General Surgery Residents Research Articles

Factors Influencing Underrepresented Minority Applicants’ Ranking of General Surgery Residency Programs

Background: Underrepresented minorities (URM) are disproportionately lacking in academic surgery, yet there is wide variation in URM in residency programs. This mixed methods study aims to describe factors that URM interns identified as important in their rank list of general surgery residency programs. These data will aid institutions in increasing URM representation and creating supportive training environments in academic surgery. Methods: We employed a mixed methods approach using an online survey and semi-structured interviews developed through focus group engagement and literature review. Interviews were audio recorded, transcribed, and coded for themes. We conducted narrative thematic analysis. Results: Sixty-four incoming general surgery interns completed the survey with median age 25 to 29. Of respondents, 67% identified as female and 34% as URM. URM general surgery interns were more likely to rate program benefits and finances, revisit opportunities (ie, organized post-interview revisit weekends), and post-graduate job opportunities higher than were non-URM participants (p<0.05). URM participants also ranked factors such as diversity of residents and faculty and diversity and inclusion statements by programs higher than did non-URM participants (p<0.05). Five URM interns completed semi-structured interviews. Qualitative themes influencing URM interns’ rank list decisions included (1) presence of URM in the program, (2) program support of resident-led goals, (3) active inclusivity initiatives, and (4) direct experiences of current URM residents. All interview participants relied heavily on interactions with current URM residents as a source of information. Detractors from programs included interns concerned with being the only person of color at their prospective program and no concrete initiatives or goals in place to support diversity and inclusion, raising concern for performative allyship. Conclusions: When evaluating residency programs, URM weighed current representation and support of URMs, active diversity and inclusion initiatives within a program, and lived experiences of URM residents. Surgery residency programs should take steps to not only intentionally recruit URM applicants but also create a supportive training environment that is diverse, inclusive, and empowering.

Surgical Resident Education and Performance in Extended Focused Abdominal Sonography for Trauma.

Extended focused assessment with sonography for trauma (eFAST) is a rapid triage tool aiding the detection of life-threatening injuries. In academic settings, residents perform most eFAST; however, the ACGME has no recommendations for eFAST training standards. We surveyed general surgery programs (GSPs) regarding eFAST training and established a baseline for sensitivity, specificity, and positive and negative predictive values for resident-performed eFAST. US GSP eFAST surveys were conducted by email and phone. We prospectively collected patient variables and evaluated resident performance from May to September 2022 and 2023 at an academic level I trauma center. A total of 60/339 general surgery residency programs (GSRPs) responded: Ten use Advanced Trauma Life Support (ATLS) only, n = 7 group training, n = 8 on-the-job only, and n = 33 several methods. Resident-performed eFAST had accuracy = 85.6%, sensitivity = 35.6%, specificity = 97.2%, PPV = 75%, and NPV = 87%. General surgery residency program training in eFAST is non-standardized. Sensitivity was considerably lower than the literature suggests. Positive resident-performed eFAST is generally accurate. We recommend a standardized approach to resident training in eFAST.

Trends in gastric surgery operative experience among general surgery residents in the United States: A nationwide retrospective analysis

BackgroundGastric surgery is a crucial component of general surgery training. However, there is a paucity of high-quality data on operative volume and the diversity of surgical procedures that general surgery residents are exposed to. MethodsWe conducted a retrospective analysis of operative case logs of all general surgery residents graduating from the American College of Graduate Medical Education–accredited program from 2009 to 2022. Data on the mean number of gastric procedures, including the mean in each subcategory, were retrieved. A Mann-Kendall trend test was used to investigate trends in operative volume. ResultsBetween 2009 and 2022, the mean overall logged gastric procedures rose significantly (τ = 0.722, P < .001) from 36.2 in 2009 to 49.2 in 2022 (35.9% increase). The most substantial growth was seen in laparoscopic gastric reduction for morbid obesity (mean 1.9 in 2017 to 19 in 2022; τ = 0.670, P = .009). A statistically significant increase was also seen in laparoscopic partial gastric resections, repair of gastric perforation, and “other major stomach procedures” (P < .05 for all comparisons).Open gastrostomy, open partial gastric resections, and open vagotomy all significantly decreased (P < .05 for all comparisons). There was no significant change in the volume of laparoscopic gastrectomy, total gastric resections, and non-laparoscopic gastric reductions for morbid obesity (P > .05 for all comparisons). ConclusionThere has been a substantial increase in the volume of gastric surgery during residency over the past 14 years, driven mainly by an increase in laparoscopic gastric reduction. However, there may still be a need for further gastric surgical training to ensure well-rounded general surgeons.

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Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs.

The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones. Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman's correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings. A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455). Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees.

Evaluation of the approach of General Surgery Specialists in Turkey to surgical videos published on YouTube

Objective: YouTube is an extremely popular social media platform used to watch, upload and share videos. YouTube contains many surgical videos intended for educational or marketing purposes. This article primarily aims to reveal Turkish general surgeons’ approach to and interest in social media, with a special focus on YouTube, and to discuss the pros and cons of YouTube as an educational source. Methods: An online survey of general surgery residents and attending physicians was conducted between April 2021 and May 2021 using a 16-item questionnaire. Participants were first asked to provide consent and provide demographic data such as age, sex and medical title, and then to answer questions about the use of social media, particularly YouTube, viewing surgical videos on YouTube, the ethical aspect of posting surgical videos on social media and whether or not they use it for educational purposes. Statistical analysis was conducted using descriptive statistics, ratios and frequencies. Results: The survey was completed by 46 general surgeons with various medical titles from different healthcare institutions. Most participants reported using YouTube to watch videos (95.7%). Almost a quarter (28.3%) reported frequently using YouTube to view surgery videos. Furthermore, most participants (87%) found the surgery videos on YouTube educational (91.3%). One of the striking results was that 52.2% of the participants reported that they had a friend who performed a first-time surgical procedure after watching it on YouTube. In addition, most surgeons considered it ethically appropriate to use surgical videos from YouTube as an educational source (76.10%). Conclusion: YouTube draws great interest from general surgeons as well as other members of society. General surgeons watch surgical videos on YouTube for educational purposes and find it ethical to post such videos. However, more extensive studies are needed to clarify further the role of increasingly used video-sharing platforms in education.

Assistance by adaptative damping on a complex bimanual task in laparoscopic surgery.

Laparoscopic surgery has improved outcomes in abdominal surgery, but presents kinematic restrictions for surgeons. Robotic comanipulation with adaptative damping has been investigated in simple laparoscopic tasks. The present protocol aimed to determine the contribution of adaptive damping in complex bimanual tasks approaching clinical setting. Fourteen residents in general surgery performed three exercises, and for each three repetitions without (classic repetitions) and three with robotic assistance (robotic repetitions) in a randomised order. The exercises chosen were trajectory, modified Pea on a Peg and intracorporeal suture. Task performance, gesture performance, workload and impression were measured. Also, a semi-directed interview was performed to collect the participants' feeling about companipulated robots and their potential application in clinical practice. Adaptative damping assistance did not impact task performance, but allowed an economy of movement in the non-dominant hand during suture exercise (distance 916 ± 500mm in classic vs. 563 ± 261mm in robotic, p < 0.001). Perceived workload (p = 0.12) and user's impression were not different between classic and robotic repetitions, except novelty (p < 0.001). Participants' interviews revealed their interest for the robotic devices, particularly the gravity compensation, and were ready to use the adaptative damping provided an intermittent use, for example to dissect dangerous areas. Adaptative damping applied by comanipulated robots does not influence the performance of the task, but improves the performance of the gesture itself, particularly for the non-dominant hand, and during the realisation of a complex task like suturing. For residents in digestive surgery, this assistance does increase workload, and they would use this help in the operating room under certain conditions.

Cultivating emotional intelligence in general surgery residents through a patient-centered experience

BackgroundEmotional intelligence (EI) can decrease physician burnout. EI and burnout were assessed in surgical residents through participation in Patient-Centric Resident Conferences (PCRCs), which incorporated patients in resident education. We hypothesized PCRCs would improve EI and reduce burnout. MethodsThis was a single institution study of General Surgery residents from 2018 to 2019. Residents participated in standard didactic conferences and PCRCs. The Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) survey and an ACGME burnout survey were administered at three time points. ResultsHigher EI scores correlated with lower burnout scores over three survey distributions (R2 0.35, 0.39, and 0.68, respectively). EI and burnout scores did not change significantly over time. EI and burnout were not associated with conference attendance, meaning in work, or satisfaction with teaching. ConclusionsGeneral Surgery resident EI and burnout scores were inversely correlated. Previously, PCRCs were shown to be associated with increased resident meaning in work. The current study demonstrates PCRCs did not have a significant impact on measures of resident EI or burnout. Further research is needed for EI and burnout in surgery.

Structured Textbook Review and Individualized Learning Plans Successfully Remediate Underperforming Residents and Improve General Surgery Program Performance on the ABSITE.

We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance. This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE. Curriculum implementation resulted in a statistically significant reduction in the number of residents scoring below the 35th percentile, from 50% to 30.8% (P = .023). One hundred percent of residents initially scoring below the 35th percentile were successfully remediated over the study period. Average overall program ABSITE percentile scores increased from 38.5% to 51.4% over a 2-year period. Structured textbook review and testing combined with a question-writing assignment and a SCORE-focused ILP successfully remediated residents scoring below the 35th percentile and improved general surgery residency ABSITE performance.

A needs assessment for simulation in African surgical education.

There is a critical need for comprehensive surgical training in African countries given the unmet surgical burden of disease in this region. Collaborative and progressive initiatives in global surgical education will have the greatest impact on trainees. Little is known about surgical education needs from the perspective of practicing surgeons and trainees in low-middle-income countries (LMICs). Even less is known about the potential role for simulation to augment training. A modified Delphi methodology with 2 rounds of responses was employed to survey program directors (PD) and associate program directors (APD) of Pan-African Association of Christian Surgeons (PAACS) general surgery residency programs across eight low-middle-income countries in Africa. 3 PD/APDs and 2 surgical residents participated in semi-structured interviews centered around the role of simulation in training. Descriptive analysis was performed to elicit key themes and illustrative examples. The survey of program directors revealed that teaching residents the psychomotor skills need to perform intracorporeal suturing was both high priority and desired in multiple training sites. Other high priority skills were laparoscopic camera driving and medial visceral rotation. The interviews revealed a specific desire to perform laparoscopic surgery and a need for a simulation curriculum to familiarize staff and trainees with laparoscopic techniques. Several barriers to laparoscopic surgery exist, such as lack of staff familiarity with the equipment, lack of public buy in, and lack of generalizable and adaptable educational modules. Trainees saw utility in the use of simulation to optimize time in the operating room and sought opportunities to improve their laparoscopic skills. Faculty and surgical trainees in LMICs have interest in learning advanced surgical techniques, such as laparoscopy. Developing a simulation curriculum tailored to the trainees' local context has the potential to fill this need.

Comparing resident operative volumes for routine general surgery cases at academic, urban community, and rural training sites.

Surgical training traditionally took place at academic centres, but changed to incorporate community and rural hospitals. As little data exist comparing resident case volumes between these locations, the objective of this study was to determine variations in these volumes for routine general surgery procedures. We analyzed senior resident case logs from 2009 to 2019 from a general surgery residency program. We classified training centres as academic, community, and rural. Cases included appendectomy, cholecystectomy, hernia repair, bowel resection, adhesiolysis, and stoma formation or reversal. We matched procedures to blocks based on date of case and compared groups using a Poisson mixed-methods model and 95% confidence intervals (CIs). We included 85 residents and 28 532 cases. Postgraduate year (PGY) 3 residents at academic sites performed 10.9 (95% CI 10.1-11.6) cases per block, which was fewer than 14.7 (95% CI 13.6-15.9) at community and 15.3 (95% CI 14.2-16.5) at rural sites. Fourth-year residents (PGY4) showed a greater difference, with academic residents performing 8.7 (95% CI 8.0-9.3) cases per block compared with 23.7 (95% CI 22.1-25.4) in the community and 25.6 (95% CI 23.6-27.9) at rural sites. This difference continued in PGY5, with academic residents performing 8.3 (95% CI 7.3-9.3) cases per block, compared with 18.9 (95% CI 16.8-21.0) in the community and 14.5 (95% CI 7.0-21.9) at rural sites. Senior residents performed fewer routine cases at academic sites than in community and rural centres. Programs can use these data to optimize scheduling for struggling residents who require exposure to routine cases, and help residents complete the requirements of a Competence by Design curriculum.

Measuring Chief Resident Skill and Entrustment Progression in An Operative Coaching Program: Four Years’ Experience

Operative coaching (OC) may facilitate improvement of surgery residents' competencies by optimizing learning and teaching. We investigated how residents' operative skills and prospective entrustment (PE) progress throughout the chief year in our OC program, how OC is perceived by participants, and how OC may facilitate learning and teaching. This is a mixed-methods study conducted within the Ohio State University Wexner Medical Center General Surgery residency. Validated performance evaluations with procedural-specific skill, general skill (GS), step-specific guidance required (SSG) (an autonomy measure), and PE measures completed by chiefs, faculty coaches, and attending surgeons from 7/2018 to 6/2022 were reviewed. We also interviewed OC participants to understand their experience. Descriptive statistical and qualitative content analysis were applied. 441 evaluations from 147 OC cases completed by 22 chiefs, 5 faculty coaches, and 24 attendings were included. Overall, resident GS (p = 0.036), SSG (p = 0.023), and PE (p = 0.002) significantly improved throughout the year. PE significantly correlated (all p < 0.0001) with SSG (r = 0.73), followed by procedural-specific skill (r = 0.59), then GS (r = 0.57). On average, chiefs underestimated their surgical skills while attendings overestimated autonomy they permitted to residents. Chiefs, coaches, and attendings reached consensus on chiefs' PE upon graduation. Five graduated chiefs and 5 attendings were interviewed. Chiefs described OC as effective in improving their self-regulated learning and particularly valued 3 OC elements: neutral authentic feedback, third-party real-time observation, and actionable feedback. Attendings noted OC promoted their engagement in skills assessment and teaching. Our findings suggest chief residents' skills, autonomy, and PE progress steadily along their OC journey. Despite differences in residents', coaches', and attendings' perceptions of skill, measures of autonomy reliably correlate with entrustment. OC promotes resident learning, faculty teaching, and assessment of resident skills, autonomy, and PE in the OR.

Can my surgeon scope? Trends in endoscopy training volume and experience among general surgery residents in the United States: a nationwide analysis.

Endoscopy is a major part of surgical training. Accreditation Council for Graduate Medical Education (ACGME) has set standards regarding the minimum volume of endoscopy cases required for graduation. However, there is paucity of high-quality data on the number of cases that most surgical graduates perform. We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from ACGME-accredited programs from 2010 to 2023. Data on mean number of endoscopy cases, including mean in each subcategory, were retrieved. Mann-Kendall trend test was used to investigate trends in endoscopy experience. Between 2010 and 2023, the mean overall endoscopy procedures per resident remained stable, with 129.5 in 2010 and 132.1 in 2023 (t = 0.429; p-value = 0.037). The majority of these cases were performed as surgeon junior (76.6% in 2010; 80.9% in 2023), while the remaining cases were logged as surgeon chief. The most substantial contribution to the overall volume was from flexible colonoscopy (mean: 64.1 in 2010 and 67.2 in 2023). The volume for colonoscopy remained fairly stable (t = 0.429; p-value = 0.036). This was followed by esophagogastroduodenoscopy (mean: 35.3 in 2010 and 35.5 in 2023), which saw a significant increase in volume (t = 0.890; p-value ≤ 0.001). There was a significant increase in the number of overall upper endoscopic procedures (t = 0.791; p-value ≤ 0.001), while lower endoscopic procedures did not change significantly (t = 0.319; p-value = 0.125). The procedural volume for endoscopic retrograde cholangiography, sigmoidoscopy, cystoscopy/ureteroscopy, laryngoscopy, and bronchoscopy decreased significantly (p-value < 0.05 for all). The overall endoscopy volume for general surgery residents has largely remained stable, with a minor increase in esophagogastroduodenoscopy and no change in colonoscopy. Future research should investigate whether simulation-based exercises can bridge the gap between procedural volume and learning curve requirements for endoscopy.

General Surgery Residents Improve Efficiency but Not Hospital Length of Stay in Trauma Care.

Background Good Samaritan University Hospital (GSUH) has been preliminary approved to become a Level I Trauma Center. The American College of Surgeons (ACS) requires Level I Trauma Centers to have senior surgery residents on the trauma service. To fulfill this requirement, GSUH has established an affiliation with Stony Brook University Hospital, a tertiary care hospital with an Accreditation Council for Graduate Medical Education-approved five-year postgraduate training program in General Surgery, to have senior surgery residents from their training program rotate and provide care to trauma patients beginning in July of 2021. Numerous studies over the past few decades have shown conflicting results on patient outcomes with resident involvement. A majority of the studies published only evaluated residents who were native to the respective hospitals. Our study evaluated the impact of surgery residents visiting from an outside hospital on hospital length of stay (LOS) in admitted trauma patients. As increased hospital LOS is strongly associated with increased hospital-acquired complications, increased healthcare costs, and poor patient experience, we used this to evaluate the efficiency of our trauma team with the addition of visiting surgery residents. Methodology A retrospective study was conducted utilizing the hospital's trauma registry. Patients were divided into two groups: the first two years before the addition of surgery residents from July 1st, 2019, to June 30th, 2021, and the second two years after the addition of surgery residents from July 1st, 2021, to June 30th, 2023. The primary outcome measured the hospital LOS between the two groups. Pearson's chi-square test was used to analyze all categorical data, and a t-test was used to compare differences in means. Results From July 1st, 2019, to June 30th, 2023, a total of 7,081 patients were admitted to the trauma service: 3,411 in the group with no surgery residents, and 3,670 patients in the group with residents (p = 0.052). The primary outcome, hospital LOS, was not significantly affected by the addition of surgery residents to the trauma service. Hospital LOS before surgery residents was 4.40 days compared to with residents at 4.41 days (p = 0.944). Mortality was significantly decreased with resident involvement at 1.9% compared to no residents at 2.7% (p = 0.017). Interestingly, the Emergency Department LOS was significantly longer in the group with residents, 268.82 minutes vs. 232.19 minutes (p = 0.004). The average New Injury Severity Score was 9.02 in the group with no residents and 9.04 in the group with surgery residents (p = 0.927). The majority of traumas in both groups were blunt trauma 96.5% with no residents vs. 97.1% with residents (p = 0.192). Conclusions The addition of visiting surgery residents to the trauma team did not significantly increase hospital LOS. Ultimately, having visiting residents on the trauma service may enhance resident education without compromising hospital LOS. Training at different hospitals can allow residents to experience different patient populations and different hospital protocols, making them adaptable and more prepared to work in different hospital settings, whether academic or community. Hospitals without their own residency programs could potentially form affiliations with residency programs to meet the ACS requirements, which can bring more patients to their hospitals.

Preliminary Development of a Program ABSITE Dashboard (PAD) to Guide Curriculum Innovation

Medical Knowledge for general surgery residents' is assessed by the American Board of Surgery In- Training Examination (ABSITE). ASBITE score reports contain many metrics residency directors can utilize to assess resident progress and perform program evaluation. The purpose of this study was to develop a framework to evaluate program effectiveness in teaching specific subtest and subtopic areas of the ABSITE, using ABSITE score reports as an indicator. The aim is to demonstrate the identification of topic areas of weakness in program-wide performance on the ABSITE to guide proposed modification of the general surgery residency program curriculum, and to initiate development of a data visualizing dashboard to communicate these metrics. A single institution retrospective study was performed utilizing ABSITE score reports from general surgery residents at a large academic training program from 2017 to 2020. ABSITE performance metrics from 320 unique records were entered into a database; statistical analysis for linear trends and variance were conducted for standard scores, subtest standard scores, and incorrect subtest topics. Deviation from national average scores were calculated by subtracting the national average score from each subtest score for each trainee. Data were displayed as medians or proportions and are displayed to optimize visualization as a proof-of-concept for the development of a program dashboard. Trends and variance in general surgery program and cohort performance on various elements of the ABSITE were visualized using figures and tables that represent a prototype for a program dashboard. Figure A1 demonstrates one example, in which a heatmap displays the median deviation from national average scores for each subtest by program year. Boxplots show the distribution of the deviation from national average, range for national average scores, and the recorded scores for each subtest by program year. Trends in median deviation from the national average scores are displayed for each program year paneled by subtest or for each exam year paneled by cohort. Median change in overall test scores from one program year to another in a cohort is visualized as a table. Bar graphs show the most often missed topics across all program years and heatmaps were generated showing the proportion of times each topic was missed for each subtest and exam year. We demonstrate use of ABSITE reports to identify specific thematic areas of opportunities for curriculum modification and innovation as an element of program evaluation. In this study we demonstrate, through data analysis and visualization, feasibility for the creation of a Program ABSITE Dashboard (PAD) that enhances the use of ABSITE reports for formative program evaluation and can guide modifications to surgery program curriculum and educational practices.

Factors associated with general surgery residents’ perceptions of vascular surgery

ObjectivesShortages of vascular surgeons are projected through 2050, and vascular surgery fellowships (VSFs) remain a critical pathway for training vascular surgeons. We sought to identify general surgery (GS) residents' perceptions of/attitudes toward VS. MethodsAnonymous, electronic questionnaires were sent to GS residents. Questions assessed demographics, fellowship preferences, and exposure to and perceptions of VS. Univariate and multivariate analyses were performed. ResultsOf 152 respondents (15% response rate), 20 (13.2%) will apply for VSF, 64 (42.1%) are interested in VS (IVS), 62 (40.8%) are not interested in VS (NIVS), and 6 (3.9%) remain undecided. Overall, among respondents encompassing all postgraduate years, 106 (69.7%) felt comfortable with medical management of vascular disease, 52 (34.2%) felt comfortable with open surgical management, and 14 (9.2%) felt comfortable with endovascular management. Compared with residents NIVS, trainees planning on applying for VSF or IVS reported greater familiarity with diseases treated (97.6%; P = .003) and procedures performed (88.1%; P = .013) by vascular surgeons. Those applying for VSFs were more likely to perceive they were essential members of the vascular team (P = .003), and their time in the operating room was productive (P = .001). Fifty-five (36.2%) respondents believed their exposure to VS in residency was inadequate for a surgeon not pursuing a VSF. More trainees NIVS reported disrespectful treatment by VS attendings, residents, and fellows (P = .043). Stratified by gender, 25 female residents (29.4%) cited male dominant (P < .001) as a reason for not choosing VS. When asked how vascular training programs impacted exposure while on VS rotations, 45 residents (70.3%) at institutions with both a VSF and integrated VS residency indicated diminished experiences owing to the presence of vascular trainees (P = .014), and 25 (39.1%) expressed lower satisfaction with their rotation (P = .012). ConclusionsExposure to VS during GS residency may be inadequate for a general surgeon entering practice. Reasons for not pursuing a VSF included disrespectful interactions from VS residents, fellows, and attendings, as well as a male-dominant field. Residents at institutions with vascular training programs expressed lower satisfaction and experiences gained. Improving these factors may increase interest in VSFs.

Description of the Dunning-Kruger effect in general surgery residents during laparoscopic cholecystectomy: a blinded prospective study.

The purpose of this study is to assess whether the Dunning-Kruger effect occurs in surgical residents when performing laparoscopic cholecystectomy in a porcine model. Prospective blinded study, which counted with forty PGY-1 general surgery residents who agreed to participate in the study were blindly recruited to perform a laparoscopic cholecystectomy in a porcine model. At the end of the procedure, the participants assigned a score of 0-10 for their own performance and the video of the operation was independently assessed by 2 experienced laparoscopic surgeons using a validated tool. Participants were divided into groups of 10 individuals according to objective performance and compared. The group with the worst objective result was inferior to the group with the best objective result (3.77 ± 0.44 vs. 8.1 ± 0.44, p < 0.001), but they were similar in self-perception of performance (5.11 ± 1.69 vs. 6.1 ± 1.79, p = 0.999). In the studied sample, it was possible to demonstrate the presence of the Dunning-Kruger effect.

Gender diversity in pediatric surgery: academic ranks and scholarly productivity amongst pediatric surgeons.

Despite a growing number of women entering medical school, a small proportion of women pursue surgical specialties, including pediatric surgery. This multi-center study assesses gender-based differences in measures of scholarly productivity and distribution of faculty positions. This is a retrospective web-based study of all pediatric surgeons at twelve large institutions across the United States. Data published by the American Association of Medical Colleges was compiled and analyzed to understand the gender distributions of medical students, general surgery residents, and pediatric surgery fellows. P-values were calculated using two-sided Student's independent t-tests and chi-squared tests. There have been a growing number of women applying into pediatric surgery, but the proportion of women matriculating into these fellowships is not concordant. Women are still underrepresented (28%) amongst the pediatric surgeon workforce. A total of 111 pediatric surgeons were identified for this study, which included 31 women (28%) and 80 males (72%). There was a significant difference in the distribution across academic ranks between genders (p < 0.001). Women had significantly fewer publications per year after residency, fewer total publications, and a lower h-index in comparison to men (p < .001, p = .005, p = .002, respectively). Women are not only underrepresented in pediatric surgery, but there are also significant differences in the distribution of faculty positions and scholarly productivity when comparing men and women. There is a pressing need to improve gender diversity and identify barriers that may prevent women from advancing to leadership positions and achieving professional success.

Faculty perception of resident promotion and prevention associated behaviors in the operating room to facilitate intra-operative learning

Previous work has demonstrated that residents are able to accurately perceive the intraoperative motivational style of faculty. Additionally, alignment of motivational style between residents and faculty has been demonstrated to enhance resident intraoperative autonomy. This study evaluated if faculty perception of resident behaviors aligned with resident self-perception in order to identify ways of enhancing intraoperative learning. General surgery residents were asked to complete a self-assessment evaluating their own intraoperative behaviors. Conversely, faculty rated how strongly the residents exhibited these behaviors in the operating room. Of the 10 intraoperative behaviors that were evaluated, eight demonstrated no correlation between resident self-perception and faculty perception of resident behavior. Similarly, inconsistent correlations emerged when behaviors were assessed according to the self-reported gender and race of the resident. Faculty are not able to accurately perceive the motivational style of residents. Strategies to improve faculty perception of resident motivational style may enhance intraoperative learning.

Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases

ObjectiveTo evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. MethodsDuring a period of two years, all General Surgery resident doctors at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. ResultsThere was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. ConclusionThe impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.