General Surgery Residents Research Articles

Can't Buy Me Love? The Use of Gifts in the Residency Application Process.

To set themselves apart, some programs use gifts or promotional items to highlight the residency program or unique local culture. The distinction between advertisement and persuasion may be blurry in this case. We sought to quantify the prevalence of gifts to applicants and how frequently the US federal threshold for "nominal gifts" was exceeded. We reviewed a publicly accessible, Internet resource called the "ERAS Megathread." This is a Google spreadsheet found on Reddit where applicants participating in The Match can anonymously contribute information about their experience. The incidence of "gifts" was quantified for surgical residency programs, along with the nominal value if indicated. The spreadsheets were reviewed for 2021, 2022, and 2023. Over the past 3 application cycles, 15.1% [11.1%-18.2%] of general surgery residency programs provided a gift to applicants. Of these programs, the majority (70.2%) are university-based programs. In 2023, 57.9% of these gifts exceeded US$20. Given the anonymous nature of the data set, and the lack of transparency in the match process, it was not possible to correlate gift giving with its effect on recruitment. Students are courted by residency programs, and a significant minority of programs provide a gift to applicants. The impact of a substantial gift on a financially vulnerable student is difficult to quantify. It behooves us as a specialty to determine what should be a universal standard and to consider outlining explicit guidelines for The Match.

100. Epidemiology of Mandibular Fracture Cases for Mataram University General Surgery Resident Competence in Hospital Education Center

Introduction: WHO (2024) estimates that 20–50 million individuals get non-fatal injuries and over 1.2 million people globally pass away on traffic accidents. craniomaxillofacial fracture cases can be done by multidisciplinary, depend on diagnosis and competence of surgeons. Methods: This study is quantitative descriptive study using medical record data of craniofacial trauma patients NTB Province General Hospital from January 2022 to September 2024, patients who experienced or who had been diagnosed of craniofacial trauma. Results: 388 patients were diagnosed with craniofacial trauma at NTB Province Hospital. There were had 99 lower face fractures, 120 mid face fractures, and 169 with upper face fractures. It was found male gender was more than female, age range of 21-30 years. the 99 patients with mandibular fractures, 66 simple mandibular fractures obtained that could be done by general surgery resident. In 2022-2023, Unram general surgery residents are not yet in the advanced surgical phase, cannot participate in mandibular fracture surgery. But this data can provide an overview that mandibular fracture cases are sufficient in number for they operative cases. Conclusions: This study, there are 66 cases of mandibular os fracture that can be performed operatively by unram general surgery residents according to competence of general surgeons as stated in the Decree Minister of Health. So that can help in help cranio maxilo facial cases in good interdisciplinary cooperation to get optimal results.

Impostor Phenomenon Among Recently Graduated General Surgeons.

Imposter phenomenon can occur in highly competitive fields causing internal feelings of fraud and self-doubt. Significant imposterism has been recently reported amongst general surgery residents. We hypothesized that attending surgeons, navigating the transition into independent practice, would report a similar experience. We surveyed and collected Clance Imposter Phenomenon Scale (CIPS) scores from 24 Army general surgeons within 4years of graduation. Nearly all exhibited at least moderate imposterism, and over half reported significant or intense imposterism. Women reported statistically higher scores than men. Surgeons who engaged in off-duty employment or participated in mentorship were less likely to have significant or intense imposterism. Transition to practice is a challenging and highly variable time for new surgeons. Identifying factors that attenuate these feelings could help with early career advancement.

Perspectives of Surgical Research Residents on Improving Their Reentry Into Clinical Training

Concerns exist about clinical and operative skill decay in surgery residents when they dedicate time away from clinical training to pursue research. However, it remains undetermined how to best prevent these negative impacts. Our study evaluated the perspectives of surgical research residents on interventions to improve their reentry into clinical training. An anonymous web-based survey was distributed between 5/01/2023 and 6/01/2023 to 102 current and former (within the previous 3 years) general surgery research residents from 4 academic medical centers in Boston, MA. Survey response rate was 35.3% (36/102 residents). About 22 of 36 residents (61.1%) felt that their clinical aptitude decreased during the research years, whereas 33 of 36 (91.7%) reported reduced surgical skills. When reflecting on their re-entry to residency, former research residents reported feeling anxious and less confident (3.84/5 on a 1-5 Likert scale) as well as being below the expected level of clinical performance (3.42/5). Most of them (12 of 17; 70.6%) reported that it took up to 6 months, whereas 5 of them (29.4%) up to 12 months to feel at the expected level. When compared to nonmoonlighting residents, those who moonlighted often and operated during moonlighting, denied a decrease in clinical and surgical skills, and reported less anxiety, higher confidence, and a quicker return to the expected level of performance. Interventions proposed for improving their clinical re-entry included individualized development plans for 3 months before returning to clinical training, established curriculum for clinical work throughout the research years, clinical preceptorships throughout the research years, and simulation curriculum throughout the research years. General surgery residents feel that their clinical and surgical skills decreased during the research years, leading to anxiety and lack of confidence when returning to residency. Therefore, comprehensive interventions are needed to improve the reentry of the research residents into clinical training.

The effects of mindfulness-focused mental performance coaching on a general surgery residency program

BackgroundBurnout is a proven challenge in surgeons and surgical trainees, associated with higher rates of attrition compared to other medical specialties. Here we report the impact of a mental performance coaching program as it relates to surgery trainee wellbeing. MethodsA mixed-format mental performance coaching program was implemented at a large academic medical center's general surgery residency over a single academic year. Survey scores related to burnout, self-efficacy, and professional fulfillment were used to analyze the impact of the program as a whole, as well as by large group, small group, and one-on-one format attendance. ResultsResidents that attended the small group or one-on-one sessions demonstrated a trend towards improved burnout and professional fulfillment. The PGY3 group attended the most small format sessions and demonstrated a significant decrease in burnout (p ​= ​0.03). ConclusionThis offers an adaptable intervention for residency programs to improve the wellbeing of their trainees.

Resident performance and program perception following merger of surgical residencies

PurposeThe primary objective of this study was to gauge resident and faculty sentiments surrounding a general surgery program merger between two programs, and to assess the effect on workplace morale and productivity. Secondarily, the authors sought to objectively examine the impact program expansion had on in-service training exam results and operative volumes.MethodsThis was a single-center, prospective, observational study that evaluated surgical resident and faculty feedback pertaining to the merger of two regional general surgery residency programs. The survey utilized the Likert scale at merger onset and post-merger to gather responses from residents and faculty from July 2020 to August 2021. Secondary outcomes evaluated case volume and ABSITE performance pre- and post-merger.ResultsA total of 27 residents and 31 faculty participated in the initial survey. The merger onset and post survey investigation found that there was increased workplace efficiency (78% onset, 96% post; p = 0.004), and increased comfort with effectively triaging patients (41% onset, 83% post; p = 0.001). Satisfaction levels regarding research infrastructure and mentorship also increased significantly (63% onset, 83% post; p = 0.03). ABSITE performance and operative volumes were not significantly changed post-merger.ConclusionThe merging of two academic programs led to feelings of increased mentorship, operative competency, and workplace efficiency among the residents. This was achieved without significant detriment to resident case volume or ABSITE performance. Our investigation also identified legitimate challenges that speak to the need for fluidity in a residency program and the constant need for continued growth and development.

Video Review Can Measure Surgical Robotic Skill Development in a Resident Robotic Hernia Curriculum: A Retrospective Cohort Study

Background: Hernia repairs are one of the most common general surgery procedures and an essential part of training for general surgery residents. The widespread incorporation of robotic hernia repairs warrants the development of a procedure-specific robotic curriculum to assist novice surgeons in improving technical skills. Objective: To evaluate a robotic hernia simulation-based curriculum for general surgery residents using video review. Methods: Retrospective cohort study of PGY-3 general surgery residents from the University of Chicago from 2019 to 2021. The residents completed inguinal hernia repair (IHR) and ventral hernia repair (VHR) drills as part of a robotic simulation curriculum. The drills were recorded and graded according to the modified objective structured assessment of technical skills (OSATS) and time to completion. The drills were completed by 3 attending surgeons to establish gold-standard benchmarks. Results: In total, 20 residents started the curriculum, 19 completed all IHR drills and 17 completed all VHR drills. Attending surgeon total OSATS scores and time to completion were significantly better than the trainees on the first attempt (P < 0.05). When comparing 1st to 4th attempt, resident OSATS scores improved significantly for IHR (15.5 vs 23.3; P < 0.001) and VHR (16.8 vs 23.3; P < 0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 minutes; P < 0.001 and VHR: 29.6 vs 21.2 minutes; P < 0.001). Residents achieved attending-level OSATS scores by their fourth attempt for VHR, but not for IHR. Residents did not achieve attending-level times for either hernia drills. Conclusions: The robotic hernia curriculum improved resident performance on hernia repair drills and was well-received by the residents.

The impact of standardized robotics course training during colorectal surgery fellowship on post-training practice: a survey of graduates

The Association of Program Directors for Colon and Rectal Surgery (APDCRS) has sponsored a standardized robotics course for colorectal and minimally invasive surgery fellows since 2011. The study objective was to assess the impact of the APDCRS-sponsored course on surgical approaches adopted by young colorectal surgeons before, during, and after fellowship. An internet-based survey was administered to 2014–2022 ACGME-accredited colorectal surgery program graduates. Study variables were summarized using frequencies and proportions. Survey response rate was 43.2%. Laparoscopic and robotic volumes were consistently higher than open and hand-assist laparoscopic volumes over the study period. About 70.0% of fellows performed ≥ 20 laparoscopic cases before 2017, and over 80% had experience with ≥ 20 laparoscopic cases during/after 2017. An increasing trend of performing ≥ 20 robotic colorectal cases during fellowship was observed (before 2017: 75.0%, 2018–2019: 76.9%, and 2021–2022: 84.8%). Multivariate logistic regression analysis showed that higher robotic volume (≥ 25 colorectal cases) during general surgery residency increased odds of performing ≥ 50 robotic cases during fellowship (OR: 4.38, 95% CI 0.88, 26.1). Higher robotic volumes during fellowship correlated with higher robotic volumes in the first year of post-fellowship practice. 88.6% of respondents agree (21.0%) or strongly agree (67.6%) that the APDCRS robotics training course met expectations, and 83.8% agree or strongly agree that the course prepared them for post-graduate robotics practice. The APDCRS-sponsored robotics training course met expectations and prepared colorectal surgery fellows for adopting the robotic approach after graduation, with the majority of respondents reporting that they utilize robotics in their post-graduation colorectal practice.

A national survey of diversity, equity, and inclusion efforts in general surgery residency programs

A national survey of diversity, equity, and inclusion efforts in general surgery residency programs

Maria Karampouga the first female neurosurgeon graduate in Cyprus.

Promoting the involvement of women in surgery, particularly in neurosurgery, is crucial in today's male-dominated landscape. Without proper recognition and encouragement, many talented and pioneering women may continue to be undervalued, despite their significant impact on the field. Gender inequality has been a persistent issue throughout history, with limited progress despite the increasing presence of women in the workforce. Historically, women were viewed as inferior to men, even within the medical profession, due to perceived physical differences. This perception was reinforced in religious texts, depicting women as bearing the consequences of the first woman's actions. However, it is important to recognize and support these talented women, allowing them to showcase their contributions in their respective fields. One notable figure in this regard is Maria Karampouga, the first female neurosurgeon graduate in Cyprus. Born in Alexandroupolis, Greece, Maria Karampouga began her medical training after passing a national examination and achieving excellence. After successfully completing her studies, attaining the top score in her graduating class she began a residency in general surgery and then neurosurgery in Greece. Seeking the best possible training, she left her studies incomplete and moved to Cyprus to restart her training in Neurosurgery. She was the first woman ever associated with Neurosurgery in Cyprus and in June 2023, she became the first woman to complete the country's residency program in Neurosurgery. Currently, she is a researcher at University of Pittsburg, Medical Center.

Geographical Distribution and Trends Analysis of Osteopathic General Surgery Residents.

In recent years, the number of Doctor of Osteopathic Medicine (DO) residents entering general surgery has increased. As DOs continue to solidify their role within the surgical domain, understanding their distribution, preferences, and the dynamics of their integration into residency programs becomes crucial for general surgery applicants. Publicly available data were gathered for each DO general surgery resident from residency programs across the nation, including details such as post-graduate year, degrees held, and residency program location. A comprehensive cross-sectional analysis was conducted to determine the geographical distribution and match trends of DO residents in these residency programs. Analysis revealed a significant rise in the number of DOs entering general surgery residencies, from 153 DO trainees beginning their residency training in 2019 to 274 DO trainees beginning their residency training in 2024. This upward trend indicates a growing presence of DOs in surgical practice. Examination of the geographical locations of programs for which DO applicants have matched showed variations nationwide. This analysis allows for a deeper understanding of the evolving match trends for DOs in surgery. It highlights the importance of addressing disparities in access to surgical training opportunities for osteopathic physicians nationwide.

The state of affairs: Assessing the scope of endocrine surgery exposure in general surgery residencies across the United States

BackgroundEndocrine surgery is a core component of general surgery training. The landscape of endocrine surgery education in surgical residency and association with entrance into endocrine surgery fellowships is unknown. MethodsIn total, 353 Accreditation Council for Graduate Medical Education–accredited general surgery program websites were identified and categorized by US region, program type and size, and endocrine surgery educational experience type. Self-identified endocrine surgeons were defined as American Association of Endocrine Surgeons members or fellowship graduates (American Association of Endocrine Surgeons surgeons) or having a thyroid/parathyroid/adrenal practice. Programs that graduated an American Association of Endocrine Surgeons fellow from 2012 onwards were identified, and characteristics associated with endocrine surgery-experience type, self-identified endocrine or American Association of Endocrine Surgeons faculty, and entrance into endocrine surgery fellowship were assessed. ResultsIn total, 353 programs were studied. The median number of general surgery residents per program was 25, with 165 (46.7%) small programs (<25 residents) and 188 (53.3%) large (≥25) programs. There were 122 (34.6%) university-based programs, 82 (23.2%) community-based, 139 (39.4%) community-based/university-affiliated, and 10 (2.8%) military. A total 665 self-identified endocrine surgeons were identified at 303 (85.8%) programs; 15 (14.2%) programs had no self-identified endocrine surgeon. There were 361 American Association of Endocrine Surgeons surgeons located at 163 (46.2%) residency programs. In total, 323 (91.5%) programs had information on curriculum/rotations available, 58 (17.9%) with dedicated endocrine surgery educational experiences, 226 (70%) with rotations mixed with other subspecialties, and 39 (12.1%) with none reported. A total 113 (35%) general surgery programs produced a future endocrine surgery fellow and were most likely to be large (81%, P < .001), university-based (64%, P < .001) programs and were more likely to have a self-identified endocrine (102, 90.3%, P = .016) or an American Association of Endocrine Surgeons surgeon (82, 72.6%, P = .004). ConclusionProgram size and type were strongly associated with endocrine surgery exposure, presence of a self-identified endocrine surgeon, and same-site American Association of Endocrine Surgeons fellowship. Endocrine surgery educational experiences are inconsistent across residencies, and efforts are needed to ensure that surgical residents receive comprehensive, equitable endocrine surgery education.

It's not that SIMPL—Identifying deficiencies in general surgery trainees' autonomy and competence performing parathyroidectomy and thyroidectomy

BackgroundAlthough many parathyroid and thyroid operations are performed by nonfellowship-trained general surgeons in the United States, there is growing uncertainty of whether graduating residents can perform these procedures competently. This study investigates trends in competency and autonomy among general surgery residents performing parathyroid and thyroid operations using a national survey-based dataset. MethodsA retrospective analysis of the Society for Improving Medical Professional Learning database was performed. Case data from categorical general surgery residents performing parathyroidectomy or thyroidectomy between 2015 and 2023 were included. Competent performance and meaningful autonomy were dichotomized on the basis of faculty surgeon responses. Agreement between resident and faculty evaluations were assessed. Logistic regression was used to examine resident performance and autonomy using postgraduate year level and case complexity as covariates. ResultsThe study included 907 parathyroidectomies and 1,555 thyroidectomies from 724 residents at 77 residency programs. Competent performance was observed in 34.0% of parathyroidectomies and 38.6% of thyroidectomies. Meaningful autonomy was observed in 31.6% of parathyroidectomies and 32.3% of thyroidectomies. Residents and faculty agreed on performance (50.3%) and autonomy (59.1%) in most cases, however when discordant residents often underestimated their performance (44.7%) or autonomy (25.3%). The likelihood of postgraduate year 5 residents demonstrating competent performance or meaningful autonomy was 65.9% and 51.6%, respectively for parathyroidectomy and 77.2% and 58.4%, respectively for thyroidectomy. ConclusionMany graduating residents do not demonstrate competent performance or meaningful autonomy in parathyroidectomy and thyroidectomy. Further initiatives are needed to improve graduating general surgeons' competence for these operations, given access disparities to high-volume endocrine surgeons.

Preparing general surgery residents for rural practice in British Columbia: Competencies, privileging and geography.

For general surgeons practising in rural areas, multiple factors influence care beyond skills learned in residency. The British Columbia Privileging Dictionary (BCPD) defines core and non-core procedures that shape the scope of general surgeons. Moreover, the Royal College has adopted a Competence by Design (CBD) curriculum which employs entrustable professional activities (EPAs) that list surgical skill residents must be proficient in by graduation. Our goal is to understand the current practice patterns of rural general surgeons in BC based on these policies and local factors. Medical service plan (MSP) data were collected from 2011 to 2021 based on general surgeons working in rural subsidiary agreement (RSA) communities. The MSP fee codes were organised into core or non-core procedures, as outlined by the BCPD. EPAs were assessed and compared to the non-core procedures. From 2011 to 2021, 223,103 procedures were performed in rural sites in BC. On average, 90.97% (standard deviation = 20.78) of procedures done in all communities were BCPD core procedures. The most common non-core surgical care performed by general surgeons was in plastic surgery (n = 8035). Over 8% of procedures performed were not general surgery EPAs. Notably, none of the EPAs are considered non-core privileges and all EPAs have been performed in rural settings. General surgeons working in rural settings perform multiple procedures outside of EPAs which account for over 8% of their caseload and approximately 6% of procedures performed are non-core privileges. This provides some insight into the potential limitations of the BCPD on graduates hoping to practise in rural communities. As the CBD curriculum has been reported to provide a more flexible approach to learning, it may be tailored to suit residents' learning and career goals, including varied surgical skills to suit rural needs. Pour les chirurgiens généraux exerçant en zone rurale, de multiples facteurs influencent les soins, et ce au-delà des compétences acquises en résidence. Le British Columbia Privileging Dictionary (BCPD) définit les procédures essentielles et non essentielles qui déterminent le champ d'action des chirurgiens généraux. En outre, le Collège royal a adopté un programme d'études intitulé « La compétence par conception » (CPC) qui utilise des activités professionnelles confiables (APC) qui énumèrent les compétences chirurgicales que les résidents doivent maîtriser avant d'obtenir leur diplôme. Notre objectif est de comprendre les modes de pratique actuels des chirurgiens généralistes ruraux en Colombie-Britannique en fonction de ces politiques et des facteurs locaux. Les données du Medical Service Plan (MSP, Plan de service médical) ont été recueillies entre 2011 et 2021 auprès des chirurgiens généralistes travaillant dans les communautés du « Rural Subsidiary Agreement » (RSA). Les codes d'honoraires du MSP ont été organisés en procédures essentielles ou non essentielles, comme indiqué par le BCPD. Les APC ont été évalués et comparés aux procédures non essentielles. Entre 2011 et 2021, 223 103 procédures ont été réalisées dans des sites ruraux en Colombie-Britannique. En moyenne, 90,97% (écart-type = 20,78) des procédures effectuées dans toutes les communautés étaient des procédures de base du BCPD. Les soins chirurgicaux non essentiels les plus courants effectués par les chirurgiens généraux étaient la chirurgie plastique (n = 8035). Plus de 8% des procédures réalisées n'étaient pas des APC de chirurgie générale. Il est à noter qu'aucune des APC n'est considérée comme un privilège non essentiel et que toutes ont été réalisées en milieu rural. Les chirurgiens généraux travaillant en milieu rural pratiquent de nombreuses procédures en dehors de l'APC, représentant plus de 8% de leur charge de travail et environ 6% des procédures pratiquées sont des privilèges non essentiels. Cela donne une idée des limites potentielles du BCPD pour les diplômés qui espèrent exercer dans les communautés rurales. Étant donné que le programme d'études CPC est réputé offrir une approche plus souple de l'apprentissage, il peut être adapté aux objectifs d'apprentissage et de carrière des résidents, notamment en leur permettant d'acquérir des compétences chirurgicales variées pour répondre aux besoins des zones rurales.

MCQs in-training examination scores of the surgical residency program in Thailand: the relationship between medical school vs public health-based training institutions

BackgroundThis study aims at investigating and evaluating the categorical knowledge of residency using an internet-based examination.MethodsAll in-training examinees from 32 Thailand’s general surgery residency training institutions participating in the online examination. One hundred fifty Multiple Choice questions (MCQs) were selected for this examination from a pool of previous MCQs used for board certification examinations. Baseline chracteristic of the examinee including residency year, training institution (medical schools and public health-based training institutions), regional-based area of the institution, overall test score, scoring by subcategory, total time to complete the examination, and the length of accredited as a training centre time were collected and analysed.ResultsTotal 613 examinees. The mean total score of 1st and 3rd year residency of a public health hospital institution differed from those with medical school-based training. On average, the scores in 4 out of 10 categories of residency from medical school training institutions were higher. However, residency from institutions with over 7 years of experience tended to score higher in the Liver, Biliary and Pancreas category.ConclusionsThe average scores of MCQs exams which reflect the medical knowledge for general surgical residency training at medical schools do not significantly differ from those of individuals undergoing public health training. Additionally, the mean scores of MCQs exams did not differ between high-experience training institutions and recent accredited training centers.

Reliability of a workplace-based assessment for the United States general surgical trainees’ intraoperative performance using multivariate generalizability theory: a psychometric study

The System for Improving and Measuring Procedure Learning (SIMPL), a smartphone-based operative assessment application, was developed to assess the intraoperative performance of surgical residents. This study aims to examine the reliability of the SIMPL assessment and determine the optimal number of procedures for a reliable assessment. In this retrospective observational study, we analyzed data collected between 2015 and 2023 from 4,616 residents across 94 General Surgery Residency programs in the United States that utilized the SIMPL smartphone application. We employed multivariate generalizability theory and initially conducted generalizability studies to estimate the variance components associated with procedures. We then performed decision studies to estimate the reliability coefficient and the minimum number of procedures required for a reproducible assessment. We estimated that the reliability of the assessment of surgical trainees' intraoperative autonomy and performance using SIMPL exceeded 0.70. Additionally, the optimal number of procedures required for a reproducible assessment was 10, 17, 15, and 17 for postgraduate year (PGY) 2, PGY 3, PGY 4, and PGY 5, respectively. Notably, the study highlighted that the assessment of residents in their senior years necessitated a larger number of procedures compared to those in their junior years. The study demonstrated that the SIMPL assessment is reliably effective for evaluating the intraoperative performance of surgical trainees. Adjusting the number of procedures based on the trainees' training stage enhances the assessment process's accuracy and effectiveness.

When the first try fails: re-implementation of SIMPL in a general surgery residency

BackgroundWorkplace-based assessment (WBA) can facilitate evaluation of operative performance; however, implementation of WBA is sometimes unsuccessful. The American Board of Surgery Entrustable Professional Activities WBA project was launched in July 2023. Some programs will face the challenge of re-implementation of a WBA following previous failures. It is unknown what interventions are most effective for WBA re-implementation. Our goal is to identify barriers and facilitators to re-implementing SIMPL, an operative performance WBA.MethodsThe System for Improving and Measuring Procedural Learning (SIMPL) was implemented at our residency in 2018, but usage rates were low. We interviewed residents and faculty to identify barriers to usage and opportunities for improvement. Residents reported that SIMPL usage declined because of several factors, including a low faculty response rate, while some faculty reported not responding because they were unable to login to the app and because usage was not mandated. We then re-implemented SIMPL using a plan based on Kotter’s Model of Change. To evaluate impact, we analyzed rates of SIMPL usage when it was first implemented, as well as before and after the date of re-implementation.ResultsIn September 2022, we re-implemented SIMPL at our program with measures addressing the identified barriers. We found that, in the six months after re-implementation, an average of 145.8 evaluations were submitted by residents per month, compared with 47 evaluations per month at the start of the original implementation and 5.8 evaluations per month just prior to re-implementation. Faculty completed 60.6% of evaluations and dictated feedback for 59.1% of these evaluations, compared with 69.1% at implementation (44% dictated) and 43% prior to re-implementation (53% dictated).ConclusionsAfter identifying barriers to implementation of a WBA, we re-implemented it with significantly higher usage by faculty and residents. Future opportunities exist to implement or re-implement assessment tools within general surgery programs. These opportunities may have a significant impact in the setting of national standardization of workplace-based assessment among general surgery residencies.

Non-Designated Preliminary to Categorical Resident: Is It All About the ABSITE?

Obtaining a categorical general surgery residency position is recognized as a highly challenging process, and many aspiring surgeons find themselves matching into a preliminary position. The American Board of Surgery In-Training Examination (ABSITE) is relevant as a discriminator, as it is the only national evaluation metric that compares residents between programs. This study examines the correlation between ABSITE performance and the likelihood of obtaining a categorical position for non-designated preliminary surgery residents. Retrospective analysis of preliminary residents who completed the ABSITE between 2011 and 2021 at a single academic training program. 108 preliminary residents were included. Among preliminary residents who were successful in securing a categorical position, the average ABSITE percentile was 59 (SD = 26.7). In contrast, those who were not able to secure a categorical position, the average ABSITE percentile was 23.6 (SD = 25.3). There was a strong significant correlation between ABSITE percentile and securing a categorical position (P < 0.001). There was a significant association between citizenship and gaining a categorical position, with US citizens being significantly more likely to successfully gain a categorical position (P = 0.01; OR 3.32 (95% CI 1.28-8.56)). There was not a significant correlation between citizenship and ABSITE score. This study presents compelling evidence that ABSITE percentile score is positively associated with the probability of securing a categorical position for preliminary general surgery residents. It is therefore imperative that both preliminary residents and their programs place a high value on ABSITE performance to enhance successful career progression.

A multi-institutional study from the United States Resident OPerative Experience (ROPE) Consortium examining factors influencing vascular surgery specialization among general surgery residents

ObjectiveThere remains a progressive projected deficit in the vascular surgery (VS) workforce for decades. Despite the expanding integrated VS residency pathway, the fellowship training model remains critical in supporting our future workforce. Therefore, it is imperative to understand the resident and program-specific factors that influence VS specialization among general surgery (GS) residents. MethodsData from the United States Resident OPerative Experience (ROPE) Consortium, which comprises 20 Accreditation Council for Graduate Medical Education-accredited GS residency programs across the United States, were queried for resident demographics and residency program-related details. Logistic regression analysis was used to identify factors associated with VS specialization. ResultsFrom 2010 to 2020, a total of 1343 graduating GS residents were included in the study. Of these, 135 (10.1%) pursued VS fellowship training. Residents pursuing VS were more frequently male (80.7% vs 62.8%; P < .0001) and younger (median age, 32 vs 33 years; P = .03) compared with other GS residents. Racial and ethnic group, underrepresented in medicine status, and international medical graduate status were similar between the VS and non-VS groups. Residency program-level details were also similar between groups, including program type (university vs community-based), region, size, resident volume, dedicated research experience, and National Institutes of Health funding. Dedicated vascular rotations were common among all GS programs (95.4%), and total months spent on a VS rotation (median, 4 vs 4.5 months; P = .11) did not differ among residents pursuing VS and all other residents. The presence of a collocated traditional (5 + 2) VS fellowship (91.1% vs 90.4%; P = .79) or integrated (0 + 5) VS residency (56.3% vs 55.0%; P = .77) were also similar between groups. On multivariate analysis, only male sex (odds ratio, 2.34; 95% confidence interval, 1.50-3.81; P < .001) was associated with pursuing VS fellowship. Factors that did not impact VS specialization included resident age, underrepresented in medicine status, international medical graduate status, program volume, dedicated research experience, or total months spent on a VS rotation. ConclusionsIn this multi-institutional study, we did not find any program-specific factors that influence VS specialization among GS residents. Notably, the presence of a collocated 0 + 5 residency or 5 + 2 fellowship program did not appear to deter GS residents from pursuing a VS fellowship. These data suggest that individual factors, such as mentorship, may be more impactful in recruiting GS residents to the VS specialty.

Health Disparities Curricula in General Surgery Residency Programs: A Critical Scoping Review

IntroductionIn 2021, the structural determinants of health (SDOH) were added to the Accreditation Council of Graduate Medical Education common program requirements for all accredited residency programs, including general surgery. In this study, we sought to explore the current scope of, and concepts used in, health disparities curricula for general surgery residents, specifically investigating how general surgery residents learn about health disparities and the SDOH. MethodsWe searched PubMed, EMBASE, Education Research Complete (EBSCOhost), and Web of Science Core Collection using keywords related to health disparities and the SDOH. Inclusion criteria consisted of all studies published after 2005 that discussed health disparities curricula for Accreditation Council of Graduate Medical Education–accredited general surgery residency programs. Five thousand three hundred seventeen articles were screened using a two-phase process. Data extraction and analysis was performed using critical review methods. ResultsSeventeen articles were identified. Within these articles, seven unique health disparities curricula were found. All seven of the identified curricula employed cultural frameworks as methods to mitigate health disparities. Three curricula, all published after 2011, included education on the SDOH. A wide variety of educational methods were utilized; in-person didactics was the most common. ConclusionsIn the current literature, culture continues to play a large role in health disparities training for general surgery residents. Though further efforts are needed to understand the methods used in programs that have not published scholarly work, it is imperative to ensure that residents are provided with the sociopolitical perspective needed to understand the SDOH and serve all patients, including those affected by health disparities.