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Spencer B, Moreci R, Weller J, Evans J, Modi BP, Gray B, Ehrlich P, Ladd A, Lillehei C, Alaish S, Gadepalli S, Hirschl RB, Newman E, Zendejas B, Sandhu G. Defining Practice Readiness in Pediatric Surgery Fellowship: A Qualitative Analysis. J Surg Educ 2024; 81:503-513. [PMID: 38403502 DOI: 10.1016/j.jsurg.2024.01.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/24/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION While competency-based training is at the forefront of educational innovation in General Surgery, Pediatric Surgery training programs should not wait for downstream changes. There is currently no consensus on what it means for a pediatric surgery fellow to be "practice-ready". In this study, we aimed to provide a framework for better defining competency and practice readiness in a way that can support the Milestones system and allow for improved assessment of pediatric surgery fellows. METHODS For this exploratory qualitative study, we developed an interview guide with nine questions focused on how faculty recognize competency and advance autonomy among pediatric surgery fellows. Demographic information was collected using an anonymous online survey platform. We iteratively reviewed data from each interview to ensure adequate information power was achieved to answer the research question. We used inductive reasoning and thematic analysis to determine appropriate codes. Additionally, the Dreyfus model was used as a framework to guide interpretation and contextualize the responses. Through this method, we generated common themes. RESULTS A total of 19 pediatric surgeons were interviewed. We identified four major themes from 127 codes that practicing pediatric surgeons associate with practice-readiness of a fellow: skill-based competency, the recognition and benefits of struggle, developing expertise and facilitating autonomy, and difficulties in variability of evaluation. While variability in evaluation is not typically included in the concept of practice readiness, assessment and evaluation were described by study participants as essential aspects of how practicing pediatric surgeons perceive practice readiness and competency in pediatric surgery fellows. Competency was further divided into interpersonal versus technical skills. Sub-themes within struggle included personal and professional struggle, benefits of struggle and how to identify and assist those who are struggling. Autonomy was commonly stated as variable based on the attending. CONCLUSION Our analysis yielded several themes associated with practice readiness of pediatric surgery fellows. We aim to further refine our list of themes using the Dreyfus Model as our interpretive framework and establish consensus amongst the community of pediatric surgeons in order to define competency and key elements that make a fellow practice-ready. Further work will then focus on establishing assessment metrics and educational interventions directed at achieving such key elements.
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Affiliation(s)
- Brianna Spencer
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
| | - Rebecca Moreci
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jennine Weller
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Evans
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Biren P Modi
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Gray
- Division of Pediatric General Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Peter Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Alan Ladd
- Division of Pediatric General Surgery, Department of Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Craig Lillehei
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel Alaish
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samir Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Erika Newman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Benjamin Zendejas
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Gow KW, Han X, Kim ES, Kotagal M, Mak G, Krishnaswami S. The First Generation of Asian American Pediatric Surgical Trainees in North America. J Surg Res 2024; 296:636-642. [PMID: 38359678 DOI: 10.1016/j.jss.2024.01.039] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Pediatric surgical trainees come from diverse races and ethnicities. However, Asian-Americans (AAs) including West, South, and East Asians may represent a unique group of individuals. We sought to identify any unique challenges and experiences. METHODS Pediatric surgical trainees were identified from, "The Genealogy of North American Pediatric Surgery: From Ladd to Now" and "Celebrating 50 Years: Canadian Association of Paediatric Surgeons/Association Canadienne de Chirurgie Pediatrique". A database was compiled, and AAs identified who completed their pediatric surgical training on or before 1980. Personal interviews and online sources provided further information. RESULTS Of 635 pediatric surgical trainees in North America (NA) there were 49 AA trainees (7.7%). There was insufficient information for seven, thus leaving 42 (41 male, one female) for review. The region of Asia of origin included 16 East, 16 West, and 10 South. Thirty-seven (88.0%) had moved to NA for training. The most frequent training programs included seven from Toronto and four each at Buffalo, Detroit, Pittsburgh, and Chicago (Children's Memorial). Thirty-five (83%) trainees spent most of their careers in NA while 7 (17%) practiced in their home country. CONCLUSIONS The first AA pediatric surgical trainees voiced few examples of discrimination but indicated needs to adjust to the NA culture and often confusion over non-Western names. Mentorship was valued and gratitude expressed over the opportunity offered to train in NA. While some had intended to return to their home countries, plans changed due to meeting spouses or political turmoil. Many of those reviewed sought each other out at national meetings.
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Affiliation(s)
- Kenneth W Gow
- Division of Pediatric General & Thoracic Surgery, University of Washington and Seattle Children's Hospital, Seattle, Washington.
| | - XiaoYue Han
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, Oregon
| | - Eugene S Kim
- Division of Pediatric Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Grace Mak
- Section of Pediatric Surgery, Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, Oregon
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Tsui GO, Kunac A, Oliver JB, Mehra S, Anjaria DJ. Why Not This Case? Differences Between Resident and Attending Operative Cases at Teaching Hospitals. J Surg Res 2024; 295:19-27. [PMID: 37972437 DOI: 10.1016/j.jss.2023.09.063] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Previous studies have focused on outcomes pertaining to resident operative autonomy, but there has been little academic work examining the types of patients and cases where autonomy is afforded. We sought to describe the differences between surgical patient populations in teaching cases where residents are and are not afforded autonomy. METHODS We examined all general and vascular operations at Veterans Affairs teaching hospitals from 2004 to 2019 using Veterans Affairs Surgical Quality Improvement Program. Level of resident supervision is prospectively recorded by the operating room nurse at the time of surgery: attending primary (AP): the attending performs the case with or without a resident; attending resident (AR): the resident performs the case with the attending scrubbed; resident primary (RP): resident operating with supervising attending not scrubbed. Resident (R) cases refer to AR + RP. Patient demographics, comorbidities, level of supervision, and top cases within each group were evaluated. RESULTS A total of 618,578 cases were analyzed; 154,217 (24.9%) were AP, 425,933 (68.9%) AR, and 38,428 (6.2%) RP. Using work relative value unit as a surrogate for complexity, RP was the least complex compared to AP and AR (10.4/14.4/14.8, P < 0.001). RP also had a lower proportion of American Society of Anesthesiologists 3 and 4 + 5 patients (P < 0.001), were younger (P < 0.001), and generally had lower comorbidities. The most common RP cases made up a higher proportion of all RP cases than they did for AP/AR and demonstrated several core competencies (hernia, cholecystectomy, appendectomy, amputation). R cases, however, were generally sicker than AP cases. CONCLUSIONS In the small proportion of cases where residents were afforded autonomy, we found they were more focused on the core general surgery cases on lower risk patients. This selection bias likely demonstrates appropriate attending judgment in affording autonomy. However, this cohort consisted of many "sicker" patients and those factors alone should not disqualify resident involvement.
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Affiliation(s)
- Grace O Tsui
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anastasia Kunac
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Joseph B Oliver
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Shyamin Mehra
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Devashish J Anjaria
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
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Verran DJ. Re: Women in surgery: trends in nine surgical specialties. ANZ J Surg 2024; 94:278. [PMID: 38185998 DOI: 10.1111/ans.18861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Deborah J Verran
- Division of Surgery, Ramsay Healthcare, Sydney, New South Wales, Australia
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Aziz H, Hockett D, Feng L, Kane S, Segalini N, Hase N, Kapadia MR, Shelton J. Financial Relationships in General Surgery Education: Recent Trends in Industry Payments to General Surgery Residency Leadership. J Surg Educ 2024; 81:210-218. [PMID: 38160119 DOI: 10.1016/j.jsurg.2023.11.002] [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] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Residency programs and their directors frequently receive funding from industry payers. Both general surgery residency program directors (PDs) and assistant program directors (APDs) receive industry funding for various reasons, including educational advancement. This study investigates recent trends in industry payments to both PDs and APDs to better understand the financial relationships among leaders in residency education. METHODS We compared industry payments to general surgery residency PDs and APDs from 2019 to 2021 utilizing the U.S. Centers for Medicare & Medicaid Services (CMS) open payments database. In addition, secondary analyses were performed among PDs to assess differences based on gender, practicing surgical specialty, and geographical region. RESULTS During the study period (2019-2021), PDs received payments amounting to 2,882,821 USD. PDs were found to receive more funding than APDs, with each receiving average funding of 10,045 vs. 323 USD (p < 0.01), respectively, over the study period. There was a significant decrease in total payments from 2019 to 2020 (1,512,190 vs. 868,811 USD; p < 0.01). Total payments made in 2021 were similar compared to 2020 (905,836 vs. 868,811 USD; p = 0.1). We found that male PDs received significantly more in-industry payments when compared to female PDs (11,702 USD per PD vs. 3971 USD per PD, p < 0.01). CONCLUSION This study presents initial data that residency program leadership has robust biomedical industry relationships, and further research is warranted to investigate the impacts of these payments on program resources, educational opportunities for residents, and program outcomes. Male PDs received significantly more industry payments when compared to female PDs. Leaders in the surgical training community must cautiously ensure that these industry relationships are appropriately navigated.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa.
| | - Diana Hockett
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Lawrence Feng
- Department of Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Shriya Kane
- Department of Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | | | - Niklas Hase
- Tufts University School of Medicine, Boston, Massachusetts
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Julia Shelton
- Department of Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa
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Cole-Clark D, Rashid P. Costs and challenges of the curriculum vitae for SET Urology training positions: a qualitative analysis. ANZ J Surg 2024; 94:57-62. [PMID: 38174656 DOI: 10.1111/ans.18844] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Surgical training programs within Australia and Aotearoa New Zealand have become more competitive. Applicants are required to build a strong application over curriculum vitae (CV), references and interview. The building of the CV often comes at significant financial and time cost with challenges. This study explores successful applicants' experiences of the costs and challenges to build a successful CV for acceptance onto the Urology training program within Australia and New Zealand. METHODS Qualitative content analysis (QCA) was undertaken of semi-structured interviews conducted with 11 nSET Urology trainees. QCA focused on the identification and evaluation of costs and challenges experienced. Analysis was reviewed over the domain of CV components. RESULTS Costs of building each domain differed significantly between trainees as they focussed on various domains. Challenges encountered were identified with four themes were identified with associated subthemes: Passion/Commitment (two subthemes); Researching Pathways (six subthemes); Challenges (two subthemes) and Acceptance Success (two subthemes). CONCLUSIONS The commitment to a surgical specialty begins before acceptance onto a training program. A high-level CV is an integral component of acceptance onto the Urology training program. Each trainee had a different journey, including time and financial sacrifices, to obtain acceptance whilst demonstrating a strong motivation for success. The average cost of each trainee who gained acceptance was $50 779 over 3 years. Consideration should be given to making the CV component less onerous.
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Affiliation(s)
- Dane Cole-Clark
- Department of Urology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
- Department of Urology, Rural Clinical School, The University of New South Wales, Port Macquarie, New South Wales, Australia
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Spencer BL, Krumm A, Izadi S, Hirschl RB, Modi BP, Ehrlich P, Newman EA, Zendejas B. How Many Operative Performance Ratings Does a Pediatric Surgery Fellow Need to Be Deemed Practice Ready? J Pediatr Surg 2024; 59:31-36. [PMID: 37845126 DOI: 10.1016/j.jpedsurg.2023.09.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Identifying the number of cases required for a fellow to achieve competence has been challenging. Workplace-based assessment (WBA) systems make collecting performance data practical and create the opportunity to translate WBA ratings into probabilistic statements about a fellow's likelihood of performing to a given standard on a subsequent assessment opportunity. METHODS We compared data from two pediatric surgery training programs that used the performance rating scale from the Society for Improving Medical Professional Learning (SIMPL). We used a Bayesian generalized linear mixed effects model to examine the relationship past and future performance for three procedures: Laparoscopic Inguinal Hernia Repair, Laparoscopic Gastrostomy Tube Placement, and Pyloromyotomy. RESULTS For site one, 26 faculty assessed 9 fellows on 16 procedures yielding 1094 ratings, of which 778 (71%) earned practice-ready ratings. For site two, 25 faculty rated 3 fellows on 4 unique procedures yielding 234 ratings of which 151 (65%) were deemed practice-ready. We identified similar model-based future performance expectations, with prior practice-ready ratings having a similar average effect across both sites (Site one, B = 0.25; Site two, B = 0.25). Similar prior practice-ready ratings were needed for Laparoscopic G-Tube Placement (Site one = 13; Site two = 14), while greater differences were observed for Laparoscopic Inguinal Hernia Repair (Site one = 10; Site two = 15) and Pyloromyotomy (Site one = 10; Site two = 15). CONCLUSION Our approach to modeling operative performance data is effective at determining future practice readiness of pediatric surgery fellows across multiple faculty and fellow groups. This method could be used to establish minimum case number requirements. TYPE OF STUDY Original manuscript, Study of Diagnostic Test. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Brianna L Spencer
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA.
| | - Andrew Krumm
- Department of Learning Health Sciences, University of Michigan Medical School, 221 Victor Vaughan Building, 1111 E. Catherine St, Ann Arbor, MI, 48109, USA
| | - Shawn Izadi
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
| | - Biren P Modi
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Peter Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
| | - Erika A Newman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
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Travers HC, Beamish AJ, McCarthy M, Lewis DR. Defining quality assessment in vascular surgery training: an expert Delphi process. Ann R Coll Surg Engl 2024; 106:70-77. [PMID: 36779452 PMCID: PMC10765177 DOI: 10.1308/rcsann.2022.0146] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION A robust and reproducible way of assessing training should optimise and standardise vascular surgical training. This study describes the methodology supporting the Vascular Surgery Specialty Advisory Committee regional quality assurance reports for vascular surgery training programmes in the UK. METHODS A Delphi consensus exercise was performed to establish the domains of training that most appropriately assess the quality of a vascular surgery training programme. A total of 54 stakeholders were invited to participate, including trainees, training programme directors and members of the vascular speciality advisory committee (SAC), vascular society executive and education committees. RESULTS A total of 39 stakeholders successfully completed the three-stage Delphi process over 15 weeks. The domains identified as most appropriate to assess the quality of a vascular training programme were: Joint Committee on Surgical Training (JCST) survey results, clinical experience, regional education programmes, radiology support, timetable, regional support for trainees, trainer support for trainees, opportunities for professional development, trainee-rated quality of consultant teaching and training, and trainee recommendation of the post. CONCLUSIONS This study describes a method to identify and prioritise domains that are appropriate to assess the quality of a vascular training programme. The domains that were identified as appropriate to assess quality are transferable internationally and the Delphi methodology could be used by other training schemes to 'fine-tune' their own domains to review and optimise the quality of their own training programmes.
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Affiliation(s)
- HC Travers
- Russell’s Hall Hospital, UK
- Vascular Surgery Specialty Advisory Committee,UK
| | - AJ Beamish
- Swansea University Medical School, Swansea University, UK
| | - M McCarthy
- Vascular Surgery Specialty Advisory Committee,UK
- University Hospitals of Leicester, UK
| | - DR Lewis
- Vascular Surgery Specialty Advisory Committee,UK
- Aneurin Bevan University Health Board, UK
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Narayanamoorthy S, McLaren R, Pendam R, Minkoff H. Are women residents of surgical specialties at a higher risk of developing imposter syndrome? Am J Surg 2024; 227:48-51. [PMID: 37758643 DOI: 10.1016/j.amjsurg.2023.09.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Imposter syndrome is a chronic feeling of doubt leading to a sense of incompetence, which is common among trainees. However, little is known about the effect of gender on imposter syndrome among surgical trainees. METHODS An online national survey was distributed to the surgical subspecialty residents between March and September 2022, including demographics, validated Clance Imposter Scale and a short questionnaire evaluating depression and anxiety. RESULTS Of the participants self identified as women (264, 69.1%) and men (118, 30.9%) (response rate 36.4%), the prevalence of imposterism was higher among women trainees (97% vs. 86%; p < 0.0001). Risk factors were being a gynecologist (156, 59%, p < 0.0001), single (157, 59.7% p = 0.007), having no dependents (233, 88.3% p = 0.001), being a foreign graduate (24, 9.1%, p = 0.024) and having feelings of anxiety (82, 31.1% p = 0.012). When using multivariate logistic regression to adjust for these factors, the prevalence of imposter syndrome remained significantly higher among women. CONCLUSION Women trainees belonging to various surgical fields are affected by Imposter syndrome. Residency programs should develop wellness programs and provide mentorship to address this condition.
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Affiliation(s)
- Sujatha Narayanamoorthy
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, 11219, USA.
| | - Rodney McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | | | - Howard Minkoff
- Department of Obstetrics and Gynecology and the School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, 11203, USA.
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Wilson D, Engstrand E, Schoel L, Goldblatt MI, Higgins RM, Dream S. Gender Disparities in General Surgery Resident Subspecialization. Am Surg 2023; 89:5972-5977. [PMID: 37300459 DOI: 10.1177/00031348231177942] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are an increasing number of women entering medical school and general surgery residency. Despite this, there remains an underrepresentation of women in some surgical specialties. The purpose of this study is to examine gender differences in fellowship subspecialization of recent general surgery graduates. METHODS Graduating residents from general surgery residencies from 2016 to 2020 were identified. Referring to each residency's graduating resident website, we noted whether or not listed alumni were reported to have entered a fellowship. If applicants were listed as having completed a fellowship, the fellowship was noted along with each applicant's expressed gender. Differences across groups were analyzed using SPSS. RESULTS The majority (82.4%) of graduates pursued a fellowship after residency training. Men were more likely to enter fellowships in Cardiothoracic Surgery, Plastic and Reconstructive Surgery, Vascular Surgery, and practice than women. Women were more likely to enter fellowships in Breast Surgery, Acute Care Surgery/Trauma Surgery, Pediatric Surgery, and Endocrine Surgery than men. CONCLUSIONS The majority of general surgery residency graduates pursue fellowship training. Gender disparities continue for a minority of subspecialties for both men and women.
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Affiliation(s)
| | | | | | | | | | - Sophie Dream
- Medical College of Wisconsin, Milwaukee, WI, USA
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Blitzer D, Benintende AJ, Nemeth S, Kurlansky P, Antkowiak M, Fischkoff K, Argenziano M, Takayama H. Trends in Comprehensive Thoracic Case Experience Among General Surgery Residents in the Modern Integrated Cardiothoracic Residency Era: Review of Twenty Years of Resident Case Logs. Am Surg 2023; 89:5512-5519. [PMID: 36797046 DOI: 10.1177/00031348231157417] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Thoracic surgery training among general surgery residents in the United States is regulated by the Accreditation Council for Graduate Medical Education (ACGME) to ensure exposure to subspecialty fields during residency. Thoracic surgery training has changed over time with the placement of work hour restrictions, the emphasis on minimally invasive surgery, and increased subspecialization of training like integrated six-year cardiothoracic surgery programs. We aim to investigate how these changes over the past twenty years have affected thoracic surgery training among general surgery residents. METHODS ACGME general surgery resident case logs from 1999 to 2019 were reviewed. Data included exposure to the thorax via thoracic, cardiac, vascular, pediatric, trauma, and alimentary tract procedures. Cases from the above categories were consolidated to determine the comprehensive experience. Descriptive statistics were performed over four 5-year Eras (Era 1:1999-2004, Era 2: 2004-2009, Era 3: 2009-2014, Era 4: 2014-2019). RESULTS Between Era 1 and Era 4, there was an increase in thoracic surgery experience (37.6 ± 1.03 vs 39.3 ± .64; P = .006). The mean total thoracic experience for thoracoscopic, open, and cardiac procedures was 12.89 ± 3.76, 20.09 ± 2.33, and 4.98 ± 1.28, respectively. There was a difference between Era 1 and Era 4 in thoracoscopic (8.78 ± .961 vs 17.18 ± .75; P < .001) and open thoracic experience (22 ± .97 vs 17.06 ± .88; P < .001), and a decrease in thoracic trauma procedures (3.7 ± .06 vs 3.2 ± .32; P = .03). DISCUSSION Over twenty years there has been a similar, to slight increase in thoracic surgery exposure among general surgery residents. The changes seen in thoracic surgery training reflect the overall movement of surgery towards minimally invasive surgery.
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Affiliation(s)
- David Blitzer
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Andrew J Benintende
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samantha Nemeth
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Mark Antkowiak
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine Fischkoff
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Argenziano
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Arismendi T, Schaper N, Falkenhain A, Karabetsos KC, Syed A, Branch R, Moreno M, Pickney C, Obayi I, Lucas SJ, González E, Graves A, Kauffman B, Maningat A, Zielke T, Nam J, Soult MC, Aziz F, Bose S, Smeds MR. Fourth-Year Medical Students' Perceptions of Vascular Surgery: Can We Improve the Pipeline? Ann Vasc Surg 2023; 97:147-156. [PMID: 37495096 DOI: 10.1016/j.avsg.2023.07.099] [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] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Since their inception, Integrated Vascular Surgery Residency (IVSR) programs have expanded widely and attracted highly competitive medical students by offering a more focused approach to learning both open surgical and endovascular techniques. However, despite substantial modifications to the training paradigm, a shortage of vascular surgeons is still projected through 2050. We aimed to gather and analyze fourth-year medical students' knowledge and perceptions of vascular surgery (VS) to further inform strategies for recruiting future vascular surgeons. METHODS We sent anonymous electronic questionnaires to fourth-year medical students at 7 allopathic and 3 osteopathic medical schools, with questions detailing demographics, specialty preferences, and exposure to and perceptions of VS. Descriptive statistics were obtained, and responses were compared between students applying to surgical specialties (SS) and nonsurgical specialties (NSS). RESULTS Two hundred eleven of 1,764 (12%) participants responded (56% female). 56% reported VS exposure, most commonly during the third year. 64 (30%) planned to apply to SS. 57% of respondents reported knowledge of the management of vascular disease, and 56% understood procedures performed by vascular surgeons. Ranking the importance of factors in choosing specialties, SS selected "experiences gained during medical school rotations" (P < 0.05), "types and/or variety of treatment modalities used in this field" (P < 0.001), and "interest in the pathology or disease processes treated" (P < 0.05) as highest priorities. NSS preferred "lifestyle (work-life balance) as an attending" (P < 0.001). Only 7% of all respondents believed vascular surgeons have a good work-life balance, with a larger percentage of SS (P < 0.001) agreeing. Stratified by gender, female students rated "limited ability of childbirth during residency and/or postponement of family plans" (P < 0.05), "gender-related concerns, such as discrimination at work or unfair career possibilities" (P < 0.001), and "fear of unfair competition" (P < 0.05) as potential negative aspects of VS careers. 55% of respondents believed the IVSR makes VS more appealing. CONCLUSIONS Medical students perceive poor quality of life and work-life balance as deterring factors to a career in VS. Opportunities exist to educate students on the pathologies treated, procedures performed, and attainable quality of life available in our field. We should also continue to develop recruitment strategies to stimulate student interest and increase early exposure in VS.
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Affiliation(s)
| | | | | | | | - Ali Syed
- Medical College of Wisconsin, Milwaukee, WI
| | - Rheyana Branch
- University of Louisville School of Medicine, Louisville, KY
| | - Marvi Moreno
- Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, NV
| | - Cole Pickney
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ikpechukwu Obayi
- City University of New York (CUNY) School of Medicine, New York, NY
| | - Spencer J Lucas
- Sanford School of Medicine, University of South Dakota, Vermillion, SD
| | | | - Aaron Graves
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO
| | | | - Alexandra Maningat
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX
| | - Tara Zielke
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Janice Nam
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Michael C Soult
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Faisal Aziz
- Penn State College of Medicine, State College, PA
| | - Saideep Bose
- Saint Louis University School of Medicine, Saint Louis, MO; Division of Vascular and Endovascular Surgery, Department of Surgery, Saint Louis University, Saint Louis, MO
| | - Matthew R Smeds
- Saint Louis University School of Medicine, Saint Louis, MO; Division of Vascular and Endovascular Surgery, Department of Surgery, Saint Louis University, Saint Louis, MO.
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Fisher AT, Fereydooni A, Mullis DM, Smith BK, Sgroi MD. Individual and Program-Related Predictors of Academic Vascular Surgery Practice. Ann Vasc Surg 2023; 97:121-128. [PMID: 37454896 DOI: 10.1016/j.avsg.2023.06.037] [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] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Several studies have explored factors affecting academic employment in surgical subspecialties; however, vascular surgery has not yet been investigated. We examined which elements of surgical training predict future academic productivity and studied characteristics of NIH-funded vascular surgery attendings. METHODS With approval from the Association of Program Directors in Vascular Surgery (APDVS), the database of recent vascular surgery fellowship (VSF) and integrated vascular surgery residency (IVSR) graduates was obtained, and public resources (Doximity, Scopus, PubMed, NIH, etc.) were queried for research output during and after training, completion of dedicated research years, individual and program NIH funding, current practice setting, and academic rank. Adjusted multivariate regression analyses were conducted for postgraduate academic productivity. RESULTS From 2013 to 2017, there were 734 graduates. Six hundred three completed VSF and 131 IVSR; 220 (29%) were female. Academic employment was predicted by MD degree, advanced degree, training at a top NIH-funded program, number publications by end of training, and H-index. Dedicated research time before or during vascular training, advanced degree, or graduating from a top NIH-funded program were predictors of publishing >1 paper/year. Number of publications by end of training and years in practice were predictive of H-index ≥5. VSF versus IVSR pathway did not have an impact on future academic employment, annual publication rate as an attending, or H-index. Characterization of NIH-funded attendings showed that they often completed dedicated research time (72%) and trained at a top NIH-funded program (79%). Mean publications by graduation among this group was 15.82 ± 11.3, and they averaged 4.31 ± 4.2 publications/year as attendings. CONCLUSIONS Research output during training, advanced degrees, and training at a top NIH-funded program predict an academic vascular surgery career. VSF and IVSR constitute equally valid paths to productive academic careers.
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Affiliation(s)
- Andrea T Fisher
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA.
| | - Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA
| | - Danielle M Mullis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA
| | - Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael D Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA
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Dasgupta R, Doski J, Gow KW. Operative standards for pediatric cancer surgery. Semin Pediatr Surg 2023; 32:151345. [PMID: 38042089 DOI: 10.1016/j.sempedsurg.2023.151345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave, Cincinnati, Ohio 45229, USA.
| | - John Doski
- Division of Pediatric Surgery, UT Health San Antonio, 703 Floyd Curl Drive, MC, San Antonio, Texas 78229-3900, USA
| | - Kenneth W Gow
- Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, USA
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15
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Adkins SE, Minchew HM, Sanner Dixon K, Chollet Hinton L, Kilgore LJ, Berbel G. A Hands-On Surgical Event to Improve Medical Student Operating Room Confidence. J Surg Res 2023; 290:156-163. [PMID: 37267705 DOI: 10.1016/j.jss.2023.04.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/10/2023] [Accepted: 04/30/2023] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The negative perceptions and lack of exposure to surgery and the operating room (OR) have been known to divert students away from surgical specialties. This study describes the impact of a surgical subspecialty exposure event (OR Essentials), combined with surgical faculty and M4 mentorship on preclinical medical students' confidence at an academic medical center. METHODS OR essentials event teaches surgical skills to preclinical medical students through hands-on skill-based workshops in a simulated OR setting. Pre and postevaluations were administered to measure program impact. RESULTS One hundred four preclinical medical students participated. Following OR essentials, students reported a significant increase in confidence in the OR (P < 0.0001) and in basic surgical skills (P < 0.0001). CONCLUSIONS Early surgical exposure events like OR essentials provide opportunities to improve medical student confidence in the OR, which will hopefully support recruitment of future surgeons.
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Affiliation(s)
- Sarah E Adkins
- University of Kansas School of Medicine, Kansas City, Kansas.
| | | | | | - Lynn Chollet Hinton
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas
| | - Lyndsey J Kilgore
- Department of General Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - German Berbel
- Department of General Surgery, University of Kansas School of Medicine, Kansas City, Kansas
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Abstract
BACKGROUND Gender disparity in surgery remains an issue worldwide. We analysed the trends in gender distribution in surgical subspecialties across Australia and New Zealand over the last 8 years. METHODS Workforce reports from the Royal Australasian College of Surgeons were reviewed from 2014 to 2021. Data relating to 4802 applicants, 1554 trainees and 6839 active surgeons across nine surgical subspecialties was analysed. Statistical analysis was performed using a difference of proportions hypothesis test. Predictions regarding time to parity were performed using a linear regression model. RESULTS All nine surgical subspecialties' surgeon numbers saw a steady increase in the representation of women between 2014 and 2021. The most significant rise seen in general surgery from 14% to 21% (P ≤ 0.001). Proportions of women trainees were variable, the only significant rise was seen in orthopaedics from 9% to 19% (P ≤ 0.001). Proportions of women applicants and successful applicants have also been variable. General surgery saw the only consistent increase in women applicants over the last 6 years, from 35% in 2016 to 43% in 2021. Linear regression predictions estimate that paediatric surgery will be the first to reach gender parity in 23 years, and orthopaedics the last, in 186 years. CONCLUSION A steady increase in women has been observed across all surgical subspecialities over the last 8 years. However, estimates based on current trends suggest that gender parity may be out of reach for the next eight generations in subspecialties such as cardiothoracic and orthopaedic surgery.
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Affiliation(s)
- Vaite Graham
- Department of Surgery, Urology Division, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Bharti Arora
- Urology Division, Mater Hospital, Brisbane, Queensland, Australia
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Markel M, Lacher M, Hall NJ, Martynov I, Siles Hinojosa A, de Augustin Asensio JC, Fortmann C, Hukkinen M, Mutanen A, Ford K, Glenisson M, Bonnard A, Dimitrios G, Zavras N, Malowiecka M, Patkowski D, Zambaiti E, Pelizzo G, Salo M, Wester T, Hoel AT, Bjornland K, Arni D, Wildhaber BE, Karagöz A, Topuzlu Tekant G, Barroso C, Correia-Pinto J, Gorter R, van Heurn E, Reusens H, Steyaert H, Dagilyte R, Strumila A, Arneitz C, Till H, Dotlaci V, Rygl M, Jukic M, Pogorelic Z, Enache T, Balanescu L, Cascio S, Zani A, Pio L. Training in minimally invasive surgery: experience of paediatric surgery trainees in Europe. Br J Surg 2023; 110:1397-1399. [PMID: 37527435 DOI: 10.1093/bjs/znad245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Moritz Markel
- Department of Paediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Martin Lacher
- Department of Paediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Illya Martynov
- Department of Paediatric Surgery, University of Leipzig, Leipzig, Germany
| | | | | | - Caroline Fortmann
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Maria Hukkinen
- Department of Paediatric Surgery, University of Helsinki, Helsinki, Finland
| | - Annika Mutanen
- Department of Paediatric Surgery, University of Helsinki, Helsinki, Finland
| | - Kathryne Ford
- Pediatric Surgery Unit, Oxford Children's Hospital and University of Oxford, Oxford, UK
| | - Mathilde Glenisson
- Department of Paediatric Surgery and Urology, Necke-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Bonnard
- Department of Paediatric Surgery and Urology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Godosis Dimitrios
- Paediatric Surgery Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Zavras
- Department of Paediatric Surgery, 'Attikon' University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Malowiecka
- Pediatric Surgery Unit, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Dariusz Patkowski
- Paediatric Surgery and Urology Department, Wroclaw University of Medicine, Wroclaw, Poland
| | - Elisa Zambaiti
- Paediatric Surgery Department, Regina Margherita Hospital, Turin, Italy
| | - Gloria Pelizzo
- Paediatric Surgery Department, 'V. Buzzi' Children's Hospital and University of Milan, Milan, Italy
| | - Martin Salo
- Department of Paediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Tomas Wester
- Department of Paediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders T Hoel
- Department of Paediatric Surgery, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Kristin Bjornland
- Department of Paediatric Surgery, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Delphine Arni
- University Centre of Paediatric Surgery of Western Switzerland, Division of Child and Adolescent Surgery, Department of Paediatrics, Gynaecology, and Obstetrics, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
| | - Barbara E Wildhaber
- University Centre of Paediatric Surgery of Western Switzerland, Division of Child and Adolescent Surgery, Department of Paediatrics, Gynaecology, and Obstetrics, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
| | - Ayse Karagöz
- Division of Paediatric Urology, Department of Paediatric Surgery, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Gonca Topuzlu Tekant
- Division of Paediatric Urology, Department of Paediatric Surgery, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Catarina Barroso
- Department of Paediatric Surgery, Hospital de Braga, Braga, Portugal
| | | | - Ramon Gorter
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital and VU University Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ernst van Heurn
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital and VU University Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Helena Reusens
- Department of Paediatric Surgery, Université Libre de Bruxelles (ULB), Queen Fabiola Children's Hospital, Brussels, Belgium
| | - Henri Steyaert
- Department of Paediatric Surgery, Université Libre de Bruxelles (ULB), Queen Fabiola Children's Hospital, Brussels, Belgium
| | - Ruta Dagilyte
- Pediatric Surgery Unit, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arunas Strumila
- Pediatric Surgery Unit, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Christoph Arneitz
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Vojtech Dotlaci
- Department of Paediatric Surgery, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Michal Rygl
- Department of Paediatric Surgery, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Miro Jukic
- Department of Paediatric Surgery, University Hospital of Split, Split, Croatia
- Department of Surgery, University of Split, School of Medicine, Split, Croatia
| | - Zenon Pogorelic
- Department of Paediatric Surgery, University Hospital of Split, Split, Croatia
- Department of Surgery, University of Split, School of Medicine, Split, Croatia
| | - Tudor Enache
- Department of Paediatric Surgery, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Laura Balanescu
- Department of Paediatric Surgery, Grigore Alexandrescu Clinical Emergency Hospital for Children, Bucharest, Romania
- Department of Paediatric Surgery and Orthopaedics, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Salvatore Cascio
- Department of Paediatric Surgery and Paediatric Urology, Children's Health Ireland at Temple Street and University College Dublin, Dublin, Ireland
| | - Augusto Zani
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Luca Pio
- Department of Paediatric Surgery and Urology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Lawaetz J, Soenens G, Eiberg J, Van Herzeele I, Konge L, Nesbitt C, Gentile F, Stavroulakis K, Weiss S, Nayahangan LJ. Facilitators and Barriers to Implementation of Simulation Based Education in Vascular Surgery in Europe. Eur J Vasc Endovasc Surg 2023; 66:428-436. [PMID: 37330202 DOI: 10.1016/j.ejvs.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/31/2023] [Revised: 04/27/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study explored the status and availability of simulation based education (SBE) for learning vascular surgical procedures identified in the 2019 General Needs Assessment in vascular surgery in Europe (GNA-2019) and identified facilitators and barriers to SBE implementation in vascular surgery. METHODS A three round iterative survey was distributed via the European Society for Vascular Surgery and the Union Européenne des Médecins Spécialistes. Members from leading committees and organisations within the European vascular surgical community were invited to participate as key opinion leaders (KOLs). Three online survey rounds explored demographics, SBE availability, and facilitators and barriers to SBE implementation. RESULTS Overall, 147 KOLs (target population 338) accepted invitation to round 1, representing 30 European countries. The dropout rates for rounds 2 and 3 were 29% and 40%, respectively. Most respondents (88%) were senior, consultant level or higher. No mandatory SBE training was required in their department before training on patients, according to 84% of the KOLs. There was high consensus on the need for structured SBE (87%) and mandatory SBE (81%). SBE is available for the top three prioritised procedures in GNA-2019 (basic open skills, basic endovascular skills, and vascular imaging interpretation) in 24, 23, and 20 of the 30 represented European countries, respectively. The highest ranking facilitators were structured SBE programmes, availability of simulation equipment locally and regionally, good quality simulators, and having a dedicated person running the SBE. The highest ranked barriers were lack of structured SBE curriculum, equipment costs, lack of SBE culture, no or limited dedicated time for faculty to teach in SBE, and clinical work overload. CONCLUSION Based largely on the opinions of KOLs in vascular surgery in Europe, this study revealed that SBE is needed in vascular surgery training and that systematic and structured programmes are required to ensure successful implementation.
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Affiliation(s)
- Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Craig Nesbitt
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | | | | | - Salome Weiss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark
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Burke JR, Fleming CA, King M, El-Sayed C, Bolton WS, Munsch C, Harji D, Bach SP, Collins JW. Utilising an accelerated Delphi process to develop consensus on the requirement and components of a pre-procedural core robotic surgery curriculum. J Robot Surg 2023; 17:1443-1455. [PMID: 36757562 PMCID: PMC9909133 DOI: 10.1007/s11701-022-01518-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/31/2022] [Indexed: 02/10/2023]
Abstract
Robot-assisted surgery (RAS) continues to grow globally. Despite this, in the UK and Ireland, it is estimated that over 70% of surgical trainees across all specialities have no access to robot-assisted surgical training (RAST). This study aimed to provide educational stakeholders guidance on a pre-procedural core robotic surgery curriculum (PPCRC) from the perspective of the end user; the surgical trainee. The study was conducted in four Phases: P1: a steering group was formed to review current literature and summarise the evidence, P2: Pan-Specialty Trainee Panel Virtual Classroom Discussion, P3: Accelerated Delphi Process and P4: Formulation of Recommendations. Forty-three surgeons in training representing all surgical specialties and training levels contributed to the three round Delphi process. Additions to the second- and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. There was 100% response from all three rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of > 0.8. There was 97.7% agreement that a standardised PPCRC would be advantageous to training and that, independent of speciality, there should be a common approach (95.5% agreement). Consensus was reached in multiple areas: 1. Experience and Exposure, 2. Access and context, 3. Curriculum Components, 4 Target Groups and Delivery, 5. Objective Metrics, Benchmarking and Assessment. Using the Delphi methodology, we achieved multispecialty consensus among trainees to develop and reach content validation for the requirements and components of a PPCRC. This guidance will benefit from further validation following implementation.
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Affiliation(s)
- Joshua Richard Burke
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | - Christina A. Fleming
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- The Royal College of Surgeons, Dublin, Ireland
| | - Martin King
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Craigavon Area Hospital, Craigavon, Northern Ireland
| | - Charlotte El-Sayed
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | | | - Chris Munsch
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
| | - Deena Harji
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon P. Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Justin W. Collins
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention, London, UK
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), UK, University College London, London, UK
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20
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Baboolal SO, Singaram VS. The Use, Effectiveness, and Impact of Workplace-Based Assessments on Teaching, Supervision and Feedback Across Surgical Specialties. J Surg Educ 2023; 80:1158-1171. [PMID: 37407351 DOI: 10.1016/j.jsurg.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/13/2022] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To investigate the use and effectiveness of Workplace-based assessments (WBAs) and their impact on training, feedback, and perioperative teaching in surgical training programs. DESIGN A mixed methods cross-sectional, national electronic survey was conducted with surgical trainees and consultant trainers. SETTINGS The trainees and supervising faculty were from all 8 major surgical training universities across 11 surgical disciplines in South Africa. PARTICIPANTS A total of 108 surgical trainees and 41 supervising consultant trainers from 11 surgical disciplines across 8 surgical training universities responded to the survey. RESULTS The most significant educational gap identified by both the surgical trainees and trainers across all surgical disciplines was inadequate perioperative feedback. A third of the respondents were currently using workplace-based assessments. The WBA users (both trainees and trainers) had a higher rating for the general quality of surgical feedback than WBA nonusers (p = 0.02). WBA users also had a higher rating for the general quality of feedback given to trainees on their skills and competence (p = 0.04) and a higher rating for trainee supervision (p = 0.01) and the specialist training program overall (p = 0.01). The WBA users also had a higher rating for the assessment of competencies such as the trainee as an effective communicator (p < 0.01) and collaborator (p = 0.04). CONCLUSION This study found that the use of WBAs enhances the quality and effectiveness of feedback in surgical training programs. We also found that the use of WBAs enhance perioperative teaching and learning and improves the assessment of relational competencies. This was also associated with high ratings for the quality of trainee supervision. Faculty and trainee development, strengthening the trainee-trainer relationship, and integrating iterative stakeholder feedback could help realize the full potential of WBAs to augment surgical training across disciplines.
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Affiliation(s)
- Sandika O Baboolal
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
| | - Veena S Singaram
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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21
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Muecke T, Bacchi S, Casson R, Chan WO. Building a bright future: discussing the weighting of academic research in standardized curriculum vitae for Australian Medical and Surgical Specialty Training College entrance. ANZ J Surg 2023; 93:1744-1753. [PMID: 37232265 DOI: 10.1111/ans.18513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Thomas Muecke
- Health & Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health & Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Neurology Department, Flinders University, South Australia, Bedford Park, Australia
| | - Robert Casson
- Health & Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Weng Onn Chan
- Health & Medical Science, University of Adelaide, Adelaide, South Australia, Australia
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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22
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Rabenstein AP, Santore LA, Starnes SL, Van Haren RM, Balaguer JM, Abdel-Misih S. Cardiac Surgery Exposure in General Surgery Residency-A Survey of General Surgery Residency Program Directors. J Surg Educ 2023; 80:633-638. [PMID: 36774212 DOI: 10.1016/j.jsurg.2023.01.007] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/05/2022] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Little is known regarding how much exposure general surgery residents have to cardiac surgery, despite cardiothoracic (CT) surgery being an offered postresidency fellowship and career. Exposure to a subspecialty is important in shaping residents' interests and career decisions. METHODS A survey was sent to all general surgery program directors via the Association of Program Directors in Surgery examining cardiac surgery exposure during training. The survey examined the presence of operative rotations in cardiac surgery and cardiac critical care, portions of cases residents were permitted to perform, cardiac surgery mentorship and education, and perceived biases in applying to cardiac surgery. Differences between programs with and without cardiothoracic training programs were analyzed. RESULTS In total, 44% (102/230) of program directors responded to the survey. Residents were involved in operative cardiac and cardiac ICU rotations in 61 programs (69.8%) and 39 programs (38.2%), respectively. Twenty programs (19.6%) had a dedicated cardiothoracic surgery training program and these programs had significantly more graduates who aspired to be cardiac surgeons (M = 2.75, SD = 2.47) compared to hospitals with no CT programs (M = 1.43, SD = 1.41; p = 0.031). 35.3% of program directors reported resident concern over family life. CONCLUSIONS There is a notable heterogeneity in general surgery resident exposure to cardiac surgery, cardiac ICU, and cardiac surgery mentorship. Increased exposure, mentorship and mitigating resident concern over the impact of social factors on cardiac surgical careers should be key areas of focus to ensure continued encouragement of future trainees and surgeons.
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Affiliation(s)
- Andrew P Rabenstein
- AHN Cardiovascular Institute at Allegheny General Hospital, Department of Thoracic and Cardiovascular Surgery, Pittsburgh, Pennsylvania.
| | - Lee Ann Santore
- Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook University Hospital, Stony Brook, New York
| | - Sandra L Starnes
- Department of Surgery, Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Van Haren
- Department of Surgery, Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jorge M Balaguer
- Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook University Hospital, Stony Brook, New York
| | - Sherif Abdel-Misih
- Department of Surgery, General Surgery Residency, Stony Brook University Hospital, Stony Brook, New York
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23
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Silvestre J, Nawaz Z, Rowe VL, Hughes K. Paradigm Shift in Vascular Surgery Training: Independent versus Integrated Match Outcomes. Ann Vasc Surg 2023; 91:57-64. [PMID: 36574831 DOI: 10.1016/j.avsg.2022.12.081] [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] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Currently, 2 predominant pathways exist for vascular surgery training: integrated and independent training pathways. We hypothesized that match rates would increase with time and be higher in the independent pathway than in the integrated pathway. METHODS The National Resident Matching Program provided data from the Vascular Surgery Match (VSM) (2008-2021). Match rates were defined as the percentage of applicants who matched. Chi-squared tests were used to evaluate temporal trends and interpathway differences. RESULTS Over the study period, the annual number of training positions increased for both the independent (119 to 129, 8% increase) and integrated (9 to 79, 778% increase) training pathways. From 2008 to 2021, the annual match rate was stable in the independent pathway (97% to 96%, P > 0.05). In the integrated pathway, the annual match rate increased from 29% to 44% (P < 0.001). During each year, match rates in the independent pathway exceeded those in the integrated pathway (P < 0.001). US allopathic graduates had higher match rates than non-US allopathic graduates in both the independent (92% vs. 82%, P < 0.001) and the integrated pathway (70% vs. 17%, P < 0.001). In the independent pathway, the percentage of applicants that matched at 1 of their top 3 choices decreased from 67% to 58% (P < 0.001). Over the study period, more training positions went unmatched in the Independent (n = 130, 8%) versus the Integrated (n = 17, 3%) pathway (P < 0.001). CONCLUSIONS VSM match rates have increased for the integrated pathway and remains competitive especially for non-US allopathic graduates. More research is needed to understand applicant variables that modulate match rates.
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Affiliation(s)
- Jason Silvestre
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Howard University College of Medicine, Washington, DC.
| | - Zaid Nawaz
- Howard University College of Medicine, Washington, DC
| | - Vincent L Rowe
- The Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Kakra Hughes
- Howard University College of Medicine, Washington, DC
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24
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Haruno LS, Chen X, Metzger M, Lin CA, Little MTM, Kanim LEA, Poon SC. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg 2023; 158:368-376. [PMID: 36753189 PMCID: PMC9909577 DOI: 10.1001/jamasurg.2022.7640] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 02/09/2023]
Abstract
Importance Racial and sex disparities are prevalent in surgical trainees. Although retrospective studies on resident attrition have been conducted for individual specialties, this study analyzes racial and sex differences in resident attrition among all surgical subspecialties over an 18-year period. Objective To evaluate the racial and sex differences in resident attrition among surgical specialties over an 18-year period. Design, Setting, and Participants This was a large, cross-sectional, database study that analyzed program-reported resident censuses (program information, resident demographics, and attrition status) obtained by the Association of American Medical Colleges from 2001 to 2018 for trainees in surgical residency programs. Data were analyzed from March 20, 2021, to June 8, 2022. Main Outcomes and Measures Demographic trends (including race and ethnicity and sex) for all surgical subspecialty training programs over an 18-year period. Resident attrition includes all-cause withdrawals, dismissals, and transfers to another specialty. Unintended attrition encompasses all withdrawals, dismissals, and transfers except for changing career plans. Results This study included 407 461 program-reported resident years collected from 112 205 individual surgical residents (67 351 male individuals [60.0%]). The mean percentage of female trainees was 40.0% (44 835) and increased over the study period. Sex disparity remained greatest in orthopedic surgery. Residents who were underrepresented in medicine (URiM) comprised 14.9% (16 695) of all surgical trainees but demonstrated a 2.1% decrease over the study period. Overall attrition rate among all specialties was 6.9% (7759), with an unintended attrition rate of 2.3% (2556). Female residents had a significantly higher relative risk (RR) of attrition (RR, 1.16; 95% CI, 1.11-1.22; P < .001) and unintended attrition (RR, 1.17; 95% CI, 1.08-1.26; P < .001) compared with their male counterparts. URiM residents were at significantly higher RR for attrition (RR, 1.40; 95% CI, 1.32-1.48; P < .001) and unintended attrition (RR, 1.92; 95% CI, 1.75-2.11; P < .001) compared with non-URiM residents. The highest attrition (10.6% [746 of 7043]) and unintended attrition (5.2% [367 of 7043]) rates were in Black/African American residents. The lowest attrition and unintended attrition rates were seen in White residents at 6.2% (4300 of 69 323) and 1.8% (1234 of 69 323), respectively. Black/African American residents were at disproportionate risk for attrition (RR, 1.66; 95% CI, 1.53-1.80; P < .001) and unintended attrition (RR, 2.59; 95% CI, 2.31-2.90; P < .001) compared with all other residents. Orthopedic surgery had the highest attrition (RR, 3.80; 95% CI, 2.84-5.09; P < .001) and unintended attrition (RR, 7.20; 95% CI, 4.84-10.71; P < .001) for Black/African American residents. Conclusions and Relevance Results of this cross-sectional study suggest that the percentage of female residents in surgical specialties has improved over the last 18 years, and the percentage of URiM residents has remained relatively unchanged. Risk for attrition and unintended attrition was significantly elevated for female and URiM residents, specifically Black/African Americans. These results highlight current racial and sex disparities in resident attrition and demonstrate the importance of developing strategies to recruit, retain, and support residents.
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Affiliation(s)
- Lee S. Haruno
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Xi Chen
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melodie Metzger
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Carol A. Lin
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Milton T. M. Little
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | | | - Selina C. Poon
- Shriners Children’s Southern California, Pasadena, California
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25
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Weisser N, Küppers J, Lindner A, Heinrich M, Zimmermann P, Muensterer OJ. SuSiPed: An initial step towards a universal, low-cost, 3D-printable platform for pediatric minimal-invasive surgery training. J Pediatr Surg 2023; 58:675-678. [PMID: 36641314 DOI: 10.1016/j.jpedsurg.2022.12.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Training platforms such as the Fundamentals of Laparoscopic Surgery have become an integral part of postgraduate adult general surgical education. So far, however, there is no such universal tool for pediatric minimal-invasive surgery (MIS). We therefore designed and validated a novel 3D printable pediatric MIS simulation program. METHODS The SuSiPed (Surgical Simulation in Pediatrics) curriculum consists of 6 MIS training modules: camera guidance, shell transfer, figure cutting, cyst resection, single interrupted suturing, and slipknot suturing. All modules can be 3D printed, and thus manufactured in a low-cost, sustainable and reproducible fashion. Instructional videos for the participants for each module were created. For validation, a group of medical students and surgical residents were compared to a group of pediatric surgical specialists with experience in MIS. All participants performed the entire SuSiPed curriculum 3 times, measuring time to task completion and technical mistakes. The results of the last attempt were compared using Welch's T-test. RESULTS There were 25 participants in the novice group and 5 in expert group. Times to task completion were lower in the expert group for all modules except camera guidance. Errors were significantly more frequent during slipknot suturing in the novice group, while there were no difference in the other modules. CONCLUSION Our novel training platform showed good construct validity for 5 out of 6 modules, while scores of camera navigation was not associated with prior experience. The SuSiPed platform is useful for pediatric minimal-invasive surgery training and evaluation, even in low-resource countries where expensive simulators are not affordable. LEVEL OF EVIDENCE Level III, Validation Study.
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Affiliation(s)
- Nora Weisser
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Medical Center, Munich, Germany
| | - Julia Küppers
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Medical Center, Munich, Germany
| | - Andreas Lindner
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Medical Center, Munich, Germany
| | - Martina Heinrich
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Medical Center, Munich, Germany
| | - Petra Zimmermann
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Medical Center, Munich, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Medical Center, Munich, Germany.
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26
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Coluccio M, Shridhar N, Liang T, Harris L. Integrated vascular surgery applicants' perspectives of virtual residency interviews during the coronavirus disease 2019 application cycle. J Vasc Surg 2023; 77:634-639.e2. [PMID: 36150637 PMCID: PMC9671692 DOI: 10.1016/j.jvs.2022.09.013] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND In agreement with Association of American Medical Colleges guidelines, the 2020 to 2021 integrated vascular surgery (I-VS) residency interviews were conducted virtually. In the present study, we collected data about the virtual interview process from the applicant's perspective, including preferences for interview format and the virtual resources they found most helpful. METHODS An anonymous, online survey study of medical students who had been accepted into I-VS residencies during the 2020 to 2021 application cycle was performed. The survey contained questions about applicant behavior during the virtual application cycle, their perception of the virtual interviews, the utility of the virtual format, their preferences, and the virtual resources they found the most helpful for determining their rank list. RESULTS Of 72 applicants, 38 (18 women, 19 men, and 1 declined to answer) had completed the survey for a 57.2% response rate. The average number of programs interviewed was 25 to 30 (31%). More than one-half (55%) of the respondents had responded that they had interviewed at more programs than they would have had the interviews been in person. More than one-half of the applicants (55%) reported that they preferred remote interviews with the option to visit in-person at their top choice programs compared with the use of all remote interviews (21%) or all in-person interviews (18%). Most had somewhat or strongly agreed (79%) that virtual interviews allowed them to properly gauge a residency program and provided adequate opportunities to interact with the residents (65%). The online resources the applicants found the most helpful in determining their rank lists were attending educational conferences, prerecorded videos from faculty and residents, and the program's social media platforms. CONCLUSIONS The results from the present study have illuminated the current trends and attitudes of I-VS applicants for virtual interviews, including the virtual resources they found the most useful. Virtual interviews were a preferred method of interviewing and allowed applicants to assess a residency program and interact with the current residents. These variables should be considered by the program leadership when developing protocols for upcoming application cycles.
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Affiliation(s)
| | | | | | - Linda Harris
- Division of Vascular Surgery, Department of Surgery, SUNY at Buffalo, Buffalo, NY
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27
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Shah HP, Kafle S, Lee JY, Cardella J, Alperovich M, Lee YH. Livestream surgeries enhance preclinical medical students' exposure to surgical specialties. Am J Surg 2023; 225:432-435. [PMID: 36280449 PMCID: PMC9840906 DOI: 10.1016/j.amjsurg.2022.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Hemali P Shah
- Yale School of Medicine, New Haven, CT, United States
| | - Samipya Kafle
- Yale School of Medicine, New Haven, CT, United States
| | - Jonathan Y Lee
- Division of Plastic and Reconstructive Surgery, University of Massachusetts Medical School-Baystate, Baystate Medical Center, Springfield, MA, United States
| | - Jonathan Cardella
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Yan Ho Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States.
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28
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Sutton E, Hanke C. ACGME Program Requirements for Surgical Specialties: How Do Dermatology and MSDO Stack Up? J Drugs Dermatol 2023; 22:90-93. [PMID: 36607748 DOI: 10.36849/jdd.6886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Dermatology and micrographic surgery and dermatologic oncology (MSDO) are two areas of medicine where surgical procedures play an important role both in training and practice. We sought to determine how dermatology and MSDO compare to ACGME surgical specialties with regard to surgical curriculum and case log requirements. We found that the surgical curriculums for dermatology and MSDO are similar to those of our surgical colleagues in ophthalmology, obstetrics, and gynecology. They are similar in that none require general surgery rotations, a general surgery postgraduate year 1 is not required, and all surgical experience can be obtained within each respective specialty residency training program. Regarding case log requirements, MSDO was found to have numerical case log requirements comparable to those of ACGME surgical specialties. Dermatology case log requirements were on the low end of the surgical spectrum. In dermatology and MSDO, surgical training is well integrated into the programs and case log requirements. They represent two of the many areas where medicine and surgery combine in the name of patient care. J Drugs Dermatol. 2023;22(1): doi:10.36849/JDD.6886.
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29
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Chan SM, Gardezi M, Satam K, Brahmandam A, Aboian E, Strosberg D, Cardella J, Ochoa Chaar CI. Virtual vascular surgery interest group during the coronavirus disease 2019 pandemic. J Vasc Surg 2023; 77:279-285.e2. [PMID: 36041674 PMCID: PMC9419433 DOI: 10.1016/j.jvs.2022.08.022] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Early exposure to vascular surgery at the medical student level positively influences one's decision to apply into an integrated vascular surgery residency program. Vascular surgery interest groups (VSIGs) are student-run and aim to facilitate such exposure, traditionally via in-person events. Social distancing during the coronavirus disease 2019 pandemic disrupted these interactions. This is a description of the virtual activities of a VSIG group during the 2020-2021 academic year and highlights their impact among medical students. METHODS The virtual activities of the VSIG at the Yale School of Medicine were reviewed. Students received surveys prior and after activities to assess their impact. Preactivity and postactivity surveys using Likert scale (1 = completely disagree; 5 = completely agree) were administered and compared. Statistical significance was achieved with a P value of less than .05. RESULTS A total of five virtual events were held: an Introductory Session (October 2020), a Simulation Session (November 2020), a Research Night (January 2021), a Journal Club (February 2021), and a National Match Panel (April 2021). The surveys of three events (Introductory Session, Simulation Session, and National Match Panel) were analyzed. Attendance at these events were 18, 55, and 103 respectively. The average presurvey response rate was 51.2% and the average postsurvey response rate was 27.46%. Students agreed that the Introductory Session increased their knowledge about vascular surgery as a subspecialty (4.22 ± 0.67) and that the session was valuable to their time (4.33 ± 1.00). The Simulation Session increased student's comfort with knot tying from 1.73 ± 0.89 to 3.21 ± 1.25 (P < .001). Students reported an increased understanding of residency program selection (2.39 ± 1.10 vs 3.21 ± 1.12; P = .018), the Electronic Residency Application Service application (2.16 ± 1.01 vs 3.00 ± 0.88; P = .007), and letters of recommendation (2.45 ± 1.07 vs 3.14 ± 1.17; P = .04). Students particularly had a significant increase in the understanding of the logistics of residency interviews, which were held virtually that year for the first time (1.84 ± 0.96 vs 3.29 ± 1.20; P < .001). CONCLUSIONS Virtual VSIG activities were feasible and effective during the pandemic in promoting student engagement and interest in vascular surgery. Despite lifting social distancing measures, the virtual format could become a valuable tool to expand outreach efforts of the vascular surgery community to recruit talented medical students.
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Affiliation(s)
| | | | | | - Anand Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edouard Aboian
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - David Strosberg
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jonathan Cardella
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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30
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Takele R, Patel ND, Greene KL, Dobbs RW. The Fate of the Unmatched Urology Applicant. Urology 2023; 171:29-34. [PMID: 36334769 DOI: 10.1016/j.urology.2022.09.030] [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] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the outcomes and eventual career paths for unmatched applicants by evaluating a historical cohort of unmatched applicants in the Urology Match. METHODS The 2008-2014 AUA Match lists were obtained from the Society of Academic Urologists and 730 unique applicants were identified with at least one unmatched result. Additional information such as preliminary training and eventual specialty choice were obtained from publicly available sources. Comparative analysis with univariable and multivariable analysis was performed between eventual urologists and those who chose alternative career paths. RESULTS Overall, 43.5% (318/730) of unmatched urology applicants subsequently continued their interest in Urology and 77.4% (246/317) of initially unsuccessful applicants eventually became urologists. Males (80.9%, P = .01), Doctor of Osteopathy (DO) degree (62.5%, P = <.001), and those undergoing a research year compared to a preliminary surgery year (85.2% vs 72.0% respectively, P = .047) had an increased likelihood of successfully becoming a urologist. The most common alternative specialty choices were Internal Medicine (13.8%), General Surgery (12.9%) and Anesthesiology (11.9%). CONCLUSION Urology is a competitive surgical sub-specialty. Surprisingly, approximately 3 in 4 unmatched urology applicants who continue their interest in urology will eventually obtain a residency position. However, only 33.7% of initially unmatched students ultimately became urologists. Unmatched applicants have several viable pathways to obtain a urological residency position. Male gender, a DO degree, and a research year are associated with successfully obtaining a urology residency position.
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Affiliation(s)
- Rebecca Takele
- Edward Via College of Osteopathic Medicine, Blacksburg VA
| | - Nishant D Patel
- Department of Urology, University of Virginia, Charlottesville VA
| | - Kirsten L Greene
- Department of Urology, University of Virginia, Charlottesville VA
| | - Ryan W Dobbs
- Division of Urology, Cook County Health and Hospitals System, Chicago IL.
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31
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Potts JR, Buyske J, Klingensmith ME. Outcomes of the Early Specialization Program in Vascular Operation. J Am Coll Surg 2022; 235:550-558. [PMID: 35972178 DOI: 10.1097/xcs.0000000000000297] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Early Specialization Program (ESP) in vascular surgery (VS) began as a "pilot program" in 2003. There is only one published report on ESP outcomes. STUDY DESIGN The general surgery (GS) and VS programs of all institutions using the ESP were contacted. Data gathered included demographics of ESP enrollees, participants' case logs (CLs), and CLs of participants' residency graduating classmates. National CLs, program and institutional data, and participants' certification status were publicly available. RESULTS Nine institutions have enrolled 34 participants. Four withdrew, and four are in the GS component. Of 26 who have completed ESP, residency CLs were available for 20. Participants' percentile rankings among national contemporaries were lower than 13th for surgeon-junior cases (SJCs), higher than 73rd for surgeon-chief cases (SCCs), and 49th for total major cases (TMCs). They were lower than the 40th percentile in all domains except operative trauma (52; SD 23.8) and vascular (84.7; SD 22.1). As a percentage of the mean (% mean) for their own graduating classes, participants performed 91.8% (SD 16.5) as many SJCs, 143.7% (SD 45.1) as many SCCs, and 105% (SD 11.4) as many TMCs. Participants performed more than 79 % mean in every domain, including 213.4% (SD 82.4) as many vascular cases. As fellows, they ranked higher than the 50th percentile nationally in all but two categories. Twenty-four of 26 certified in GS. GS certification has lapsed for 5, 17 remain initially certified, and 2 have re-certified. All have current VS certification. CONCLUSION Although infrequently employed, ESP remains an effective option for those who seek both GS and VS certification.
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Affiliation(s)
- John R Potts
- From the Superior Value in Program Accreditation, Chicago, IL (Potts)
| | - Jo Buyske
- the American Board of Surgery, Philadelphia, PA (Buyske)
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32
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Mellor K, Robinson DB, Luton O, James OP, Powell AGMT, Hopkins L, Hemington-Gorse S, Egan RJ, Lewis WG. Prognostic significance of competition ratios in surgical specialty training selection. Postgrad Med J 2022; 98:700-704. [PMID: 37062983 DOI: 10.1136/postgradmedj-2020-139491] [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] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Abstract
BackgroundA competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on National Training Number (NTN) selection in a single UK Statutory Education Body.MethodsConsecutive core surgical trainees numbering 154 (105 men, 49 women; median years since graduation: four) were studied over a 6-year period. Annual specialty specific CRs were obtained from Health Education England’s website, and primary outcome measure was UK NTN appointment.ResultsOverall NTN appointment was 45.5%. Median CR was 2.36; range Oral & Maxillofacial Surgery 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p=0.003), a single scientific publication (OR 6.25, p=0.001), cohort year (2019, OR 12.65, p=0.003) and Universal Annual Review of Competence Progression Outcome 1 (OR 45.24, p<0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n=8) versus 49.2% (n=62), p=0.018.ConclusionCRs displayed 30-fold variation, with CRs below 4.42 associated with twofold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.
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Affiliation(s)
- Katie Mellor
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - David B Robinson
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Oliver Luton
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Osian P James
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Arfon G M T Powell
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Luke Hopkins
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
| | - Sarah Hemington-Gorse
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- Department of Surgery, Morriston Hospital, Swansea, Wales, UK
| | - Richard J Egan
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
- Department of Surgery, Morriston Hospital, Swansea, Wales, UK
| | - Wyn G Lewis
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
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Jogerst K, Chou E, Tanious A, Latz C, Boitano L, Mohapatra A, Petrusa E, Dua A. Virtual Simulation of Intra-operative Decision-Making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis. J Surg Educ 2022; 79:1043-1054. [PMID: 35379583 DOI: 10.1016/j.jsurg.2022.03.004] [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] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To create and pilot test a novel open abdominal aortic aneurysm (AAA) repair virtual simulation focused on intraoperative decision-making. To identify if the simulation replicated real-time intra-operative decision-making and discover how learners' respond to this type of simulation. DESIGN An explanatory sequential mixed methods study. We developed a step-by-step outline of major intra-operative decision points within a standard open AAA repair. Perioperative and intraoperative decision-making trees were developed and coded into an online virtual simulation. The simulation was piloted. Quantitative data was collected from the simulation platform. We then performed a qualitative thematic analysis on feedback from interviewed participants. SETTING Four academic general and vascular surgical training programs across the US. PARTICIPANTS Seventeen vascular and general surgery trainees and 6 vascular surgery faculty. RESULTS Participants spent on average 27 minutes (range: 8-45 minutes) interacting with the interface. 93% of participants reported feeling they were making real intraoperative decisions. 85% said it added to their knowledge base. 96% requested additional simulations. 22 interviews were completed: 241 primary codes were collapsed into 21 parent codes, and 6 emerging themes identified. Themes included the benefit of how (1) "Virtual Learning Could Standardize the Training Experience"; how (2) "Dealing with the Unexpected" as a trainee is an important part of surgical education growth, and that this (3) "Choose Your Own Adventure" virtual format simulates this intraoperative growth experience. Participants requested a (4) "Looping Feature Feedback Diagram" for future simulation iterations and highlighted that (5) "Fancier is Not Necessarily More Educational." Finally, many trainees wondered about (6) "The Attending Impact" from the simulation: if faculty would notice a difference between trainees who did vs did not utilize the simulation for case preparation. CONCLUSIONS Operative simulation training should focus on both technical skills and intra-operative decision-making, particularly "dealing with the unexpected." The learners' responses indicate that a low-fidelity, scalable, virtual platform can effectively deliver knowledge and allow for intra-operative decision-making practice in a remote learning environment.
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Affiliation(s)
- Kristen Jogerst
- Department of Surgery, Mayo Clinic, Phoenix, Arizona; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Elizabeth Chou
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam Tanious
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher Latz
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura Boitano
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Abhisekh Mohapatra
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Anahita Dua
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Abstract
OBJECTIVES To compare gender diversity between UK surgical specialties, assess trends over time, and estimate when gender parity might be achieved. DESIGN Observational study. SETTING National Health Service, UK. PARTICIPANTS NHS Hospital & Community Health Service workforce statistics for 2011 to 2020 MAIN OUTCOME MEASURES: Logistic regression was used to compare female representation in 2020 between surgical specialties, and to examine for any significant trends between 2011 and 2020. The method of least squares was used to estimate when female representation of specialty registrars would reach 50% ('gender parity') for specialties with <40% female representation. RESULTS In 2020, female consultant and specialty registrar representation was significantly different between surgical specialties (both p<0.001). Female representation for each specialty were as follows (from highest to lowest): Specialty Registrars-Ophthalmology 49.7%, Otolaryngology 48.2%, Paediatric Surgery 45.5%, Plastic Surgery 42.2%, General Surgery 39.8%, Urology 31.6%, Vascular Surgery 25.0%, Neurosurgery 24.7%, Cardiothoracic Surgery 21.3%, and Trauma and Orthopaedics 20.6%; Consultants-Ophthalmology 32.4%, Paediatric Surgery 31.7%, Plastic Surgery 20.9%, General Surgery 17.5%, Otolaryngology 17%, Vascular Surgery 13.7%, Urology 11.7%, Cardiothoracic Surgery 10.8%, Neurosurgery 8.2%, and Trauma and Orthopaedics 7.3%. There was a significant positive trend in female representation of specialty registrars between 2011 and 2020 for all specialties except for Paediatric Surgery (representation consistently >45%) and Vascular Surgery (representation consistently <30%). General Surgery was estimated to achieve gender parity of their specialty registrars by 2028, Urology by 2033, Neurosurgery by 2064, Trauma and Orthopaedics by 2070, and Cardiothoracic Surgery by 2082. CONCLUSIONS Despite improvements over the last decade, gender disparity persists in the UK surgical workforce and there are significant differences between surgical specialties. Further work is necessary to establish the reasons for these observed differences with a specific focus on Vascular Surgery, Cardiothoracic Surgery, Neurosurgery, and Trauma and Orthopaedics.
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Affiliation(s)
| | - Matthew G Parry
- London School of Hygiene and Tropical Medicine Department of Health Services Research and Policy, London, London, UK
| | - Roxanna Zakeri
- Whittington Hospital, London, London, UK
- UCL Division of Medicine, London, London, UK
| | - Victoria Pegna
- Kent Surrey and Sussex Deanery, Crawley, West Sussex, UK
- Royal College of Surgeons of England, London, London, UK
| | - Amy Nagle
- Urological Department, Barts Health NHS Trust, London, London, UK
| | - Farah Bhatti
- Royal College of Surgeons of England, London, London, UK
- Cardiothoracic surgery, Morriston Hospital, Swansea, Wales, UK
| | - Stella Vig
- Royal College of Surgeons of England, London, London, UK
- Department of Vascular and General Surgery, Croydon Health Services NHS Trust, Croydon, Greater London, UK
| | - James Stephen Arthur Green
- Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
- Health Service and Population Research Department, Center for Implementation Science, King's College London, London, UK
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Eguia E, Kolachina S, Miller E, Eguia MA. Medical Students from Socioeconomically Disadvantaged Backgrounds are Less Likely to Match into Surgery. World J Surg 2022; 46:1261-1267. [PMID: 35294613 DOI: 10.1007/s00268-022-06510-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study aims to understand the demographic and academic characteristics that play a role in enrollment in surgical residency programs as well as any racial or socioeconomic disparities that may exist for medical students entering surgical specialties at the Loyola University Chicago Stritch School of Medicine (LUC-SSOM). METHODS Demographic data for 993 medical students graduating between 2013 and 2019 from LUC-SSOM were compared using a series of t tests, Chi-square tests, and logistic regression models. RESULTS Students entering surgical residency programs had two times greater odds of coming from a family with a median family income greater than $75,000 than those entering non-surgical residencies (OR 2.19, 95% CI [1.35, 3.53]). Students from disadvantaged backgrounds had 50% decreased odds of going into surgery when compared to those not entering surgery (OR 0.50, 95% CI [0.28, 0.90]). CONCLUSIONS Students from low socioeconomic status backgrounds face more barriers in pursuing surgical subspecialties.
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Affiliation(s)
- Emanuel Eguia
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
| | - Shilpa Kolachina
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Elizabeth Miller
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Mary A Eguia
- Department of Family Medicine, Loyola University Medical Center, Maywood, IL, USA
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Abstract
UNLABELLED The aim of surgical training across the 10 surgical specialties is to produce competent day 1 consultants. Progression through training in the UK is assessed by the Annual Review of Competency Progression (ARCP). OBJECTIVE This study aimed to examine variation in ARCP outcomes within surgical training and identify differences in outcomes between specialties. DESIGN A national cohort study using data from the UK Medical Education Database was performed. ARCP outcome was the primary outcome measure. Multilevel ordinal regression analyses were performed, with ARCP outcomes nested within trainees. PARTICIPANTS Higher surgical trainees (ST3-ST8) from nine UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 and 2017 were included. RESULTS Eight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31 788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes recorded across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest (12.4%). After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard ARCP outcome compared with trainees in trauma and orthopaedics (T&O) (OR 1.33, 95% CI 1.21 to 1.45, p=0.001). Urology trainees were 36% less likely to receive a non-standard outcome compared with T&O trainees (OR 0.64, 95% CI 0.54 to 0.75, p<0.001). Female trainees and older age were associated with non-standard outcomes (OR 1.11, 95% CI 1.02 to 1.22, p=0.020; OR 1.04, 95% CI 1.03 to 1.05, p<0.001). CONCLUSION There is wide variation in the training outcome assessments across surgical specialties. General surgery has higher rates of non-standard outcomes compared with other surgical specialties. Across all specialties, female sex and older age were associated with non-standard outcomes.
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Affiliation(s)
- Carla Hope
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jonathan Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | - Gareth Griffiths
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - David Humes
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University, Nottingham, UK
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OUP accepted manuscript. BJS Open. [PMID: 35441208 PMCID: PMC9019067 DOI: 10.1093/bjsopen/zrac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
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Haffner MR, Van BW, Wick JB, Le HV. What is the Trend in Representation of Women and Under-represented Minorities in Orthopaedic Surgery Residency? Clin Orthop Relat Res 2021; 479:2610-2617. [PMID: 34180873 PMCID: PMC8726541 DOI: 10.1097/corr.0000000000001881] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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] [Received: 01/26/2021] [Accepted: 06/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic surgery training programs have lagged behind other surgical specialties in increasing their representation of women and people from under-represented minority (URM) groups. Comparative data between orthopaedic surgery and other specialties are needed to help identify solutions to closing the diversity gap. QUESTIONS/PURPOSES (1) Which surgical specialties have the greatest representation of women residents and residents from URM groups? (2) How have the proportions of women residents and residents from URM groups changed across the surgical specialties during the past decade? METHODS This was a retrospective evaluation of a large, longitudinally maintained survey database. Resident data by gender and ethnicity were retrieved from the Accreditation Council for Graduate Medical Education Data Resource Books for the 2011 to 2012 through 2019 to 2020 academic years. The Accreditation Council for Graduate Medical Education database is updated annually; thus, it is the most up-to-date and complete database available for gender and ethnicity data for all surgical residents. Data were obtained and analyzed for seven different surgical specialties: orthopaedic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, general surgery, and urology. No sampling was necessary, and thus descriptive statistics of the data were completed. Because the entire population of residents was included for the period of time in question, no statistical comparisons were made, and the reported differences represent absolute differences between the groups for these periods. Linear regression analyses were performed to estimate the annual growth rates of women residents and residents from URM groups in each specialty. RESULTS Among the seven surgical specialties, representation of women residents increased from 28% (4640 of 16,854) of residents in 2012 to 33% (6879 of 20,788) in 2020. Orthopaedic surgery had the lowest representation of women residents every year, with women residents comprising 16% of residents (700 of 4342) in 2020. Among the seven surgical specialties, representation of residents from URM groups increased from 8.1% (1362 of 16,854) in 2012 to 9.7% (2013 of 20,788) in 2020. In 2020, the representation of residents from URM groups in orthopaedic surgery was 7.7% (333 of 4342). In 2020, general surgery had the highest representation of women residents (42%; 3696 of 8809) as well as residents from URM groups (12%; 1065 of 8809). Plastic surgery (1.46% per year) and general surgery (0.95% per year) had larger annual growth rates of women residents than the other specialties did. In each surgical specialty, the annual growth rate of residents from URM groups was insignificant. CONCLUSION During the past decade, there was only a small increase in the representation of women in orthopaedic surgery, while the representation of people from URM groups did not change. In contrast, by 2020, general surgery had become the most diverse among the seven surgical specialties. To increase diversity in our field, we need to evaluate and implement some of the effective interventions that have helped general surgery become the diverse surgical specialty that it is today. CLINICAL RELEVANCE General surgery has substantially reduced gender and ethnic disparities that existed in the past, while those in orthopaedic surgery still persist. General surgery residencies have implemented a holistic review of resident applications and longitudinal mentoring programs to successfully address these disparities. Orthopaedic surgery programs should consider placing less emphasis on United States Medical Licensing Examination score thresholds and more weight on applicants' non-academic attributes, and put more efforts into targeted longitudinal mentorship programs, some of which should be led by non-minority faculty.
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Affiliation(s)
- Max R. Haffner
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | - Benjamin W. Van
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | - Joseph B. Wick
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
| | - Hai V. Le
- Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA
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Affiliation(s)
- Rachel Harwood
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
- Institute of Systems and Molecular Biology, University of Liverpool, Liverpool, UK
| | - Paul D Losty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Kunac A, Oliver JB, McFarlane JL, Anjaria DJ. General Surgical Resident Operative Autonomy vs Patient Outcomes: Are we Compromising Training without Net Benefit to Hospitals or Patients? J Surg Educ 2021; 78:e174-e182. [PMID: 34702689 DOI: 10.1016/j.jsurg.2021.09.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 03/27/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Resident operative autonomy has been steadily declining. The reasons are multifactorial and include concerns related to patient safety and operating room efficiency. Simultaneously, faculty have expressed that residents are less prepared for independent practice. We sought to understand the effect of decreasing resident autonomy on patient outcomes and operative duration. DESIGN Retrospective study utilizing the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. SETTING Operative cases within the VASQIP database from July 1, 2004-September 30, 2019 were analyzed. PARTICIPANTS All adult patients who underwent a surgical procedure from July 1, 2004 to September 30, 2019 were analyzed. The subpopulation of patients that underwent a surgical procedure in General Surgery or Peripheral Vascular Surgery were identified based on the code of the specialty surgeon. Within these subgroups, the most frequent cases by current procedural terminology (CPT) code were selected for study inclusion. The principle CPT code of all cases was further coded by level of supervision: attending primary surgeon (AP); attending and resident (AR), or resident primary with the attending supervising but not scrubbed (RP). Baseline demographics, operative variables, and outcomes were compared between groups. RESULTS The VASQIP database included 698,391 total general/vascular surgery cases. 38,483 (6%) of them were RP cases. Analysis revealed that the top 5 RP cases account for 73% of total RP volume-these include: 1) Hernias (55% total; 33% open inguinal, 13% umbilical, 5% open ventral/incisional, and 4% laparoscopic) 2) cholecystectomy (18%), 3) Amputations (17% total; 10% above knee, 7% below knee), 4) Appendectomy (7%) and 5) Open colectomy (3%). The percentage of cases at teaching hospitals that were RP cases significantly decreased from 15% in 2004 to 5% in 2019 (p < 0.001). RP cases were generally sicker as demonstrated by higher ASA classifications and more likely to be emergent cases. Operative times were also increased with resident involvement, but RP cases were faster than AR cases on average. After adjusting for baseline demographics, case type, and year of procedure, mortality was no different between groups. Complications were higher in the AR group but not in the RP group. CONCLUSIONS The rate of resident autonomy in routine general surgery cases has decreased by two-thirds over the 15-year study period. Cases performed by residents without an attending surgeon scrubbed were performed faster than cases performed by a resident and attending together and there was no increase in patient morbidity or mortality when residents performed cases independently. The erosion of resident autonomy is not justified based upon operative time or patient outcomes. Efforts to increase surgical resident operative autonomy are needed.
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Affiliation(s)
- Anastasia Kunac
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Joseph B Oliver
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey
| | - Jamal L McFarlane
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Devashish J Anjaria
- Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Arya S, Franco-Mesa C, Erben Y. An analysis of gender disparities amongst United States medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce. J Vasc Surg 2021; 75:5-9. [PMID: 34619315 DOI: 10.1016/j.jvs.2021.09.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022]
Abstract
Gender diversity in medicine continues to be a critical topic, and gender diversity within surgical fields remains an overarching challenge. In the following review, we objectively address the data available in terms of training slots for women in general and vascular surgery and within the vascular surgery workforce. Overall, women comprise 36% of active physicians in the 2019 Association of American Medical Colleges data. The number of women in surgical fields is lower representing 22% in general surgery, 9% in neurosurgery, 6% in orthopedic surgery, 17% in plastic surgery, 8% in thoracic surgery, and 15% in vascular surgery. Also notable is the lower academic ranks held by women in surgery. The proportion of women instructors in surgery in 2020 was 61%, assistant professors 30%, associate professors 23%, and full-time professors only 13.5%. There are multiple opportunities across the divisional/institutional/societal domains in which mentorship and sponsorship can promote gender equity and inclusion. Recruitment and retention of women and minorities into the vascular academic and private practices is essential to ensure best patient outcomes and quality of care for our patients. We hope that by shedding light on this topic, there will be greater awareness and improved strategies to address the disparities within institutions.
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Affiliation(s)
- Shipra Arya
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Camila Franco-Mesa
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Fla.
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Abstract
BACKGROUND The covid-19 pandemic has dramatically changed lives of residents and medical students. In particular, the learning process has undergone widely changes, especially due to the rules of social distancing which have forced universities and various institutes to modify lessons, work shifts and internships. PURPOSE The purpose of our review is to evaluate how the various institutes have faced the covid-19 emergency and guaranteed the perpetuation of the learning process of resident and students. METHODS A comprehensive search of the medical literature in PubMed and Google Scholar was performed including all the works explaining how the institutes have reorganized teaching for resident and undergraduate students. MAIN FINDINGS The use of internet for the dissemination of teaching material and educational meetings has built bridges, albeit virtual, between resident and teachers. New techniques for teaching and conducting exams have been introduced. The rotating team system allowed the continuation of the teaching activity in safety. CONCLUSION Thanks to remodulation of the teach modalities, the massive use of internet platforms, a wise distribution of work shifts, and others, universities and hospitals have not only reduced the impact on the learning process of resident and students but also turn this pandemic into a moment of personal and professional growth for the new generation of healthcare professionals.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy
| | - Lucio Cipollaro
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy
| | - Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England, UK; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, UK.
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Esparaz JR, Mathis MS, Russell RT. The Fellowship Effect: Does Surgical Subspecialty Training Affect Pediatric Surgery Case Volume? J Surg Educ 2021; 78:1438-1442. [PMID: 33483280 DOI: 10.1016/j.jsurg.2021.01.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/26/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE The Accreditation Council for Graduate Medical Education (ACGME) monitors fellow case numbers. Previous literature has shown new fellowships detrimentally affecting general surgery residency case numbers. We hypothesize that an increase in pediatric otolaryngology and pediatric urology fellowships would decrease overlapping case numbers in pediatric surgery fellowships. MATERIALS AND METHODS A review of each specialties' fellowship match results was performed. Publicly available pediatric surgery cases logs were reviewed for overlapping cases including thyroidectomy, parathyroidectomy, branchial cleft cyst excision, thyroglossal duct cyst excision, major neck tumor excision, nephrectomy, orchidopexy, inguinal hernia, and testicular torsion. Analyzed data included average case numbers and number of fellows each year. Linear regression analysis was performed. RESULTS We identified a significant increase in fellowship graduates from 2003 to 2018 (p < 0.006). Reviewed cases showed little fluctuation despite an increase in graduates. A decrease in tumor-related nephrectomies and orchidopexies was identified for pediatric surgery fellows (p < 0.001; p < 0.004). Though significant, nephrectomy fluctuation was between 2 and 4 cases. Similarly, we identified a significant rise in thyroidectomies (p < 0.001). Again, the increase was by 3 cases each year. CONCLUSIONS Despite the increase in number of fellowships, there has been a minimal overall effect on pediatric surgery case volume. Continuing to monitor these trends will help ensure adequate training for all pediatric surgical subspecialties.
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Affiliation(s)
- Joseph R Esparaz
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, Alabama; Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Michelle S Mathis
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, Alabama
| | - Robert T Russell
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, Alabama; Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Wise CE, Bereknyei Merrell S, Sasnal M, Forrester JD, Hawn MT, Lau JN, Lin DT, Schmiederer IS, Spain DA, Nassar AK, Knowlton LM. COVID-19 Impact on Surgical Resident Education and Coping. J Surg Res 2021; 264:534-543. [PMID: 33862581 PMCID: PMC7877215 DOI: 10.1016/j.jss.2021.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Healthcare systems and surgical residency training programs have been significantly affected by the novel coronavirus disease 2019 (COVID-19) pandemic. A shelter-in-place and social distancing mandate went into effect in our county on March 16, 2020, considerably altering clinical and educational operations. Along with the suspension of elective procedures, resident academic curricula transitioned to an entirely virtual platform. We aimed to evaluate the impact of these modifications on surgical training and resident concerns about COVID-19. MATERIALS AND METHODS We surveyed residents and fellows from all eight surgical specialties at our institution regarding their COVID-19 experiences from March to May 2020. Residents completed the survey via a secure Qualtrics link. A total of 38 questions addressed demographic information and perspectives regarding the impact of the COVID-19 pandemic on surgical training, education, and general coping during the pandemic. RESULTS Of 256 eligible participants across surgical specialties, 146 completed the survey (57.0%). Junior residents comprised 43.6% (n = 61), compared to seniors 37.1% (n = 52) and fellows 19.3% (n = 27). Most participants, 97.9% (n = 138), anticipated being able to complete their academic year on time, and 75.2% (n = 100) perceived virtual learning to be the same as or better than in-person didactic sessions. Participants were most concerned about their ability to have sufficient knowledge and skills to care for patients with COVID-19, and the possibility of exposure to COVID-19. CONCLUSIONS Although COVID-19 impacted residents' overall teaching and clinical volume, residency programs may identify novel virtual opportunities to meet their educational and research milestones during these challenging times.
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Affiliation(s)
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California
| | - Marzena Sasnal
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California
| | - Joseph D Forrester
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mary T Hawn
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California; Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - James N Lau
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Dana T Lin
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Ingrid S Schmiederer
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - David A Spain
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa Marie Knowlton
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California; Department of Surgery, Stanford University School of Medicine, Stanford, California.
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Xu Y, Li X. A commentary on COVID-19 impact on surgical training and recovery planning (COVID-STAR) - A cross-sectional observational study. Int J Surg 2021; 91:106011. [PMID: 34242816 PMCID: PMC8260487 DOI: 10.1016/j.ijsu.2021.106011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Yueping Xu
- Department of Infectious Diseases, YiWu Central Hospital, Zhejiang, 322000, China
| | - Xiaofei Li
- Department of Infectious Diseases, YiWu Central Hospital, Zhejiang, 322000, China.
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Giantini Larsen AM, Pories S, Parangi S, Robertson FC. Barriers to Pursuing a Career in Surgery: An Institutional Survey of Harvard Medical School Students. Ann Surg 2021; 273:1120-1126. [PMID: 31599803 DOI: 10.1097/sla.000000000000361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study aimed to elucidate current medical student perceptions on barriers to a career in surgery, with a particular focus on gender-specific differences. SUMMARY BACKGROUND DATA Although gender parity in medical school composition has been reached, women continue to be underrepresented in the field of surgery. METHODS An anonymous, single-institution, internet-based survey conducted at Harvard Medical School. RESULTS Approximately 720 medical students were surveyed and 261 completed the questionnaire (36.3%; 58.6% women, 41% men, 0.4% transgender). Overall, there was no significant gender difference in intention to pursue surgery (27% of men, 22% of women; P = 0.38). Sixty-nine percent of all students and 75% of those pursuing surgery reported verbal discouragement from pursuing a surgical career. Women were significantly more likely to perceive that the verbal discouragement was based on gender (P < 0.0001), age (P < 0.0001), and family aspirations (P = 0.043) compared to men. Surgical work hours and time for outside interests were the greatest deterrents for both genders. Significantly more women reported concerns about time to date or marry (P = 0.042), time to spend with family (P = 0.015), finding time during residency to have a child (P < 0.0001), taking maternity/paternity leave during residency (P < 0.0001), and being too old after residency to have a child (P < 0.0001). CONCLUSIONS Both men and women reported high rates of verbal discouragement, but more women perceived that the discouragement was gender-based. Concerns about marriage and childbearing/rearing significantly deterred more women than men. Family aspirations were also a significant factor for men to choose an alternative career path. Additional support within the surgical field is needed to mitigate these concerns and support trainees in both their career and familial aspirations.
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Affiliation(s)
| | - Susan Pories
- Harvard Medical School, Boston, MA
- Mount Auburn Hospital, Cambridge, MA
| | - Sareh Parangi
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | - Faith C Robertson
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
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Affiliation(s)
- Kristin E Rojas
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mediget Teshome
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Sarah E Tevis
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
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Abstract
Over the past decades, extensive studies have underscored the growing importance of simulation-based medical education (SBME) for medical students. However, the underlying influence of SBME on undergraduate students is yet to be investigated. This work is a single-center cohort study involving 1178 undergraduate students who were divided into a control group and an SBME group. All participants gave their written informed consent. We compared the theoretical and practical achievements of these 2 groups and distributed a feedback questionnaire. Results show that SBME significantly improves the practical or theoretical achievements of students (P < .001). The humanistic care (improvement rate: 69.2%) and doctor-patient communication (improvement rate: 56.3%) performances of these studies were vastly improved. The students in the SBME group tend to allocate more time to communicating with others. SBME is an effective teaching method that can improve the reflective capacity and communication skills of undergraduate medical students, thereby resulting in their relatively improved performance.
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Affiliation(s)
- Shangqian Wang
- The State Key Lab of Reproductive, Department of Urology, the First Affiliated Hospital of Nanjing Medical University
| | - Xiaohan Ren
- The State Key Lab of Reproductive, Department of Urology, the First Affiliated Hospital of Nanjing Medical University
| | - Jun Ye
- The First Clinical Medical College, Nanjing Medical University, Nanjing, PR China
| | - Wei Wang
- The State Key Lab of Reproductive, Department of Urology, the First Affiliated Hospital of Nanjing Medical University
| | - Huaxing Huang
- The First Clinical Medical College, Nanjing Medical University, Nanjing, PR China
| | - Chao Qin
- The State Key Lab of Reproductive, Department of Urology, the First Affiliated Hospital of Nanjing Medical University
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Mahat N, Zubaidi SA, Soe HHK, Nah SA. Paediatric surgical response to an 'adult' COVID-19 pandemic. Med J Malaysia 2021; 76:284-290. [PMID: 34031324] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The Coronavirus Disease 2019 (COVID-19) has dramatically affected global healthcare systems. We aimed to determine the response of our paediatric surgical fraternity to a disease that overwhelmingly affects adults. MATERIALS AND METHODS We conducted a cross-sectional questionnaire-based study over 6 weeks during a federally mandated lockdown. Using snowball sampling, we recruited paediatric surgeons, trainees and medical officers from paediatric surgical units in Malaysia. The anonymous online questionnaire covered sociodemographic information, changes in patient care, redeployment, concerns regarding family members, and impact on training. Mental well-being was assessed using the Depression, Anxiety and Stress Scale (DASS-21). Kruskal-Wallis, ANOVA and multiple regression analysis was used, with significance level 0.05. RESULTS Of the 129 eligible participants, 100(77%) responded. Junior doctors had clinically higher levels of depression, anxiety, and stress. Age <30 years was significantly associated with anxiety. Junior doctors believed that redeployment led to loss of surgical skills (p<0.001) and trainees felt that clinical application of knowledge had reduced (p<0.020). CONCLUSION Specific to our paediatric surgical community, this study highlights areas of concern, particularly among junior doctors. It is likely that recurrent cycles of the pandemic will occur soon. These issues must be addressed to preserve the mental and emotional well-being of all health care workers.
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Affiliation(s)
- N Mahat
- University of Malaya, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia
| | - S A Zubaidi
- University of Malaya Medical Centre, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia
| | - H H K Soe
- Melaka Manipal Medical College, Department of Community Medicine, Melaka, Malaysia
| | - S A Nah
- University of Malaya, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia.
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