Type Of Residency Training Research Articles

Billing and Coding Education and Knowledge Among Military Orthopaedic Surgeons

Objectives: The purpose of this study is to evaluate the current level of billing and coding knowledge among resident and staff military orthopaedic surgeons. Design: Prospective survey, training, and assessment. Setting: Academic Military Level 1 Trauma Center. Intervention: Voluntary, anonymous survey relating to practice setting, billing, and coding practices, type of residency training and prior education on the subject. A quiz consisting of 23 questions to assess billing and coding knowledge. Main outcome measurement: Survey results and quiz scores. Results and conclusions: We had 68 responses comprised of 23 residents and 45 staff orthopaedic surgeons. Among residents, 86.14% (20/23) reported that they code encounters yet only 17.39% (4/23) responded that they have had formal training on billing and coding. 91.30% (21/23) felt that this topic should be taught in residency training. Among staff surgeons, 93.33% (42/45) code their own encounters and 42.22% (19/45) reported formal training on billing and coding. 93.33% (42/45) of staff felt that billing and coding should be taught in residency. The average quiz scores among residents and staff were 43.48% and 58.36%, respectively (p<0.0001). Scores among those with prior training in billing and coding were significantly higher overall (p= 0.033). Among staff there was no significant differences in scores related to years of experience, residency type, working with residents, years remaining in the military or participation in off-duty employment. Conclusion: There remains a paucity of formal training on billing and coding among military orthopaedic surgeons and this problem is not unique to military orthopaedic residency training programs. Those with formal training in billing and coding performed significantly better than those without, indicating that formal billing and coding training as part of graduate medical education may be effective in improving billing and coding knowledge among military orthopaedic surgeons. Level of Evidence: IV; survey Keywords: Billing, Coding, Medical education, Practice management.

Interdisciplinary Representation of Burn Surgery Journal and Society Leadership.

Burn care is a complex craft that requires an interdisciplinary approach. It includes a diverse array of specialty providers to provide holistic, specialized care to burn victims. This study aims to evaluate the diverse array of subspecialties involved in burn surgery journal and society leadership. A cross-sectional study was conducted in July 2019 by examining the characteristics of society and journal leaders. Current governance and committee members of the American Burn Association (ABA) and International Society of Burn Injuries (ISBI) were determined, as well as the editors of five major burn journals. Information gathered included occupation, advanced degrees obtained, and type of residency training. Of 384 editorial board members identified, 76% were physicians (n = 291), with specialties including burn surgery (n = 208, 54%) and anesthesiology (n = 22, 6%). Among nonphysicians (n = 78, 20%), 76% were medical researchers (n = 59), 8% physical therapists (n = 6), and 5% nurses (n = 4). Looking at ABA and ISBI governance (n = 29), 82% were physicians (n = 24). Nonphysician ABA and ISBI leaders were nurses (n = 2, 7%) and occupational therapists (n = 2, 7%). Of 467 identified ABA and ISBI committee members, half were physicians (n = 244, 52%). There was a wide array of nonphysician occupations among committee members, from nurses (n = 99, 21%), to occupational therapists (n = 25, 5%), and even firefighters (n = 6, 1%). Burn surgery journal and society leadership reflect the interdisciplinary nature of burn care by including an array of subspecialties. Yet, physicians tend to dominate academic burn leadership in comparison to other disciplines, highlighting the need for more nonphysician representation in leadership positions.

746 Racial and Ethnic Disparities Among Burn Surgery Leadership

Abstract Introduction The underrepresentation of racial and ethnic minority groups has existed and been well documented in general and plastic surgery literature but has not been described in burn surgery. The aim of this study is to evaluate current minority group representation among burn surgery leadership. Methods A cross-sectional study was performed in January 2019 to evaluate minority group representation among burn surgery leadership. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers in the US, past and current presidents of the ABA and International Society of Burn Injuries (ISBI), and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and h-index. Results Among 71 burn center directors, 68 societal presidents, and 197 journal editors, minority ethnic groups represented 18.3, 7.4, and 34.5 percent, respectively. Among US burn center directors, the group classified collectively as non-white was significantly younger (white = 56 years, non-white = 49 years; p< 0.01), graduated more recently (white = 1996, non-white = 2003; p < 0.01), and had a lower h-index (white = 17.4, non-white = 9.5; p < 0.05) than white colleagues. There were no significant differences in gender, type of residency training, advanced degrees obtained, and fellowships completed between white and non-white groups.The were no significant differences in the likelihood of white and non-white directors in academia to be full professor, residency or fellowship director, or chair of the department.When compared to the 2018 US National Census, burn unit directors had a 5.1 percent decrease in non-white representation. Specifically, Asians had an 8.3 percent increase in representation, while there was a decrease in both Black (12.0%) and Hispanic (15.3%) representation. Conclusions Disparities in representation of ethnic and racial minorities exist in burn surgery leadership. The most extreme disparities were seen with Black and Hispanic surgeons. However, because these surgeons are younger and graduated more recently, it is promising that minority representation will continue to rise in the future. Applicability of Research to Practice Programs should be initiated in burn surgery that address the implicit biases of burn surgeons and increase mentorship opportunities for underrepresented minorities.

Racial and Ethnic Disparities Among Burn Surgery Leadership.

The underrepresentation of racial and ethnic minority groups has been well-documented in general and plastic surgery but not in burn surgery. The aim of this study is to evaluate current minority group disparities among burn surgery leadership. A cross-sectional analysis was performed. Burn surgeons included directors of American Burn Association-verified burn centers in the United States, past and current presidents of the American Burn Association, and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and Hirsch index (h-index). Among 71 burn center directors, 50 societal presidents, and 197 journal editors, minority groups represented 18.3, 2.0, and 34.5%, respectively. Among burn center directors, the group classified collectively as nonwhite was significantly younger (49 vs 56; P < .01), graduated more recently (2003 vs 1996; P < .01), and had a lower h-index (9.5 vs 17.4; P < .05). There were no significant differences in gender, type of residency training, advanced degrees obtained, fellowships, academic rank, and academic leadership positions between white and nonwhite groups. When compared with the 2018 U.S. National Census, burn unit directors had a 5.1% decrease in nonwhite representation. Disparities in representation of ethnic and racial minorities exist in burn surgery despite having similar qualifying factors.

AOSpine Global Survey: International Trends in Utilization of Magnetic Resonance Imaging/Computed Tomography for Spinal Trauma and Spinal Cord Injury across AO Regions.

The aim of this study was to determine the current trends in magnetic resonance imaging (MRI)/computed tomography (CT) utilization for spine trauma in various clinical scenarios. We conducted a survey across six AO regions and preformed pair-wise comparisons between responses obtained from different AO regions. The survey was sent to 5813 surgeons and had a 9.6% response rate with the majority being orthopedic followed by neurosurgeons. In a neurologically intact patient, the predominant imaging modality for all AO regions was CT. For patients with spinal cord injury (SCI), the predominant choice for all AO regions was CT + MRI + x-ray except North America, which was CT + MRI; pair-wise comparisons revealed significant differences involving LATAM (Latin America) versus (Asia-Pacific [APAC], Europe [EU], and Middle East [MEA]) and APAC versus (LATAM and North America [NA]). In a patient with incomplete SCI (ISCI) who presented within 4 h and had CT, the predominant choice for all AO regions was "forgo MRI and proceed to operating room (OR)." Similar to ISCI, in a patient with complete SCI, the predominant option for all AO regions was the same as ISCI, but the range was lower. Pair-wise comparisons noted significant differences between MEA and APAC, with both exhibiting differences compare to NA, LATAM, and EU for complete and ISCI. Most AO regions obtained post-operative MRI only if there was a new deficit. In summary, decisions about the use of a particular imaging modality across AO regions appears to be influenced by the neurological status of the patient upon admission and the presence of neurological deficits post-surgery. Type of residency training and fellowship training did not have an influence on choosing the appropriate imaging modality for both intact and impaired patients. Further study is needed to determine whether accessibility to MRI would change surgeons' attitude toward obtaining MRI in patients with SCI.

Primary Residency Training and Clinical Practice Profiles Among Board-Certified Hand Surgeons

This study seeks to identify the relationship between the type of residency training (general, plastic, or orthopedic surgery) and the clinical practice profiles of hand surgeons in the United States. Membership applications to the American Society for Surgery of the Hand (ASSH) from 2011 to 2015 were analyzed. Data on type of residency training, practice type, the percentage of hand surgery in practice, and the time to application were collected. Total cases and the number of cases in each key clinical category were collected from surgical case logs. From 2011 to 2015, a total of 451 hand surgeons applied for ASSH membership. Of these, 73.8% were orthopedic surgeons, 16.0% plastic surgeons, and 10.2% general surgeons. The median times to application after fellowship graduation and completion of the Certificate of Added Qualifications (CAQ) were 5 and 1 years, respectively and were similar between groups. Orthopedic surgeons are more likely to be in a private practice and perform the highest volume of cases. Plastic surgeons are most likely to be in an academic practice but perform nearly 20% of their cases outside of the field of hand surgery. Failure to meet the minimum case requirement inthe joint contracture (40.7%), congenital (80.5%), and microvascular surgery (47.6%) categorieswere the most common for all applicants. Orthopedic surgeons were most likely toperform bone and joint, nerve, tendon and muscle, and tumor cases. Plastic surgeons were themost likely to perform skin and wound, congenital, and microvascular cases. Orthopedic-, plastic-, and general surgery-trained hand surgeons early in their career have varied practice types and have different clinical case profiles. Differences in case profiles may be due to surgeon interest and/or training experience. Promoting a collaborative relationship between hand surgeons of varied backgrounds is crucial to the training of future hand surgeons and the continued advancement of the field.

Primary Residency Training Pre-determines Post-fellowship Clinical Practice in Board-certified Hand Surgeons: N/A - Not a clinical study

There is no financial information to disclose. This study seeks to identify the relationship between the type of residency training (general, plastic, or orthopaedic surgery) and the clinical practice profiles of hand surgeons in the United States. Membership applications to the American Society for Surgery of the Hand (ASSH) from 2011-2015 were obtained with permission. Data on type of residency training, practice type (private, private-university, hospital, or other), the percentage of hand surgery in practice, and the time to application from fellowship and CAQ completion were collected. The total number of cases as well as the number of cases in each key clinical category were collected from surgical case logs. Categorical variables were evaluated with chi-squared tests and continuous variable with Mood’s median tests and Kruskal-Wallis tests; the numbers of surgical cases were analyzed with Poisson regression. All statistical analysis were performed with STATA (v. 13.1, Mac). From 2011-2015, a total of 451 hand surgeons applied for ASSH membership. 73.8% were orthopaedic surgeons (16.0% plastic surgeons and 10.2% general surgeons). After excluding outliers, the median time to application after fellowship graduation and completion of the CAQ was 5 and 1 years, respectively, and was similar between groups. Plastic surgeons were more likely to be in an academic practice (48.3% versus 17.0% for orthopedics and 7.7% for general surgery, P < 0.0001). General surgeons were most likely to be in private practice (71.8% versus 59.2% for orthopedics and 39.7% for plastic surgery). Plastic surgeons had the smallest and most variable proportion of their practice dedicated to hand surgery (77.5%, SD 18.7%). Orthopaedic surgeons had the highest volume of cases (median 306, P < 0.0001). Out of all applicants, deficiencies in joint contracture (40.7%), congenital (80.5%), and microvascular surgery (47.6%) were the most common. Orthopaedic surgeons were most likely to perform bone and joint, nerve, tendon and muscle and tumor cases. Plastic surgeons were the most likely to perform skin and wound, congenital and microvascular cases. General surgeons did notably fewer bone and joint, tendon and muscle, and congenital cases relative to both plastic and orthopaedic surgeons. See Figure 1 for detailed results. •Orthopaedic, plastic, and general surgery-trained hand surgeons early in their career seek varied practice types and have different clinical case profiles.•Differences in case profiles may be due to surgeon interest and/or training experience.•Evaluation of training curriculums for hand fellows should ensure that graduates are adequately exposed to the full range of hand surgery.

Current trends in the practice of endoscopy among surgeons in the USA.

The diagnostic and therapeutic roles for endoscopic intervention are expanding. To continue emphasis on endoscopy in surgical training, The Society of American Gastrointestinal and Endoscopic Surgeons has developed the Fundamentals of Endoscopic Surgery (FES) course to standardize and assess endoscopy training. However, little demographic information exists about the current practice of endoscopy by general surgeons and how to best integrate endoscopic skills into surgical training. A survey to collect data regarding the current practice patterns of endoscopy was sent to surgeons with a valid email address in the American Medical Association masterfile. Information regarding the type of training (academic vs. community general surgery residency) and current practice environment (academic medical center vs. community hospital) was collected. The respondents' current practice volume of upper endoscopy and colonoscopy over the prior year was stratified into three groups: rare (<1 per month), moderate (1-10 per month), and frequent (>10 per month). Pearson's Chi-squared test was used to analyze the data. The survey was sent to 9902 general surgeons. There were 767 who provided answers regarding their current practice of endoscopy. Mean time in practice was 18±10years, 87% were male, and 83% practiced in a metropolitan area. Respondents who trained at academic general surgery programs were less likely than those at community programs to frequently perform colonoscopy (17.3 vs. 27.9%, p<0.05) and upper endoscopy (11.8 vs. 17.1%, p<0.05). Those who currently practice in academic medical centers were also less likely to be frequent performers of colonoscopy (5.6 vs. 24.7%, p<0.05) and upper endoscopy (9.8 vs. 14.8%, p<0.05) than those who practice at community hospitals. The type of residency training and current practice setting of general surgeons has a significant influence on the volume of endoscopic procedures performed. This study identifies areas where more emphasis on endoscopic skills training is needed, such as FES.

Treatment preferences for trigger digit by members of the American Association for Hand Surgery.

Trigger digit is a common pathology encountered by hand surgeons, but there is a lack of evidence-based guidelines. We investigated the treatment preferences of hand surgeons and explored whether geographic location, type of residency training, or clinical experience is associated with differences in practice. An online survey was distributed via email by the American Association for Hand Surgery to 615 members. The survey consisted of 17 questions related to conservative and operative management of trigger digits. One hundred thirty-nine unique responses were received (22.6%). Geographic distribution of respondents encompassed the entire USA and was not associated with variations in practice. Of the respondents, 56.8% were trained in orthopedic surgery while 37.4% had plastic surgery training. In regards to duration of practice, 8.6% were in practice for up to 5years, 29.5% for 6-15years, 33.8% for 16-25years, and 28.1% for more than 25years. Notably, the great majority of respondents preferred corticosteroid injections for initial treatment. Those who were willing to give three or more injections prior to surgery were more likely to be plastic surgeons in practice for 16years or more. A large minority of surgeons utilized splinting in their conservative management. Orthopedic surgeons were more likely to perform tenolysis during pulley release and more likely to use monitored anesthesia care. Variation exists between the treatment algorithms of hand surgeons when managing a trigger digit. Some of these differences may be attributable to the type of training or the duration of clinical practice.

Evaluating the Effect of Emergency Residency Training on Productivity in the Emergency Department

BackgroundResident productivity, defined as patients seen per unit time, is one measure that is used to assess the performance and educational progress of residents in the emergency department (ED). One published study suggested that emergency residency training (EM) does not improve productivity compared with that in other specialties, including internal medicine (IM). ObjectivesThis study assesses how EM and IM trainees perform in the ED and illustrates how resident productivity changes through the academic year. MethodsA retrospective review of attending physicians and residents working 8-h shifts in the higher acuity zone of a large-volume, tertiary, academic health care center was performed for July 2009, October 2009, January 2010, and April 2010. The total number of patients seen primarily and admitted during each shift was recorded. ED volume was approximated by the number of patients seen by the attending physician, and acuity was approximated by admission rate. A mixed model regression assessed the impact of year and type of residency training (e.g., EM1, EM2, IM1, and IM2), ED volume, and acuity on resident productivity (number of patients per shift). The study was granted waiver of informed consent by our institutional review board. ResultsWe reviewed 936 shifts. After adjusting for acuity and ED volume, the EM1 group had a significant increase in patients per shift over the year, from 6.11 in July to 10.3 in April (p < 0.001). No other group increased productivity significantly. ConclusionsThe first EM training year leads to a significant change in productivity that separates EM from IM residents. This contradicts the previous assertion that non-EM residents have the same productivity as EM residents in the ED.

A survey of oregon emergency physicians' reporting patterns of intoxicated drivers in the state of oregon

Study objectives: Because of low reporting and conviction rates among intoxicated drivers involved in nonfatal motor vehicle crashes, some states have proposed mandatory hospital or provider reporting laws. Oregon recently passed an amendment in May 2003 (ORS 676.260) that mandates that providers notify law enforcement within 5 calendar days of a motor vehicle crash, if a presumed driver had an elevated blood alcohol level. The objectives of our study were to (1) assess physician reporting patterns before and after the introduction of mandatory reporting; (2) assess whether education, type of practice, and knowledge of the law are associated with reporting pattern; and (3) educate and inform Oregon emergency physicians about this new mandatory reporting law. Methods: A 1-page self-assessment survey was mailed to 504 emergency physicians in the state of Oregon in April 2004. The list was compiled by the Oregon Chapter of American College of Emergency Physicians. The survey consisted of 8 questions about demographics, awareness of the law, reporting practice, and opinions on mandatory reporting. Reporting frequency was collected on a 4-point ordinal scale (never, occasionally, most of the time, always) for intoxicated drivers of motor vehicles involved in crashes and intoxicated drivers leaving the emergency department (ED) before and after the law was passed. These values were treated as paired observations and assessed for an increase with the passing of the law (Wilcoxon's signed rank test). Associations of postlaw reporting and demographic and knowledge factors were sought (χ 2 test). Results: Of the 504 surveys mailed, 250 (50%) were submitted and adequate for analysis. One hundred forty-one (56%) of these 250 physicians were aware of the law. Two hundred twenty-nine (92%) agreed that physicians should be required to report some crimes. Reporting frequency for both motor vehicle crash–involved drivers (MIDs) and drivers leaving the ED (DLEs) increased with the passing of the law. MIDs were always reported by 18% of physicians before the law and by 46% afterward. DLEs were always reported by 56% of physicians before the law and by 66% afterward. Sex and type of residency training were independent of all reporting frequency measures. A greater length of time since residency was associated with increased reporting frequency for MIDs after the law passed. A greater annual ED census was associated with less frequent reporting of DLEs before the law passed. Awareness of the law was associated with increased reporting frequency of MIDs after the law passed. Conclusion: Forty-four percent of responding Oregon emergency physicians are unaware of a mandated reporting law for intoxicated drivers presenting to the ED. However, more physicians are commonly reporting after passage of the law, largely amongst those aware of the law. Years since residency and practice setting influence reporting frequency.

The role of the emergency physician in providing pediatric emergency care — A membership survey

A survey of the membership of the American College of Emergency Physicians (ACEP) was undertaken to identify members with special interest or expertise in pediatric emergency medicine. A questionnaire was published in the August 1988 issue of ACEP News, which was distributed to 12,079 members. One hundred seventy-one responses were returned, revealing a subset of the membership (1.42%) with a special interest or expertise in pediatric emergency care. This group was characterized as to type of residency training, board certification (completed or planned), practice location, and percentage of practice composed of children. Opinions were sought regarding subspecialty certification, continuing medical education needs, and quality and quantity of pediatric emergency medical training in pediatric and emergency medicine residency programs. More than 200 physicians were identified as resources in pediatric emergency medicine for ACEP. The majority of the respondents favored subspecialty board certification. Continuing education needs are generally being met, but there is a need for better geographical distribution of courses. Minifellowships and more pediatric rotations for emergency medicine residents were suggested.

An analysis of the movement to private psychiatric practice.

Survey data were analyzed from 900 psychiatrists who graduated between 1961 and 1976 from one of 17 state mental hospitals (SMHs) or ten university psychiatry residency programs in one of five states and are used to describe the differential influence of (1) foreign or US medical education, (2) SMH or university training program, and (3) years since graduation on the decision to take a job in either a private, public, or university medical school practice setting. Descriptive statistical models show that (1) about 25% of all respondents chose a private, 55% a public, and 20% a university for their first job, and (2) substantial numbers of both foreign and US medical graduates (FMGs, USMGs) left public jobs and chose and remained in private jobs, so that 55% of respondents had their current job in the private sector. Type of residency training was associated only with first job choice. Compared with USMGs, more FMGs initially took and remained in public jobs. These models highlight manpower problems. In fact, most of the respondents did not confine their work to a single kind of practice setting.

Criteria for cessation of CPR in the emergency department

Specific criteria have been proposed for the cessation of cardiopulmonary resuscitation (CPR) in the emergency department. Using these criteria and others, we developed a survey which was completed by 78 physicians practicing emergency medicine. The physicians surveyed did not make decisions to cease CPR that were consistent with any such criteria which might guide them in clinical decision making. In this survey, the type of residency training, the size of city in which the physician practiced, and the number of years an individual had practiced emergency medicine significantly correlated with how he made the decision to cease CPR. Based on a review of the current literature, and due to the fact that considerable and variable ethical and psychological factors weigh in each clinical circumstance, the authors recommend that no criteria be followed for ceasing CPR.

Postgraduate surgical training and the changing economic status of patients.

Surgery is the first of the branches of medicine to be severely hampered in its graduate teaching by the changing economic status of patients. Halsted introduced to the United States the present type of residency training, which is modified from the German system. This type of training, now adopted by most other branches of medicine, provides gradually increasing experience and responsibility until the final year, when complete or nearly complete responsibility is given to the resident. Surgery is the first specialty to be seriously affected, because voluntary surgical fee insurance is the most popular type of medical fee insurance today. Thus, surgery, the most popular type of graduate medical training, is the first specialty to have its graduate medical training affected by the changing economic status of patients. It is also obvious that, when in the future there is complete or nearly complete coverage of all individuals by professional fee