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Kucejko RJ, Breen EM, Kleiman DA, Kuhnen AH, Marcello PW, Saraidaridis JT, Abelson JS. A Growing Divide? Social Determinants of the Use of Nonoperative Management of Rectal Cancer and Its Impact on Survival. J Surg Res 2023; 292:137-143. [PMID: 37619498 DOI: 10.1016/j.jss.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Nonoperative management (NOM) of locally advanced rectal cancer was described as early as 2004. Initial national data demonstrated increase in utilization of NOM from 1998 to 2010, but newer national utilization data are not available. METHODS We performed a retrospective cohort study using the National Cancer Database to assess utilization and 5-y overall survival (OS) of NOM of locally advanced rectal cancer. All patients had American Joint Committee on Cancer stage 2 or 3 rectal cancer, were over 40 y old, received both chemotherapy and radiation therapy, and were not being treated with palliative intent. RESULTS 74,780 patients were analyzed. 64,540 (86.2%) underwent a definitive resection, 10,330 (13.8%) had NOM. Utilization of NOM steadily increased from 11.3% in 2010 to 18.6% in 2018. Multivariate regression identified the highest predictors of utilization of NOM to be uninsured status, government insurance, Black race, and treatment at a community cancer center. Multivariate regression identified NOM as the highest hazard for mortality (hazard ratio = 2.286, confidence interval 2.209-2.366). After propensity score matching, the mean estimated 5-y OS was 52.0% for those managed operatively compared to 39.8% for those managed nonoperatively. CONCLUSIONS From 2004 to 2018, the utilization of NOM of locally advanced rectal cancer significantly increased. However, there was a significant discrepancy in OS in comparison to surgical resection for these patients. Further study is needed to determine the long-term oncologic safety of NOM.
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Affiliation(s)
- Robert J Kucejko
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Elizabeth M Breen
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David A Kleiman
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Angela H Kuhnen
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Peter W Marcello
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Julia T Saraidaridis
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jonathan S Abelson
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Al Jabri A, Bhat H, Abelson JS, Breen EM, Kuhnen AH, Stein SL, Steinhagen E, Saraidaridis JT. The Presence of Implicit Gender Bias in Colon and Rectal Surgery Residency Letters of Recommendation. Dis Colon Rectum 2023; 66:848-856. [PMID: 36876958 DOI: 10.1097/dcr.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Selection for colorectal surgery residency relies on letters of recommendation for assessment of candidates' strengths and weaknesses. It is unclear whether this process incorporates implicit gender bias. OBJECTIVE This study aimed to assess the presence of gender bias in letters of recommendation for colorectal surgery residency. DESIGN Mixed methods assessment of the characteristics described within the blinded letters of the 2019 application cycle to a single academic residency. SETTINGS Academic medical center. PATIENTS Blinded letters from the 2019 colorectal surgery residency application cycle. INTERVENTIONS Characteristics of the letters were qualitatively and quantitatively analyzed. MAIN OUTCOME MEASURES Association of gender with the presence of descriptors within the letters. RESULTS A total of 111 applicants, 409 letter writers, and 658 letters were analyzed. Forty-three percent of applicants were female. Female and male applicants had an equal mean number of positive (5.4 vs 5.8; p = 0.10) and negative (0.5 vs 0.4; p = 0.07) attributes represented. Female applicants were more likely to be described as having poor academic skills (6.0 vs 3.4%; p = 0.04) and possessing negative leadership qualities (5.2% vs 1.4%; p < 0.01) than male applicants. Male applicants were more likely to be described as kind (36.6% vs 28.3%; p = 0.03), curious (16.4% vs 9.2%; p = 0.01), possessing positive academic skills (33.7% vs 20.0%; p < 0.01), and possessing positive teaching skills (23.5% vs 17.0%; p = 0.04). LIMITATIONS This study analyzed a single year of applications to an academic center and may not be generalizable. CONCLUSIONS There are differences in the qualities used to describe female versus male applicants in colorectal surgery residency application letters of recommendation. Female applicants were more often described in negative academic terms and possessing negative leadership qualities. Males were more likely to be described as kind, curious, academically impressive, and possessing good teaching skills. The field may benefit from educational initiatives to reduce implicit gender bias in letters of recommendation. See Video Abstract at http://links.lww.com/DCR/C191 . LA PRESENCIA DE SESGO DE GNERO IMPLCITO EN LAS CARTAS DE RECOMENDACIN DE RESIDENCIA EN CIRUGA DE COLON Y RECTO ANTECEDENTES:La selección para la residencia en cirugía colorrectal se basa en cartas de recomendación para la evaluación subjetiva de las fortalezas y debilidades de los candidatos. No está claro si este proceso incorpora un sesgo de género implícito.OBJETIVO:Evaluar la presencia de sesgo de género en las cartas de recomendación para la residencia en cirugía colorrectal.DISEÑO:Evaluación de métodos mixtos de las características descritas dentro de las cartas selladas del ciclo de solicitud de 2019 a una sola residencia académica.ENTORNO CLÍNICO:Centro médico académico.PACIENTES:Cartas selladas del ciclo de solicitud de residencia en cirugía colorrectal de 2019.INTERVENCIONES:Las características de las cartas se determinaron utilizando medidas cualitativas y cuantitativas.PRINCIPALES MEDIDAS DE VALORACIÓN:Asociación del género con la presencia de descriptores dentro de las cartas.RESULTADOS:Hubo 111 solicitantes, 409 escritores de cartas y se analizaron 658 cartas. El 43% de los solicitantes eran mujeres. Los solicitantes masculinos y femeninos tenían el mismo promedio de atributos positivos (5,4 frente a 5,8; p = 0,10) y negativos (0,5 frente a 0,4; p = 0,07) representados. Las solicitantes femeninas tenían más probabilidades de ser descritas como con deficientes habilidades académicas (6,0 frente a 3,4%, p = 0,04) y poseían cualidades de liderazgo negativas (5,2% frente a 1,4%; p < 0,01) en comparacion con los solicitantes masculinos. Los solicitantes masculinos tenían más probabilidades de ser descritos como amables (36,6 % frente a 28,3%; p = 0,03), curiosos (16,4% frente a 9,2%; p = 0,01), que poseían habilidades académicas positivas (33,7 % frente a 20,0%; p < 0,01), y habilidades docentes positivas (23,5% vs 17,0%; p = 0,04).LIMITACIONES:Este estudio analizó un solo año de solicitudes a un centro académico y puede no ser generalizable.CONCLUSIÓN:Existen diferencias en las cualidades utilizadas para describir a los solicitantes femeninos versus masculinos en las cartas de recomendación de solicitud de residencia en cirugía colorrectal. Las candidatas femeninas se describieron con mayor frecuencia en términos académicos negativos y poseían cualidades de liderazgo negativas. Los hombres eran más propensos a ser descritos como amables, curiosos, académicamente impresionantes y con buenas habilidades docentes. El campo puede beneficiarse de iniciativas educativas para reducir el sesgo de género implícito en las cartas de recomendación. Consulte Video Resumen en http://links.lww.com/DCR/C191 . (Traducción-Dr. Ingrid Melo ).
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Affiliation(s)
- Ali Al Jabri
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Hina Bhat
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jonathan S Abelson
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Elizabeth M Breen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Angela H Kuhnen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sharon L Stein
- Division of Colon and Rectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Emily Steinhagen
- Division of Colon and Rectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Julia T Saraidaridis
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
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Aulet TH, Spencer SB, Abelson JS, Breen EM, Kuhnen AH, Saraidaridis JT, Marcello PW, Kleiman DA. Impact of the first COVID-19 surge on the outcomes of diverticulitis. Surgery in Practice and Science 2022; 10:100116. [PMCID: PMC9316939 DOI: 10.1016/j.sipas.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 10/26/2022] Open
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Fogle SE, Donahue CA, Beresneva O, Kuhnen AH, Kleiman DA, Breen EM, Schoetz DJ, Roberts PL, Marcello PW, Saraidaridis JT. Horseshoe Fistulae in the Age of LIFT. J Gastrointest Surg 2022; 26:1077-1083. [PMID: 35064458 DOI: 10.1007/s11605-021-05233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Horseshoe fistula is a challenging benign anorectal condition to treat. The aim of this study was to assess the utilization and success of different definitive fistula repair techniques in the treatment of horseshoe fistula. METHODS This was a retrospective case series which included all patients who were treated for horseshoe fistula from 2006 to 2019 at a single, tertiary care center and whom had at least one follow-up visit. Patients were excluded if < 18 years of age or carried a diagnosis of Crohn's disease. Patients were assessed for fistula recurrence and incontinence. RESULTS Sixty-eight patients were identified. On average, they were 47 years old, 63% male, and 18% current smokers. Seventy-nine percent required seton during their treatment course. Of the 8 first attempts at fistula repair, the types of repair included flap (15%), LIFT (35%), fistulotomy (31%), plug (12%), and fistulotomy and immediate reconstruction (1%). Recurrence for these procedures was as follows: flap 30%, LIFT 21%, fistulotomy 14%, plug 88%, and fistulotomy and immediate reconstruction 0%. Twelve patients who recurred underwent 17 additional procedures to attempt to cure their fistula. Overall, of those who underwent any attempt at definitive repair, 82% of patients were cured of their fistula, 12% had a chronic seton, and 6% had a chronic fistula. Thirteen percent of those who were cured had incontinence. The mean follow-up time was 1.1 years. Patients required a median of 3 procedures (range 1-11). CONCLUSION Horseshoe fistula remains a complex anorectal condition. Successful repair can be performed in > 80% of patients. However, repair can often require multiple surgical procedures.
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Affiliation(s)
- Sydney E Fogle
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Colleen A Donahue
- Division of Colon and Rectal Surgery, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC, 29405, USA
| | - Olga Beresneva
- Division of Colon and Rectal Surgery, Boston Medical Center, 830 Harrison Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Angela H Kuhnen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - David A Kleiman
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Elizabeth M Breen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - David J Schoetz
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Patricia L Roberts
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Peter W Marcello
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA
| | - Julia T Saraidaridis
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA.
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Donahue CA, Kuhnen AH, Kleiman DA, Marcello PW, Schoetz DJ, Roberts PL, Breen EM, Saraidaridis JT. How to Get Ahead: Early-Career Colorectal Surgeons Reflect on Their First Few Years in Practice. J Surg Educ 2021; 78:126-133. [PMID: 32660856 DOI: 10.1016/j.jsurg.2020.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/04/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify strategies and barriers to career progression in early-career colorectal surgeons. DESIGN Qualitative research study performed via semi-structured interviews with early-career, board-certified colon, and rectal surgeons. Responses were analyzed, coded, and categorized to understand strategies towards career progression, perceived barriers to career progression, beliefs about case mix, and referral patterns. SETTING Interviews conducted in person and via telephone across the United States and Canada. PARTICIPANTS Early-career board-certified colorectal surgeons RESULTS: Twenty-two board-certified colorectal surgeons currently employed in 14 states and 1 foreign country were interviewed. Fourty-five percent were female. Their current practice environment was described as academic (77%), private practice (18%), or military (5%). Seventy-seven percent of surgeons were satisfied with their career progression. Seventy-two percent were satisfied with the case volume. Seventy-two percent were satisfied with their case mix. When asked about strategies for career progression, surgeons made 77 comments focused on three main themes: optimization of their job search, optimization of relationships while on the job, and efforts to augment individual achievement. When asked about barriers to career advancement, surgeons most frequently commented on a lack of time and a lack of mentors. When asked about case mix, 63% of surgeons felt that they had no control over it. They were evenly divided between believing that a broad case mix or a niche specialized case mix was more instrumental for career progression. CONCLUSIONS Early-career colorectal surgeons were mostly satisfied with their career progression, volume, and case mix. In discussing their careers, many have developed a number of strategies focused on growth as an individual as well as relationship building. They also identified a number of barriers including lack of time and lack of mentorship. Early-career surgeons may be able to utilize these strategies and anticipate barriers prior to starting their first job, leading to greater likelihood of career satisfaction.
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Affiliation(s)
- Colleen A Donahue
- Division of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Angela H Kuhnen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David A Kleiman
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Peter W Marcello
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David J Schoetz
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Patricia L Roberts
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Elizabeth M Breen
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Julia T Saraidaridis
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
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Saraidaridis JT, Read TE, Marcello PW, Schoetz DJ, Rusin LC, Kleiman DA, Melnitchouk N, Roberts PL, Breen EM. What do Young Colorectal Surgeons Value From Their CRS Residency Training? J Surg Educ 2019; 76:720-726. [PMID: 30342854 DOI: 10.1016/j.jsurg.2018.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/02/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Colorectal surgery (CRS) training has seen many changes over the years. This study sought to identify aspects of CRS residency curriculum that were most valued by recent graduates and what changes could be made to improve training. DESIGN Semistructured interviews were performed with board-certified colorectal surgeons 2 to 7years removed from their CRS residency. Interview responses were qualitatively analyzed and converted to coded, categorizable data. Subjects were recruited via a snowball sampling method. SETTING Interviews were conducted in person and via telephone with surgeons in a variety of practices across the United States and Canada. Analysis was performed by a team at Lahey Clinic, Burlington, MA, an academic, tertiary care center. PARTICIPANTS Board certified colorectal surgeons 2 to 7years removed from CRS residency. RESULTS Twenty surgeons from 11 different CRS residencies were interviewed. At the time of the interview, surgeons were employed in 13 states and 1 foreign country. When asked what aspects of their CRS residency were of value, surgeons produced 74 comments emphasizing: volume of cases (65% of subjects), variety of cases (55%), development of technical skills (40%), management of specific diseases (35%), faculty (30%), mentorship (30%), and practice management (15%). With regard to technical skills, surgeons cited pelvic surgery (40%) and minimally invasive techniques (45%) as the exposures that helped them become successful. When discussing what could be added to training, subjects made 54 comments identifying: more robotic exposure (35%), more anorectal disease (30%), more pelvic floor exposure (25%), and practice management/billing (35%) as items to incorporate. Sixty five percent of subjects believed that "nothing" should be eliminated from their training. CONCLUSIONS Young colon and rectal surgeons valued their training highly and strongly declined to eliminate any substantial part of the existing curriculum. They also expressed a strong desire to add more elements to the CRS residency including further robotic training, more anorectal, more pelvic floor, and further training in practice management.
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Affiliation(s)
| | - Thomas E Read
- Division of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
| | - Peter W Marcello
- Division of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
| | - David J Schoetz
- Division of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
| | - Lawrence C Rusin
- Division of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
| | - David A Kleiman
- Division of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
| | - Nelya Melnitchouk
- Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Patricia L Roberts
- Division of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
| | - Elizabeth M Breen
- Division of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts
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Pernar LIM, Peyre SE, Hasson RM, Lipsitz S, Corso K, Ashley SW, Breen EM. Exploring the Content of Intraoperative Teaching. J Surg Educ 2016; 73:79-84. [PMID: 26489601 DOI: 10.1016/j.jsurg.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/12/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Much teaching to surgical residents takes place in the operating room (OR). The explicit content of what is taught in the OR, however, has not previously been described. This study investigated the content of what is taught in the OR, specifically during laparoscopic cholecystectomies (LCs), for which a cognitive task analysis (CTA), explicitly delineating individual steps, was available in the literature. METHODS A checklist of necessary technical and decision-making steps to be executed during performance of LCs, anchored in the previously published CTA, was developed. A convenience sample of LCs was identified over a 12-month period from February 2011 to February 2012. Using the checklist, a trained observer recorded explicit teaching that occurred regarding these steps during each observed case. All observations were tallied and analyzed. RESULTS In all, 51 LCs were observed; 14 surgery attendings and 33 residents participated in the observed cases. Of 1042 observable teaching points, only 560 (53.7%) were observed during the study period. As a proportion of all observable steps, technical steps were observed more frequently, 377 (67.3%), than decision-making steps, 183 (32.7%). Also when focusing on technical and decision-making steps alone, technical steps were taught more frequently (60.9% vs 43.3%). CONCLUSIONS Only approximately half of all possible observable teaching steps were explicitly taught during LCs in this study. Technical steps were more frequently taught than decision-making steps. These findings may have important implications: a better understanding of the content of intraoperative teaching would allow educators to steer residents' preoperative preparation, modulate intraoperative instruction by members of the surgical faculty, and guide residents to the most appropriate teaching venues.
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Affiliation(s)
- Luise I M Pernar
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sarah E Peyre
- Center for Experiential Learning, University of Rochester Medical Center, Rochester, New York
| | - Rian M Hasson
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katherine Corso
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth M Breen
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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Peyre SE, Frankl SE, Thorndike M, Breen EM. Observation of clinical teaching: interest in a faculty development program for surgeons. J Surg Educ 2011; 68:372-376. [PMID: 21821215 DOI: 10.1016/j.jsurg.2011.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/02/2011] [Accepted: 04/04/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Observation of clinical teaching is a powerful tool to develop faculty teaching skills. However, the process of being observed can be intimidating for any educator. Our aim is to assess interest in an Observation of Teaching Program within an academic surgical department. DESIGN An electronic survey asking faculty to indicate interest in participation in a faculty development program that consists of a peer, expert, and/or cross-disciplinary physician observation of teaching was used. Faculty members were also asked whether they would like to observe other faculty as part of a peer-review track. The results were compiled for descriptive statistical analysis. SETTING Electronic survey. PARTICIPANTS In all, 46 faculty, all of whom have assigned medical student and resident teaching responsibilities, were introduced to the Observation of Teaching Program and surveyed on their interest in participating. RESULTS A total of 87% (40/46) of faculty responded after 2 e-mails and 75% (30/40) indicated interest in the Observation of Teaching Program. All faculty who responded positively indicated interest in expert review (30/30), 90% (27/30) in peer review, 87% (26/30) in surgeon review, and 83% (25/30) in cross-disciplinary physician review. A total of 48% (19/40) indicated interest in observing others. Of those who were not interested in the Observation of Teaching Program, restrictions on time (4/10), not enough clinical care responsibilities (2/10), not wanting to be watched (2/10), and program did not seem effective (1/10) were cited as reasons for not participating. CONCLUSIONS Surgical faculty are interested in being observed and receiving feedback about their clinical teaching by experts, peers, colleagues, and cross-disciplinary physicians. Professional development programs for surgeons should consider observation as a teaching methodology.
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Affiliation(s)
- Sarah E Peyre
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, MA 02115, USA.
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Abbett SK, Hevelone ND, Breen EM, Lipsitz SR, Peyre SE, Ashley SW, Smink DS. Interest in and perceived barriers to flexible-track residencies in general surgery: a national survey of residents and program directors. J Surg Educ 2011; 68:365-371. [PMID: 21821214 DOI: 10.1016/j.jsurg.2011.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/30/2011] [Accepted: 04/27/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The American Board of Surgery now permits general surgery residents to complete their clinical training over a 6-year period. Despite this new policy, the level of interest in flexible scheduling remains undefined. We sought to determine why residents and program directors (PDs) are interested in flexible tracks and to understand implementation barriers. DESIGN National survey. SETTING All United States general surgery residency programs that participate in the Association of Program Directors in Surgery listserv. PARTICIPANTS PDs and categorical general surgery residents in the United States. MAIN OUTCOME MEASURES Attitudes about flexible tracks in surgery training. A flexible track was defined as a schedule that allows residents to pursue nonclinical time during residency with resulting delay in residency completion. RESULTS Of the 748 residents and 81 PDs who responded, 505 residents and 45 PDs were supportive of flexible tracks (68% vs 56%, p = 0.03). Residents and PDs both were interested in flexible tracks to pursue research (86% vs 82%, p = 0.47) and child bearing (69% vs 58%, p = 0.13), but residents were more interested in pursuing international work (74% vs 53%, p = 0.004) and child rearing (63% vs 44%, p = 0.02). Although 71% of residents believe that flexible-track residents would not be respected as the equal of other residents, only 17% of PDs indicated they would not respect flexible-track residents (p < 0.001). CONCLUSION Most residents and PDs support flexible tracks, although they differ in their motivation and perceived barriers. This finding lends support to the new policy of the American Board of Surgery.
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Affiliation(s)
- Sarah K Abbett
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Pernar LI, Peyre SE, Warren LE, Gu X, Lipsitz S, Alexander EK, Ashley SW, Breen EM. Mini-clinical evaluation exercise as a student assessment tool in a surgery clerkship: Lessons learned from a 5-year experience. Surgery 2011; 150:272-7. [DOI: 10.1016/j.surg.2011.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 06/14/2011] [Indexed: 11/25/2022]
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Ahmadiyeh N, Cho NL, Kellogg KC, Lipsitz SR, Moore FD, Ashley SW, Zinner MJ, Breen EM. Career satisfaction of women in surgery: perceptions, factors, and strategies. J Am Coll Surg 2009; 210:23-8. [PMID: 20123327 DOI: 10.1016/j.jamcollsurg.2009.08.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 08/11/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the current and projected shortages of general surgeons, more attention is being paid to the increasing pool of women physicians. This study seeks to understand the variables leading to career satisfaction for women surgeons to better recruit, retain, and support them. STUDY DESIGN Eighteen semi-structured interviews of 12 female and 6 male surgeons 2 to 12 years into practice were qualitatively analyzed and converted to coded, categorized data. Significance was derived by Fisher's exact test. Participants were recruited by snowball sampling. RESULTS Our sample represents a highly satisfied group of female and male surgeons. Although both women and men describe with equal frequency having made career tradeoffs for personal and family time, and vice versa, women far more frequently than men cite reasons related to their personal time, predictable time, and family relationships as why they are currently satisfied with their career (34.1% versus 8.7%; p < 0.05). Both cite being satisfied by career content equally. When describing strategies used in developing a successful surgical career, women most frequently cite social networks as a key to success (88% versus 12% by men; p < 0.05), and men more frequently cite reasons related to training (29% versus 0% by women; p < 0.05) and compensation (24% versus 0% by women; p < 0.05). CONCLUSIONS Although both men and women make tradeoffs of career for family and family for career, women's perception of satisfaction comes from viewing their surgical career within the broader context of their lives. Women might be attracted to a career that acknowledges and values the whole person beyond the surgeon, and could benefit from work infrastructures that enhance networking.
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Affiliation(s)
- Nasim Ahmadiyeh
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Beleniski F, Rosen H, Gu X, Lipsitz SR, Hafler JP, Breen EM. Faculty preceptors benefit students' experience in a surgery clerkship. J Am Coll Surg 2009. [DOI: 10.1016/j.jamcollsurg.2009.06.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ahmadiyeh N, Cho NL, Kellogg KC, Lipsitz SR, Ashley SW, Moore FD, Zinner MJ, Breen EM. Factors promoting career satisfaction in women in surgery. J Am Coll Surg 2008. [DOI: 10.1016/j.jamcollsurg.2008.06.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Matzie KA, Kerfoot BP, Hafler JP, Breen EM. Spaced education improves the feedback that surgical residents give to medical students: a randomized trial. Am J Surg 2008; 197:252-7. [PMID: 18722585 DOI: 10.1016/j.amjsurg.2008.01.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 01/08/2008] [Accepted: 01/08/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgery residents teach medical students; feedback is one critical teaching skill. We investigated whether feedback given by surgery residents to students could be improved through an online spaced education program. METHODS Surgery residents were randomized to receive either a weekly spaced education e-mail during a 9-month period containing teaching bullets on how to provide effective feedback, or no intervention. Medical students rated the frequency and quality of feedback they received from the residents. RESULTS Students reported 45% (67 of 149) of the spaced education residents gave frequent feedback, compared with 31% (55 of 175) of control residents (relative risk [RR], 1.43; P = .016). Students reported resident feedback was "helpful in their learning" in 92% (132 of 143) of their evaluations of spaced education residents, compared with 82% (132 of 161) of their evaluations of control residents (RR, 1.13; P = .01). CONCLUSIONS Educational programs using feedback bullets e-mailed weekly can significantly improve the frequency and quality of feedback that surgical residents provide medical students.
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Affiliation(s)
- Kimberly A Matzie
- Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Greenberg JA, Irani JL, Greenberg CC, Blanco MA, Lipsitz S, Ashley SW, Breen EM, Hafler JP. The ACGME competencies in the operating room. Surgery 2007; 142:180-4. [PMID: 17689683 DOI: 10.1016/j.surg.2007.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/14/2007] [Accepted: 03/16/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 1999, the ACGME introduced the 6 competencies that have become the basis for resident education. Since the operating room (OR) has traditionally been the major focus for resident teaching in surgery, we performed an observational study to determine whether it is an appropriate setting for the teaching and/or assessment of the competencies. METHODS A 3-person team observed 11 operations and recorded all teaching events. Observers then determined whether each event involved the teaching of a competency by faculty or demonstration of a competency by residents. Frequency counts, mean times, and ranges were calculated for each competency taught and demonstrated. RESULTS The Patient Care competency was both the most commonly taught and demonstrated. Faculty spent an average of 33% of operative time instructing in patient care, and residents demonstrated it 65% of the time. The Interpersonal/Communication Skills (4%) and Practice-Based Learning/Improvement (4%) competencies were also occasionally demonstrated by residents. The remaining competencies were addressed less frequently. CONCLUSIONS OR teaching was primarily devoted to the Patient Care competency. The OR was also an appropriate setting for evaluating resident performance in this area. New approaches to OR teaching or educational efforts in other settings such as the clinic are necessary for teaching and assessing the remaining competencies.
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Affiliation(s)
- Jacob A Greenberg
- Department of Surgery, Brigham and Women's Hospital, Boston, Mass, USA
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16
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Abstract
PURPOSE Perineal wound complications are common following abdominoperineal resection. This study investigates the factors contributing to these complications. METHODS Patients undergoing abdominoperineal resection at our institution from June 1997 to May 2003 were reviewed. Significant predictors associated with minor (separation <2 cm, stitch abscesses, or sinus tracts) or major (>2 cm of separation, reoperation required, or readmission) wound complications were ascertained. RESULTS Of 153 patients, there were 22 major (14 percent) and 32 minor (24 percent) wound complications. Patients with anal cancer had a higher rate of major complications than those with rectal cancer or inflammatory bowel disease. Minor wound complications were more common in patients with anal cancer and inflammatory bowel disease than those with rectal cancer. Factors associated with a higher rate of major wound complications included flap closure, tumor size, body mass index, diabetes, and indication for the procedure. When the subset of patients with rectal cancer was considered, higher rates of major wounds were associated with increased body mass index, diabetes, and stage. Minor complications were associated with a two-team approach and increasing body mass index. CONCLUSIONS This is currently the largest review of perineal wound complications following abdominoperineal resection. Patients with anal cancer and inflammatory bowel disease were at higher risk for perineal wound complications than those with rectal cancer. Preoperative radiation and primary closure were not associated with increased complications following abdominoperineal resection for rectal cancer.
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Affiliation(s)
- Caprice K Christian
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Affiliation(s)
- E M Breen
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Breen EM, Schoetz DJ, Marcello PW, Roberts PL, Coller JA, Murray JJ, Rusin LC. Functional results after perineal complications of ileal pouch-anal anastomosis. Dis Colon Rectum 1998; 41:691-5. [PMID: 9645736 DOI: 10.1007/bf02236254] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE This study investigated the functional significance of perineal complications after ileal pouch-anal anastomosis. METHODS Review of a prospective registry of 628 patients was undertaken. Bowel function was assessed by detailed functional questionnaire. Statistical analyses were performed using chi-squared and Fisher's exact probability tests. RESULTS Of 628 patients, 153 (24.4 percent) had 171 perineal complications. The 277 control patients had no complications. Complications included 66 (10.5 percent) anastomotic strictures, 28 (4.5 percent) anastomotic separations, 36 (5.7 percent) pouch fistulas, 41 (6.5 percent) episodes of pelvic sepsis, and 18 (2.9 percent) patients with multiple complications. After these complications were addressed, the pouch failure rate was low (10 percent); in 90 percent of patients, the pouch could be salvaged. Most pouch failures were the result of pouch fistulas, and most occurred in patients ultimately diagnosed with Crohn's disease. Functional results after cure of these perineal complications revealed no significant functional differences between control patients and those cured of anastomotic separations, anastomotic strictures, and pouch fistulas. Only a few minor differences were demonstrated in function after an episode of pelvic sepsis. The major deterioration in function occurred after treatment for multiple perineal complications. CONCLUSIONS An appreciable number of perineal complications occur after ileal pouch-anal anastomosis. Pouch-perineal fistulas are associated with the highest pouch failure rate. The majority of these fistulas occur in patients ultimately diagnosed with Crohn's disease or indeterminate colitis. Although there is no substitute for good technique and sound clinical judgment in the success of ileal pouch-anal anastomosis, if perineal complications are successfully treated, functional outcome is equivalent to that in patients without perineal complications.
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Affiliation(s)
- E M Breen
- Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA
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Affiliation(s)
- J H Check
- UMDNJ, Robert Wood Johnson Medical School, Camden
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