Invasive Surgery Fellowship Research Articles

11371 Academic Retention and Geographic Distribution of Recent Graduates of Minimally Invasive Gynecologic Surgery Fellowships

11371 Academic Retention and Geographic Distribution of Recent Graduates of Minimally Invasive Gynecologic Surgery Fellowships

11825 Race, Ethnicity, and Sex Representation Trends Among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates

11825 Race, Ethnicity, and Sex Representation Trends Among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates

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.

Race, Ethnicity, and Sex Representation Trends Among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates

Study ObjectiveTo study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates. DesignA retrospective cross-sectional study. SettingAAMC databases were queried for demographic information between 2011 and 2023. Patients/subjectsAAGL FMIGS fellows and graduates. InterventionsN/A Measurements and Main ResultsDescriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population.477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00–0.03; p = .027). Compared to their distribution among US OBGYN residents, White fellows’ representation was lower [AE ratio, 95% CI 0.60 (0.44–0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47–3.21)]. Female fellows’ representation was lower than expected [AE ratio, 95% CI 0.68 (0.48–0.96)] compared to their distribution among US OBGYN residents.Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48–0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34–0.83)] representation was lower. Asian fellows’ representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48–9.88)]. ConclusionWhite and Hispanic fellows’ representation was lower than expected, while Asian fellows’ representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows’ representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.

Demographics and Characteristics of US-Based Minimally Invasive Gynecologic Surgery Fellowship Program Directors: A 2023 Descriptive Analysis

Fellowship program directors (FPDs) play an important role in the development of fellows and learners, but little is known about their demographics. This cross-sectional study aims to examine the characteristics of minimally invasive gynecologic surgery (MIGS) FPDs. A retrospective cross-sectional study. Data obtained from publicly available information on official websites of the program directors studied. MIGS fellowship program directors. All US-based MIGS programs affiliated with the AAGL in 2023 were included. Information about FPD gender, medical school attended and graduation year, residency program attended and graduation year, any additional graduate degrees earned, fellowship programs completed, and the year of their appointment as FPD was collected through publicly available sources. Scholarly activity was measured by peer-reviewed articles and the Hirsch index. Of the 54 FPDs, 28 (51.85%) were female and 26 (48.15%) were male. Male FPDs were significantly older (54.6 ± 8.7 years) than female FPDs (46.2 ± 5.0 years), p < 0.05. Average age at appointment was 43.1 ± 6.7 years, with female FPDs being appointed at significantly younger ages (39.4 ± 5.1 years) compared to male FPDs (44.5 ± 6.8 years), p < 0.05. Male FPDs had statistically significant higher Hirsch indices (14 ± 11.4) compared to female FPDs (8 ± 5.8), p < 0.05. Of the FPDs who completed a fellowship, 27 (50.00%) did so in MIGS, eight (14.81%) in Gynecologic-Oncology, six (11.11%) in Urogynecology, and four (7.41%) in Reproductive Endocrinology/Infertility. MIGS fellowships have a uniquely equal representation of male and female FPDs, as surgical subspecialties historically tend to be male dominant. Notably, there is diversity in the type of fellowship pursued by MIGS FPDs, with nearly half of FPDs completing a fellowship outside of MIGS. The reasons for differences in scholarly contributions, indicated by Hirsch index, of male versus female FPDs is unclear.

9817 Simulation Training Experience and Trends in Minimally Invasive Gynecologic Surgery Fellowship: A Survey

9817 Simulation Training Experience and Trends in Minimally Invasive Gynecologic Surgery Fellowship: A Survey

Characterization of the robotic surgery experience in minimally invasive surgery fellowships from 2010 to 2021.

Robotic surgery has experienced exponential growth in the past decade. Few studies have evaluated the impact of robotics within minimally invasive surgery (MIS) fellowship training programs. The purpose of our study was to examine and characterize recent trends in robotic surgery within MIS fellowship training programs. De-identified case log data from the Fellowship Council from 2010 to 2021 were evaluated. Percentage of operations performed with robot assistance over time was assessed and compared to the laparoscopic and open experience. Case logs were further stratified by operative category (e.g., bariatric, hernia, foregut), and robotic experience over time was evaluated for each category. Programs were stratified by percent robot use and the experience over time within each quartile was evaluated. MIS fellowship training programs with a robotic platform increased from 45.1% (51/113) to 90.4% (123/136) over the study period. The percentage of robotic cases increased from 2.0% (1127/56,033) to 23.2% (16,139/69,496) while laparoscopic cases decreased from 80.2% (44,954/56,033) to 65.3% (45,356/69,496). Hernia and colorectal case categories had the largest increase in robot usage [hernia: 0.7% (62/8614) to 38.4% (4661/12,135); colorectal 4.2% (116/2747) to 31.8% (666/2094)]. When stratified by percentage of robot utilization, current (2020-2021) programs in the > 95th percentile performed 21.8% (3523/16,139) of robotic operations and programs in the > 50th percentile performed 90.0% (14,533/16,139) of all robotic cases. The median number of robotic cases performed per MIS fellow significantly increased from 2010 to 2021 [0 (0-6) to 72.5 (17.8-171.5), p < 0.01]. Robotic use in MIS fellowship training programs has grown substantially in the past decade, but the laparoscopic and open experience remains robust. There remains an imbalance with the top 50% of busiest robotic programs performing over 90% of robot trainee cases. The experience in MIS programs varies widely and trainees should examine program case logs closely to confirm parallel interests.

Demographic and practice patterns among minimally invasive surgery fellowship graduates.

Previous reports show that over 85% of general surgery residents choose to pursue fellowship training after completing residency. There continues to be an increase interest among general surgery residents in minimally invasive surgery (MIS) fellowship. Moreover, demographic disparities, particularly gender disparities continue to persist among surgical sub-specialties. In this study, we evaluated the gender disparities and practice patterns among graduating MIS fellows. MIS fellows were surveyed, and 169 results were received from fellows who completed training in the years: 2010, 2015-2019. Surveys collected were used to create a descriptive analysis of the demographics, practice patterns and job finding measures. Loglinear regression model was performed to assess gender trend variation over training years. Fellows self-reported gender showed 65% male, 30% female, and 5% prefer not to say. The cohort of participants was described as 45.3% white, 5.3% African American, and 6.5% Hispanic or Latino. Further, results showed 87.1% of fellows work in MIS surgery with 91.8% reporting their fellowship experience facilitated their ability to find a job. Most alumni pursue a comprehensive MIS practice. Moreover, the proportion of female fellows increased from 29 to 41%, but this increase over time was not significant using loglinear regressions [p-value = 0.0810, Relative risk = 1.1994 (95% CI 0.9778, 1.4711)]. Overall, there is good evidence to support that fellowship training facilitates future career advancements. Further, MIS fellows have differential practice patterns. Finally, females remain underrepresented among the MIS fellows which should call for leadership action to bridge these gaps.

Development of a Classification System for Live Surgical Feedback

Live feedback in the operating room is essential in surgical training. Despite the role this feedback plays in developing surgical skills, an accepted methodology to characterize the salient features of feedback has not been defined. To quantify the intraoperative feedback provided to trainees during live surgical cases and propose a standardized deconstruction for feedback. In this qualitative study using a mixed methods analysis, surgeons at a single academic tertiary care hospital were audio and video recorded in the operating room from April to October 2022. Urological residents, fellows, and faculty attending surgeons involved in robotic teaching cases during which trainees had active control of the robotic console for at least some portion of a surgery were eligible to voluntarily participate. Feedback was time stamped and transcribed verbatim. An iterative coding process was performed using recordings and transcript data until recurring themes emerged. Feedback in audiovisual recorded surgery. The primary outcomes were the reliability and generalizability of a feedback classification system in characterizing surgical feedback. Secondary outcomes included assessing the utility of our system. In 29 surgical procedures that were recorded and analyzed, 4 attending surgeons, 6 minimally invasive surgery fellows, and 5 residents (postgraduate years, 3-5) were involved. For the reliability of the system, 3 trained raters achieved moderate to substantial interrater reliability in coding cases using 5 types of triggers, 6 types of feedback, and 9 types of responses (prevalence-adjusted and bias-adjusted κ range: a 0.56 [95% CI, 0.45-0.68] minimum for triggers to a 0.99 [95% CI, 0.97-1.00] maximum for feedback and responses). For the generalizability of the system, 6 types of surgical procedures and 3711 instances of feedback were analyzed and coded with types of triggers, feedback, and responses. Significant differences in triggers, feedback, and responses reflected surgeon experience level and surgical task being performed. For example, as a response, attending surgeons took over for safety concerns more often for fellows than residents (prevalence rate ratio [RR], 3.97 [95% CI, 3.12-4.82]; P = .002), and suturing involved more errors that triggered feedback than dissection (RR, 1.65 [95% CI, 1.03-3.33]; P = .007). For the utility of the system, different combinations of trainer feedback had associations with rates of different trainee responses. For example, technical feedback with a visual component was associated with an increased rate of trainee behavioral change or verbal acknowledgment responses (RR, 1.11 [95% CI, 1.03-1.20]; P = .02). These findings suggest that identifying different types of triggers, feedback, and responses may be a feasible and reliable method for classifying surgical feedback across several robotic procedures. Outcomes suggest that a system that can be generalized across surgical specialties and for trainees of different experience levels may help galvanize novel surgical education strategies.

Editorial introductions.

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Editors-in-Chief, Associate Editor and Section Editors for this issue. SECTION EDITORS Matthew HartwigMatthew HartwigDr. Hartwig is a thoracic surgeon with a clinical focus in robotic assisted minimally invasive thoracic surgery for the treatment of diseases of the chest. He serves as the Surgical Director of the Esophageal Center at Duke. He is also the Director of the Minimally Invasive Thoracic Surgery Fellowship at Duke, while providing advanced instruction in robotic surgery to surgeons around the world. He also leads a successful program of clinical, basic and translational research in thoracic surgery and lung transplantation. He currently directs the Duke Ex Vivo Organ Laboratory (DEVOL), is the Chief of Lung Transplant Research, and is a faculty member at the Duke Clinical Research Institute (DCRI). John L.R. ForsytheJohn L.R. ForsytheProfessor John Forsythe was first appointed as a Consultant Transplant Surgeon at the Royal Infirmary of Edinburgh, UK in 1995. Prior to this, he was a Consultant Surgeon with special interest in renal transplantation at the Royal Victoria Infirmary, Newcastle upon Tyne, UK. He is currently an Organ Utilisation Consultant for NHSBT, working with all departments of health for the UK. Professor Forsythe has held many professional committee appointments, among them Lead Clinician for Organ Donation and Transplantation in Scotland, Chairman of the Scottish Donation and Transplant Group and Chairman of the Safety of Blood, Tissues and Organs Advisory Committee to all four UK health ministers. He is a Past President of the British Transplantation Society and remains Honorary President of the British Society for Histocompatibility and Immunogenetics. Shunji NagaiShunji NagaiDr. Shunji Nagai is a general surgeon in Detroit, Michigan and is affiliated with Henry Ford Hospital. He received his medical degree from Nagoya University- School of Medicine and has been in practice for more than 20 years.

Why do not we talk about MIS fellowship? A short review of the short literature.

The minimally invasive surgery (MIS) fellowship has existed for three decades and has steadily grown in both number of positions available and variety of techniques practiced. Despite continued popularity, growth, and wide breadth of surgical techniques of the MIS fellowship, publication rates in medical journals regarding these fellowships have not been as robust as one may expect. Our goal was to review the available literature on MIS fellowship. We reviewed PubMed to search for articles pertinent for MIS fellowship. The initial search included "MIS fellowship" "minimally invasive surgery fellowship" and "laparoscopy fellowship." Articles pertaining to MIS fellowship were then reviewed by title and abstract for content. Articles were excluded from subsequent analysis if they focused on disciplines that were not direct extensions of general surgery (such as urology, gynecology, oncology). Using similar search techniques, we tabulated unfiltered publications rates specific to other major surgical fellowship disciplines. The metric articles per position was created by dividing the total number articles for each discipline by the annual fellowship positions RESULTS: An initial review of available literature produced 134 articles pertinent to MIS fellowship. Further analysis for direct relevance to MIS yielded only 58 published articles. MIS had the fewest number of publications and smallest APP, 0.7, of any of the major fellowship disciplines. There is a surprising dearth of material on MIS fellowship. While, MIS fellowship is a one-year experience, we have the opportunity to build on three decades of clinical experience to continue optimize the fellow experience and improve subspecialized surgical training and patient outcomes. This could be facilitated through broadened focus of inquiry and publication of findings.

What is MIS fellowship? Community and academic program experience.

Minimally invasive surgery (MIS) fellowship is one of the most popular fellowship programs, but little is known about the individual fellow's clinical experience. Our goal was to determine the differences in case volume and case type in academic and community programs. A retrospective review of advanced gastrointestinal, MIS, foregut, or bariatric fellowship cases logged into the Fellowship Council directory of fellowships during the 2020 and 2021 academic years included for analysis. The final cohort included 57,324 cases from all fellowship programs, that list data on the Fellowship Council website, including 58 academic programs and 62 community-based programs. All comparisons between groups were completed using Student's t-test. The mean number of cases logged during a fellowship year was 477.7 ± 149.9 with similar case numbers in academic and community programs, 462.5 ± 115.0 and 491.9 ± 176.2 respectively (p = 0.28). The mean data is illustrated in Fig.1. The most common performed cases were in the following categories: bariatric surgery (149.8 ± 86.9 cases), endoscopy (111.1 ± 86.4 cases), hernia (68.0 ± 57.7 cases) and foregut (62.8 ± 37.3 cases). In these case-type categories, no significant differences in case volume were found between academic and community-based MIS fellowship programs. However, community-based programs had significantly more case experience compared to academic programs in all of the less commonly performed case-type categories: appendix 7.8 ± 12.8 vs 4.6 ± 5.1 cases (p = 0.08), colon 16.1 ± 20.7 vs 6.8 ± 11.7 cases (p = 0.003), hepato-pancreatic-biliary 46.9 ± 50.8 vs 32.5 ± 18.5 cases (p = 0.04), peritoneum 11.7 ± 16.0 vs 7.0 ± 7.6 cases (p = 0.04), and small bowel 11.9 ± 9.6 vs 8.8 ± 5.9 cases (p = 0.03). MIS fellowship has been a well-established fellowship program under the Fellowship Council guideline. In our study, we aimed to identify the categories of fellowship training and the perspective case volumes in academic vs community setting. We conclude that fellowship training experience is similar in case volumes of commonly performed cases when comparing academic and community programs. However, there is substantial variability in the operative experience among MIS fellowship programs. Further study is necessary to identify the quality of fellowship training experience.

Evidence-Based Recommendations for Referral and Consultation to a Minimally Invasive Gynecologic Surgeon: A Systematic Review

Study Objective Minimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic pathology. To date, no formal recommendations have been made in defining a referral system for MIGS. This systematic review investigates the evidence regarding common pathologies and procedures including leiomyomatous uteri, endometriosis, and complex hysterectomies and their outcomes, and posits a basis for MIGS referral. Design Systematic Review. Setting University-Affiliated Community Hospital. Patients or Participants A PubMed literature search of pertinent research published within the preceding 5 years from January 2017 - Dec 2021. 1435 titles and abstracts were identified, and of these 372 full articles screened. 26 retrospective studies were eligible and included in this systematic review. Interventions The following PubMed MeSH terms were used for literature review: Leiomyomas - fibroids, myomectomy, complications, outcomes; Endometriosis - endometriosis, minimally invasive gynecologic surgery fellowship; and Complex Hysterectomy - complex MIS, Hysterectomy, obesity, outcomes, high volume, high volume gynecologic surgeon. Measurements and Main Results In instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes and therefore benefit from the skills of MIGS subspecialists: Fibroids - ≥5 myomas, myoma size ≥9cm, and suspected myoma weight ≥500g; Endometriosis - presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; and Complex Hysterectomy - uteri ≥250g or 12 weeks estimated size, ≥3 prior laparotomies, obesity, and complex surgical history with suspected adhesive disease. Conclusion A referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies. Minimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic pathology. To date, no formal recommendations have been made in defining a referral system for MIGS. This systematic review investigates the evidence regarding common pathologies and procedures including leiomyomatous uteri, endometriosis, and complex hysterectomies and their outcomes, and posits a basis for MIGS referral. Systematic Review. University-Affiliated Community Hospital. A PubMed literature search of pertinent research published within the preceding 5 years from January 2017 - Dec 2021. 1435 titles and abstracts were identified, and of these 372 full articles screened. 26 retrospective studies were eligible and included in this systematic review. The following PubMed MeSH terms were used for literature review: Leiomyomas - fibroids, myomectomy, complications, outcomes; Endometriosis - endometriosis, minimally invasive gynecologic surgery fellowship; and Complex Hysterectomy - complex MIS, Hysterectomy, obesity, outcomes, high volume, high volume gynecologic surgeon. In instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes and therefore benefit from the skills of MIGS subspecialists: Fibroids - ≥5 myomas, myoma size ≥9cm, and suspected myoma weight ≥500g; Endometriosis - presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; and Complex Hysterectomy - uteri ≥250g or 12 weeks estimated size, ≥3 prior laparotomies, obesity, and complex surgical history with suspected adhesive disease. A referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies.

Minimally Invasive Surgery (MIS) fellowship website content: are applicants receiving enough information?

Advanced GI/Minimally Invasive Surgery (MIS) fellowships are one of the largest non-ACGME post-residency training pathways. MIS programs are highly competitive, with only 68% of applicants in the 2021 cycle successfully matching into fellowship positions. An evaluation of MIS fellowship program websites is warranted to determine if applicants are receiving adequate information to meet their needs. Using the Fellowship Council website, the authors identified 92 MIS fellowship programs that advertised open fellowships positions for general surgery residency graduates. These 92 fellowship websites were evaluated for 12 pre-identified variables based on published literature. 90% of websites included access to contact information for a program director/coordinator and 72% of websites displayed selection criteria; however, other recruitment information offered to applicants was limited. Only 25% of websites mentioned interview details, 34% of websites showcased current or past fellows, and 51% included a faculty directory. Regarding operative information, only 46% of MIS fellowship websites mentioned case volume, 23% mentioned locations of rotations, and 55% mentioned rotation schedule selection criteria. Didactic information was focused on research productivity with 80% of websites highlighting scholarly requirements; academic conferences were only mentioned in 40% of websites. Fellow wellness and career information was skipped on many websites, with 30% describing resident benefits and 16% dedicating a section to career development. Overall, the mean number of pre-identified variables present on a fellowship website was 6.57 ± 2.39 (54.75 ± 19.17%). General surgery residents turn to program websites when evaluating MIS fellowships. Although websites contain adequate information on several variables evaluated in the study, information on benefits and career development, fellow and faculty support, and case volume were limited. By including relevant information, MIS fellowship websites can align with ACGME requirements, strengthen existing frameworks, and help display data that are important to applicants.

Virtual Interviews for Surgical Fellowship are an Acceptable Alternative to In-Person Interviews for Applicants and Faculty Alike.

Background: In-person interviews have traditionally been an integral part of the fellowship application process to allow faculty and applicants to interact and evaluate the intangible aspects of the matching process. COVID-19 has forced a transition away from in-person interviews to a virtual platform. This study sought to track faculty and applicant perspectives on this transition. Study Design: Prospectively collected survey data was obtained from all participants after each of 3 consecutive virtual interview days for minimally invasive surgery fellowship at a single academic institution. Results: One hundred percent (27/27 applicants and 9/9 faculty) of interview participants completed the survey. Cost (100% applicants, 77.8% faculty) was perceived as the greatest barrier to in-person interviews, and "inability to get a feel for the program/applicant" was the largest concern for virtual interviews (66.7% applicants, 88.9% faculty). After interviews, most participants strongly agreed that they were able to assess education (66.7% applicants, 77.8% faculty), clinical experience (70.4% applicants, 77.8% faculty), and research potential (70.4% applicants, 88.9% faculty) through the virtual platform. Only 44.4% of each group strongly agreed that they could assess "overall fit" equally as well. Most faculty (6/9, 66.7%), but fewer applicants (10/27, 37.0%), were willing to completely eliminate in-person interviews. Conclusion: Virtual interviews may be an acceptable alternative to in-person interviews in times of COVID-19 and beyond. Offering a virtual format may help to eliminate costs associated with in-person visits while adequately assessing the fit of a program for both applicants and faculty, though applicants still desire an in-person option.

Linguistic Differences by Gender in Letters of Recommendation for Minimally Invasive Gynecologic Surgery Fellowship Applicants

Various surgical specialties have reported gender bias in letters of recommendation (LOR). We aimed to determine if linguistic differences exist in LOR for female and male physicians applying to Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Retrospective cohort study including application cycles 2019 and 2020. Academic university hospital. FMIGS applicants. Applicant demographic and baseline data included age, race, gender, geographical region of residency training, Step 1 and 2 scores, number of research and volunteer activities, Alpha Omega Alpha and Gold Humanism status and number of LOR, as well as the gender and academic rank of the letter writer. The Linguistic Inquiry and Word Count software, a validated text analysis program, was used to characterize LOR linguistic content. A total of 118 applications, including 391 letters, were analyzed. Seventy-six (64.4%) applicants were female and 42 (35.6%) were male. Most female applicants were white (46% vs. 36%, p = 0.04), had Alpha Omega Alpha status (13% vs. 0%, p = 0.01), higher Step 2 scores (239.7 vs. 230.4, p < 0.01), and more service activities (7.7 vs. 4.7, p < 0.01), compared to male applicants. Male applicants were more likely to graduate from international medical schools (45% vs. 16%, p < 0.01). Female authors wrote 159 LOR, and male authors wrote 232. Following multivariable analysis controlling for race, Step 1 score and letter writer gender, no significant differences in average LOR word count for female and male applicants (406.7 ± 24.2 words vs. 340.1 ± 35.4 words), or differences in Linguistic Inquiry and Word Count linguistic categories existed. Although Baseline differences were noted between female and male FMIGS applicants, no differences in LOR length or linguistic categories were noted. These results likely reflect the impact of female predominance and increased efforts to address gender bias within Obstetrics and Gynecology.

Residents versus minimally invasive surgery fellows as first assistant: Outcome differences for laparoscopic Roux-en-Y gastric bypass

• Senior residents perform LRYGB with outcomes comparable to those of postgraduate • Fellows. • Laparoscopic Roux-en-Y gastric bypass morbidity, reoperations, and readmission did not differ between residents and fellows. • Trained senior residents can perform LRYGB with outcomes comparable to those of postgraduate fellows. : Determining when a trainee can perform technically challenging bariatric operations can be difficult. Laparoscopic Roux-en-Y gastric bypass operations performed by residents were compared to fellows to determine if surgical outcomes were comparable. : Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data (January 1, 2015 - December 31, 2018) were analyzed in this retrospective study. Categorical variables were analyzed with Chi-square test. Continuous variables are presented as means with standard deviations and analyzed with Student's t -test. : Residents (R) assisted in 79 (42%) cases as surgeon while fellows (F) assisted in 109 (58%) cases. Patient age; sex; BMI kg/m2; and ASA ≥ 3 were comparable for both groups. Postoperative complications (R = 13%, F = 12%, p=0.83) and length of stay (R = 2.5 ± 1.9 days, F = 2.4 ± 0.8 days, p=0.62) were similar between groups as were unplanned 30-day readmissions (R=6% vs F=7%, p=0.78) and reoperations (R=3% vs F=1%, p =0.31). Duration of operation was longer for residents (173 ± 52.3 minutes) than fellows (166 ± 43.1 minutes, p =0.16) but not significantly different. : While there have been several studies of bariatric surgery outcomes involving trainees, few have compared outcomes based on whether the assistant was a resident or a fellow. Operative times were similar for fellows and residents, in contrast to several other studies. We conclude that at our institution chief residents appear to be given similar autonomy to fellows, with fellows having slightly shorter operative duration as would be expected based on level of training. : In this study of laparoscopic Roux-en-Y gastric bypass patients at a single institution, no differences in post-operative complications, operative duration, length of stay, reoperation, or readmission were identified between cases performed with a resident versus minimally invasive surgery fellow. We conclude that trained chief residents can perform laparoscopic Roux-en-Y gastric bypass as first assistant with outcomes comparable to those of postgraduate fellows.

The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures.

IntroductionDuring the COVID-19 pandemic, the redeployment of operating room (OR) staff resulted in a significant ramp-down of elective surgery. To mitigate the negative effects of the pandemic on surgical education, this study was planned to estimate the impact of the first wave of the pandemic on the participation of general surgery residency and fellowship trainees in operative procedures.MethodsThis study is a retrospective review of all adult general surgery procedures performed at 3 sites of an academic health care network. Cases performed during the first wave of the pandemic (March–June 2020) were compared to the same period of the previous year pre-pandemic (March–June 2019). Trainees were categorized as junior (Post-Graduate-Year [PGY] 1–2), senior (PGY3-5), or fellows (PGY6-7). Operating exposure was defined as (1) the total number of cases attended by at least one trainee and (2) total time spent in the OR by all trainees (hours). The impact of the pandemic was estimated as percentage of baseline (2019).ResultsDuring the first wave of the pandemic, a total of 914 cases were performed, compared to 1328 in the pre-pandemic period (69%). Junior trainees were more affected than senior trainees with reductions in both case volume (68% versus 78% of baseline attendance) and time (68% versus 77% of baseline operating time). Minimally invasive surgery fellows were most severely affected trainees and colorectal fellows were least affected (14% and 75% of baseline cases, respectively). Participation in emergency surgery cases and surgical oncology cases was relatively preserved (87% and 105% of baseline, respectively).ConclusionsThe first wave of the COVID-19 pandemic reduced operative exposure for general surgery trainees by approximately 30%. Procedure-specific patterns reflected institutional policies for prioritizing cancer operations and emergency surgeries. These findings may inform the design of remediation activities to mitigate the impact of the pandemic on surgical training.

Linguistic Differences by Gender in Letters of Recommendation for Minimally Invasive Gynecologic Surgery Fellowship Applicants

<h3>Study Objective</h3> Various surgical specialties have reported gender bias in letters of recommendations (LORs). Currently, no studies have evaluated this phenomenon in Gynecological sub-specialties. We aimed to determine if linguistic differences exist in LORs for female and male physicians applying to Minimally Invasive Gynecologic Surgery (MIGS) fellowship. <h3>Design</h3> Retrospective cohort study including application cycles 2019 and 2020. <h3>Setting</h3> Academic university hospital. <h3>Patients or Participants</h3> MIGS fellowship applicants. <h3>Interventions</h3> Not applicable. <h3>Measurements and Main Results</h3> Abstracted applicant demographic data included age, race, gender, geographical region of residency training, Step 1 and 2 scores, number of research and volunteer activities, Alpha Omega Alpha (AOA) status and number of LORs, as well as the gender and academic rank of the letter writer. We utilized the Linguistic Inquiry and Word Count (LIWC) software, a validated text analysis program, to characterize LORs linguistic content by frequency of words in predetermined categories. A total of 118 applications, including 391 letters, were analyzed. Seventy-six (64.4%) of applicants were female and 42 (35.6%) were male. A majority of female applicants were white (46% versus 36%, p=0.04), had AOA status (13% vs. 0%), higher Step 2 scores (239.7 vs. 230.4, p <0.01), and more service activities (7.7 versus 4.7, p<0.01), compared to male applicants. Male applicants were more likely to graduate from international residency programs (45% vs. 16%, p <0.01). Female authors wrote 159 LORs, and male authors wrote 232. Following multivariable analysis controlling for race, Step 1 score and letter writer gender, no significant differences in average LOR word count for female and male applicants (406.7 ± 24.2 words vs. 340.1 ± 35.4 words), or differences in LIWC linguistic categories existed. <h3>Conclusion</h3> Although demographic differences were noted between female and male MIGS applicants, no differences in LOR length or linguistic categories were noted. These results likely reflect a shift towards a female-dominated field and increased efforts to address gender bias.

Gender disparities in gastrointestinal surgery fellowship programs.

Gender disparities in surgical leadership have come under increased scrutiny, and in order to better understand why these disparities exist, it is important to study the disparities across surgical fellowship programs. Data derived from the Fellowship Council (FC) database for fellows completing training from academic years 2015-2019 were analyzed. Available information included institution, fellowship type, program director (PD), associate program director (APD), faculty, and fellow names for all FC Fellowships. Faculty and fellow gender were determined from personal knowledge or publicly available online biographical information. A total of 1023 fellows and 221 programs were analyzed. The advanced gastrointestinal (GI)/minimally invasive surgery (MIS) fellowship programs included 321 fellows, with a small increase in the percentage of female fellows from 28 to 31% over 5years. Advanced GI/MIS/bariatric fellowship programs had a total of 262 fellows, also with a small increase in the percent of female fellows, from 29 to 38% in the study period. The gender of program directors, assistant program directors, and faculty for the fellowship programs studied were analyzed as well. Of the 221 programs in the Fellowship Council data, 13.6% of program directors, 18.3% of associate program directors, and 19.9% of faculty were female. Advanced GI/MIS fellowship programs had the lowest percentage of female PDs, with only 9.3% of the program directors being female. Colorectal surgery fellowships had the highest percentage of female PDs, with 33% being female. In conclusion, women are underrepresented in gastrointestinal surgery fellowships among both trainees and educators. It is likely that a significant contributing factor to this underrepresentation of female fellows is the underrepresentation of female program directors and faculty; although neither our study nor any previously published study has proven that statistically.