Pediatric Surgery Training Research Articles

Validation study of synthetic models for esophageal atresia with tracheoesophageal fistula (EA/TEF): A simulation-based training in pediatric surgery

BackgroundPediatric surgery is a highly specialised field, with minimally invasive surgery (MIS) posing greater technical challenges than conventional open surgery. Proficiency requires both in and out-of-operating-room training, with simulation playing a crucial role. The purpose of this study was to explore MIS perceptions, training experiences, and preferences regarding laparoscopic simulation training. Furthermore, we aimed to validate two synthetic EA/TEF models. MethodA questionnaire focused on the degree of adoption of MIS among paediatric surgeons was proposed online to participants at the 68th Czech and Slovak Pediatric Surgery Congress in Slovakia in 2024. All participants also had scheduled sessions to practice advanced laparoscopic skills on two synthetic EA/TEF models. The purpose of this study was to analyse experiences with paediatric MIS, the implementation of simulation training, and personal stances on integrating simulation training into training curricula. EA/TEF models were validated with a 5-point Likert scale. ResultsThirty-three paediatric surgeons from 14 centres in two countries completed the questionnaire. Six (18 %) were novices, 12 (36 %) intermediate trainees, and 15 (45 %) specialists with over 11 years of practice. Eight participants (18 %) declared weekly access to simulation training, while 49 % had none. Additionally, 15 individuals (45.5 %) strongly agree and 48.5 % agree that regular training on simulators enhances surgical skills in MIS procedures in the operating room. Twenty-six respondents (76 %) believe that simulator training should be part of the requirements for pediatric surgical trainees, with no significant difference according to the surgeons' experience (p = 0.290). Thirty surgeons validated the EA/TEF models. Highest ratings were for overall impression and tool usefulness in experienced surgeons' training (mean scores: 4.5 and 4.6). The working space received the lowest score (mean: 3.6 ± 0.8), with experienced surgeons rating it significantly lower (3.4) than the inexperienced group (4.1, p = 0.030). No significant differences were observed between models in Likert scale parameters. ConclusionSimulation training is essential for teaching MIS in paediatric surgery, improving skills, and should be part of specialisation preparation. Synthetic EA/TEF models received high ratings as effective training tools for thoracoscopic EA/TEF training. Further studies are needed to prove construct validity.

Prevalence and Extent of Industry Funding to Program Directors Across Pediatric Surgical Specialties

IntroductionIndustry funding in surgical education offers benefits but presents conflicts of interest. This study defines the prevalence and extent of industry funding to fellowship program directors (FPDs) across pediatric surgical specialties. Materials and methodsThis was a retrospective cross-sectional analysis of FPDs in pediatric surgical specialties. Data were amalgamated from the Centers for Medicare and Medicaid Services and the Accreditation Council for Graduate Medical Education. Characteristics of FPDs were obtained from academic websites and medical licensing boards. Personal industry payments from 2016 to 2022 were analyzed, and temporal trends were elucidated. Comparisons were made by year, surgical specialty, and control groups with nonparametric tests. ResultsA total of 241 FPDs were identified, with 206 (85%) receiving industry payments over the study period. The specialties with the highest prevalence of industry funding to FPDs were pediatric orthopedic surgery (100%), pediatric urology (96%), and pediatric surgery (85%). Total industry payments aggregated to $7.3 million dollars with the majority awarded to pediatric orthopedic surgery (91%). Most industry payments were for royalties or licensing (57%) and consulting fees (31%). Median total industry payments per FPD differed between subspecialties (P < 0.001) and was highest in pediatric orthopedic surgery ($7009, interquartile range [IQR], $1771-$50,239) and lowest in pediatric otolaryngology ($116, IQR, $75-$1626). Male FPDs had higher median total industry payments than female FPDs ($1643, IQR, $172-$8731 versus $193, IQR, $84-$712, P < 0.001). ConclusionsIndustry payments to FPDs in pediatric surgical specialties are highly prevalent, but the magnitude varies by specialty. Future work is needed to establish mechanisms that promote equitable partnerships between academia and industry for pediatric surgery training.

Prediction model for early diagnosis of late-onset sepsis in preterm newborns.

Late-onset neonatal sepsis has a high mortality rate in premature infants. To date, no single test in the evaluation of neonatal sepsis has been demonstrated to be both sensitive and specific enough to assist in timely decision making. The aim of our study is to develop a predictive model that can be applied to all premature babies, using clinical and laboratory findings in premature babies, to recognize late-onset neonatal sepsis. 65 premature patients diagnosed with culture-proven late-onset neonatal sepsis and hospitalized in Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital neonatal intensive care unit between January 2018 and December 2020, and 65 premature newborns of similar age and gender who did not have sepsis were included in the study retrospectively. In our study, feeding difficulties, worsening in clinical appearance and fever were found to be significant among clinical findings, while thrombocytopenia and high C-reactive protein among laboratory findings are the strongest data supporting late-onset neonatal sepsis. In multiple regression analysis, thrombocytopenia, mean platelet volume, C-reactive protein, lymphocyte count and feeding difficulties had the highest odds ratio (p < 0.05). By converting these data into a scoring system, a nomogram was created that can be easily used by all clinicians. In our study, we developed a scoring system that can be easily applied to all premature patients by evaluating the clinical and laboratory findings in late-onset neonatal sepsis. We think that it will help in recognizing late-onset neonatal sepsis and strengthening the treatment decision. Predicting the individual probability of sepsis in preterm newborns may provide benefits for uninfected newborns to be exposed to less antibiotics, not to be separated from mother and baby, and to reduce healthcare system expenditures. The nomogram can be used to assess the likelihood of sepsis and guide treatment decision.

Assessment of Quality of Lıfe in Patients with Anorectal Malformations

Objective: Our main purpose in this study is to examine the effects of patients on their quality of life (QOL) according to anorectal malformations (ARM) types, and to compare them to patients with stool incontinence in the healthy population.&#x0D; Methods: The research group was selected from 116 patients who were operated due to ARM between 2004-2018 and fulfilled the inclusion criteria, in University of Health Science İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital. The control group was composed of 12 participants among 348 children between the ages 5-15 who were operated for phimosis in 2018 -2019. Fecal Incontinence Related Life Quality Questionnaire (QQVCFCA) scales were applied to both groups. SPSS 22.0 program was used.&#x0D; Results: The research group was completed with 75 participants and the control group with 12 participants. The QQVCFCA score of the low-type ARM was significantly higher than the participants with the high-type ARM (p

Coaching Program to Address Burnout, Well-being, and Professional Development in Pediatric Surgery Trainees: A Randomized Controlled Trial.

To assess impact of participation in a positive psychology coaching program on trainee burnout and well-being. Coaching using principles of positive psychology can improve well-being and reduce physician burnout. We hypothesized that participation in a coaching program would improve pediatric surgery trainee well-being. With IRB approval, a coaching program was implemented during the COVID-19 pandemic (September 2020 to July 2021) in the American Pediatric Surgical Association. Volunteer pediatric surgery trainees (n=43) were randomized to receive either one-on-one quarterly virtual coaching (n=22) from a pediatric surgeon trained in coaching skills or wellness reading materials (n=21). Participants completed prestudy and poststudy surveys containing validated measures, including positive emotion, engagement, relationships, meaning, accomplishment, professional fulfillment, burnout, self-valuation, gratitude, coping skills, and workplace experiences. Results were analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, or χ 2 test. Forty trainees (93%) completed both the baseline and year-end surveys and were included in the analysis. Twenty-five (64%) were female, mean age 35.7 (SD 2.3), and 65% were first-year fellows. Coached trainees showed an improved change in positive emotion, engagement, relationships, meaning, accomplishment ( P =0.034), burnout ( P =0.024), and gratitude ( P =0.03) scores from precoaching to postcoaching compared with noncoached trainees. Coping skills also improved. More coaching sessions were associated with higher self-valuation scores ( P =0.042), and more opportunities to reflect were associated with improved burnout and self-valuation. Despite the stress and challenges of medicine during COVID-19, a virtual positive psychology coaching program provided benefits in well-being and burnout to pediatric surgery trainees. Coaching should be integrated into existing wellness programs to support the acquisition of coping skills that help trainees cope with the stressors they will face during their careers.

Pediatric Surgery Workforce Around the World: A Need to Revise Residency Programs?

Objectives:The study aimed to address the shortage of pediatric surgery specialists globally by investigating the discrepancies in training programs and population metrics across different countries and regions. Methods: An international survey of pediatric surgeons gathered data on training duration, examination procedures, certification, and population metrics like mortality rate and surgeon-to-population ratio. Results: The study included 44 countries. The average length of pediatric surgery training was 5.7 years, with no significant difference between different regions. The pediatric mortality rate and surgeons count per 100 000 people were inversely correlated, while training duration was associated with GDP and life expectancy, but not pediatric mortality rate or surgeons' count. Conclusion: Many countries' pediatric surgery training programs do not align with their actual need for pediatric surgeons. Nations with limited economic resources may opt to shorten residency programs or offer pediatric surgery as a direct specialty after medical school to mitigate the shortage effectively.

Simulation in pediatric minimally invasive surgery: adaptation of a simple series of exercises as part of the process of an initial implementation of a resident training program.

the simulation in minimally invasive surgery is fundamental for surgeon in training to learning and training skills, especially in pediatrics, due to the particularities, reduced spaces, specific and rare procedures. The aim of this study was to propose an adapted series of exercises and to simply evaluate the performance of pediatric surgery residents in the initial implementation of a training program. seven basic skills exercises in video surgery, based on series and programs already published and using low-cost materials, were performed by six residents in 2 moments, with an interval of 15 days and evaluated by simple instrument. there was no difficulty with models. Considering the individual averages of the seven exercises together in the two moments, five of the six residents increased the score in the second moment. The average score per exercise increased in five of the seven tasks. Despite the small number of participants and repetition, it has already been possible to observe a trend of better performance with decreased time of all residents after a single repetition. All considered the exercises capable of training essential skills of the specialty, with simple and inexpensive materials. given the challenges of simulated training in pediatric video surgery, it is known the benefit of a continuous program, with exercises that can simulate real situations. A pre-established schedule, more participants and repetitions, supervision of experienced surgeons and validated instruments are fundamental to evaluate surgeons in training and show statistical benefits of simulated exercises in this series.

Bir çocuk hastanesinde evde sağlık hizmetleri başvurularının retrospektif incelenmesi

Introduction: The purpose of the present study was to examine the descriptive data regarding the children, their families, and living conditions in the records of home healthcare services provided for children between 01.04.2020 and 01.04.2021 at a children’s university hospital. Methods: The sample of this descriptive study consisted of the files of 170 pediatric patients who received service from Health Sciences University (SBU) Izmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital Home Healthcare Services Unit between 01.04.2020 and 01.04.2021. The data were collected with the Data Record Form that was created by the researchers in line with the contents of the files kept for patients. The analysis of the data in this form was made in the SPSS package program 25.0 trial version. The data were described in terms of numbers, percentages, and averages, and the Chi-Square Significance Test was used in the comparisons made between the demographic data. The statistical significance level was considered as p&amp;lt;0.05. To conduct the study, permission was obtained from the Ethics Committee of S.B.U. Izmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital. Results: The children who were included in the study were between the ages of 0 and 17 and the average age was 9.11±4.61. It was found that a total of 54.7% of the children were male, 97.6% were cared for by their mothers, 61.8% of the children whose files were examined had social security at the Social Security Institution (SSI), 51.8% were receiving service from the unit and were diagnosed with a neurological disease, and 58.8% were fully dependent in their daily living activities, 27.1% of them used mechanical ventilation, 37.6% used aspirator devices, 37.1% needed Oxygen (O2) support, 48.7% were fed orally, 27.7% were fed through the nasogastric route, and 23.6% were fed through Percutaneous endoscopic gastrostomy (PEG) and 4.2% of the participating children developed pressure sores. According to the records regarding the physical conditions of the places where children lived, 72.4% lived in apartments, 38.8% had a house that was heated by a heating system natural gas, 98.8% had good lighting in their homes, and 57.1% had alaturka toilet in their homes. Also, 64.8% of the children stayed in the living room of the house and 92.4% had good home hygiene. A statistically significant difference was detected between the income status of the children’s families and their social security (X2= 47.542 p=0.001, df=1). Conclusion: The factors such as the majority of patients registered to home healthcare services being cared for by their mothers, their high rates of dependency in daily living activities, some developing pressure sores, the need to be attached to a medical device, and varying home conditions in suitability for care show that patients have varying medical, psychological and social needs. For this reason, it would be beneficial to focus on pediatric studies in home healthcare services, organize.

Advances in Pediatric Surgery Simulation-Based Training.

Pediatric surgery is the diagnostic, operative, and postoperative surgical care of children with congenital and acquired anomalies and diseases. The early history of the specialty followed the classic "see one, do one, teach one" philosophy of training but has since evolved to modern methods including simulation-based training (SBT). Current trainees in pediatric surgery face numerous challenges, such as the decreasing incidence of congenital disease and reduced work hours. SBT consists of several modalities that together assist in the acquisition of technical skills and improve performance in the operating room. SBT has evolved to incorporate simulator models and video gaming technology, in parallel with the development of simulation in other surgical and non-surgical pediatric fields. SBT has advanced to a level of sophistication that means that it can improve the skills of not only pediatric surgery trainees but also practicing attending surgeons. In this review, we will discuss the history of pediatric surgery, simulation in pediatric surgery training, and the potential direction of pediatric surgical simulation training in the future.

Usage of Surfactant and Evaluation of Lung Problems in Late Preterm Infants

OBJECTIVE: We aimed to evaluate surfactant frequency and surfactant indications, as well as lung problems in late preterm infants. STUDY DESIGN: This retrospective and cross-sectional study was carried out by HSU Izmir Dr. Behcet Uz Pediatric Diseases and Surgery Research and Training Hospital. Infants who were born late preterm between January 2016 and January 2022 were hospitalized in the NICU due to respiratory distress in the first 24 hours. Lung problems and surfactant administration of these infants were evaluated. The frequency of surfactant dosages, their indications, and their effects were examined. As the control group, patients who were admitted to the NICU in the same period due to respiratory distress with similar indications but did not receive surfactant were considered. RESULTS: It was observed that surfactant was not administered to 105 infants and surfactant was administered to 106 infants. The median gestational week of the infants included in the study was 35 (34/36) weeks and the birth weight was 2185 (1780/2590) grams. A significant difference was observed in birth weight between the groups (p&lt;0.001). Invasive ventilation was required in 52.1% of all cases and noninvasive ventilation was required in 33.6%. In the delivery room, the need for resuscitation and intubation was higher in the group requiring surfactant (p=0.001). The most common lung pathology in the surfactant group was RDS. CONCLUSION: It must not be forgotten that infants who are born late preterm infants are preterm infants and the evaluation of antenatal steroid administration must not be ignored.

Point of Care Ultrasound in Pediatric Surgery across the European Region-European Pediatric Surgery Association Endorsed Survey.

Our purpose was to assess the state of training, clinical practice, and barriers to use point-of-care ultrasound (POCUS) in pediatric surgery in Europe. An electronic survey was disseminated among European pediatric surgeons utilizing the European Pediatric Surgery Association network and other existing networks. There were 186 respondents from 27 European countries and 7 non-European countries. In most countries (86.6%; N = 161), the initial ultrasound for acute admissions is performed by radiologists, with 1 to 6 hours turnover in 62.9% (N = 117) of urgent cases. Ultrasound by pediatric surgeons (point-of-care ultrasound/POCUS) is performed by 48.4% (N = 90) of respondents, with 29% (N = 54) using it at least once per week. The most common indications for POCUS include abdominal focused abdominal sonography in trauma (53.8%; N = 100), diagnosis of appendicitis (41.9%; N = 78), and intussusception (44.6%; N = 84). In malrotation-volvulus, 28.5% (N = 53) used ultrasound for its diagnosis, while 27.5% (N = 51) would not see an indication here. Training in POCUS occurred informally for 55.4% (N = 103) of participants, while 31.2% (N = 58) attended formal training courses. Almost all respondents wanted to attain further POCUS training (89.3%; N = 166), only 7% (N = 13) did not think this would be useful. For 73.1% (N = 136), POCUS is not currently part of the pediatric surgery training curriculum in their country. Perceived barriers to POCUS use include a lack of training opportunities (26.3% [N = 49]) and a paucity of portable ultrasound machines (17.8% [N = 33]). There is a wide spectrum of POCUS use in pediatric surgery across Europe. For those surgeons who practice POCUS, it is most used for the diagnosis of abdominal conditions. There are differing views among clinicians concerning the most useful applications of POCUS. The extent to which ultrasound is taught during pediatric surgery training differs substantially across European curricula.

Inanimate 3D printed model for thoracoscopic repair of esophageal atresia with tracheoesophageal fistula.

Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) poses significant technical challenges. This study aimed to develop an inexpensive, reusable, high-fidelity synthetic tissue model for simulating EA/TEF repairs and to assess the validity of the simulator. By using 3D printing and silicone casting, we designed an inexpensive and reusable inanimate model for training in thoracoscopic EA/TEF repair. The objective was to validate the model using a 5-point Likert scale and the Objective Structured Assessment of Technical Skills (OSATS) to evaluate participants' surgical proficiency. A total of 18 participants (7 medical students, 4 pediatric surgery trainees, and 7 experienced surgeons), after being instructed and trained, were asked to perform TEF ligation, dissection, as well as esophageal anastomosis using six sliding knots on the EA/TEF simulator. All participants in the expert group completed the task within the 120-minute time limit, however only 4 (57%) participants from the novice/intermediate completed the task within the time limit. There was a statistically significant difference in OSATS scores for the "flow of task" (p = 0.018) and scores for the "overall MIS skills" (p = 0.010) task distinguishing between novice and intermediates and experts. The simulator demonstrated strong suitability as a training tool, indicated by a mean score of 4.66. The mean scores for the model's realism and the working environment were 4.25 and 4.5, respectively. Overall, the face validity was scored significantly lower in the expert group compared to the novice/intermediate groups (p = 0.0002). Our study established good face and content validity of the simulator. Due to its reusability, and suitability for individual participants, our model holds promise as a training tool for thoracoscopic procedures among surgeons. However, novices and trainees struggled with advanced minimally invasive surgical procedures. Therefore, a structured and focused training curriculum in pediatric MIS is needed for optimal utilization of the available training hours.

Neonatal and pediatric endoscopic surgery training in Europe

Neonatal and pediatric endoscopic surgery training in Europe

Language Differences by Race on Letters of Recommendation for the Pediatric Surgery Match

This study aims to evaluate if there is any significant linguistic difference in LoR based on applicant's race/ethnicity. Retrospective review of applications to pediatric surgery fellowship at a single institution (2016-2020). Race was self-reported by applicants. LoR were analyzed via the Linguistic Inquiry and Word Count (LIWC) software program. Johns Hopkins All Children's Hospital, St. Petersburg, Florida USA. A free-standing tertiary pediatric hospital. Pediatric surgery fellowship applicants from 2016 to 2020. A total of 1086 LoR from 280 applicants (52% female) were analyzed. Racial distribution was Caucasians 62.1%, Asian 12.1%, Hispanics 7.1%, multiracial 6.4% African Americans 5%, and other/unknown 7.1%. Letter writers were largely male (84%), pediatric surgeons (63%) and professors (57%). There was no difference in LoR word count across races. LoR for female multiracial candidates contained higher use of affiliation and negative emotion terms compared to Hispanic females (p = 0.002 and 0.048, respectively), and past focus terms when compared to Caucasian and Asian female applicants (p < 0.001 and p = 0.003, respectively). Religion terms were more common in LoR for Asian females when compared to Caucasian females (p < 0.001). This study demonstrates linguistic differences in LoR for pediatric surgery training programs based on applicant race/ethnicity. While differences are present, these do not suggest overt bias based on applicants race or ethnicity.

How Many Operative Performance Ratings Does a Pediatric Surgery Fellow Need to Be Deemed Practice Ready?

PurposeIdentifying the number of cases required for a fellow to achieve competence has been challenging. Workplace-based assessment (WBA) systems make collecting performance data practical and create the opportunity to translate WBA ratings into probabilistic statements about a fellow's likelihood of performing to a given standard on a subsequent assessment opportunity. MethodsWe compared data from two pediatric surgery training programs that used the performance rating scale from the Society for Improving Medical Professional Learning (SIMPL). We used a Bayesian generalized linear mixed effects model to examine the relationship past and future performance for three procedures: Laparoscopic Inguinal Hernia Repair, Laparoscopic Gastrostomy Tube Placement, and Pyloromyotomy. ResultsFor site one, 26 faculty assessed 9 fellows on 16 procedures yielding 1094 ratings, of which 778 (71%) earned practice-ready ratings. For site two, 25 faculty rated 3 fellows on 4 unique procedures yielding 234 ratings of which 151 (65%) were deemed practice-ready. We identified similar model-based future performance expectations, with prior practice-ready ratings having a similar average effect across both sites (Site one, B = 0.25; Site two, B = 0.25). Similar prior practice-ready ratings were needed for Laparoscopic G-Tube Placement (Site one = 13; Site two = 14), while greater differences were observed for Laparoscopic Inguinal Hernia Repair (Site one = 10; Site two = 15) and Pyloromyotomy (Site one = 10; Site two = 15). ConclusionOur approach to modeling operative performance data is effective at determining future practice readiness of pediatric surgery fellows across multiple faculty and fellow groups. This method could be used to establish minimum case number requirements. Type of StudyOriginal manuscript, Study of Diagnostic Test. Level of EvidenceII.

Training in Pediatric Gastrointestinal Endoscopy during Surgery Residency: Can Training Programs Currently Educate Proficient Pediatric Endoscopists? A Nationwide Assessment

Background: Technological advances in pediatric gastrointestinal (GI) endoscopy require highly specialized physicians. Therefore, proper training is fundamental. The aim of this study was to assess the level of competence of pediatric surgery residents to determine areas that should be addressed to design better training programs focused on pediatric GI endoscopy. Methods: An observational study was performed on all Italian pediatric surgery trainees that concluded the training program by the end of 2021, who were asked to answer a questionnaire about the quality of the GI endoscopy education received during their 5 years of residency. Results: 12 out 14 (86%) pediatric surgery trainees answered the questionnaire. A total of 50% (6/12) of the trainees declared they were interested in pediatric GI endoscopy, and 42% (5/12) said that they would be interested in dedicating themselves to this discipline in the future. Only 33% (4/12) of them were in a center equipped with endoscopy simulators. Among them, 17% (2/12) never took part in GI endoscopic procedures while working in centers in which GI endoscopy is performed exclusively by pediatric gastroenterologists, 25% (3/12) had never performed GI endoscopic procedures as a first operator and 17% (2/12) not even as assistant. Overall, 50% (6/12) were not satisfied with the level of education received and only 17% (2/12) declared that they felt confident enough to perform routine endoscopies alone. Conclusions: Our study highlights great inhomogeneity between different schools and some important failings. Better programs should be designed to educate proficient pediatric GI endoscopists.

The safe introduction of robotic surgery in a free-standing children's hospital.

The aim of this study is to report the experience of implementing a pediatric robotic surgery program at a free-standing pediatric teaching hospital. A database was created to prospectively collect perioperative data for all robotic surgeries performed by the pediatric surgery department. The database was queried for all operations completed from October 2015 to December 2021. Descriptive statistics were used to characterize the dataset, using median and interquartile ranges for continuous variables. From October 2015 to December 2021, a total of 249 robotic surgeries were performed in the department of pediatric surgery. Of the 249 cases, 170 (68.3%) were female and 79 (31.7%) were male. Across all patients, there was a median weight (IQR) of 62.65kg (48.2-76.68kg) and a median (IQR) age of 16years (13-18years). The median (IQR) operative time was 104min (79.0-138min). The median console time was 54.0min (33.0-76.0min) and the median docking time was 7min (5-11min). The majority of procedures were performed on the biliary tree (52.6%). In the 249 procedures, there were no technical failures of the robot and only two operations (0.8%) were converted to open procedures and one (0.4%) to laparoscopic. This study highlights the ability to successfully integrate a pediatric robotic surgery program into a free-standing children's hospital with a low conversion rate. Additionally, the program extended across multiple surgical procedures and offered real-time exposure to advanced surgical techniques for current and aspiring pediatric surgery trainees.

Assessing Trends in Supply and Demand for Pediatric Surgery Training

This study assessed the supply and demand for Pediatric Surgery training in the U.S. from 2008 to 2022. We hypothesized that in the Pediatric Surgery Match: match rates would increase over time; U.S. MD Graduates would have higher match rates than non-U.S. MD Graduates; and fewer applicants would match at one of their top fellowship choices. This was a retrospective cohort study of Pediatric Surgery Match applicants (2008-2022). Cochran-Armitage tests elucidated temporal trends and chi square tests compared outcomes by applicant archetype. Accreditation Council for Graduate Medical Education (ACGME)-accredited Pediatric Surgery training programs in the United States and non-ACGME-accredited programs in Canada. A total of 1,133 applicants for Pediatric Surgery training. From 2008 to 2012, growth in the annual number of fellowship positions (34-43, 27% increase) exceeded growth in number of applicants (62-69, 11% increase) (p < 0.001). Over the study period, the applicant-to-training ratio peaked at 2.1 to 2.2 in 2017 to 2018 and decreased to 1.4 to 1.6 in 2021 to 2022. The annual match rate for U.S. MD Graduates increased from 60% to 68% (p < 0.05), but decreased from 40% to 22% (p < 0.05) for non-U.S. MD Graduates. In 2022, there was a 3.1-fold difference in match rates between U.S. MD and non-U.S. MD Graduates (68% vs 22%, p < 0.001). The percentage of applicants that matched at their first choice (25%-20%, p < 0.001), second choice (11%-4%, p < 0.001), and third choice (7%-4%, p < 0.001) fellowships decreased over the study period. The percentage of applicants that matched at their fourth choice to least desirable fellowship increased from 23% to 33% (p < 0.001). The demand for Pediatric Surgery training peaked in 2017 to 2018 and has decreased since. However, the Pediatric Surgery Match remains competitive especially for non-U.S. MD Graduates. More research is needed to understand barriers to matching into Pediatric Surgery for non-U.S. MD Graduates.

How does the number of training years in pediatric surgery affect appendectomy outcomes?

Appendectomy has traditionally been considered as a training operation for junior pediatric surgeons during their training period. However, with the increase of laparoscopic appendectomy, there has been a growing concern about the performance of this procedure by junior trainees. Our aim is to analyze intra-/postoperative appendectomy outcomes according to the number of training years during Pediatric Surgical residency training program. A retrospective study was performed in patients who underwent appendectomy between 2018 and 2021 in our institution, who were divided into 5 groups according to the number of training years of the junior surgeon who performed the intervention (Y1-Y5). Demographics, complicated appendicitis rate, operation time, and postoperative complications were compared. A stratified analysis according to the technique performed (open/laparoscopic) was performed. A total of 1274 appendectomized patients were analyzed, of which 1257 (98.7%) were operated on by junior trainees (81 in Y1; 407 in Y2; 337 in Y3; 261 in Y4; and 171 in Y5) without demographic differences between groups. As the year of training increased, an elevation in complicated appendicitis rate was observed, although without statistically significant differences. However, laparoscopic/open appendectomies ratio increased with increasing year of training (p < 0.001). Operative time decreased significantly with increasing year of training (p < 0.001), both in open and laparoscopic appendectomies. There were no significant differences in postoperative complications, nor in the stratified analysis according to surgical technique. Appendectomy performed by junior pediatric surgery trainees can be considered a safe procedure from the first year of training, regardless of the technique used.

Loss of interest for training in paediatric surgery in India.

Background Despite the sizeable Indian paediatric population, few students have opted for postdoctoral (Magister Chirurgiae [MCh]/Diplomate of the National Board of Examinations [DNB]) courses in the past decade. We analyse the apparent loss of interest for training in paediatric surgery in India and suggest remedies. Methods We did a combination of an online questionnaire-based survey and several interviews among students, teachers and practitioners of paediatric surgery. The results were collated and analysed. Results Information from 238 questionnaires, 35 interviews and 75 feedbacks were distilled. About 83% of respondents agreed to a definite loss of interest among students in paediatric surgery, largely because of poor exposure during undergraduate/postgraduate courses and absence of a department in medical colleges. The blanket increase in seats has led to vacancies. The low saleability of paediatric surgery is linked to high personnel and infrastructure investment, modest remunerative potential and poor insurance cover for patients. Besides increasing public awareness, strategic governmental patronage in postdoctoral training (e.g. establishing a department in medical colleges, moderating the number of seats, encouraging performing training centres and rationalizing the bond after the training course) and facilitation of patient care (e.g. insurance cover for congenital conditions and paediatric surgeon in neonatal care units in district hospitals) is suggested. Conclusions The loss of interest in paediatric surgery among medical trainees is real and urgently requires a multipronged strategy by the medical fraternity, professional organizations and regulatory bodies across government and non-governmental sectors to facilitate a revival and cater to the sick surgical child in the future.