Independent Residents Research Articles

Quantifying the Pipeline of Ethnically Underrepresented in Medicine Physicians in Academic Plastic Surgery Leadership.

The lack of underrepresented in medicine (UIM) physicians in academic plastic surgery is emerging as a critical issue. Lack of diversity has a negative effect on patient care and on the culture of our health care system. This study reports the current status of ethnically UIM physicians in the plastic surgery pipeline, starting from the medical student level and progressing to national leadership positions. The Electronic Residency Applications Service, National Resident Matching Program, Association of American Medical Colleges, and professional Web sites for journals and national societies were accessed for racial demographic information from 2008 to 2019. Over the past decade, there has been no change or a slight decrease in representation of Blacks among plastic surgery residency applicants, trainees, and academic faculty, at half or less than expected, compared with US Census data. The first point of drop-off occurs at the resident (3.8% of integrated and 5.6% of independent residents) to faculty level (<2.8%). Two percent of program directors and department heads/division chiefs are Black. The next point of drop-off occurs at the national level: there has never been a Black president of American Society of Plastic Surgeons or Plastic Surgery Foundation, and there are no Black editors-in-chiefs of major plastic surgery journals.Following LatinX American surgeons down the pipeline over the past decade, there has been no change or a decrease in representation among plastic surgery residency applicants, resident physicians, and academic faculty, at one-third or less than expected, compared with US Census data. The first point of drop-off occurs at the faculty (4.8%) to local leadership level (0% of program directors and department heads/division chiefs) where there is no representation of LatinX. Once this drop-off occurs, there is no recovery at the national leadership level. In order for our profession to reflect our nation's demographics, academic plastic surgery is in need of a paradigm shift now. Attrition of UIM physicians in plastic surgery begins at medical school graduation and persists through surgical training, faculty appointments, and attainment of leadership positions. Creative and innovative commitment to diversity and inclusion is necessary.

First-Year Survival of Northern Fur Seals (Callorhinus ursinus) Can Be Explained by Pollock (Gadus chalcogrammus) Catches in the Eastern Bering Sea

The Pribilof northern fur seal (Callorhinus ursinus) herd in the eastern Bering Sea has declined by ~70% since the 1970s, for elusive reasons. Competition for pollock (Gadus chalcogramma) with the commercial fishery has been suspected as a contributing factor, but no correlative relationship between fishing activity and fur seal population declines has heretofore been demonstrated. Here, we present evidence for a moderately strong inverse relationship between fishery catches of pollock and first-year survival of fur seals, based on three different approaches to evaluation. We suspect this relationship results from the dependence of lactating female fur seals on locating dense and extensive schools of pollock near the Pribilof Islands to efficiently provide nutrition for their pups, because the pollock fishery also targets these same schools, and when fished, the remnants of these schools are fragmented and dispersed, making them more difficult for fur seals to locate and exploit. Inadequately fed pups are less likely to survive their initial independent residence at sea as they migrate south from the Pribilof Islands in the fall. Our results imply that pollock catches above ~1,000,000 t within ~300 km of the Pribilof Islands may continue to suppress first-year survival of Pribilof fur seals below the estimated equilibrium survival value of 0.50, leading to continued decline of the population.

The Workforce Innovation and Opportunity Act: Supporting “Successful” Transitions into Adulthood

Completing education, obtaining employment, and securing an independent residence, tasks tied to an ideal of self-sufficiency are viewed as important hallmarks of adulthood. Yet, not all youth and young adults (YYA) have adequate resources and many require assistance to overcome transition barriers including lack of social support, poverty, and homelessness. This study analyzed the policy design and social justice values (equity, equality, and adequacy) of three federal workforce programs, authorized by the Workforce Innovation and Opportunity Act (WIOA), and designed to increase economic self-sufficiency among disconnected YYA. These programs lack stable and adequate funding and currently serve a small fraction of the YYA who could benefit. A value of equity is evident in the eligibility and financing criteria, while adequacy as it relates to programming—particularly benefits and services offered to address basic needs, economic stability, and healthy development—warrants further investigation. The programs’ focus on self-sufficiency through connection to education, training, and employment ignores research suggesting that at least six other dimensions are crucial for a successful transition to adulthood. Research on program entry and exit, primary services/benefits received, and life experiences of program participants is needed to determine current levels of support and the potential of these programs to enhance other components of a healthy transition including health, community engagement, and social support among disconnected YYA. Such research may also need to be focused regionally, given the highly localized control of programs.

Aging in Place: Challenges of Older Adults with Self-Reported Cognitive Decline

BackgroundAn emergent concern related to the aging and the increased risk of cognitive decline is the institutionalization of older adults. Evidence has shown that aging in place leads to many benefits, including higher quality of life. In order to support older adults, it is imperative that we understand the challenges people with changes in cognition face while aging in place.MethodsA total of sixteen older adults with self-reported cognitive decline and six informal caregivers of individuals reporting cognitive decline, all of whom are living in independent residences, participated. Focus group sessions with semi-structured interviews were conducted, followed by thematic qualitative data analyses.ResultsThematic analyses led to the identification of six challenges to aging in place, including: 1) memory decline, 2) emotional challenges/low mood, 3) social isolation/loneliness, 4) difficulty with mobility and physical tasks, 5) difficulties with activities of daily living/instrumental activities of daily living, and 6) lack of educational resources on cognitive change.ConclusionThe themes identified in the current study represent common challenges in aging in place for older adults with self-reported cognitive decline. Identification of these themes allows for important next steps, which can focus on supports through targeted interventions.

Improving Medical Student Recruitment into Plastic Surgery: Pairing Orphaned Medical Students with Sister Mentorship Programs.

Accessibility to a plastic surgery residency program during medical school can significantly impact a student’s understanding of plastic surgery and enrich his or her experience by providing plastic surgery exposure as well as research opportunities to advance the specialty. For those who choose to pursue postgraduate training in plastic surgery, exposure to a residency program can also provide a “home-field advantage” when applying to Match. For these reasons, medical students who do not have access to a plastic surgery training program are at a significant disadvantage as compared with their peers. Medical students in the United States are enrolled in either allopathic or osteopathic programs. Both are accredited by the Accreditation Council for Graduate Medical Education, and graduates of either program are eligible to apply for an integrated or independent residency in plastic surgery. Forty-seven allopathic and 40 osteopathic programs do not have plastic surgery training programs at their institutions.1 This leads to an inconsistent, and often nonexistent, introduction to plastic surgery for approximately 50,000 medical students (57 percent of American medical students).2 Broadening the reach of plastic surgery and encouraging the engagement of these students should be a priority for the plastic surgery academic community. Providing all students an opportunity to evaluate their interests would likely result in a stronger, more diverse cohort of plastic surgery trainees. We believe that creating a system that encourages intentional collaboration between programs with residencies (mentorship) and those without (orphaned) will account for the deficiency of plastic surgery exposure for students from these 87 institutions. To facilitate this, we developed a database that matched each orphaned institution with multiple mentorship programs within reasonable proximity. This database was provided to the American Council of Academic Plastic Surgeons, which then requested plastic surgery program directors and coordinators reach out to their partnered orphaned institutions to offer participation in education, mentorship, and interest groups for eligible students.3 The first step of this process was implemented fairly quickly. Such an initiative would do a service to plastic surgery, so that exposure to the specialty is not restricted to those students who are fortunate enough to be at an institution with a plastic surgery training program. Further directions being undertaken include the administration of a survey to students at these orphaned institutions to ascertain their interest in pursuing plastic surgery, perception of the field, opportunities available at their institution, and concerns with entering the field from a position of relative disadvantage. Preliminary results show comparable populations considering application to residency when compared to schools with residency programs. Intensely positive feedback from these students suggests that their need for a platform is much higher than anticipated. In summary, there is no reason why plastic surgery should not be available to all students as part of their core education. Only then can we mentor and develop the passion for plastic surgery in these students, much as it was done for those of us who have chosen to make it a lifelong career. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Association of Temporary Financial Assistance With Housing Stability Among US Veterans in the Supportive Services for Veteran Families Program

Temporary financial assistance (TFA) for housing-related expenses is a key component of interventions to prevent homelessness or to quickly house those who have become homeless. Through the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) program, the department provides TFA to veterans in need of housing assistance. To assess the association between TFA and housing stability among US veterans enrolled in the SSVF program. This retrospective cohort study analyzed data on veterans who were enrolled in the SSVF program at 1 of 203 partner organizations in 49 US states and territories. Some veterans had repeat SSVF episodes, but only the first episodes were included in this analysis. An episode was defined as the period between entry into and exit from the program occurring between October 1, 2015, and September 30, 2018. Receipt of TFA. The main outcome was stable housing, defined as permanent, independent residence with payment by the program client or housing subsidy after exit from the SSVF program. Covariates included demographic characteristics, monthly income and source, public benefits, health insurance, use of other VA programs for homelessness, comorbidities, and geographic location. Multivariable mixed-effects logistic regression, inverse probability of treatment weighting, and instrumental variable approaches were used. The overall cohort consisted of 41 969 veterans enrolled in the SSVF program, of whom 29 184 (mean [SD] age, 50.4 [12.9] years; 25 396 men [87.0%]) received TFA and 12 785 (mean [SD] age, 50.0 [13.3] years; 11 229 men [87.8%]) did not receive TFA. The mean (SD) duration of SSVF episodes was 90.5 (57.7) days. A total of 69.5% of SSVF episodes involved receipt of TFA, and the mean (SD) amount of TFA was $6070 ($7272). Stable housing was obtained in 81.4% of the episodes. Compared with those who did not receive TFA, veterans who received TFA were significantly more likely to have stable housing outcomes (risk difference, 0.253; 95% CI, 0.240-0.265). An association between the amount of TFA received and stable housing was also found, with risk differences ranging from 0.168 (95% CI, 0.149-0.188) for those who received $0 to $2000 in TFA to 0.226 (95% CI, 0.203-0.249) for those who received more than $2000 to $4000 in TFA. This study found that receipt of TFA through the SSVF program was associated with increased rates of stable housing. These results may inform national policy debates regarding the optimal solutions to prevent and reduce housing instability.

Разработка системы сбора данных для мониторинга состояния атмосферного воздуха в Kрасноярском крае

Air pollution is a threat to the natural environment and human health. In Russia, there is a federal monitoring system for atmospheric air, which provides its assessment for a number of characteristics, as well as provides a forecast and prescriptions for government. In Russia and in many European countries, in addition to monitoring the quality of atmospheric air carried out by federal organizations, public monitoring is also carried out by independent organizations and interested residents of settlements. public monitoring and the availability of simple air quality measurement tools in recent years has led to the emergence of an alternative network that provides accessible and more detailed data. The measurement results in a simplified form are available to a large number of peoples, which causes a wide resonance among the population in a number of regions of the country. The paper considers the task of developing and supporting a specialized system for environmental monitoring of the state of the natural environment and resources, built on the basis of GIS technologies, the Internet, processing remote sensing data and data from stationary and mobile observation stations. Considerable attention is paid to web services and APIs. The problem of the formation of a geoinformation web-system for monitoring the state of the natural environment for the decision-making support system at the level of the Krasnoyarsk region is considered. An important role is played by the use of modern data visualization tools using GIS technologies. The main focus is on describing the problems and solutions associated with the development of web services and applications for such Internet systems. The solution to the problem of collecting, processing and efficiently assessing data on air pollution is considered on the example of the Krasnoyarsk region and the city of Krasnoyarsk, which is included in the list of the most polluted cities in the country. however, the proposed solution can be used in other cities and regions.

Characteristics and Academic Productivity Among Pediatric Plastic Surgeons in the United States.

The characteristics that predispose plastic surgeons to a career in pediatric plastic surgery remain unclear. Therefore, the aim of this study is to analyze the characteristics of current pediatric plastic surgeons and to determine their academic productivity. Pediatric plastic surgeons were identified through an internet search of all academic children's hospitals affiliated with an Accreditation Council for Graduate Medical Education-accredited integrated or independent plastic surgery program. Demographics, training background, institutional and leadership positions, and academic productivity were determined. A total of 304 pediatric plastic surgeons were identified. The majority of pediatric plastic surgeons were white (n = 217, 71.8%) males (n = 235, 77.6%). Clinical fellowships were completed by 86.8% (n = 263) of the cohort, with craniofacial (n = 181, 59.7%) being the most common followed by hand (n = 54, 17.8%); 41.1% had clinical fellowship training at 10 institutions, with the top 3 most represented programs being University of Pennsylvania (n = 19, 6.2%), University of California-Los Angeles (n = 16, 5.3%), and Harvard University (n = 15, 4.9%); 25.7% (n = 78) held leadership positions within their institutions. A significant higher academic productivity was found among research fellowship-trained surgeons, chiefs of pediatric plastic surgery, fellowship directors, and members of departments of plastic surgery. Those who completed an independent residency had a significant higher H-index and number of citations. Pediatric plastic surgery is represented by surgeons of diverse training background. An elite cohort of programs has trained the most pediatric plastic surgeons. Lastly, high academic productivity was found to be correlated with certain demographic and leadership variables highlighting its impact on career advancement.

Evaluation of plastic surgery resident aesthetic clinic websites

BackgroundThe purpose of the present study was to evaluate the website pages of integrated plastic and reconstructive surgery resident aesthetic clinics in the United States. MethodsWebsite pages dedicated to resident aesthetic clinics in all integrated plastic and reconstructive surgery residency programs (n = 79) were accessed between October and November 2019 and evaluated across several criteria, including: number of pages, procedures offered, faculty participation, respective prices, patient photographs, patient testimonials, contact information, and specific recruitment incentives. ResultsSeventy-nine integrated and 54 independent residency programs were identified, 31 of which had both an integrated and an independent residency program for a total of 102 distinct programs. Out of these, only 11 programs (10.8%) had a webpage dedicated to their resident aesthetic clinic (Figure 1). Twelve other programs (13.7%) that did not have a dedicated webpage mentioned a resident aesthetic clinic elsewhere on their residency program website. For each of the eleven programs with space for the resident aesthetic clinic, there was exactly one dedicated webpage. None of the programs with dedicated webpages included photographs of before and after cases, nor procedures performed, nor a listing of resident aesthetic clinic prices. Three of the dedicated webpages included information about faculty participation. Out of the 24 ASAPS endorsed aesthetic fellowship programs, 6 (25%) had a webpage dedicated to the fellow aesthetic clinic. Four of these webpages were comprised of a single webpage, while one program had 6 webpages and one program had 8 webpages. Only one program's webpage included before and after pictures. Four programs (16.7%) included information about faculty participation on the webpage. Five out of the 6 programs had a procedure list on the webpage. DiscussionResident aesthetic clinic websites are an important tool in recruiting patients as well as medical students. Addressing the lack and quality of such websites may improve recruitment of patients and students to plastic and reconstructive surgery residency programs. As a primary source of information for potential future residents and patients, plastic and reconstructive surgery programs need to maximize the content and utility of their websites.

The State of Burn Care Training During Plastic Surgery Residency.

There is an ongoing shortage of burn specialists, and workforce reports suggest possible hurdles attracting plastic surgeons into burn care. The purpose of this study was to (1) determine the state of burn care in plastic surgery residency and (2) identify what barriers might exist for plastic surgeons pursuing a practice that involves burn care. Surveys were distributed to North American plastic surgery program directors and residents, respectively, during the 2018-2019 academic year. Fifty-eight program directors (response, 54%) and 320 plastic surgery residents (response, 30%) participated. Burn care was felt to be an important component in training by most program directors (USA, 88%; Canada, 100%) and residents (USA, 87%; Canada, 99%). The majority of program directors included a burn unit rotation (USA, 88%; Canada, 90%). Rotations for integrated residents averaged 2.5 months and most commonly occurred during second year; independent residents spent 1.2 months on rotation, usually in first year. Three-quarters of American residents were interested in a career that involves burn care in some capacity, primarily burn reconstruction (40%). Factors that would discourage a trainee from practicing burn care in the future included the nature of burn care (60%) and burn operations (45%), the on-call commitment (39%), and a narrow scope of practice (38%). This study challenges the belief that plastic surgery trainees are disinterested in burn care. Burn surgery remains an important component of training programs, and we propose several steps to encourage greater interest and participation in the burn surgery workforce.

The relationship between care dependency and pain in nursing home residents

ContextPain is a common health problem experienced by up to 57 % of nursing home residents which has many negative side effects, including a reduced quality of life. Several studies have been carried out on the prevalence of pain and pain management. However, these study findings remain controversial. ObjectivesTherefore, the aim of this study was to compare care dependent and care independent nursing home residents with regard to their (1) pain prevalence and levels and (2) their pain management. MethodsThis cross-sectional study is conducted annually in Austrian nursing homes. We measured pain prevalence and levels by asking questions about the pain experienced and pain level measured in the seven days prior to the interview, as well as the pain experienced at the time of this interview. ResultsThe study sample comprised 81.1 % of the 1528 residents of Austrian nursing homes. Overall, pain prevalence was higher in care dependent residents than in care independent residents. Care dependent residents experienced more often mild/moderate pain than care independent residents. Both, prevalence and levels of pain were not statistically significant different between the levels of care dependency. Care dependent residents who suffered from pain received a statistically significantly higher number of non-pharmacological interventions as compared to care independent residents who suffered from pain. ConclusionsWe identified a higher prevalence of pain among care dependent residents. Furthermore, the found differences in pain relief seem to be correlated with different degrees of care dependency, an aspect that requires further investigation.

Comparing Operative Performance between Independent and Integrated Plastic Surgery Residents

Anecdotally, faculty report that independent residents' operative skills differ from those of their integrated peers. This study compared operative competency between integrated (postgraduate years 4 to 6) and independent plastic surgery residents. The authors compared independent (postgraduate years 1 to 3) and integrated (postgraduate years 4 to 6) plastic surgery residents at their institution using operative performance data from the Operative Entrustability Assessment, a validated five-point assessment tool that provides residents with real-time feedback about their operative performance, documenting performance at the point of care. Independent postgraduate year 1, 2, and 3 residents were categorized as postgraduate year 4, 5, and 6 residents, respectively, for comparison. The authors analyzed attending physician (evaluator) Operative Entrustability Assessment scores over time using the independent t test. From July 1, 2013, to June 30, 2018, Operative Entrustability Assessments were completed at one training program for residents in postgraduate years 4 to 6: 1886 (47.4 percent) by independent [n = 12 (37.5 percent)] and 2094 (52.6 percent) by integrated [n = 20 (62.5 percent)] residents. Evaluator scores were lower for independent track residents throughout the first two quarters of postgraduate year 4 (quarter 1 delta, -0.49 point, p < 0.001; quarter 2 delta, -0.36 point, p < 0.001). However, this difference was no longer statistically significant during the third and fourth quarters of postgraduate year 4 (p = 0.192 and p = 0.228, respectively). No difference was detectable at postgraduate year 5 (p = 0.095) or postgraduate year 6 (p = 0.877). Operative Entrustability Assessment data demonstrate that differences between independent and integrated plastic surgery residents regarding operative skills (0.49 of 5 points) and amount of time needed for independent residents to catch up (6 months) is minimal and resolves during the third quarter of independent postgraduate year 1. Programs can design curricula to facilitate independent residents' plastic surgery skill acquisition during their first two quarters.

Exercise and perceived quality of life among frail older adults

PurposeThe purpose of this paper is to explore the association between level of physical activity (PA) and perception of quality of life (QOL) and physical health in frail and non-frail older adults.Design/methodology/approachVolunteer participants in this quantitative cross-sectional study were a convenience sample of 236 independent residents (120 frail, 116 non-frail) in an assisted living facility in Israel. Frailty was measured by Fried et al.’s phenotype; QOL and physical health were measured using the World Health Organization Quality of Life Instruments (WHOQOL-BREF) questionnaire. PA level was ascertained from attendance lists completed by exercise class instructors in each class during the eight-week study.FindingsFrail older adults who engaged in regular PA (at least 2.5 h/week) reported the same physical health as non-frail older individuals performing a similar level.Research limitationsUnsupervised PA performed independently was not taken into consideration; exercise class attendance may be a less reliable criterion of PA than collection of objective data, i.e. calories burned; participants were selected from an economically homogeneous population of a specific assisted living facility with easy access to a variety of PA.Practical implicationsThe level of PA performed by frail older adults impacts their perceived QOL and physical health. The logs were an incentive to attend PA classes.Originality/valueA minimum of 2.5 h a week of regular PA can be a protective factor that improves perceived QOL and physical health in frail older adults.

Is the Glass-Ceiling Higher Than We Think? Sex Disparity Trends in Physician Executive Positions and Academic Plastic Surgery.

Advanced levels of professorship and executive positions are considered markers of success in medical academia. Despite sex parity in medical school graduates, sex disparities within positions of power remain unequal. The purpose of this study was to analyze sex composition at different levels of leadership at multiple academic, highly ranked institutions. Hospital executives and academic plastic surgery faculty were identified through an internet-based search of all Accreditation Council for Graduate Medical Education-accredited plastic surgery integrated and independent residency training programs. Institutions from the U.S. News 2018-19 Top 20 Best Hospitals Honor Roll and Beckers Review 2018: 100 Great Hospitals in America were also included. Information on board of directors/trustees (BOD), administrators, and plastic surgery faculty with focus on title, sex, degree, specialty, and academic rank was collected from departmental and hospital websites. Duplicate institutions were excluded. Data on chief executive officers (CEOs)/presidents (n = 275) and BOD members (n = 5347) from 153 medical institutions were analyzed. Physicians consisted of 40.7% (n = 112) of CEOs/presidents, of which 10.7% (n = 12) were surgeons, and 15.6% (n = 835) of the BOD membership. Female physicians in executive roles were disproportionally low, consisting of 5% (n = 14) of CEOs/presidents, reaching significance (P = 0.033).Sex representation within plastic surgery departments demonstrated similar trends. Women comprised 18.3% of the overall plastic surgery faculty (n = 1441). Significant differences between mean male and female plastic surgeons (8.2 vs 1.84, P = <0.001) were observed. In addition, female plastic surgeons represented only 26.3% of all assistant professors (P = <0.001), 18.75% of total associate professors (P = <0.001), and 7.8% of full professors (P = <0.001). Although women are increasingly pursuing careers in medicine and surgery, the data suggest that there remains a paucity of female physicians in top leadership roles. At the departmental level, female plastic surgeons are also underrepresented. At the executive level, men make up over 88% of physician CEOs at the highest-ranked medical institutions. This study further highlights the need for the development of educational, mentorship, and career pathways to further improve female representation in positions of power within academia.

Influencing Factors for Influenza Vaccination among South Korean Adolescents with Asthma Based on a Nationwide Cross-Sectional Study

Background:Influenza viral infection is a major public health problem with significant morbidity and mortality.Asthma is a risk factor for developing serious complications related to influenza infection. Objective: We explored factors associated with influenza vaccination coverage among adolescents with asthma. Methods: Data were obtained from 62,276 participants in the 13th Korean Youth Risk Behavior Web-Based Survey (KYRBS) conducted in 2017. KYRBS data were obtained from a stratified, multistage, clustered sample. We used multiple logistic regression analyses to identify variables potentially related to influenza vaccination in adolescents with asthma. Results: The proportion of asthma was 8.8%, and the influenza vaccination rate overall was 37.9%. It was 41.8% in the asthma group and 37.5% in the nonasthma group (p < 0.001). After regression, male sex (odds ratio (OR) = 1.45; 95% CI 1.35–1.55), a high socioeconomic status (OR = 1.12; 95% CI 1.05–1.19), residence at an orphanage (OR = 1.93; 95% CI 1.38–2.29), regular breakfast consumption (OR = 1.09; 95% CI 1.02–1.17), and subjective good health (OR = 2.39; 95% CI 1.69–3.39) were associated with increased influenza vaccination, whereas current smoking (OR = 0.87; 95% CI 0.67–0.96) and a depressive mood (OR = 0.77; 95% CI 0.64–0.95) were inversely associated in adolescents with asthma. Conclusion: It is important to improve influenza vaccination in adolescents with asthma, especially females, those with a low socioeconomic status, independent residents, breakfast skippers, current smokers, and those who consider themselves unhealthy and have depressive moods.

Reliability of residents\u2019 assessments of their postgraduate medical education learning environment: an observational study

BackgroundEven in anonymous evaluations of a postgraduate medical education (PGME) program, residents may be reluctant to provide an honest evaluation of their PGME program, because they fear embarrassment or repercussions from their supervisors if their anonymity as a respondent is endangered. This study was set up to test the hypothesis that current residents in a PGME program provide more positive evaluations of their PGME program than residents having completed it. We therefore compared PGME learning environment evaluations of current residents in the program to leaving residents having completed it.MethodsThis observational study used data gathered routinely in the quality cycle of PGME programs at two Dutch teaching hospitals to test our hypothesis. At both hospitals, all current PGME residents are requested to complete the Scan of Postgraduate Education Environment Domains (SPEED) annually. Residents leaving the hospital after completion of the PGME program are also asked to complete the SPEED after an exit interview with the hospital’s independent residency coordinator. All SPEED evaluations are collected and analysed anonymously. We compared the residents’ grades (on a continuous scale ranging from 0 (poor) to 10 (excellent)) on the three SPEED domains (content, atmosphere, and organization of the program) and their mean (overall department grade) between current and leaving residents.ResultsMean (SD) overall SPEED department grades were 8.00 (0.52) for 287 current residents in 39 PGME programs and 8.07 (0.48) for 170 leaving residents in 39 programs. Neither the overall SPEED department grades (t test, p = 0.53, 95% CI for difference − 0.16 to 0.31) nor the department SPEED domain grades (MANOVA, F(3, 62) = 0.79, p = 0.51) were significantly different between current and leaving residents.ConclusionsResidents leaving the program did not provide more critical evaluations of their PGME learning environment than current residents in the program. This suggests that current residents’ evaluations of their postgraduate learning environment were not affected by social desirability bias or fear of repercussions from faculty.

NOT ENJOYING THE MEAL WAS ASSOCIATED WITH DEPRESSIVE SYMPTOMS, DESPITE THE SIZE OF SOCIAL CONNECTIONS

Conventional studies report that the enjoyment of the meal is related to likelihood of contracting depressive mood. The Japanese assisted living facilities currently support seniors build social connections to maintain their health and well-being, but psychological feeling during mealtime is often left unquestioned. Because seniors engage in conversation with tablemates while dining, the feeling during mealtime should not be ignored. This study aimed to explore the relationship among social connection, enjoyment during mealtime, and depressive mood. A cross-sectional questionnaire study was performed for independent residents at assisted living facility in Kanagawa Prefecture, Japan. The size of social connection (the number of facility residents that one can easily talk to) and enjoyment during the meal were assessed by a single item, respectively. The 15-item Geriatric Depression Scale was used to measure depressive symptoms. The analysis included 190 questionnaires. A logistic regression analysis showed that enjoyment during mealtime was associated with less likelihood of depressive symptoms, but the size of social connection was not, after adjusting for socio-demographics and health conditions. Moreover, a significant interaction between social connection and enjoyment during mealtime was observed. This indicated that greater size of social connection was inversely related to depressive symptoms among those who enjoyed the meal; however, among those who did not enjoy the meal, the likelihood of depressive symptoms were stably higher despite the size of social connection. The findings suggested that along with helping seniors build social connection, care takers should focus on improving the dining environment of seniors.

Multimodal health promotion – An approach to successful aging

Abstract Multimodal health promotion (MHP) is especially relevant for older persons, because of their high rate of disability, functional dependence, and use of healthcare resources. The purpose of this health promotion and research project was to assess the immediate and long-term effects of MHP on functional fitness (FF), body composition (BC), health and quality of live (HQL), and cardio metabolic risk factors (CMRF). The main objectives of the project are; 1) to promote health of older age groups so they; a) can take part in the future, both better and longer, in the activities of daily life, b) can live longer in an independent residence, c) can prevent or delay entry into residential and nursing homes, d) have the opportunity to work longer in the labor market; 2) to improve the quality of life of older age groups; 3) to reduce government and municipalities expenditures. The MHP consisted of three 6-month periods with emphasis on daily endurance training and twice-a-week strength training. This was supported by monthly lectures with emphasis on nutrition, use of medicine in connection with training, healthy ageing, mindfulness, goal-settings in old age, endurance, strength and flexibility training, and how to train. The design was a suitable sample with baseline assessment and three 6-month MHP phases. After each MHP phase, positive improvement was seen in FF, BC, HQL and CMRF. Males and females retained achieved changes and improved further at the end of each 6-month measurement. Our results suggest that regular MHP can improve or prevent decline in functional fitness in older individuals, reduce cardio metabolic risk factors, influence their health and lifestyle and positively affect their ability to stay independent, thus reducing the need for institutional care. MHP is feasible and beneficial in older populations as an integral part of prevention in municipalities and management of chronic age-related disorders.

Plastic Surgery Training and the Problematic Resident: A Survey of Plastic Surgery Program Directors.

Plastic surgery resident education is a significant commitment by both programs and residents. Unfortunately, problematic resident behavior may occur and be difficult to manage. This study was designed to survey plastic surgery program directors to elucidate their experience with problematic resident behavior. A electronic survey was prepared using the online platform, qualtrics. The survey was distributed by email to all plastic surgery program directors. Questions were designed to evaluate frequency of problematic behavior and methods to manage the behaviors. A reminder was sent 3 weeks after initial distribution. Responses were collected for an additional 3 weeks. Responses were pooled separately for integrated and independent program directors. Thirty-eight program directors responded including 10 independent and 28 integrated program directors. Integrated and independent program directors estimated prevalence of problematic behavior at 17.5 ± 14.4% and 11.8 ± 7.9%, respectively. Poor clinical skills/judgment and unprofessional behavior were the most commonly reported problematic behaviors by integrated program directors at 21% each. These were also the most commonly reported behaviors by independent program directors at 20.8% and 16.7%, respectively. Fourteen integrated program directors and 5 independent program directors reported having dismissed a resident. Only 5 integrated and 2 independent program directors reported warning signs in hindsight during the resident's initial application. Nine integrated program directors and 4 independent program directors reported at least sometimes reviewing applicant social media accounts. Prevalence of problematic behavior is estimated between 10% and 20% of plastic surgery residents. Type of problematic behavior are similar between integrated and independent residents. Warning signs on initial application are uncommon. As such, understanding problematic behaviors and methods to manage them are essential.

Learning curve for robotic surgery in children: a systematic review of outcomes and fellowship programs

The learning curve (LC) of a new technique is fundamental for its application and assessment, and for the training. Literature was analysed to define the LCs of different surgical procedures and the impact of fellowship programs. MEDLINE, EMBASE and paediatric surgical journals' databases from January 1995 to December 2018 were systematically analysed. Two independent residents sought for articles providing description of robotic-assisted procedures' LCs in paediatric age/population. Seventeen articles were selected, describing LC of robotic-assisted pyeloplasty (n = 9), fundoplication (n = 4), cholecystectomy (n = 2), choledochal cyst resection (n = 1) and lingual tonsillectomy (n = 1), with 721 procedures. Ten studies refer to one single surgeon; six to more than one; one does not specify the number of operators. Eleven studies are unicentric retrospective, two multicentric retrospective, three prospective and one is a comparative analysis between a retrospective case series and a prospective cohort. The most recruited parameter is operative time alone in 3 articles, associated with complications in 12, length of hospital stay in 6, blood loss in 3, resolution in 4 and narcotic use in 2. The LC is described as impacting procedural planning (n = 17), training (n = 9) and economic costs (n = 2). To date, operative time is the most reported outcome to measure LC and proficiency. Efforts are needed to consider measures of surgical expertise and patient status. Robotic training should be standardized on targeted programs planned upon well-defined LCs.