Surgical Program Research Articles

Formal degree programs in physiology promote careers of clinical scientists and benefit basic science departments.

Physiologists may play critical roles in the development of clinician-scientists who aspire to an academic career. The complexity of contemporary biomedical science and economic matters regarding postgraduate education pose real conundrums. We report a more than 22-year follow-up of surgical trainees pursuing bench laboratory science experience through a collaboration between a physiology postgraduate program and a surgical researcher program within a single public medical school. The sources and resources include selection, funding, physiology classroom work, and laboratory studies with personal involvement by faculty that have seldom been recorded, especially with longer term career outcomes. These selected PhD candidates have subsequently pursued several lines of activity, many with distinguished careers and major influences upon future generations of academic surgeons.

A Novel Curriculum for Surgical Oncology Fellowship Training in West Africa.

Low- and middle-income countries (LMICs) lack the surgical capacity to contend with the growing burden of cancer care. West Africa is particularly affected, where limited cancer surgery is performed primarily by general surgeons without any subspecialty training. As a first step to develop surgical oncology capacity in the region, the West African College of Surgeons (WACS) in partnership with the Global Oncology Group at Queen's University, Canada, co-created a novel surgical oncology fellowship training program. Curriculum development began with a literature review of publications, global position statements, and curricular documents from surgical oncology societies and accreditation bodies. The results were reviewed by the WACS team members to reach consensus on the competencies and objectives of the program based on the perceived needs and available resources in West Africa. Iterative discussions between the Queen's Global Oncology Group and WACS leadership led to the creation of the surgical oncology curricular documents. A curriculum tailored to the West African context was developed to deliver essential knowledge, skills, and competencies for surgical oncologists in the region. The curriculum focuses on the six core domains of general surgical oncology, highlighting specific knowledge base and procedural skills within each clinical domain. Educational activities were outlined and the curriculum format, delivery, and trainee assessment were also described. A surgical oncology curriculum developed specifically for the West African context will enhance the capacity for cancer surgery in the region. This curriculum may serve as a model for future surgical oncology program development in LMICs.

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

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

Can Ileostomy Reversal Be Safely Performed by Surgical Residents?

Background and Objectives: The growing number of colorectal cancer patients has highlighted the importance of surgical education in colorectal surgery. Despite the negative impact of the COVID-19 pandemic on surgical training, recent changes in the Polish surgical training program have increased the number of intestinal procedures required to be completed by residents. This study aims to assess the safety of ileostomy reversal procedures performed by surgical residents. Materials and Methods: A multicenter prospective cohort study, the LILEO study, was conducted from October 2022 until December 2023 across 20 Polish surgical departments. The study included 199 patients who underwent ileostomy reversal and were divided into two groups: 139 patients operated by specialist surgeons and 60 patients operated by surgical residents. The primary outcomes measured were postoperative complications, length of hospital stay (LOS), and 30-day reoperation rate. Secondary outcomes included the severity of perioperative complications assessed using the Clavien–Dindo classification and a focused analysis of loop ileostomy reversal outcomes. Results: The median LOS was significantly shorter in the resident group (5.5 days vs. 6 days, p < 0.05). Although the overall complication rate was lower in the resident group (21.7% vs. 33.1% in the specialist surgeon group), this difference was not statistically significant (p = 0.105). The 30-day reoperation rate was 3.3% in the resident group and 8.6% in the specialist surgeon group (p = 0.179). In terms of severity, minor complications (Clavien–Dindo grades 1 and 2) were more common in the specialist group (p < 0.05). The analysis of loop ileostomy reversals revealed no significant differences in postoperative outcomes between the two groups. Conclusions: Ileostomy reversal procedures performed by surgical residents under supervision are safe and feasible, with outcomes comparable to those performed only by specialist surgeons. These findings support ileostomy reversal as a valuable procedure for developing surgical residents’ skills and do not negatively affect postoperative outcomes.

Starting a surgical prehabilitation program: results from a pragmatic nonrandomized feasibility study.

We sought to assess the feasibility and estimate the effects on outcomes of a multimodal prehabilitation service implemented as an ancillary surgical service. We conducted a pragmatic, nonrandomized feasibility study of surgical prehabilitation. Patients were eligible if they were ≥ 18yr of age, fluent in English, and referred by a health professional for prehabilitation. Participants received an individualized program of preoperative exercise, nutrition, psychological, and/or smoking cessation support. The primary outcome was operational feasibility, including referral volume, enrolment rate, prehabilitation window, engagement, completion rate, and safety. Secondary outcomes included surgical complications, length of hospital stay, readmission, quality of life, and physical and mental health. Qualitative data related to intervention feasibility and acceptability. We compared intervention participants with patients who were referred for, but declined, prehabilitation. One hundred and sixteen patients were referred for prehabilitation. The mean age of referred patients was 71yr and 55% were male. Over 90% of referrals were from surgical oncology, and the most common indication for referral was frailty (46%). Of the 116 referred patients, 83 consented to participate in the study. Patient-reported and objectively measured outcomes improved by a clinically important margin from baseline to presurgery, and returned to presurgery levels by 90days postoperatively. Qualitative findings suggest that the prehabilitation intervention was well received. Multimodal surgical prehabilitation is feasible as an integrated clinical service and may be effective for improving physical and psychological outcomes. Further evaluations of clinically integrated prehabilitation programs in Canada are needed to confirm these findings.

Deep learning for surgical instrument recognition and segmentation in robotic-assisted surgeries: a systematic review

Applying deep learning (DL) for annotating surgical instruments in robot-assisted minimally invasive surgeries (MIS) represents a significant advancement in surgical technology. This systematic review examines 48 studies that utilize advanced DL methods and architectures. These sophisticated DL models have shown notable improvements in the precision and efficiency of detecting and segmenting surgical tools. The enhanced capabilities of these models support various clinical applications, including real-time intraoperative guidance, comprehensive postoperative evaluations, and objective assessments of surgical skills. By accurately identifying and segmenting surgical instruments in video data, DL models provide detailed feedback to surgeons, thereby improving surgical outcomes and reducing complication risks. Furthermore, the application of DL in surgical education is transformative. The review underscores the significant impact of DL on improving the accuracy of skill assessments and the overall quality of surgical training programs. However, implementing DL in surgical tool detection and segmentation faces challenges, such as the need for large, accurately annotated datasets to train these models effectively. The manual annotation process is labor-intensive and time-consuming, posing a significant bottleneck. Future research should focus on automating the detection and segmentation process and enhancing the robustness of DL models against environmental variations. Expanding the application of DL models across various surgical specialties will be essential to fully realize this technology’s potential. Integrating DL with other emerging technologies, such as augmented reality (AR), also offers promising opportunities to further enhance the precision and efficacy of surgical procedures.

Neurocognitive and Neuromuscular Rehabilitation Techniques after ACL Injury, Part 1: Optimizing Recovery in the Acute Post-Operative Phase- A Clinical Commentary.

Anterior cruciate ligament (ACL) injury rates are on the rise, despite improved surgical techniques and prevention programs. While traditional rehabilitation emphasizes the restoration of motion, strength, and physical performance, emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury. These deficits, including altered proprioception, impaired motor control and muscle recruitment, as well as heightened reliance on visual feedback, can significantly increase the risk of re-injury and impede return to sport. The purpose of this clinical commentary is to outline a proposed comprehensive approach to rehabilitation that challenges the neurocognitive system to optimize rehabilitation outcomes and reduce reinjury risk. Thus, this clinical commentary discusses the rationale for integrating neurocognitive training into all phases of ACLR rehabilitation, from initial injury to eight weeks post-surgery. It details the neurophysiological changes caused by ACL injury and presents evidence supporting the use of exercises that challenge visual attention, decision-making, and motor planning. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve long-term outcomes and reduce re-injury risk. Level of Evidence: 5.

Residency program directors’ views on ideal applicant: a national survey

PurposeThe aim of this study is to investigate and highlight the most important factors influencing the candidate’s selection for residency matching by program directors of surgical and non-surgical specialties in Saudi Arabia.MethodThis cross-sectional study was conducted in the Central, Eastern, Western, Northern, and Southern regions of Saudi Arabia from February 1, 2023, to August 31, 2023. A total of sixty-one program directors completed a questionnaire, which was adapted and validated from a previous study with permission and tailored to meet the objectives of this research.ResultsThe mean age of the study population was 40.2 years, with surgical specialty program directors being older at 41.7 years and nonsurgical specialty program directors being younger at 39.6 years. In both cases, the highest importance was given to ‘Applicant’s attitude and professionalism’, followed in surgical specialties by ‘Doing clinical rotations in the PD institution’ and ‘Performance in clinical rotation during internship’ in non-surgical specialties. with a mean score of 4.13 and 4.95, respectively. The importance of ‘The impression/opinion of current residents’ has had a certain importance in both specialties. While the number of research projects was prioritized more by surgical PDs (38.6%) compared to non-surgical PDs (29.4%).ConclusionThis study highlights the critical role of professionalism and a positive attitude in clinical rotations and interviews for program acceptance in Saudi Arabia. The significance of letters of recommendation and research focus varies between surgical and non-surgical program directors. Program directors should adopt effective recruitment strategies that incorporate practical implications during internships.

The Impact of Leadership Training on Burnout and Fulfillment Among Direct Reports

SUMMARY Goal Burnout, decreased professional fulfillment, and resultant attrition across the medical professions are increasingly recognized as threats to sustainable and cost-effective healthcare delivery. While the skill level of leaders as perceived by their direct reports has been correlated with rates of burnout and fulfillment, no studies, to our knowledge, have directly evaluated whether intervention via leadership training impacts burnout and fulfillment among direct reports. The goal of this study was to evaluate the effectiveness of a leadership training intervention on direct reports’ perceptions of the leadership skills of supervising residents and subsequently on the well-being of the direct reports. Methods We implemented a leadership training program with supervising (i.e., chief) resident volunteers in two surgical residency programs. The leadership training included two sessions of approximately 2 hours each that consisted of interactive didactic and small group activities. The training focused on the following themes: defining leadership (i.e.,characteristics and behaviors), team building, fostering trust, managing conflict, navigating difficult conversations, and feedback. We administered pretraining and posttraining surveys to the direct reports (i.e., junior residents) to assess the perceived leadership skills of supervising residents, as well as burnout and professional fulfillment. Principal Findings Leadership scores significantly improved following the leadership training intervention. Additionally, improvement in leadership scores following training was positively correlated with professional fulfillment among the junior residents (direct reports). Practical Applications The results of this study suggest that incorporating leadership training into residency programs may serve as an appropriate initial intervention to improve the leadership skills of supervising residents, and in turn, improve professional fulfillment and retention among medical professionals. This intervention involved minimal cost and time investment, with potentially significant returns in combating the well-being and attrition crisis. These findings may be applicable across the healthcare field to tackle the impending healthcare worker crisis.

Age-related cataract without surgery is related to exacerbated depression symptoms: a cross-sectional study of Chinese adults from Anhui, China.

The present study sought to evaluate the relationship between age-related cataracts, a prevalent ocular condition among the elderly, and the occurrence of depressive symptoms within a cohort of Chinese adults residing in Anhui, China. A survey involving 252 Chinese individuals aged 65 years and older was conducted at Lu'an People's Hospital. Depressive symptoms were assessed using the Hamilton Depression Scale (HAMD) consisting of 17 items, while age-related cataracts were clinically classified according to the Lens Opacities Classification System (LOCS) III. Depressive symptoms were identified by a HAMD score exceeding 7. Logistic regression analyses were employed to determine the odds ratios (OR) and 95% confidence intervals (CI) pertaining to the association between age-related cataracts and depressive symptoms. Cataract patients aged 65 years and older had significantly higher scores of depressive symptoms than those under 65 years (mean scores of 8.17 ± 3.26 versus 5.18 ± 1.86, p < 0.001). In addition, patients aged 65 years and above exhibited a diminished quality of life relative to patients aged under 65 years. The findings indicated that adults experiencing depressive symptoms reported lower monthly incomes (p = 0.036), lower educational attainment (p = 0.044), and living alone (p = 0.007). Furthermore, fewer elderly patients with depressive symptoms received surgical treatment (15 patients) than those without depressive symptoms (61 patients), with a significant difference (p = 0.011). Multivariate analysis revealed that the presence of depressive symptoms was significantly correlated with a lack of formal education (p = 0.048), reduced income (p = 0.003), solitary living arrangements (p = 0.025), and the presence of cataracts without surgical intervention (p = 0.007). These findings suggested a significant association between age-related cataracts and depressive symptoms among older adults. Specifically, cataracts that remain untreated surgically were notably linked to depression in elderly patients. It is recommended that initiatives and resources be directed toward surgical treatment programs for cataracts in individuals exhibiting depressive symptoms.

Engagement and learning approaches among medical students in an online surgical teaching programme: A cross-sectional study

BackgroundThe COVID-19 pandemic prompted the transition of all teaching and learning of final-year General Surgery students to an online platform. Despite the utility of online methods, challenges exist such as a sense of impersonal learning, and poor student engagement. Student engagement with course content is important for deep learning. An Online Student Engagement Scale (OSE) and a revised Biggs Two-Factor Study Process Questionnaire (R-SPQ-2F) were used to evaluate student engagement and learning approaches respectively. MethodsA cross-sectional study was conducted in 2021 at a South African university. The OSE and R-SPQ-2F online survey tools were administered to all final-year students (n = 325) enrolled in the surgical online module. Quantitative data was collected, and the data was analysed statistically using R-Statistical computing software. Results are presented in the form of descriptive and inferential statistics. The reliability of the tools was evaluated by Cronbach's alpha. ResultsThe survey response rate was 35.4 % (115/325). Students were engaged at a high level, and the median (IQR) scores of the OSE tool were 71.0 (63.0–78.0). Overall, students adopted a deep approach (DA) to learning, with median (IQR) scores of 34.0 (30.0–39.0) on the R-SPQ-2F tool. There was a moderate positive correlation between the total OSE score and DA (0.53, p < 0.001). Both the OSE and R-SPQ-2F tools showed an acceptable level of internal consistency of 0.893 and 0.806 respectively. ConclusionsStudent engagement was associated with deep learning approaches. The OSE and R-SPQ-2F tools were reliable tools to measure student engagement and learning approaches among medical students.

Reducing barriers through education: A scoping review calling for structured disability curricula in surgical training programs

BackgroundPatients with disabilities face widespread barriers to accessing surgical care given inaccessible health systems, resulting in poor clinical outcomes and perpetuation of health inequities. One barrier is the lack of education, and therefore awareness, among trainees/providers, of the need for reasonable accommodations for surgical patients with disabilities. MethodsWe conducted a scoping review of the literature on the current state of disabilities curricula in medical education and graduate residency curriculum. ResultsWhile the literature does demonstrate a causal link between reasonable accommodation training and positive patient-provider relationships and improved clinical outcomes, in practice, disability-focused curricula are rare and often limited in time and to awareness-based didactic courses in medical education and surgical training. ConclusionsThe absence of structured curricula to educate on anti-ableism and care for patients with disabilities promotes a system of structural “ableism.” Expanding disability curricula for medical students and trainees may be an opportunity to intervene and promote better surgical care for all patients.

Gender-Specific and Cross-Gender Reasons for Choosing 'Surgeon' as a Career - A Scoping Review

The availability of highly qualified surgical staff in Germany has been a challenge for years. Despite various initiatives to increase the attractiveness of surgical training programs, there are still problems in attracting motivated and qualified doctors to surgery. In order to develop customized offers for recruiting junior staff, the decision-making factors must be known. To present the gender-specific and cross-gender reasons for choosing a surgical specialist training program. As part of a scoping review, studies were identified using PubMed and a subsequent reverse search to answer the research question. Data extracted from the studies were summarized narratively and categories were defined. The analysis of 12 studies revealed that men and women wanted to become a surgeon based on the characteristics of the surgical specialty, personal factors and factors related to the training position. Gender-specific differences were also identified. Specific measures are proposed to promote the next generation of surgeons.

A comparison of general surgery training programmes across 11 countries: improving understanding of the experience level of international medical graduates in the UK.

Within the past five years there has been a significant increase in the number of international medical graduates (IMGs) joining the United Kingdom's (UK) workforce. Having mentors and supervisors who understand the needs of IMGs and clinical and cultural differences in the workplace can benefit in the transition to working in a new country. Improving knowledge of and understanding differences between general surgical training programmes and grades across different countries could therefore aid in the support of IMGs within the UK. Data on general surgical training programmes of the top ten countries for the primary medical qualifications of IMGs in the UK were collected to provide comparison with the UK training programme. The following countries were included: UK, India, Pakistan, Nigeria, Egypt, Ireland, Sudan, Sri Lanka, Romania, Iraq and South Africa. Training programme lengths ranged from 3 to 10 years. Only some training programmes provide additional training and qualification in sub-specialisation in general surgery. Other differences included a requirement for internship/non specialist training prior to training, differences in lengths of time spent in other surgical specialties and a requirement for research. Understanding the training programmes of other countries may help UK surgeons to understand the prior experience of IMGs and enable them to provide better training and support.

Assessing Neurosurgery Training: Accreditation Council for Graduate Medical Education Case Minimums Versus Surgical Autonomy.

The Accreditation Council for Graduate Medical Education (ACGME) requires neurosurgery residents to reach a set number of cases in specified procedure types (case minimums) before graduation and mandates completion of Milestones. We used the Surgical Autonomy Program, a validated method of autonomy-based resident evaluation, to determine the number of cases it took for residents to become competent and compared these with the ACGME case minimums. We collected data from neurosurgery residents at Duke University on 7 procedures (tumor craniotomy, trauma craniotomy, ventriculoperitoneal shunt, anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), discectomy/laminectomy, and posterior thoracolumbar spinal fusion [PSF]). We defined competency as being graded at the highest autonomy level in the Surgical Autonomy Program by attending neurosurgeons for the first and second time and determined the case volume on the ACGME case log when these were achieved. These results were analyzed with summary statistics. The median case volume among residents (N = 4-8) for the first and second competency rating (and ACGME minimum) for each procedure type was found to be: tumor: 44.5 and 64.5 (min. 60), trauma: 21 and 30 (min. 60), ventriculoperitoneal shunt: 11.3 and 13 (min. 20), ACDF: 30 and 32.5 (min. 20), PCF: 24 and 40 (min. 30), discectomy/laminectomy: 28 and 36 (min. 30), and PSF: 51 and 54 (min. 30). We found variation in the case numbers to reach competency and that for some procedures (tumor, ACDF, PCF, discectomy/laminectomy, and PSF), most residents required more cases than the ACGME case minimums to achieve competency. The ACGME case minimums may not accurately reflect the number of cases required for neurosurgical residents to reach competency. To promote trainee-centered education, individualized, competency-based evaluation systems may be better determining readiness for graduation, including a system that builds off the established ACGME Milestones.

Educational needs of the EAES young surgeons.

Surgical residency programs are facing ongoing challenges since the pandemic. The Young Member (YM) Task Force of the European Association for Endoscopic Surgery (EAES) has been created to support surgical residents and surgeons under 40, promoting activities that could be useful for young surgeons and to improve networking between members of different countries. This project aimed to explore educational needs among European surgical residents to inform the EAES curriculum for young surgeons. Within the EAES surgical society, the YM developed a survey to capture residents' views on their professional needs. Different aspects were considered, from demographic information to the major topics of interest on a professional side. Semi-automatic answers and personal suggestions have been gathered and considered for the analysis. Data were captured from 386 respondents across 57 different countries, major responders were represented by the group of 31-35years old (40%). Considering professional growth, young surgeons rely on scientific research (56%), but they struggle finding adequate support of facilities. In the education and training section, fellowships and hands-on-courses (27%) were the most proficient activities. Mentorships and webinars were important to develop leadership, as well as social events to build up a professional network. This project has identified young surgeons' educational and professional needs that can inform the EAES future projects and activities.

Sculpting the good surgeon or excising the bad one: How clinical teachers could perpetuate attrition in surgical residency programmes.

Attrition in surgical residencies remains a significant issue, with traditional research focusing mainly on individual and programme factors. This study explores the role of clinical teachers (CTs) in influencing attrition rates. CTs are essential in moulding residents' training, serving both as enablers of workplace learning and guardians of their medical fields. We employed a hermeneutic phenomenology framework to understand the sociocultural impacts on attrition. Data were collected through semi-structured interviews involving 19 CTs, 3 residents who left the programme and 2 who underwent remediation, following a six-step hermeneutic phenomenological analysis process. The entrenched 'good surgeon' narrative within the department demanded selflessness and total dedication, which CTs reinforced, thereby normalising a rigorous and challenging environment. This has led to attrition when residents fail to meet these challenges or choose to disengage from the system. We illustrated that CTs were pivotal in perpetuating these expectations, contributing significantly to resident attrition. CTs played a crucial role in resident attrition by enforcing a stringent cultural norm within surgical training programmes. Addressing this issue requires a visible change in CTs' role to foster a more supportive educational environment. Emphasising the beneficial aspects of the 'good surgeon' narrative and mitigating its adverse impacts is essential for reducing attrition rates and assisting all residents, including those facing challenges, in successfully completing their training.

Endocrine surgery fellowship is necessary for competent endocrine surgical practice: perspectives from Australia and New Zealand.

Currently pathways to practice in endocrine surgery vary based on location and surgical training programme. International data highlights the impact of surgeon volume on outcomes, and the importance of understanding the learning curve in developing minimum training competencies. This study aims to explore how surgeons obtain competence in endocrine surgery in Australia and New Zealand, and perceptions around competence and scope of practice. A web-based survey was distributed to fellows practicing endocrine surgery. Participants were invited to complete a semi-structured interview to explore key themes around competence. Thematic analysis was performed. Responses from 87 surgeons, with 30% practicing primarily in a regional or rural area, showed 94% emphasized post-fellowship training to be competent in endocrine surgery. Median primary operator procedural volume learning curves were 50 thyroid, 30 parathyroid and 20 laparoscopic adrenalectomy procedures. Semi-structured interviews with 12 participants identified four major themes: (1) learning opportunities during general surgical education and training programmes alone are insufficient for consultant-level competence; (2) the importance of sufficient training to develop clinical decision-making, insight and judgement to appropriately select patients in the management of endocrine disease; (3) expected standards of clinical and technical performance are independent of practice location or context; (4) the importance of multi-disciplinary teams for complex cases including advanced cancers. Practicing endocrine surgeons acknowledge formal fellowship training is required to achieve competence across technical and non-technical domains. The definition of competence and expectations regarding technical outcomes are independent of practice location or context.

Hospital variation in post-operative cardiac extracorporeal membrane oxygenation use and relationship to post-operative mortality.

It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality. Retrospective analysis of 37 hospitals contributing to the Pediatric Cardiac Critical Care Consortium clinical registry from 1 August 2014 to 31 December 2019. Hospitalisations including cardiothoracic surgery and post-operative admission to paediatric cardiac ICUs were included. Two-level multivariable logistic regression with hospital random effect was used to determine case-mix adjusted post-operative extracorporeal membrane oxygenation use rates and in-hospital mortality. Hospitals were grouped into extracorporeal membrane oxygenation use tertiles, and mortality was compared across tertiles. There were 43,640 eligible surgical hospitalisations; 1397 (3.2%) included at least one post-operative extracorporeal membrane oxygenation run. Case-mix adjusted extracorporeal membrane oxygenation rates varied more than sevenfold (0.9-6.9%) across hospitals, and adjusted mortality varied 10-fold (0-5.5%). Extracorporeal membrane oxygenation rates were 2.0%, 3.5%, and 5.2%, respectively, for low, middle, and high extracorporeal membrane oxygenation use tertiles (P < 0.0001), and mortality rates were 1.9%, 3.0%, and 3.1% (p < 0.0001), respectively. High extracorporeal membrane oxygenation use hospitals were more likely to initiate extracorporeal membrane oxygenation support intraoperatively (1.6% vs. 0.6% low and 1.1% middle, p < 0.0001). Extracorporeal membrane oxygenation indications were similar across hospital tertiles. When extracorporeal cardiopulmonary resuscitation was excluded, variation in extracorporeal membrane oxygenation use rates persisted (1.5%, 2.6%, 3.8%, p < 0.001). There is hospital variation in adjusted post-operative extracorporeal membrane oxygenation use after paediatric cardiac surgery and a significant association with adjusted post-operative mortality. These findings suggest that post-operative extracorporeal membrane oxygenation use could be a complementary quality metric to mortality to assess performance of cardiac surgical programmes.

Pointing to success: a discussion of the role of professional achievements in the selection of specialist surgical trainees

In Australia and New Zealand, competitive selection processes for surgical specialty training programs often use a standardized curriculum vitae (CV) to assess criteria such as professional achievements. This review aims to assess the predictive validity, standardization, and implicit biases of these selection methods, as well as their implications for trainees and the diversity of surgical cohorts. The 2023 CV scoring criteria were collected for all available specialty surgical programs in Australia and New Zealand. In 2023, each of the 11 surgical craft programs published publicly available standardized CV scoring criteria. In this study, scored items that constitute 'professional achievements' were recorded and tabulated. Observational analysis of the collected data was then conducted. In 2023, each of the 11 specialty surgical craft programs published publicly available structured CVs, of which 10/11 allocated points for professional achievements. Designated points for professional achievements were classified as awards, scholarships, committee positions, and prior training courses: 4/11 programs offered points for scholarships/grants, 6/11 programs offered points for academic and/or non-academic prizes, and 8/11 programs offered points for professional development courses. Observational analysis of these findings suggests that professional achievements are desired in training program applicants. Variability in medical school opportunities and inherent heterogeneity reduce the CV's efficacy, unfairly disadvantaging some applicants. Observational analysis of hence highlights the need for future research to assess potential updates in CV parameters to enhance predictive validity, reduce bias, and promote diversity.