Additional Fellowship Training Research Articles

Identification of Factors that May Predict Career Trajectory Among Neuro-Ophthalmology Fellows.

There is modest literature regarding fellowship applicant factors that may predict future career achievement. We aim to characterize neuro-ophthalmology fellows and identify and analyze characteristics that may predict future career trajectory. Data, including demographic information, academic background, scholarly activities, and practice information, were collected using publicly available sources, on individuals who completed neuro-ophthalmology fellowships from 2015 to 2021. Summary statistics describing the cohort were calculated. Prefellowship characteristics were compared with postfellowship characteristics to evaluate which prefellowship characteristics may predict postfellowship academic productivity and career achievement. Data were collected on 174 individuals (41.6% men, 58.4% women). Sixty-five percent were residency-trained in ophthalmology, 31% neurology, 1.7% both, and 1.7% pediatric neurology. Fifty-eight percent completed residency in the US, 8% in Canada, 32% internationally, and 2% in multiple locations. Among those practicing in the US/Canada, 63.8% practice at academic centers, 35.3% private practice, and 0.9% at both. Thirty-one percent completed additional subspecialty training and 17.8% additional graduate degrees. Completion of additional fellowship training or graduate degrees, and publication of more papers before fellowship, correlated with later academic productivity. There were no significant correlations between completion of an additional fellowship or graduate degree with current practice environment or attainment of leadership roles. There were no significant correlations between total publishing productivity prefellowship and practice environment or leadership roles postfellowship. Additional graduate degrees/subspecialty training, and prefellowship academic productivity, correlated with later academic productivity among neuro-ophthalmologists, suggesting that these metrics may be helpful in predicting future academic performance among fellowship applicants.

MP18-08 SHOULD CONTEMPORARY UROLOGY RESIDENTS EXPECT TO BE ABLE PERFORM HYPOSPADIAS REPAIR WHEN THEY GRADUATE WITHOUT FELLOWSHIP TRAINING: RESULTS FROM A SURVEY OF SPU MEMBERSHIP

You have accessJournal of UrologyCME1 Apr 2023MP18-08 SHOULD CONTEMPORARY UROLOGY RESIDENTS EXPECT TO BE ABLE PERFORM HYPOSPADIAS REPAIR WHEN THEY GRADUATE WITHOUT FELLOWSHIP TRAINING: RESULTS FROM A SURVEY OF SPU MEMBERSHIP John M. Masterson, Michael Zaliznyak, Aurash Naser-Tavakolian, Peris Castaneda, and Andrew Freedman John M. MastersonJohn M. Masterson More articles by this author , Michael ZaliznyakMichael Zaliznyak More articles by this author , Aurash Naser-TavakolianAurash Naser-Tavakolian More articles by this author , Peris CastanedaPeris Castaneda More articles by this author , and Andrew FreedmanAndrew Freedman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As surgical training has become increasingly subspecialized, residents have been encouraged to pursue additional fellowship training. We sought to better understand current attitudes regarding expectations for competency for non-fellowship trained graduates in sub-specialty procedures and how this has affected teaching practices during residency training. We chose to study hypospadias as a model as it is a signature procedure for pediatric urologists that is both technically challenging and at the same time quite common. METHODS: We created a survey tool utilizing the well-established Zwisch scale to assess the level of autonomy afforded to trainees by survey respondents during various types of hypospadias repair as well as elicited attitudes regarding post-training expectations. Our survey was distributed via email to the Society of Pediatric Urology membership. We also collected respondent demographic data such as geographic location, years in practice, and practice setting. RESULTS: 178 of 761 (23%) unique recipients completed the survey. We excluded 6 respondents who are retired or do not perform hypospadias repair. 170 of 172 (98%) included respondents felt that trainees should not perform hypospadias repair independently in practice without additional fellowship training. Among pediatric urologists who train residents, trainee autonomy as measured by the Zwisch scale was limited to an assistant role for the vast majority of trainees and decreased as the severity of the hypospadias increased (Figure 1). CONCLUSIONS: Urology residents for the most part are not being afforded a level of autonomy in hypospadias cases during training that would suggest competency for independence following graduation. Additionally, there is consensus that contemporary graduates are not expected to be competent to perform hypospadias repair in independent practice without additional fellowship training. This raises the question if there are other common sub-specialty procedures in urology where residents are not expected to achieve competence, and if so, how should we as educators, be forthcoming about the limitations of urology residency training to set appropriate trainee and employer expectations? Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e225 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Michael Zaliznyak More articles by this author Aurash Naser-Tavakolian More articles by this author Peris Castaneda More articles by this author Andrew Freedman More articles by this author Expand All Advertisement PDF downloadLoading ...

Residency graduates should not be expected to perform hypospadias repair without fellowship training: Results from a survey of SPU membership

Trainee autonomy has eroded over time as surgery has become more subspecialized and as attending oversight has increased, causing many trainees to seek additional fellowship training beyond residency. Less clear is whether there are cases that attendings view as "fellowship-level" or "privileged" cases in which resident-level trainees should not have high levels of autonomy due to complexity or high-stakes outcomes. We sought to better understand current attitudes and practices with regards to trainee autonomy in hypospadias repair as it represents a high complexity procedure within pediatric urology. We administered a RedCap survey to the SPU membership, asking respondents to describe the level of autonomy afforded to trainees in various types of hypospadias repair (distal, midshaft, proximal, perineal) as measured by the Zwisch scale. The Zwisch scale describes the role of the attending in the attending-trainee relationship in a low-to-high trainee autonomy fashion: show and tell; active help; passive help; supervision only. 177 of 761 (23%) unique recipients completed our survey and 174 of 177 (98%) of respondents felt that trainees should not perform hypospadias repair independently in practice without additional fellowship training. Among pediatric urologists who train residents, trainee autonomy as measured by the Zwisch scale decreased as the type of hypospadias repair moved from distal to proximal. There was near unanimous agreement among respondents that urology trainees should not perform hypospadias repair in practice without additional pediatric urology fellowship training, and that current practice affords little trainee autonomy in hypospadias repair at the resident level. These findings introduce a new wrinkle into the issue of trainee autonomy: cases in which trainees perhaps should not have autonomy. Concurrently, the concern with such findings is that this intentional lack of autonomy may extend to other urologic procedures that one would expect trainees to be able to perform independently. Urology trainees are not expected to be able to perform hypospadias in practice without additional training. This raises the question that there may be other such procedures in urology, and if so, should we as instructors, be forthcoming about the limitations of urology residency training to set appropriate trainee expectations?

The Underrepresented Minority in Hand Surgery: Challenges and Strategy for Success.

Hand surgery is a subspecialty that requires additional fellowship training after a primary residency; a long and competitive journey to achieve success. An underrepresented in medicine (UIM) student's journey to becoming a hand surgeon in the United States adds another level of challenge given several defined obstacles. Despite the lack of representation, the chances of becoming a hand surgeon are difficult but not impossible. A comprehensive strategy for an UIM student to become a hand surgeon is outlined in detail.

6. The Influence of Integrated vs Independent Pathway and Hospital Type on Plastic Surgery Post-Residency Plans Unchanged by Global Pandemic

Background: Statements are often made about what percentage of plastic surgery (PRS) residents go into fellowship vs. private practice vs. academia after graduation. However, few objective studies have been completed. This project is designed to illuminate career choices of PRS residents immediately after graduation from 2018-2022 and secondarily, determine if the pandemic had any measurable impact. Methods: Publicly available data was obtained from institution websites or program queries. Demographic data was collected including sex/gender, training pathway, primary residency, length of training, and post-residency fellowship vs private practice job vs academic job vs military appointment. Comparison of percentages between pre-Covid and post-Covid (2018-19 vs 2020-22), training pathways (independent vs integrated), institution type (private vs public) and program rank (per Doximity) were analyzed using Fisher’s exact test. P values were 2-sided and comparisons with P < 0.01 were considered significant. Statistical analysis was performed using SAS software. Results: Data was collected for 691 graduates across 64 training programs (28% independent, 71% integrated). Most graduates pursued fellowship-training (61%) followed by 28% direct to private practice, 5% direct to academic practice and 1% assumed a military post. Independent residents were more likely to pursue private practice (40%vs.26%, p=0.001), while integrated residents were more likely to pursue additional fellowship training (49%vs70%, p<0.0001). Public institution graduates are more likely to go into private practice (37%vs.23%, p=0.0002), while private institution residents are more likely to pursue fellowship (55%vs.72%, p<0.0001). However, pandemic (p=0.31) and institutional rank (p=0.11) showed no association. Conclusion: In this report, we present career choice trends amongst PRS trainees. We found independent residents more likely to pursue private practice, perhaps due to prolonged training period (minimum 8 years vs 6 years), while integrated residents were more likely to pursue fellowship training. Public/State institution graduates were more likely to pursue private practice, potentially influenced by more exposure to community faculty than trainees in private academic settings. This study demonstrates that training pathway and institution type have a significant impact on post-graduation plans, whereas global pandemic and institutional rank do not. This information can be used by programs and students as they plan for the future.

Factors Influencing the Choice of Radiology Subspecialty Among Radiology Trainees in Sudan.

Background and objective There are numerous reasons why radiologists would be interested in seeking additional fellowship training, some of which are personal, such as the possibility of bettering their career prospects, while others are work-related. This study aimed to identify whether the Sudanese radiology trainees wanted to pursue fellowshipand what were the motivating and restricting factors affecting their career choices. Methods This was a re-do research of a study from Saudi Arabia previously published in the Cureus journal in 2019. This wasa descriptive cross-sectional study conducted among the radiology registrarstraining under Sudan Medical Specialization Board (SMSB) in 2022 (n=90). By using convenient sampling, 74 of the 90 registrars were contacted, and aresponse rate of 81% (n=60) was achieved. Data were collected using a pre-tested self-administered online questionnaire. Data were analyzed usingIBMSPSS®Statistics version 25.0 (IBM Corp., Armonk, NY). A p-value ≤0.05 was considered statistically significant. Results The majority of the trainees in our study were females (61.7%, 37/60). More than 93% (n=56) of our participants were training in Khartoum, the capital of Sudan. The most commonly chosen subspecialties in our study were as follows: neuroradiology (33.3%, n=20) body imaging (26.7%, n=16), and interventional radiology (25%, n=15). In contrast, nuclear medicine (1.7%, n=1) and emergency radiology (3.3%, n=2)were among the least popular subspecialties.The top influencing factors among our trainees in choosing a subspecialty included "strong personal interest," "lifestyle," and "area of strongpersonal knowledge." The most common factors preventing trainees from opting for a fellowship were "financial restriction" (55%, n=33) and "family obligation" (28.3%, n=17). Of those with no plans to subspecialize, 75% (six out of eight) stated that the lack of a fellowship program in Sudan is a possible deterrent. A statistically significant association was found between genderand the choice of subspecialty in interventional radiology and women's/mammogram imaging. Our findings revealed that there are currently no trainees in the first year of radiology residency because the last selection exam had been conducted in 2019. Despite thecurrent unavailability of subspecialty training in Sudan, 75% (n=45) of trainees in our study were interested in joining a local program for fellowship training in the future. Conclusion Radiology trainees in Sudan share similar interests and influencing and restricting factors when pursuing subspecialty training, as reported in the literature. Unlike other countries, females predominate in the field of radiology training in Sudan at the moment. Radiologists from Sudan who are interested in subspecializing usually travel abroad for training; and once they find better prospects, many of them may not return. Programs offeringsubspecialization locally could mitigate the attrition of radiologists in Sudan. When designing subspecialty training programs in Sudan, stakeholders should use knowledge of influential factors and understanding of subspecialty decision trends among radiology trainees as a reference point. To the best of our knowledge, this study is the first of its kind to be conducted in this field in Sudan.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Current Trends in Subspecialty Fellowship Training for 1691 Academic Neurological Surgeons

Neurosurgical subspecialty fellowship training has become increasingly popular in recent decades. However, few studies have evaluated recent trends in postgraduate subspecialty education. This study aims to provide a detailed cross-sectional analysis of subspecialty fellowship training completion trends and demographics among U.S. academic neurosurgeons. Academic clinical faculty (M.D. or D.O.) teaching at accredited neurosurgery programs were included. Demographic, career, and fellowship data were collected from departmental physician profiles and the American Association of Neurological Surgeons (AANS) membership database. Relative citation ratio scores were retrieved using the National Institutes of Health iCite tool. This study included 1691 surgeons (1756 fellowships) from 125 institutions. The majority (79.13%) reported fellowship training. Fellowship completion was more common among recent graduates (residency year >2000), as was training in multiple subspecialties (P < 0.0001). Spine was the most popular subspecialty (16.04%), followed by pediatrics (11.18%), and cerebrovascular (9.46%). The least common were trauma/critical care (2.52%) and peripheral nerve (1.26%). Spine, neuroradiology, and endovascular subspecialties grew in popularity over time. Pediatrics and spine were the most popular for females and males, respectively. Epilepsy and cerebrovascular had the most full professors, while endovascular and spine had the most assistant professors. Stereotactic/functional and epilepsy had the most Ph.Ds. Fellowship training correlated with higher weighted, but not mean, relative citation ratio scores among associate (P= 0.002) and full professors (P= 0.005). There is an emerging proclivity for additional fellowship training among young neurosurgeons, often in multiple subspecialties. These findings are intended to help guide professional decision-making and optimize the delivery of postgraduate education.

Plastic Surgery Training During Coronavirus Disease 2019 Pandemic: A Quantitative Study on Trainees' Wellness and Education.

Coronavirus disease 2019 (COVID-19) pandemic has had far reaching impacts on all aspects of the healthcare system, including plastic surgery training. Due to reduction in the number of elective surgery cases and need for social distancing, plastic surgery education has shifted from the operating room to the virtual learning environment. Although these changes have been qualitatively described, the authors present a quantitative analysis of plastic surgery training changes due to the COVID-19 pandemic. Our study has identified residents' greatest impediments and inquired about suggestions for further improvements. Our goal is to help residency programs through the COVID-19 pandemic era and contribute to future guidelines when residency education encounters additional unexpected changes. An institutional review board approved anonymous survey using Qualtrics was forwarded on April 23, 2020 to US plastic surgery program directors to be distributed to plastic surgery residents and fellows. Questions centered on the impact of COVID-19 on residents' well-being, education and career plans results were collected for data analysis. Residents were given the option to be in a raffle to win a $50 amazon gift card. Completion of the survey was both anonymous and voluntary. A total of 69 trainees responded (52 integrated residents and 17 independent fellows) from 18 states. Fifty-one percent were male and 49% were female. Fifty-six percent of trainees plan to complete a fellowship program after graduation, 31% will join private practice. Nine percent of trainees reported changes in their postgraduation plans due to the pandemic, 67% were senior trainees. Of those whose goals were affected by COVID-19 pandemic, 56% opted to pursue additional fellowship training. They described reduced operative exposure and cancelations of elective surgeries (50%), the limited availability of private practice jobs (37.5%), and financial reasons (12.5%) for their decision. Twelve percent reported being concerned about not meeting the necessary requirements to finish their residency and graduate on time. Seventy-six percent of trainees expressed concerns about the health and safety of themselves, family and loved ones. Forty-nine percent of trainees reported increased levels of stress since the onset of the pandemic. Ninety-seven percent of trainees reported having reduction in their operative time during the COVID-19 pandemic. They utilized their nonoperative time for online education modules (84%), educational readings (82%), and research (80%). Plastic surgery trainees learned about national webinars through emails from professional society (83%), co-resident/fellow (77%), program director emails (74%), and social media (22%). Webinars attended were mostly through virtual platform modalities, among which Zoom and Webex were the most preferred. Less interactions with colleagues and faculty was the biggest barrier to adopting virtual conferences. Despite this, 72% agreed that having grand rounds, didactics and journal clubs online increased attendance. Additionally, 88% of respondents expressed interests in attending professional society sponsored virtual grand rounds in the future. Results from our survey demonstrated that the overwhelming majority of plastic surgery residents have had reductions in operative times and widespread curriculum changes during the COVID-19 pandemic. These recent changes have increased residents' stress levels and adversity affected their future career plans. Additionally, COVID-19 has heralded an increase in virtual conferences and learning modules. Plastic surgery trainees expressed a preference for virtual educational platforms and interest in continuing virtual didactics in the future. This may irreversibly change the landscape of future plastic surgery training.

Job market in head and neck surgery: A survey and analysis of recent fellowship graduates

ObjectiveRecent years have seen increase in individuals pursuing postgraduate fellowships in head and neck (HN) surgery. This has presented concerns about insufficient jobs where graduates can apply their scope of specialized training. MethodsData was collected in two manners- a survey and a manual online search of American Head and Neck Society (AHNS) fellowship graduates. A 25-question survey was sent in 2021 to approximately 400 HN fellows who graduated between 2010 and 2020. The AHNS list of graduates from the same years were searched online to collect information including gender, graduation year, fellowship training, and current job practice. ResultsOf the 78 survey responses, 64.1 % were male and 34.6 % female. 96.2 % reported ablative, 84.6 % microvascular, and 82.1 % TORS training. Mean number of interviews was 4 with most interviewing during the 3rd quarter (January to March). Majority reported being in academic and university-based practices (79.6 %). Online search was done on 393 graduates. Since 2010 the number of graduates almost doubled. There was a statistically significant increase in females by year (p = 0.022). There was a significant decrease (p = 0.022) in graduates with additional fellowship training from that of their AHNS fellowship. There was also a statistically significant increase in graduates being in academic practices (p = 0.022). ConclusionDespite growing numbers, there appears to be more graduates entering an academic practice, although the definition of an academic HN practice may be evolving. These results provide guidance on how to approach the job search in a select market. Level of evidenceII.

A multi-institutional study from the US ROPE Consortium examining factors associated with directly entering practice upon residency graduation

BackgroundThere is concern regarding the competency of today’s general surgery graduates as a large proportion defer independent practice in favor of additional fellowship training. Little is known about the graduates who directly enter general surgery practice and if their operative experiences during residency differ from graduates who pursue fellowship. MethodsNineteen Accreditation Council for Graduate Medical Education–accredited general surgery programs from the US Resident OPerative Experience Consortium were included. Demographics, career choice, and case logs from graduates between 2010 to 2020 were analyzed. ResultsThere were 1,264 general surgery residents who graduated over the 11-year period. A total of 248 (19.6%) went directly into practice and 1,016 (80.4%) pursued fellowship. Graduates directly entering practice were more likely to be a high-volume resident (43.1% vs 30.5%, P < .01) and graduate from a high-volume program (49.2% vs 33.0%, P < .01). Direct-to-practice graduates performed 53 more cases compared with fellowship-bound graduates (1,203 vs 1,150, P < .01). On multivariable analysis, entering directly into practice was positively associated with total surgeon chief case volume (odds ratio = 1.47, 95% confidence interval 1.18–1.84, P < .01) and graduating from a US medical school (odds ratio = 2.54, 95% confidence interval 1.45–4.44, P < .01) while negatively associated with completing a dedicated research experience (odds ratio = 0.31, 95% confidence interval 0.22–0.45, P < .01). ConclusionThis is the first multi-institutional study exploring resident operative experience and career choice. These data suggest residents who desire immediate practice can tailor their experience with less research time and increased operative volume. These data may be helpful for programs when designing their experience for residents with different career goals.

Early-Career Sports Medicine Surgeons Perform a Large Volume of Non-Sports Medicine Procedures: American Board of Orthopaedic Surgery (ABOS) Part-II Data Regarding Orthopaedic Surgeons Specializing in Sports Medicine.

The purpose of this study was to utilize the American Board of Orthopaedic Surgery (ABOS) Part-II Case List database to (1) define the practice patterns of sports medicine-trained ABOS Part- II Oral Examination Candidates and (2) describe the frequency and practice patterns of individuals who are dual fellowship-trained sports medicine candidates. The ABOS Part-II Case List database was utilized to define all cases submitted by 3,298 applicants indicating completion of a sports medicine fellowship between January 1, 2003, and January 1, 2020. Cases were classified by subspecialty category and case type. The frequency and practice patterns of candidates pursuing additional fellowship training (i.e., "dual fellowship-trained") were recorded. Descriptive statistical methods were used to describe the annual and overall procedure volume and candidate case mix. Trends in the relative frequency of cases performed and fellowship training patterns were determined using linear regression analysis. On average, sports medicine-trained candidates submitted 100.6 cases for review during the 6-month case collection period: 59.0 (58.6%) sports medicine/arthroscopy cases, 29.3 (29.1%) trauma/general cases, 4.5 (4.5%) adult reconstruction cases, and 7.8 (7.8%) "other" cases per candidate. Although candidates performed fewer total (r 2 = 0.84, p < 0.001) and sports medicine/arthroscopy (r 2 = 0.85, p < 0.001) cases over the study period, the proportion of sports medicine/arthroscopy cases did not change over the study period (p = 0.18). Dual fellowship training was indicated by 333 individuals (10.1%). The number of dual fellowship-trained candidates pursuing additional fellowship training in pediatrics and adult reconstruction increased over the study period, and the number of dual fellowship-trained candidates pursuing additional fellowship training in trauma decreased over the study period. Early-career sports medicine candidates are likely to perform >40% of cases outside of the sports medicine subspecialty. Sports medicine trainees are increasingly likely to pursue a second fellowship in pediatrics or adult reconstruction. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Are we training oral and maxillofacial surgeons in minimally invasive cosmetic procedures?

Oral and maxillofacial surgeons (OMS) are well trained in facial anatomy, but exposure to cosmetic procedures in residencies is inconsistent due to several factors, including the patient population, technique, and cost. The primary objective of the present study was to identify an association with exposure to treatment modality in residency with likelihood to perform these procedures in practice. This was a cross-sectional survey distributed to practicing OMS in the United States. Links to the online survey were distributed using communications from local, state, and regional OMS surgery societies. Information was gathered on clinical practice and training during and after residency. The study outcome was whether the respondent performed injectables (dermal fillers or neuromodulators) in their practice. A total of 150 responses were included in the study sample, and no responses were excluded. Only 42.7% of respondents reported performing injectables. Just 37% of respondents stated they had had an opportunity to perform these procedures as a resident, suggesting that 5.7% did not perform injectables until they started practice. Dual-degree training, additional fellowship training, and practical and didactic continuing education training were all associated with higher likelihoods of having an injectable practice. Injectable exposure in residency did not significantly affect the prevalence of having an injectable practice. OMS who performed injectables were more likely to seek additional forms of training outside of residency. Educators should reevaluate the way that they are approaching cosmetics procedures in residency.

SAGES Advanced GI/MIS Certificate Program

SAGES partners with the Fellowship Council (FC) to offer fellowships in MIS and flexible endoscopy. The FC has a robust accreditation process for fellowship programs; however, the FC is not able to address certification of individual graduates. This situation is similar to the structure of residencies whereby the ACGME accredits programs but individual board certification is delegated to constituent boards of the American Board of Medical Specialties (ABMS). In light of this gap, sponsoring societies have developed programs for issuing certificates to graduates of fellowship programs who have met predetermined standards. The purpose of this paper is to describe the SAGES Certificate Process for Adv GI MIS and Flexible Endoscopy Fellowships. The SAGES Certificate program was developed through a rigorous process and has undergone recent revision to modernize the certificate criteria. Research has shown that as many as 80% of general surgery graduates go on to complete additional fellowship training. Given the number of graduates who complete this subspecialty training each year, general surgery board certification may not be an appropriate final benchmark. The SAGES certificate program joins a long list of certification pathways for surgical fellowship trainees in ACGME and non-ACGME programs. In the future, SAGES plans to assess competency in all of core content domains with validated assessments.

An Examination of General Surgery Residency Programs with a Rural Track

There is a steady decline in the general surgery workforce in rural areas of the United States. In response, some surgery residency programs have developed rural tracks to encourage rural practice and adequately prepare trainees for this setting. To compare the practice type and location of graduates from general surgery residency programs with and without a dedicated rural track between 2011-2020. General surgery residency programs with and without a rural track were identified using the American Medical Association Residency and Fellowship Electronic Interactive Database and the Rural Surgery Program list from the American College of Surgeons. Graduates of these programs who entered general surgery practice between 2011-2020 were subsequently identified from individual residency program websites and tracked to their current practice setting using a Google search of first and last name and residency affiliation. Practice location was identified by zip code or county name and coded by Rural-Urban Continuum Codes (RUCC, Economic Research Service, USDA). We identified 2,582 general surgery residency graduates from 2011 to 2020 across 66 residency programs. Of these graduates from programs without a rural track, 23.6% entered general surgery practice without additional fellowship training, compared to 34.0% from residency programs with a rural track (p = 0.019). Community or University-based program designation was not associated with decision to enter general surgery practice over fellowship training (p = 0.420). Proportion of graduates entering rural practice as defined by RUCC groups 7-9 was not associated with having a rural program track or with community or university-based program status. Residency programs with a rural track produce a higher proportion of graduates entering general surgery compared to fellowship, though they are no more likely than programs without a rural track to produce graduates who ultimately practice in rural areas.

Survey of Clinical Neurophysiology and Epilepsy Fellowship Programs in the United States During COVID-19.

The COVID-19 pandemic impacted clinical practice, education, and research in Neurophysiology/Epilepsy. Although there is published literature on clinical impact, its educational impact is not well described. A national survey of Clinical Neurophysiology (CNP) and Epilepsy fellowship programs was conducted to assess the impact of COVID-19 on fellowship education. A list of accredited Clinical Neurophysiology and Epilepsy fellowship programs was obtained from the Accreditation Council for Graduate Medical Education. Program directors at individual locations were contacted to complete a brief survey about the program and impact of COVID-19. Fellows from responding programs were subsequently invited to share their perceptions about the impact of the pandemic on their training. From 176 programs, 40 PDs responded (22.7%). From these 40 programs, fellows from 26 completed surveys (65.0% response). There was a reduction in EEG and epilepsy monitoring unit volumes post-COVID-19, with a trend of change for EMG, whereas continuous EEG volumes were mostly unchanged. The impact of the pandemic on training was rated as moderate to severe (≥50%) by 30.0% of PDs and 49.0% of trainees. In remarkable agreement, 20.0% of PDs and 20.4% of fellows believed that additional fellowship training was needed before graduation. Lack of fellow satisfaction was correlated with the perceived impact of the pandemic on education ( p = 0.008). This survey revealed a considerable impact on EEG/EMG clinical volume because of COVID-19, although continuous EEG was not as impacted. More fellows than PDs believed that training was considerably impacted by COVID-19, but a similar number thought that additional training was needed. It was unclear from this study whether the fellows' perception of educational impact was solely because of the pandemic or in addition to preexisting training deficiencies in the training programs.

The Role of Cadaver-Based Flap Course in Microsurgical Education and Practice Patterns of Attendees: A Survey Study.

In 2017, our institution initiated a cadaver laboratory-based course dedicated to teaching reconstructive microsurgery indications, preoperative planning, and flap dissection. The goals of this study are to describe the demographics and experience of participants/instructors and to evaluate the learning objectives and effectiveness of the course. Penn Flap Course (PFC) participants were sent an anonymous survey at the inaugural PFC 2017. Then, in 2019, both instructors and participants were sent a more comprehensive survey. Surveys included questions regarding demographics, training background, experiences in practice and/or training, and course evaluation. At PFC 2017, participant response rate was 25% (12/44), and the primary reason for attending the course was to observe and learn from instructor dissections (66.7%). At PFC 2019, the response rate was 77.3% (17/22) for faculty and 73.0% (35/48) for participants. Both in 2017 and 2019, the vast majority of participants reported perceived improvement in understanding of flap dissection principles across all anatomic domains (94.3%-100%). In 2019, when asked about their background experience, the majority of participants reported comfort performing arterial and venous anastomosis without supervision (71%-77%) and being least comfortable with head and neck (H&N) microsurgery (mean comfort level: 5.2/10). Half of the participants (e.g., residents) find the presence of a microsurgery fellow at their institution useful to their educational experience. Instructors with additional fellowship training in microsurgery reported performing a higher volume of free flaps per week (7 vs. 2.3) and per year (94.2 vs. 27.8; p < 0.05 for both) and trend toward performing more H&N reconstruction (p = 0.057). Participants feel least comfortable with H&N microsurgical reconstruction. Surgical faculty with microsurgical fellowship training performs greater volume of microsurgical cases with a trend toward more H&N reconstruction. A cadaver/lecture-based flap course is an effective way to improve participants' perceived confidence and understanding of complex flap and microsurgical reconstructive procedures.

The Current State of Gender-Affirming Surgery Training in Plastic Surgery Residency Programs as Reported by Residency Program Directors.

The purpose of this Web-based survey was to elucidate the current perspectives of plastic surgery residency program directors on training residents to perform gender-affirming surgery. Web-based surveys were distributed to 79 plastic surgery program directors. Demographic information and perspectives on training of gender-affirming surgery in plastic surgery residency were queried. Of 79 distributed surveys, there were 43 responses (54 percent). Overall, program directors reported that their trainees were prepared to address plastic surgery-related transgender concerns (67 percent), and believe plastic surgeons are the most appropriate specialty referral for each type of gender-affirming surgery (top/chest, 98 percent; facial, 95 percent; and bottom/genital, 79 percent). Ninety-three percent of program directors noted that transgender surgery is becoming more accepted and/or practiced in their referral area, with 26 percent reporting a dedicated clinic experience. There was a mixed response on the need for additional fellowship training for gender-affirming surgery. Residents are exposed to significantly more bottom (p = 0.0018), top (p = 0.0013), and facial operations (p = 0.00005) if they rotate through a "gender" clinic. Of the queried program directors, the majority feel their residents are well-trained in gender-affirming surgery. However, residents have more clinical exposure in facial and top (chest) gender-affirming surgery as compared to bottom (genital) surgery. Although most program directors agree that plastic surgeons are the most important referral for top, bottom, and facial operations, there is less consensus over the role of fellowship training. Most program directors reported a desire to devote additional CME time to the topic in the coming years.

EMIG Simulation Systems Construct Validation Trial: Laparoscopic Component

Study Objective Construct validation of the EMIG Laparoscopic Surgery Simulation System. Design A prospective, controlled cohort comparison. Setting Thirteen teaching institutions in the US and Canada and an AAGL Congress Patients or Participants 221 subjects who fit one of 4 categories of exposure to laparoscopic surgery and surgical simulation: 77 novices within 100 days of starting posgraduate year 1 (PGY-1); 71 within the first 100 days of starting PGY-3; 30 American Board of Obstetrics and Gynecology (ABOG) certified and no additional fellowship training (“Proficient”); 43 who had completed the two-year Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Interventions Subjects were oriented to the simulation system and then tested under proctor supervision on the 5 EMIG laparoscopic exercises. These included the sleeve to peg transfer (L-1); the circular pattern cut (L-2); extracorporeal knotting (L-3); intracorporeal knotting (L-4); and a running suture (L-5). Time and accuracy scoring were entered electronically on site, but sessions were video recorded and study materials such as cutting and suturing targets were labeled and stored for subsequent review to optimize data quality. Measurements and Main Results Each exercise was timed, and a number of objective metrics recorded that reflected cutting and suturing accuracy and technique. Each exercise had a “time cap”; if a subject had not completed the exercise by the end of the allotted time, they were categorized “Did Not Complete” and the maximum time was entered for data analysis. Preliminary data analysis demonstrates that the novice group consistently demonstrated the poorest performance and the FMIGS cohort consistently the best. The PGY-3 and “Proficient” cohorts were generally similar to each other but each performed better than the PGY-1 group and well below the FMIGS group. Conclusion The EMIG Laparoscopic Simulation System can be used to distinguish amongst PGY-1, PGY-3, Proficient and FMIGS subjects. FMIGS-trained subjects consistently had the best results with almost no “Did not Complete” outcomes. Construct validation of the EMIG Laparoscopic Surgery Simulation System. A prospective, controlled cohort comparison. Thirteen teaching institutions in the US and Canada and an AAGL Congress 221 subjects who fit one of 4 categories of exposure to laparoscopic surgery and surgical simulation: 77 novices within 100 days of starting posgraduate year 1 (PGY-1); 71 within the first 100 days of starting PGY-3; 30 American Board of Obstetrics and Gynecology (ABOG) certified and no additional fellowship training (“Proficient”); 43 who had completed the two-year Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Subjects were oriented to the simulation system and then tested under proctor supervision on the 5 EMIG laparoscopic exercises. These included the sleeve to peg transfer (L-1); the circular pattern cut (L-2); extracorporeal knotting (L-3); intracorporeal knotting (L-4); and a running suture (L-5). Time and accuracy scoring were entered electronically on site, but sessions were video recorded and study materials such as cutting and suturing targets were labeled and stored for subsequent review to optimize data quality. Each exercise was timed, and a number of objective metrics recorded that reflected cutting and suturing accuracy and technique. Each exercise had a “time cap”; if a subject had not completed the exercise by the end of the allotted time, they were categorized “Did Not Complete” and the maximum time was entered for data analysis. Preliminary data analysis demonstrates that the novice group consistently demonstrated the poorest performance and the FMIGS cohort consistently the best. The PGY-3 and “Proficient” cohorts were generally similar to each other but each performed better than the PGY-1 group and well below the FMIGS group. The EMIG Laparoscopic Simulation System can be used to distinguish amongst PGY-1, PGY-3, Proficient and FMIGS subjects. FMIGS-trained subjects consistently had the best results with almost no “Did not Complete” outcomes.

EMIG Simulation Systems Construct Validation Trial: Hysteroscopic Component

<h3>Study Objective</h3> Construct validation of the EMIG Hysteroscopic Surgery Simulation System. <h3>Design</h3> A prospective, controlled cohort comparison. <h3>Setting</h3> Thirteen teaching institutions in the US and Canada and an AAGL Congress. <h3>Patients or Participants</h3> 240 subjects who fit one of 4 categories of exposure to hysteroscopic surgery and surgical simulation: 76 novices within 100 days of starting posgraduate year 1 (PGY-1); 69 within the first 100 days of starting PGY-3; 27 American Board of Obstetrics and Gynecology (ABOG) certified and no additional fellowship training ("Proficient"); 43 who had completed the two-year Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). <h3>Interventions</h3> Subjects were oriented to the simulation system and then tested under proctor supervision on the 2 EMIG hysteroscopic exercises. These included the Targeting Exercise (H-1); and the Polyp Removal Exercise (H-2). Time and accuracy scoring were entered electronically on site, but sessions were video recorded and stored for subsequent review to optimize data quality. <h3>Measurements and Main Results</h3> Each exercise was timed, and a number of objective metrics recorded that were designed to assess accuracy, efficiency and technique. Each exercise had a "time cap"; if a subject had not completed the exercise in by the end of the alloted time, they were categorized as "Did Not Complete" and the maximum time was entered for data analysis. Preliminary data analysis demonstrates that for both H-1 and H-2 the novice group consistently demonstrated the poorest performance and the FMIGS cohort consistently the best. The PGY-3 and "Proficient" cohorts were generally similar to each other but each performed better than the PGY-1 group and well below the FMIGS group. <h3>Conclusion</h3> The EMIG Hystroscopic Simulation System can be used to distinguish amongst PGY-1, PGY-3, Proficient and FMIGS subjects. FMIGS-trained subjects consistently had the best results.