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Singh NP, Patel PA, Nahm WJ, Frey JD, Boyd CJ. Financial Well-Being: Contextualizing Resident Compensation Compared to Other Professionals. Am Surg 2024; 90:1131-1132. [PMID: 38225890 DOI: 10.1177/00031348241227196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Nikhi P Singh
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis, IN, United States
| | - Parth A Patel
- Augusta University Medical Center, Augusta University, Augusta, GA, United States
| | - William J Nahm
- NYU Grossman School of Medicine, New York, NY, United States
| | - Jordan D Frey
- Department of Plastic Surgery, University of Buffalo, Buffalo, NY, United States
| | - Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
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Romeo DJ, Du S, Massenburg BB, Ng JJ, Wu M, Villavisanis DF, Fischer JP, Swanson JW, Bartlett SP, Taylor JA. Clinical Research Fellowship Fosters Mentorship, Teamwork, and Productivity: Our 11-Year Experience With a Craniofacial Research Fellowship. J Craniofac Surg 2024:00001665-990000000-01390. [PMID: 38421207 DOI: 10.1097/scs.0000000000009978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/03/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION This study describes the development and explores the academic impact of a cleft and craniofacial research fellowship. MATERIALS AND METHODS Research and career outcomes from 3 cleft and craniofacial surgeons, 14 clinical fellows, and 25 research fellows between 2010 and 2023 were examined. Academic productivity was measured by the number of peer-reviewed publications indexed in PubMed and podium presentations at national/international meetings. Residency match statistics were recorded for eligible research fellows. RESULTS Over this 14-year period (11 with research fellows), the team produced 500 publications in 96 peer-reviewed journals, with 153 (31%) in Plastic and Reconstructive Surgery, 117 (23%) in the Journal of Craniofacial Surgery, and 32 (6%) in The Cleft Palate-Craniofacial Journal. Yearly publications increased from 15.3±7.6 per year (before fellowship) to 23.0±5.3 (with 1 fellow) to 38.3±12.9 (2 fellows) to 81.0±5.7 (3 fellows; P<0.001). There was a strong annual linear growth in publications since the beginning the research fellowship position (r=0.88, P<0.001). All (100%) clinical research fellows developed strong relationships with senior surgeons, and all who applied to plastic surgery residency matched a significantly higher success rate than the national average (P<0.05). CONCLUSION Implementing a structured cleft and craniofacial clinical research fellowship was associated with a broad impact across all cleft and craniofacial team members, as reflected by increased academic output and high match rates among fellows. The fellowship also strengthens the talent pipeline into plastic surgery by fostering meaningful mentor/mentee relationships and provides a model that can be adopted in both surgical and nonsurgical fields.
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Affiliation(s)
- Dominic J Romeo
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - Steven Du
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - Benjamin B Massenburg
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - Jinggang J Ng
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - Meagan Wu
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - Dillan F Villavisanis
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - John P Fischer
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - Scott P Bartlett
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
| | - Jesse A Taylor
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia
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Kolcun JPG, Mazza JM, Pawlowski KD, Varela JR, Kolb B, Traynelis VC, Byrne RW, Fontes RBV. The Evolving Role of Postgraduate Year 7 in Neurological Surgery Residency. Neurosurgery 2024; 94:350-357. [PMID: 37706880 DOI: 10.1227/neu.0000000000002685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/25/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In 2013, all neurosurgery programs were mandated to adopt a 7-year structure. We sought to characterize how programs use the seventh year of training (postgraduate year 7 [PGY7]). METHODS We surveyed all accredited neurosurgery programs in the United States regarding the PGY7 residents' primary role and the availability of enfolded fellowships. We compiled responses from different individuals in each program: chair, program director, program coordinator, and current chiefs. RESULTS Of 120 accredited neurological surgery residency programs within the United States, 91 (76%) submitted responses. At these programs, the primary roles of the PGY7 were chief of service (COS, 71%), enfolded fellowships (EFF, 18%), transition to practice (10%), and elective time (1%). Most residencies have been 7-year programs for >10 years (52, 57%). Sixty-seven programs stated that they offer some form of EFF (73.6%). The most common EFFs were endovascular (57, 62.6%), spine (49, 53.9%), critical care (41, 45.1%), and functional (37, 40.7%). These were also the most common specialties listed as Committee on Advanced Subspecialty Training accredited by survey respondents. Spine and endovascular EFFs were most likely to be restricted to PGY7 (24.2% and 23.1%, respectively), followed by neuro-oncology (12, 13.2%). The most common EFFs reported as Committee on Advanced Subspecialty Training accredited but not restricted to PGY7 were endovascular (24, 26.4%) and critical care (23, 25.3%). CONCLUSION Most accredited neurological surgery training programs use the COS as the primary PGY7 role. Programs younger in their PGY7 structure seem to maintain the traditional COS role. Those more established seem to be experimenting with various roles the PGY7 year can fill, including enfolded fellowships and transition-to-practice years, predominantly. Most programs offer some form of enfolded fellowship. This serves as a basis for characterization of how neurological surgery training may develop in years to come.
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Affiliation(s)
- John Paul G Kolcun
- Department of Neurological Surgery, Rush University Medical Center, Chicago , Illinois , USA
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Maqsood HA, Somppi-Montgomery L, Feng L, Alvi S, Segalini N, Kapadia MR, Aziz H. Program Website Evaluation Regarding Dedicated Research Years Offered in General Surgery Residency Programs in the United States. J Surg Res 2023; 291:374-379. [PMID: 37516044 DOI: 10.1016/j.jss.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/25/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Research is a vital component in the advancements of surgical sciences due to the reliance of treatment options on innovations and outcomes of patient care. This study aimed to identify research pathways, opportunities, and academic productivities of different general surgery residency programs in the United States. MATERIALS AND METHODS A web-based review was conducted concerning accredited US general surgery residency programs. Each program's official website was assessed for the availability of research year, compulsory status, duration, type, structure, and location. The study also identified faculty supervision, research day, funding, output, and opportunities to obtain an advanced degree. RESULTS Data were collected from all 313 general surgery programs in the United States, out of which 127 (41%) offered a dedicated research year to their residents. The research year was deemed mandatory in 27 programs (8%) and optional in 100 programs (32%). Seventy-two programs (23%) offered to start the dedicated research year after postgraduate year 2 or postgraduate year 3. Twenty-two programs (7.02%) provided examples of resident publications and presentations. Resident research day was cited by 42 programs (13.41%). On campus research opportunity was mentioned by nine programs (2.8%), while the off campus chance was provided by 10 programs (3.19%). Furthermore, 36 programs (11.5%) demonstrated potential funding sources. Finally, 38 (12.14%) programs mentioned receiving advanced degrees after the research year. CONCLUSIONS Although dedicated research time is provided to trainees for some research programs, there is a lack of structure and the need to expand the available content and information regarding research opportunities for the various general surgery residency programs.
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Affiliation(s)
- Hannan A Maqsood
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Lawrence Feng
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Saba Alvi
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicole Segalini
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Muneera R Kapadia
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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Bakhshi SK, Abdul Rahim K, Merchant AAH, Afzal N, Qadeer Shaikh N, Noorali AA, Lakhdir MPA, Mahmood SBZ, Tariq M, Haider AH. Barriers to research productivity amongst postgraduate trainees: results from a survey of 333 medical and surgical residents. Postgrad Med J 2023; 99:1182-1188. [PMID: 37544657 DOI: 10.1093/postmj/qgad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE We aimed to determine the perceptions of, barriers to, and predictors of research engagement amongst residents at a national level in Pakistan. METHODS This cross-sectional study used REDCap for online survey dissemination to residents from 12 institutes accredited by the national accreditation body (College of Physicians and Surgeons Pakistan) for core medical and surgical specialties. Logistic regression was used to estimate associations between likelihood of publications and participant characteristics. RESULTS The response rate was 79% (333/423), with 171 (51%) medical and 162 (49%) surgical residents. The mean ± standard deviation age was 28.8 ± 2.7 years; 137 (41%) were males and 195 (59%) females. More than half the residents, 202 (61%), had received research training, but 189 (57%) scored <33% on basic research knowledge. While most residents agreed on the positive impact of research on their careers (P = .012) and realized that they should be involved in it (P = .33), they also strongly believed that it was difficult to engage in research during training (P < .01). Only 60 (18%) trainees had published a paper in local and 37 (11%) in international journals, respectively. The most significant barriers to conducting research included time limitation due to clinical work, lack of financial support, and unavailability of data (P < .01). CONCLUSION Residents have a positive attitude towards research. However, research engagement among residents is low. Improving research mentorship and creating systems that enable protected time and institutional access to data are needed to increase research output of postgraduate trainees. Key messages What is already known on this topic Postgraduate trainees benefit academically from research conducted during residency training. However, in low- and middle-income countries like Pakistan, research output among residents has remained low over the years. The nation has consistently produced very little research. What this study adds The current study helped shed light on the reasons for low research productivity amongst medical and surgical residents in Pakistan. How this study might affect research, practice, or policy The potential predictors for low research involvement highlighted in this study necessitate modification of the existing national residency curriculum to increase research engagement and productivity among residents. Not only can the potential factors be improved, but the study also helps in bringing stakeholders' attention to increasing research opportunities in Pakistan.
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Affiliation(s)
- Saqib K Bakhshi
- Section of Neurosurgery, Department of Surgery, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Komal Abdul Rahim
- Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Asma A H Merchant
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Noreen Afzal
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Namra Qadeer Shaikh
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Ali A Noorali
- Department of Community Health Sciences, Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | | | - Saad B Z Mahmood
- Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Muhammad Tariq
- Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Adil H Haider
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan
- Department of Community Health Sciences, Medical College, Aga Khan University, Karachi, 74800, Pakistan
- Department of Surgery, Medical College, Aga Khan University, Karachi, 74800, Pakistan
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Noubani M, Smolkin C, Yang J, Pryor AD. Demographic and practice patterns among minimally invasive surgery fellowship graduates. Surg Endosc 2023; 37:7784-7789. [PMID: 37587239 DOI: 10.1007/s00464-023-10304-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Previous reports show that over 85% of general surgery residents choose to pursue fellowship training after completing residency. There continues to be an increase interest among general surgery residents in minimally invasive surgery (MIS) fellowship. Moreover, demographic disparities, particularly gender disparities continue to persist among surgical sub-specialties. In this study, we evaluated the gender disparities and practice patterns among graduating MIS fellows. METHODS AND PROCEDURES MIS fellows were surveyed, and 169 results were received from fellows who completed training in the years: 2010, 2015-2019. Surveys collected were used to create a descriptive analysis of the demographics, practice patterns and job finding measures. Loglinear regression model was performed to assess gender trend variation over training years. RESULTS Fellows self-reported gender showed 65% male, 30% female, and 5% prefer not to say. The cohort of participants was described as 45.3% white, 5.3% African American, and 6.5% Hispanic or Latino. Further, results showed 87.1% of fellows work in MIS surgery with 91.8% reporting their fellowship experience facilitated their ability to find a job. Most alumni pursue a comprehensive MIS practice. Moreover, the proportion of female fellows increased from 29 to 41%, but this increase over time was not significant using loglinear regressions [p-value = 0.0810, Relative risk = 1.1994 (95% CI 0.9778, 1.4711)]. CONCLUSION Overall, there is good evidence to support that fellowship training facilitates future career advancements. Further, MIS fellows have differential practice patterns. Finally, females remain underrepresented among the MIS fellows which should call for leadership action to bridge these gaps.
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Affiliation(s)
- Mohammad Noubani
- Department of Surgery, PGY1 at the University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27517, USA.
| | - Caroline Smolkin
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aurora D Pryor
- Department of Surgery, Northwell Health System, New York, NY, USA
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Nofi CP, Roberts BK, Hansen L, Coppa GF, Patel V. Surgical Rehabilitation for Research Residents: A Pilot Program to Offset Surgical Skill Decay. JOURNAL OF SURGICAL EDUCATION 2023; 80:1385-1394. [PMID: 37567801 DOI: 10.1016/j.jsurg.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/13/2023] [Accepted: 07/16/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Select general surgery residents in the surgeon-scientist pipeline dedicate time away from clinical residency to conduct research. However, these research residents (RR) are vulnerable to operative skill decay. The aim of this study is to assess the feasibility of implementation and impact of an organized intervention designed to combat skill decay experienced by RR. DESIGN RR were enrolled in a pilot Surgical Rehabilitation Program (SRP). The SRP is comprised of 12 cadaver-based simulation sessions and supplemented with Fundamentals of Laparoscopic Surgery-based simulation workouts. The RR were integrated with the clinical residents (CR) during the cadaver sessions and were subsequently performance tested, surveyed, and interviewed. SETTING One academic general surgery residency program graduating 8 chief residents yearly in New York. PARTICIPANTS General surgery CR and residents on dedicated research years. RESULTS Data were collected for all local RR (n = 8) and 77% (n = 37) of CR. Local RR conducted research within the same health system that sponsors the residency. RR experienced gaps in training ranging from 2 to 4 years. All RR were permitted to moonlight on surgical services, however performed 0 operations and only 0.88 procedures on average per shift. Although RR performed similarly to level-matched CR on basic laparoscopic tasks, they required significantly more time on laparoscopic suturing-based skills than CR (p < 0.001). RR had significantly lower confidence levels precadaver sessions but gained confidence postcadaver sessions (p < 0.05), whereas CR confidence was unchanged. Regarding the SRP, qualitative interviews revealed major themes emphasizing the integration of RR, exposure to CR and faculty, technical skill development, maintenance of surgical know-how, and improved confidence for RR. CONCLUSIONS The implementation of such structured interventions, like our SRP, aimed at supporting RR over gap years is essential to help residents maintain skills and confidence needed to achieve their goals of becoming surgeon scientists.
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Affiliation(s)
- Colleen P Nofi
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York.
| | - Bailey K Roberts
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York
| | - Laura Hansen
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell Department of Surgery, Hempstead, New York
| | - Gene F Coppa
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell Department of Surgery, Hempstead, New York
| | - Vihas Patel
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell Department of Surgery, Hempstead, New York
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Saeed S, Chand P, Sulaiman A, Nisar I, Humayun KN, Malik MGR, Jehan F. Process evaluation of paediatric fellowship training programs at a University Hospital in Pakistan. BMC MEDICAL EDUCATION 2023; 23:612. [PMID: 37641130 PMCID: PMC10464138 DOI: 10.1186/s12909-023-04501-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Fellowship programs offer training in a subspecialty focusing on distinct and advanced clinical/academic skills. This advanced postgraduate training allows physicians, who desire a more specialized practice, to further develop clinical, academic, research, and leadership/administrative skills. The Aga Khan University (AKU) is one of the few institutes offering paediatric sub-specialty training in Pakistan. We aimed to evaluate the current Paediatric fellowship programs at AKU. METHODS Process evaluation of six paediatric fellowship programs (cardiology, neurology, endocrinology, critical care medicine, neonatology, and infectious disease) was conducted from September 2020 to April 2021 by senior clinicians and medical educationists. Evidence was collected through document review (using existing postgraduate medical education program information form), observation of teaching and learning support, and focused group discussions/interviews with program faculty and fellows were conducted. A review of the evaluation report was done as part of this study. This study received an exemption from the ethical review committee. The quantitative data were analyzed using SPSS (22.0) while the reports of discussion with fellows and friends underwent content analysis. RESULTS All fellowship programs met the criteria for having a robust competency-based fellowship curriculum as per the institutional and national guidelines. Formative assessment in the form of continuous evaluation was found to be integrated into all the fellowship programs, however, most of the programs were found to lack a summative assessment plan. Fellows in training and program faculty were satisfied with the opportunities for mentorship, teaching, and learning. Thematic analysis of the discussion reports with faculty and fellows revealed three key themes including, program aspects translating into strengthening the training, gaps in the training program in delivering the expectations, and making ways to reach par excellence. CONCLUSIONS The process evaluation of paediatric fellowship programs provided an opportunity to holistically review the current strengths and quality of the training in individual programs along with the unmet needs of the trainees. This will help the program stakeholders to prioritize, align and allocate the resources to further enhance the quality of training and outcome of individual fellowship programs to ensure wider impacts at a regional, national, and international health system level.
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Affiliation(s)
- Sana Saeed
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - Prem Chand
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Asna Sulaiman
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Imran Nisar
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Khadija Nuzhat Humayun
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Marib Ghulam Rasool Malik
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Fyezah Jehan
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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Long BA, Sweeney MJ. Examining the Growing Demand for Surgical Care in Rural Communities and Novel Approaches to Achieving a Sustainable Surgical Workforce: A Narrative Review. Cureus 2023; 15:e43817. [PMID: 37736467 PMCID: PMC10511206 DOI: 10.7759/cureus.43817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
Surgery continues to be an increasingly vital component of public health and aspect of patient care in rural communities. An anticipated shortage of surgeons within the next decade in the United States prompts a growing concern for increasing the delivery of essential surgical care to these populations. When considering the existing barriers to surgical healthcare in rural communities, there is a sense of urgency to identify innovative approaches that will promote a sustainable surgeon workforce. A narrative review was conducted to investigate the current state of access to essential surgical care in rural communities. Qualitative and quantitative data were collected to better understand the key issues in rural healthcare and to provide statistical data related to the status of the surgical workforce. With the anticipated shortage of surgeons in both rural and urban areas, this review highlights the importance of enacting immediate measures to address the concern. This review has accomplished the initial objectives of gaining a better understanding of the current state of access to surgical care in rural communities and utilizing this knowledge to provide recommendations to readily attain a sustainable number of rural surgeons. With each approach addressing ways to address the contributory issues to the surgeon shortage, this review reveals a new avenue of integrating valuable aspects from each approach, rather than relying on a single approach. In particular, enhancing the overall pipeline of medical training to attending status may prove to be more beneficial for achieving this goal. Ultimately, this may be accomplished by introducing additional rural surgical mentorship opportunities for medical students, developing a rural surgery fellowship, and incorporating a market-based response that will correspond to attractive incentives that help to retain a sustainable number of surgeons working in rural areas.
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Affiliation(s)
- Brittany A Long
- General Surgery, Florida State University College of Medicine, Tallahassee, USA
| | - Michael J Sweeney
- General Surgery, Florida State University College of Medicine, Tallahassee, USA
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Lee EKS, Verhoeff K, Purich K, Sydora D, Turner SR, Strickland M. Factors Associated With Resident Research Success: An Analysis of Canadian General Surgery Trainees. JOURNAL OF SURGICAL EDUCATION 2023; 80:520-527. [PMID: 36581542 DOI: 10.1016/j.jsurg.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Better understanding the research productivity of Canadian general surgery residents and factors associated with success would provide a valuable reference and help inform actions to enable success. We aimed to characterize the research productivity of Canadian general surgery residents and to evaluate factors associated with residents' research quantity and impact. DESIGN A cross-sectional, observational study was performed using publicly available data evaluating Canadian General Surgery resident research productivity. Research productivity was characterized using measures including publications per postgraduate year (PGY) and CiteScore among others. Residency programs were then comparatively assessed using a multivariable logistic regression to evaluate program and resident factors associated with achieving >50th percentile research productivity. SETTING AND PARTICIPANTS All General Surgery residents from English speaking Canadian training programs were included in this study, which was completed at the University of Alberta, a tertiary level academic center in Edmonton, Canada. RESULTS A wide range of resident research productivity was observed across Canada with the median publications per PGY of 0.29, and the median sum of a resident's publication CiteScores of 2.05. The median h-index was 0.90. Graduate degree completion and publication experience prior to residency were significantly associated with higher publications per PGY (OR 2.94 and OR 2.10, respectively), as well as higher mean CiteScore (OR 3.42 and 2.24). The program factors that were assessed, including program size, research blocks, mandatory projects, or higher staff research productivity, did not show significant association with increased research output. CONCLUSIONS There is a wide range in research output by general surgery residents across the country. Successful completion of graduate degrees and the experience of publication prior to residency are associated with higher research productivity and impact.
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Affiliation(s)
- Esther K S Lee
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Kieran Purich
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Dasan Sydora
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matt Strickland
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Trends in pancreatic surgery experience in general surgery residency in the US, 1990–2021. Am J Surg 2023:S0002-9610(23)00114-9. [PMID: 36990833 DOI: 10.1016/j.amjsurg.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND We hypothesized a decline in resident pancreatic operative experience. The study assesses trends in that experience since 1990. METHODS Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residency graduates from 1990 to 2021 were reviewed. Collected and analyzed were the mean and median total number of pancreatic operations per resident, the mean number of specific case types performed, and the annual number of residency graduates. For selected procedures, the mean number of cases by resident role (Surgeon-Chief and Surgeon-Junior) was also analyzed. RESULTS Both the mean and median total number of resident pancreatic operations has declined since 2009 as have the mean number of several specific pancreatic case types, including resections. The annual number of residency graduates has significantly increased since 1990, and particularly since 2009. CONCLUSIONS Resident volume in pancreatic operations has significantly declined over the last decade.
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Hedges EA, Khan TM, Teke M, Wach MM, Hernandez JM, Hoover SJ. Breast Surgical Oncology Fellowship applicant selection and ranking: A survey of Society of Surgical Oncology programs. J Surg Oncol 2023; 127:34-39. [PMID: 36181515 PMCID: PMC10691500 DOI: 10.1002/jso.27101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2003, the Society of Surgical Oncology (SSO) initiated a breast surgical oncology fellowship, which has now grown to 60 SSO accredited programs as of 2021. Limited knowledge exists on the traits of successful applicants and the factors influencing the rank list. METHODS A web-based, anonymous survey was sent to all SSO Breast Surgical Oncology Fellowship program directors. The survey consisted of 26 questions. Descriptive statistics were used to analyze survey responses and evaluate impact on applicant interview and rank list. RESULTS Thirty-four programs (57% response rate) completed the survey. Programs received an average of 70 applications and granted 24 interviews. Most programs reported a minimum ABSITE cut-off score (n = 28, 82%) and a defined publication requirement (n = 22, 65%), including a first-author requirement (n = 18, 53%) to extend an invitation to interview. For postinterview rank, applicant interpersonal skills were highly valued. The interview was the most important aspect for the rank list. CONCLUSIONS Many programs have ABSITE and publication thresholds before offering an interview. Upon receiving interview invitation, the applicant's interview performance, interpersonal skills, and letters of recommendation were the most important aspect in rank list decision making.
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Affiliation(s)
- Elizabeth A. Hedges
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tahsin M. Khan
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Martha Teke
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Jonathan M. Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Analysis of Surgical Residents' Salaries and Associated Funding During Eight Residency Training Cycles: Toward Improving Future Residents' Benefits and Compensation. J Surg Res 2023; 281:70-81. [PMID: 36116210 DOI: 10.1016/j.jss.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We aimed to investigate the trends in surgical residents' salaries across the nation and by region from 2014-2015 to 2021-2022 to identify areas for improvement in resident benefits and compensation. METHODS This is a retrospective study investigating the trends in US medical resident salaries from 2014-2015 to 2021-2022. Residency salary was analyzed over time, by region, and between surgical specialties both unadjusted and adjusted for cost of living. Salary by surgical specialty was collected from available years 2014-2015 to 2019-2020. Trends in residency salaries were also compared to the trends in graduate medical education (GME) Medicare funding. RESULTS The average resident salary/cost of living ratio did not significantly change over the study period (2014-2015: 0.96, 2020-2021, 0.96, P = 0.654). The South and Midwest had significantly higher average resident salaries than the Northeast (P < 0.001) and West (P < 0.001) after adjusting for the cost of living. The average total GME Medicare funding per resident increased significantly more than the average resident salary ($12,278 versus $4540, P < 0.001). The average general surgery resident salary (2014-2015: $57,000, 2019-2020: $61,500, Δ = $4500) increased significantly less than the average salary of all specialties (2014-2015: $51,586, 2019-2020: $57,191, Δ = $5605, P = 0.001). CONCLUSIONS Residency salaries have increased marginally from 2014-2015 to 2021-2022 and remain below the average US cost of living. Residency salaries vary significantly between surgical specialties and by region. Discussions aimed at reformulating GME compensation that takes into consideration regional differences in cost of living are needed.
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Lee ACH, Lee SM, Ferguson MK. Recent Changes in Characteristics of Applicants and Matriculants to Thoracic Surgery Fellowships. Semin Thorac Cardiovasc Surg 2022; 36:57-64. [PMID: 35931349 DOI: 10.1053/j.semtcvs.2022.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022]
Abstract
The match rate for traditional thoracic surgery fellowships decreased from 97.5% in 2012 to 59.1% in 2021, reflecting an increase in applications. We queried whether characteristics of applicants and matriculants to traditional thoracic surgery fellowships changed during this time period. Applicant data from the 2008 through 2018 application cycles were extracted from the Electronic Residency Application System (ERAS) and Graduate Medical Education (GME) Track Resident Survey and stratified by period of application (2008-2014 vs 2015-2018). Characteristics of applicants and matriculants were analyzed. There were 697 applicant records in the early period and 530 in the recent period (application rate 99.6/year vs 132.5/year; P = 0.0005), and 607 matriculant records in the early period and 383 in the recent period (matriculation rate 87% vs 72%; P < 0.0001). There was no difference in representation of university-affiliated versus community-based general surgery residency programs among applicants comparing the periods. Higher proportions of applicants and matriculants in the early period trained in general surgery programs affiliated with a comprehensive cancer center or a thoracic surgery fellowship. Applicants and matriculants of the recent period had higher median numbers of journal publications and had higher impact factor journal publications. The increase in applicants for thoracic surgery training is primarily from general surgery trainees in residency programs not affiliated with a comprehensive cancer center or a thoracic surgery fellowship. The increased interest in thoracic surgery training was accompanied by overall enhanced scholarship production among the applicants and matriculants regardless of their residency characteristics.
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Affiliation(s)
- Andy Chao Hsuan Lee
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Sang Mee Lee
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois.
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Mikhail A, Connor AA, Ahmed N. Impact of Research Training on Performance in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2022; 79:342-348. [PMID: 34824045 DOI: 10.1016/j.jsurg.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/07/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION It is common for North American surgical trainees to interrupt clinical training to complete 2 or more years of research training. The impact of this practice on surgical aptitudes is unknown. The University of Toronto has large general surgery and surgeon scientist training programs. We compared the examination scores of general surgery residents in continuous clinical training with those of residents whose training was interrupted by research. METHODS We collected anonymized scores obtained at written and oral annual in-training examinations by general surgery residents at the University of Toronto from 2011 to 2016, inclusive. The written exam assessed knowledge, while the oral exam assessed judgment. Residents were dichotomized into continuous versus non-continuous clinical training streams. We compared performance prior to, during, and following divergence for research training both within and between the 2 groups. RESULTS At the junior resident level, future enrollment in research training was associated with higher examination performance (Pwritten = .003). Annual scores plateaued during research training, while scores of residents who continued in continuous clinical training improved year over year (Pwritten = .009). Non-continuous stream resident exam scores remained stagnant after 1 year then improved in the second year after return to clinical training (Pwritten = .00007). Scores obtained in the final year of residency training did not significantly differ between residents who underwent continuous versus non-continuous clinical training. Results from written and oral exams trended concordantly. CONCLUSIONS We demonstrate that interruption of clinical training for 2 or more years of research is associated with a stagnation of performance on annual in-training examinations assessing both knowledge and judgment. This phenomenon is followed by an eventual catching-up after at least 2 years return to full-time clinical training. This may inform residency program curriculum design.
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Affiliation(s)
| | - Ashton A Connor
- Department of Surgery, Houston Methodist Hospital, Houston, USA
| | - Najma Ahmed
- University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada.
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16
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Gedde SJ, Feuer WJ, Crane AM, Shi W. Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists. Am J Ophthalmol 2022; 234:285-326. [PMID: 34157277 DOI: 10.1016/j.ajo.2021.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/12/2021] [Accepted: 06/12/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction. METHODS A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area. RESULTS Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life. CONCLUSIONS The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Barker JC, Jalilvand A, Onuma A, Shelby R, Shah K, Daulton R, Bumgardner GL. Facilitating Success of the Early Stage Surgeon Scientist Trainee: Growing the Surgeon Scientist Pipeline. Ann Surg 2022; 275:e334-e344. [PMID: 33938494 PMCID: PMC8977112 DOI: 10.1097/sla.0000000000004924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Surgeon scientists bring to bear highly specialized talent and innovative and impactful solutions for complicated clinical problems. Our objective is to inform and provide framework for early stage surgeon scientist training and support. SUMMARY OF BACKGROUND DATA Undergraduate, medical student, and residency experiences impact the career trajectory of surgeon scientists. To combat the attrition of the surgeon scientist pipeline, interventions are needed to engage trainees and to increase the likelihood of success of future surgeon scientists. METHODS A surgery resident writing group at an academic medical center, with guidance from faculty, prepared this guidance document for early stage surgeon scientist trainees with integration of the published literature to provide context. The publicly available National Institutes of Health RePORTER tool was queried to provide data salient to early stage surgeon scientist training. RESULTS The educational path of surgeons and the potential research career entry points are outlined. Challenges and critical supportive elements needed to inspire and sustain progress along the surgeon scientist training path are detailed. Funding mechanisms available to support formal scientific training of early stage surgeon scientists are identified and obstacles specific to surgical careers are discussed. CONCLUSIONS This guidance enhances awareness of essential education, communication, infrastructure, resources, and advocacy by surgery leaders and other stakeholders to promote quality research training in residency and to re-invigorate the surgeon scientist pipeline.
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Affiliation(s)
- Jenny C. Barker
- Department of Plastic and Reconstructive Surgery, Ohio State University, Columbus, Ohio
- Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Amblessed Onuma
- Department of Surgery, Ohio State University, Columbus, Ohio
| | - Rita Shelby
- Department of Surgery, Ohio State University, Columbus, Ohio
| | - Kejal Shah
- Department of Surgery, Ohio State University, Columbus, Ohio
- Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Robert Daulton
- Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, Ohio
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Gupta VS, Meier J, Nunez JH, Abdelfattah KR, Balentine C, Zeh HJ, Carlson D, Levi B. How We Did It: Implementing a Trainee-Focused Surgical Research Curriculum and Infrastructure. JOURNAL OF SURGICAL EDUCATION 2022; 79:35-39. [PMID: 34353762 DOI: 10.1016/j.jsurg.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the implementation of a department-wide research curriculum and infrastructure created to promote academic collaboration and productivity, particularly amongst trainees and junior investigators involved in basic, translational, clinical, quality, or education research. DESIGN Description of UT Southwestern Medical Center's (UTSW) surgical research resources and infrastructure and the development of a didactic curriculum focused on research methods, writing skills, and optimizing academic time and effort. SETTING The collaboration was initiated by UTSW Department of Surgery residents who were on dedicated research time (DRT) and grew to include trainees and faculty at all levels of the institution. Guest lecturers from institutions around the country were incorporated via virtual meeting platforms. PARTICIPANTS Medical students, residents, and clinical and research faculty from the Department of Surgery were invited to attend research meetings, didactics, and the guest-lecture series. Additionally, all groups were given access to shared resources and encouraged to share their own work. RESULTS A robust set of resources including data analysis tools, manuscript and grant writing templates, funding opportunities, and a comprehensive list of surgical conferences was created and made accessible to UTSW Surgery team members. Moreover, a curriculum of lectures covering a broad variety of topics for all types of research was created and has thus far reached an audience of over 40 UTSW Surgery trainees and staff. CONCLUSIONS A comprehensive set of lectures and resources targeted toward facilitating surgical research was designed and implemented at one of the largest surgical training programs in the country. This effort represents a low-cost, feasible, and accessible way to improve academic productivity and enhance the training of surgeon-scientists and can serve as a blueprint for other institutions around the country.
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Affiliation(s)
- Vikas S Gupta
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas.
| | - Jennie Meier
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Johanna H Nunez
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Kareem R Abdelfattah
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Courtney Balentine
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Herb J Zeh
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Deborah Carlson
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Benjamin Levi
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
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Drake JA, Diggs LP, Martin SP, Wach MM, Jafferji MS, Steinberg SM, Blakely AM, Davis JL, Hoang CD, Ripley RT, Hernandez JM. Characteristics of Matriculants to Thoracic Surgery Residency Training Programs. Ann Thorac Surg 2021; 112:2070-2075. [PMID: 33378696 PMCID: PMC9913615 DOI: 10.1016/j.athoracsur.2020.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thoracic surgery (TS) residency positions are in high demand. There is no study describing the nationwide attributes of successful matriculants in this specialty. We examined the characteristics of TS resident applicants and identified factors associated with acceptance. METHODS Applicant data from 2014 to 2017 application cycles was extracted from the Electronic Residency Application System and stratified by matriculation status. Medical education, type of general surgery residency, and research achievements were analyzed. The number of peer-reviewed publications and the corresponding impact factor for the journals where they were published were quantified. RESULTS There were 492 applicants and 358 matriculants. The overall population was primarily male (79.5%), white (55.1%), educated at United States allopathic medical schools (66.5%), and trained at university-based general surgery residencies (59.6%). Education at United States allopathic schools (odds ratio [OR], 2.54; P < .0001), being a member of the American Osteopathic Association (OR, 3.27; P = .021), general surgery residency affiliation with a TS residency (OR, 2.41; P = .0003) or National Cancer Institute designated Comprehensive Cancer Center (OR, 1.76; P = .0172), and being a first-time applicant (OR, 4.71, P < .0001) were independently associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 3 vs 2, P < .0001) and more frequently published in higher impact journals (P < .0001). CONCLUSIONS Our study includes objective and quantifiable data from recent application cycles and represents an in-depth examination of applicants to TS residency. The type of medical school and residency, as well as academic productivity, correlate with successful matriculation.
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Affiliation(s)
- Justin A Drake
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sean P Martin
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael M Wach
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mohammad S Jafferji
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew M Blakely
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Chuong D Hoang
- Thoracic Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - R Taylor Ripley
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Abstract
Research is crucial to train the next generation of academic surgeons. Formal training builds research skills, starting with the ability to generate hypotheses, formulate questions, and address gaps in knowledge. Essential factors that are important to a research pathway include a supportive environment, experienced mentorship team, work-life balance, and a source of funding. Oral and maxillofacial surgery must make diversity a top priority, and protocols must be implemented to retain members of underrepresented groups throughout their careers.
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Affiliation(s)
- Andrea B Burke
- Department of Oral & Maxillofacial Surgery, University of Washington School of Dentistry, 1959 Northeast Pacific Street, Box 357134, Seattle, WA 98195-7134, USA.
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21
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Kane WJ, Berry PS, Denton AH, Schroen AT. Attainment of an Additional Graduate Degree Is Associated With Sustained Scholarly Activity Beyond Surgical Residency. JOURNAL OF SURGICAL EDUCATION 2021; 78:1189-1196. [PMID: 33349567 DOI: 10.1016/j.jsurg.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/12/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine whether attainment of an additional graduate-level degree during general surgery residency, such as an MSc, MPH, MBA, or PhD, is associated with increased research productivity beyond completion of training. DESIGN Observational cohort study comparing publication productivity of general surgery residency graduates who did and did not obtain a degree. PubMed queries and the Web of Science Core Collection were used to capture publication metrics. Graduate characteristics, including degree attainment, were obtained from an institutional database. Practice webpages were reviewed to designate an academic surgical practice, defined as an assistant, associate, or full professorship appointment. SETTING Single academic general surgery residency program. PARTICIPANTS Categorical general surgery residency graduates who performed at least 1 year of dedicated research. RESULTS 1768 total publications, representing 1500 unique publications, were authored by 54 residents, of which 18 (33.3%) residents attained an additional graduate-level degree during dedicated research. 1369 (91.3%) publications had identifiable Journal Impact Factors and citation data. Degree attainers were more likely to be female (55.6% vs. 25.0%, p = 0.03) and spend more time in dedicated research (mean 2.2 vs. 1.8 years, p = 0.02). Overall, degree attainers published more frequently during residency (median 4.4 vs. 2.1 publications/year, p < 0.001) and fellowship (median 2.0 vs. 1.0 publications/year, p = 0.046). Analysis of the first 4 post-training years demonstrated degree attainers produced 1.2 more publications per year among all graduates (2.3 vs. 1.1 publications/year, p = 0.02) and 1.6 more publications per year among graduates practicing academic surgery (3.3 vs. 1.7 publications/year, p = 0.02). There were no differences in the Journal Impact Factor or publication citations per year among degree and nondegree attaining graduates. CONCLUSIONS Attainment of an additional graduate-level degree was associated with increased research productivity that was sustained beyond surgical residency. Programs with the goal of training academic surgeons should support professional degrees during dedicated research years.
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Affiliation(s)
- William J Kane
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Puja S Berry
- Department of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrea H Denton
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, Virginia
| | - Anneke T Schroen
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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22
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Mullens CL, Hernandez JA, Kirk RJ, Parascandola L, Marsh JW, Borgstrom DC. Lacking Advanced Degrees are Not a Barrier to Entry into Academic Surgery Leadership. J Surg Res 2021; 267:167-171. [PMID: 34153559 DOI: 10.1016/j.jss.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Undergraduate and graduate medical education offerings continue to create opportunities for medical students to pursue MD+ degree education. These educational endeavors provide formal education in fields related to surgery, which gives trainees and surgeons diverse perspectives on surgical care. This study sought to assess current prevalence of additional advanced degrees among leaders in academic surgery to assess the relationship between dual degree attainment and holding various leadership positions within surgical departments. METHODS The Association for Program Directors in Surgery database was used to identify academic surgical programs, which comprised our study population. Each department of surgery website in the APDS database was interrogated for departmental leaders and their reported academic degrees. RESULTS Among 3223 identified surgeon leaders, 14.6% (470/3223) were found to possess MD+ degrees. Most common degrees possessed included MBA, MPH, and PhD. In comparing different types of surgeon leaders such as chairs, program directors, and division chiefs, no group was found to have a significantly higher prevalence of MD+ degrees than others. CONCLUSION Prevalence of MD+ degrees among current academic surgery leaders is low, and the lack of an advanced degree should not be considered a barrier to entry into leadership positions. We hypothesize that these findings are likely to evolve as larger proportions of trainees obtain MD+ degrees during medical school and academic development time throughout residency.
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Affiliation(s)
| | - J Andres Hernandez
- Duke University School of Medicine, Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery. Durham, NC
| | - Ryan J Kirk
- West Virginia University School of Medicine, Morgantown, WV
| | | | - J Wallis Marsh
- West Virginia University School of Medicine, Department of Surgery, Morgantown, WV
| | - David C Borgstrom
- West Virginia University School of Medicine, Department of Surgery, Morgantown, WV
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Aranda-Michel E, Arnaoutakis G, Kilic A, Bavaria J, Szeto WY, Yousef S, Navid W, Serna-Gallegos D, Sultan I. Thoracic Surgery Foundation Research Awards: Leading the Way to Excellence. Ann Thorac Surg 2021; 113:1015-1020. [PMID: 33882294 DOI: 10.1016/j.athoracsur.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Combining clinical and research excellence has become an increasingly difficult endeavor for thoracic surgeons, with typical success rates for the NHLBI and NCI being 25.1% and 11.3% respectively. The Thoracic Surgery Foundation (TSF), which is an arm of the Society of Thoracic Surgeons, provides research awards and grants aimed at early career faculty to assist in securing federal peer reviewed funding. The aim of this study was to assess the impact of these awards. METHODS Faculty awardees of the TSF research awards from 1995 to 2019 were included in the study. The scholarly work of awardees was assessed using SCOPUS , MEDLINE, and google scholar for publications, citations and h-index. NIH RePorter and federal RePorter was used to search for any grants awarded to these individuals. For publications and citations associated with a TSF grant, a four-year window from the time of the research award was utilized. RESULTS Fifty-two research awards were given to early career faculty during this study period, 8 (15%) were awarded to MD PhDs. Six (12%) of awardees were female. Cardiac faculty were awarded 27 (52%) of awards and general thoracic faculty were awarded 25 (48%); of the cardiac faculty, 4 (17.4%) were congenital cardiac faculty. In the 4-year period following the TSF grant award, the mean number of published articles per awardee was 23 (interquartile range (IQR) 12-36) with a median citation count of 147 (IQR 32-327). The current median h-index was 26 (IQR 15-36) with 2,323 (IQR 1,173-4,568) median citations. Forty-eight percent of all awardees received at least 1 subsequent grant grant, with 40.4% being awarded from the NIH and25% having two or more NIH grants. Comparing academic position at the time of the award to current position, 54% of awardees had an advancement in their professional rank. On analyzing leadership positions, 42% of awardees were division chiefs, 21% were associate clinical directors, and 28% were clinical directors. CONCLUSIONS Being a recipient of the TSF award may position an individual to excel in academic medicine, with a large portion of awardees improving their academic standing with time. The rate of successful NIH grant funding after being a TSF awardee is higher than typical institutional success rates.
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Schultz KS, Hess DT, Sachs TE, Tseng JF, Pernar LIM. A Structured Mentorship Elective Deepens Personal Connections and Increases Scholarly Achievements of Senior Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2021; 78:405-411. [PMID: 32863175 DOI: 10.1016/j.jsurg.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/02/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Surgery residents have few opportunities to work closely with attending surgeons or conduct research during clinical time. We hypothesized that a mentorship elective with a required research project would benefit residents' career development, including their personal connections with faculty mentors, and would help them build their academic portfolio. DESIGN We created a mentorship elective designed as a one-on-one apprenticeship. Completion of a scholarly project was a core component of the elective. Residents, faculty, and the most senior resident ('non-mentee') on the same service as the elective resident were interviewed after the completion of their rotation. SETTING University-based surgery residency at Boston Medical Center, Boston, MA. PARTICIPANTS All 5 residents in postgraduate year 4 (PGY-4) participated in the mentorship elective during the 2019 to 2020 academic year. Residents identified their faculty mentor. All mentees (5/5), most mentors (4/5), and all non-mentees (4/4) were interviewed. RESULTS All mentees reported interacting with their mentor daily, performing clinical duties or discussing their research project. For mentees, the top factor when selecting their mentor was the mentor's clinical expertise, and the most valuable aspect of the rotation was developing a relationship with their mentor. All mentors responded that their mentee gained an understanding of running an academic surgical practice and developed research skills. Four of 5 mentees completed critical portions of their scholarly project during the elective with one publishing in a peer-reviewed journal, 2 having their work accepted to a national conference, and one creating vascular surgery educational videos. All stated the elective was valuable. CONCLUSIONS A structured apprenticeship rotation allowed for closer relationships with attending surgeons and increased the scholarly achievement of PGY-4 surgery residents. We provide an example of how to incorporate a successful elective rotation into the surgery curriculum that strengthens resident career development and research productivity.
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Affiliation(s)
- Kurt S Schultz
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts
| | - Donald T Hess
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Teviah E Sachs
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jennifer F Tseng
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Luise I M Pernar
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.
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Karimov Z, Kazim SF, Schmidt M, Gandhi C, Vanderhooft J, Cole C, Stein A, Al-Mufti F, Bowers C. Rapid exponential increase in neurosurgery departmental scholarly output following an intensive research initiative. Postgrad Med J 2021; 98:239-245. [PMID: 33632761 DOI: 10.1136/postgradmedj-2020-139133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 11/04/2022]
Abstract
There has been extensive research into methods of increasing academic departmental scholarly activity (DSA) through targeted interventions. Residency programmes are responsible for ensuring sufficient scholarly opportunities for residents. We sought to discover the outcomes of an intensive research initiative (IRI) on DSA in our department in a short-time interval. IRI was implemented, consisting of multiple interventions, to rapidly produce an increase in DSA through resident/medical student faculty engagement. We compare pre-IRI (8 years) and post-IRI (2 years) research products (RP), defined as the sum of oral presentations and publications, to evaluate the IRI. The study was performed in 2020. The IRI resulted in an exponential increase in DSA with an annual RP increase of 350% from 2017 (3 RP) to 2018 (14 RP), with another 92% from 2018 (14 RP) to 2019 (27 RP). RP/year exponentially increased from 2.1/year to 10.5/year for residents and 0.5/year to 10/year for medical students, resulting in a 400% and 1900% increase in RP/year, respectively. The common methods in literature to increase DSA included instituting protected research time (23.8%) and research curriculum (21.5%). We share our department's increase in DSA over a short 2-year period after implementing our IRI. Our goal in reporting our experience is to provide an example for departments that need to rapidly increase their DSA. By reporting the shortest time interval to achieve exponential DSA growth, we hope this example can support programmes in petitioning hospitals and medical colleges for academic support resources.
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Affiliation(s)
- Zafar Karimov
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Meic Schmidt
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Chirag Gandhi
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Jordan Vanderhooft
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Chad Cole
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Rabski JE, Saha A, Cusimano MD. Setting standards of performance expected in neurosurgery residency: A study on entrustable professional activities in competency-based medical education. Am J Surg 2020; 221:388-393. [PMID: 33341234 DOI: 10.1016/j.amjsurg.2020.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Competency-based medical education requires evaluations of residents' performances of tasks of the discipline (ie. entrustable professional activities (EPAs)). Using neurosurgical Faculty perspectives, this study investigated whether a sample of neurosurgical EPAs accurately reflected the expectations of general neurosurgical practice. METHOD A questionnaire was sent to all Canadian neurosurgery Faculty using a SurveyMonkey® platform. RESULTS The proportion of respondents who believed the EPAs were representative of general neurosurgery competences varied significantly across all EPAs [47%-100%] (p < 0.0001). For 9/15 proposed EPAs, ≥75% agreed they were appropriate for general neurosurgery training and expected residents to attain the highest standard of performance. However, a range of 27-53% of the respondents felt the other six EPAs would be more appropriate for fellowship training and thus, require a lower standard of performance from graduating residents. CONCLUSION The shift towards subspecialization in neurosurgery has implications for curriculum design, delivery and certification of graduating residents.
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Affiliation(s)
- Jessica E Rabski
- Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
| | - Ashirbani Saha
- Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Huffman EM, Anderson TN, Choi JN, Smith BK. Why the Lab? What is Really Motivating General Surgery Residents to Take Time for Dedicated Research. JOURNAL OF SURGICAL EDUCATION 2020; 77:e39-e46. [PMID: 32768383 DOI: 10.1016/j.jsurg.2020.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/01/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Over one third of general surgery residents interrupt their clinical training to pursue dedicated research time (DRT), which has financial implications for programs and residents. Studies have examined the impact of DRT on academic outcomes, but little is known about why residents pursue DRT. Therefore, this study aimed to examine resident motivations regarding DRT in order to gain an understanding of resident goals and challenges surrounding this phase of training. DESIGN Surgical residents currently participating in DRT and residents considering completing DRT were recruited to participate. Members of the research team at each institution conducted interviews and focus groups, which were recorded and transcribed. Data was analyzed using the qualitative method of open and focused coding. Identified themes guided the development of a conceptual framework. SETTING Interviews and focus groups were held at three geographically diverse US academic health centers. PARTICIPANTS Twenty-one surgery residents participated. RESULTS Reasons for pursuing DRT fell into 1 of 3 themes: strategic career planning, professional development, and personal rejuvenation. Residents described the perceived need for publications or networking to enhance future competitiveness for desired fellowships or academic appointments. Residents also expressed the desire to have time for career exploration and to cultivate mentorship for their professional career. The need to take time off for more personal reasons, including burnout, was pervasive. Additionally, many in DRT felt under-supported in developing their research skills and expressed a desire for more formal instruction and guidance from mentors. CONCLUSIONS General surgery residents' motivations to pursue DRT are multifactorial. Professional development is a pervasive motivation and includes learning skills that can be applied to future research. Current DRT programs may be inadequate in supporting residents to achieve this goal. These results can be used to inform programmatic efforts to optimize DRT for residents and mentors alike.
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Affiliation(s)
| | - Tiffany N Anderson
- Stanford University, Department of Surgery, Goodman Surgical Education Center, Stanford, California
| | - Jennifer N Choi
- Indiana University, Department of Surgery, Indianapolis, Indiana
| | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah
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Frankel WC, Scott BG, Massarweh NN, Silberfein EJ, Zhang Q, Rosengart TK, LeMaire SA, Trautner BW. A Multifaceted Research Engagement Program Improved the Academic Productivity of General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:1082-1087. [PMID: 32505672 DOI: 10.1016/j.jsurg.2020.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgeon-scientists are becoming increasingly scarce, and therefore, engaging residents in research during their training is important. We evaluated whether a multifaceted research engagement program was associated with increased academic productivity of general surgery residents. DESIGN Our research engagement program has 4 pillars: A research requirement, a structured research curriculum, infrastructure to support residents' research, and an annual resident research day to highlight trainees' work. We compared the number of manuscripts published per chief resident during the 4 years before and after program implementation in 2013. We performed subgroup analyses to examine productivity of research track residents and clinical track residents. SETTING A general surgery residency program in an academic setting. PARTICIPANTS The participants were 57 general surgery residents (23 research track and 34 clinical track) graduating between 2010 and 2017. RESULTS There was a significant increase in overall research productivity, with 28 chief residents publishing an average of 2.3 ± 1.0 manuscripts before and 29 chief residents publishing an average of 8.5 ± 3.2 manuscripts after program implementation (p = 0.01). Research track residents had a nonsignificant increase in publications from an average of 6.3 ± 3.1 before to 15.4 ± 8.9 after the new program (p = 0.10). Clinical track residents had a significant increase in publications from a median of 0.9 (interquartile range: 0.5, 1.0) before to a median of 1.3 (interquartile range: 1.2, 8.6) after the new program (p = 0.03). CONCLUSIONS Implementation of a multifaceted research engagement program was associated with a significant increase in manuscripts published by general surgery residents, including clinical track residents. Components of our program may be of use to other programs looking to improve resident research engagement and productivity.
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Affiliation(s)
| | - Bradford G Scott
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nader N Massarweh
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Eric J Silberfein
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Qianzi Zhang
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Todd K Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - Barbara W Trautner
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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Zuo KJ, Meng Y, Gordon L, Saun TJ, Mazine A, Ahuja CS, Lipsman N, Rutka JT, Fehlings MG. Navigating the Postgraduate Research Fellowship: A Roadmap for Surgical Residents. J Surg Res 2020; 256:282-289. [PMID: 32712442 DOI: 10.1016/j.jss.2020.06.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/03/2020] [Accepted: 06/16/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND To preserve the future of surgical innovation, opportunities for surgical residents to receive structured research training are paramount. The objective of this article is to help surgical residents navigate a research fellowship by overviewing key topics such as choosing an area of focus and supervisor, applying for external funding, transitioning away from clinical duties, managing intellectual property, integrating family planning, and incorporating research experience into independent career development. MATERIALS AND METHODS Using the framework of the University of Toronto's graduate degree-awarding Surgeon-Scientist Training Program, the authors outline key considerations, decisions, and pearls for surgical residents considering or currently enrolled in a full-time research fellowship training program. RESULTS Full-time research fellowships offer a unique opportunity for residents interested in an academic career. Such full-time research fellowships away from clinical duties allow surgical trainees to focus on developing key research competencies, including how to generate hypotheses, apply research methodology, gain experience presenting and publishing manuscripts, and ultimately apply these skills as independent investigators to improve patient and population health. Research fellowships may also be an opportunity to develop intellectual property or facilitate family planning. Practical tips are provided for the transition back into clinical training and how to effectively market one's research skills for career advancement. CONCLUSIONS The authors outline key considerations, decisions, and pearls for surgical residents considering or currently enrolled in a full-time research fellowship training program. By adhering to the principles highlighted in this article, residents will be able to successfully navigate a full-time research fellowship to optimize their intellectual development, maximize their academic productivity, and facilitate their transition into an independent investigator.
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Affiliation(s)
- Kevin J Zuo
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ying Meng
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Gordon
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; International Centre for Surgical Safety, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tomas J Saun
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Ahuja
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Cell Biology, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Super Fellowships Among Cardiothoracic Trainees: Prevalence and Motivations. Ann Thorac Surg 2020; 111:1724-1729. [PMID: 32682757 DOI: 10.1016/j.athoracsur.2020.05.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND After completing traditional fellowship or integrated residency in cardiothoracic surgery, many trainees spend time in nonaccredited "super fellowships." The prevalence and motivations for pursuing super fellowships are unknown. METHODS A survey was distributed to all 776 cardiothoracic surgery graduates who completed training between 2008 and 2019. The number of graduates was used as the denominator to calculate response rate. Comparisons between responses were made using Fisher's exact test. RESULTS Over an 8-week period, 261 surveys were completed with a response rate of 34%. The majority were traditional graduates (75%), for example, not integrated residents, and of those, 64% did a 2-year program. The majority (60%) did not pursue super fellowships. Among those who did complete a super fellowship, areas of training included congenital, transplantation, aortic pathology, valvular disease, and other. Among the 90 who completed super fellowships, reasons included "congenital" (34%), "felt training inadequate" (28%), "required for position" (24%), "personal" (6%), and "other" (8%). Among the 25 who selected "training inadequate," 32% focused in general thoracic-related areas. There was no relationship between length of traditional training (2 vs 3 years) and completing additional training (P = .17), but there was a significant association between completing a traditional track versus integrated residency and pursuing a super fellowship (P = .02). CONCLUSIONS Additional training in cardiothoracic surgery is common. The reasons for further instruction are varied but relate to readiness and need for specialized skills. Program directors should consider employers' needs to ensure trainees graduate with the necessary skills for future practice.
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Abstract
OBJECTIVE The aim of the study was to address the controversy surrounding the effects of duty hour reform on new surgeon performance, we analyzed patients treated by new surgeons following the transition to independent practice. SUMMARY BACKGROUND DATA In 2003, duty hour reform affected all US surgical training programs. Its impact on the performance of new surgeons remains unstudied. METHODS We studied 30-day mortality among 1,483,074 Medicare beneficiaries undergoing general and orthopedic operations between 1999 and 2003 ("traditional" era) and 2009 and 2013 ("modern" era). The operations were performed by 2762 new surgeons trained before the reform, 2119 new surgeons trained following reform and 15,041 experienced surgeons. We used a difference-in-differences analysis comparing outcomes in matched patients treated by new versus experienced surgeons within each era, controlling for the hospital, operation, and patient risk factors. RESULTS Traditional era odds of 30-day mortality among matched patients treated by new versus experienced surgeons were significantly elevated [odds ratio (OR) 1.13; 95% confidence interval (CI) (1.05, 1.22), P < 0.001). The modern era elevated odds of mortality were not significant [OR 1.06; 95% CI (0.97-1.16), P = 0.239]. Relative performance of new and experienced surgeons with respect to 30-day mortality did not appear to change from the traditional era to the modern era [OR 0.93; 95% CI (0.83-1.05), P = 0.233]. There were statistically significant adverse changes over time in relative performance to experienced surgeons in prolonged length of stay [OR 1.08; 95% CI (1.02-1.15), P = 0.015], anesthesia time [9 min; 95% CI (8-10), P < 0.001], and costs [255USD; 95% CI (2-508), P = 0.049]. CONCLUSIONS Duty hour reform showed no significant effect on 30-day mortality achieved by new surgeons compared to their more experienced colleagues. Patients of new surgeons, however, trained after duty hour reform displayed some increases in the resources needed for their care.
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Tran A, Gawad N, Martel A, Manhas N, Allen M, Hameed M, Balaa F. The changing face of academic general surgery in Canada: a cross-sectional cohort study. Can J Surg 2020; 62:381-385. [PMID: 31782294 DOI: 10.1503/cjs.016418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Little is known regarding the research and training expectations faced by modern general surgery graduates interested in pursuing academic surgical careers. In this study, we describe the changing face of the Canadian academic general surgeon by outlining the in-residency research productivity and postresidency clinical and academic training trends over time. Methods Our cross-sectional cohort included Canadian academic general surgeons, defined as those with a university-affiliated appointment as assistant, associate or full professor. Academic surgeons were identified by the Royal College of Physicians and Surgeons of Canada online directory as well as directories of university and hospital websites. Data points included institution, faculty appointment and rank, graduation year, graduate education, fellowship training and research productivity. Results Our cohort included 417 surgeons from 17 Canadian academic institutions. The majority of surgeons were male (72.9%), had completed at least 1 fellowship (72.9%) and had had some form of supplementary research training (51.8%). Surgeons in the cohort had practised a median of 17 (10–27) years. The mean number of total and first-author publications for the participants in this study has increased consistently each decade before the 1980s (p < 0.001). The proportion of academic surgeons completing graduate degrees has increased steadily every decade, reaching a peak of 61.5% for surgeons graduating in the 2010s. Conclusion The Canadian academic surgeon is becoming increasingly productive in research during residency and is pursuing higher levels of graduate education and more fellowships than ever before. These changes probably correspond to an evolving employment and research funding landscape that places tremendous academic pressure on surgical trainees.
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Affiliation(s)
- Alexandre Tran
- From the Department Surgery, The Ottawa Hospital, Ottawa, Ont. (Tran, Gawad, Martel, Balaa); the Faculty Of Education, University of Ottawa, Ottawa, Ont. (Tran); the Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Ottawa, Ont. (Gawad); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas, Allen); and the Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Nada Gawad
- From the Department Surgery, The Ottawa Hospital, Ottawa, Ont. (Tran, Gawad, Martel, Balaa); the Faculty Of Education, University of Ottawa, Ottawa, Ont. (Tran); the Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Ottawa, Ont. (Gawad); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas, Allen); and the Vancouver General Hospital, Vancouver, BC (Hameed)
| | - André Martel
- From the Department Surgery, The Ottawa Hospital, Ottawa, Ont. (Tran, Gawad, Martel, Balaa); the Faculty Of Education, University of Ottawa, Ottawa, Ont. (Tran); the Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Ottawa, Ont. (Gawad); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas, Allen); and the Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Neraj Manhas
- From the Department Surgery, The Ottawa Hospital, Ottawa, Ont. (Tran, Gawad, Martel, Balaa); the Faculty Of Education, University of Ottawa, Ottawa, Ont. (Tran); the Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Ottawa, Ont. (Gawad); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas, Allen); and the Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Molly Allen
- From the Department Surgery, The Ottawa Hospital, Ottawa, Ont. (Tran, Gawad, Martel, Balaa); the Faculty Of Education, University of Ottawa, Ottawa, Ont. (Tran); the Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Ottawa, Ont. (Gawad); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas, Allen); and the Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Morad Hameed
- From the Department Surgery, The Ottawa Hospital, Ottawa, Ont. (Tran, Gawad, Martel, Balaa); the Faculty Of Education, University of Ottawa, Ottawa, Ont. (Tran); the Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Ottawa, Ont. (Gawad); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas, Allen); and the Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Fady Balaa
- From the Department Surgery, The Ottawa Hospital, Ottawa, Ont. (Tran, Gawad, Martel, Balaa); the Faculty Of Education, University of Ottawa, Ottawa, Ont. (Tran); the Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Ottawa, Ont. (Gawad); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas, Allen); and the Vancouver General Hospital, Vancouver, BC (Hameed)
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Huffman EM, Martin JR, Stefanidis D. Teaching technical surgery. Surgery 2020; 167:782-786. [DOI: 10.1016/j.surg.2019.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/18/2022]
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Yheulon CG, Cole WC, Ernat JJ, Davis SS. Normalized Competitive Index: Analyzing Trends in Surgical Fellowship Training Over the Past Decade (2009-2018). JOURNAL OF SURGICAL EDUCATION 2020; 77:74-81. [PMID: 31422019 DOI: 10.1016/j.jsurg.2019.07.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVE There is a lack of literature describing how competitive surgical fellowships are, especially across specialties. Such information would be valuable to prospective candidates, especially as immediate postresidency subspecialty training becomes the norm for general surgery. Match-rates alone may be misleading indicators as programs may not fill positions with unqualified applicants. We propose a simple metric to analyze the competitiveness of various surgical subspecialties to each other and themselves over time. DESIGN Retrospective cohort study. The Competitive Index is defined as the percentage of filled programs within each specialty divided by the match-rate for that specialty. For ease of comparison, a Normalized Competitive Index (NCI) was developed, normalizing the metric for all specialties in that year to a value of 1. SETTING The National Resident Matching Program, The Fellowship Council, and the San Francisco Match publicly available match data from 2009 to 2018. PARTICIPANTS General Surgery Associated Fellowship Applicants (Abdominal Transplant, Colorectal, Surgical Oncology, Minimally Invasive Surgery, Pediatric, Plastic, Critical Care, Thoracic, and Vascular). RESULTS The overall match rate for all specialties was 74.6% and 84.0% of all programs were filled. Over the past decade, pediatric surgery was significantly more competitive than other specialties (NCI 1.67, p < 0.0001), while surgical critical care (NCI 0.58, p < 0.0001) and vascular (NCI 0.90, p < 0.0492) were significantly less competitive. When comparing the NCI within each specialty from the first 5 years (2009-2013) to the last 5 years, (2014-2018), surgical critical care (NCI 0.54 vs. 0.62, p = 0.0462) and thoracic (NCI 0.74 vs. 1.08, p=0.0025) became significantly more competitive, while transplant (NCI 1.10 vs. 0.92, p = 0.0343) and colorectal (NCI 1.32 vs. 1.09, p = 0.0021) became significantly less competitive. CONCLUSION The NCI is a metric which might be useful to prospective applicants and which could be provided annually by organizations sponsoring fellowship matching processes. Further research must be performed to establish what defines a qualified applicant in each specialty.
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Affiliation(s)
| | - William C Cole
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | - Justin J Ernat
- Department of Orthopaedic Surgery, Blanchfield Army Community Hospital, Fort Campbell, Kentucky
| | - S Scott Davis
- Division of General and GI Surgery, Emory University Hospital, Atlanta Georgia
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Mullins CH, Goyer S, Cantrell CK, Hendershot K, Corey B. An assessment of the online presentation of MIS fellowship information for residents. Surg Endosc 2019; 34:3986-3991. [PMID: 31628622 DOI: 10.1007/s00464-019-07179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Residents often utilize internet resources to evaluate and search for fellowship programs within their desired field. The presence of these resources and the information available through them has the potential to influence applicant decisions. The objective of this study was to analyze the online MIS fellowship information relevant to resident applicants provided by the Fellowship Council Directory (FCD) and institutionally based program webpages. MATERIALS AND METHODS The programs evaluated were chosen based on their inclusion in the FCD, the accrediting body for MIS fellowships. The FCD provides each program a template through which program directors detail information for applicants. This information is publicly accessible through the directory, with each program having a specific page. These webpages were assessed for the presence or absence of 21 previously established individual content criteria. In addition, the presence or absence of a functional link to an institutionally based, program-specific webpage was determined. These program-specific, institutional webpages were then independently accessed via Google® search and separately assessed for the presence or absence of the same 21 previously established content criteria. RESULTS In total, the FCD listed 144 programs. Each program had a dedicated page within the directory itself with 104 (72%) having functional links listed. Ninety-six (66.6%) of the FCD links were identified as being specific webpages to the fellowship program, verified through a Google® search. Less than half of the programs fulfilled over 50% of identified criteria through the FCD templated directory, with one-third of programs listed failing to provide any program-specific information via a webpage outside the FCD. CONCLUSION Information available online for MIS fellowship programs is lacking, with many institutionally supported webpages absent altogether outside of the FCD. Templated formats seem to assist in this deficiency, but should be used cautiously as they also can potentially omit relevant information.
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Affiliation(s)
- C Haddon Mullins
- School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - Sydnée Goyer
- Department of Surgery, University of Alabama at Birmingham, LHRB 112, Birmingham, AL, 35294, USA
| | - Colin K Cantrell
- School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - Kimberly Hendershot
- Department of Surgery, University of Alabama at Birmingham, LHRB 112, Birmingham, AL, 35294, USA
| | - Britney Corey
- Department of Surgery, University of Alabama at Birmingham, LHRB 112, Birmingham, AL, 35294, USA. .,Birmingham Veteran's Affairs Medical Center, KB 420, 1720 2nd Ave S, Birmingham, AL, 35294, USA.
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When rural is no longer rural: Demand for subspecialty trained surgeons increases with increasing population of a non-metropolitan area. Am J Surg 2019; 218:1022-1027. [PMID: 31227187 DOI: 10.1016/j.amjsurg.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/23/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgery in larger, non-metropolitan, communities may be distinct from rural practice. Understanding these differences may help guide training. We hypothesize that increasing community size is associated with a desire for subspecialty surgeons. METHODS We designed a mixed methods study with the ACS Rural Advisory Council. Rural (<50,000 people), small non-metropolitan (50,000-100,000), and large non-metropolitan (>100,000) communities were compared. Quantitative and qualitative data were analyzed. RESULTS We received 237 responses, and desire to hire subspecialty-trained surgeons was associated with practice in a large non-metropolitan community, OR 4.5, (1.2-16.5). Qualitative themes demonstrated that rural surgeons limit practices to align with available hospital resources while large non-metropolitan surgeons specialize according to interest and market pressures. CONCLUSIONS Surgery in rural versus large non-metropolitan communities may be more distinct than previously understood. Rural practice requires broad preparation while large non-metropolitan practice favors subspecialty training.
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Lillemoe HA, Scally CP, Adams CL, Bednarski BK, Balch CM, Aloia TA, Gershenwald JE, Lee JE, Grubbs EG. Complex General Surgical Oncology Fellowship Applicants: Trends over Time and the Impact of Board Certification Eligibility. Ann Surg Oncol 2019; 26:2667-2674. [DOI: 10.1245/s10434-019-07420-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Indexed: 11/18/2022]
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Wach MM, Ayabe RI, Ruff SM, D'Angelica M, Dineen SP, Grubbs EG, Shibata D, Shirley L, Weiss MJ, Davis JL, Hernandez JM. A Survey of the Complex General Surgical Oncology Fellowship Programs Regarding Applicant Selection and Rank. Ann Surg Oncol 2019; 26:2675-2681. [PMID: 31011903 DOI: 10.1245/s10434-019-07372-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is significant demand for training in Complex General Surgical Oncology (CGSO) fellowships. Previous work has explored objective quantitative metrics of applicants that matriculated to CGSO fellowships; however, ambiguity remains concerning academic benchmarks and qualitative factors that impact matriculation. STUDY DESIGN A web-based survey was sent to each ACGME/SSO-approved CGSO fellowship training program. The survey was comprised of 24 questions in various forms, including dichotomous, ranked, and five-point Likert scale questions. RESULTS Twenty-nine of 30 program directors (97%) submitted complete survey responses, representing 64 of the 65 CGSO fellowship positions (99%) currently offered. Programs received a mean of 73 applications per cycle (range 50-125) and granted a mean of 26 interviews (range 2-45). Seventy-two percent of programs had an established benchmark for ABSITE score percentile before offering a candidate an interview, with 62% of those programs setting that benchmark above the 50th percentile. The majority of programs also had established benchmarks for quantity of first author publications (mean: 2.3) and all publications of any authorship (mean: 4.4). An applicant's interview was ranked as the most important factor in determining inclusion on the program's rank list. The ability to work as part of a team, interpersonal interaction/communication abilities, and operative skills were rated as most important applicant characteristics, whereas an applicant's personal statement was ranked as least important. CONCLUSIONS After established academic benchmarks have been met, a multitude of factors influences ranking of applicants to the CGSO fellowship, most of which are assessed at the interview.
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Affiliation(s)
- Michael M Wach
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Reed I Ayabe
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samantha M Ruff
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Sean P Dineen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | | | | | - Jeremy L Davis
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan M Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Elsey EJ, West J, Griffiths G, Humes DJ. Time Out of General Surgery Specialty Training in the UK: A National Database Study. JOURNAL OF SURGICAL EDUCATION 2019; 76:55-64. [PMID: 30093329 DOI: 10.1016/j.jsurg.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE General surgery specialty training in the United Kingdom takes 6 years and allows trainees to take time out of training. Studies from the United States have highlighted an increasing trend for taking time out of surgical training for research. This study aimed to evaluate trends in time out of training and the impact on the duration of UK general surgical specialty training. DESIGN, SETTING, AND PARTICIPANTS A cohort study using routinely collected surgical training data from the Intercollegiate Surgical Curriculum Program database for General surgery trainees registered from August 1, 2007. Trainees were classified as Completed Training or In-Training. Out of training periods were identified and time in training calculated (both unadjusted and adjusted for out of training periods) with a predicted time in training for those In-Training. RESULTS Of the trainees still In-Training (n = 994), a greater proportion had taken time out of training compared with those who had completed training (n = 360; 54.5% vs 45.9%, p < 0.01). A greater proportion of the In-Training group had undertaken a formal research period compared with the Completed Training group (35.1% vs 6.1%, p < 0.01). Total unadjusted training time in the Completed Training group was a median 6.0 (interquartile range 6.0-7.0) years compared with a predicted unadjusted training time in the In-Training group, with an out of training period recorded, of a median 8.0 (interquartile range 7.0-9.0) years. CONCLUSIONS Trainees are increasingly taking time out of surgical training, particularly for research, with a subsequent increase in total time of training. This should be considered when redesigning surgical training programs and planning the future surgical workforce.
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Affiliation(s)
- Elizabeth J Elsey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - David J Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Wach MM, Ruff SM, Ayabe RI, Martin SP, Diggs LP, Alexander IA, Steinberg SM, Davis JL, Hernandez JM. An Examination of Applicants and Factors Associated with Matriculation to Complex General Surgical Oncology Fellowship Training Programs. Ann Surg Oncol 2018; 25:3436-3442. [PMID: 30054823 DOI: 10.1245/s10434-018-6674-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The demand for training in complex general surgical oncology (CGSO) fellowships currently exceeds the number of positions offered; however, there are scarce data defining the applicant pool or characteristics associated with successful matriculation. Our study described the applicant population and to determine factors associated with acceptance into the fellowship. STUDY DESIGN Data were extracted from the Electronic Residency Application System for applicants in 2015 and 2016 and stratified based on matriculation status. Applicant demographics, including medical education, residency, and research achievements, were analyzed. Academic productivity was quantified using the number of peer-reviewed publications as well as the journal with the highest impact factor in which an applicant's work was published. RESULTS Data were gathered on a total of 283 applicants, of which 105 matriculated. The overall population was primarily male (63.2%), Caucasian (40.6%), educated at a U.S. allopathic medical school (53.4%), and trained at a university-based General Surgery residency (55.5%). Education at a U.S. allopathic school (OR = 5.63, p < 0.0001), university-based classification of the applicant's surgical residency (OR = 4.20, p < 0.0001), and a residency affiliation with a CGSO fellowship (OR = 2.61, p = 0.004) or National Cancer Institute designated Comprehensive Cancer Center (OR = 3.16, p < 0.001) were found to be associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 10 vs. 4.5, p < 0.0001) and more frequently achieved publication in journals with higher impact factors (p < 0.0001). CONCLUSIONS This study represents the first objective description of the CGSO fellowship applicant pool. Applicants' medical school, residency, and research data points correlated with successful matriculation.
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Affiliation(s)
- Michael M Wach
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samantha M Ruff
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Reed I Ayabe
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sean P Martin
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laurence P Diggs
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imani A Alexander
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeremy L Davis
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan M Hernandez
- Thoracic and Oncologic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Cantrell CK, Dahlgren NJ, Young BL, Hendershot KM. Evaluation of Accredited Trauma, Surgical Critical Care, and Acute Care Surgery Fellowship Websites. J Surg Res 2018; 232:160-163. [PMID: 30463713 DOI: 10.1016/j.jss.2018.05.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/05/2018] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Surgical residents are increasingly pursuing fellowships and rely heavily on fellowship programs' web sites as a primary source of information. Accessibility, quality, and content of a program web site can encourage or deter an applicant from applying to a particular program. The goal of this study was to perform an analysis of trauma, surgical critical care, and acute care surgery fellowship program web sites. MATERIALS AND METHODS A list of trauma, surgical critical care, and acute care surgery fellowship programs was obtained from the Eastern Association for the Surgery of Trauma (EAST) web site. The existence of a functional hyperlink in the EAST program directory and a systematic Google search was assessed to determine web site accessibility. Twenty-one content criteria were used to evaluate accessible web sites. RESULTS The EAST directory contained 102 fellowship programs. Ninety-one programs had web sites accessible through a Google search. No web site contained all 21 criteria. Only 29 web sites contained at least half of the evaluated content criteria. The most common data point included was program description (97%), while role of seeing patients in clinic (4%) was the least common criteria present. CONCLUSIONS Many programs in the EAST directory lack functional links and accessible web sites. Content that has been deemed important to applicants is lacking in varying degrees. Incorporation of this missing content may benefit both applicants and programs, allowing for more informed decision-making when choosing a program, thus promoting better fit of fellows with programs during the application process.
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Affiliation(s)
- Colin K Cantrell
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas J Dahlgren
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bradley L Young
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Brandt AM, Rettig SA, Kale NK, Zuckerman JD, Egol KA. Can a Clinician-Scientist Training Program Develop Academic Orthopaedic Surgeons? One Program's Thirty-Year Experience. JOURNAL OF SURGICAL EDUCATION 2018; 75:1039-1044. [PMID: 29102560 DOI: 10.1016/j.jsurg.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/14/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Clinician-scientist numbers have been stagnant over the past few decades despite awareness of this trend. Interventions attempting to change this problem have been seemingly ineffective, but research residency positions have shown potential benefit. OBJECTIVE We sought to evaluate the effectiveness of a clinician-scientist training program (CSTP) in an academic orthopedic residency in improving academic productivity and increasing interest in academic careers. METHODS Resident training records were identified and reviewed for all residents who completed training between 1976 and 2014 (n = 329). There were no designated research residents prior to 1984 (pre-CSTP). Between 1984 and 2005, residents self-selected for the program (CSTP-SS). In 2005, residents were selected by program before residency (CSTP-PS). Residents were also grouped by program participation, research vs. clinical residents (RR vs. CR). Data were collected on academic positions and productivity through Internet-based and PubMed search, as well as direct e-mail or phone contact. Variables were then compared based on the time duration and designation. RESULTS Comparing all RR with CR, RR residents were more likely to enter academic practice after training (RR, 34%; CR, 20%; p = 0.0001) and were 4 times more productive based on median publications (RR, 14; CR, 4; p < 0.0001). Furthermore, 42% of RR are still active in research compared to 29% of CR (p = 0.04), but no statistical difference in postgraduate academic productivity identified. CONCLUSIONS The CSTP increased academic productivity during residency for the residents and the program. However, this program did not lead to a clear increase in academic productivity after residency and did not result in more trainees choosing a career as clinician-scientists.
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Affiliation(s)
- Aaron M Brandt
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Samantha A Rettig
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York City, New York
| | - Neel K Kale
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York City, New York
| | - Joseph D Zuckerman
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York City, New York
| | - Kenneth A Egol
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York City, New York.
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Goudreau BJ, Hassinger TE, Hedrick TL, Slingluff CL, Schroen AT, Dengel LT. Academic or community practice? What is driving decision-making and career choices. Surgery 2018; 164:571-576. [PMID: 29929756 DOI: 10.1016/j.surg.2018.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/23/2018] [Accepted: 05/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Identifying factors that impact progression of surgery trainees into academic versus non-academic practices may permit tailoring residency experiences to promote academic careers in institutions charged with the training of future surgeon scientists. The aim of this study was to identify factors associated with progression of surgery trainees into academic versus non-academic practice. METHODS A survey was distributed to 135 surgeons graduating from the University of Virginia residency program from 1964-2016, a single academic institution. Questions addressed practice type, research productivity, work/life balance, mentorship, and overall sentiment toward research and academic surgery. A 5-point Likert scale measured career satisfaction and influence of factors in practice setting choice. RESULTS Of the 135 surveys that were electronically distributed, 69 participants responded (response rate: 51%). Of the 54 with known current practice types, 34 (63%) were academic and 20 (37%) non-academic. Academic surgeons reported more publications by the conclusion of surgery training (56% vs 25% with >10 publications, P = .02). More academic surgeons reported >$100,000 in student debt at graduation (44% vs 25%, P < .05). Factors encouraging an academic career were similar for both types of surgeons, including involvement in education of trainees and access to mentorship. Both groups were discouraged from an academic practice by requirements of grant-writing and funding responsibilities. Surgeons in academic practice were more likely to recommend surgery as a career to a current medical student (100% vs 70%, P = .001). CONCLUSION This knowledge may help to tailor training experiences to promote academic careers. By supporting funding mechanisms and grant-writing programs, while encouraging mentorship and productive research experiences, current surgical trainees may be more enthusiastic about a career in academic practice.
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Affiliation(s)
- Bernadette J Goudreau
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
| | - Taryn E Hassinger
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Traci L Hedrick
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Craig L Slingluff
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Anneke T Schroen
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lynn T Dengel
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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Brochu A, Aggarwal R. Research during general surgery residency: a Web-based review of opportunities, structure and outputs. J Surg Res 2018; 223:149-154. [DOI: 10.1016/j.jss.2017.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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D'Angelo ALD, D'Angelo JD, Rogers DA, Pugh CM. Faculty perceptions of resident skills decay during dedicated research fellowships. Am J Surg 2018; 215:336-340. [DOI: 10.1016/j.amjsurg.2017.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/29/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
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Abstract
INTRODUCTION Most orthopaedic surgery residents elect to pursue additional subspecialty training; however, factors influencing the choice of subspecialty and the ways that these factors change during training are not well understood. The aim of this investigation was to determine, on the basis of a trainee's postgraduate year (PGY), whether variability exists in factors valued when choosing a specific subspecialty. METHODS We emailed an online survey (intended for distribution to current trainees) to a list of orthopaedic surgery residency program coordinators in the United States. The survey queried demographic information, PGY level, and the importance of 14 discrete factors in the selection of fellowship specialty according to a Likert scale rating from 1 to 4. RESULTS There were 359 respondents representing an even distribution of PGY levels. Junior trainees assigned greater relative value to geographic location, on-call responsibilities, financial compensation, and the tradition of the residency program, whereas senior trainees assigned greater relative value to variety of cases and intellectual stimulation (all P < 0.05). DISCUSSION The differences seen in factors valued based on trainee experience may highlight the relative importance of greater exposure to the breadth of orthopaedic surgical practice during training and increasing awareness of clinical competencies and responsibilities. CONCLUSIONS When deciding on orthopaedic subspecialty choice, junior trainees value lifestyle factors relatively more than do senior trainees, whereas senior trainees value case variety and stimulation relatively more than junior trainees do.
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Karpinski J, Ajjawi R, Moreau K. Fellowship training: a qualitative study of scope and purpose across one department of medicine. BMC MEDICAL EDUCATION 2017; 17:223. [PMID: 29157228 PMCID: PMC5697383 DOI: 10.1186/s12909-017-1062-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 11/07/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an "invisible phase of postgraduate training" lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education. METHODS During the 2013-14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantitative data. RESULTS We interviewed 16 division heads (94%), 15 fellowship directors (63%) and 8 fellows (21%). We identified three distinct types of fellowships. Individualized fellowships focus on the career goals of the trainee and/or the recruitment goals of the division. Clinical fellowships focus on the attainment of clinical expertise over and above the competencies of residency. Research fellowships focus on research productivity. Participants identified a variety of reasons to offer fellowships: improve academic productivity; improve clinical productivity; share/develop enhanced clinical expertise; recruit future faculty members/attain an academic position; enhance the reputation of the division/department/trainee; and enhance the scholarly environment. CONCLUSIONS Fellowships serve a variety of purposes which benefit both individual trainees as well as the academic enterprise. Fellowships can be categorized within a distinct taxonomy: individualized; clinical; and research. Each type of fellowship may serve a variety of purposes, and each may need distinct support and resources. Further research is needed to catalogue the operational requirements for hosting and undertaking fellowship training, and establish recommendations for educational and administrative policy and processes in this new phase of postgraduate education.
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Affiliation(s)
- Jolanta Karpinski
- Department of Medicine, University of Ottawa, Rm 5-16, 1967 Riverside Drive, Ottawa, Ontario K1H 7W9 Canada
| | - Rola Ajjawi
- Centre for Medical Education, University of Dundee, Dundee, UK
| | - Katherine Moreau
- Faculty of Education, University of Ottawa, Ottawa, Ontario Canada
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Grova MM, Yang AD, Humphries MD, Galante JM, Salcedo ES. Dedicated Research Time During Surgery Residency Leads to a Significant Decline In Self-Assessed Clinical Aptitude and Surgical Skills. JOURNAL OF SURGICAL EDUCATION 2017; 74:980-985. [PMID: 28533183 DOI: 10.1016/j.jsurg.2017.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/26/2017] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The surgical community commonly perceives a decline in surgical and patient care skills among residents who take dedicated time away from clinical activity to engage in research. We hypothesize that residents perceive a decline in their skills because of dedicated research time. SETTING UC Davis Medical Center, Sacramento, CA, an institutional tertiary care center. PARTICIPANTS General surgery residents and graduates from UC Davis general surgery residency training program, who had completed at least 1 year of research during their training. A total of 35 people were asked to complete the survey, and 19 people submitted a completed survey. DESIGN Participants were invited to complete an online survey. Factors associated with the decline in skills following their research years were examined. All statistical analyses were performed with IBM SPSS Statistics software. RESULTS A total of 19 current or former general surgery residents responded to the survey (54% response rate). Overall, 42% described their research as "basic science." Thirteen residents (68%) dedicated 1 year to research, while the remainder spent 2 or more years. Basic science researchers were significantly more likely to report a decrease in clinical judgment (75% vs. 22%, p = 0.013) as well as a decrease in patient care skills (63% vs. 0%, p = 0.002). Residents who dedicated at least 2 years to research were more likely to perceive a decline in overall aptitude and surgical skills (100% vs. 46%, p = 0.02), and a decline in patient care skills (67% vs. 8%, p = 0.007). CONCLUSIONS Most residents who dedicate time for research perceive a decline in their overall clinical aptitude and surgical skills. This can have a dramatic effect on the confidence of these residents in caring for patients and leading a care team once they re-enter clinical training. Residents who engaged in 2 or more years of research were significantly more likely to perceive these problems. Further research should determine how to keep residents who are interested in academics from losing ground clinically while they are pursuing research training.
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Affiliation(s)
- Monica M Grova
- Department of Surgery, UC Davis School of Medicine, Sacramento, California.
| | - Anthony D Yang
- Department of Surgery, UC Davis School of Medicine, Sacramento, California; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Misty D Humphries
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Joseph M Galante
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Edgardo S Salcedo
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
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Baimas-George M, Fleischer B, Slakey D, Kandil E, Korndorffer JR, DuCoin C. Is it All About the Money? Not All Surgical Subspecialization Leads to Higher Lifetime Revenue when Compared to General Surgery. JOURNAL OF SURGICAL EDUCATION 2017; 74:e62-e66. [PMID: 28705484 DOI: 10.1016/j.jsurg.2017.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE It is believed that spending additional years gaining expertise in surgical subspecialization leads to higher lifetime revenue. Literature shows that more surgeons are pursuing fellowship training and dedicated research years; however, there are no data looking at the aggregate economic impact when training time is accounted for. It is hypothesized that there will be a discrepancy in lifetime income when delay to practice is considered. DESIGN Data were collected from the Medical Group Management Association's 2015 report of average annual salaries. Fixed time of practice was set at 30 years, and total adjusted revenue was calculated based on variable years spent in research and fellowship. All total revenue outcomes were compared to general surgery and calculated in US dollars. PARTICIPANTS The financial data on general surgeons and 9 surgical specialties (vascular, pediatric, plastic, breast, surgical oncology, cardiothoracic, thoracic primary, transplant, and trauma) were examined. RESULTS With fellowship and no research, breast and surgical oncology made significantly less than general surgery (-$1,561,441, -$1,704,958), with a difference in opportunity cost equivalent to approximately 4 years of work. Pediatric and cardiothoracic surgeons made significantly more than general surgeons, with an increase of opportunity cost equivalent to $5,301,985 and $3,718,632, respectively. With 1 research year, trauma surgeons ended up netting less than a general surgeon by $325,665. With 2 research years, plastic and transplant surgeons had total lifetime revenues approximately equivalent to that of a general surgeon. CONCLUSIONS Significant disparities exist in lifetime total revenue between surgical subspecialties and in comparison, to general surgery. Although most specialists do gross more than general surgeons, breast and surgical oncologists end up netting significantly less over their lifetime as well as trauma surgeons if they do 1 year of research. Thus, the economic advantage of completing additional training is dependent on surgical field and duration of research.
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Affiliation(s)
- Maria Baimas-George
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Brian Fleischer
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Douglas Slakey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - James R Korndorffer
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Christopher DuCoin
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
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