Applicants Performance in Interview for a General Surgery Residency Pre- and During Coronavirus Disease-19 Pandemic

INTRODUCTION

The coronavirus disease-19 (COVID-19) pandemic has created a shift from traditional in-person interviews for a residency position to a virtual platform over the last 2 y (2020-2021). With this significant shift, there is controversy about how this may affect applicant performance. We hypothesized that applicants scored higher during virtual interviews than in-person interviews.

METHODS

Applicants interviewed for postgraduate year 1 positions at a single university-based residency program over six interview cycles were divided into group A (4 cycles, pre-COVID-19) and group B (2 cycles, during COVID-19). All candidates were interviewed by faculty and senior surgical residents and scored on letters of recommendation (LOR), personal statement (PS), research (RS), the way the candidate represented themselves (RP), interest in the geographic area (IN), and degree of connection between candidate and interviewer (CN). Differences in mean scores between candidates in these two groups were assessed using an independent-sample t-test.

RESULTS

Of 332 total applicants, 187 (56.3%) were in group A (cycles 2016-2019) and 145 (43.7%) were in group B (cycles 2020-2022). Group-B had higher United States Medical Licensing Examination Step 2 and Step 1 mean (standard deviation) scores (251.1 ± 10.6 versus 247.6 ± 11.8, P = 0.006 and 241.1 ± 10.3 versus 238.4 ± 10.4, P = 0.02). Group A scored higher median [interquartile range] in CN (4.4 [4.1, 4.6] versus 4.2 [3.9, 4.6], P = 0.005) and IN (4.3 [4.0, 4.5] versus 4.1 [3.8, 4.4], P = 0.002), while group B scored higher in LOR (4.3 [4.1, 4.6] versus 4.2 [3.9, 4.5], P = 0.011) and PS (4.3 [4.1, 4.4] versus 4.1 [3.8, 4.4], P = 0.001). No differences were noted between groups A and B in RS (3.9 [3.4, 4.5] versus 4.1 [3.5, 4.5], P = 0.108) or RP (4.4 [4.1, 4.7] versus 4.4 [4.2, 4.8], P = 0.317). No differences in the median [interquartile range] total scores of personal characteristic categories (25.1 [23.7, 26.5] versus 25.1 [23.8, 26.7], P = 0.703) were observed.

CONCLUSIONS

From a program perspective, there were no differences between groups; however, candidates in the pre-COVID era scored higher in CN and IN, while those who interviewed virtually had higher scores in LOR and PS. Applicants perceptions may differ regarding in-person versus virtual interviews.

Are There Racial Differences in the Rate of Surgical Site Infection Based on Surgical Subspecialty?

Background: Surgical site infection (SSI) is a common, morbid post-operative complication. We hypothesized the presence of racial differences in SSI rates, comparing black/African American (BAA) to white non-Hispanic (WNH) patients. Patients and Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2017), BAA and WNH surgery patients across 10 surgical specialties were identified: general surgery (GS), vascular surgery (VS), cardiac surgery (CS), thoracic surgery (TS), orthopedics (OS), neurosurgery (NS), urology (US), otolaryngology (ENT), plastic surgery (PS), and gynecology (GYN). The primary outcome was SSI rate (superficial, deep incisional, or organ/space). The secondary outcome was rate of non-surgical infection. Pearson χ2 and Fisher exact tests were used to test group differences of categorical variables. Continuous variables were tested with the Student t-test, or Mann-Whitney U test, with statistical significance set at a value of p < 0.05. Multivariable logistic regression models were conducted to analyze the association between race/ethnicity and the infection outcomes. Results: A total of 740,144 patients were included: 99,425 (13.4%) BAA and 640,749 (86.6%) WNH, distributed as follows; 32,2976 GS, 17,6175 OS, 44,383 VS, 2,227 CS, 9,645 TS, 42,298 NS, 42,726 US, 18,518 ENT, 20,709 PS, and 60,517 GYN cases. Surgical site infection rates were higher among WNH in GS (4.4% vs. 4.1%; p = 0.003) and TS (3.1% vs. 1.7%; p = 0.015); lower in VS (3.2% vs. 4.4%; p < 0.001), OS (1.2% vs.1.6%; p < 0.001), and GYN (2.4% vs. 3%; p < 0.001); and similar between WNH and BAA in ENT (1.8% vs 1.8%; p = 0.76), and US (1.9% vs. 1.9%; p = 0.90). Non-surgical infection was higher in BAA in NS (3.2% vs. 2.5%; p = 0.003), and higher in WNH in GYN (2.6% vs. 2%; p < 0.001), OS (1.7% vs. 1.1%; p < 0.001), US (4.4% vs. 3.6%; p = 0.014), and VS (3.4% vs. 2.6%; p < 0.001). Conclusions: Variation exists in SSI rates between WNH and BAA patients among surgical subspecialties. Further research is required to understand these differences and address racial disparities in outcomes.

The importance of USMLE step 2 on the screening and selection of applicants for general surgery residency positions

Background

As announced by the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Step 1 score reporting has transitioned to pass/fail outcomes instead of the traditional numeric score after January 26, 2022. USMLE Step 1 scores have been used widely as a crucial tool in screening and selecting applicants for residency programs. This study aims to determine the role of USMLE Step 2 in the selection of applicants for general surgery residency.

Methods

A retrospective study was conducted over six recruiting cycles from 2016 to 2021. The data from 334 interviewed applicants from one general surgery residency program were assessed. Data analyzed included USMLE Step 1 and Step 2 scores, applicant gender, Alpha Omega Alpha (AOA) status, letters of recommendation (LOR), and research/publications (RS).

Results

Of the 334 interviewed applicants, 209 (62.6%) were male. The mean [SD] USMLE Step 1 and USMLE Step 2 C K (Clinical Knowledge) scores were 239.6 [±10.4] and 249.2 [±11.4], respectively. The mean (SD) LOR and RS scores were 4.24 [±0.4] and 3.9 [±0.7], respectively. A positive correlation was observed between USMLE Step 1 and USMLE Step 2 C K (Clinical Knowledge) scores (r = 0.60, p < .001), LOR scores (r = 0.24, p = .008), and AOA status (r = 0.19, p = .038). There was a negligible correlation between USMLE scores and applicant gender.

Conclusion

Transitioning USMLE Step 1 to pass/fail will make the initial screening and selection process of applications challenging for residency programs. In the short term, USMLE Step 2 scores, LOR, and AOA status are important as screening assessments. Valid measures to ensure appropriate, equitable, and fair assessments are needed.

Antibody-nucleotide conjugate as a substrate for DNA polymerases

Here we report on the development of an antibody-modified nucleotide and its sequence-selective incorporation into nascent DNA catalysed by DNA polymerases. Although the modification of the nucleotide is several orders of magnitude larger than the natural dNTP substrate and even exceeds the size of the DNA polymerase, it is well accepted by the enzyme. Moreover, the recognition of the antibody is not abolished by the conjugation but can be recognized by a secondary antibody that is conjugated to a signal-generating enzyme (i.e., horse radish peroxidase). This product can thus be exploited for a colorimetric read-out of nucleotide incorporation by the naked eye that allows detection of DNA as low as 10 amol. In future, assays like the one described herein might allow nucleic acid diagnostics at single nucleotide resolution without any laboratory equipment.

DNA polymerase-catalyzed incorporation of nucleotides modified with a G-quadruplex-derived DNAzyme

We show that nucleotides which are modified with a G-quadruplex-derived DNAzyme are substrates for DNA polymerases. Based on this finding we developed a naked-eye detection system that allows the detection of single nucleotide variations in DNA.

EPR-Untersuchungen an kupferdotierten Triglyzinsulfat- und Glyzin-Einkristallen

Der Einbau von Kupferionen in Triglyzinsulfat- und Glyzin-Einkristalle wird untersucht. Die Dotierung der Kristalle erfolgt beim Züchten durch Einbau von Kupfer (II) -Glyzinat-Komplexen aus der Mutterlösung. Es werden die Molekularbahnen für die Symmetrie D2h konstruiert. Aus den experimentell bestimmten Parametern des Spin-Hamilton-Operators werden die Bindungsparameter des orthorhombischen Komplexes berechnet und diskutiert. Der Einfluß der Kupferdotierung auf die ferroelektrischen Eigenschaften von Triglyzinsulfat wird diskutiert.

Physical determinants of vascular network remodeling during tumor growth

The process in which a growing tumor transforms a hierarchically organized arterio-venous blood vessel network into a tumor specific vasculature is analyzed with a theoretical model. The physical determinants of this remodeling involve the morphological and hydrodynamic properties of the initial network, generation of new vessels (sprouting angiogenesis), vessel dilation (circumferential growth), vessel regression, tumor cell proliferation and death, and the interdependence of these processes via spatio-temporal changes of blood flow parameters, oxygen/nutrient supply and growth factor concentration fields. The emerging tumor vasculature is non-hierarchical, compartmentalized into well-characterized zones, displays a complex geometry with necrotic zones and "hot spots" of increased vascular density and blood flow of varying size, and transports drug injections efficiently. Implications for current theoretical views on tumor-induced angiogenesis are discussed.

Vascular remodelling of an arterio-venous blood vessel network during solid tumour growth

We formulate a theoretical model to analyze the vascular remodelling process of an arterio-venous vessel network during solid tumour growth. The model incorporates a hierarchically organized initial vasculature comprising arteries, veins and capillaries, and involves sprouting angiogenesis, vessel cooption, dilation and regression as well as tumour cell proliferation and death. The emerging tumour vasculature is non-hierarchical, compartmentalized into well-characterized zones and transports efficiently an injected drug-bolus. It displays a complex geometry with necrotic zones and "hot spots" of increased vascular density and blood flow of varying size. The corresponding cluster size distribution is algebraic, reminiscent of a self-organized critical state. The intra-tumour vascular-density fluctuations correlate with pressure drops in the initial vasculature suggesting a physical mechanism underlying hot spot formation.

Emergent vascular network inhomogeneities and resulting blood flow patterns in a growing tumor

Tumors acquire sufficient oxygen and nutrient supply by coopting host vessels and neovasculature created via angiogenesis, thereby transforming a highly ordered network into chaotic heterogeneous tumor specific vasculature. Vessel regression inside the tumor leads to large regions of necrotic tissue interspersed with isolated surviving vessels. We extend our recently introduced model to incorporate Fahraeus-Lindqvist- and phase separation effects, refined tissue oxygen level computation and drug flow computations. We find, unexpectedly, that collapse and regression accelerates rather than diminishes the perfusion and that a tracer substance flowing through the remodeled network reaches all parts of the tumor vasculature very well. The reason for decreased drug delivery well known in tumors should therefore be different from collapse and vessel regression. Implications for drug delivery in real tumors are discussed.

Epidemiology of group C rotavirus infection in Western New York women of childbearing age

Umbilical cord serum samples (380), an average of 10 per month for 3 years (1990 to 1992), were tested by indirect immunofluorescence assay for group C rotavirus immunoglobulin G. Thirty percent were positive, suggesting that approximately one-third of women of childbearing age in western New York have experienced group C rotavirus infection.

[Surgery for arrhythmia in patients with therapy-resistant ventricular tachycardia]

We reviewed the data of 42 consecutive patients (mean age 55 +/- 12 years) who underwent surgery for control of recurrent drug-refractory ventricular arrhythmia. A history of myocardial infarction was present in 38 patients, 4 patients had congenital heart disease (2 aneurysms, 1 right ventricular dysplasia, 1 hamartoma). The mean LV ejection fraction was 40 +/- 14%. At preoperative electrophysiologic study, ventricular tachycardia was inducible in 32 of 33 patients. The mean heart rate was 188/min. A mean of 3.3 +/- 2.1 antiarrhythmic drug trials were ineffective. The most frequently performed surgical procedure (n = 36) was visually guided subendocardial resection, alone or in combination with cryothermal ablation. In 30 patients additional aneurysmectomy was performed. A mean of 1.9 +/- 1.4 coronary arteries in 32 patients were bypassed. The overall in-hospital mortality (30 days) was 9.5% (1 arrhythmic death, 1 pump failure, 1 sepsis, 1 hemorrhagic shock). We found 2 significant (p < 0.05) predictors of perioperative mortality: recent myocardial infarction and patient's age. During a mean follow-up of 33 months (range 1 to 90), there were 3 sudden cardiac deaths and 6 nonfatal recurrences of ventricular tachycardia which were subsequently prevented with antiarrhythmic drug therapy. Thus, the overall success in control of arrhythmia was 92%, in 59% by surgery alone. Survival was 79% at 2 years after surgery and 63% at 5 years. We conclude that patients who have successful subendocardial resection and aneurysmectomy for control of ventricular arrhythmia have an excellent chance of arrhythmia-free survival and a relatively good prognosis.