gender Diversity of Academic Plastic Surgery Programs

BACKGROUND

Women seldom reach the highest leadership positions in academic plastic surgery. Contributing factors include lack of female role models/mentors and lack of gender diversity. Studies show that female role models and mentors are critical for recruiting and retaining female surgeons and that gender diversity within organizations more strongly influences women's career choices. The authors therefore sought to determine the current gender diversity of academic plastic surgery programs and investigate influences of gender and leadership on program gender composition.

METHODS

A cross-sectional study of U.S. plastic surgery residency programs was performed in December of 2018. Genders of the leadership were collected, including medical school dean, department of surgery chair, department/division of plastic surgery chair/chief, plastic surgery program director, plastic surgery faculty, and plastic surgery residents. Gender relationships among these groups were analyzed.

RESULTS

Ninety-nine residency programs were identified (79 integrated with or without independent and 20 independent). Women represented a smaller proportion of academic plastic surgeons in more senior positions (38 percent residents, 20 percent faculty, 13 percent program directors, and 8 percent chairs). Plastic surgery chair gender was significantly correlated with program director gender, and plastic surgery faculty gender was significantly associated with plastic surgery resident gender. Although not statistically significant, female plastic surgery chair gender was associated with a 45 percent relative increase in female plastic surgery residents.

CONCLUSIONS

Women in leadership and gender diversity influence the composition of academic plastic surgery programs. Gender disparity exists at all levels, worsening up the academic ladder. Recruitment, retention, and promotion of women is critical, as such diversity is required for continued progress in innovation and problem-solving within plastic surgery.

Career Development in Plastic Surgery

SUMMARY

Professional development as a plastic surgeon is a critical component of a balanced and rewarding career. The phase of career plays an important role in what opportunities are available and what decisions must be made to affect the trajectory of the surgeon's life and practice. Engagement and proactive strategic planning can help identify these points in a career. The goal of this article is to describe some of the fundamental choices in professional development, discuss recent literature related to the phases of career progression, and present the construct of career as a continuum integrated with life goals. Foundational career planning has roots even before becoming a resident or fellow, with increasing attention paid during medical school and undergraduate years. Mentorship and leadership roles, and work-life balance challenges, grow with entry into practice. Career sustainment with continuing education, ergonomic resources, and transition to retirement become important considerations for the experienced surgeon. Career success is a diverse vision, with composition unique to the individual surgeon. Understanding the merit of different career directions will help the surgeon take full advantage of the plethora of opportunities available in the plastic surgery specialty. Importantly, this planning and engagement has contributed to the decreased rate of burnout seen in plastic surgery.

What Does It Take to Become an Academic Plastic Surgeon in Canada: Hiring Trends Over the Last 50 Years

Objective: Academic plastic surgery positions have become highly competitive secondary to delayed retirement, stagnant hospital funding, and an increasing number of plastic surgery graduates. Little information is available to help residents navigate this challenging landscape. Our objectives were to evaluate the training backgrounds of all Canadian academic plastic surgeons and to develop recommendations for residents interested in an academic career. Methods: All Canadian academic plastic surgeons were included. Training histories were obtained from institutions’ websites. Surgeons were subsequently emailed to confirm this information and complete missing details. Multivariate regressions were designed to analyze the effect of gender and FRCSC year on graduate and fellowship training and time to first academic position. Results: Training information was available for 196 surgeons (22% female), with a 56% email response rate; 91% of surgeons completed residency in Canada; 94% completed fellowship training, while 43% held graduate degrees; 74% were employed where they previously trained. Female gender significantly lengthened the time from graduation to first academic job, despite equal qualification. Younger surgeons were more likely to hold graduate degrees (P < .01). Conclusions: We identified objective data that correlate with being hired at an academic centre, including training at the same institution, obtaining a graduate degree during residency, and pursuing fellowship training. In addition, we demonstrated that women take significantly longer to acquire academic positions (P < .01), despite equal qualification. Trainees should consider these patterns when planning their careers. Future research should explore gender-based discrepancies in hiring practices.

Self-development Tools Utilized by Plastic Surgeons: A Survey of ASPS Members

The plastic surgery literature is devoid of research on the topic of professional development tools that may be used to enhance performance as a plastic surgeon. After an extensive review of the medical literature, we selected the most frequently referenced professional development tools utilized by plastic surgeons, which included the following: goal setting, positive visualization, scheduled practice, critically analyzing mistakes, professional development conferences, involvement in sports, motivational videos, podcasts & audiobooks, daily morning routines, self-development books, and advice from mentors.

METHODS

A 10-question survey was sent to 2542 members of the American Society of Plastic Surgeons (ASPS). The algorithm used to select ASPS members to survey was based on member demographics that would best reflect the views of the entire active society membership. Responses were compared based on demographic factors such as type of practice, gender, and age.

RESULTS

A total of 286/2542 (11.25%) ASPS members participated in the survey. Analyzing mistakes (96.3%), goal setting (88.51%), and advice from mentors (85.2%) were most commonly attributed to self-development. Respondents in an academic practice favored conferences and advice from mentors. Participants in a solo practice favored self-help books and morning routines. No statistical differences were observed based on training background.

CONCLUSIONS

ASPS members attribute their professional development to setting measurable goals, carefully analyzing surgical mistakes, and guidance from mentors. This information opens the door for continued analysis of professional development within plastic surgery as well as supplement training practices at the resident and post-graduate level.

Modifiable risk factors for burnout in vascular surgery trainees

OBJECTIVE

Burnout is prevalent among vascular surgery trainees. Here we aim to identify modifiable risk factors for burnout in vascular surgery training, to facilitate the development of programs to enhance and sustain trainee well-being.

METHODS

The Association of Program Directors in Vascular Surgery issued the Annual Training survey in the fall of 2018 to all trainees. The survey contained items to assess frequency of burnout, as well as mentorship, training environment, and stress coping mechanisms using an abbreviated COPE (Coping Orientation to Problems Experienced) inventory.

RESULTS

Of 628 surveys issued, the response rate was 30% (n = 188). Respondents indicated that the majority of programs offer mentorship opportunities (n = 150 [83%]) that are longitudinal throughout the duration of training (n = 140 [77%]). Fifty-eight percent (n = 109) indicated there was an appropriate balance between learning and productivity in their program, with more respondents leaning toward too much clinical productivity (n = 57) and fewer toward too much learning (n = 19). Forty-five percent of respondents indicated feeling burnout at least weekly (n = 81). The burnout group was less likely to report an appropriate balance between clinical productivity and learning (49.4% vs 67.7%; P < .001), as well as a lower frequency of mentorship opportunities (72.1% vs 92.7%; P < .001). Certain coping skills were used more frequently in the burnout group, including self-distraction, disengagement, humor, self-blame, and substance use. In multivariate analysis, frequent use of self-blame conferred a 9.847-fold increased risk (95% confidence interval, 2.114-45.871) of burnout (P = .003), while feeling appropriately challenged by the faculty was significantly protective (odds ratio for burnout, 0.158; 95% confidence interval, 0.031-0.820; P = .03).

CONCLUSIONS

The protective effect against vascular surgery trainee burnout conferred by the availability of mentorship suggests that an expansion and emphasis on mentorship in training may help to mitigate trainee burnout. Mentorship may also be a suitable channel to assess for an appropriate level of challenge, as well as for an appropriate balance between clinical productivity and learning that, when present, are also protective against burnout. Furthermore, the correlation between the frequent use of certain coping skills and burnout highlight this as an area for intervention, potentially through a combination of mentor modeling and formal training on healthy stress-related coping strategies.

Factors That Affect Medical Students' Perception and Impression of a Plastic Surgery Program: The Role of Elective Rotations and Interviews

OBJECTIVE

Securing a residency training position in plastic surgery is highly competitive each year with a limited quota of positions and numerous qualified applicants. Although previous studies have highlighted the importance of residency programs and applicants seeking a "good fit," it remains poorly understood what influences a medical student's impression and desire to train at a certain program over others. The objective of this cross-sectional study was to identify which specific potentially modifiable factors during elective rotations and program interviews were most important to Canadian medical students when ranking plastic surgery programs.

METHODS

An electronic survey with 42 questions was administered to Canadian final year medical students who applied through the 2017 Canadian Residency Match Service to the plastic surgery training program at the University of Toronto. The survey consisted of 7-point Likert scale questions related to demographics, general factors affecting impression of a plastic surgery program, and specific factors related to the elective and interview experiences. Survey responses were collected anonymously for analysis.

RESULTS

Twenty-three of 46 applicants completed the survey (50% response rate). The most important general factors affecting a medical student's impression and desire to train at a residency program were mentors at a specific program (weighted average, 6.39) and geographic location of a program (weighted average, 5.65). During elective rotations, the most important factors identified were overall impression of resident and staff collegiality (weighted average, 6.57), overall impression of resident happiness (weighted average, 6.52), and having a formal rotation-end debrief evaluation with the supervising staff (weighted average, 6.04). At program interviews, perceiving an atmosphere of collegiality (weighted average, 6.45) and opportunities to interact with residents and faculty at an organized social event (weighted average, 5.95) were considered of greatest importance.

CONCLUSIONS

Current applicants to plastic surgery in Canada prioritize resident happiness, program collegiality, and meaningful faculty relationships, such as those with a mentor, when ranking residency programs. Although finding a mutually "good fit" between applicant and program will remain a major aim, these findings indicate the importance of certain tangible, potentially modifiable factors that affect how medical students ultimately perceive and rank plastic surgery programs.

Racial and Ethnic Disparities Among Burn Surgery Leadership

The underrepresentation of racial and ethnic minority groups has been well-documented in general and plastic surgery but not in burn surgery. The aim of this study is to evaluate current minority group disparities among burn surgery leadership. A cross-sectional analysis was performed. Burn surgeons included directors of American Burn Association-verified burn centers in the United States, past and current presidents of the American Burn Association, and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and Hirsch index (h-index). Among 71 burn center directors, 50 societal presidents, and 197 journal editors, minority groups represented 18.3, 2.0, and 34.5%, respectively. Among burn center directors, the group classified collectively as nonwhite was significantly younger (49 vs 56; P &lt; .01), graduated more recently (2003 vs 1996; P &lt; .01), and had a lower h-index (9.5 vs 17.4; P &lt; .05). There were no significant differences in gender, type of residency training, advanced degrees obtained, fellowships, academic rank, and academic leadership positions between white and nonwhite groups. When compared with the 2018 U.S. National Census, burn unit directors had a 5.1% decrease in nonwhite representation. Disparities in representation of ethnic and racial minorities exist in burn surgery despite having similar qualifying factors.

Improving Information and Communications Technology (ICT) Knowledge and Skills to Develop Health Research Capacity in Kenya

Objectives Information and communication technology (ICT) tools are increasingly important for clinical care and international research. Many technologies would be particularly useful for healthcare workers in resource-limited settings; however, these individuals are the least likely to utilize ICT tools due tolack of knowledge and skills necessary to use them. Our program aimed to train researchers in low-resource settings on using ICT tools and to understand how different didactic modalities build knowledge and skills in this area. Methods We conducted a tiered, blended learning program for researchers in Kenya on three areas of ICT: geographic information systems, data management, and communication tools. Each course included three tiers: online courses, skills workshops, and mentored projects. Concurrently, a training of trainers course was taught to ensure sustainable ongoing training. A mixed qualitative and quantitative survey was conducted at the end of each training to assess knowledge and skill acquisition. Results Course elements that incorporated local examples and hands-on skill building activities were most valuable. Discussion boards were sometimes distracting, depending on multiple factors. Mentored projects were most useful when there were clear expectations, pre-existing projects, and clear timelines. Discussion Training in the use of ICT tools is highly valued among researchers in low-income settings, particularly when it includes hands-on skill-building and local examples. Our students demonstrated acquisition of new skills and felt these skills to be valuable in their workplaces. Conclusions Further training in ICT skills should be considered in other low-resource settings using our program as a foundational model.

Standing on the Shoulders of Giants: Dental Students Seek Academically Productive Mentors

PURPOSE

The purpose of this study was to determine whether a strong statistical correlation exists between the involvement of trainee groups and the academic productivity of the senior author.

MATERIALS AND METHODS

A retrospective cohort study of publications in the Journal of Oral and Maxillofacial Surgery from 2002 to 2016 was designed and implemented. The primary predictor variables were the presence of a trainee (dental student or oral and maxillofacial surgery [OMS] resident), year of publication, and study design and topic. The outcome variable was the Hirsch index (h-index) of the senior author. Author affiliations were queried using ScienceDirect, and the Scopus database was used to identify the h-index of the senior author from each publication spanning the previous 15 years. Descriptive statistics and t tests were performed to determine significance.

RESULTS

Of the 6,398 articles published in the Journal of Oral and Maxillofacial Surgery from January 2002 to December 2016, 1,341 (21.0%) met the inclusion criteria. The mean h-index of senior authors of articles with trainees or OMS residents was not significantly different from the mean h-index of senior authors without trainees (P = .50) or OMS residents (P = .37), whereas the mean h-index of senior authors working with dental students was significantly greater than the h-index of those not working with dental students (P < .01). Dental student mentors had a mean h-index that was below the sample mean from 2002 to 2007 but rose above the sample mean from 2010 to 2016. Trainees were more likely to work with academically productive mentors in orthognathic surgery (P < .01), temporomandibular joint (P < .05), retrospective cohort (P < .05), and innovative technique (P < .05) studies but less likely in randomized controlled trials (P < .05).

CONCLUSIONS

Dental students seek more academically productive mentors to a greater degree. More studies should be conducted to elucidate the attributes of the ideal mentor in academic OMS and to determine whether differences in mentorship exist between domestic and foreign OMS programs.

A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery

BACKGROUND

Mentoring is crucial to the growth and development of mentors, mentees, and host organisations. Yet, the process of mentoring in surgery is poorly understood and increasingly mired in ethical concerns that compromise the quality of mentorship and prevent mentors, mentees, and host organisations from maximising its full potential. A systematic scoping review was undertaken to map the ethical issues in surgical mentoring to enhance understanding, assessment, and guidance on ethical conduct.

METHODS

Arksey and O'Malley's methodological framework was used to guide a systematic scoping review involving articles published between January 1, 2000 and December 31, 2018 in PubMed, Embase, Scopus, ERIC, ScienceDirect, Mednar, and OpenGrey databases. Braun and Clarke's thematic analysis approach was adopted to compare ethical issues in surgical mentoring across different settings, mentee and mentor populations, and host organisations.

RESULTS

A total of 3849 abstracts were identified, 464 full-text articles were retrieved, and 50 articles were included. The 3 themes concerned ethical lapses at the levels of mentor or mentee, mentoring relationships, and host organisation.

CONCLUSIONS

Mentoring abuse in surgery involves lapses in conduct, understanding of roles and responsibilities, poor alignment of expectations, and a lack of clear standards of practice. It is only with better structuring of mentoring processes and effective support of host organisation tasked with providing timely, longitudinal, and holistic assessment and oversight will surgical mentoring overcome prevailing ethical concerns surrounding it.

The Canadian Plastic Surgery Workforce Analysis: Forecasting Future Need

BACKGROUND

Projecting the demand for plastic surgeons has become increasingly important in a climate of scarce public resource within a single payer health-care system. The goal of this study is to provide a comprehensive workforce update and describe the perceptions of the workforce among Canadian Plastic Surgery residents and surgeons.

METHODS

Two questionnaires were developed by a national task force under the Canadian Plastic Surgery Research Collaborative. The surveys were distributed to residents and practicing surgeons, respectively.

RESULTS

Two-hundred fifteen (49%) surgeons responded, with a mean age of 51.4 years (standard deviation [SD] = 11.5); 78% were male. Thirty-three percent had been in practice for 25 years or longer. More than half of respondents were practicing in a large urban center. Fifty-nine percent believed their group was going to hire in the next 2 to 3 years; however, only 36% believed their health authority/provincial government had the necessary resources. The mean desired age of retirement was 67 years (SD = 6.4). We predict the surgeons-to-population ratio to be 1.55:100 000 and the graduate-to-retiree ratio to be 2.16:1 within the next 5 to 10 years. Seventy-seven (49%) residents responded. Most were "very satisfied" with their training (61%) and operative experience (90%). Eighty-nine percent of respondents planned to pursue addqitional training after residency, with 70% stating that the current job market was contributing to their decision. Most residents responded that they were concerned with the current job market.

CONCLUSIONS

The results of this study predict an adequate number of plastic surgeons will be trained within the next 10 years to suit the population's requirements; however, there is concern that newly trained surgeons will not have access to the necessary resources to meet growing demands. Furthermore, there is an evident shortage of those practicing in rural areas. Many trainees worry about the availability of jobs, despite evidence of active recruitment. The workforce may benefit from structured career mentorship in residency and improved transparency in hiring practices, particularly to attract young surgeons to smaller communities. It may also benefit from a coordinated national approach to recruitment and succession planning.

Undergraduate Plastic Surgery Education: A National Survey of Clerkship Directors

Background

The delivery of medical education has received increased attention in recent years due to ongoing time and financial constraints faced by medical educators. Given the recent calls to action by the Carnegie Foundation and Health Canada, an evaluation of the specialty education sector is warranted. To our knowledge, this is the first assessment of the Canadian plastic surgery undergraduate clerkship curriculum.

Method

An anonymous electronic survey was distributed to the plastic surgery clerkship directors of all Canadian medical schools (N = 17). The survey consisted of Likert scales and open-ended short answer questions. Themes included general clerkship information, exposure characteristics, teaching characteristics, resource characteristics, and challenges and barriers faced by clerkship directors.

Results

Survey response rate was 88%. All responding schools offered a clerkship rotation of varying length in time (1-4 weeks). Students had the most exposure to breast surgery (100%) and general plastic surgery (100%) and the least exposure to aesthetic surgery (40%). Sixty percent of schools indicated the use of modern educational methods. Resources available for teaching students varied. Rotations received excellent feedback from medical students (67%). More than half of respondents would like to see a universal, nationally formulated plastic surgery clerkship curriculum.

Conclusion

There is significant heterogeneity in the delivery of plastic surgery clerkship in Canada. A number of areas for improvement have been identified. We hope to establish a national plastic surgery clerkship task force to address the concerns raised here and improve the delivery of undergraduate medical education. Assessment of students based on a national curriculum may help in decision-making regarding plastic surgery program admissions by introducing an element of standardization to clerkship exposure.

All That You Can't Leave Behind: Professionalism as the Focus of Mentoring and Modeling

Mentoring serves a critical and necessary role not only in the advancement of plastic surgery, but also in maintaining the health of our specialty. In addition to providing a driving force for innovation--which remains the core competency of plastic surgery--mentoring is a powerful, educational tool that helps us teach the critical skills of communication and model the tenets of professionalism. Our identity as innovators, healers, and providers of hope is dependent on conferring what it means to be a professional, from those who are just beginning their journey as surgeons, to those who are still on that odyssey.

Mentoring in general surgery in Switzerland

BACKGROUND

Mentorship has been found as a key factor for a successful and satisfying career in academic medicine and surgery. The present study was conducted to describe the current situation of mentoring in the surgical community in Switzerland and to evaluate sex differences regarding the impact of mentoring on career success and professional satisfaction.

METHODS

The study was designed as an anonymous national survey to all members of the Swiss Surgical Society in 2011 (820 ordinary and 49 junior members). It was a 25-item questionnaire addressing mentor-mentee relationships and their impact on the professional front.

RESULTS

Of the 869 mailed surveys, 512 responses were received (response rate: 58.9%). Mentor-mentee relationships were reported by 344 respondents (68.1%) and structured mentoring programs were noted in 23 respondents (6.7%). Compared to individuals without mentors, male mentees exhibited significantly higher subjective career advancement (5.4±1.2 vs. 5.0±1.3; p=0.03) and career development (3.3±1.9 vs. 2.5±1.7; p<0.01) scores, but the differences for female mentees were not statistically significant (4.7±1.1 vs. 4.3±1.2, p=0.16; 2.5±1.6 vs. 1.9±1.4, p=0.26; respectively). The pursuit of an academic career was not influenced by the presence of a mentor-mentee relationship for female (p=0.14) or male participants (p=0.22).

CONCLUSIONS

Mentor-mentee relationships are important for the career advancement of male surgeons. The reason for the lack of an impact on the careers of female surgeons is difficult to ascertain. However, mentoring also provides lifelong learning and personal development. Thus, specific attention should be paid to the development of more structured mentoring programs for both sexes.

Influence of training institution on academic affiliation and productivity among plastic surgery faculty in the United States

BACKGROUND

Educational processes that encourage a career in academic plastic surgery remain unclear. The authors' study aim was to examine the impact of training institution on the pursuit of a career in academic plastic surgery.

METHODS

Academic plastic surgery faculty (n = 838) were identified through an Internet-based search of all 94 Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs. Academic productivity was determined by number of peer-reviewed publications and Scopus h-index. Linear and logistic regression analyses were performed to determine the correlation between attributes after adjusting for the clustering of surgeons within programs.

RESULTS

In the United States, 39 percent of plastic surgeons in academic practice are trained in only 11 programs, 30 percent of faculty remained at training institutions, and 39 percent were affiliated with a private practice model. Faculty from frequently represented training programs were more likely to pursue fellowship training (OR, 1.32; 95 percent CI, 1.00 to 1.75), have higher h-indices (9.0 versus 5.4; p < 0.001), and have a greater number of peer-reviewed articles (46.6 versus 24.3; p < 0.001). Higher h-indices were correlated with male sex (7.1 versus 4.7; p < 0.001), fellowship training (7.3 versus 6.1; p < 0.05), and no private practice affiliation (5.2 versus 7.8; p < 0.001). Female surgeons represented 14.1 percent of academic plastic surgeons, were younger based on the median year of board certification (2005 versus 2000; p < 0.05), and were more likely to be on the tenure track (66.9 percent versus 57.2 percent; p < 0.05) and at the assistant professor level (73.1 percent versus 43.6 percent; p < 0.05).

CONCLUSION

Identification of educational processes that encourage a career in academic practice may improve resident mentorship and resident interest in academic plastic surgery.

Funding research in the twenty-first century: current opinions and future directions

For all academic biomedical researchers, the process of submitting grants and securing research funding is a critical part of advancing one's career. In the current era of decreasing new grant awards and renewals leading to significantly worse success rates, it is hard for young aspiring physician-scientists to remain optimistic regarding their future in academic medicine. It is important that today's young surgeon-scientists prepare for and adapt to the inevitably changing climate of research funding. This article provides a primer on developing a successful career as a funded surgeon-scientist and pathways for building a robust research platform worthy of extramural National Institutes of Health funding in the twenty-first century.

Impact of mentoring medical students on scholarly productivity

BACKGROUND

Our objectives were to evaluate collaboration with medical students and other nondoctoral authors, and assess whether mentoring such students influences the academic productivity of senior authors.

METHODS

Six issues of the Laryngoscope and International Forum of Allergy & Rhinology (IFAR) were examined for the corresponding author of each manuscript, and whether any students were involved in authorship. The h-index of all corresponding authors was calculated using the Scopus database to compare the scholarly impact of authors collaborating with students and those collaborating exclusively with other physicians or doctoral-level researchers.

RESULTS

Of 261 Laryngoscope manuscripts, 71.6% had exclusively physician or doctoral-level authors, 9.2% had "students" (nondoctoral-level authors) as first authors, and another 19.2% involved "student" authors. Corresponding values for IFAR manuscripts were 57.1%, 6.3%, and 36.5%. Corresponding authors who collaborated with students had higher scholarly impact, as measured by the h-index, than those collaborating exclusively with physicians and doctoral-level scientists in both journals.

CONCLUSION

Collaboration with individuals who do not have doctoral-level degrees, presumably medical students, has a strong association with scholarly impact among researchers publishing in the Laryngoscope and IFAR. Research mentorship of medical students interested in otolaryngology may allow a physician-scientist to evaluate the students' effectiveness and functioning in a team setting, a critical component of success in residency training, and may have beneficial effects on research productivity for the senior author.

Application of the "see one, do one, teach one" concept in surgical training

BACKGROUND

The traditional method of teaching in surgery is known as "see one, do one, teach one." However, many have argued that this method is no longer applicable, mainly because of concerns for patient safety. The purpose of this article is to show that the basis of the traditional teaching method is still valid in surgical training if it is combined with various adult learning principles.

METHODS

The authors reviewed literature regarding the history of the formation of the surgical residency program, adult learning principles, mentoring, and medical simulation. The authors provide examples for how these learning techniques can be incorporated into a surgical resident training program.

RESULTS

The surgical residency program created by Dr. William Halsted remained virtually unchanged until recently with reductions in resident work hours and changes to a competency-based training system. Such changes have reduced the teaching time between attending physicians and residents. Learning principles such as experience, observation, thinking, and action and deliberate practice can be used to train residents. Mentoring is also an important aspect in teaching surgical technique. The authors review the different types of simulators-standardized patients, virtual reality applications, and high-fidelity mannequin simulators-and the advantages and disadvantages of using them.

CONCLUSIONS

The traditional teaching method of "see one, do one, teach one" in surgical residency programs is simple but still applicable. It needs to evolve with current changes in the medical system to adequately train surgical residents and also provide patients with safe, evidence-based care.