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Schenarts PJ, Scarborough AJ, Abraham RJ, Philip G. Teaching Before, During, and After a Surgical Resuscitation. Surg Clin North Am 2024; 104:451-471. [PMID: 38453313 DOI: 10.1016/j.suc.2023.10.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA.
| | - Alec J Scarborough
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ren J Abraham
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - George Philip
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
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2
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Punja VP, Schenarts PJ. The Tides of Change: Emergencies in General Surgery. Surg Clin North Am 2023; 103:xvii-xviii. [PMID: 37838470 DOI: 10.1016/j.suc.2023.07.010] [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: 10/16/2023]
Affiliation(s)
- Viren Premnath Punja
- Department of Surgery, Creighton University, School of Medicine, Omaha, NE 68124, USA.
| | - Paul J Schenarts
- Department of Surgery, Creighton University, School of Medicine, Omaha, NE 68124, USA.
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Anderton LC, Johnson MG, Frawley CA, Chan J, Garcia CA, Waibel BH, Schenarts PJ. Visual Misrepresentations: The Lack of Skin Tone and Sex Equity in General Surgical Textbooks. J Surg Educ 2023; 80:1675-1681. [PMID: 37507299 DOI: 10.1016/j.jsurg.2023.06.029] [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: 02/27/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Lack of racial and ethnic diversity in educational material contributes to health disparities. This study sought to determine if images of skin color and sex in general surgery textbooks were reflective of the U.S. POPULATION DESIGN All human figures with discernable sex characteristics and/or skin tone were evaluated independently by 4 coders. Each image was categorized as male or female. Skin tone in each image was categorized using the Massey- Martin skin color scale. This data was compared to 2020 U.S. Census Data. SETTING U.S. Medical School. PARTICIPANTS Not applicable. RESULTS A total of 1179 images were evaluated for skin tone alone; 293 images for sex alone. 650 images depicted characteristics of both sex and skin tone. Interrater reliability was 0.78 for skin tone and 0.91 for sex. While the U.S. population is 59.3% white, 29.5% non-black persons of color and 13.6% black, in surgical textbooks, 90.7% of images were white, 6.5% were non-black persons of color, and 2.8% were black. Distribution of skin tone for all textbooks were significantly different. (p < 0.001) compared to the U.S. POPULATION The U.S. population is 49.5% male and 50.5% female. When images of sex specific genitalia and breasts are excluded, surgical textbook images are 62.9% male and 37.1% female. Only 1 textbook had a distribution of sex that was similar to the U.S. POPULATION CONCLUSIONS Despite increasing diversity in the U.S. population there is a lack of skin tone and sex diversity in traditional surgical textbooks.
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Affiliation(s)
- Leah C Anderton
- Departments of Surgery, College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - Madeline G Johnson
- Departments of Surgery, College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - Connor A Frawley
- Departments of Surgery, College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - Jesse Chan
- Departments of Surgery, College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - Chelsea A Garcia
- Departments of Surgery, College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | | | - Paul J Schenarts
- Departments of Surgery, College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa; School of Medicine, Creighton University, Omaha, Nebraska.
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4
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Beaty JS, Schenarts PJ. Open in Case of SOAP Emergency: Preparation for and Recovery after Failing to Match. J Surg Educ 2023; 80:1362-1364. [PMID: 37541938 DOI: 10.1016/j.jsurg.2023.07.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/14/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
Failing to secure an internship is an extremely stressful event. In this manuscript we describe a process to prepare students for success, should they fail to match. This process involves an assessment of individual vulnerability, implementing mitigation strategies, developing a comprehensive plan in the event of failing to match, that is executed if the student needs to enter the Supplemental Offer Acceptance Program (SOAP) or the "scramble".
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Affiliation(s)
- Jennifer S Beaty
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - Paul J Schenarts
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa; School of Medicine, Creighton University, Omaha, Nebraska.
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5
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Schenarts PJ, Panwar A, Mukkai Krishnamurty D, Nandipati K. A Primer on General Surgery Applicants Who Have Graduated From Indian Medical Schools. Am Surg 2023:31348221148360. [PMID: 36609170 DOI: 10.1177/00031348221148360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Graduates of Indian medical schools account for the greatest proportion of non-US born international medical graduates applying to general surgery residency programs.Purpose: Provide information to facilitate fair and holistic review of applicants from Indian medical schools.Research Design: Comprehensive review of the Indian medical education system, including history, regulatory agencies, medical school admission, curriculum, cultural differences, immigration issues, and outcomes after residency.Results: The Indian medical education system is one of the world's oldest. The number of medical schools and graduates continues to increase. Medical school admission criteria are variable. Recent regulatory changes have improved the quality of applicants entering the US. Emphasis on academic performance over volunteerism as well as communication styles differ from US graduates. The success of graduates during and after residency is well documented.Conclusions: Understanding the differences in the US and Indian medical education systems will provide a basis for the fair evaluation of applicants.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, 12282Creighton University, Omaha, NE, USA
| | - Aru Panwar
- Department of Surgery, School of Medicine, 12282Creighton University, Omaha, NE, USA
| | | | - Kalyana Nandipati
- Department of Surgery, School of Medicine, 12282Creighton University, Omaha, NE, USA
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Abstract
COVID-19 continues to rampage around the world. Noncritical care-trained physicians may be deployed into the intensive care unit to manage these complex patients. Although COVID-19 is primarily a respiratory disease, it is also associated with significant pathology in the brain, heart, vasculature, lungs, gastrointestinal tract, and kidneys. This article provides an overview of COVID-19 using an organ-based, systematic approach.
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Schenarts PJ, Bourne J. Invited Response to The Inadvertent Personal Liability of Graduate Medical Education (ASU-21-0920-Letter to the Editor). Am Surg 2021; 87:1850. [PMID: 34758664 DOI: 10.1177/00031348211056280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul J Schenarts
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Jennifer Bourne
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
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Schenarts PJ. Education and the General Surgeon. Surg Clin North Am 2021. [DOI: 10.1016/s0039-6109(21)00072-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schenarts PJ. Preface: Surgical Education. Surg Clin North Am 2021; 101:xvii-xviii. [PMID: 34242613 DOI: 10.1016/j.suc.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paul J Schenarts
- Des Moines University, College of Osteopathic Medicine, 3200 Grand Avenue, Des Moines, IA 50312-4198, USA; Creighton University, School of Medicine, Omaha, NE, USA.
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Abstract
The COVID-19 pandemic has uncovered disparities for allopathic and osteopathic surgical applicants for the upcoming 2021 residency application cycle. It has provided an opportunity for change to the current paradigm in surgical resident selection. This study seeks to quantify the disproportionality of opportunities between allopathic and osteopathic students and provides solutions to level the playing field for all applicants.
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Affiliation(s)
- Brandon S Petree
- 477020Arkansas College of Osteopathic Medicine, Fort Smith, AR, USA
| | - Matthew A Heard
- 115985University of New England College of Osteopathic Medicine, Biddeford, ME, USA
| | | | - Jennifer S Beaty
- Department of Surgery, 41468Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA.,12282Creighton University, Omaha, NE, USA
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11
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Randle RW, Ahle SL, Elfenbein DM, Hildreth AN, Lee CY, Greenberg JA, Schenarts PJ, Kempenich JW. Surgical Trainees’ Sense of Responsibility for Patient Outcomes: A Multi-institutional Appraisal. J Surg Res 2020; 255:58-65. [DOI: 10.1016/j.jss.2020.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/14/2020] [Accepted: 05/03/2020] [Indexed: 01/25/2023]
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Abstract
OBJECTIVE To provide an overview of the Generation Z, compare and contrast Generation Z with previous generations, and present information on how to best educate members of Generation Z. DESIGN Literature review. SETTING Not applicable. PARTICIPANTS Not applicable. RESULTS Historical events and societal trends as well as changes in parenting style has resulted in unique characteristics for Generation Z. The most significant influence on this generation has been the wide-spread use of the smart phone. While this device has great educational potential, it also presents a real risk with digital foot prints influencing residency selection and evolution of mental health problems. CONCLUSIONS The characteristics of Generation Z such accountability, emphasis on achievement and dedication to long-term goals makes them different from previous generations.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, Nebraska.
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Kempenich JW, Willis RE, Campi HD, Schenarts PJ. The Cost of Compliance: The Financial Burden of Fulfilling Accreditation Council for Graduate Medical Education and American Board of Surgery Requirements. J Surg Educ 2018; 75:e47-e53. [PMID: 30122641 DOI: 10.1016/j.jsurg.2018.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/03/2018] [Revised: 06/25/2018] [Accepted: 07/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE There has been a significant increase in the number of regulatory requirements for general surgery graduate medical education (GME) programs over the last 20 years from the governing bodies of the American Board of Surgery (ABS) and the Accreditation Council of Graduate Medical Education (ACGME). We endeavored to calculate the cost to general surgery GME programs of regulatory requirements. DESIGN We examined the requirements for General Surgery ABS Certification as well as the 2017 ACGME Program Requirements in General Surgery for all mandates that require funding by the surgery program to achieve. The requirements requiring funding include certification in Advanced Cardiac Life Support, Advanced Trauma Life Support, Fundamentals of Laparoscopic Surgery, Fundamentals of Endoscopic Surgery; access to medical references; simulation capability, program director protected time (30%); program coordinator salary (Association for Hospital Medical Education reported mean); and faculty time devoted to morbidity and mortality conference, journal club, Clinical Competency Committee, and Program Evaluation Committee. We then identified the cost of each mandate based on the average program in the United States of 5 residents per year in 5 clinical years. RESULTS Total cost for the average program per year as the result of ABS or ACGME mandate equaled a minimum of $227,043. The ABS associated costs are $8900 per year. The ACGME associated costs are $218,143. The cost of program director and faculty time to meet the minimum ACGME requirements equaled $159,600. CONCLUSIONS The most significant cost associated with mandates set forth by the ABS and ACGME are program director and faculty time devoted to resident education and evaluation. Recognition of this cost burden by institutions and policymakers for the allocation of funds is important to maintain strong general surgery GME programs.
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Affiliation(s)
- Jason W Kempenich
- University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ross E Willis
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Haisar Dao Campi
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
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14
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Deal SB, Alseidi AA, Chipman JG, Gauvin J, Meara M, Sidwell R, Stefanidis D, Schenarts PJ. Identifying Priorities for Faculty Development in General Surgery Using the Delphi Consensus Method. J Surg Educ 2018; 75:1504-1512. [PMID: 30115566 DOI: 10.1016/j.jsurg.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/23/2018] [Revised: 04/21/2018] [Accepted: 05/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Faculty teaching skills are critical for effective surgical education, however, which skills are most important to be taught in a faculty development program have not been well defined. The objective of this study was to identify priorities for faculty development as perceived by surgical educators. DESIGN We used a modified Delphi methodology to assess faculty perceptions of the value of faculty development activities, best learning modalities, as well as barriers and priorities for faculty development. An expert panel developed the initial survey and distributed it to the membership of the Association of Program Directors in Surgery. Responses were reviewed by the expert panel and condensed to 3 key questions that were redistributed to the survey participants for final ranking. PARTICIPANTS Seven experts reviewed responses to 8 questions by 110 participants. 35 participants determined the final ranking responses to 3 key questions. RESULTS The top three priorities for faculty development were: 1) Resident assessment/evaluation and feedback 2) Coaching for faculty teaching, and 3) Improving intraoperative teaching skills. The top 3 learning modalities were: 1) Coaching 2) Interactive small group sessions, and 3) Video-based education. Barriers to implementing faculty development included time limitations, clinical workload, faculty interest, and financial support. CONCLUSIONS Faculty development programs should focus on resident assessment methods, intraoperative and general faculty teaching skills using a combination of coaching, small group didactic and video-based education. Concerted efforts to recognize and financially reward the value of teaching and faculty development is required to support these endeavors and improve the learning environment for both residents and faculty.
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Affiliation(s)
- Shanley B Deal
- Virginia Mason Medical Center, General, Thoracic and Vascular Surgery, Seattle, Washington.
| | - Adnan A Alseidi
- Virginia Mason Medical Center, General, Thoracic and Vascular Surgery, Seattle, Washington
| | - Jeffrey G Chipman
- University of Minnesota, Department of Surgery, Minneapolis, Minnesota
| | - Jeffrey Gauvin
- Santa Barbara Cottage Hospital, Department of General Surgery, Santa Barbara, California
| | - Michael Meara
- Ohio State University Wexner College, Columbus, Ohio
| | | | | | - Paul J Schenarts
- University of Nebraska Medical Center, Department of Surgery, Omaha, Nebraska
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15
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Schenarts PJ, Martin RF. Emergency General Surgery. Surg Clin North Am 2018. [DOI: 10.1016/s0039-6109(18)30115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schlitzkus LL, Summers JI, Schenarts PJ. Rapid Reversal of Novel Anticoagulant and Antiplatelet Medications in General Surgery Emergencies. Surg Clin North Am 2018; 98:1073-1080. [PMID: 30243448 DOI: 10.1016/j.suc.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The reversal of the new class of nonvitamin K antagonist oral anticoagulants (NOACs) is challenging in the emergent perioperative setting. This summary focuses on the reversal of NOACs, determining the emergent nature (risk analysis), and other considerations in reversal.
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Affiliation(s)
- Lisa L Schlitzkus
- Trauma, Surgical Critical Care and Emergency General Surgery, Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-3280, USA.
| | - Jessica I Summers
- Trauma, Surgical Critical Care and Emergency General Surgery, Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Paul J Schenarts
- Trauma, Surgical Critical Care and Emergency General Surgery, Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-3280, USA
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18
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Grams BM, Schenarts PJ. A Resident's operative role: Perception Is not reality. Am J Surg 2017; 213:827-828. [PMID: 28143665 DOI: 10.1016/j.amjsurg.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/21/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Benjamin M Grams
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, NE, USA
| | - Paul J Schenarts
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, NE, USA.
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Abstract
Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.
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Affiliation(s)
- Paul J. Schenarts
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, Nebraska
| | - Sean Langenfeld
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, Nebraska
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20
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Schenarts PJ, Langenfeld S. The Fundamentals of Resident Dismissal. Am Surg 2017; 83:119-126. [PMID: 28228197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.
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21
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Langenfeld SJ, Vargo DJ, Schenarts PJ. Balancing Privacy and Professionalism: A Survey of General Surgery Program Directors on Social Media and Surgical Education. J Surg Educ 2016; 73:e28-e32. [PMID: 27524278 DOI: 10.1016/j.jsurg.2016.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/28/2016] [Accepted: 07/18/2016] [Indexed: 05/24/2023]
Abstract
PURPOSE Unprofessional behavior is common among surgical residents and faculty surgeons on Facebook. Usage of social media outlets such as Facebook and Twitter is growing at exponential rates, so it is imperative that surgery program directors (PDs) focus on professionalism within social media, and develop guidelines for their trainees and surgical colleagues. Our study focuses on the surgery PDs current approach to online professionalism within surgical education. METHODS An online survey of general surgery PDs was conducted in October 2015 through the Association for Program Directors in Surgery listserv. Baseline PD demographics, usage and approach to popular social media outlets, existing institutional policies, and formal curricula were assessed. RESULTS A total of 110 PDs responded to the survey (110/259, 42.5% response rate). Social media usage was high among PDs (Facebook 68% and Twitter 40%). PDs frequently viewed the social media profiles of students, residents, and faculty. Overall, 11% of PDs reported lowering the rank or completely removing a residency applicant from the rank order list because of online behavior, and 10% reported formal disciplinary action against a surgical resident because of online behavior. Overall, 68% of respondents agreed that online professionalism is important, and that residents should receive instruction on the safe use of social media. However, most programs did not have formal didactics or known institutional policies in place. CONCLUSIONS Use of social media is high among PDs, and they often view the online behavior of residency applicants, surgical residents, and faculty surgeons. Within surgical education, there needs to be an increased focus on institutional policies and standardized curricula to help educate physicians on social media and online professionalism.
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Affiliation(s)
- Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Daniel J Vargo
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paul J Schenarts
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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22
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Kempenich JW, Willis RE, Blue RJ, Al Fayyadh MJ, Cromer RM, Schenarts PJ, Van Sickle KR, Dent DL. The Effect of Patient Education on the Perceptions of Resident Participation in Surgical Care. J Surg Educ 2016; 73:e111-e117. [PMID: 27663084 DOI: 10.1016/j.jsurg.2016.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To decipher if patient attitudes toward resident participation in their surgical care can be improved with patient education regarding resident roles, education, and responsibilities. DESIGN An anonymous questionnaire was created and distributed in outpatient surgery clinics that had residents involved with patient care. In total, 3 groups of patients were surveyed, a control group and 2 intervention groups. Each intervention group was given an informational pamphlet explaining the role, education, and responsibilities of residents. The first pamphlet used an analogy-based explanation. The second pamphlet used literature citations and statistics. SETTING Keesler Medical Center, Keesler AFB, MS. University of Texas Health Science Center at San Antonio, San Antonio, TX. PARTICIPANTS A total of 454 responses were collected and analyzed-211 in the control group, 118 in the analogy pamphlet group, and 125 in the statistics pamphlet group. RESULTS Patients had favorable views of residents assisting with their surgical procedures, and the majority felt that outcomes were the same or better regardless of whether they read an informational pamphlet. Of all the patients surveyed, 80% agreed or strongly agreed that they expect to be asked permission for residents to be involved in their care. Further, 52% of patients in the control group agreed or strongly agreed to a fifth-year surgery resident operating on them independently for routine procedures compared to 62% and 65% of the patients who read the analogy pamphlet and statistics pamphlet, respectively (p = 0.05). When we combined the 2 intervention groups compared to the control group, this significant difference persisted (p = 0.02). CONCLUSION Most patients welcome resident participation in their surgical care, but they expect to be asked permission for resident involvement. Patient education using an information pamphlet describing resident roles, education, and responsibilities improved patient willingness to allow a chief resident to operate independently.
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Affiliation(s)
- Jason W Kempenich
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi.
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert J Blue
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Mohammed J Al Fayyadh
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert M Cromer
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Paul J Schenarts
- Division of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kent R Van Sickle
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Schneider E, Schenarts PJ, Shostrom V, Schenarts KD, Evans CH. "I got it on Ebay!": cost-effective approach to surgical skills laboratories. J Surg Res 2016; 207:190-197. [PMID: 27979476 DOI: 10.1016/j.jss.2016.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/04/2016] [Accepted: 08/03/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical education is witnessing a surge in the use of simulation. However, implementation of simulation is often cost-prohibitive. Online shopping offers a low budget alternative. The aim of this study was to implement cost-effective skills laboratories and analyze online versus manufacturers' prices to evaluate for savings. MATERIALS AND METHODS Four skills laboratories were designed for the surgery clerkship from July 2014 to June 2015. Skills laboratories were implemented using hand-built simulation and instruments purchased online. Trademarked simulation was priced online and instruments priced from a manufacturer. Costs were compiled, and a descriptive cost analysis of online and manufacturers' prices was performed. Learners rated their level of satisfaction for all educational activities, and levels of satisfaction were compared. RESULTS A total of 119 third-year medical students participated. Supply lists and costs were compiled for each laboratory. A descriptive cost analysis of online and manufacturers' prices showed online prices were substantially lower than manufacturers, with a per laboratory savings of: $1779.26 (suturing), $1752.52 (chest tube), $2448.52 (anastomosis), and $1891.64 (laparoscopic), resulting in a year 1 savings of $47,285. Mean student satisfaction scores for the skills laboratories were 4.32, with statistical significance compared to live lectures at 2.96 (P < 0.05) and small group activities at 3.67 (P < 0.05). CONCLUSIONS A cost-effective approach for implementation of skills laboratories showed substantial savings. By using hand-built simulation boxes and online resources to purchase surgical equipment, surgical educators overcome financial obstacles limiting the use of simulation and provide learning opportunities that medical students perceive as beneficial.
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Affiliation(s)
- Ethan Schneider
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul J Schenarts
- Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Valerie Shostrom
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kimberly D Schenarts
- Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Charity H Evans
- Division of Acute Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
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Damewood R, Morris JB, Mellinger J, Friedell ML, Borman KR, Dent DL, Schenarts PJ, Jarman BT. Association of Program Directors in Surgery Position Response to ACGME for Position on Accreditation Requirements. J Surg Educ 2016; 73:363-369. [PMID: 27068188 DOI: 10.1016/j.jsurg.2016.03.002] [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] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Richard Damewood
- President, Association of Program Directors in Surgery, Department of Surgery, WellSpan Health York Hospital, York, Pennsylvania.
| | - Jon B Morris
- Immediate Past President, Association of Program Directors in Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Mellinger
- Association of Program Directors in Surgery, Department of Surgery, SIU School of Medicine, Springfield, Illinois
| | - Mark L Friedell
- Past President, Association of Program Directors in Surgery, University of Missouri Kansas City, School of Medicine, Kansas City, Missouri
| | - Karen R Borman
- Past President, Association of Program Directors in Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Daniel L Dent
- President Elect, Association of Program Directors in Surgery, UT Health Science Center, San Antonio, Texas
| | - Paul J Schenarts
- Secretary, Association of Program Directors in Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Benjamin T Jarman
- Treasurer, Association of Program Directors in Surgery, Gundersen Medical Foundation, La Crosse, Wisconsin
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Affiliation(s)
- Ronald F Martin
- Marshfield Clinic, Saint Joseph's Hospital, 1000 North Oak Avenue, Marshfield, WI 54449, USA; University of Wisconsin School of Medicine and Public Health, Department of Surgery, 750 Highland Avenue, Madison, WI 53726, USA.
| | - Paul J Schenarts
- Critical Care and Emergency Surgery, Department of Surgery, University of Nebraska College of Medicine, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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Martin RF, Schenarts PJ. Development of a Surgeon: Medical School through Retirement. Surg Clin North Am 2016. [DOI: 10.1016/s0039-6109(15)00186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Langenfeld SJ, Sudbeck C, Luers T, Adamson P, Cook G, Schenarts PJ. The Glass Houses of Attending Surgeons: An Assessment of Unprofessional Behavior on Facebook Among Practicing Surgeons. J Surg Educ 2015; 72:e280-e285. [PMID: 26276300 DOI: 10.1016/j.jsurg.2015.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 04/04/2015] [Revised: 06/22/2015] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE Our recent publication demonstrated that unprofessional behavior on Facebook is common among surgical residents. In the formulation of standards and curricula to address this issue, it is important that surgical faculty lead by example. Our current study refocuses on the Facebook profiles of faculty surgeons involved in the education of general surgery residents. METHODS The American College of Surgeons (ACS) web site was used to identify general surgery residencies located in the Midwest. Departmental web sites were then searched to identify teaching faculty for the general surgery residency. Facebook was then searched to determine which faculty had profiles available for viewing by the general public. Profiles were then placed in 1 of the 3 following categories: professional, potentially unprofessional, or clearly unprofessional. STATISTICAL ANALYSIS A chi-square test was used to determine significance. RESULTS In all, 57 residency programs were identified on the ACS web site, 100% of which provided an institutional web site listing the surgical faculty. A total of 758 general surgery faculty were identified (133 women and 625 men), of which 195 (25.7%) had identifiable Facebook accounts. In all, 165 faculty (84.6%) had no unprofessional content, 20 (10.3%) had potentially unprofessional content, and 10 (5.1%) had clearly unprofessional content. Inter-rater reliability was good (88.9% agreement, κ = 0.784). Clearly unprofessional behavior was found only in male surgeons. For male surgeons, clearly unprofessional behavior was more common among those in practice for less than 5 years (p = 0.031). Alcohol and politics were the most commonly found variables in the potentially unprofessional group. Inappropriate language and sexually suggestive material were the most commonly found variables in the clearly unprofessional group. CONCLUSIONS Unprofessional behavior on Facebook is less common among surgical faculty compared with surgical residents. However, the rates remain unacceptably high, especially among men and those in practice for less than 5 years. Education on the dangers of social media should not be limited to residents but should instead be extended to attending surgeons as well.
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Affiliation(s)
- Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Craig Sudbeck
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Thomas Luers
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Peter Adamson
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gates Cook
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul J Schenarts
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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Schenarts PJ. Perioperative management. Surg Clin North Am 2015; 95:xv-xvi. [PMID: 25814119 DOI: 10.1016/j.suc.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paul J Schenarts
- Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Nebraska, College of Medicine, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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Abstract
The older population only represents 13.7% of the US population but has grown by 21% since 2002. The centenarian population is growing at a faster rate than the total US population. This unprecedented growth has significantly increased surgical demand. The establishment of quality and performance improvement data has allowed researchers to focus attention on the older patient population, resulting in an exponential increase in studies. Although there is still much work to be done in this field, overlying themes regarding the perioperative management of elderly patients are presented in this article based on a thorough literature review.
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Affiliation(s)
- Lisa L Schlitzkus
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Alyson A Melin
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Paul J Schenarts
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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Lowe JJ, Jelden KC, Schenarts PJ, Rupp LE, Hawes KJ, Tysor BM, Swansiger RG, Schwedhelm SS, Smith PW, Gibbs SG. Considerations for safe EMS transport of patients infected with Ebola virus. PREHOSP EMERG CARE 2014; 19:179-83. [PMID: 25380073 DOI: 10.3109/10903127.2014.983661] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Nebraska Biocontainment Unit through the Nebraska Medical Center in Omaha, Nebraska, recently received patients with confirmed Ebola virus from West Africa. The Nebraska Biocontainment Unit and Omaha Fire Department's emergency medical services (EMS) coordinated patient transportation from airport to the high-level isolation unit. Transportation of these highly infectious patients capitalized on over 8 years of meticulous planning and rigorous infection control training to ensure the safety of transport personnel as well as the community during transport. Although these transports occurred with advanced notice and after confirmed Ebola virus disease (EVD) diagnosis, approaches and key lessons acquired through this effort will advance the ability of any EMS provider to safely transport a confirmed or suspected patient with EVD. Three critical areas have been identified from our experience: ambulance preparation, appropriate selection and use of personal protective equipment, and environmental decontamination.
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Langenfeld SJ, Cook G, Sudbeck C, Luers T, Schenarts PJ. An assessment of unprofessional behavior among surgical residents on Facebook: a warning of the dangers of social media. J Surg Educ 2014; 71:e28-e32. [PMID: 24981657 DOI: 10.1016/j.jsurg.2014.05.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Dismissal from residency is most commonly because of unprofessional conduct rather than cognitive failure. Disciplinary action by medical boards has also been associated with prior unprofessional behavior during medical school. Facebook is a social media network that has become ubiquitous in recent years and has the potential to offer an unvarnished view into the lives of residents using a public forum that is open to the public and program directors alike. The aim of this study was to evaluate the publically available Facebook profiles of surgical residents to determine the incidence and degree of unprofessional conduct. METHODS The American College of Surgeons Web site was used to identify general surgery residencies located in the Midwest. Resident rosters were then obtained using departmental Web sites. Facebook was then searched to determine which residents had profiles available for viewing by the public. The Accreditation Council for Graduate Medical Education's components of professionalism and the American Medical Association's report on professionalism in the use of social media were used to develop the following 3 categories: professional, potentially unprofessional, or clearly unprofessional. STATISTICAL ANALYSIS The chi-square test was used to determine significance. RESULTS A total of 57 residency programs were identified on the American College of Surgeons Web site, of which 40 (70.2%) provided an institutional Web site with a current resident roster. A total of 996 surgical residents were identified, of which 319 (32%) had identifiable Facebook profiles. Overall, 235 residents (73.7%) had no unprofessional content, 45 (14.1%) had potentially unprofessional content, and 39 (12.2%) had clearly unprofessional content. Binge drinking, sexually suggestive photos, and Health Insurance Portability and Accountability Act violations were the most commonly found variables in the clearly unprofessional group. There were no statistical differences in professionalism based on sex (p = 0.93) or postgraduate year status (p = 0.88). CONCLUSIONS Unprofessional behavior is prevalent among surgical residents who use Facebook, and this behavior does not appear to decrease as residents progress through training. This represents a risk to the reputations of hospitals and residency programs, and residents should be educated on the dangers of social media. Although it may be perceived as an invasion of privacy, this information is publically available, and program directors may benefit from monitoring these sites to identify gaps in professionalism that require correction.
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Affiliation(s)
- Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Gates Cook
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Craig Sudbeck
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Thomas Luers
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul J Schenarts
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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Schenarts PJ, Evans C. The eye of the master. Am J Surg 2014; 208:178-9. [PMID: 24933666 DOI: 10.1016/j.amjsurg.2014.02.007] [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: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Paul J Schenarts
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, NE, USA.
| | - Charity Evans
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, NE, USA
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Schenarts PJ, Melin A. The Allopathic Program Director's Dilemma. J Grad Med Educ 2014; 6:351-2. [PMID: 24949149 PMCID: PMC4054744 DOI: 10.4300/jgme-d-14-00184.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Friedell ML, VanderMeer TJ, Cheatham ML, Fuhrman GM, Schenarts PJ, Mellinger JD, Morris JB. Perceptions of Graduating General Surgery Chief Residents: Are They Confident in Their Training? J Am Coll Surg 2014; 218:695-703. [DOI: 10.1016/j.jamcollsurg.2013.12.022] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
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Schlitzkus LL, Schenarts PJ, Schenarts KD. It was the night before the interview: perceptions of resident applicants about the preinterview reception. J Surg Educ 2013; 70:750-757. [PMID: 24209651 DOI: 10.1016/j.jsurg.2013.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 04/12/2013] [Accepted: 05/26/2013] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Hosting a reception for prospective interns the evening before the interview has become a well-established expectation. It is thought that these initial impressions significantly influence the ranking process. Despite these well-held beliefs, there has been a paucity of studies exploring the preinterview reception. DESIGN A survey tool was created and piloted to ensure validity. The survey was then administered to a fourth-year class of allopathic medical students immediately after interviews but before Match Day. SETTING A university, teaching hospital. PARTICIPANTS Fourth-year allopathic medical students. RESULTS The response rate was 100% (n = 69). Ninety-six percent of programs hosted an event. Although these events were minimally stressful (86%), the same percent felt that not attending would limit their knowledge of the program, and 66% felt that it would negatively affect their application. Forty percent believe this event to be extremely important to residency programs in selecting interns. Ninety-five percent are attended by residents only, and approximately half were at a casual restaurant. Most applicants (97%) never paid for their own meal, and 69% felt that if they did, it would leave a negative impression of the program. CONCLUSIONS Candidates believe the preinterview reception is important in the selection process, that failing to attend would negatively affect their application, and provides insight about the program. Alcohol is often provided but rarely has a negative effect. Applicants prefer an informal setting with unfettered interactions with the residents.
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Affiliation(s)
- Lisa L Schlitzkus
- Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
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Wilson KL, Schenarts PJ, Bacchetta MD, Rai PR, Nakayama DK. Pediatric Trauma Experience in a Combat Support Hospital in Eastern Afghanistan over 10 Months, 2010 to 2011. Am Surg 2013. [DOI: 10.1177/000313481307900323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We reviewed the pediatric trauma experience of one Combat Support Hospital (CSH) in Afghanistan to focus on injuries, surgery, and outcomes in a war zone. We conducted a review of all pediatric patients over 10 months in an eastern Afghanistan CSH. We studied 41 children (1 to 18 years; mean, 8.5 years; median, 9 years), 28 (68.2%) with penetrating injuries. Blasts (13 patients) and burns (nine) were the most common mechanisms. At arrival 19 (46.3%) underwent endotracheal intubation, four (9.8%) had no palpable blood pressure, 10.6 per cent (four of 38) a Glasgow Coma Score of 5 or less, 30.6 per cent (11 of 36) base deficits of 6 or less, and 41.7 per cent (15 of 36) hematocrit 30 or less. Red cells were given in 14 (34.1%) and plasma in 11 (26.8%). Of 32 total nonburn patients, 12 (37.5%) had multiple system injuries. Three-fourths of injuries were severe (75.8% [47 of 62] Abbreviated Injury Score 3 or greater). Thirty-two patients (78.0%) required major operations: burn and wound care, orthopedic, chest, abdominal, vascular, and neurosurgical. Second operations were performed in 16 (39.0%), most often burn and orthopedic procedures. Six died (14.6%), 13 were transferred to other hospitals (31.7%), and 20 were discharged to home (48.8%; two not noted). Broad experience in operative trauma care, pediatric resuscitation, and critical care is a priority for military surgeons.
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Affiliation(s)
- Kenneth L. Wilson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia; the
| | - Paul J. Schenarts
- Department of Surgery, University of Nebraska School of Medicine, Omaha, Nebraska; the
| | | | - Pradeep R. Rai
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia; the
| | - Don K. Nakayama
- Department of Surgery, Mercer University School of Medicine, Macon, Georgia
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Wilson KL, Schenarts PJ, Bacchetta MD, Rai PR, Nakayama DK. Pediatric trauma experience in a combat support hospital in eastern Afghanistan over 10 months, 2010 to 2011. Am Surg 2013; 79:257-260. [PMID: 23461950] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We reviewed the pediatric trauma experience of one Combat Support Hospital (CSH) in Afghanistan to focus on injuries, surgery, and outcomes in a war zone. We conducted a review of all pediatric patients over 10 months in an eastern Afghanistan CSH. We studied 41 children (1 to 18 years; mean, 8.5 years; median, 9 years), 28 (68.2%) with penetrating injuries. Blasts (13 patients) and burns (nine) were the most common mechanisms. At arrival 19 (46.3%) underwent endotracheal intubation, four (9.8%) had no palpable blood pressure, 10.6 per cent (four of 38) a Glasgow coma score of 5 or less, 30.6 per cent (11 of 36) base deficits of 6 or less, and 41.7 per cent (15 of 36) hematocrit 30 or less. Red cells were given in 14 (34.1%) and plasma in 11 (26.8%). Of 32 total nonburn patients, 12 (37.5%) had multiple system injuries. Three-fourths of injuries were severe (75.8% [47 of 62] Abbreviated Injury Score 3 or greater). Thirty-two patients (78.0%) required major operations: burn and wound care, orthopedic, chest, abdominal, vascular, and neurosurgical. Second operations were performed in 16 (39.0%), most often burn and orthopedic procedures. Six died (14.6%), 13 were transferred to other hospitals (31.7%), and 20 were discharged to home (48.8%; two not noted). Broad experience in operative trauma care, pediatric resuscitation, and critical care is a priority for military surgeons.
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Affiliation(s)
- Kenneth L Wilson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
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Schlitzkus LL, Clark CJ, Agle SC, Schenarts PJ. A six year head-to-head comparison of osteopathic and allopathic applicants to a university-based, allopathic general surgery residency. J Surg Educ 2012; 69:699-704. [PMID: 23111033 DOI: 10.1016/j.jsurg.2012.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/14/2012] [Accepted: 07/18/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The number of osteopathic physicians is increasing as is the number applying to allopathic general surgery residency programs. A lack of knowledge of osteopathic schooling leads to a potential applicant bias in favor of allopathic applicants, but the 2 groups have not been compared head to head. DESIGN Applications over a 6-year period to an allopathic general surgery residency program were reviewed. Demographics, examination scores, employment, education, and research experience were catalogued into a database. Allopathic applicants were compared with osteopathic applicants utilizing statistical analysis. SETTING A university teaching hospital. PARTICIPANTS Allopathic and osteopathic applicants to an allopathic general surgery residency program. RESULTS A total of 1290 applications were reviewed; 1155 allopathic and 135 osteopathic applications. Other than race, the 2 cohorts are similar in age, gender, and citizenship. The groups are not significantly different with regard to the number of letter of recommendations, volunteer activities, scholarly works, and advanced degrees. Graduates of both proceed directly to residency. A significantly higher percentage of allopathic graduates reported their United States medical licensing examination (USMLE) scores, yet when osteopaths released their USMLE transcript, they scored significantly higher on the USMLE Step 1 examination and required fewer attempts to pass. These differences do not apply to the USMLE Step 2 examination. CONCLUSIONS No single screening tool exists for selecting a successful general surgery resident. We are seeing increased numbers of osteopathic applicants. Many criteria used to evaluate applicants do not apply to osteopathic applicants, but our comparison of common selection variables on the Electronic Residency Application Service (ERAS) application did not demonstrate an overall difference. While our analysis demonstrated a statistically higher USMLE Step 1 score by osteopathic applicants, they may only self-report favorable data.
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Affiliation(s)
- Lisa L Schlitzkus
- Division of Surgical Education, Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, NC, USA
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Abstract
It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.
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Affiliation(s)
- Paul J. Schenarts
- From the Division of Trauma Surgery & Surgical Critical Care, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Claudia E. Goettler
- From the Division of Trauma Surgery & Surgical Critical Care, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Michael A. White
- From the Division of Trauma Surgery & Surgical Critical Care, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Brett H. Waibel
- From the Division of Trauma Surgery & Surgical Critical Care, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Schenarts PJ, Goettler CE, White MA, Waibel BH. An objective study of the impact of the electronic medical record on outcomes in trauma patients. Am Surg 2012; 78:1249-1254. [PMID: 23089444] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.
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Affiliation(s)
- Paul J Schenarts
- Division of Trauma Surgery & Surgical Critical Care, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.
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Rose JS, Waibel BH, Schenarts PJ. Resident perceptions of the impact of paging on intraoperative education. Am Surg 2012; 78:642-646. [PMID: 22643257] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Our purpose was to evaluate the impact of paging on perceptions of intraoperative learning. Intraoperative logs of pager interruptions were kept by surgical residents at a university hospital over a 30-day period. The postgraduate year, number of pages, category of caller, reason for call, and level of urgency were recorded during each operation. At the conclusion of each operation, residents also completed a two-item survey with responses on a 5-point scale (1 = strongly disagree to 5 = strongly agree), querying if interruptions negatively impacted the intraoperative experience and if a message taken by a third party was effective in limiting interruptions. Logs were completed for 124 of 204 operations. Fifty-five per cent of operations were interrupted at least once with 49 per cent interrupted two to five times and 6 per cent were interrupted six or more times. Junior residents had 69 per cent of their operations interrupted compared with 39 per cent of senior residents (P = 0.001). Ninety-two per cent of pages were nonurgent. Residents did not perceive pager interruptions negatively impacted their educational experience (mean 2.3) but were neutral with respect if messages taken by a third party decreased interruptions (mean 3.8). Although our hypothesis was that pager interruptions were frequent and disrupt resident education, our data demonstrate the opposite.
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Affiliation(s)
- Joel S Rose
- Division of Surgical Education, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Abstract
Our purpose was to evaluate the impact of paging on perceptions of intraoperative learning. Intraoperative logs of pager interruptions were kept by surgical residents at a university hospital over a 30-day period. The postgraduate year, number of pages, category of caller, reason for call, and level of urgency were recorded during each operation. At the conclusion of each operation, residents also completed a two-item survey with responses on a 5-point scale (1 = strongly disagree to 5 = strongly agree), querying if interruptions negatively impacted the intraoperative experience and if a message taken by a third party was effective in limiting interruptions. Logs were completed for 124 of 204 operations. Fifty-five per cent of operations were interrupted at least once with 49 per cent interrupted two to five times and 6 per cent were interrupted six or more times. Junior residents had 69 per cent of their operations interrupted compared with 39 per cent of senior residents ( P = 0.001). Ninety-two per cent of pages were nonurgent. Residents did not perceive pager interruptions negatively impacted their educational experience (mean 2.3) but were neutral with respect if messages taken by a third party decreased interruptions (mean 3.8). Although our hypothesis was that pager interruptions were frequent and disrupt resident education, our data demonstrate the opposite.
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Affiliation(s)
- Joel S. Rose
- Division of Surgical Education, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Brett H. Waibel
- Division of Surgical Education, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Paul J. Schenarts
- Division of Surgical Education, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Abstract
INTRODUCTION The electronic medical record (EMR) is commonly thought to improve the safety and quality of care; however, there is scant information on the impact the EMR has on graduate medical education (GME). METHODS A review of English language literature was performed using MEDLINE and OVID databases using or combining the terms, EMR, GME, electronic health record, education, medical student, resident, clinical decisions support systems, quality, and safety. RESULTS The EMR has a negative effect on teacher and learner interactions, clinical reasoning, and has an inconsistent impact on resident workflow. Data on the impact of the EMR on patient safety, quality of care, and medical finances are mixed. DISCUSSION Based on the literature to date, the EMR has not had as dramatic an effect on patient outcomes is commonly believed. While the overall impact of the EMR on education seems to be negative, there are actions that can be taken to mitigate this impact.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, Division of Surgical Education, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA.
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Rose JS, Waibel BH, Schenarts PJ. Disparity between resident and faculty surgeons' perceptions of preoperative preparation, intraoperative teaching, and postoperative feedback. J Surg Educ 2011; 68:459-64. [PMID: 22000531 DOI: 10.1016/j.jsurg.2011.04.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/30/2011] [Accepted: 04/08/2011] [Indexed: 05/12/2023]
Abstract
PURPOSE The education occurring within the operating room is fundamental to the development of a surgical resident. The purpose of this study was to investigate differing perceptions of surgical residents and faculty in regard to preoperative preparation, intraoperative teaching, and postoperative feedback. METHODS A validated survey tool was slightly adapted, piloted, and then administered to the surgical residents and faculty of a university-based general surgery residency program. The wording of the survey was specific to either residents or faculty and consisted of similar questions with responses on a 5-point Likert scale (1: strongly disagree to 5: strongly agree). The responses of the 2 groups for each question were averaged and compared using Wilcoxon-Mann-Whitney test to determine significant differences. RESULTS In all, 27 residents and 30 faculty members completed the survey for a response rate of 100%. With respect to preoperative preparation, significant differences were found in perceptions about reading (4.22 vs 2.59; p < 0.001) and anatomy review (4.11 vs 2.31; p < 0.001) before the procedure. Considering intraoperative perceptions, significant differences were found with respect to teaching the operative steps (3.59 vs 4.06 p = 0.048), surgical skills (2.85 vs 3.78; p = 0.001), instrument handling (3.19 vs 4.00; p = 0.002), and surgical technique (3.44 vs 4.28; p < 0.001). Significant disagreement was found in the perceived effort of the faculty to act as a teacher in the operating room (3.56 vs 4.09; p < 0.007). Postoperatively, significant differences were found in perceptions of positive feedback (2.63 vs 3.34; p = 0.01) and feedback on areas to improve (2.78 vs 3.50; p = 0.009). CONCLUSIONS Although there is agreement on the need to improve intraoperative education, there is significant disparity in perceptions of preoperative preparation as well as intraoperative and postoperative feedback between residents and surgical faculty.
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Affiliation(s)
- Joel S Rose
- Department of Surgery, Division of Surgical Education, East Carolina University, Greenville, North Carolina 27858, USA
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Schenarts PJ, Termuhlen PM, Pasley J, Rose JS, Friedell ML. A primer on how to select osteopathic applicants to an allopathic general surgery residency. J Surg Educ 2011; 68:239-245. [PMID: 21481810 DOI: 10.1016/j.jsurg.2011.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 01/05/2011] [Accepted: 01/17/2011] [Indexed: 05/30/2023]
Affiliation(s)
- Paul J Schenarts
- Department of Surgery, East Carolina University, Greenville, North Carolina 27858, USA.
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Meara MP, Schlitzkus LL, Witherington M, Haisch C, Rotondo MF, Schenarts PJ. Surgical resident education: what is the department's price for commitment? J Surg Educ 2010; 67:427-431. [PMID: 21156303 DOI: 10.1016/j.jsurg.2010.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/14/2010] [Accepted: 06/15/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The current recession has impacted all aspects of our economy. Some residency programs have experienced faculty salary cuts, furlough days, and cessation of funding for travel to academic meetings. This milieu forced many residency programs to reevaluate their commitment to resident education, particularly for those expenses not provided for by Direct Medical Education (DME) and Indirect Medical Education (IME) funds. The purpose of this study was to determine what price a Department of Surgery pays to fulfill its commitment to resident education. DESIGN A financial analysis of 1 academic year was performed for all expenses not covered by DME or IME funds and is paid for by the faculty practice plan. These expenses were categorized and further analyzed to determine the funds required for resident-related scholarly activity. SETTING A university-based general surgery residency program. PARTICIPANTS Twenty-eight surgical residents and a program coordinator. RESULTS The departmental faculty provided $153,141 during 1 academic year to support the educational mission of the residency. This amount is in addition to the $1.6 million in faculty time, $850,000 provided by the federal government in terms of DME funds, and $14 million of IME funds, which are distributed on an institutional basis. Resident presentations at scientific meetings accounted for $49,672, and program coordinator costs of $44,190 accounted for nearly two-thirds of this funding. The departmental faculty committed $6400 per categorical resident. CONCLUSIONS In addition to DME and IME funds, a department of surgery must commit significant additional monies to meet the educational goals of surgical residency.
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Affiliation(s)
- Michael P Meara
- Division of Surgical Education, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA
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Claydon CS, Schenarts PJ, Sagraves SG. Acute management of traumatic hemi-section of the female pelvis with one-year follow-up. Am Surg 2010; 76:E116-E117. [PMID: 21513628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Claydon CS, Schenarts PJ, Sagraves SG. Acute Management of Traumatic Hemi-Section of the Female Pelvis with One-Year Follow-up. Am Surg 2010. [DOI: 10.1177/000313481007600807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C. Sage Claydon
- Brody School of Medicine East Carolina University Greenville, North Carolina
| | - Paul J. Schenarts
- Brody School of Medicine East Carolina University Greenville, North Carolina
| | - Scott G. Sagraves
- Brody School of Medicine East Carolina University Greenville, North Carolina
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Claydon CS, Schenarts PJ, Sagraves SG. Acute Management of Traumatic Hemi-Section of the Female Pelvis with One-Year Follow-up. Am Surg 2010; 76:116-117. [PMID: 28958227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- C Sage Claydon
- Brody School of Medicine East Carolina University Greenville, North Carolina, USA
| | - Paul J Schenarts
- Brody School of Medicine East Carolina University Greenville, North Carolina, USA
| | - Scott G Sagraves
- Brody School of Medicine East Carolina University Greenville, North Carolina, USA
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