Surgical Subspecialties Research Articles

Analysis of Racial and Gender Distribution of US MD Graduates Entering Into General Surgery and Surgical Subspecialties Residencies: The Need for Effective & Sustainable Diversity, Equity, and Inclusion Strategies

IntroductionWe aim to investigate disparities & inequities based on race, sex, graduating age, and the number of peer-reviewed publications among allopathic U.S. Doctor of Medicine graduates who reported entering a surgical training program over a span of 5 y. MethodsA retrospective cohort analysis of the Association of American Medical Colleges student records system and Electronic Residency Application Service for graduates entering a surgical specialty residency during graduate medical education training cycles 2015-2020. ResultsAfrican American, Asian, and Hispanic applicants each accounted for less than 1% of graduates who reported entering a surgical training program. Asians (OR = 0.58, P = 0.01) and those identifying as other races (OR = 0.74, P = 0.01) were significantly less likely to enter a surgical subspecialty when compared to Caucasians. Orthopedic surgery contained the lowest proportion of minorities; African Americans 0.5% (n = 18), Asians 0.3% (n = 11), Hispanics 0.1% (n = 4), and others with 2% (n = 68). Females who reported entering Orthopedic surgery training represented the smallest female population in surgical specialties (17%, n = 527). The number of peer-reviewed publications was significantly associated with male sex (β = 0.28, P < 0.01), age between 30 and 32 at graduation (β = 1.76, P < 0.01), and identification as other races (β = 1.53, P < 0.01). ConclusionsRacial minorities represented only 5.1% of graduates who reported entering a surgical specialty graduate medical education training program. Minority races and females were significantly less likely to enter a surgical subspecialty training program compared to Caucasian graduates and males, especially in orthopedic surgery. Implementation of specialty-specific programs and diversity, equity, and inclusion departments that promote mentorship and guidance toward residency programs is needed to combat continued race and sex disparities.

National Institutes of Health Funding to Departments of Orthopaedic Surgery at U.S. Medical Schools from 2015 to 2021.

National Institutes of Health (NIH) funding of orthopaedic surgery departments has historically lagged behind that of other surgical disciplines. In this study, we present an updated analysis of NIH grants awarded to orthopaedic surgery departments at U.S. medical schools and an evaluation of the characteristics of NIH-funded principal investigators (PIs). The NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database was queried for grants awarded to orthopaedic surgery departments in the 2015 to 2021 fiscal years. Funding totals were calculated for 4 categories: award mechanism, awarding institute, recipient institute, and PI. Trends in funding from 2015 to 2021 were determined and compared with the annual NIH budget. Funding awarded to orthopaedic surgery departments was compared with awards received by other surgical specialties in 2021. The characteristics of NIH-funded PIs and co-PIs were evaluated. Funding awarded to orthopaedic surgery departments in 2021 was compared with funding in 2014 as reported in a previous study. In 2021, 287 grants were awarded to 187 PIs at 47 orthopaedic surgery departments for a total of $104,710,841, representing 0.4% of the overall NIH budget. The top 5 departments earned $41,750,321 (39.9%) of the total NIH funding for orthopaedic surgery. From 2015 to 2021, total funding increased by 79.7% (p < 0.001), but the rate of increase was not significantly different from that of the overall annual NIH budget (p = 0.469). In 2021, grants were most commonly awarded via the R01 mechanism (70.0% of total funding), with a median annual award of $397,144 (interquartile range [IQR], $335,017 to $491,248). The majority of grants (70.0%) supported basic science research, followed by translational (12.2%), clinical (9.4%), and educational (8.4%) research. NIH funding did not vary by the gender of the PI (p = 0.505), and the proportion of female PIs was significantly greater in 2021 than in 2014 (33.9% versus 20.5%, p = 0.009). Compared with other surgical departments, orthopaedic surgery departments ranked second-lowest in terms of the total NIH funding received in 2021. NIH funding to orthopaedic surgery departments continues to be limited and lags behind that of other surgical subspecialties, which may create challenges in addressing the rising burden of musculoskeletal disease in the U.S. These findings highlight the importance of efforts to identify barriers to grant procurement in orthopaedic surgery.

Where Have All the Rhinoplasties Gone? A Call to Action for Academic Plastic Surgeons to Focus on Increasing Rhinoplasty Procedures Before It Is Too Late.

The armamentarium of a plastic surgeon is vast, consisting of an array of surgical procedures from head to toe. Unfortunately, plastic surgeons have been losing portions of their operative domain to other surgical subspecialties for years. The number of subspecialties invading our niche is bothersome, but more concerning is the fact that losing the reins of these core procedures results in less surgical exposure and competency for plastic surgery residents.Lately, in academic institutions, otolaryngologists seem to be performing most rhinoplasty procedures, resulting in fewer surgeries performed by plastic surgeons. Trainees must perform 10 rhinoplasties to fulfill graduation requirements but, more importantly, residents should graduate feeling competent and confident performing rhinoplasties. The aims of this study are to determine the number of rhinoplasties being performed at academic centers each year and to evaluate the trend with regard to which specialties are performing these procedures. Three academic institutions with plastic surgery and otolaryngology residency programs searched medical records for rhinoplasty Current Procedural Terminology codes from January 1, 2009, to December 31, 2019. The total numbers of rhinoplasties performed each year, by each specialty, were tallied. Growth rate in rhinoplasty volume among participating institutions ranged from 27% to 149%. At these institutions, plastic surgeons performed less than one third of all rhinoplasties. In 2009, 10% of rhinoplasties were performed by plastic surgeons at institution 1, 22% at institution 2, and 18% at institution 3. In 2019, the volume of rhinoplasties performed by plastic surgeons was 5%, 12%, and 27%, respectively. The 3 ENT departments had statistically significant increasing trends in rhinoplasty volume. Institutions 1 and 2's plastic surgery departments showed that negative volume trends, however, were not statistically significant. Institution 3's plastic surgery department has had an increasing trend, which was statistically significant. Otolaryngology is performing most rhinoplasties at several academic institutions. This is concerning for the education of plastic surgery trainees. Academic plastic surgeons must focus on increasing the number of rhinoplasties performed to adequately train residents this core procedure. If rhinoplasties are not made a priority now, this surgery may become a historic operation instead of a vital skill in plastic surgeons' armamentarium.

Trends in Race and Sex Representation Among Entering Orthopaedic Surgery Residents: A Continued Call for Active Diversification Efforts.

Multiple studies have analyzed the diversity of surgical subspecialties, in which orthopaedic surgery consistently lags behind in female and minority representation. This study aims to examine contemporary data on trends in sex and racial representation among entering orthopaedic surgery residents. The American Association of Medical Colleges' Graduate Medical Education Track data set was queried for all individuals entering surgical residencies in the United States from 2001 to 2020. Deidentified data on self-reported sex and race (American Indian or Alaska Native [AIAN]; Asian; Black or African American, Hispanic, Latino, or of Spanish Origin; Native Hawaiian or Other Pacific Islander [NHOPI]; White; and Other) for individuals across all surgical subspecialties were collected. Sex and race proportions for newly matriculating surgical residents were analyzed and aggregated across the study period. From 2001 to 2020, there was a 9.2% increase in the proportion of new female orthopaedic surgery residents, with approximately one in five identifying as such in 2020. By contrast, surgical specialties in aggregate saw a 16.3% increase. A 11.7% decrease was observed in entering orthopaedic residents who identified as White with a corresponding increase in representation by multiracial (9.2%) individuals and those identifying as "Other" (1.9%). The proportion of Asian (range: 10.4 to 15.4%), Black (2.5 to 6.2%), Hispanic (0.3 to 4.4%), AIAN (0.0 to 1.2%), and NHOPI (0.0 to 0.5%) new trainees has largely remained unchanged throughout the study period. A similar trend was observed among surgical specialties in aggregate. Of the identities most represented by the multiracial cohort, the most common were Asian (range: 7.0 to 50.0%), Hispanic (0.0 to 53.5%), and White (30.2 to 50.0%). Although orthopaedic surgery has improved in sex diversity in its entering class of residents, measures to increase racial diversity have been less successful. Efforts at improving the recruitment of a diverse class of trainees are necessary and will require acknowledging the importance of both racial and sex representation diversity metrics.

Appropriateness of antibiotic prescribing varies by clinical services at United States children's hospitals.

To describe patterns of inappropriate antibiotic prescribing at US children's hospitals and how these patterns vary by clinical service. Serial, cross-sectional study using quarterly surveys. Surveys were completed in quarter 1 2019-quarter 3 2020 across 28 children's hospitals in the United States. Patients at children's hospitals with ≥1 antibiotic order at 8:00 a.m. on institution-selected quarterly survey days. Antimicrobial stewardship physicians and pharmacists collected data on antibiotic orders and evaluated appropriateness of prescribing. The primary outcome was percentage of inappropriate antibiotics, stratified by clinical service and antibiotic class. Secondary outcomes included reasons for inappropriate use and association of infectious diseases (ID) consultation with appropriateness. Of 13,344 orders, 1,847 (13.8%) were inappropriate; 17.5% of patients receiving antibiotics had ≥1 inappropriate order. Pediatric intensive care units (PICU) and hospitalists contributed the most inappropriate orders (n = 384 and n = 314, respectively). Surgical subspecialists had the highest percentage of inappropriate orders (22.5%), and 56.8% of these were for prolonged or unnecessary surgical prophylaxis. ID consultation in the previous 7 days was associated with fewer inappropriate orders (15% vs 10%; P < .001); this association was most pronounced for hospitalist, PICU, and surgical and medical subspecialty services. Inappropriate antibiotic use for hospitalized children persists and varies by clinical service. Across 28 children's hospitals, PICUs and hospitalists contributed the most inappropriate antibiotic orders, and surgical subspecialists' orders were most often judged inappropriate. Understanding service-specific prescribing patterns will enable antimicrobial stewardship programs to better design interventions to optimize antibiotic use.

Racial and Ethnic Bias in Letters of Recommendation and Personal Statements for Application to Otolaryngology Residency

Introduction: The persistent lack of racial and ethnic diversity within the field of otolaryngology calls for an analysis of potential bias within the residency application system. Letters of recommendation (LORs) and personal statements (PSs) are the most important subjective application constituents. This subjectivity predisposes these components to implicit bias. In applications to various surgical subspecialties, prior linguistic studies assessing bias in reviews of LOR show race-based differences. Thus far, racial and ethnic linguistic differences in LORs for otolaryngology applicants have not been analyzed in the literature. Methods: LORs and PSs were abstracted from otolaryngology – head and neck surgery applications in the Electronic Residency Application Service for the 2019–20 and 2020–21 application cycles. Linguistic Inquiry and Word Count 2015 was used for quantitative analysis of emotional, cognitive, and structural components of written text. Results: Race-pair analysis of the 2019–2021 application cycles revealed higher mean “teaching” scores for LORs for Asian, black, Hispanic, and white applicants when compared to applicants who self-identified as Other. White applicants had lower scores for the terms “research” and “analytic” when compared to Asian and black applicants, respectively. Analysis of PSs revealed greater scores for an “authentic” writing style for white versus Asian applicants. White applicants were found to have higher scores for “tone” compared to black applicants. Conclusion: Minor racial and ethnic language differences exist in both LORs and PSs. A statistically significant difference was observed among LORs, with the “teaching” term used more frequently for Asian, black, Hispanic, and white applicants compared to self-identified Other individuals. For PSs, statistically significant differences were observed among white applicants, who wrote about themselves using more “authentic” language when compared with Asian applicants and who also had higher scores for “tone” compared to black applicants. Although these differences were statistically significant, the practical impact of the variances is likely small.

Global Neurosurgery Advocacy

The white paper published by the Lancet Commission put forward surgery as a global health priority. In that paper, their findings showed that 5 billion people in the world do not have access to 'safe, affordable surgical and anesthesia services when needed,' and this inequity is more evident in lower- and middle-income countries (LMICs). These deficits are even more profound in surgical subspecialties such as neurosurgery. The paper "Global Neurosurgery: The Unmet Needs," published in 2016, addresses the system-level thinking and programs required to address the needs of neurosurgical care in lower resource settings. Neurosurgeons need to have influence, presence, and leadership role in advocating for the surgical system strengthening worldwide as it is estimated that there are 5 million emergency and essential neurosurgery neurosurgical services currently unmet, especially in LMICs. Thus, in 2019, the World Federation of Neurosurgical Societies (WFNS) established the Global Neurosurgery Committee (GNC), an ad hoc committee dedicated to organizing and furthering global neurosurgical efforts. The Committee is co-chaired by Kee B. Park, MD, MPH from the United States, and Abdessamad El Ouahabi, MD from Morocco. The body of the GNC was the Committee of 22 neurosurgeons from 19 countries; the Secretariat Team primarily managed internal GNC operations with support from the later-added Junior Committee, both of which were international medical students and trainees. One of the objectives of this Committee is to promote advocacy efforts for neurosurgical care within universal healthcare coverage. This paper explores the fifth "ADVOCATE" objective, including its significance, the GNC's efforts, and progress toward executing its defining targets.

A Comparison of Surgical Subspecialty Match Rates in 2022 in the United States.

This paper examines the 2022 surgical subspecialty results within the Match hosted yearly by the National Resident Matching Program (NRMP) in the United States. It exists to place medical graduates with post-graduate training programs via an algorithm based on ranked lists provided by both residency programs and individual applicants around the world. This paper compares the match rates between allopathic medical graduates (MDs) and osteopathic medical graduates (DOs). Using published NRMP data and reports from Program Director surveys, we explored possible reasons for match rate differences between the two groups, hypothesizing that lower match rates among DOs could be explained by completion of less volunteerism, research, or curricular activities that may have affected their overall first-choice match rates in competitive surgical specialties. While the data showed that MDs consistently out-matched DOs, the cause was deemed multifactorial as the data did not provide concrete evidence to the contrary. We concluded that more data over time should be collected to understand why osteopathic students do not match as well as allopathic students in surgical specialties.

MP57-16 CLOSING THE GENDER GAP IN UROLOGY AND OTHER SURGICAL SPECIALTIES

You have accessJournal of UrologyCME1 Apr 2023MP57-16 CLOSING THE GENDER GAP IN UROLOGY AND OTHER SURGICAL SPECIALTIES Finn Hennig, Guillaume Farah, Kyle Waisanen, and Teresa Danforth Finn HennigFinn Hennig More articles by this author , Guillaume FarahGuillaume Farah More articles by this author , Kyle WaisanenKyle Waisanen More articles by this author , and Teresa DanforthTeresa Danforth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the past decade, urologists have seen an increase in the number of female as well as gender diverse patients. Therefore, it is important that the field of urology reflects gender diversity within their workforce. The primary objective of this study was to evaluate the trend in the gender of matched urology applicants over the past 5 years and in addition, compare this trend to other surgical subspecialties. METHODS: Data was collected on resident demographics and match statistics through the ACGME and AUA respectively, available online from the years 2017-2022. Chi-squared, linear regression and ANCOVA analyses were run using R software with a p-value of 0.05 used for significance. RESULTS: Last year, 2021, was the first year the AUA reported the gender marker non-binary and transgender (NB/TG) for urology residency applicants. This year, 2022, was the first proportion of matched NB/TG applicants was described (33%). There were significantly less female and NB/TG applicants matching into urology than males between the years 2018-2022 (p=0.017). While the rate of female/NB/TG identified applicants to urology has increased, the rate of female/NB/TG identified individuals matching into urology was significantly higher over the past 5 years (1.3 % per year vs. 2.9% per year, respectively) (p=0.014). The number of female/NB/TG identified residents was highest in general surgery and with the greatest overall increase of 7.4% over 5 years. Urology, neurosurgery, and orthopedic surgery had the lowest percentages overall, but all increased∼3% over 5 years. The proportional increase from 2017 however, was higher in neurosurgery and orthopedic surgery (17.2% and 19.7% respectively) than urology (11.9%). CONCLUSIONS: Almost all surgical subspecialties have seen an increase in the number of female/NB/TG residents. The most recent 2022 match data reported the highest proportion of matched females (35.6%) and NB/TG applicants (33%). Interestingly, the number of matched female/NB/TG individuals increased at a rate greater than expected based on the number of applicants. Despite this increase, representation is still significantly lower than males. Taken together, this could be the first evidence of success of initiatives by urology residency programs to support equity, diversity and inclusion. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e791 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Finn Hennig More articles by this author Guillaume Farah More articles by this author Kyle Waisanen More articles by this author Teresa Danforth More articles by this author Expand All Advertisement PDF downloadLoading ...

Has the Increase of Women in Surgical Training Programs Led to a Concomitant Increase in Female Leadership Positions? A 10-Year Analysis.

Women represent greater than 50% of medical students in America and are becoming increasingly well represented in surgical fields. However, parity at the trainee level has yet to be accomplished, and surgical leadership positions have remained disproportionately biased toward men. To date, there have been no comparisons on the progress within plastic surgery and other surgical specialties. This investigates the gender disparity in resident and leadership representation over the past 10 years within surgical specialties and how these disparities compare to plastic surgery. Counts of female and male residents and surgical society leaders were collected from 2008 to 2018. Surgical fields included plastic, vascular, urologic, neurologic, orthopedic, cardiothoracic, and general surgery. Leadership positions were defined as board seats on executive committees of major surgical societies or board associations. Data were acquired from publicly available sources or provided directly from the organizations. Resident data were obtained from the Accreditation Council of Graduate Medical Education residents' reports. Individuals holding more than 1 leadership position within a year were counted only once. In our aggregated analysis, the proportion of women in surgical leadership lags behind women in surgical residency training across all specialties (13.2% vs 27.3%, P < 0.01). General surgery had the highest proportion of female residents and leaders (35% and 18.8%, P < 0.01), followed by plastic (32.2% and 17.3%, P < 0.01), vascular (28.2% and 11.3%, P < 0.01), urologic (24.3% and 5.1%), and cardiothoracic surgery (20.5% and 7.8%, P < 0.01). Women in surgical leadership, however, increased at a faster rate than women in surgical training (11% vs 7%, P < 0.05). Plastic surgery showed the greatest rate of increase in both residents and leaders (17% and 19%, P < 0.05) followed by cardiothoracic surgery (16% and 9%, P < 0.05) and general surgery (8% and 14%, P < 0.05). For neurologic and orthopedic surgery, neither the difference in proportions between residents and leaders nor the yearly growth of these groups were significant. Between 2008 and 2018, women in plastic surgery training and leadership positions have shown the most significant growth compared with other surgical subspecialties, demonstrating a strong concerted effort toward gender equality among surgical professions.

MP75-17 MATERNAL, NEONATAL AND PREGNANCY OUTCOMES IN UROLOGY: HOW DO WE MEASURE UP?

You have accessJournal of UrologyCME1 Apr 2023MP75-17 MATERNAL, NEONATAL AND PREGNANCY OUTCOMES IN UROLOGY: HOW DO WE MEASURE UP? Brittany Levy, Tess London-Bounds, Alexandra Kejner, Nikita Gupta, Adam Dugan, Will Cranford, and Amanda Saltzman Brittany LevyBrittany Levy More articles by this author , Tess London-BoundsTess London-Bounds More articles by this author , Alexandra KejnerAlexandra Kejner More articles by this author , Nikita GuptaNikita Gupta More articles by this author , Adam DuganAdam Dugan More articles by this author , Will CranfordWill Cranford More articles by this author , and Amanda SaltzmanAmanda Saltzman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Physicians and especially surgeons, are higher risk for pregnancy complications leading to poor pregnancy, neonatal and health outcomes. However, across surgical specialties, pregnancy and neonatal outcomes have not been delineated. The objective of this survey study was to evaluate maternal, neonatal and pregnancy outcomes compared to other surgical specialties. METHODS: A survey was distributed to practicing surgeons across specialties including general surgery, urology, otolaryngology, and associated subspecialties. Survey questions regarding demographics, career stage, pregnancy/delivery, neonatal complications, maternity leave, breast feeding goals, and barriers to meeting these goals were asked. Responses were analyzed comparing urology/urologic subspecialties to other surgical specialties. RESULTS: S:1162 births across surgical specialties were obtained, 159 of which were to urologic surgeons. Of these births, 454 were to trainees, while 694 children were birthed to attendings. Similarities across surgical subspecialties included gestational age at delivery (p=0.161). Those in urology/urology subspecialties were less likely to have pregnancy complications compared to other surgical specialties (31.4% vs 44.4%, p=0.003). Additionally, children born to urologists were more frequently healthy (87.8% vs 78.1%, p=0.031) without major or minor neonatal health issues (Figure 1). CONCLUSIONS: Overall, urologists have improved pregnancy and infant health outcomes compared to other surgical specialties. Further research is needed to identify specific etiologies to enable directed quality improvement measures for all child bearing surgeons. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1087 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Levy More articles by this author Tess London-Bounds More articles by this author Alexandra Kejner More articles by this author Nikita Gupta More articles by this author Adam Dugan More articles by this author Will Cranford More articles by this author Amanda Saltzman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP06-12 STANDARDIZATION AND VISUALIZATION OF THE SURGICAL TIME OUT ACROSS SURGICAL SUBSPECIALTIES

You have accessJournal of UrologyCME1 Apr 2023MP06-12 STANDARDIZATION AND VISUALIZATION OF THE SURGICAL TIME OUT ACROSS SURGICAL SUBSPECIALTIES Brittany Levy, Sherry Lantz, Wesley Wilt, and Andrew Harris Brittany LevyBrittany Levy More articles by this author , Sherry LantzSherry Lantz More articles by this author , Wesley WiltWesley Wilt More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The timeout (TO) can prevent adverse events but is subject to TO engagement. We hypothesize transforming the TO to an auditable, active process will improve compliance and engagement. METHODS: The passive nature of the current TO was identified as a potential safety issue on staff patient safety culture surveys. Subsequently, the Time Out Engagement and Standardization (TOES) quality improvement initiative was developed. 11 TOs were audited concerning engagement and content. Leadership and frontline stakeholders were engaged as members of the TOES team to determine potential interventions. A TO consisting of 15 elements utilizing a TO whiteboard with role specific objectives was developed. Plan, Do, Study, Act (PDSA) cycles commenced. Following implementation, 17 TOs in urology, general surgery, and vascular surgery were audited based on engagement and content. RESULTS: Engagement varied with nurse participating in 100% compared to anesthesia provider or surgeon participating in 18%. No TO included all 15 elements and only 13% of elements were standardized across TOs. Overall, 40% of the elements were discussed in 80% of TOs. Post-implementation of TOES, nursing, anesthesia, and surgeon participated in 100% of TOs. The 15 standardized elements of the TO were discussed 90% of the time. Voice of the customer audits revealed widespread acceptance of the active TO. Within the robotic OR, urologists noted a particular improvement in preoperative planning communication across the surgical team. CONCLUSIONS: We identified a need for increased engagement of the TO based on staff concerns which were verified through auditing. Implementation of a team driven intervention and rapid PDSA cycles led to measurable improvement of the surgical TO. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e57 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Levy More articles by this author Sherry Lantz More articles by this author Wesley Wilt More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF downloadLoading ...

The comparative study of intraperitoneal access by open versus close method to create pneumoperitoneum in laparoscopic surgeries

Background: Laparoscopy is a Latin word; ‘laparo’ means abdomen and ‘scopein’ means to examine, hence it is an art of examination of abdomen and visceral contents. laparoscopic procedure has been revolutionized and come under routine practice by surgical subspecialties because of it has many advantages over conventional laparotomy like small size scar, short hospital stays, less chance of wound infection, minimal postoperative pain, quick recovery after surgery. The aim of the study was to compare the rates and nature of complication during creation of pneumoperitoneum in open and closed laparoscopic procedure. Methods: This is a single centre, comparative, observational study. Tools of study include, observation, intraoperative and post-operative observation of complications. Nonprobability sampling (purposive sampling) technique was used in this study. Sample size was 44 (in each group). Written and Informed consent has been taken from all patients who were underwent abdominal laparoscopic surgery. Results: This study represents the comparison between different open and closed methods for creation of pneumoperitoneum in laparoscopic abdominal surgeries. In this study, according to classification of complication at entry level in open method omental injury found in 2 (12%) patients; extra peritoneal insufflations 1 (6%), port site gas leakage 10 (59%), loss of space 1 (6%), entry in wrong plane 3 (17%). In closed method omental injury found in 4 (13%) patients; extra peritoneal insufflations 4 (13%), port site gas leakage 8 (27%) loss of space 5 (17%), entry in wrong plane 7 (23%), abdominal wall haematoma 4 (13%). Conclusions: Open method is merely safer than closed technique but due to small number of patients took into study as well as study time period is short. Final judgment for the research, multi centric trials in different institutions are required for the initial, crucial, and technically challenging step of newly emerging field of surgery.

Development and Interrater Agreement of a Novel Classification System Combining Medical and Surgical Adverse Event Reporting

Categorization systems for adverse events are not standardized across care settings and specialties and do not always include near miss events (events where there was potential for patient harm, but where no actual harm occurred), making it difficult to effectively assess patient safety for quality improvement. To develop and assess interrater agreement on a classification system for adverse events reporting that incorporates events in both inpatient and outpatient settings across medical and surgical subspecialties including near miss events. A cross-sectional study in a tertiary care center including 174 patient cases occurring from 2018 to 2020 was carried out. Data were abstracted from a Department of Otorhinolaryngology-Head and Neck Surgery Quality Assurance database. The cases were comprised of near miss and adverse events occurring in adult and pediatric patients in inpatient, outpatient, and emergency department settings. The ratings took place in March and April of 2022. Four raters (2 attending physicians and 2 senior resident physicians) were recruited to classify these cases according to 3 classification systems: the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP), Clavien-Dindo, and our novel Quality Improvement Classification System (QICS). The primary outcome was overall interrater agreements using Fleiss κ. Across all 4 raters grading 174 cases, the NCC-MERP, Clavien-Dindo, and QICS received a κ score. Fair-to-moderate interrater reliability was observed between the resident and attending physician groups across the 3 classification systems: NCC-MERP (κ = 0.33; 95% CI, 0.30-0.35), Clavien-Dindo (κ = 0.47; 95% CI, 0.43-0.50), and QICS (κ = 0.42; 95% CI, 0.39-0.44). Strong interrater concordance was observed for complications across all scenarios. This cross-sectional study found that the new QICS classification scheme was applicable to wide-ranging clinical scenarios with a focus on patient-centered outcomes including near miss events. In addition, QICS allowed for the comparison of patient outcome data in a multitude of settings.

Matching into competitive surgical residencies: predictors of success

ABSTRACT Evidence-informed data may help students matching into competitive residency programs guide curricular activities, extracurricular activities, and residency career choices. We aimed to examine the characteristics of students applying to competitive surgical residencies and identify predictors of matching success. We identified the five lowest match rates for the surgical subspecialities listed in the 2020 National Resident Matching Program report to define a surgical residency as competitive. We analyzed a database from 115 United States medical schools regarding application data from 2017 to 2020. Multilevel logistic regression was used to determine predictors of matching. Statistical significance was set at p < 0.05.A total of 1,448 medical students submitted 25,549 applications. The five most competitive specialties included were plastic surgery (N = 172), otolaryngology (N = 342), neurological surgery (N = 163), vascular surgery (N = 52), orthopedic surgery (N = 679), and thoracic surgery (N = 40). We found that medical students with a geographical connection (adjusted OR, 1.65 [95% CI, 1.41 to 1.93]), and students who did an away rotation at the applied program (adjusted OR, 3.22 [95% CI, 2.75 to 3.78]) had statistically significantly increased odds of matching into a competitive surgical specialty. Furthermore, we found that students with a United States Medical Licensing Examination (USMLE) Step 1 score below 230 and Step 2 Clinical Knowledge (CK) score below 240 had increased odds of matching if they completed an away rotation at the applied program. Completing an away rotation and geographical connection to the institution may contribute more than academic criteria for selection into a competitive surgical residency after an interview. This finding may be due to less variation in academic criteria among this pool of high-performing medical students. Students with limited resources who apply to a competitive surgical specialty may be at a disadvantage given the financial burden of an away rotation.

The Impact of COVID-19 on the Urology Residency Match and Geographic Proximity of Applicants

ObjectiveTo determine the impacts of COVID-19 pandemic-related changes and program-specific characteristics on the geographic diversity of the 2021 and 2022 urology match classes. MethodsWe gathered publicly available information to compare match outcomes in 2021 and 2022 to the previous 5 application cycles (2016-2020). Variables included residency program class size, program and resident AUA section, and program and resident medical school. Univariate comparisons were made with Fisher's t-tests. Odds ratios were calculated following multivariable analysis. ResultsComparing the previous 5 application cycles to the 2 pandemic years individually and together showed no significant changes in home or in-section matches. However, when comparisons were stratified by small (1-2 residents) vs large (3+ residents) programs, a significant increase in at-home and in-section matches was observed for small programs in 2021. Large programs did not experience significant changes in match patterns. Multivariate analysis showed that small programs had significantly lower odds of matching applicants from home institutions and within AUA sections. Additionally, certain AUA sections demonstrated significantly increased likelihood of accepting in-section applicants. ConclusionThe changes from in-person to virtual application cycles during the pandemic particularly affected small residency programs in 2021. With easing restrictions and logistical improvements in the 2022 cycle, locoregional match rates partially shifted back to prepandemic patterns, though not completely. Although the pandemic did not affect geographic diversity in urology as much as in other surgical subspecialties, these findings and further study should be considered to optimize upcoming cycles.

A Call to Action to Train Underrepresented Minorities in Surgical Subspecialties and Fellowships.

With each succession along the surgical career pathway, from medical school to faculty, the percentage of those who identify as underrepresented in medicine (URiM) decreases. We sought to evaluate the demographic trend of surgical fellowship applicants, matriculants, and graduates over time. The Electronic Residency Application Service and the Graduate Medical Education Survey for general surgery fellowships in colorectal surgery, surgical oncology, pediatric surgery, thoracic surgery, and vascular surgery were retrospectively analyzed (2005 to 2020). The data were stratified by race and gender, descriptive statistics were performed, and time series were evaluated. Race/ethnicity groups included White, Asian, other, and URiM, which is defined as Black/African American, Hispanic/Latino(a), Alaskan or Hawaiian Native, and Native American. From 2005 to 2020, there were 5,357 Electronic Residency Application Service applicants, 4,559 matriculants, and 4,178 graduates to surgery fellowships. Whites, followed by Asians, represented the highest percentage of applicants (62.7% and 22.3%, respectively), matriculants (65.4% and 23.8% respectively), and graduates (65.4% and 24.0%, respectively). For URiMs, the applicants (13.4%), matriculants (9.1%), and graduates (9.1%) remained significantly low (p < 0.001). When stratified by both race and gender, only 4.6% of the applicants, 2.7% of matriculants, and 2.4% of graduates identified as both URiM and female compared to White female applicants (20.0%), matriculants (17.9%), and graduates (16.5%, p < 0.001). Significant disparities exist for URiMs in general surgery subspecialty fellowships. These results serve as a call to action to re-examine and improve the existing processes to increase the number of URiMs in the surgery subspecialty fellowship training pathway.

Complex Vascular Resections for Retroperitoneal Soft Tissue Sarcoma

Retroperitoneal sarcomas (RPSs) are locally aggressive tumors that can compromise major vessels of the retroperitoneum including the inferior vena cava, aorta, or main tributary vessels. Vascular involvement can be secondary to the tumor's infiltrating growth pattern or primary vascular origin. Surgery is still the mainstay for curing this disease, and resection of RPSs may include major vascular resections to secure adequate oncologic results. Our improved knowledge in the tumor biology of RPSs, in conjunction with the growing surgical expertise in both sarcoma and vascular surgical techniques, has allowed for major vascular reconstructions within multi-visceral resections for RPSs with good perioperative results. This complex surgical approach may include the combined work of various surgical subspecialties.

Parental-leave policies and perceptions of pregnancy during surgical residency training in North America: a scoping review.

The number of surgical residents experiencing childbearing during residency training is increasing, and there is an absence of clarity with respect to parental-leave, lactation and return-to-work policies in support of residents. The aim of this review was to examine parental-leave policies during residency training in surgery and the perceptions of these policies by residents, program directors and coresidents, as described in the literature. We performed a scoping review of the literature based on the following themes: maternity or parental-leave policies; antepartum work-restriction policies and obstetric complications; accommodations for training absences; support for, and perceptions of, maternity or parental leave during residency training; and challenges upon return to work, namely resident performance and breastfeeding. Parental-leave policies during surgical residency training have historically lacked clarity and enforcement. Although recommendations for parental leave are now in place, this may have historically contributed to a lack of perceived support for surgical residents and may result in variable leave permitted to residents. Unclear policies may also contribute to career dissatisfaction among resident parents, which may deter qualified individuals from selecting surgical subspecialties. A call for a cultural shift is required to inform policies that would better support residents across all surgical specialties to pursue success in their dual roles as parents and surgeons. With increased awareness, progress in policy and guideline development is under way.

Diagnostic accuracy and management concordance of otorhinolaryngological diseases through telehealth or remote visits: A systematic review & meta-analysis

Introduction COVID-19 has led to delays in providing healthcare in both emergency and non-emergency settings, especially in surgical subspecialties which rely heavily on referrals and in-person visits. Without an established telehealth infrastructure, many otorhinolaryngological departments experienced decreases in consultations. Telemedicine has attempted to bridge the gap between pre- and post-pandemic periods by creating a safe avenue of communication between otorhinolaryngologists and patients. This review hopes to address the accuracy of telemedicine in patient diagnosis and management. Methods Searches were conducted since study conception until June 30, 2022, on multiple databases including PubMed, SCOPUS, and CINAHL for this systematic review and meta-analysis. Diagnostic accuracy, management accuracy, kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were meta-analyzed by comparing virtual visits to in-person visits (gold standard). Results Nineteen studies were included in this review. A total of 1518 patients were included across all studies. When comparing virtual visits against in-person visits, accurate diagnosis was made in 86.2% [82.1,89.9, I2 = 73.5%, P < 0.0001] of patients and management accuracy was 91.5% [86.1,95.7, I2 = 81.8%, P < 0.0001] when treating patients. Kappa value determining interrater reliability was 0.8 [0.7,0.9, I2 = 81.8%, P < 0.0001]. Conclusion Our data suggest that diagnostic and management concordance is above 80% when comparing diagnosis and management strategies in patients who underwent both telehealth and in-person visits with an otorhinolaryngologist. In uncomplicated patients, telehealth might be a reliable source for diagnosis and management however, in-person consultation is likely still required for pathologies in which physical exam, imaging or procedural elements represent a vital component of the work-up.