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Zmijewski P, Park YS, Hogan S, Holmboe E, Klingensmith M, Cortez A, Lindeman B, Chen H, Smith B, Fazendin J. Trends in Operative Case Logs of Chief Residents in Surgery by Sex and Race: A 5-year National Study. Ann Surg 2024; 280:473-479. [PMID: 38957982 DOI: 10.1097/sla.0000000000006373] [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: 07/04/2024]
Abstract
OBJECTIVE To examine case logs reported by general surgery residents and identify potential disparities in operative experience. BACKGROUND A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time these data have been examined nationally. METHODS We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t tests for female versus male and URiM versus non-URiM overall case numbers. RESULTS A total of 6458 residents submitted case logs from 319 accredited programs. Eight-hundred fifty-four (13%) were URiM and 5604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD ± 160.57) major cases versus 1115.96 (±160.53) for non-URiM residents (difference = 19 cases, P = 0.001). Case logs were submitted by 3833 (60.1%) male residents and 2625 (39.9%) female residents over the 5-year study period. Male residents reported 1128.56 (SD ± 168.32) cases versus 1091.38 (±145.98) cases reported by females (difference = 37.18, P < 0.001). When looking at surgeon chief and teaching assistant cases, there was no significant difference noted between cases submitted by URiM versus non- URiM residents. However, male residents reported significantly more in both categories than their female peers ( P < 0.001). CONCLUSIONS Overall, URiM residents submitted fewer cases in the 5-year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30 to 40 cases can amount to 1 to 3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.
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Affiliation(s)
- Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Yoon Soo Park
- Department of Surgery, University of Illinois College of Medicine, Chicago, IL
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Sean Hogan
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Mary Klingensmith
- Accreditation Council for Graduate Medical Education, Chicago, IL
- Department of Surgery, Washington University in St Louis, St Louis, MO
| | - Alexander Cortez
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Brigitte Smith
- Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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Barranquero AG, Maestre González Y, Mestres Petit N, Gas Ruiz C, Codina-Corrons L, Sisó Soler E, Villalobos Mori R, Olsina Kissler JJ. Delay in the residents' choice for General and Digestive Surgery: Analysis of the period 2018-2022. Cir Esp 2024; 102:408-416. [PMID: 37993098 DOI: 10.1016/j.cireng.2023.08.006] [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: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties. METHODS Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted. RESULTS The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621-3284) in 2018, and 3484 (IQR: 2306-4156) in 2022 (p: .000). These differences remained significant after adjusting for the number of available positions (p: .000). The choice of Urology, Thoracic Surgery, Cardiovascular Surgery, Gastroenterology, and Paediatrics also declined during this period, while Plastic Surgery, Dermatology, Ophthalmology, Anesthesiology, and Endocrinology improved their numbers. CONCLUSION The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018-2022. The increase in the number of available positions has not been associated with a proportional increase in demand.
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Affiliation(s)
- Alberto G Barranquero
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain.
| | - Yolanda Maestre González
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain
| | - Núria Mestres Petit
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain
| | - Cristina Gas Ruiz
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain
| | - Laia Codina-Corrons
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain
| | - Eduardo Sisó Soler
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain
| | - Rafael Villalobos Mori
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain
| | - Jorge Juan Olsina Kissler
- Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, Spain
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Merchant AAH, Shah SA, Khursheed AA, Ali M, Najam S, Farooq R, Bakhshi SK, Afzal N, Rahim KA, Shaikh NQ, Haider AH. Quality of Trauma Surgery Podcasts in Credibility, Content, and Design. JAMA Netw Open 2024; 7:e2415636. [PMID: 38900427 PMCID: PMC11190801 DOI: 10.1001/jamanetworkopen.2024.15636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/04/2024] [Indexed: 06/21/2024] Open
Abstract
Importance There has been an emerging trend of podcast use in medical education over the past decade. With the increasing number of podcasts and learners' interest in trauma surgery, it is vital to validate the quality of these podcasts. Objective To determine the quantity and quality of podcast episodes on trauma surgery. Design, Setting, and Participants This cross-sectional study identified trauma surgery podcasts published globally on the Google, Apple, and Spotify platforms as of May 31, 2023. An initial screening excluded podcasts not fulfilling the inclusion criteria (published as of May 31, 2023, and covering clinical knowledge or mentorship on general trauma surgery). A 10-item checklist developed from a modified Delphi consensus method was created to assess the podcasts' credibility, content, and design as indicators of quality. Data extracted from each podcast episode included the duration, setting, host and guest credentials, and fulfillment of quality indicators. Data were analyzed on August 13, 2023. Main Outcomes and Measures The quality of each podcast was assessed using the 10-question checklist. A score of at least 80% in credibility (4 of 5 points), 75% in content (3 of 4 points), and 100% in design (1 of 1 point) was required to classify a podcast episode as having good quality. Results The initial search identified 204 podcasts on trauma surgery, of which 55 podcasts met the inclusion criteria. All 55 podcasts were published after 2014, with the majority hosted by males (85% [61 of 72 hosts]), based in the US (91% [50 of 55 podcasts]), and focused on clinical knowledge (80% [44 of 55 podcasts]). Podcast hosts and guests predominantly held a Doctor of Medicine degree (83% [113 of 136]), with 72% [46 of 64] of guests identifying as practicing trauma surgeons. While all 55 podcasts had excellent quality in terms of content and design, 20% (11 of 55) of podcasts were rated poorly on credibility. Credibility was further reduced for 60% (33 of 55) of podcasts because of nondisclosure of conflicts of interest. Conclusions and Relevance In this cross-sectional study of trauma surgery podcasts, most had good-quality content and design, but there was a lack of explicit conflict of interest disclosure. Content producers need to disclose their conflicts of interest appropriately to ensure credibility and improve the quality of their podcasts.
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Affiliation(s)
| | - Shayan Ali Shah
- Dean’s Office, Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Madeeha Ali
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Sohaib Najam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Rimsha Farooq
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Saqib Kamran Bakhshi
- Dean’s Office, Medical College, Aga Khan University, Karachi, Pakistan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Noreen Afzal
- Dean’s Office, Medical College, Aga Khan University, Karachi, Pakistan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Komal Abdul Rahim
- Dean’s Office, Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Adil H. Haider
- Dean’s Office, Medical College, Aga Khan University, Karachi, Pakistan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Geoffrion R, Koenig NA, Cundiff GW, Flood C, Hyakutake MT, Schulz J, Brennand EA, Lee T, Singer J, Todd NJ. Procedure-specific simulation for vaginal surgery training: A randomized controlled trial. Acta Obstet Gynecol Scand 2024; 103:1165-1174. [PMID: 38382912 PMCID: PMC11103140 DOI: 10.1111/aogs.14810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure-specific simulation skills, vs usual training, result in improved operative competence. MATERIAL AND METHODS We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair (PR), vaginal hysterectomy (VH), recruiting novice gynecology residents at three academic centers. We evaluated performance via global rating scale (GRS) in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self-confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05). CLINICALTRIALS gov: Registration no. NCT05887570. RESULTS We randomized 83 residents to intervention or control and 55 completed the trial (2011-23). Baseline characteristics were similar, except for more fourth-year control residents. After adjustment of confounders (age, level, baseline knowledge), GRS scores showed significant differences overall (mean difference 8.2; 95% confidence interval [CI]: 0.2-16.1; p = 0.044) and for VH (mean difference 12.0; 95% CI: 1.8-22.3; p = 0.02). The intervention group had significantly higher procedural steps knowledge and self-confidence for VH and/or PR (p < 0.05, adjusted analysis). Estimated blood loss, operative time and complications were similar between groups. CONCLUSIONS Compared to usual training, procedure-specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters.
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Affiliation(s)
- Roxana Geoffrion
- Division of Gynecologic Specialties, Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nicole A. Koenig
- Division of Gynecologic Specialties, Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Geoffrey W. Cundiff
- Division of Gynecologic Specialties, Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Catherine Flood
- Division of Urogynecology, Department of Obstetrics and GynecologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Momoe T. Hyakutake
- Division of Urogynecology, Department of Obstetrics and GynecologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Jane Schulz
- Division of Urogynecology, Department of Obstetrics and GynecologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Erin A. Brennand
- Division of Urogynecology, Department of Obstetrics and GynecologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Terry Lee
- Centre for Advancing Health OutcomesVancouverBritish ColumbiaCanada
| | - Joel Singer
- Centre for Advancing Health OutcomesVancouverBritish ColumbiaCanada
| | - Nicole J. Todd
- Division of Gynecologic Specialties, Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Wilson DJ, Higgins RM. Invited commentary: Surgical training disparities - How can we bridge the gender gap? Am J Surg 2024:115775. [PMID: 38811242 DOI: 10.1016/j.amjsurg.2024.115775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Danielle J Wilson
- Medical College of Wisconsin, Department of Surgery, 8701 W Watertown Plank Rd, Milwaukee, WI, USA
| | - Rana M Higgins
- Medical College of Wisconsin, Department of Surgery, 8701 W Watertown Plank Rd, Milwaukee, WI, USA.
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Parks MA, Gaskins JT, Jin A, Galandiuk S, Kavalukas SL. You Want to be a Surgical Leader? Consider Training Elsewhere - An Observation of How Training Background May Impact Leadership Selection. JOURNAL OF SURGICAL EDUCATION 2024; 81:564-569. [PMID: 38388306 DOI: 10.1016/j.jsurg.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/15/2023] [Accepted: 12/22/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The significance of thought differences has always held importance in medicine, but it could be considered as increasingly acknowledged and valued to a greater extent in recent times as more emphasis is placed on diversity, equity, and inclusion. These unique perspectives have been examined according to race, gender, and ethnicity, but there is limited published data examining the prevalence of leadership roles within surgical departments in terms of training background. Our main objective is to identify trends in surgical leaders' education, and emphasize training diversity in surgical leadership. DESIGN A descriptive study of the training background of all surgical academic leaders. SETTING This internet search was performed at a tertiary care, academic medical center. PARTICIPANTS Academic chairpersons, division directors, and program directors. RESULTS 124 programs had pertinent information available. There was a mean of 7.6 leaders per institute examined: total 939 positions (119 chairs, 704 division directors, 116 program directors). 90/119 (76%) of the Chairs led at institutions outside of the places they completed their training. 4/119 (3%) did all their training at the same institution they chaired. 25/119 (21%) completed at least some but not all their training there, and later rose to the role of Chair. Among division directors, 217/704 (31%) did some training at that institution, and program directors were significantly more likely to have completed some training at their current institute (53/116, 46%; p = 0.001). There were no statistically significant differences when examined geographically. Women made up 18% of the leaders and were significantly more likely to lead as program director rather than a chair or division director (p < 0.001). CONCLUSION A majority of surgery chairs hold positions at institutions where they did not complete their medical training. This suggests that outside perspective could be a contributing factor when searching for this position.
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Affiliation(s)
- Mary Alex Parks
- University of Louisville, Department of Surgery, Louisville, Kentucky
| | - Jeremy T Gaskins
- University of Louisville, Department of Bioinformatics & Biostatistics, Louisville, Kentucky
| | - Allie Jin
- University of Louisville, Department of Surgery, Louisville, Kentucky
| | - Susan Galandiuk
- University of Louisville, Department of Surgery, Louisville, Kentucky
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García-Vega C, Carbonell Morote S, Villodre Tudela C, Viñas Martinez T, Ramia JM. Gender gap in the general surgery residence. Cir Esp 2024; 102:230-232. [PMID: 38373615 DOI: 10.1016/j.cireng.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024]
Affiliation(s)
- Celia García-Vega
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain.
| | - Silvia Carbonell Morote
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Celia Villodre Tudela
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Tamara Viñas Martinez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - José Manuel Ramia
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
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Lenaine Westney O. Editorial Comment. Urology 2024; 185:24-25. [PMID: 38336132 DOI: 10.1016/j.urology.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Ouida Lenaine Westney
- Department of Urology, University of Texas - MD Anderson Cancer Center, Houston, TX.
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Marchetti KA, Ferreri CA, Bethel EC, Lesser-Lee B, Daignault-Newton S, Merrill S, Badalato GM, Brown ET, Guzzo T, Houston Thompson R, Klausner A, Lee R, Parekh DJ, Raman JD, Reese A, Shenot P, Williams DH, Zaslau S, Kraft KH. Gender-based Disparity Exists in the Surgical Experience of Female and Male Urology Residents. Urology 2024; 185:17-23. [PMID: 38336129 DOI: 10.1016/j.urology.2023.11.035] [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: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To determine if a discrepancy exists in the number and type of cases logged between female and male urology residents. MATERIALS AND METHODS ACGME case log data from 13 urology residency programs was collected from 2007 to 2020. The number and type of cases for each resident were recorded and correlated with resident gender and year of graduation. The median, 25th and 75th percentiles number of cases were calculated by gender, and then compared between female and male residents using Wilcoxon rank sum test. RESULTS A total of 473 residents were included in the study, 100 (21%) were female. Female residents completed significantly fewer cases, 2174, compared to male residents, 2273 (P = .038). Analysis by case type revealed male residents completed significantly more general urology (526 vs 571, P = .011) and oncology cases (261 vs 280, P = .026). Additionally, female residents had a 1.3-fold increased odds of logging a case in the assistant role than male residents (95% confidence interval: 1.27-1.34, P < .001). CONCLUSION Gender-based disparity exists within the urology training of female and male residents. Male residents logged nearly 100 more cases than female residents over 4years, with significant differences in certain case subtypes and resident roles. The ACGME works to provide an equal training environment for all residents. Addressing this finding within individual training programs is critical.
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Affiliation(s)
- Kathryn A Marchetti
- University of Pittsburgh Medical Center, Department of Urology, Pittsburgh, PA.
| | - Charles A Ferreri
- Vanderbilt University Medical Center, Department of Urology, Nashville, TN
| | - Emma C Bethel
- University of North Carolina School of Medicine, Department of Urology, Chapel Hill, NC
| | | | | | | | | | - Elizabeth T Brown
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Thomas Guzzo
- University of Pennsylvania, Department of Urology, Philadelphia, PA
| | | | - Adam Klausner
- Virginia Commonwealth University, Division of Urology, Richmond, VA
| | - Richard Lee
- Weill Cornell Medicine, Department of Urology, New York, NY
| | - Dipen J Parekh
- University of Miami Health System, Department of Urology, Miami, FL
| | - Jay D Raman
- Pennsylvania State University College of Medicine, Department of Urology, Hershey, PA
| | - Adam Reese
- Temple University, Department of Urology, Philadelphia, PA
| | - Patrick Shenot
- Jefferson Health, Department of Urology, Philadelphia, PA
| | | | - Stanley Zaslau
- West Virginia University School of Medicine Urology, Morgantown, WV
| | - Kate H Kraft
- University of Michigan Health System, Department of Urology, Ann Arbor, MI
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