ACGME-accredited Residency Programs Research Articles

The Diversity of Surgical Trainees Index identifies racial and ethnic disparities among surgical specialties

ObjectiveRacial and ethnic disparities have been well-described among surgical specialties; however, variations in underrepresented in medicine (URiM) representation between these specialties have not previously been quantified. MethodsData collected from Accreditation Council for Graduate Medical Education (ACGME) annual reports were used to derive the Diversity of Surgical Trainee Index (DoSTI), which was calculated as the proportion of URiM residents and fellow physicians within a given surgical specialty, relative to the overall proportion of URiM trainees within all surgical and non-surgical ACGME-accredited programs in the same academic year. ResultsFrom 2013 to 2022, a total of 108,193 ACGME-accredited residency programs trained 1,296,204 residents and fellows in the United States. Of these, 14.1% (n = 182,680) of trainees self-identified as URiM over the study period. The mean DoSTI among all surgical specialties was 0.80 (standard error, 0.01) compared with all ACGME-accredited programs. High DoSTI specialties incorporated significantly higher proportions of trainees who identify as Hispanic (8.7% vs 6.3%) and Black or African American (5.2% vs 2.5%) when compared with low DoSTI specialties (P < .0001 each). General surgery (1.06 ± 0.01), plastic surgery (traditional) (1.12 ± 0.06), vascular surgery (integrated) (0.96 ± 0.03), and vascular surgery (traditional) (0.94 ± 0.06) had the highest DoSTI (P < .05 each vs composite). On linear regression analysis, only ophthalmology (+0.01/year; R2 = 0.41; P = .019), orthopedic surgery (+0.01/year; R2 = 0.33; P = .047), otolaryngology (+0.02/year; R2 = 0.86; P < .001), and pediatric surgery (+0.06/year; R2 = 0.33; P = .048) demonstrated an annual increase in DoSTI. ConclusionsThe DoSTI is a novel metric used to quantify the degree of URiM representation among surgical specialties. DoSTI has revealed specialty-specific variations in racial/ethnic minority representation among surgical training programs. This metric may be used to improve provider awareness and identify high performing DoSTI specialties to highlight best practices to ultimately recruit a more diverse surgical workforce.

Osteopathic Students Have Decreased Match Rates in Orthopaedic Surgery Compared with Allopathic Students.

Orthopaedic surgery continues to be one of the most competitive specialties to match into as a medical student, particularly for osteopathic medical students. Therefore, in this study, we sought to examine the prevalence of osteopathic students (DO) matching into orthopaedic surgery at traditional Accreditation Council for Graduate Medical Education (ACGME) accredited programs (former allopathic residency programs) in recent years. A retrospective review of National Residency Match Program annual reports and Association of American Medical Colleges's Electronic Residency Application Service Statistic reports were performed to determine the number of applications and match rates among osteopathic (DO) and allopathic (MD) medical students into orthopaedic surgery from 2019 to 2023. Data on the degree type of current residents at all ACGME-accredited residency programs were identified. During the analyzed study period of 2019 to 2023, there were 3,473 (74.5%) allopathic students and 571 (59.9%) osteopathic students who successfully matched into orthopaedic surgery. This match rate for allopathic students was 74.5% compared with 59.9% for osteopathic students. Of the 3,506 medical students who hold postgraduate orthopaedic surgery positions at former allopathic programs over the past 5 years, only 58 (1.7%) hold an osteopathic degree. Of the 560 medical students who hold postgraduate orthopaedic surgery positions at former osteopathic programs over the past 5 years, 47 (8.4%) hold an allopathic degree. The match rate of allopathic students at former osteopathic programs is significantly higher than the match rate of osteopathic students at former allopathic programs. Osteopathic students continue to match into orthopaedic surgery at lower rates than their allopathic counterparts. In addition, there remains a consistent and low number of osteopathic students matching into former allopathic programs. Allopathic students also have a higher likelihood of matching into former osteopathic programs when compared with osteopathic students matching into previous allopathic orthopaedic surgery programs.

Radiation Treatment Plan Evaluation Education in Residency: A Needs Assessment

Advances in radiation oncology have steadily increased the complexity of radiation treatment plan (RTP) development and evaluation. We hypothesized that radiation oncology attendings and residents would hold different attitudes regarding resident knowledge and comfort with RTP review. A web-based survey was distributed to residents (38-item) and attendings (32-item) at 14 ACGME-accredited residency programs. The survey consisted of a combination of multiple-choice questions and free text responses. A total of 169 residents and 71 faculty received the survey. The response rate was 38%. Resident respondents (n = 71) were PGY-2 (21%), -3 (30%), -4 (21%), and -5 (28%), and faculty respondents (n = 20) had 1-4 years (30%), 5-9 (35%), 10-15 (25%), >15 (10%) years in practice. 34% of residents report reviewing ≤2 plans and spending ≤20 minutes on plan review each week. 47% of residents report reviewing less than half of all new treatment plans for their patients. While 20% of residents report "often" or "always" reviewing treatment plans with an attending, 31% report they "rarely" or "never" do. More than half (56%) of residents felt that they have inadequate exposure to RTP review and 47% felt they are receiving inadequate education in this area. 83% cited "difficulty aligning resident and attending schedules" as a reason for inadequate exposure and education. 32% of residents report "rarely" or "never" making suggestions to optimize a plan and 21% report they do so "often" or "always". 54% of residents do not feel confident independently evaluating treatment plans, 31% do not feel confident identifying major planning errors, and 42% do not feel confident optimizing or suggesting minor improvements to plans. In contrast, attendings report that on average, they review 70% of all new treatment plans alongside residents. 40% report they do not have enough time to review RTPs with residents, with 75% citing "difficulty aligning resident and attending schedules" as a main reason. 50% of attendings report that residents "rarely" or "never" suggest optimizations for treatment plans that require them, but 90% of attendings "agree" or "strongly agree" that residents are competent at RTP evaluation by the end of a rotation. Both residents and attendings (90% each) believe that residents would benefit from a dedicated resource on RTP review. Across respondents, 96% were familiar with a systematic RTP review approach and 97% "agree" or "strongly agree" that systematic RTP review improves their ability to evaluate a plan. A large percentage of residents feel they have inadequate RTP education in residency and lack confidence when evaluating RTPs. There is discordance between resident and faculty perceptions of RTP review education and resident competence, but a vast majority agree that systematic RTP review is valuable. Future work should focus on development of learning tools for RTP evaluation using a systematic review process.

The Impact of Post-graduate Year and Program Accreditation Status on In-Training Examination Performance in Orthopaedic Surgery.

Introduction The progression of medical knowledge competency during surgical residency training is poorly understood. This study measures the acquisition of medical knowledge as orthopedic surgery residents advance during training and the impact of accreditation status on orthopedic in-training examination (OITE) performance. Methods Orthopedic surgery residents taking the OITE during 2020 and 2021 were included. Residents were grouped into cohorts by post-graduate year (PGY) and Accreditation Council for Graduate Medical Education (ACGME) accreditation status. Comparisons were made with parametric tests. Results Eight thousand eight hundred and seventy-one ACGME-accredited residents (89%) and 1,057 non-ACGME-accredited residents (11%) were evenly distributed by the PGY level (range, 19-21%). Residents in both ACGME- and non-ACGME-accredited residency programs had a significant increase in OITE performance at each PGY level (P<0.001). At ACGME-accredited programs, OITE performance increased from PGY1 (51%), PGY2 (59%), PGY3 (65%), PGY4 (68%), and PGY5 (70%) (P<0.001). There were progressively smaller percentage increases in OITE performance during accredited residency training (range, 2-8%), but this increase was linear in non-accredited residency training (range, 4%). At each PGY level, residents at accredited programs outperformed their counterparts at non-accredited programs (P<0.001). Conclusion OITE performance increases during residency training. Among ACGME-accredited residents, performance on the OITE progresses rapidly during junior years and plateaus during senior years. Residents in ACGME-accredited residency programs outperform their counterparts in non-accredited residency programs. More research is needed to understand optimal training environments that promote medical knowledge acquisition during orthopedic surgery residency.

Trends in emergency medicine resident procedural reporting over a 10-year period.

Procedural competency is expected of all emergency medicine (EM) residents upon graduation. The ACGME requires a minimum number of essential procedures to successfully complete training. However, data are limited on the actual number of procedures residents perform and prior studies are limited to single institutions over short time periods. This study sought to assess the number of Key Index Procedures completed during EM residency training and evaluate trends over time. We conducted a retrospective review of graduating EM resident procedure logs across eight ACGME accredited residency programs over the last 10 years (2013-2022). Sites were selected to ensure diversity of program length, program type, and geography. All data from EM residents graduating in 2013-2022 were eligible for inclusion. Data from residents from combined training programs, those who did not complete their full training at that institution (i.e., transferred in/out), or those who did not have data available were excluded. We determined the list of procedures based upon the ACGME Key Index Procedures list. Sites obtained totals for each of the identified procedures for each resident upon graduation. We calculated the mean and 95% CI for each procedure. We collected data from a total of 914 residents, with 881 (96.4%) meeting inclusion criteria. The most common procedures were point-of-care ultrasound, adult medical resuscitation, adult trauma resuscitation, and intubation. The least frequent procedures included pericardiocentesis, cricothyroidotomy, cardiac pacing, vaginal delivery, and chest tubes. Most procedures were stable over time with the exception of lumbar punctures (decreased) and point-of-care ultrasound (increased). In a national sample of EM programs, procedural numbers remained stable except for lumbar puncture and ultrasound. This information can inform residency training curricula and accreditation requirements.

Current Educational Practices within Resident Rotations across Radiation Oncology Residency Programs

<h3>Purpose/Objective(s)</h3> Limited information is available about the structure and components of radiation oncology residency rotations. We hypothesize that there is variation in rotations between and within residency programs. We evaluated various educational elements of radiation oncology rotations among United States residents. <h3>Materials/Methods</h3> We developed and distributed an anonymous online survey to current radiation oncology residents (PGY2 – PGY5) in ACGME-accredited residency programs in 2021 - 2022. Questions address rotation design, educational sessions, and attending feedback. <h3>Results</h3> A total of 117 residents completed the survey (overall response rate, 15%). Respondents consisted of more junior than senior residents (60% PGY2 or PGY3 vs. 40% PGY4 or PGY5) and a higher proportion of men than women (68% vs. 32%). Seventy-seven percent of responding residents (90/117) stated that half of their rotations or fewer featured regular educational sessions outside of didactics, and 62% (72/117) of all respondents stated they wanted more routine educational sessions. Over a quarter (27%, 32/117) said that no attending had ever evaluated one of their patient encounters, either directly or remotely, during real or simulated encounters. While all respondents said that at least some attendings provide feedback on contours (in-person or remotely), only 52% (61/117) replied that this occurs during every rotation. <h3>Conclusion</h3> A striking number of residents receive insufficient evaluation and feedback in patient encounters and contouring, two significant components of radiation oncology practice. More than half of respondents are seeking more dedicated education from teaching faculty members. Although the impact of these practices on resident development is unclear, we have identified potential deficiencies in radiation oncology residency education.

Predictors of an Academic Career in Radiation Oncology 5 to 10 Years after Residency

<h3>Purpose/Objective(s)</h3> To report the percent of radiation oncology graduates from ACGME-accredited residency programs who are actively working in academic medicine 5 to 10 years after residency, and to analyze metrics of early career success. <h3>Materials/Methods</h3> The study population was comprised of 1,134 radiation oncologists who graduated residency between 2011 and 2017. The year of analysis of career status was 2021, 5 to 10 years after residency. Career status in 2021 was classified as academic or private practice based on affiliation with a residency program or publication record. Degree of academic productivity was evaluated with 3 metrics: h-index ≥ 5; ≥ 1 first or corresponding authorship publication ≥ 2 years after residency, and NIH funding. <h3>Results</h3> Status in 2021 as a percentage of 1,134 graduates in the years 2011 to 2017 were as follows: (1) 43% in academic medicine; (2) 40% in academic medicine with an h-index of ≥ 5; (3) 35% in academic medicine with ≥ 1 first or corresponding authorship publication; and (4) 8% in academic medicine with NIH funding. Three factors were associated with a near doubling of the probability of an academic career, with differences being statistically significant at the p < 0.05 level on both univariate and multivariate analysis. Specifically, the percentage of graduates with an academic career in 2021 were as follows: (1) Holman Pathway residency (yes, 75%; no, 42%); (2) Doximity Top-10 ranked residency program (yes, 65%; no, 35%); and (3) PhD prior to residency (yes, 65%; no, 37%). Regarding gender, there were no substantial differences in the percent of women versus men establishing academic careers at the 5- to 10-year post-residency timepoint. <h3>Conclusion</h3> Since 2011, about 40% of radiation oncology residents have gone into academic medicine and are academically productive 5 to 10 years after residency based on standard metrics. These results are much higher than for most other fields of medicine. Training in the Holman pathway, attending a Doximity Top-10 residency program, or having a PhD degree prior to residency approximately doubles the probability of an academic career. Radiation oncology is on track to achieve gender equity in academic medicine.

FERTILITY BENEFITS FOR RESIDENTS: PUBLICLY AVAILABLE INFORMATION AT THE TOP 50 US MEDICAL SCHOOLS

Infertility affects one in four physicians, yet current availability of fertility benefits within ACGME-accredited residency programs in the United States (US) is unknown. In particular, 29% of residents experience infertility, and 63% feel low or no support from their residency program regarding fertility care (Aghajanova et al., 2017). Our objective was to examine the publicly available fertility benefits information for prospective residents.

THE IMPACT OF COVID-19 PANDEMIC ON THE CHOICE OF SUB-SPECIALTY TRAINING IN US MEDICAL RESIDENCY PROGRAMS

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The Covid-19 pandemic led to critical shortage of personal protective equipment worldwide & challenged the motto of safety in healthcare occupations. Pulmonary & critical care medicine (PCCM) is one of the specialties that was heavily involved in care of Covid-19 infected patients. It is not yet determined how an active pandemic can shape the minds of Internal Medicine (IM) residents who wished to pursue fellowship training. While some may deem PCCM to be too high a risk and avoid it altogether, others may process it as a calling. The purpose of this survey study was to determine these effects. METHODS: We surveyed the IM residents enrolled in ACGME accredited residency programs in the United States. The survey invitation link was distributed to the preferred contact email listed on the American Medical Association: Residency & Fellowship Database (FREIDA™) using a mass emailing service. Programs were requested to distribute the survey to IM residents to complete voluntarily. Study data were collected & managed using REDCap electronic data capture tools hosted at Case Western Reserve University. A reminder email was sent at 2-week period to the programs that didn't open the initial enrollment email. Data analysis was completed using REDCap & Microsoft Excel. RESULTS: Of the 258 responses, 12 were excluded due to incomplete data or not meeting criteria. A total of 245 responses were used for analysis of which 48.4% self-identified as male & 51.6% as female. Subgroups based on year of training were: PGY1(66, 26.9%), PGY2(94, 38.4%), PGY3(75, 30.6%) & PGY4(10, 4.1%). Majority of residents were in age group 26-35 (226, 92.2%) with geographical distribution into Northeast (55, 22.4%), Midwest (82, 33.5%), South (61, 24.9%) & West (47, 19.2%). Of the respondents, 179/245(73.1%) were residents aspiring for fellowship positions, 30/245(12.2 %) were undecided & 36/245(14.69%) were not interested in pursuing fellowship. The pandemic events of year 2020 altered the decision to pursue fellowship with an average influence factor of 59.08 (SD 23.4) on a linear scale of 0-100. This change affected 10.6% (26/245) of the respondents, swaying 46.1% of these residents against the field of PCCM & 23% for it. CONCLUSIONS: The COVID-19 pandemic affected only a small proportion of residents into altering their decisions to pursue fellowship of their original choice. However, when applicable it mostly deterred residents from applying to a high risk fellowship such as PCCM. This survey study is limited by the relatively small number of respondents, general limitations of voluntary surveys & lack of responses from some geographic locations. CLINICAL IMPLICATIONS: Covid-19 pandemic may have influenced the decision to pursue fellowship training with a potentially deleterious effect on PCCM. This could be due to ongoing concerns for personal safety. Additional studies are needed to determine underlying factors. DISCLOSURES: No relevant relationships by Samantha DiBenedetto, source=Web Response No relevant relationships by Enambir Josan, source=Web Response No relevant relationships by Ziad Shaman, source=Web Response No relevant relationships by vikrant singh, source=Web Response

Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US

The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician's career. To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation. In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts. The types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained. Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts. Of 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients' families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]). In this survey study, EM residents reported that workplace mistreatment occurred frequently. The findings suggest common sources of mistreatment for which educational interventions may be developed to help ensure resident wellness and career satisfaction.

Specialty differences in resident resilience and burnout - A national survey

BackgroundBurnout is widespread among resident physicians, but higher resilience is associated with lower burnout. This study characterizes the relationship between resilience and burnout in medical (MR) and surgical (SR) resident physicians. MethodsA cross-sectional survey was distributed to all ACGME-accredited residency programs with the Connor-Davidson Resilience Scale and Abbreviated Maslach Burnout Inventory. ResultsOf the 682 respondents, both Medical and Surgical Residents with higher resilience had lower burnout. Higher resilience was seen in Surgical Residents who were men, had greater family support, more residency program support, and enjoyed greater autonomy. Burnout was greater in women, Caucasians, those in an academic setting, and with less autonomy and program support. Burnout was similar among the medical and surgical groups, but surgical trainees had higher resilience. Overall, family and institutional support was associated positively with high resilience and decreased burnout. ConclusionsIncreasing resilience and program support can decrease burnout, especially for high-risk subgroups.

First Author Publications of US Radiation Oncology Residents Graduating Between 2015 and 2019

Scholarly work is seen as an increasingly important component of radiation oncology (RO) residency. In fact, most programs now provide residents with dedicated research time and support to augment clinical training. In this study, we sought to describe scholarly work among graduating RO residents nationwide in the modern era. Using publicly available information from the ARRO directory, residency program and hospital websites, we identified RO residents who graduated from ACGME-accredited residency programs in the United States between 2015 and 2019. We then queried PubMed to identify first-author peer-reviewed publications completed by each resident during residency. To account for publication lag after completing residency, articles published between January 1st of PGY-2 and December 31st of the year of graduation were included. Publications were downloaded and manually checked. We extracted meta-data, including journal name, impact factor, and articles citing the publication. Publications were classified into original articles, reviews, or commentary; original articles were further classified by type. Results were aggregated by individual and by residency program. This project was determined to be exempt human research by our IRB (19-02888). We identified 882 RO residents from 87 programs who produced 2683 first author publications (median 2; range 0-59; interquartile range (IQR) 1-4). 78% of residents authored ≥1 publication. The articles were published in 394 distinct peer-reviewed journals. The median 2018 impact factor was 3.13 (range 0-70.7, IQR 2.3-6.1), with the two most common journals being IJROBP (14%) and PRO (7%). 76% of publications were original scientific articles, 13.5% - reviews, and 10.5% - commentaries. Grant support was identified in 25% of original research publications. Within original research, 70% of studies were retrospective, of which 27% of data originated from a national database (e.g. NCDB/SEER). Additionally, 8% of publications were classified as case reports, 6% as physics/dosimetry, 4% as clinical trials, 4% as basic/translational science, 3% as surveys, 2% as economic analyses, and 1% as meta-analyses. We then grouped residency programs into quartiles of productivity. Residents from programs in the top quartile published a median of 3 publications per resident, while those from programs in the lowest quartile published a median of 1 publication per resident. The most productive program had a median of 7.5 publications per resident, while 13% of programs had a median of 0 publications per resident. Programs with higher average residency productivity tended to publish in journals with a higher impact factor (r = 0.41, p<0.001). Substantial variability exists in resident research productivity nationwide, both in terms of publication numbers and study design. These data serve as an important benchmark for first-author publications in RO residency.

University of South Alabama College of Medicine.

University of South Alabama College of Medicine.

Got Milk? Design and Implementation of a Lactation Support Program for Surgeons

Got Milk? Design and Implementation of a Lactation Support Program for Surgeons

Integrated residency is associated with an increase in women among vascular surgery trainees

BackgroundDuring the past decade, the proportion of women within graduate medical education has increased. Correspondingly, the proportion of women in almost every specialty has increased, including surgical specialties. We sought to evaluate the effect of establishing vascular surgery integrated residencies (VSIRs) on the proportion of women in vascular surgery training programs. MethodsResident data were obtained from the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book for the academic years 2007 to 2016. Data were collected on overall ACGME residency numbers as well as on the following surgical subspecialties: vascular, general, thoracic, neurologic, orthopedic, otolaryngologic, and urologic surgery. The number and proportion of women per year in VSIRs and vascular surgery fellowships were compared with those in the other surgical specialties. ResultsDuring the study period, the proportion of women in ACGME-accredited residency programs increased from 0.41 (n = 43,695/107,851) to 0.44 (n = 57,130/129,720) of residents. Since the advent of the VSIR, the number of trainees within vascular surgery has increased by 56% from 221 to 501 trainees. The proportion of women in vascular surgery training programs has increased from 0.12 (n = 27/221) to 0.33 (n = 164/501) of trainees. This increase during the 9-year study period was greater than in any other surgical subspecialty and greatest within the VSIR. Compared with fellowship training programs, integrated surgical training programs within the same subspecialty had a higher proportion of women, although variability between surgical subspecialties remained notable. ConclusionsAlthough it is lower than the proportion of women within all graduate medical education training programs, an increasing proportion of women have entered vascular surgery training during the study period. This appears to be related to the introduction of VSIRs and exceeds the proportion of women entering almost all other surgical subspecialties at a rate of change faster than in all other surgical subspecialties. Further work to understand surgical specialty preferences and choice of careers after training is warranted.

How to Incorporate Bariatric Training Into Your Fellowship Program.

How to Incorporate Bariatric Training Into Your Fellowship Program.

Equivalency? An Analysis of the AACS General Cosmetic Surgery Fellowship Through the Lens of the ACGME 6 Core Competencies

The American Academy of Cosmetic Surgeons (AACS) and American Board of Cosmetic Surgery (ABCS) have developed a 1-year fellowship program in cosmetic surgery with a pathway for board certification. However, attempts by ABCS physicians to advertise as “board certified cosmetic surgeons” have been met with resistance in some states, claiming that this training is not equivalent in scope, content, and duration to training accredited by the Accreditation Council of Graduate Medical Education (ACGME). This has led us to examine the AACS Cosmetic Surgery Fellowship through the lens of the ACGME 6 core competencies and milestones. We conclude that the AACS General Cosmetic Surgery Fellowship meets the ACGME core competencies. Medical knowledge and patient care are the competencies in which it is easiest to demonstrate equivalency to training accredited by the ACGME. Professionalism, systems-based practice, interpersonal communication skills, and practice-based learning are met, although they are more challenging to document. This problem is no different from that faced by ACGME-accredited residency programs and fellowships, who have also found it difficult to measure the competencies independently of one another in a meaningful way.

Can the use of femoral notch view alone decrease measurement error of distal interlocking screws after retrograde femoral nailing

ObjectivesDetermine if using different fluoroscopic views of the knee (Notch or Tangential) improves accuracy of screw lengths assessment compared to the standard posteroanterior (PA).Participants and Methods: Orthopaedic surgeons at three ACGME-accredited residency programs were asked via survey to assess screw lengths on PA, femoral notch, and tangential radiographic views. ResultsResponders correctly identified screw length using PA, femoral notch, and medial tangential views at rates of 46.75%, 52.27%, and 44.37% respectively. Respondents detected overall screw length discrepancies most accurately using the femoral notch view (Odds Ratio 1.26; 95% confidence interval: 1.07–1.47; P < 0.005). There was no statistical difference between the residents and faculty cohort in ability to detect screw length discrepancy. ConclusionDifferentiating distal interlocking screw lengths on traditional imaging (AP/Notch/Tangential) is poor. The femoral notch view significantly improves accuracy in radiographic determination of screw length. The femoral notch view should be used in conjunction with the traditional PA view to maximize sensitivity and specificity for detecting prominent screws.

The Standardized Video Interview: How Does It Affect the Likelihood to Invite for a Residency Interview?

The Association of American Medical Colleges instituted a standardized video interview (SVI) for all applicants to emergency medicine (EM). It is unclear how the SVI affects a faculty reviewer's decision on likelihood to invite an applicant (LTI) for an interview. The objective was to determine whether the SVI affects the LTI. Nine Accreditation Council of Graduate Medication Education (ACGME)-accredited EM residency programs participated in this prospective, observational study. LTI was defined on a 5-point Likert scale as follows: 1=definitely not invite, 2=likely not invite, 3=might invite, 4=probably invite, 5=definitely invite. LTI was recorded at three instances during each review: 1) after typical screening (blinded to the SVI), 2) after unblinding to the SVI score, and 3) after viewing the SVI video. Seventeen reviewers at nine ACGME-accredited residency programs participated. We reviewed 2,219 applications representing 1,424 unique applicants. After unblinding the SVI score, LTI did not change in 2,065 (93.1%), increased in 85 (3.8%) and decreased in 69 (3.1%; p=0.22). In subgroup analyses, the effect of the SVI on LTI was unchanged by United States Medical Licensing Examination score. However, when examining subgroups of SVI scores, the percentage of applicants in whom the SVI score changed the LTI was significantly different in those that scored in the lower and upper subgroups (p<0.0001). The SVI video was viewed in 816 (36.8%) applications. Watching the video did not change the LTI in 631 (77.3%); LTI increased in 106 (13.0%) and decreased in 79 (9.7%) applications (p=0.04). The SVI score changed the LTI in 7% of applications. In this group, the score was equally likely to increase or decrease the LTI. Lower SVI scores were more likely to decrease the LTI than higher scores were to increase the LTI. Watching the SVI video was more likely to increase the LTI than to decrease it.

Integrated Residency Is Associated With an Increase in Women Among Vascular Surgery Trainees

During the past decade, the proportion of women within graduate medical education (GME) has increased. Correspondingly, the proportion of women in almost every specialty has increased, including surgical specialties. We sought to evaluate the effect of establishing vascular surgery integrated residencies (VSIRs) on the proportion of women in vascular surgery (VS) training programs. Resident data were obtained from the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book for the academic years 2007 to 2016. Data were collected on overall ACGME residency numbers as well as on the following surgical subspecialties: vascular; general; thoracic; neurologic; orthopedic, ear, nose, and throat; plastic; and urologic. The number and proportion of women per year in VSIRs and VS fellowships were compared with those in the other surgical specialties. During the study period, the overall number of women in ACGME-accredited residency programs increased from 41% (n = 43,695/10,7851) to 44% (n = 57,130/129,720) of residents. Since the advent of the VSIR, the number of trainees within VS has grown by 56% from 221 to 501 trainees. The proportion of women in VS training programs has increased from 12% (n = 27/221) to 33% (n = 164/501) of trainees. This increase during the 9-year study period was greater than in any other surgical subspecialty and greatest within the VSIR. Compared with fellowship training programs, integrated surgical training programs within the same subspecialty had a higher proportion of women, although variability between surgical subspecialties remained notable. Although it is lower than the proportion of women within all GME training programs, an increasing proportion of women have entered VS training during the study period. This appears to be related to the introduction of VSIRs and exceeds the proportion of women entering other surgical, subspecialties. Further work to understand surgical specialty preferences and choice of careers after training is warranted.