Chair Of Surgery Research Articles

Do male chairs of surgery have implicit gender bias in the residency application process?

IntroductionMedical students applying for general surgery residencies often require a letter of recommendation (LOR) from the Surgical Chair. However, LORs may reveal gender and ethnic bias. This study examines the presence of implicit bias in general surgery resident selection by evaluating chair LORs. MethodsA retrospective study of 149 LORs for categorical general surgery residents, at an academic institution, written by surgery chairs from 1980 to 2013 was performed. Two independent reviewers scored each letter for overall quality, mention of personality, academic deficiencies, technical skills, and standout adjectives. Scores were compared across gender and race and statistical analysis performed using SPSS. ResultsMales comprised 85% of the applicants; racial makeup was Caucasian (90%), black (4%), Asian (4%), and Hispanic (2%). Male chairs wrote all letters. Letters for female students received higher overall scores than males (4.13 ± 0.16, 3.59 ± 0.08, p = 0.005). Discussion of personality was significantly less for Asian students (1.28 ± 0.08, 1.83 ± 0.48, 0.5 ± 0.224, 1.67 ± 0.67, p 0.050). No difference was present in mention of academic deficiencies, technical skills, or standout adjectives. DiscussionFemale medical students invited to interview at a top academic general surgery residency had higher quality LORs than their male counterparts. Asian applicants had statistically significant less discussion of personality. Further examination of residency selection processes is necessary to implement changes that mitigate implicit bias in trainee selection.

Discussion: Plastic Surgery Chairs and Program Directors: Are the Qualifications Different for Men and Women?

Discussion: Plastic Surgery Chairs and Program Directors: Are the Qualifications Different for Men and Women?

The Changing Face of Academic Surgery: Overrepresentation of Women among Surgeon-Scientists with R01 Funding

There has been a recent focus on sex-based disparities within the field of academic surgery. However, the proportion of female surgeons conducting NIH-funded research is unknown. The NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) was queried for R01 grants from surgery departments for which the principal investigator (PI) had a primary medical degree, as of October 2018. Characteristics of the PI and their respective grants were collected. Institutional faculty profiles were reviewed for PI and departmental characteristics. PIs were stratified by sex and compared using standard univariate statistics. There were a total of 212 R01 grants in surgery departments held by 159 PIs. Of these, 26.4% (n= 42) of R01-funded surgeons were female compared with the reported 19% of academic surgery female faculty (as reported by the Association of American Medical Colleges; p= 0.02). Women with R01 grants were more likely to be first-time grant recipients with no concurrent or previous NIH funding (21.4% vs 8.6%; p= 0.03) and less likely to have a previous R01 or equivalent grant (54.8% vs 73.5%; p= 0.03). Women were more likely to be from departments with a female surgery chair (31.0% vs 13.7%; p= 0.01) or a department with > 30% female surgeons (35.0% vs 18.2%; p= 0.03). Although female surgeons remain a minority in academic surgery, they hold a greater than anticipated proportion of NIH funding, with a high number of first-time grants, forming a crucial component of the next generation of surgeon-scientists.

Professor Ian Aird: Master of surgical education.

Ian Aird (1905-1962) was a Scottish surgeon renowned for his textbook: "A companion in surgical studies", a uniquely single-author work of thousands of pages. It was an essential study for young surgeons aspiring to pass the FRCS (Edin) examination. He was appointed Chair of Surgery of the Royal Postgraduate Medical School at Hammersmith Hospital in London. Under his direction, his faculty developed a pump oxygenator, used it successfully for the first time in a patient and introduced cardiac surgery in Russia. They also pioneered kidney transplantation in Britain. Aird himself discovered the relationship of blood groups to cancer and peptic ulceration. He became famous for the surgical separation of conjoined twins from Nigeria, fame that created conflicts with medical authority on the issue of cooperating with the press. He became frustrated when the medical council refused to support and sponsor funding for research. Sadly, even his indomitable energy and brilliance could not see him through his depression. He committed suicide at the age of 57.

La práctica y la enseñanza de la anatomía en la Real Universidad de México, siglos XVI y XVII

This paper focuses on the first anatomical studies of human bodies and the development of the practice in New Spain during the 16th and 17th centuries. Even before the Royal University of Mexico developed an anatomy chair, dissections were already very common throughout the Viceroyalty. During the second half of the 16th century, physicians and surgeons conducted autopsies for diverse purposes, suggesting that New Spain was influenced by the anatomical reform of the Renaissance. Later, in 1621, it was created the chair of anatomy and surgery in Mexican university, giving royal institutions greater control over scientific development and knowledge. As a result, anatomical studies stagnated, as a concession to Counter-Reformation doctrine.

Plastic Surgery Chairs and Program Directors: Are the Qualifications Different for Men and Women?

The gender disparity between the number of female and male chairs and program directors has been previously established. The aim of this study was to determine whether any differences in objective credentials existed between male and female plastic surgery department chairs/division chiefs and program directors. Information about each plastic surgery program director and chair/chief was extracted from the websites of all institutions affiliated with a plastic surgery residency program. For each individual, information about the length of their career, number of fellowships completed, and number of publications was recorded. The two-tailed t test was used to compare differences between male and female chairs and program directors. A total of 99 chairs were recorded, of which nine (9.1 percent) were female. Of the 99 program directors, 13 (13.1 percent) were female. There was no difference in the number of years in practice or number of fellowships between men and women for either position. On average, male chairs had significantly fewer publications than female chairs (71.9 versus 128; p < 0.05). There was no significant difference in the number of publications between male and female program directors. Compared to program directors, chairs had significantly more years in practice and numbers of publications, which held true for both men and women. Women are not only underrepresented in the department chair and program director positions, but also possess higher qualifications that may reflect differences in standards for promotion and appointment. Additional research is needed to elucidate the reasons behind the observed differences in qualifications.

Mentor of the Month Series: How to Review a Manuscript from an Editor’s Perspective?

The Resident and Fellow Education Committee of the Society for Surgery of the Alimentary Tract (SSAT) is committed to the education of surgical trainees and has many initiatives to connect the candidate members with the leadership of the society. This month, the Mentor of the Month series features Dr. Timothy Pawlik MD, MPH, MTS, PhD. Dr. Pawlik received his medical degree from Tufts University School of Medicine and surgical training at the University of Michigan. He also spent 2 years at the Massachusetts General Hospital as a surgical oncology research fellow and went for an advanced training in surgical oncology at The University of Texas MD Anderson Cancer Center in Houston. Dr. Pawlik is currently the Chair of Surgery, Urban Meyer III and Shelley Meyer Chair for Cancer Research, and the Surgeon in Chief at The Ohio State University Wexner Medical Center. He is discussing his path to becoming co-editor in Chief of the Journal of Gastrointestinal Surgery, how to get involved as a reviewer for the journal, and how to critically review a manuscript.

A Call to Action: Black/African American Women Surgeon Scientists, Where are They?

To determine the representation of Black/AA women surgeons in academic medicine among U.S. medical school faculty and to assess the number of NIH grants awarded to Black/AA women surgeon-scientists over the past 2 decades. Despite increasing ethnic/racial and sex diversity in U.S. medical schools and residencies, Black/AA women have historically been underrepresented in academic surgery. A retrospective review of the Association of American Medical Colleges 2017 Faculty Roster was performed and the number of grants awarded to surgeons from the NIH (1998-2017) was obtained. Data from the Association of American Medical Colleges included the total number of medical school surgery faculty, academic rank, tenure status, and department Chair roles. Descriptive statistics were performed. Of the 15,671 U.S. medical school surgical faculty, 123 (0.79%) were Black/AA women surgeons with only 11 (0.54%) being tenured faculty. When stratified by academic rank, 15 (12%) Black/AA women surgeons were instructors, 73 (59%) were assistant professors, 19 (15%) were associate professors, and 10 (8%) were full professors of surgery. Of the 372 U.S. department Chairs of surgery, none were Black/AA women. Of the 9139 NIH grants awarded to academic surgeons from 1998 and 2017, 31 (0.34%) grants were awarded to fewer than 12 Black/AA women surgeons. A significant disparity in the number of Black/AA women in academic surgery exists with few attaining promotion to the rank of professor with tenure and none ascending to the role of department Chair of surgery. Identifying and removing structural barriers to promotion, NIH grant funding, and academic advancement of Black/AA women as leaders and surgeon-scientists is needed.

Needle in an Aneurysm Sac: William Macewen and His Innovative Method of Treating AAAs

It was 1889 when a new medical school in Baltimore, searching for its inaugural chair of surgery, attempted to recruit William Macewen from Glasgow. Only after negotiations faltered did the Johns Hopkins Hospital offer the position to William Halsted—a twist of fate that forever transformed the trajectory of American surgery.1 By the 1880s, Macewen had emerged as an international leader in surgery, contributing to such diverse areas as aseptic technique, operations on the central nervous system, and orthopedics.

Francesco Rubino: formerly reluctant bariatric surgeon

“When I was choosing a specialty, one thing I knew for sure was that I did not want to be a bariatric surgeon”, says Francesco Rubino. In 2013, Rubino became the first professor of metabolic and bariatric surgery in the world and is now Chair of Metabolic and Bariatric Surgery at King's College London. As a student, Rubino wasn't even excited about surgery: “I thought that all the discoveries in surgery had been made”, he says. But in the end he chose to pursue surgery because of his desire for a strong doctor–patient relationship. Still, bariatric surgery was not on his radar for many years because, like most clinicians then, he saw obesity as a lifestyle choice: “I thought perhaps I would do cancer surgery”, he muses. “I thought that I should instead treat people who had done nothing wrong and became ill”, he explains. However, his opinion has changed greatly over the years, and he is now heavily involved in reducing the stigma of obesity.

Gender disparities in academic vascular surgeons

ObjectivePrevious studies have identified significant gender discrepancies in grant funding, leadership positions, and publication impact in surgical subspecialties. We investigated whether these discrepancies were also present in academic vascular surgery. MethodsAcademic websites from institutions with vascular surgery training programs were queried to identify academic faculty, and leadership positions were noted. H-index, number of citations, and total number of publications were obtained from Scopus and PubMed. Grant funding amounts and awards data were obtained from the National Institutes of Health (NIH) and Society for Vascular Surgery websites. Industry funding amount was obtained from the Centers for Medicare and Medicaid Services website. Nonsurgical physicians and support staff were excluded from this analysis. ResultsWe identified 177 female faculty (18.6%) and 774 male faculty (81.4%). A total of 41 (23.2%) female surgeons held leadership positions within their institutions compared with 254 (32.9%) male surgeons (P = .009). Female surgeons held the rank of assistant professor 50.3% of the time in contrast to 33.9% of men (P < .001). The rank of associate professor was held at similar rates, 25.4% vs 20.7% (P = .187), respectively. Fewer women than men held the full professor rank, 10.7% compared with 26.2% (P < .001). Similarly, women held leadership positions less often than men, including division chief (6.8% vs 13.7%; P < .012) and vice chair of surgery (0% vs 2.2%; P < .047), but held more positions as vice dean of surgery (0.6% vs 0%; P < .037) and chief executive officer (0.6% vs 0%; P < .037). Scientific contributions based on the number of each surgeon's publications were found to be statistically different between men and women. Women had an average of 42.3 publications compared with 64.8 for men (P < .001). Female vascular surgeons were cited an average of 655.2 times, less than half the average citations of their male counterparts with 1387 citations (P < .001). The average H-index was 9.5 for female vascular surgeons compared with 13.7 for male vascular surgeons (P < .001). Correcting for years since initial board certification, women had a higher H-index per year in practice (1.32 vs 1.02; P = .005). Female vascular surgeons were more likely to have received NIH grants than their male colleagues (9.6% vs 4.0%; P = .017). Although substantial, the average value of NIH grants awarded was not statistically significant between men and women, with men on average receiving $915,590.74 ($199,119.00-$2,910,600.00) and women receiving $707,205.35 ($61,612.00-$4,857,220.00; P = .416). There was no difference in the distribution of Society for Vascular Surgery seed grants to women and men since 2007. Industry payments made publicly available according to the Sunshine Act for the year 2018 were also compared, and female vascular surgeons received an average of $2155.28 compared with their male counterparts, who received almost four times as much at $8452.43 (P < .001). ConclusionsAlthough there is certainly improved representation of women in vascular surgery compared with several decades ago, a discrepancy still persists. Women tend to have more grants than men and receive less in industry payments, but they hold fewer leadership positions, do not publish as frequently, and are cited less than their male counterparts. Further investigation should be aimed at identifying the causes of gender disparity and systemic barriers to gender equity in academic vascular surgery.

Editorial introductions

Editorial introductions

Leo Fabian: A Life of Accomplishment

Leo Fabian played a role in many anesthesia firsts: the first halothane anesthetics in the United States, the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. As was common for men of his generation, Fabian’s first taste of medicine came during World War II, as a pharmacist’s mate aboard the U.S.S. Bountiful. Afterward, he pursued his medical education before joining Dr. C. Ronald Stephen and the anesthesiology department at Duke. There he helped to create one of the first inhalers for halothane, the Fabian Newton Stephen (F-N-S) Fluothane Vaporizer. Fabian left Duke for the University of Mississippi Medical Center, where he consistently worked with the chair of surgery, Dr. James Hardy. Together they performed the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. By the end of his time at Mississippi, Fabian and Hardy had several philosophical disagreements, and Fabian ultimately left for Washington University in St. Louis, where he rejoined Dr. Stephen. He served as Stephen’s right-hand man and would oversee the department when Stephen was away. Fabian spent the final years of his career as chair of the department before his own health forced him to step down.

A Call to Action for Male Surgeons in the Wake of the #MeToo Movement: Mentor Female Surgeons.

A Call to Action for Male Surgeons in the Wake of the #MeToo Movement: Mentor Female Surgeons.

Modern possibilities of application of the project method while organizing the educational process at the postgraduate level

The purpose of the work is to optimize the principles and methods of organizing independent work on the basis of interactive learning technologies (design method) in the context of planning the educational process of interns in the specialty “Surgery”, clinical residents, postgraduates and students (optional) in the cycles of thematic improvement within the program Cycles of the Chair of Surgery and Vascular Surgery of Shupyk National Medical Academy of Postgraduate Education. The use of traditional educational and pedagogical means, technologies and methods does not ensure the intensive development of all areas of activity at the postgraduate level. Overcoming these contradictions is possible provided that new modern and innovative approaches to the formation of knowledge and skills are taken into account, taking into account the existing possibilities of information and communication technologies. Solving the problem is possible through the use of interactive learning methods — the method of projects. The introduction of interactive methods in the educational process at all levels of postgraduate training is aimed at the systematic formation of knowledge of specialists who can solve problems in various areas of practical professional activities.

Defining a Leader—Characteristics That Distinguish a Chair of Surgery

BackgroundChair of the Department of Surgery, sometimes known as the Chief, holds a title that has significant historical connotations. Our goal was to assess a group of objectively measurable characteristics that unify these individuals as a group. MethodsUtilizing publicly available data for all US teaching hospitals, demographic information was accumulated for the named chiefs/chairs of surgery. Information collected included location of their program, their medical/surgical training history, their surgical specialty, previous chair/chief titles held, and academic productivity. ResultsOf the 259 programs listed, data were available on 244 individuals who were trained in 19 different specialties. The top three specialties of these practitioners are General Surgery (40, 16.3%), Surgical Oncology (38, 15.5%), and Vascular Surgery (33, 13.5%). There were only 14 female chairs (5.7%) and only one chair with a doctor of osteopathic medicine degree. The majority (62.3%) had been a previous chief of a surgical subdivision with only 26% having been a previous chair/chief of the surgical department.The average chair had 72 peer-reviewed manuscripts with 28 published book chapters. Chair's at academic institutions with university affiliation had a significantly higher number of peer-reviewed manuscripts (P < 0.0001) as well as were more likely to be trained at academic institutions (P = 0.013). ConclusionsThere are no set characteristics that define the Chair of a Department of Surgery. By understanding a group of baseline characteristics that unify these surgical leaders, young faculty and trainees with leadership aspirations may begin to understand what is necessary to fill these roles in the future.

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.

The clinical evaluation of sepsis-1 and sepsis-3 in patients with acute surgical abdominal pathology

Purpose of the study. Comparison Sepsis-1 and Sepsis-3 use in clinical practice at patients with acute surgical abdominal pathology.&#x0D; Materials and methods. The treatment results of 3302 patients with acute surgical abdominal pathology, which were operated at the clinic of the Chair of surgery and endoscopy at Lviv Danylo Halytskyi national medical university in 2008–2018 are analysed. In 272 (8,2%) cases there were signs of abdominal sepsis (AS). Gram-negative flora (E. coli in 198 (72,8%) of patients) was the most common cause of infection. We evaluated clinical and laboratory characteristics, which are used for stratification of patients according to classifications Sepsis-1 and Sepsis-3.&#x0D; Results. Patients were stratified using Sepsis-1, of which 227 (83,5%) were diagnosed using Sepsis-3 (SOFA г 2). Mortality among patients with Sepsis-1 was 41,2% (112/272), among those with Sepsis-3 – 45,4% (103/227). Using Sepsis-3, 45 (16,5%) patients were excluded; values of APACHE II and SOFA, as well as length of stay in these patients was significantly lower; no deaths occurred. Therefore, diagnostic criteria of Sepsis-3 significantly reduce the number of patients with acute surgical abdominal pathology, complicated AS, compared with Sepsis-1. Diagnostic value of various factors that allow early detection of sepsis in the absence of an ideal standard is important.&#x0D; Conclusion. Indicators of Sepsis-3 are informative in the diagnosis and staging of abdominal sepsis.

Using Convolutional Neural Networks for the Detection of Spinal Transverse Processes

Introduction: Scoliosis, an excessive curvature of the spine, affects approximately 1 in 1,000 individuals. As a result, there have formerly been implementations of mandatory scoliosis screening procedures. Screening programs are no longer widely used as the harms often outweigh the benefits; it causes many adolescents to undergo frequent diagnosis X-ray procedure This makes spinal ultrasounds an ideal substitute for scoliosis screening in patients, as it does not expose them to those levels of radiation.&#x0D; Spinal curvatures can be accurately computed from the location of spinal transverse processes, by measuring the vertebral angle from a reference line [1]. However, ultrasound images are less clear than x-ray images, making it difficult to identify the spinal processes. To overcome this, we employ deep learning using a convolutional neural network, which is a powerful tool for computer vision and image classification [2].&#x0D; Method: A total of 2,752 ultrasound images were recorded from a spine phantom to train a convolutional neural network. Subsequently, we took another recording of 747 images to be used for testing. All the ultrasound images from the scans were then segmented manually, using the 3D Slicer (www.slicer.org) software. Next, the dataset was fed through a convolutional neural network. The network used was a modified version of GoogLeNet (Inception v1), with 2 linearly stacked inception models. This network was chosen because it provided a balance between accurate performance, and time efficient computations.&#x0D; Results: Deep learning classification using the Inception model achieved an accuracy of 84% for the phantom scan.&#x0D; Conclusion: The classification model performs with considerable accuracy. Better accuracy needs to be achieved, possibly with more available data and improvements in the classification model.&#x0D; Acknowledgements: G. Fichtinger is supported as a Canada Research Chair in Computer-Integrated Surgery. This work was funded, in part, by NIH/NIBIB and NIH/NIGMS (via grant 1R01EB021396-01A1 - Slicer+PLUS: Point-of-Care Ultrasound) and by CANARIE’s Research Software Program. &#x0D; &#x0D; Figure 1: Ultrasound scan containing a transverse process (left), and ultrasound scan containing no transverse process (right). Figure 2: Accuracy of classification for training (red) and validation (blue).&#x0D;

The Ochsner Legacy

One of the iconic families in American surgery is the Ochsners. The youngest son of Swiss immigrants, Henry Ochsner (1877-1902) was the first to enter the medical profession. His promising internship at the Johns Hopkins Hospital ended when he died of cholera, a tragedy deeply felt by his mentor William Osler. On another branch of the family tree, Albert Ochsner (1858-1925) wrote authoritative textbooks on surgery and became president of the ACS and the American Surgical Association. His most significant achievement may have been his mentorship of his cousin's son Alton (1896-1981), guiding his medical education and training in surgery. The younger Ochsner succeeded Rudolph Matas as chair of surgery at Tulane University at the age of only 31 years. Under his leadership, Charity Hospital in New Orleans became a leading program for surgical training and Tulane earned a reputation for clinical excellence. Ochsner and four partners from the Tulane faculty created a multidisciplinary clinic to attract patients from a wider area, a facility that would become today's Ochsner Clinic. His son John (1927-2018) followed him in the profession and received specialty training in cardiovascular surgery under Michael DeBakey in Houston, a Tulane graduate and an Ochsner trainee. John Ochsner returned to the Ochsner Clinic to establish a major cardiothoracic and vascular surgery program. Further generations of the Ochsner family continued the family legacy in surgery and medicine, exemplified by M. Gage Ochsner (1954-2013), Alton's grandson and John's nephew, who became a leading traumatologist and surgical educator in Savannah.