Board Of Surgery Research Articles

The Vascular Surgery in Training Examination Is Highly Predictive of Board Pass Rates

During each year of training, vascular surgery trainees participate in the Vascular Surgery In-Training Examination (VSITE). Although considered a low stakes formative examination, correlation of the examination to pass/fail performance on the American Board of Surgery Vascular Surgery Board qualifying and certifying examinations could provide program directors and trainees stratification of passing probability. The ability of the VSITE to predict future board certification was evaluated.

Impact of the early COVID-19 pandemic on Breast Surgical Oncology fellow education.

IntroductionThe early COVID‐19 pandemic rapidly transformed healthcare and medical education. We sought to evaluate the professional and personal impact of the pandemic on 2019–2020 Breast Surgical Oncology (BSO) fellows in Society of Surgical Oncology approved programs to capture the experience and direct future changes.MethodsFrom July 15, 2020 to August 4, 2020 a survey was administered to the American Society of Breast Surgeons' fellow members. The survey assessed the impact of the pandemic on clinical experience, education/research opportunities, personal health/well‐being, and future career. Responses were collected and aggregated to quantify the collective experience of respondents.ResultsTwenty‐eight of fifty‐seven (54%) eligible fellows responded. Twenty‐one (75%) indicated the clinical experience changed. Twenty‐seven (96%) reported less time spent caring for ambulatory breast patients and sixteen (57%) reported the same/more time spent in the operating room. Fourteen (50%) stated their future job was impacted and eight (29%) delayed general surgery board examinations. Stress was increased in 26 (93%). Personal health was unaffected in 20 (71%), and 3 (10%) quarantined for COVID‐19 exposure/infection.ConclusionThe COVID‐19 pandemic altered the clinical experience of BSO fellows; however, the operative experience was generally unaffected. The creation of frameworks and support mechanisms to mitigate potential challenges for fellows and fellowship programs in the ongoing pandemic and other times of national crisis should be considered.

Evolving Trends in Unilateral Cleft Lip Repair Based on Continuous Certification by the American Board of Plastic Surgery.

The American Board of Plastic Surgery (ABPS) began collecting data from unilateral cleft lip (UCL) corrections in 2011 as a component of the continuous certification process. We evaluated these data to understand practice patterns in UCL repair, in the United States, and whether these practice patterns had changed over the past 9 years. Tracer data for UCL correction were reviewed from its inception in October 2011 through 2016 and compared to UCL cases between 2017 and March 2020. Trends in practice patterns were evaluated against literature reviews meant to coincide with the ABPS continuous certification data. A total of 520 cases were included from October 2011 to March 2020. Median age of UCL repair was 4 months and 66% of patients were male. Fifty-one percent of cases presented with a complete cleft lip. There was a decrease in postoperative adverse events when data from 2011 to 2016 was compared to 2017 to 2019 (P = 0.020). Revisions were the most common postoperative adverse event (2%). There was a decrease in nasoalveolar molding from 25% to 12% (P < 0.001) and 56% of total cases underwent a concurrent primary cleft rhinoplasty. The rate of gingivoperiosteoplasty at the time of primary cleft lip repair also fell (9% versus 1%; P < 0.001). This article reviews tracer data obtained by the ABPS for UCL repair. The American Board of Plastic Surgery tracer data provides a national, cleft lip-specific database with longer follow-up times than other large databases.

QS10: Clinical Practice Patterns and Evidence-based Medicine in Dupuytren’s Contracture: A Twelve-year Review of Continuous Certification Tracer Data From The American Board of Plastic Surgery

Purpose:Since 2008, The American Board of Plastic Surgery (ABPS) has collected clinical practice data on Dupuytren’s contracture repair as part of their Continuous Certification (CC) process. Submitted twice every ten years by each plastic surgeon, this collection can help describe clinical trends in Dupuyren’s contracture repair as they relate to Evidence-Based Medicine (EBM) articles published in this timeframe.Methods:Cumulative tracer data for Dupuytren’s contracture repair from February, 2008 through December, 2014 were reviewed and compared to data from January, 2015 through March, 2020 with the goal of identifying national practice trends. These trends were then evaluated alongside EBM reviews published in 2010, 2014 and 2017.Results:As of March 2020, 230 cases of Dupuytren’s contracture were included in the tracer. The median age at time of surgery was 65 years (range, 38-91 years), and the average age of disease onset was 47 years. The most common surgical technique was limited fasciectomy, comprising 62% of cases. There were no postoperative adverse events reported in 77% of cases. The most common complications were loss of finger flexion (3%) and skin loss (2%). Topics addressed in EBM articles but not tracer data included adjuvant treatments and non-operative techniques such as tamoxifen administration. The use of minimally invasive procedures such as percutaneous cordotomy (0% vs. 13%) and collagenase injections (0% vs. 9%, p = .001) showed significant increases between the two time periods. More invasive procedures such as radical fasciectomy decreased in popularity (34% vs. 16%, p = .002). Use of Z-plasty also decreased between 2015 and 2020 (67% vs. 45%, p < .001). General anesthesia was the most commonly used form of anesthesia, being employed in 54% of tracer cases. There was an increase in the use of Bier block regional anesthesia (1% vs. 9%, p = 0.029) as well as in the use of epinephrine for hemostasis (0 vs. 8%, p = 0.006). Significant changes were also noted in post-operative management, including a decrease in the employment of formal postoperative hand therapy. This is consistent with evidence showing that it has no significant clinical benefit.Conclusion:The tracer data collected on Dupuytren’s contracture repair over a twelve-year period allow us to describe national trends in presentation and surgical techniques, and can help plastic surgeons evaluate their surgical practice in the context of these trends and EBM.

The Baby and the Board: A Step Toward Normalizing Childbearing During Surgical Training.

The Baby and the Board: A Step Toward Normalizing Childbearing During Surgical Training.

Characteristics of the Dual Board-Certified Sleep Otolaryngology Workforce.

Sleep medicine is a multidisciplinary field that includes otolaryngology. After 2011, sleep medicine board eligibility required completion of a dedicated sleep medicine fellowship. The objective of our study is to describe the characteristics and geographic distribution of the dual board-certified sleep otolaryngology workforce and to assess the impact of the 2011 change. A cross-sectional analysis of sleep-certified otolaryngologists registered with the American Board of Otolaryngology-Head and Neck Surgery in 2019 was performed to characterize the sleep otolaryngology workforce. County and regional analysis of provider density was conducted by comparing provider characteristics with county-level data from the United States Census Bureau. There were 275 active dual board-certified sleep otolaryngologists, or approximately 1 for every 1.12million Americans. 77.8% were in private practice and 2.9% had American Society of Pediatric Otolaryngology membership. Eighty-eight percent were male, with females more likely than males to be in an academic setting (36.4% for females compared to 20.2% for males; P=.045). The South Atlantic and South Central regions had the highest number of sleep board-certified otolaryngologists per capita. Before 2011, an average of 75.7 otolaryngologists took the sleep board exam per 2-year cycle, compared to 14.3 otolaryngologists after 2011 (P=.029). There are few dual board-certified sleep otolaryngologists across the country, which may affect care for patients with sleep-disordered breathing. Increased resident exposure and otolaryngology training in sleep medicine can strengthen the otolaryngology contribution to the multidisciplinary care of these patients. 4 Laryngoscope, 131:E2712-E2717, 2021.

A Phased Approach: The General Surgery Experience Adopting Entrustable Professional Activities in the United States.

Entrustable professional activities (EPAs) have been increasingly used as an assessment framework to formally capture the myriad ad hoc entrustment decisions that occur on a daily basis in clinical settings with learners present. Following the definition of Core EPAs for Entering Residency by the Association of American Medical Colleges in 2014, the American Board of Surgery (ABS) began to explore the utility of EPAs as a framework to support competency-based resident education within general surgery in 2016. As the complement of EPAs drafted for a specialty serve to define the core tasks of a professional within that discipline, initial efforts to define the entire scope of general surgery were fraught with difficulty as no commonly accepted definition of a general surgeon currently exists. Opting to prioritize a pilot of the EPA conceptual framework within surgical training rather than defining the entirety of the specialty, ABS leaders identified 5 EPAs that represent a core of general surgery with which to begin. This article details the process of choosing the initial set of EPAs and provides a roadmap for other disciplines interested in testing the feasibility of this assessment framework while garnering buy-in among the community of educators. Future steps, including implementation of the existing 5 EPAs beyond the initial pilot sites and drafting and implementation of the additional complement of EPAs, are also described.

Outcomes of the First Virtual General Surgery Certifying Exam of the American Board of Surgery.

To Study the Outcomes of the First Virtual General Surgery Certifying Exam of the American Board of Surgery. The ABS General Surgery CE is normally an in-person oral examination. Due to the COVID-19 outbreak, the ABS was required to reschedule these. After 2 small pilots, the CE's October administration represented the first large-scale remote virtual exam. The purpose of this report is to compare the outcomes of this virtual and the previous in-person CEs. CE candidates were asked to provide feedback on their experience via a survey. The passing rate was compared to the 1025 candidates who took the 2019-2020 in-person CEs. Of the 308 candidates who registered for the virtual CE, 306 completed the exam (99.4%) and 188 completed the survey (61.4%). The majority had a very positive experience. They rated the virtual CE as very good/excellent in security (90%), ease of exam platform (77%), audio quality (71%), video quality (69%), and overall satisfaction (86%). Notably, when asked their preference, 78% preferred the virtual exam. There were no differences in the passing rates between the virtual or in-person exams. The first virtual CE by the ABS was completed using available internet technology. There was high satisfaction, with the majority preferring the virtual platform. Compared to past in-person CEs, there was no difference in outcomes as measured by passing rates. These data suggest that expansion of the virtual CE may be desirable.

Proceedings From the First Cleft, Craniofacial, and Pediatric Oral and Maxillofacial Surgery Summit

The first Cleft, Craniofacial, and Pediatric Oral and Maxillofacial Surgery Summit took place in Oklahoma City on November 23, 2019. The symposium was hosted by Dr. Paul S. Tiwana and was co-sponsored by American Association of Oral and Maxillofacial Surgeons (AAOMS) Committee on Cleft, Craniofacial, and Pediatric OMS (CCCPOMS). The Summit convened directors of fellowship programs, experts, and leaders in the fields of cleft, craniofacial, and pediatric oral and maxillofacial surgery. Representatives from AAOMS and American Board of Oral and Maxillofacial Surgery (ABOMS) also attended (Fig.

Are General Surgery Residencies Preparing Graduates for the Practice of Today's General Surgeon? An Analysis of American Board of Surgery Data From Applicants and Re-certifying Surgeons.

To compare the operative experience of general surgery residents and practicing general surgeons. The scope of general surgery has evolved, yet it remains unknown whether residents are being exposed to the right mix of operations during residency. A retrospective review of operative case logs submitted to the American Board of Surgery by US general surgery graduates and practicing general surgeons from 2013 to 2017 was performed. The operative experience of both cohorts was calculated as a proportion of total experience and ranked by frequency. The proportional experience between cohorts was analyzed using factorial analysis of variance. During the 5-year period, 5482 graduates applied for initial American Board of Surgery certification, and 4152 diplomates applied for recertification. Among all operative domains, the graduate experience was similar to that of diplomates in 6 of 12 areas (abdomen, alimentary tract, endoscopy, endocrine, other, skin/soft tissue; all P > 0.05). Residents have a greater experience in subspecialty areas (pediatric, thoracic, trauma, vascular, and plastic) at the expense of fewer breast procedures (all P < 0.05). The 30 operations most commonly performed by graduates comprised 67% of their total operative experience. Among these, residents performed 25 cases ≥10 times, 14 cases ≥20 times, and 7 cases ≥40 times. The operative experience of graduating US general surgery residents is largely similar to that of practicing general surgeons, particularly for core general surgery domains. These data offer reassurance that surgical training in the modern era appropriately exposes residents to the operations they may perform in practice.

The Content of US Plastic Surgery Private Practices' Websites.

Connecting patients with healthcare providers continues to grow as the digital era evolves. A successful website has the power to influence patients on choosing a practice and provider. The objectives of this study were to characterize information provided on private practice websites of plastics surgeons in the United States and to assess the relationship among the websites based on the number of years that the physicians have been in practice. Newly board-certified plastic surgeons by the American Board of Plastic Surgery in 2005, 2010, and 2015 were identified. A Google search was conducted on all participants, and only those in private practice were included in this study. Each webpage was quantitatively and qualitatively assessed for the presence or absence of 23 criteria that were categorized as practice, physician, patient, or procedure information. χ2 was used for statistical analysis using Microsoft Excel (PSPP 1.2.0). A P value of less than 0.05 was considered statistically significant. Most plastic surgeons in each cohort were currently in private practice. A total of 532 plastic surgery private practice websites were analyzed. The data points found on 100% of the websites were directions to the facility and the contact for any billing questions. Most websites provided information on the practice and its surgeons. The most common web-based data points included online consultations and links to their social media. Information on expenses incurred by patients, such as cancellation policies and consultation fees, was least commonly listed. Our study shows that the number of years in practice is not associated with comprehensiveness of their website's content. This study provides insight into the content of plastic surgery private practices' websites in the United States in relation to the practice, the physician, the patient, and the procedures. This information may be useful for expanding and optimizing their websites. This has the potential to increase patient satisfaction and visibility of the practice. The success of these businesses is vital as the private sector in plastic surgery continues to grow.

Marlon V. del Rosario, MD (1956 – 2021)

Marlon graduated from the University of Santo Tomas (UST) Faculty of Medicine and Surgery in 1982. He completed his internship at the Ospital ng Maynila Medical Center (OMMC) the following year. He then proceeded to complete the OMMC residency training program in Otolaryngology-Head and Neck Surgery (then chaired by the venerable Dr. Angel Enriquez). In 1988, he attained the title of Diplomate in Otolaryngology-Head and Neck Surgery.&#x0D; Marlon established his private practice in his hometown of Tanza, Cavite. It is also here where he co-founded the Divine Grace Medical Center, the first tertiary medical facility in this part of Cavite. In 1989, with the encouragement of Dr. Joselito “Che” Jamir, a respected fellow Caviteño otolaryngologist, he joined the faculty of De La Salle Medical and Health Sciences Institute in Dasmariñas, Cavite, serving for 30 years as Assistant Professor. He also served as an Associate Board Examiner for the Philippine Board of Otolaryngology-Head and Neck Surgery until 2016.&#x0D; With this short statement alone, one can already see the exemplary medical career Marlon had. But to properly pay tribute to him, one must see and know the man behind the endoscope, the man beneath the white tailored medical overcoat.&#x0D; Marlon’s character was a bit of a paradox. He was a humble and modest person despite his substantial resources. He was unassuming yet self-assured. He was reserved but gregarious at the same time. For instance, in our conventions or other gatherings of fellows, he would most likely be seated at the farthest portion of the meeting quietly and attentively listening to the proceedings. But once outside the session hall when he gets to meet up with his buddies, he transforms and takes center stage in what will eventually be a boisterous exchange of banter. The usual suspects in these animated gatherings were Drs. Arsenio “Boy” Pascual, Howard Enriquez, Tomas “Tom” Antonio and Diosdado “Dado” Uy. Indeed, he was the epitome of someone who worked hard and played hard.&#x0D; He was a man with foresight. Instead of investing in clinic spaces in large and established medical centers in Metro Manila and Cavite, he staked his money on building the Divine Grace Medical Center, a tertiary medical center in what was then a sleepy town of Tanza, Cavite. This sleepy town is now a commercial and financial hub in the northwestern part of Cavite, with his hospital located right in the middle of all the commercial and infrastructure developments. And as his practice started to thrive, he tempered his success with kindness and compassion, earning him more prominence in his hometown.&#x0D; He was also a music aficionado. While many of us are only recently going back to the turntable and vinyl records, he never let go of his turntable set up. He was a bit of a snob when it came to music. He found tapes and digitized sound inferior to vinyl records, and his vinyl record collection is still an envy of many. He appreciated all forms of music, but the genre he truly loved (like a true Caviteño) was Rock and Roll. His love for music did not stop there. He was a musician as well and played a mean guitar. This is illustrated by the manner in which his family arranged the altar where his urn was placed. Amidst the flowers on the altar was a picture of a grinning Marlon with a guitar slung over his shoulder. His treasured guitars were right beside him: his acoustic guitar placed on one side of the altar and his electric guitar on the other.&#x0D; His true crowning glory however, was his family. He became a family man at the tender age of 21. His family was his foundation and inspiration. His lovely and ever supportive wife Ellie held the fort while he was away in Manila to study medicine and undergo residency training. They were blessed with 3 boys whom he was extremely proud of. His eldest son Marc (43 years old) is a US - trained interventional cardiologist who practices in several large medical institutions around Metro Manila and Cavite. Michael (40 years old) is an associate professor of entrepreneurship and marketing at De La Salle University – Dasmariñas and currently completing his requirements for his doctorate degree in business administration and management. The youngest son Mikko (32 years old) seems to have a special interest in local Cavite politics.&#x0D; Indeed, Marlon’s life was colorful and complete. Nonetheless, it was still too soon for him to embark on this final journey. But such is life and we just have to accept it.&#x0D; My dear friend and compadre Marlon, I raise my glass of your favorite Japanese single malt whiskey and congratulate you for a life well-lived.&#x0D; Godspeed and rest easy

Fifteen-Year Review of the American Board of Plastic Surgery Maintenance of Certification Tracer Data: Clinical Practice Patterns and Evidence-Based Medicine in Zygomatico-Orbital Fractures.

From 2005 to 2020, the American Board of Plastic Surgery collected data on 20 common plastic surgery operations as part of the Maintenance of Certification process. These data allow the authors to examine national trends in zygomatico-orbital fracture repair over a 15-year period. Tracer data for zygomatico-orbital fracture repair were reviewed in cohorts from 2005 to 2013 and 2014 to 2020. Results were categorized based on their presence in evidence-based medicine articles published during this period. Differences between years were assessed using the t test or chi-square test as appropriate. Four hundred thirty patients were included as of March of 2020. Average age was 37 years (range, 6 to 85 years), and 76 percent were male. Operations took place on average 10 days from injury. There were significant decreases in the use of subciliary (31.9 percent versus 10.0 percent; p < 0.001), gingival buccal (84.3 percent versus 56.4 percent; p < 0.001), and lateral brow (45.2 percent versus 22.3 percent; p < 0.001) incisions, with an increase in lower lid external incisions (15.2 percent versus 30.9 percent; p < 0.001); 2.7 percent of patients had a complication requiring readmission and 4.5 percent required reoperation. The incidence of postoperative diplopia was 7.7 percent, and the infection rate was 1.7 percent. This article reviews the American Board of Plastic Surgery tracer data for zygomatico-orbital fracture repair. The Maintenance of Certification tracer data provide a national database with longer follow-up and more specific information than comparable databases. Analysis of these data over time enables the authors to describe practice trends and gives surgeons the opportunity to compare their outcomes to national norms.

Pediatric Hand Fractures and Congenital Differences: An Analysis of Data From the American Board of Orthopaedic Surgery and the American Board of Plastic Surgery

Pediatric patients with hand trauma and congenital differences are treated across multiple surgical subspecialties. The purpose of this study was to assess operative trends over an 11-year period using the American Board of Orthopaedic Surgery and the American Board of Plastic Surgery databases to better understand which surgeons were caring for pediatric hand fractures and birth differences in the first 2 years of their practice. We queried the American Board of Orthopaedic Surgery and the American Board of Plastic Surgery databases for surgical procedures performed by applicants for the oral examinations between 2004 and 2014. Candidates self-identified as general orthopedic surgeon, pediatric orthopedic surgeon, hand surgeon (orthopedic and plastic), and general plastic surgeon. This included a total of 2,453 Board applicants. A total of 6,835 surgeries for birth differences or hand trauma were identified and reviewed for patients <18 years of age. There were 5,759 trauma and 1,076 congenital difference surgeries. A total of 4,786 (70%) surgeries were performed by orthopedic surgeons. Fellowship-trained hand surgeons (orthopedic and plastic) performed 3,809 (56%) surgeries. Pediatric orthopedic surgeons performed 608 (9%) surgeries. Over the 11 years, general orthopedic surgeons performed 4.2 fewer surgeries per year, whereas surgeons in hand orthopedics and pediatric orthopedics performed 10.8 and 4.7 additional surgeries per year. There were 3.1 fewer general orthopedic surgeons per year, whereas there were 3.6 and 1.4 additional surgeons in hand orthopedics and pediatric orthopedics each year, respectively. The number of surgeries and the number of surgeons submitting surgeries did not significantly change for those in general plastics or hand plastics. This analysis of early practice patterns over 11 years demonstrates that the increasing numbers of surgeons in pediatric orthopedics and hand orthopedics are performing more surgeries compared with other fields. The care of children with hand injuries and congenital differences is evolving, with direct implications for residency and fellowship education.

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

How to choose your surgeon for colorectal cancer: The influence of fellowship training on outcomes.

e18603 Background: Rectal cancer has a well-established volume-outcome relationship. However, the impact of fellowship training on outcomes following colorectal cancer resection is unknown. Methods: Patients who underwent stage I-III colorectal adenocarcinoma resection (2004-2014) were identified in the New York State Cancer Registry and Statewide Planning &amp; Research Cooperative System. Hierarchical analyses assessed the association between surgeon American Board of Colorectal Surgery (ABCRS) certification and postoperative outcomes and survival. Derived from volume tertiles, surgeons who performed ≥15 annual colon cancer resections or ≥10 annual rectal cancer resections were characterized as high-volume colon (HVCSs) or rectal (HVRSs) surgeons, respectively. Results: 47,491 colorectal cancer resections (right colon = 23,824, 50.2%; left colon = 18,154, 38.2%; rectal cancer = 5,513, 11.6%) met inclusion criteria. ABCRS-certified HVCSs (N = 92) comprised only 5.5% of the surgeon cohort but performed 20.6% of the colon cancer resections. Similarly, ABCRS-certified HVRSs (N = 31) comprised only 3.8% of the surgeon cohort but performed 16.5% of the rectal cancer resections. Despite no significant difference in complications, ABCRS-certified HVCS/HVRSs overall had better postoperative outcomes and were associated with improved survival following colorectal cancer resection. Conclusions: These results suggest that for the best outcomes and long-term survival following colon and rectal cancer resection, referral to high-volume, ABCRS-certified surgeons may be the best choice.[Table: see text]

Board Certification and Surgeon's Fee for Aesthetic Rhinoplasty

Elective rhinoplasty surgeons' fees vary considerably and are influenced by geographic surgeon density, surgeon's experience, local economic factors, patient demand, and other factors. The American Board of Facial Plastic and Reconstructive Surgery, the American Society of Plastic Surgery, and other organizations certify physicians who profess expertise in rhinoplasty. We sought to determine if specific board certification or experience correlates with higher rhinoplasty fee. An internet search was conducted of seven U.S. metropolitan areas using the search terms "rhinoplasty and "city name." Top search results were surveyed for rhinoplasty fee, years of experience, annual volume of rhinoplasties, board certification, and other demographic data. Using both univariate and multivariate comparisons, the data were analyzed for forces having significant correlation with rhinoplasty fee. Sixty-seven surgeons were included in the study. The average price for ABFPRS certified surgeons was significantly higher than surgeons with other board certifications ($10,550.00 ± 3,722.10 compared with $8,524.50 ± 2816.30, p = 0.0142). The volume of rhinoplasties performed per year was also significantly correlated with fee charged for rhinoplasty by the surgeon (r = 0.37773, p = 0.032). Additionally, surgeons practicing on the West Coast (LA) charged significantly higher fees ($12,059.09 ± 3014.53) compared with the Mid United States. ($8316.07 ± 2449.43) and the East Coast ($9152.86 ± 3639.78) (p = 0.0047). On multivariable linear regression, controlling for volume of rhinoplasty and region of the United States, ABFPRS certified surgeons charged significantly higher fees for rhinoplasty (p = 0.0230). ABFPRS board certification correlates with higher fees charged for rhinoplasty. Other important variables include surgeon's annual rhinoplasty and practice on the West Coast.

European Panorama on Vascular Surgery: Results from Five Years of FEBVS Examinations

(Angiol Cir Vasc vol. 15 no. 3 set. 2019) Objective: The Fellow of the European Board of Vascular Surgery (FEBVS) examination is a comprehensive exam for Certified Vascular Surgeons or General Surgeons with Vascular Certification. It includes a thorough assessment of vascular pathology knowledge, and includes critical analysis of diverse clinical cases and vascular subjects (clinical viva), critical review of an academic paper, and direct open and endovascular skills examination in independently validated simulators. It is, therefore, increasingly seen as a quality standard for International Vascular Specialists, so that it currently represents the final exam for Vascular Surgery Certification in countries including the Netherlands and Switzerland. Through this work, a critical review of the results of 10 FEBVS examinations was performed. Methods: Data on the results of open technical skills assessment (aortic anastomosis, distal anastomosis, and carotid endarterectomy), endovascular technical skills assessment, clinical viva, and academic paper analysis were collected from 10 consecutive FEBVS examinations. Candidates’ demographic characteristics were also reviewed. A review of both global and specific failure rates, as well as their behaviour throughout the years was performed. Results: Three hundred consecutive candidates, who performed their vascular training in 26 countries, were assessed in 10 different examinations performed over a period of five years (2014 – 2018). Most candidates were male (77.7%), with a mean age of 36 years. The majority of candidates were from the Netherlands (24.1%), although Germany (13.4%), Spain (12.4%), and the United Kingdom (11.4%) had significant representation as well. The global failure rate was 28.3%, and 5.3% of the candidates were granted “honours” for outstanding performance (global score > 90%). Of the failed candidates, 21.2% repeated the exam, with a global pass rate of 56.1%. In terms of the individual assessments that constitute the exam, failure rate was significantly higher in the academic paper review (24.7%), compared with technical open (16%), technical endo (14%), and clinical viva assessments (15.5%). Regarding each of the individual skills evaluated in the open technical section, the failure rate was significantly higher in the aortic anastomosis (29.3%), compared with distal anastomosis (16%) and carotid endarterectomy (17.6%). More importantly, a progressive increase in the failure rate in aortic anastomosis assessment was observed through the years (Fig. 1), in accordance with the known perception of progressive loss of open aortic skills among young physicians. Portugal represents only 4.2% of all FEBVS candidates, with a pass rate of 100%. Conclusion: The FEBVS examination is a comprehensive exam that independently assesses both theoretical and technical knowledge. The failure rate is high, although the existence of “honours” confirms a balanced difficulty level. An alarming loss of open aortic skills is noticeable and reinforces the need for simulation training in such territory. Keywords: FEBVS, Training, Vascular surgery

2020 Women in Thoracic Surgery Update on the Status of Women in Cardiothoracic Surgery

BackgroundWomen in Thoracic Surgery (WTS) has previously reported on the status of women in cardiothoracic (CT) surgery. We sought to provide a 10-year update on women in CT surgery. MethodsAn anonymous research electronic data capture survey link was emailed to female diplomats of the American Board of Thoracic Surgery. Survey questions queried respondents regarding demographics, training, accolades, practice details, and career satisfaction. The survey link was open for 30 days. Results were compared with The Society of Thoracic Surgeons 2019 workforce survey. Descriptive analyses were performed using frequency and proportions. Comparisons were performed using Student’s t tests, Fisher's exact tests, and χ2 tests. ResultsOf 354 female diplomats, 309 were contacted and 176 (57%) responded. The majority of respondents were aged 36 to 50 years (59%), white (67.4%), and had graduated from traditional-track programs (91.4%). Most respondents reported practicing in an urban (64%) and academic setting (73.1%). 36.4% and 23.9% reported a general thoracic and adult cardiac practice (22.7% mixed practice, 9.6% congenital). Fifty percent of respondents reported salaries between $400,000 and $700,000 annually; 37.7% reported salaries less than 90% of their male colleagues; 21.6% of respondents in academia are full professor; 53.4% reported having a leadership role. Whereas 74.1% would pursue a career in CT surgery again, only 27.3% agreed that CT surgery is a healthy and positive environment for women. ConclusionsThe number of women in CT surgery has steadily increased. Although women are rising in academic rank and into leadership positions, salary disparities and the CT surgery work environment remain important issues in achieving a diverse work force.

SCORE-Based Simulated ABSITE Exam Performance as a Predictor of Performance on the ABSITE

The American Board of Surgery In-Training Examination (ABSITE) is a crucial, objective assessment of surgical knowledge during training. In 2014, the American Board of Surgery (ABS) announced the alignment of the ABSITE to the SCORE® (Surgical Council on Resident Education) Curriculum Outline for General Surgery Residency. We hypothesized that implementing a pre-ABSITE SCORE-based exam would help identify underperforming residents and provide early guidance to improve performance on the ABSITE. In October 2014, our university-based surgical residency program began administering a yearly comprehensive pre-ABSITE SCORE-based exam consisting of 225 to 250 multiple-choice questions selected from the SCORE question bank to all our general surgery residents, preliminary and categorical. The 4-hour exam addresses both clinical management (80%) and applied sciences (20%). Residents receive reports with their scores (percentage correct). Residents performing at less than 60% meet with the Program Director for discussion and formulation of a study plan. Correlational analysis was performed between resident ABSITE scores, pre-ABSITE SCORE-based exam scores, gender, resident status (preliminary vs. categorical), postgraduate year (PGY), and the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores. A total of 244 exam scores (122 pre-ABSITE SCORE-based exams and 122 matched ABSITE) were completed by 51 residents at different PGY levels (32 PGY1, 32 PGY2, 20 PGY3, 19 PGY4, and 18 PGY5). Fifty-seven percent were males, 62% were categorical residents, and 38% were preliminary residents. October pre-ABSITE SCORE-based exam scores were compared to the subsequent January ABSITE scores. Categorical residents completed 101 (83%) of the January exams, while preliminary residents completed 21 (17%) of these paired exams. We found strong correlations between the correct percentage on ABSITE and pre-ABSITE SCORE-based scores (r = 0.637, p < 0.001), between the correct percentage on ABSITE and PGY (r = 0.688, p < 0.001), and between ABSITE and resident status (r = 0.462, p < 0.001). Additionally, there was a weak to negligible correlation between the correct percentage on ABSITE and resident gender (r = 0.274, p = 0.001), USMLE-2 (r = 0.12, p = 0.16), and USMLE-1 (r = 0.04, p = 0.653). Multiple regression analysis, with all predictors, was performed to predict the percentage score on the ABSITE and produced R2 0.58, with an adjusted R2 of 0.57, with a large size effect, p < 0.001. After controlling for the other variables, three factors reached statistical significance (p < 0.05): pre-ABSITE SCORE-based exam scores, PGY, and resident gender. We found a strong correlation between performance on the pre-ABSITE SCORE-based exam and performance on the ABSITE exam. Surgery residents are encouraged to start studying earlier and to utilize SCORE contents as outlined by the ABS in their study plan.