Board Certification In Surgery Research Articles

A Post-COVID Population-Based Analysis of Mohs Micrographic Surgeon Distribution in the United States.

Policy changes to Mohs micrographic surgery board certification eligibility and population shifts in the wake of the COVID-19 pandemic have significant implications for the accessibility of Mohs micrographic surgeons across the United States. To examine the geographic distribution of micrographic surgery providers considering recent population trends and assess the impact of certification eligibility changes and population shifts on accessibility. Medicare claims data were utilized to identify micrographic surgery providers. Surgeon densities were calculated per 100,000 people by county and state. Population changes were analyzed using US census data. Practicing micrographic surgeons were concentrated in metropolitan and nonmetropolitan areas. Overall, 80.4% of counties lacked micrographic surgery providers, with rural areas being the most underserved. Population changes varied among states. Shifts in micrographic surgery certification requirements, US population distribution, and micrographic surgeon location emphasize challenges in accessibility, especially in rural areas across the United States.

Trained to cut? A literature review of veterinary surgical resident training.

A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.

Update on Educational Resources and Evaluation Tools for Orthopaedic Surgery Residents.

Innovations in orthopaedic resident educational resources and evaluation tools are essential to ensuring appropriate training and ultimately the graduation of competent orthopaedic surgeons. In recent years, there have been several advancements in comprehensive educational platforms within orthopaedic surgery. Orthobullets PASS, Journal of Bone and Joint Surgery Clinical Classroom, and American Academy of Orthopaedic Surgery Resident Orthopaedic Core Knowledge each have their own unique advantages in preparation for the Orthopaedic In-Training Examination and American Board of Orthopaedic Surgery board certification examinations. In addition, the Accreditation Council for Graduate Medical Education Milestones 2.0 and the American Board of Orthopaedic Surgery Knowledge Skills Behavior program each provide objective assessment of resident core competencies. Understanding and using these new platforms will help orthopaedic residents, faculty, residency programs, and program leadership to best train and evaluate their residents.

Rates of National Institutes of Health Funding for Surgeon-Scientists, 1995-2020

Surgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists. To examine how NIH funding has been awarded to surgeon-scientists over time. This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database for research project grants awarded to departments of surgery between 1995 and 2020. Surgeon-scientists were defined as NIH-funded faculty holding an MD or MD-PhD degree with board certification in surgery; PhD scientists were NIH-funded faculty holding a PhD degree. Statistical analysis was performed from April 1 to August 31, 2022. National Institutes of Health funding to surgeon-scientists compared with PhD scientists, as well as NIH funding to surgeon-scientists across surgical subspecialties. Between 1995 and 2020, the number of NIH-funded investigators in surgical departments increased 1.9-fold from 968 to 1874 investigators, corresponding to a 4.0-fold increase in total funding (1995, $214 million; 2020, $861 million). Although the total amount of NIH funding to both surgeon-scientists and PhD scientists increased, the funding gap between surgeon-scientists and PhD scientists increased 2.8-fold from a $73 million difference in 1995 to a $208 million difference in 2020, favoring PhD scientists. National Institutes of Health funding to female surgeon-scientists increased significantly at a rate of 0.53% (95% CI, 0.48%-0.57%) per year from 4.8% of grants awarded to female surgeon-scientists in 1995 to 18.8% in 2020 (P < .001). However, substantial disparity remained, with female surgeon-scientists receiving less than 20% of NIH grants and funding dollars in 2020. In addition, although there was increased NIH funding to neurosurgeons and otolaryngologists, funding to urologists decreased significantly from 14.9% of all grants in 1995 to 7.5% in 2020 (annual percent change, -0.39% [95% CI, -0.47% to -0.30%]; P < .001). Despite surgical diseases making up 30% of the global disease burden, representation of surgeon-scientists among NIH investigators remains less than 2%. This study suggests that research performed by surgeon-scientists continues to be underrepresented in the NIH funding portfolio, highlighting a fundamental need to support and fund more surgeon-scientists.

Fat Grafting Practices and Preferences, Are We Any Closer to a Standardized Approach? A Survey Providing Insights on Current Trends in Small and Large Fat Grafting

INTRODUCTION: Fat grafting has revolutionized plastic surgery practices since Coleman brought it to the frontline in 1995, and it is now used in a variety of areas ranging from breast reconstruction to regenerative medicine. However, due to a lack of evidence-based studies, multicenter, prospective, and/or randomized trials, we still don’t recognize which variables influence fat grafting’s positive clinical outcomes. METHODS: Following International Society of Plastic Regenerative Surgeons (ISPRES) Board approval, a 30-item questionnaire online survey was designed for distribution to a randomized cohort of ISPRES members) from 2nd July to 16th July 2021, participation in the survey was voluntary and participants could exit the survey without submitting their responses at any time. No participant compensation was provided. The questionnaire was designed to delineate in addition to demographic information, experience, practices, and beliefs among surgeons with regard to the use of autologous fat for contour restoration. RESULTS: The survey was completed by 62 ISPRES members, with 93.5% of the participants having Plastic Surgery Board Certification Status. The mean age of the surveyed members was 53 (9.7). The majority of the members (69.4%) work predominantly in aesthetic plastic surgery. Experience with Large-volume Fat Grafting Donor Site Selection The most commonly used donor area selection criteria were based on the patient’s fat availability (59.7 percent). In addition, 35.5 percent said they preferred to go directly to the abdomen, and only three (4.8 percent) said the patients chose the donor area. Nevertheless, when asked which zones they prefer to remove fat, when possible, abdomen (88.7%) was the commonest site, followed by flanks (62.9 percent). Fat Grafting Harvesting Infiltration Solution, Harvesting Instrument and Technique The most common infiltration solutions used in high volume fat transfers are the 3: 1 ratio tumescent solution (41.9 percent), secondly the super wet solution (40.3 percent) and thirdly the wet solution {100-300 ml of liquid (with or without epinephrine) at each site to be treated} (14.5 percent). Most respondents chose multiple options for the preferred cannula size, tip, holes and method used for fat harvest. The most common instrument preferred for large-volume fat harvesting amongst the respondents are 3-4mm cannulas (69.5 percent). Respondents’ preference of type of cannula tip and holes for fat harvest in large-volume procedures were the three-hole standard cannulas. Handheld suction (59.7 percent) was the most preferred fat harvest method followed by vacuum machine suction (46.8 percent.) Fat Graft Processing Following fat harvest, 56.5 percent (n=35) respondents (without exclusivity) performed decantation of fat, 43.5 percent performed centrifugation. Routine addition of PRP (platelet-rich-plasma) and adipose stem cells have been reported by 12.9 percent and 9.7 percent respondents respectively. Furthermore, 13 respondents report employing additional processing steps to isolate, prepare and store adipose stem cells. Fat Injection For handheld injections (without exclusivity), respondents prefer 1-2mm cannula with 1cc syringe (58.1 percent), closely followed by 1-2mm cannula with 10cc syringe (56.4 percent). Assessment of Outcome Preoperative and postoperative picture evaluation (59.6 percent) and clinical assessment (20.9 percent) were the most commonly used for assessment of fat graft survival by respondents. Only 14.5 percent of participants use preoperative and postoperative 3D images to evaluate. Fat Transfer in Cosmetic Breast Augmentation and Application of Pre-expansion Devices for Breast Augmentation The most commonly preferred plane for fat injection in cosmetic breast augmentation were gland and subcutaneous tissue. Only 8.1 percent (n=5) respondents routinely use pre-expansion devices for breast augmentation before fat grafting. Experience with Small-volume Fat Grafting The majority (53.3 percent) of the responders performed none or less than 25 percent of the small volume fat grafts under general anesthesia. Although there are almost 29 percent of surgeons who apply general anesthesia in 50 percent or more of them, being that 8 percent of them perform almost all surgeries with general anesthesia. CONCLUSION: Evidence-based studies incorporating randomized controlled, prospective, multicenter trials are imperative to understand which variables influence positive fat grafting clinical outcomes. Our research shows preliminary findings analyzing the current practices and preferences of the ISPRES community. The respondents’ tendencies were similar to previous literature, with some exceptions, such as the technique for preparing fat and enrichment, as well as the disparity in responses in the use of cannulas. A cross-sectional survey study of a wider scope, involving national delegates and global representatives of plastic surgeons is anticipated.

The Impact of Senior Author Profile on Publication Level of Evidence in Plastic and Reconstructive Surgery.

Background:Plastic and Reconstructive Surgery (PRS) incorporated the level of evidence (LOE) pyramid in 2011 to highlight evidence-based medicine in plastic surgery. This study aimed to assess the relationship between the profile of senior authors publishing in PRS and the LOE of publications.Methods:All accepted publications by American senior authors to PRS between January 2018 and March 2020 were classified by LOE. Demographic, educational, and career data on all senior authors were collected using publicly available online resources.Results:A total of 1030 articles were screened‚ of which 266 (25.8%) were eligible for LOE classification with the following distribution: I, 0.8%; II, 14.3%; III, 45.1%; IV, 33.1%; and V, 7.1%. Senior author demographic factors, including gender and race/ethnicity, did not significantly impact LOE (P > 0.05 for all). An advanced degree was associated with more publications per year, and only a PhD (P = 0.022) and board certification (P = 0.012) were associated with a higher LOE of publications (P = 0.022). Physicians working in an academic setting were significantly more likely to publish level III evidence than their private/community-based counterparts (P = 0.006). Breast papers constituted the highest proportion of level III evidence (41.4%; P < 0.001).Conclusions:Most publications in PRS contain level III-IV evidence. Senior author gender, race, and ethnicity did not impact LOE of publications. Plastic surgery board certification, possession of a PhD, and academic practice setting were associated with higher LOE of publications.

Characteristics of Physicians Obtaining Micrographic Dermatologic Surgery Board Certification in 2021.

Characteristics of Physicians Obtaining Micrographic Dermatologic Surgery Board Certification in 2021.

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.

Fundamentals of Laparoscopic Surgery Pro Tips Series Part 2: Tasks # 4 & 5

Study Objective This objective of this video is to describe several tips and tricks to help familiarize residents with the Fundamentals of Laparoscopic Surgery (FLS) tasks and to improve their technical skills and efficiency. In part 1 of this 2-part series, we provide specific strategies for the peg board, circle cut, and ligating loop tasks. Design Educational instructional video. Setting N/A Patients or Participants N/A Interventions FLS uses five simulation stations to assess basic laparoscopic surgery skills. It is a reliable and valid curriculum which has been shown to improve intraoperative trainee performance. It was developed in 2004, and since 2009 has been a requirement to qualify for the American Board of Surgery board certification. In 2018, the American Board of Obstetrics and Gynecology (ABOG) announced that FLS will be a prerequisite for specialty board certification for obstetrics and gynecology residents graduating after May 2020. ABOG states that this will “ensure that diplomates possess critical skills for the contemporary practice of obstetrics and gynecology.” Measurements and Main Results N/A Conclusion FLS is now a requirement for all OB/GYN residencies. Mastering the skills requires time and effort on the part of the learners but using these pro tips can help gain confidence and improve efficiency.

How Many Attempts Are Needed to Achieve General Surgery Board Certification?

Surgical trainees are subject to pressure from variety of stakeholders to secure board certification from the American Board of Surgery (ABS). To meet these expectations, trainees must pass a written qualifying exam (QE) and an oral certifying exam (CE) within 7 years of completing general surgery residency. Board certification outcomes for candidates who fail either the QE or CE examination are not well characterized, but this information could help candidates, policymakers, and other stakeholders make informed decisions about how to respond to examination failure. We retrospectively examined ABS records for all surgeons who completed general surgery residency from 2000 to 2013 and attempted general surgery board certification. Among 14,483 surgeons who attempted general surgery certification, 13,566 (94%) passed both the QE and CE within the 7-year certification window. Of those who did ultimately obtain certification, 97% passed the QE within 2 attempts and 97% passed the CE within 2 attempts. For those who failed either the QE or the CE twice, 67% ultimately obtained certification. Most surgeons who obtained ABS general surgery board certification did so within 2 attempts at each board examination. Candidates who fail either examination twice are less likely to achieve board certification.

A Roadmap for Noninvasive Vascular Laboratory Education

Since 2014, the Registered Physician in Vascular Interpretation (RPVI) designation has been required for a vascular surgery board certification candidate to register for the vascular surgery certifying exam. Although the importance of the noninvasive vascular laboratory (NIVL) is recognized, vascular laboratory education within vascular surgery fellowship programs is heterogeneous and much less regulated compared with clinical education. Evidence suggests that many vascular surgery trainees may not have received ideal training to obtain RPVI certification or direct an NIVL. The NIVL curriculum at The Ohio State University Wexner Medical Center has been used since 2005 and combines didactics, supervised reading, videos, hands-on experience with vascular sonographers, and one on one time with the vascular laboratory medical director. This curriculum is outlined in this article and can be used as a guide for creating NIVL curricula for vascular surgery and other training programs.

Association of Demographic and Program Factors With American Board of Surgery Qualifying and Certifying Examinations Pass Rates

American Board of Surgery board certification requires passing both a written qualifying examination and an oral certifying examination. No studies have been conducted assessing the effect of sociodemographic variables on board passage rates. To evaluate if trainee sociodemographic factors are associated with board passage rates. This national and multi-institutional prospective observational cohort study of 1048 categorical general surgery trainees starting in 2007-2008 were surveyed. Data collection began in June 2007, follow-up was completed on December 31, 2016, and analysis began September 2018. Survey responses were linked to American Board of Surgery board passage data. Of 662 examinees who had complete survey and follow-up data, 443 (65%) were men and 459 (69%) were white, with an overall board passage rate of 87% (n = 578). In a multinomial regression model, trainees of Hispanic ethnicity were more likely to not attempt the examinations (vs passed both) than non-Hispanic trainees (odds ratio [OR], 4.7; 95% CI, 1.5-14). Compared with examinees who were married with children during internship, examinees who were married without children (OR, 0.3; 95% CI, 0.1-0.8) or were single (OR, 0.4; 95% CI, 0.2-0.9) were less likely to fail the examinations. Logistic regression showed white examinees compared with nonwhite examinees (black individuals, Asian individuals, and individuals of other races) (OR, 1.8; 95% CI, 1.03-3.0) and examinees who performed better on their first American Board of Surgery In-Training Examination (OR, 1.03; 95% CI, 1.02-1.05) were more likely to pass the qualifying examination on the first try. White examinees compared with nonwhite examinees (OR, 1.8; 95% CI, 1.1-2.8), non-Hispanic compared with Hispanic examinees (OR, 2.4; 95% CI, 1.2-4.7), and single women compared with women who were married with children during internship (OR, 10.3; 95% CI, 2.1-51) were more likely to pass the certifying examination on the first try. Resident race, ethnicity, sex, and family status at internship were observed to be associated with board passage rates. There are multiple possible explanations for these worrisome observations that need to be explored. Tracking demographics of trainees to help understand passage rates based on demographics will be important. The American Board of Surgery already has begun addressing the potential for unconscious bias among board examiners by increasing diversity and adding implicit bias training.

Variability in Noninvasive Vascular Laboratory Experience of Vascular Surgery Training Programs Based on Survey of Trainees Suggests the Need for a Standardized Curriculum

Although a Registered Physician in Vascular Interpretation certification is required for vascular surgery board certification, no standardized noninvasive vascular laboratory (NIVL) curriculum for vascular surgery trainees exists. The purpose of this study is to investigate the NIVL experience of trainees and understand what helps them feel well prepared. Current trainees in all 0+5 and 5+2 vascular surgery training programs (114) were surveyed. The most complete survey from each program was included in the analysis. Programs were divided into those in which trainees felt well prepared (WP) and those in which trainees felt unprepared (UP) for the Physician Vascular Interpretation (PVI) examination. Responses for the 2 groups were compared. Responses from 61 of the 114 programs (53.5%) were analyzed. Most programs devote <0.5days per week to the NIVL (52.5%), assign lectures and textbook reading (55.7% and 47.5%), and provide hands-on experience with vascular technologists (60.7%) and attending surgeons (52.5%). Respondents from 15 programs (24.6%) took a PVI examination review course. The first-time PVI examination pass rate was 92.9% (13 of 14 trainees). The WP group reported higher rates of a structured curriculum for the NIVL (100% vs. 33.3%, P=0.0001), one-on-one time with vascular technologists (78.6% vs. 44.4%, P=0.05), mandatory lectures (78.6% vs. 33.3%, P=0.004), and assigned articles (64.3% vs. 11.1%, P=0.002). There is wide variation in NIVL experience among vascular surgery training programs. Many trainees feel unprepared for the PVI examination, especially those without a structured curriculum. These results suggest that a structured NIVL curriculum that includes dedicated time with vascular technologists, lectures, and articles should be established.

National criteria for academic appointment in vascular surgery

ObjectiveAdvancement in academic medicine is multifactorial. Our objectives were to characterize academic appointments in vascular surgery and to investigate what factors, particularly publications, influenced academic appointment. MethodsAcademic vascular surgeons at Accreditation Council for Graduate Medical Education vascular training programs or at primary sites of U.S. allopathic medical schools were included. Those with qualified titles, such as “adjunct” or a “clinical” prefix, were excluded. Sex, education, region, board certification, and affiliation details were recorded. Web of Science was queried for publication details and h-index. The h-index is a “personal impact factor” defined as “x” number of publications cited at least “x” number of times. After surgeons' information was deidentified, univariate and multivariable analyses were completed for academic appointment and appointment as division chief. ResultsThere were 642 vascular surgeons who met criteria: 297 (46.3%) assistant professors, 150 (23.4%) associate professors, and 195 (30.4%) professors. There were 96 (15%) division chiefs and 10 (1.6%) chairs of surgery, and 83.2% were male. Surgeons worked in the Northeast (33.5%), Southern (32.6%), Central (20.1%), and Western (13.9%) United States. The mean (±standard deviation) number of publications was 13.7 ± 15.4 for assistant professors, 33.9 ± 28.8 for associate professors, and 86.8 ± 63.6 for professors (P < .001). Mean number of first or last author publications was 5.3 ± 6.4 for assistant professors, 12.2 ± 12.7 for associate professors, and 38.7 ± 35.3 for professors (P < .001). Mean h-index was 5.9 ± 5.4 for assistant professors, 12 ± 7.7 for associate professors, and 24.9 ± 12.6 for professors (P < .001). In multivariable analysis, vascular surgery board certification (adjusted odds ratio [OR], 6.08; 95% confidence interval [CI], 1.15-32.2; P = .03), academic appointment at a public medical school (OR, 1.99; 95% CI, 1.18-3.37; P = .01), years since medical school graduation (OR, 1.13; 95% CI, 1.09-1.18; P < .001, per year), and number of publications (OR, 1.05; 95% CI, 1.03-1.06; P < .001, per publication) were independently associated with associate professor. Factors independently associated with professor were years since medical school graduation (OR, 1.18; 95% CI, 1.12-1.24; P < .001, per year) and number of first or last author publications (OR, 1.05; 95% CI, 1.02-1.09; P = .003, per publication). Appointment as division chief was independently associated with h-index (OR, 1.04; 95% CI, 1.01-1.08; P = .016, per point). ConclusionsTotal number of publications was independently associated with associate professor, with number of first or last author publications particularly important for professor. The h-index was not independently associated with academic appointment, but it was for appointment as division chief. This study provides relevant data for promotional guidance in academic vascular surgery.

Training in the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons during 225 consecutive pancreaticoduodenectomies.

Backgrounds/AimsA board certification system has been established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) for certifying surgeons who can perform high-level hepato-biliary-pancreatic surgeries safely. The aim of this study was to compare operative outcomes after pancreaticoduodenectomy performed by trainees, board-certified instructors, and expert surgeons of JSHBPS to determine the efficacy of education of trainees and operative safety.MethodsFrom 2009 to 2017, 225 consecutive patients underwent pancreaticoduodenectomy. Operations were performed by trainees, instructors, or JSHBPS experts. Clinical course and postoperative outcomes were retrospectively evaluated.ResultsTwenty-two surgeons performed pancreaticoduodenectomy and two became expert surgeons. First, data of all patients who underwent pancreaticoduodenectomy (n=225) were analyzed. Significantly shorter median operating time and less median operative bleeding were documented in the experts' group (428 min, 576 g, respectively) than in the trainees' (498.5 min, 818 g, respectively) and instructors' (557 min, 911 g, respectively) groups. Morbidity did not differ significantly between the three groups. Second, data of patients who underwent simple pancreaticoduodenectomy (n=130) were analyzed. Similarly, operating time was shorter and operative bleeding less in the experts' group. With increasing their experiences, intraoperative bleeding by 2 surgeons became the expert surgeons decreased.ConclusionsSurgeons judged experts by the JSHBPS board certification system achieve significantly shorter operating time and less operative bleeding during pancreaticoduodenectomy. In addition, PD performed by trainees has an acceptable incidence of postoperative complications. This is the first report which indicated the efficacy of education toward being the JSHPBS board-certified expert surgeon.

Is pancreaticoduodenectomy justified for octogenarians even in the low-volume center? Single community-based center opinion

Introduction: Establishment of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system has decreased mortality subsequent to pancreaticoduodenectomy (PD) in Japan. However, not all patients, especially octogenarians, live in proximity to board-certified centers. The aim of this study is to evaluate clinical outcomes of PD in octogenarians from a community-based low-volume center. Method: Between 2006 and 2017, a total of 54 PD were performed. We analyzed clinicopathological data and short-term outcomes in octogenarians (Group O: n = 15) compared with patients <80 years (Group Y: n = 39). Results: In our center, the proportion of octogenarians who underwent PD reached 27.8%. There were no statistical differences between two groups in preoperative morbidity; however, preoperative median prognostic nutritional index (PNI) in Group O was 37.7 (26.3–51.9) and significantly lower than Group Y (p = 0.0036). There were no significant differences in operative time and blood transfusion between two groups. In terms of postoperative complications, Clavien-Dindo IIIa≧ was 26.7% in Group O and 12.8% in Group Y, which was not significantly different (p = 0.415). The rate of postoperative fistula, delayed gastric empting, and severe infection were almost same between two groups. The median length of hospital stay were 25 days in Group O and 17 days in Group Y, which was not significantly different (p=0.067). The rate of hospital mortality was 0% in Group O and 2.6% in Group Y. Conclusions: Fortunately, our outcomes of PD were equivalent of high-volume centers; however, if there is a system that board-certified surgeons relocate to low-volume centers, further developments may be expected.

Who gets a pouch after colectomy in New York state and why?

This study identified variation and factors associated with ileal pouch-anal anastomosis after total colectomy for ulcerative colitis. The Statewide Planning & Research Cooperative System was used to identify patients with ulcerative colitis who underwent total colectomy in New York state from 2000-2013. Bivariate and mixed-effects multivariable analyses were performed to assess patient, surgeon, and hospital-level factors as well as surgeon and hospital-level variation associated with ileal pouch-anal anastomosis after total colectomy. Across 2,203 patients, the rate of ileal pouch-anal anastomosis was 34%. Overall, 465 surgeons and 148 hospitals performed at least one total colectomy for ulcerative colitis from 2000-2013, and 178 surgeons and 80 hospitals performed at least one ileal pouch-anal anastomosis for ulcerative colitis during the study period. The median rate of ileal pouch-anal anastomosis creation was 14% (range=6% to 69%) across surgeons and 14% (range=7% to 63%) across hospitals. Patient-level factors independently associated with ileal pouch-anal anastomosis were younger age, lower comorbidity burden, and elective total colectomy. Surgeon and hospital-level factors independently associated with ileal pouch-anal anastomosis were colorectal surgery board-certification, surgeon ileal pouch-anal anastomosis volume, and hospital ileal pouch-anal anastomosis volume. Patient-level factors explained 43% of the surgeon and 47% of the hospital variation in ileal pouch-anal anastomosis creation while surgeon-level factors explained 26% of the surgeon and 21% of the hospital variation. These findings suggest that variation in ileal pouch-anal anastomosis creation for ulcerative colitis is influenced largely by provider practices/preferences or lack of referral of patients after colectomy to surgeons and centers that perform ileal pouch-anal anastomosis. Providers and hospitals that do not routinely perform ileal pouch-anal anastomosis should refer patients to centers with ileal pouch-anal anastomosis expertise after total colectomy.

Investigating Plastic Surgery Board Certification: Do our Patients know how to do their Homework?

Investigating Plastic Surgery Board Certification: Do our Patients know how to do their Homework?

Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons.

We investigated safety-related outcomes of hepatobiliary pancreatic (HBP) surgeries performed after establishment of the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) board certification system for expert surgeons. We analyzed post-HBP surgery mortality data obtained from annual safety reports provided by board-certified training institutions between 2012 and 2015. The 90-day mortality rate for the 53,929 high-level HBP surgeries performed at board-certified training institutions was 1.7%. The 30-day mortality rates for 2012, 2013, 2014, and 2015 were 0.9%, 0.7%, 0.6%, and 0.6%, respectively, and the 90-day mortality rates were 2.1%, 1.8%, 1.6%, and 1.3%, respectively, with significant decreases in both. The surgeries with high 4-year cumulative mortality rates were left hepatic trisectionectomy (10.3%), hepatopancreatectomy (7.6%), liver transplant recipient surgery (6.7%), hepatectomy with extrahepatic bile duct resection (4.6%), and right hepatic trisectionectomy (4.5%). Over the 4-year period, the number of operations increased, but the 90-day mortality rates for these surgeries, with the exception of right trisectionectomy, decreased. The JSHBPS board certification system for expert surgeons has significantly decreased mortality subsequent to high-level HBP surgeries. Reducing mortality associated with high-risk HBP surgeries will be our next challenge.

Tutorial Assistance for Board Certification in Surgery: Frequency, Associated Time and Cost.

Tutorial assistance is related to extra time and cost, and the hospitals' financial compensation for this activity is under debate. We therefore aimed at quantifying the extra time and resulting cost required to train one surgical resident in the operating theatre for board certification in Switzerland as an example of a training curriculum involving several surgical subspecialties. Additionally, we intended to quantify the percentage of tutorial assistance. We analysed 200,700 operations carried out between 2008 and 2012. Median duration of procedure categories was calculated according to four different seniority levels. The extra time if the procedure was performed by residents, and resulting cost were analysed. The percentage of procedures carried out by residents as compared to more experienced surgeons was assessed over time. On average, residents performed about a third of all operations including typical teaching procedures like appendectomies. An increase in duration and cost of well-defined procedures categories, e.g. cholecystectomies was demonstrated if a resident performed the procedure. In less well-defined categories, residents seemed to perform less difficult procedures than senior consultants resulting in shorter durations of surgery. The financial impact of tutorial assistance is important, and solutions need to be found to compensate for this activity. The low percentage of procedures performed by trainees may make it difficult to fulfil requirements for board certification within a reasonable period of time. This should be addressed within the training curriculum.