Surgery Certification Research Articles

How We Solved the Shortage of Cardiothoracic Surgeons: Train More or Work Longer

BackgroundIn the early 2000s, a significant shortage of cardiothoracic surgeons was predicted. We sought to evaluate our specialty’s progress and to update the predicted needs of cardiothoracic surgeons in the coming decades. MethodsTo assess the supply of cardiothoracic surgeons, the evolution of cardiothoracic surgery training was reviewed. The cardiothoracic surgery workforce and future supply and demand were obtained from the National Center for Health Workforce Analysis. Based on these data, predictions from the early 2000s were compared with the current status, and future supply of cardiothoracic surgeons was modeled. ResultsThe number of cardiothoracic surgery trainees increased from 230 in 2008-2009 to 519 in 2022-2023. In 2022-2023, 174 trainees underwent the American Board of Thoracic Surgery Certification Exam, with 129 certificates awarded. From 2005 to 2021, the total number of practicing cardiothoracic surgeons in the United States increased from 4000 to 5200, which contradicts all projections from the early 2000s. The average attrition of 31 cardiothoracic surgeons per year was significantly less than predictive models from the early 2000s. Predictive models project a need of 7000 cardiothoracic surgeons by 2050, which can be met if we continue to fill our available training spots with 173 graduates per year. ConclusionsThe predicted shortage of cardiothoracic surgeons by midcentury has been overcome by training more cardiothoracic surgeons as well as by a reduction in cardiothoracic surgeon attrition. Future increasing demand can be met by filling our available training positions. Continual assessment of cardiothoracic surgeon supply and demand will help achieve the optimal number of cardiothoracic surgery training positions.

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.

Certified Fellowship in Abdominal Wall Surgery-A Collaboration Between the UEMS and the European Hernia Society.

Background: Abdominal wall surgery (AWS) is characterised by the increasing caseload and the complexity of the surgical procedures. The introduction of a tailored approach to AWS utilising laparoendoscopic, robotic and/or open techniques requires the surgeon to master several surgical techniques. All of which have an associated learning curve, and the necessary knowledge/experience to know which operation is the right one for the individual patient. However, the reality in general surgery training shows that training in just a limited number of procedures is not enough. By the end of general surgery training, many chief residents do not feel they are yet ready to carry out surgery independently. Therefore, hernia surgery experts and societies have called for the introduction of a Fellowship in Abdominal Wall Surgery. Methods: The UEMS (Union Européenne des Médecins Spécialistes, European Union of Medical Specialists) in collaboration with the European Hernia Society (EHS) introduced a fellowship by examination in 2019. As a prerequisite, candidates must complete further training of at least 2years with a special focus on abdominal wall surgery after having completed their training in general surgery. To be eligible for the examination, candidates must provide evidence of having performed 300 hernia procedures. In addition, candidates must have accrued sufficient "knowledge points" by attending abdominal wall surgery congresses, courses and clinical visitations, and engaged in scientific activities. On meeting the requirements, a candidate may be admitted to the written and oral examination. Results: To date, three examinations have been held on the occasion of the Annual Congress of the European Hernia Society in Copenhagen (2021), Manchester (2022) and Barcelona (2023). Having met the requirements, 48 surgeons passed the written and oral examination and were awarded the Fellow European Board of Surgery-Abdominal Wall Surgery certificate. During this time period, a further 25 surgeons applied to sit the examination but did not fulfil all the criteria to be eligible for the examination. Fifty experienced abdominal wall surgeons applied to become an Honorary Fellow European Board of Surgery-Abdominal Wall Surgery. Fourty eight were successful in their application. Conclusion: The Fellowship of the European Board of Surgery - Abdominal Wall Surgery by examination has been successfully introduced at European level by the joint work of the UEMS and the EHS. The examination is also open to surgeons who work outside the European area, if they can fulfil the eligibility criteria.

Certification Training and Liver Transplant Experience Improves Liver Procurement Outcomes: The Dutch Approach.

This study investigates the impact of certification training and liver transplant experience on procurement outcomes of deceased donor liver procurement in the Netherlands. Three groups (trainee, certified, and master) were formed, with further subdivision based on liver transplant experience. Three key outcomes-surgical injury, graft discard after injury, and donor hepatectomy duration-were analyzed. There were no significant differences in surgical graft injury in the three groups (trainee, 16.9%; certified, 14.8%; master, 18.2%; P = 0.357; 2011 to 2018). The only predictor for surgical graft injury was donation after circulatory death (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.10-2.02). Of the three groups, the master group had the highest discard rate after surgical injury (trainee, 0%; certified, 1.3%; master, 2.8%; P = 0.013). Master group without liver transplant experience (OR, 3.16; 95% CI, 1.21-8.27) and male donor sex (OR, 3.58; 95% CI, 1.32-9.73) were independent risk factors for discarding livers after surgical injury. Independent predictors for shorter hepatectomy durations included donors older than 50 years (coefficient [Coeff], -7.04; 95% CI, -8.03 to -3.29; P < 0.001), and master group (Coeff, -9.84; 95% CI, -14.37 to -5.31; P < 0.001) and certified group with liver transplant experience (Coeff, -6.54; 95% CI, -10.83 to -2.26; P = 0.003). On the other hand, master group without liver transplant experience (Coeff, 5.00; 95% CI, 1.03-8.96; P = 0.014) and donation after circulatory death (Coeff, 10.81; 95% CI, 8.32-13.3; P < 0.001) were associated with longer hepatectomy durations. Training and certification in abdominal organ procurement surgery were associated with a reduced discard rate for surgical injured livers and shorter hepatectomy times. The contrast between master group with and without liver transplant experience underscores the need for specialized training in this field.

ChatGPT Earns American Board Certification in Hand Surgery

PurposeArtificial Intelligence (AI), and specifically ChatGPT, has shown potential in healthcare, yet its performance in specialized medical examinations such as the Orthopaedic Surgery In-Training Examination and European Board Hand Surgery diploma has been inconsistent. This study aims to evaluate the capability of ChatGPT-4 to pass the American Hand Surgery Certifying Examination. MethodsChatGPT-4 was tested on the 2019 American Society for Surgery of the Hand (ASSH) Self-Assessment Exam. All 200 questions available online (https://onlinecme.assh.org) were retrieved. All media-containing questions were flagged and carefully reviewed. Eight media-containing questions were excluded as they either relied purely on videos or could not be rationalized from the presented information. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT-4. The ASSH report was used to compare ChatGPT-4’s performance to that of the 322 physicians who completed the 2019 ASSH self-assessment. ResultsChatGPT-4 answered 192 questions with an overall score of 61.98%. Performance on media-containing questions was 55.56%, while on non-media questions it was 65.83%, with no statistical difference in performance based on media inclusion. Despite scoring below the average physician’s performance, ChatGPT-4 outperformed in the ‘vascular’ section with 81.82%. Its performance was lower in the ‘bone and joint’ (48.54%) and ‘neuromuscular’ (56.25%) sections. ConclusionsChatGPT-4 achieved a good overall score of 61.98%. This AI language model demonstrates significant capability in processing and answering specialized medical examination questions, albeit with room for improvement in areas requiring complex clinical judgment and nuanced interpretation. ChatGPT-4’s proficiency is influenced by the structure and language of the examination, with no replacement for the depth of trained medical specialists. This study underscores the supportive role of AI in medical education and clinical decision-making while highlighting the current limitations in nuanced fields such as hand surgery.

Board Certification in Cosmetic Surgery: An Analysis of Punitive Actions: Correction.

Board Certification in Cosmetic Surgery: An Analysis of Punitive Actions: Correction.

Gender Differences in the Pediatric Neurosurgical Workforce: Professional Practice, Work-Life Balance, and Beyond.

Evidence suggests that female neurosurgeons experience unique challenges in the workplace including lack of academic advancement, challenges with work-life balance, harassment, and discrimination. How these factors influence the gender gap in neurosurgery remains unclear. This analysis investigated gender differences in pediatric neurosurgeons in professional and nonprofessional activities and responsibilities. A survey examining professional activities, work-life balance, family dynamics, career satisfaction, and workplace discrimination and harassment was administered to 495 pediatric neurosurgeons. Response rate was 49% (n = 241). One-third of the pediatric neurosurgical workforce is female. There were no gender differences in race/ethnicity, American Board of Neurological Surgery/American Board of Pediatric Neurological Surgery certification rates, or pediatric neurosurgery fellowship completion. No gender differences were found in operative caseload, weekly hours worked, or working after 8 pm or weekends. Women took call more frequently than men ( P = .044). Men were more likely to work in academia ( P = .004) and have salary subsidization from external sources ( P = .026). Women were more likely to anticipate retirement by age 65 years ( P = .044), were less happy with call commitments ( P = .012), and worked more hours at home while off ( P = .050). Women more frequently reported witnessing and experiencing racial discrimination ( P = .008; P < .001), sexual harassment ( P = .002, P < .001), and feeling less safe at work ( P < .001). Men were more likely married ( P = .042) with 1 ( P = .004) or more children ( P = .034). Women reported significantly greater responsibility for child and domestic care ( P < .001). There were no gender differences in work-life balance, feeling supported at work, or having enough time to do things outside of work. Despite little difference in workload and professional responsibilities, women held more domestic responsibilities and experienced and witnessed more racial and sexual discrimination in the workplace. Surprisingly, there were no reported differences in work-life balance or feeling supported at work between genders. These findings suggest that factors unique to female neurosurgeons may contribute to continued gender disparity in the field.

A Novel Evaluation Model for Assessing ChatGPT on Otolaryngology-Head and Neck Surgery Certification Examinations: Performance Study.

ChatGPT is among the most popular large language models (LLMs), exhibiting proficiency in various standardized tests, including multiple-choice medical board examinations. However, its performance on otolaryngology-head and neck surgery (OHNS) certification examinations and open-ended medical board certification examinations has not been reported. We aimed to evaluate the performance of ChatGPT on OHNS board examinations and propose a novel method to assess an AI model's performance on open-ended medical board examination questions. Twenty-one open-ended questions were adopted from the Royal College of Physicians and Surgeons of Canada's sample examination to query ChatGPT on April 11, 2023, with and without prompts. A new model, named Concordance, Validity, Safety, Competency (CVSC), was developed to evaluate its performance. In an open-ended question assessment, ChatGPT achieved a passing mark (an average of 75% across 3 trials) in the attempts and demonstrated higher accuracy with prompts. The model demonstrated high concordance (92.06%) and satisfactory validity. While demonstrating considerable consistency in regenerating answers, it often provided only partially correct responses. Notably, concerning features such as hallucinations and self-conflicting answers were observed. ChatGPT achieved a passing score in the sample examination and demonstrated the potential to pass the OHNS certification examination of the Royal College of Physicians and Surgeons of Canada. Some concerns remain due to its hallucinations, which could pose risks to patient safety. Further adjustments are necessary to yield safer and more accurate answers for clinical implementation.

First postgraduate certificate in soft tissue surgery.

First postgraduate certificate in soft tissue surgery.

Item analysis of general surgery multi-institutional mock oral exam: opportunities for quality improvement

PurposeMock oral examinations (MOE) prepare general surgery residents for the American Board of Surgery Certifying Exam by assessing their medical knowledge and clinical judgement. There is no standard accepted process for quality analysis among MOE content items. Effective questions should correlate with mastery of MOE content, as well as exam passage. Our aim was to identify opportunities for question improvement via item analysis of a standardized MOE.MethodsRetrospective review of testing data from the 2022 Southern California Virtual MOE, which examined 64 general surgery residents from six training programs. Each resident was assessed with 73 exam questions distributed through 12 standardized cases. Study authors indexed questions by clinical topic (e.g. breast, trauma) and competency category (e.g. professionalism, operative approach). We defined MOE passage as mean percentage correct and mean room score within 1 standard deviation of the mean or higher. Questions were assessed for difficulty, discrimination between PGY level, and correlation with MOE passage.ResultsPassage rate was 77% overall (49/64 residents), with no differences between postgraduate year (PGY) levels. PGY3 residents answered fewer questions correctly vs PGY4 residents (72% vs 78%, p < 0.001) and PGY5 residents (72% vs 82%, p < 0.001). Out of 73 total questions, 17 questions (23.2%) significantly correlated with MOE passage or failure. By competency category, these were predominantly related to patient care (52.9%) and operative approach (23.5%), with fewer related to diagnosis (11.8%), professional behavior (5.9%), and decision to operate (5.9%). By clinical topic these were equally distributed between trauma (17.7%), large intestine (17.7%), endocrine (17.7%), and surgical critical care (17.7%), with fewer in breast (11.8%), stomach (11.8%), and pediatric surgery (5.9%). We identified two types of ineffective questions: 1) questions answered correctly by 100% of test-takers with no discriminatory ability (n = 3); and 2) questions that varied inversely with exam passage (n = 11). In total, 19% (14/73) of exam questions were deemed ineffective.ConclusionsItem analysis of multi-institutional mock oral exam found that 23% of questions correlated with exam passage or failure, effectively discriminating which examinees had mastery of MOE content. We also recognized 19% of questions as ineffective that can be targeted for improvement.

Optimal Timing of Fundamentals of Endoscopic Surgery (FES) Testing in General Surgery Residency: Early Is Better

BackgroundFundamentals of endoscopic surgery (FES) completion is mandatory for certification by the American Board of Surgery (ABS). As early simulation and competency assessment can bolster development of trainee proficiency, we sought to determine the optimal timing for FES examination by evaluating pass rates based on training level and previous endoscopic experience. MethodsPGY2-5 residents at a university-based medical center who were novice to FES were assigned to complete FES training and testing. Training year, prior endoscopic experience, and FES exam scores were recorded with pre- and post-test surveys. ResultsMost residents in the program (88%) were able to complete FES training and testing within a single academic year. Most required only a single faculty-led session (88%) to feel confident to take the exam, augmented by varying numbers of independent practice sessions (50% 1–2, 19% 3–5, 27% > 5). After training, most (84%) felt confident that they would pass the exam, and 93% did so on their first attempt. While higher written exam scores were noted in the PGY5 group, there were no other statistically significant differences in overall pass rates or technical exam scores based on PGY level (p = 0.24). A number of previously completed endoscopic cases did not correlate with exam scores (p = 0.24 written, p = 0.91 technical). ConclusionFundamentals of endoscopic surgery (FES) certification can be successfully completed by junior level general surgery residents regardless of previous endoscopic experience. Moving this exam to earlier training years can benefit resident development and preparedness in the clinical setting without negatively impacting pass rates.

Assessment of Surgical Tasks Using Neuroimaging Dataset (ASTaUND)

Functional near-infrared spectroscopy (fNIRS) is a neuroimaging tool for studying brain activity in mobile subjects. Open-access fNIRS datasets are limited to simple and/or motion-restricted tasks. Here, we report a fNIRS dataset acquired on mobile subjects performing Fundamentals of Laparoscopic Surgery (FLS) tasks in a laboratory environment. Demonstrating competency in the FLS tasks is a prerequisite for board certification in general surgery in the United States. The ASTaUND data set was acquired over four different studies. We provide the relevant information about the hardware, FLS task execution protocols, and subject demographics to facilitate the use of this open-access data set. We also provide the concurrent FLS scores, a quantitative metric for surgical skill assessment developed by the FLS committee. This data set is expected to support the growing field of assessing surgical skills via neuroimaging data and provide an example of data processing pipeline for use in realistic, non-restrictive environments.

Evaluating the Quality of Ankle Fracture Education on Short-Form Video Platform YouTube Shorts

Category: Ankle; Trauma Introduction/Purpose: Social media has had a significant impact on medical education. YouTube has been an established platform and has recently expanded into short form videos (YTS) that receives over 50 billion views per day, approximately 625% of the World population. Prior investigations have shown that the quality of education on the YouTube platform is unregulated, lacking in quality measures and content delivery. To date YTS has not been investigated in the field of orthopedic surgery. Our study analyzes the quality of ankle fracture education on YTS and the distribution of the topic’s video creators. Methods: For this analysis, we acquired the top 75 videos on YTS with the search query "#anklefracture + shorts." Duplicate shorts, shorts containing irrelevant material, and shorts without measurable content were excluded. Videos that met the inclusion criteria were then scored using previously verified scoring systems: GQS Score, PEMAT Understandability %, PEMAT Actionability %, and JAMA Score. The following continuous variables were acquired: Views, Date Posted, Likes, Comments, Followers, Video Engagement Rate (VER). Categorical variables were acquired: Advertisement Status, Verified Account, Creator Type. The authorship of each channel was identified based on American Board of Orthopedic Surgery (ABOS) certification. We compared two groups, American Board-certified channels vs channels of any other education level. All variables were analyzed utilizing a one-way ANOVA for significance. Results: Of the top 75 videos, 21 meet our inclusion criteria. Only 3 authors, 27.2%, had ABOS certification. Of the 6 verified YT channels none were orthopedic surgeons. 9 videos were created by ABOS certified channels and 12 by other channels. The video upload date ranged from February-2021 to January-2023. The average scores for ABOS authors were likes 666, 11.4 comments, 359666 followers, 0.448% engagement rate, GQS score 3.67, JAMAScore 3, PEMATUnderstandability 91.9%, and PEMATActionability 14.8%. Average scores for authors of any other education level: 403 likes, 11.3 comments, 140856 followers, 3.61% engagement rate, GQS score 3.83, JAMAScore 3.08, PEMATUnderstandability 94.5%, PEMATActionability 50%. Followers and Actionability were the only significant variables (p &lt; 0.05); ABOS channels had more followers while other channels had higher actionability. Conclusion: Directing the online message in orthopedic patient care and education is important. This study emphasizes that orthopedic surgeons are skilled at capturing followers but fall short when compared to other channels in calling their viewers to action. It also shows how Orthopedic surgeons are equivalent when it comes to educating viewers in an understandable and verified manner. In order to lead ankle fracture education on YTS and other social media platforms, orthopedic surgeons need to utilize the popularity of their following to deliver actionable educational content and improve in categories that non-orthopedic surgeons dominate on YouTube Shorts.

Animal model of polytrauma for surgical training

Introduction: The aim of this study was to develop a training program for surgeons that would enable them to improve their practical skills using an animal model of polytrauma. Methods: Injury to the stomach, small and large bowel as well as spleen and liver injury were caused laparoscopically, and tension pneumothorax was induced thoracoscopically, in 60 laboratory pigs. A thus obtained polytrauma model was then used for the training of examination processes according to ATLS (advanced trauma life support) principles and of the treatment protocol according to DCS (damage control surgery) principles. Less experienced surgeons (N=10) completed a total of 4 training sessions, and experienced surgeons with postgraduate certification in surgery (N=10) performed 2 treatments. The relative training benefit was subsequently assessed by comparing the first and the last attempt. Furthermore, the absolute benefit of training for the beginners (novice trainees) was evaluated by comparing their last attempt with the first attempt of experienced surgeons. Results: The beginners (less experienced surgeons) showed an improvement (first vs fourth attempt) in all parameters except bowel injury management and laparotomy closure time. Based on the comparison of the experienced surgeons’ first attempt and the beginners’ first attempt, the beginners performed significantly worse in all parameters except the two mentioned above. Average total blood loss was also higher in the beginners’ group – 2531 (±661.1) g vs 1189 (±509.5) g in the experienced surgeons’ group (p&lt;0.001). Conclusion: A novel animal model of polytrauma that can be used for the training of life threatening injury management was developed and validated in the study. The beginners improved significantly in all parameters after the training. However, longer training would be required to achieve results comparable to those of experienced surgeons.

Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery: Developed by the AUGS Quality Improvement and Outcomes Research Network.

Surgery for the correction of stress urinary incontinence is an elective procedure that can have a dramatic and positive impact on quality of life. Anti-incontinence procedures, like inguinal hernia repairs or cholecystectomies, can be classified as high-volume/low-morbidity procedures. The performance of a standard set of perioperative tasks has been suggested as one way to optimize quality of care in elective high-volume/low-morbidity procedures. Our primary objective was to evaluate the performance of 5 perioperative tasks-(1) offering nonsurgical treatment, (2) performance of a standard preoperative prolapse examination, (3) cough stress test, (4) postvoid residual test, and (5) intraoperative cystoscopy for women undergoing surgery for stress urinary incontinence-compared among surgeons with and without board certification in female pelvic medicine and reconstructive surgery (FPMRS). This study was a retrospective chart review of anti-incontinence surgical procedures performed between 2011 and 2013 at 9 health systems. Cases were reviewed for surgical volume, adverse outcomes, and the performance of 5 perioperative tasks and compared between surgeons with and without FPMRS certification. Non-FPMRS surgeons performed fewer anti-incontinence procedures than FPMRS-certified surgeons. Female pelvic medicine and reconstructive surgery surgeons were more likely to perform all 5 perioperative tasks compared with non-FPMRS surgeons. After propensity matching, FPMRS surgeons had fewer patients readmitted within 30 days of surgery compared with non-FPMRS surgeons. Female pelvic medicine and reconstructive surgery surgeons performed higher volumes of anti-incontinence procedures, were more likely to document the performance of the 5 perioperative tasks, and were less likely to have their patients readmitted within 30 days.

Residents perform better technically, have less stress and workload, and prefer robotic to laparoscopic technique during inanimate simulation.

With the widespread adoption of minimally invasive surgery, there is a growing need for surgical residents to be trained by a procedure-specific curriculum. This study aimed to evaluate the technical performance and feedback of surgical residents undergoing the robotic and laparoscopic hepaticojejunostomy (HJ) and gastrojejunostomy (GJ) biotissue modules. A total of 23 PGY-3 surgical residents participated in this study and performed the laparoscopic and robotic HJ and GJ drills, which were recorded and scored by two independent graders using the modified objective structured assessment of technical skills (OSATS). After completing each drill, all participants filled out the NASA Task Load Index (NASA-TLX), Borg Exertion Scale, and Edwards Arousal Rating Questionnaire. Twenty-two (95.7%) residents had already received fundamentals of laparoscopic surgery certification. Eighteen (78.3%) residents had robotic virtual simulation training and the median (range) number of robotic surgery console experience was 4 (0-30). In the HJ comparison of the six OSATS domains, the robotic system was superior in Gentleness (p = 0.031). In the GJ comparison, the robotic system was superior in Time and Motion (p < 0.001), Instrument Handling (p = 0.001), Flow of Operation (p = 0.002), Tissue Exposure (p = 0.013), and Summary (p < 0.001). Participants answered significantly higher demand scores for laparoscopy on all six facets of NASA-TLX for both HJ and GJ (p < 0.05). The Borg Level of Exertion was > 2 points higher for laparoscopic HJ and GJ (p < 0.001). Residents rated more Nervousness and Anxiety for laparoscopic compared to robotic (p < 0.05) HJ and GJ. Additionally, when asked to score preference for robotic and laparoscopic approach in terms of technique and ergonomics, residents scored robot as better (laparoscopy worse) for both HJ and GJ in both domains. The robotic surgical system provided a more favorable environment for trainees with less mental and physical burden for minimally invasive HJ and GJ curriculum.

An Indispensable Revolution For Pakistan, The Beginning Of Robot Assisted MIMVS.

Madam, Minimally invasive surgical (MIS) techniques or ‘sternal sparing’ strategies, performed by making minor right chest incisions, were introduced in the mid-1990s [1,3]. From that point forward, there has been a decrease in surgical injury and postoperative recuperation, coming about in expanded acknowledgement of these approaches. It works on three essential standards: rebuilding and conserving MV pamphlet portability, creating a vast flyer coaptation surface, and remodeling of the mitral annulus to supply an ideal and steady orifice area. [1] The history of MIMVS expanded from the 1990s when minimally invasive approaches such as the parasternal incision, hemi sternal incision and the mini thoracotomy were investigated by autonomous groups led by Delos Cosgrove and Lawrence Cohn. Further advancements include the primary video-directed repair and substitutions performed through a mini-thoracotomy and the primary utilization of end balloon clamping. Later, improvements incorporated the coming of stereoscopic 3D video endoscopy and mechanical surgery. [5] Robotic technology facilitates complex surgical procedures on the mitral valve without opening the chest. The most significant advantage is diminished surgical injury, which deciphers into early recuperation. In 1998, robotic mitral valve repair was initiated and adopted in 2005 by the US following the first multicenter trial. In classic robotic mitral valve surgery, femoral-femoral cardiopulmonary machine cannulation is performed through a small incision in the groin. The surgeon leading the robotic mitral valve surgery must have the relevant heart surgery certification from the country's certifying institution. The console surgeon should be experienced in all aspects of mitral valve surgery and be highly versed in repair techniques as robotic procedures take longer than traditional surgeries, especially during the learning curve. Apprenticeship in the so-called mini-mitral using conventional videoscopy is also an advantage, but not a mandatory requirement The courses on robotic mitral valve surgery including formal didactic and practice-oriented training should be obtained by the lead surgeon and the team. Virtual stimulators and wet labs should be provided by the hospital to the team to practice their first 8-10 cases until they gain expertise ---Continue

Plastic Surgery Training: Trends in Hand Surgery Fellowship in the Setting of a Pandemic.

Hand meeting registration and educational content were analyzed over the past 10 years. Current hand surgery job offerings were evaluated for training requirements, and the annual rates of subspecialty certificate in surgery of the hand board certifications were compared across training backgrounds. Top categories of annual meeting educational content were "bone/joint," "other," and "professional development." A majority of American Society for Surgery of the Hand presidents had training backgrounds in orthopedics (55%), followed by plastics (23%) and general surgery (22%). The job offerings on the American Society for Surgery of the Hand and Association for Surgery of the Hand websites specified more training requirements in orthopedics than in plastics. Additionally, there were two to three times as many examinees taking the surgery of the hand examination from orthopedic surgery compared with plastics, with an overall higher pass rate. Hand fellowship programs were also predominantly offered for orthopedic surgery (80.8%). Optimization of training, society membership, and clinical practice profiles may increase the presence of plastic surgery-trained hand surgeons. The extent of the economic impact of the COVID-19 pandemic is yet to be fully determined, but our analysis suggests that a lucrative market for reconstructive/hand surgery may exist in the face of economic downturn.

Recent Training Trends in Independent Plastic Surgery Graduates: American Board of Surgery Certification and Academic Priorities.

Among independent plastic surgery graduates, most have general surgery training, but the utility of American Board of Surgery (ABS) certification in plastic surgery practice is unclear. We elucidated attitudes and trends of ABS certification in American Board of Plastic Surgery diplomates. American Board of Plastic Surgery diplomates from 2018 to 2020 were reviewed to identify independent plastic surgery graduates. These graduates were anonymously surveyed regarding demographics, employment, fellowships, practices, and attitudes toward ABS certification. Of 568 American Board of Plastic Surgery diplomates, 223 independent graduates (39%) were identified. Sixty-eight percent of these graduates were ABS certified, 80% of whom achieved certification during the beginning of plastic and reconstructive surgery training; 41% were fellowship trained. About half are in private practice, 25% are part of a hospital group, and 17% work in universities. Of 223 independent graduates, 54 (24.4%) completed the survey; 85.2% reported ABS certification, and 21.7% perform general surgery procedures. Most stated that general surgery training was valuable to their career, regardless of certification. Most agreed that ABS certification benefited their career; 63% plan to recertify. Of those surveyed, 59.3% had completed a plastic surgery fellowship. Non-fellowship-trained surgeons felt more strongly that ABS certification was beneficial (P = 0.014) and valued by patients (P = 0.026) compared with fellowship-trained surgeons. American Board of Surgery certification is a priority to independent plastic surgery trainees, despite potential disruption to training, personal costs, and unclear utility to their practice. Although few perform general surgery procedures, most plan to recertify. Future studies should investigate recertification among surgeons later in their careers and the impacts of dual board certification on plastic surgery practice.