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Khosrowzadeh N, Saini AS, Samimi K, Chambers K, Gompels M, Takita C, Meshman J, Washington C. Disparities in physician compensation for breast and prostate cancer operations. PLoS One 2025; 20:e0323892. [PMID: 40373030 PMCID: PMC12080758 DOI: 10.1371/journal.pone.0323892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Accepted: 04/15/2025] [Indexed: 05/17/2025] Open
Abstract
The objective of this study was to determine whether the Center for Medicare and Medicaid services (CMS) pays more relative value units (RVUs) for prostatectomies than mastectomies across different treatment modalities. The RVU model is public information, subject to review every 5 years at minimum and has implications directly or indirectly to every medical center in the United States. These findings shed light on how the CMS values the two most prominent cancers among men and women: breast cancer and prostate cancer. An economic evaluation was conducted to appraise physician compensation for treating breast cancer vs prostate cancer. Work RVUs, malpractice RVUs, and practice expense RVUs were collected from the CMS' 2023 Physician Fee Scheduler. The total operative times, including time spent in pre-op consultations and follow ups, used by the RVU update committee to create these values were collected from the CMS' 2023 Final Rule Physician Work Times. Surgical oncologists treating breast cancer were paid an average of 15.45 RVUs per mastectomy and 2.74 per hour. The average work RVUs paid for a prostatectomy was 24.64 and 3.06 per hour. The average work RVUs paid for an axillary lymph node removal was 12.29 and 2.94 per hour. The average work RVUs paid for a pelvic lymphadenectomy was 15.87 and 3.04 per hour. The data assimilated in this study acts to illustrate the discrepancy between work RVUs for breast cancer and prostate cancer operations.
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Affiliation(s)
- Noah Khosrowzadeh
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
| | - Aren Singh Saini
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
| | - Kayla Samimi
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
| | - Kyle Chambers
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
| | - Matthew Gompels
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
| | - Cristiane Takita
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
| | - Jessica Meshman
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
| | - Cyrus Washington
- University of Miami Hospitals and Clinics: Sylvester Comprehensive Cancer Center, Miami, Florida, United States of America
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HoSang KM, Gao TP, Williams AD, Bleicher RJ, Kuo LE. Twenty Years in the Making: An Analysis of National Trends in ACGME Resident Breast Surgery Experiences. J Surg Res 2025; 310:49-56. [PMID: 40273733 DOI: 10.1016/j.jss.2025.03.041] [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: 11/10/2024] [Revised: 02/26/2025] [Accepted: 03/22/2025] [Indexed: 04/26/2025]
Abstract
INTRODUCTION Breast surgery is a core component of general surgery; however, previous studies have shown that general surgery residents (GSRs) are performing fewer operations in this area. This study analyzes the 20-y trends in GSR breast surgery experience. METHODS Case numbers were extracted from the Accreditation Council for Graduate Medical Education database from 2003 to 2023. Breast cases were categorized by sentinel lymph node biopsy, excisional biopsy (EB), simple mastectomy (SM), modified radical mastectomy, and radical mastectomy. Yearly average case numbers for total general and breast surgery cases were calculated. Surgical resident role (chief versus junior residents) was evaluated. Linear regression analyzed time trends. RESULTS From 2003 to 2023, GSRs reported a 15% increase in average total cases performed (P < 0.001), although there was a nonsignificant 8.1% decrease in total breast cases performed. Juniors performed 56.9-61.6 operations/year, where chiefs performed 9.2-10.3 breast operations/year. The annual number of chief-performed sentinel lymph node biopsies (1.8-0.8, P < 0.001) and modified radical mastectomies (2.0-0.4 cases, P < 0.001) decreased significantly over this time period, as did the number performed by juniors (4.0-3.7 cases [P < 0.001] and 8.1-2.8 cases [P < 0.001], respectively). Conversely, the number of chief-performed EBs (1.8-4.1 cases, P < 0.001) and SMs (1.7-1.9 cases, P = 0.012), and junior-performed EBs (8.7-24.3, P < 0.001) and SMs (7.1-9.4 cases, P < 0.001), significantly increased during this time. CONCLUSIONS Although the number of breast surgeries performed by GSRs has not changed significantly, case mixes have shifted. Guideline changes are impacting the case composition for trainees and may affect comfort in practice, as opportunities to perform certain cases continue to decrease.
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Affiliation(s)
- Kristen M HoSang
- Temple University Hospital, Department of General Surgery, Philadelphia, Pennsylvania.
| | - Terry P Gao
- Temple University Hospital, Department of General Surgery, Philadelphia, Pennsylvania
| | - Austin D Williams
- Fox Chase Cancer Center, Division of Breast Surgery, Department of Surgical Oncology, Philadelphia, Pennsylvania
| | - Richard J Bleicher
- Fox Chase Cancer Center, Division of Breast Surgery, Department of Surgical Oncology, Philadelphia, Pennsylvania
| | - Lindsay E Kuo
- Temple University Hospital, Department of General Surgery, Philadelphia, Pennsylvania
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Mercedes R, Corey Z, Gaither T, Lehman E, Lemack GE, Clifton MM, Klausner AP, Mehta A, Atiemo H, Lee R, Sorensen MD, Smith R, Buckley J, Thompson RH, Breyer BN, Badalato GM, Wallen EM, Raman JD. Impact of Subsequent Fellowship on Urology Chief Resident Case Log Volumes. JOURNAL OF SURGICAL EDUCATION 2025; 82:103433. [PMID: 39848088 DOI: 10.1016/j.jsurg.2025.103433] [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: 09/18/2024] [Revised: 11/25/2024] [Accepted: 01/04/2025] [Indexed: 01/25/2025]
Abstract
OBJECTIVE To characterize the impact of subsequent fellowship on the case log experience of trainees throughout their residency and specifically their chief resident year. MATERIALS AND METHODS Urology resident case logs from 2010 to 2022 were obtained from 13 institutions for total residency and chief years. Five categorized index procedures were included for analysis: General Urology; Endourology; Reconstructive Urology; Urologic Oncology; and Pediatric Urology. Subsequent fellowship data (yes/no and type) were available for 338. Regression models analyzed the interactions of case log volumes and subsequent fellowship RESULTS: Of the 338 residents, 141 (42%) went onto practice and 197 (58%) completed a fellowship including 53 in oncology, 44 in reconstruction, 43 in endourology, 29 in pediatric, and 28 in another nonindexed domain. A total of 419,353 cases were logged during training, including 125,319 (30%) during the chief resident year. The median number of total cases completed per resident increased irrespective of subsequent fellowship. Conversely, the median number of total cases completed during chief year declined with the slope of decline being significant in those residents not completing a fellowship [slope = -2.44, CI: (-4.66, -0.23), p-value = 0.031]. Temporal trends demonstrated that absence of subsequent fellowship was associated with decrease in chief resident cases across all index domains (p for all < 0.001). The specific type of fellowship, however, had no association with chief year trends. CONCLUSIONS The median number of chief resident cases has declined, most significantly in those trainees not pursuing a fellowship, possibly reflecting a focus on urology encounters which are not captured in ACGME logs.
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Affiliation(s)
- Raidizon Mercedes
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Zachary Corey
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Talmadge Gaither
- Department of Urology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Erik Lehman
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marisa M Clifton
- Department of Urology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam P Klausner
- Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Viginia
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Humphrey Atiemo
- Department of Urology, Henry Ford Hospital, Detroit, Michigan
| | - Richard Lee
- Department of Urology, Weill Cornell Medical Center, New York, New York
| | - Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Ryan Smith
- Department of Urology, University of Virginia School of Medicine, Charlottesville, Viginia
| | - Jill Buckley
- Department of Urology, University of California San Diego School of Medicine, San Diego, California
| | | | - Benjamin N Breyer
- Department of Urology, University of California San Francisco School of Medicine, San Francisco, California
| | - Gina M Badalato
- Department of Urology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Eric M Wallen
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jay D Raman
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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Goldberg D, Sharpe J, Bakillah E, Landau S, Syvyk S, Wirtalla C, Kelz R. Trends in general surgeon operative practice patterns in a modern cohort. Am J Surg 2025; 239:116017. [PMID: 39500007 DOI: 10.1016/j.amjsurg.2024.116017] [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: 06/05/2024] [Revised: 09/11/2024] [Accepted: 10/11/2024] [Indexed: 12/17/2024]
Abstract
INTRODUCTION Analyzing general surgeons' operative case mix can provide an update on contemporary practice patterns and inform pragmatic residency training. METHODS We performed a retrospective cohort study of general surgeons in Florida, Iowa, and Maryland, 2016-2020. Cases were identified using billing codes. The Cochran-Armitage test of trends was used to evaluate the proportion of practice devoted to specific case types and operative setting over time. RESULTS General surgeons (n = 1300) performed 1,287,745 cases. The mean (±SD) annual volume per surgeon for all procedures was 356 (±250), with 198 (±152) general surgery operations, 57 (±142) endoscopic procedures, and 101 (±109) other cases. On average, surgeons operated on 7.1 (±2.6) different organ systems. Trends toward a lower proportion of general surgery operations, and a greater proportion of subspecialty procedures and surgery in the outpatient setting over time were demonstrated (p < 0.001). CONCLUSION The practice pattern of the general surgeon continues to be heterogeneous, reflecting the persistent need for a broad training paradigm that permits specialization.
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Affiliation(s)
- Drew Goldberg
- Center for Surgery and Health Economics, University of Pennsylvania, USA; Department of Surgery, Hospital of the University of Pennsylvania, USA.
| | - James Sharpe
- Center for Surgery and Health Economics, University of Pennsylvania, USA
| | - Emna Bakillah
- Center for Surgery and Health Economics, University of Pennsylvania, USA; Department of Surgery, Hospital of the University of Pennsylvania, USA
| | - Sarah Landau
- Center for Surgery and Health Economics, University of Pennsylvania, USA; Department of Surgery, Hospital of the University of Pennsylvania, USA
| | - Solomiya Syvyk
- Center for Surgery and Health Economics, University of Pennsylvania, USA
| | - Chris Wirtalla
- Center for Surgery and Health Economics, University of Pennsylvania, USA
| | - Rachel Kelz
- Center for Surgery and Health Economics, University of Pennsylvania, USA; Department of Surgery, Hospital of the University of Pennsylvania, USA
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Keshwani S, Lunt L, Akers R, Coogan A, Madrigrano A, Ferrigno C, Velasco J. Novel Approach to Residents Training in Breast Surgery Using Human Donors. J Surg Res 2024; 303:1-7. [PMID: 39276601 DOI: 10.1016/j.jss.2024.07.067] [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: 02/27/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION Given the high incidence rate of breast cancer and shortage of fellowship trained specialists, general surgeons are frequently responsible for these patients. Residents have less operative exposure to breast surgery due to duty hour restrictions and decreased resident autonomy. We created a curriculum using human donors designed to teach junior residents to perform breast lumpectomy and sentinel lymph node biopsies. METHODS All eighteen junior surgery residents were invited. We chose fresh human donors to represent tissue planes more accurately. We inserted Savi Scout reflectors (Merit Oncology, Inc) in each breast for tumor localization. An olive pit plus 1 mL of methylene blue was inserted in the axilla for SLN identification. In session 1, attendings discussed proper technique and residents performed the procedures and received feedback. In session 2 after 2 mo, residents performed the same operation without any guidance. They were graded on technique during both sessions and filled out a postsession survey to gauge confidence. RESULTS Seven PGY1 and six PGY2 residents participated. Half of the respondents strongly felt this session improved their understanding of lumpectomies, sentinel lymph node biopsies, and axillary anatomy. Most felt strongly that their skills improved and these skills were transferable to the operating room. In attending evaluations, PGY1 residents significantly improved in all aspects of the procedures; PGY2 residents showed nonstatistical significant improvement. CONCLUSIONS Residents find these sessions helpful in learning anatomy, improving confidence and efficiency, and facilitating skill acquisition that is transferable to the operating room. We believe this approach should be considered in general surgery training programs.
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Affiliation(s)
| | - Lilia Lunt
- Rush University Medical Center, Chicago, Illinois
| | - Rachel Akers
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Jose Velasco
- Rush University Medical Center, Chicago, Illinois
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Vu L, Jeganathan C, Ponniah K, Ofri A. Trainees as primary operators do not significantly impact perioperative complication rates in breast surgery. Surgeon 2024; 22:121-124. [PMID: 38105134 DOI: 10.1016/j.surge.2023.11.008] [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: 07/30/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND There is a trend for specialist care in breast surgery resulting in fewer primary operative cases for general surgery trainees; and subsequently that trainees performing advanced oncoplastic techniques in breast surgery may negatively impact patient morbidity. We have reviewed the complication rates between Australian general surgery trainees and Breast Consultants. METHODS A retrospective analysis was performed over a 5-year period (January 2016-December 2021). The key endpoints measured were relative complication rates for consultants compared to trainees, subdivided by surgery type. Surgeries were categorised as either benign, primary breast cancer surgery or re-excision. RESULTS A total of 2646 operative cases were performed with the primary operator rate for consultants 58.35 % (n = 1544) and for trainees 41.65 %% (n = 1102). The overall complication rate was 2.83 % (n = 75); the overall rate for the consultants was 2.65 % and 3.08 % for the trainees. The complication rates were not statistically significant (p = 0.59) between the two groups. The mastectomy only complication rate was higher in the consultant group with a result of 7.3 % compared to 2.8 % for the trainees however was not statistically significant (p = 0.18). The most common complication was haematoma formation for both groups. CONCLUSIONS This study has demonstrated that trainees can safely perform advanced oncoplastic techniques without statistically elevated morbidity. In an era where breast surgery caseloads are increasing, but the exposure to breast surgery during training are decreasing, it is necessary to implement a practice where trainees can perform breast operations under supervision at a specialized unit.
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Affiliation(s)
- Linda Vu
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Chaithanya Jeganathan
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Kallyani Ponniah
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Adam Ofri
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Surgery, Mater Hospital, North Sydney, NSW 2060, Australia; Central Clinical School, University of Sydney, Sydney, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia
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Kramer B, Plitt G, French JC, Nygaard RM, Cassaro S, Edelman DA, Lees JS, Meier AH, Joshi AR, Johnson MP, Chavez J, Hope WW, Morrissey S, Gauvin JM, Puri R, LaFemina J, Kang HS, Harzman AE, Jaafar S, Chandramouli MA, Lipman JM. A Multicenter Analysis of the Early Impact of COVID-19 on Junior Resident Operative Case Volume. J Surg Res 2022; 279:208-217. [PMID: 35780534 PMCID: PMC9212465 DOI: 10.1016/j.jss.2022.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/13/2022] [Accepted: 06/04/2022] [Indexed: 01/04/2023]
Abstract
Introduction Institutions have reported decreases in operative volume due to COVID-19. Junior residents have fewer opportunities for operative experience and COVID-19 further jeopardizes their operative exposure. This study quantifies the impact of the COVID-19 pandemic on resident operative exposure using resident case logs focusing on junior residents and categorizes the response of surgical residency programs to the COVID-19 pandemic. Materials and methods A retrospective multicenter cohort study was conducted; 276,481 case logs were collected from 407 general surgery residents of 18 participating institutions, spanning 2016-2020. Characteristics of each institution and program changes in response to COVID-19 were collected via surveys. Results Senior residents performed 117 more cases than junior residents each year (P < 0.001). Prior to the pandemic, senior resident case volume increased each year (38 per year, 95% confidence interval 2.9-74.9) while junior resident case volume remained stagnant (95% confidence interval 13.7-22.0). Early in the COVID-19 pandemic, junior residents reported on average 11% fewer cases when compared to the three prior academic years (P = 0.001). The largest decreases in cases were those with higher resident autonomy (Surgeon Jr, P = 0.03). The greatest impact of COVID-19 on junior resident case volume was in community-based medical centers (246 prepandemic versus 216 during pandemic, P = 0.009) and institutions which reached Stage 3 Program Pandemic Status (P = 0.01). Conclusions Residents reported a significant decrease in operative volume during the 2019 academic year, disproportionately impacting junior residents. The long-term consequences of COVID-19 on junior surgical trainee competence and ability to reach cases requirements are yet unknown but are unlikely to be negligible.
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Tuma F, Malgor RD, Kapila N, Kamel MK. Trends of core versus subspecialty operative procedures completed in general surgery residency training programs. Postgrad Med J 2021; 98:772-777. [PMID: 37062995 DOI: 10.1136/postgradmedj-2021-140503] [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: 05/17/2021] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION General surgery residency involves performing subspecialty procedures in addition to the core general procedures. However, the proportion of core general surgery versus subspecialty procedures during training is variable and its temporal changes are unknown. The goal of our study was to assess the current trends in core general surgery and subspecialty procedure distributions during general surgery residency training. METHODS Data were collected from the ACGME core general surgery national resident available report case logs from 2007 to 2019. Descriptive and time series analyses were used to compare proportions of average procedures performed per resident in the core general surgery category versus the subspecialty category. F-tests were conducted to show whether the slopes of the trend lines were significantly non-zero. RESULTS The mean of total procedures completed for major credit by the average general surgery resident increased from 910.1 (SD=30.31) in 2007 to 1070.5 (SD=37.59) in 2019. Over that same period, the number of general, cardiothoracic, plastic and urology surgery procedures increased by 24.9%, 9.8%, 76.6% and 19.3%, respectively. Conversely, vascular and paediatric surgery procedures decreased by 7.6% and 30.7%, respectively. The neurological surgery procedures remain stable at 1.1 procedures per resident per year. A significant positive correlation in the trend reflecting total (p<0.0001), general (p<0.0001) and plastic (p<0.0016) surgery procedures and the negative correlation in the trend lines for vascular (p<0.0006) and paediatric (p<0.0001) surgery procedures were also noted. CONCLUSIONS Trends in overall surgical case volume performed by general surgery residents over the last 12 years have shown a steady increase in operative training opportunity despite the increasing number of subspecialty training programmes and fellowships. Further research to identify areas for improvement and to study the diversity of operative procedures, and their outcomes is warranted in the years to come.
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Affiliation(s)
- Faiz Tuma
- Central Michigan University College of Medicine, Saginaw, Michigan, USA
| | - Rafael D Malgor
- University of Colorado Denver Anschutz Medical Center Bookstore, Aurora, Colorado, USA
| | - Nikit Kapila
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Mohamed K Kamel
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
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Mavroudis CL, Tong J, Wirtalla C, Brooks ES, Morris JB, Aarons CB, Kelz RR. (Re)thinking the Residential in Residency: Modern Surgical Practice Continues to Move Away From the Inpatient Setting. JOURNAL OF SURGICAL EDUCATION 2021; 78:1250-1255. [PMID: 33358760 DOI: 10.1016/j.jsurg.2020.12.005] [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: 07/29/2020] [Revised: 11/16/2020] [Accepted: 12/05/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Despite the overall shift in care delivery to an ambulatory setting, the majority of general surgical education still relies on the experience of caring for inpatients. We aimed to investigate how the inpatient practice patterns of newly minted general surgeons (GS) have changed since 2008, in order to better inform education policies regarding both training approach and setting for modern surgical trainees. METHODS State discharge data from NY and FL (2008-2017) were linked to data on GS from the American Medical Association Masterfile, and to hospital data from the American Hospital Association annual survey. Mean annual inpatient case volume (CV) and case type breadth (CB) were compared between surgeons who were new-to-practice (0-3 years of experience) in 2008 and in 2013. Each new surgeon cohort was followed for 5 years. Case type was classified by organ system. RESULTS The 2008 cohort included 328 GS with a mean age of 37.1, 79.6% male and 94.2% board-certified. The 2013 cohort included 359 GS with a mean age of 36.2, 73.0% male and 93.9% board-certified. CV was higher among the 2008 cohort than the 2013 cohort for each year of practice in the study period. CB included at least 4 organ system types for all new GS with greater breadth among the 2008 cohort for each year in the study period. CONCLUSIONS Declining rates of inpatient surgery affect general surgeons who were new-to-practice in 2013 significantly more than those entering practice only 5 years ahead of them. New surgeons continue to start their practices broadly, suggesting a need to continue broad training while expanding formal educational policies to include the full spectrum of ambulatory surgery.
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Affiliation(s)
| | - Jason Tong
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
| | | | - Ezra S Brooks
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jon B Morris
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
| | - Cary B Aarons
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania
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Kankam H, Lenti L, Razai MS, Hourston G, Khatib M. The role of simulation in training breast surgeons: a systematic review. Ann R Coll Surg Engl 2021; 103:318-323. [PMID: 33851882 DOI: 10.1308/rcsann.2020.7138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As surgical education has evolved, most curricula have favoured a competency-based approach over traditional apprenticeship models. Surgical simulation can be a useful aide in the training of both oncological and reconstructive breast surgery trainees. This review investigates the extent to which simulation of breast surgery procedures has been validated as a training tool. METHODS A comprehensive literature search for studies evaluating the objective validity of breast surgery simulators was performed, using MEDLINE, EMBASE and the Cochrane Library databases. Studies assessing construct, concurrent or predictive validity were included, as well as those demonstrating skill acquisition. FINDINGS The initial literature search returned 1,625 hits, with only five articles meeting the inclusion criteria. Simulators were designed to train procedures such as breast augmentation, lesion biopsy and excision. Of these, breast biopsy was the most simulated procedure (three studies). Two studies evaluated animal models, two evaluated synthetic models and one study assessed both a synthetic and animal model. Construct validity was confirmed in two studies, concurrent validity in one study and a learning curve demonstrated in another study. No association between experience and performance was seen in the remaining study. The quality of the evidence presented in each article was low due to numerous limitations. Despite the abundance of breast surgery simulators created for trainees, few have been objectively validated and they only cover a narrow range of breast procedures. Although early results are promising, further studies are required before routine use of simulators is considered in breast surgery curricula.
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Affiliation(s)
| | - L Lenti
- St George's University of London Medical School, London, UK
| | - M S Razai
- Population Health Research Institute, St George's University of London, London, UK
| | - Gjm Hourston
- James Paget University Hospital, Great Yarmouth, UK
| | - M Khatib
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
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Resident experience in brachytherapy: An analysis of Accreditation Council for Graduate Medical Education case logs for intracavitary and interstitial brachytherapy from 2007 to 2018. Brachytherapy 2020; 19:718-724. [DOI: 10.1016/j.brachy.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
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12
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Park KU, Selby L, Chen XP, Cochran A, Harzman A, Shen C, Gregory ME. Development of Residents' Self-Efficacy in Multidisciplinary Management of Breast Cancer Survey. J Surg Res 2020; 251:275-280. [PMID: 32197183 DOI: 10.1016/j.jss.2020.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/23/2020] [Accepted: 02/16/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Treating patients with breast cancer is multidisciplinary; however, it is unclear whether surgery residency programs provide sufficient training in multidisciplinary care. Self-efficacy is one way of measuring the adequacy of training. Our goal was to develop a method of assessing self-efficacy in multidisciplinary breast cancer care. METHODS Based on a literature review and subject-matter expert input, we developed a 30-item self-efficacy survey to measure six domains of breast cancer care (genetics, surgery, medical oncology, radiation oncology, pathology, and radiology). We constructed and validated the survey using a seven-step survey development framework. The survey was administered to general surgery residents at a single academic surgical residency. RESULTS Response rate was 66% (n = 31). Internal consistency was strong (Cronbach alpha = 0.92). Self-efficacy was moderate (mean = 3.05) and tended to increase with training (postgraduate year [PGY] 1: mean= 2.37 versus PGY 5: mean= 3.54; P < 0.001), providing evidence for construct validity. Self-efficacy was highest in the surgery (3.56) compared with others (genetics 2.67, medical oncology 3, radiation oncology 2.67, pathology 2.67, and radiology 3.33). This trend was similar across all PGY groups, except for interns, whose self-efficacy in surgery was low. CONCLUSIONS We created a survey to assess self-efficacy in multidisciplinary breast cancer care and provided initial evidence of survey validity. Although self-efficacy in surgery improved with years in training, medical and radiation oncology self-efficacy remained low. As modern breast cancer treatment is highly multidisciplinary, an expanded education program is needed to help trainees incorporate multidisciplinary clinical perspectives.
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Affiliation(s)
- Ko Un Park
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
| | - Luke Selby
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Xiaodong Phoenix Chen
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amalia Cochran
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alan Harzman
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Chengli Shen
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Megan E Gregory
- Department of Biomedical Informatics, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
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Rosenberger LH, Thomas SM, Plichta JK, Fayanju OM, Hyslop T, Greenup RA, Hwang ES. Decreasing rates of axillary lymph node dissections over time: Implications for surgical resident exposure and operative skills development. Am J Surg 2019; 218:786-791. [PMID: 31350006 PMCID: PMC6768717 DOI: 10.1016/j.amjsurg.2019.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/23/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy has supplanted axillary lymph node dissection (ALND) in clinically node-negative breast cancer and select node-positive disease. We hypothesized a decreasing rate of both ALND and resident exposure over time. METHODS We identified women with clinical Stage I-III breast cancer in the National Cancer Data Base (2004-2014). Adjusted multivariate logistic regression was used to estimate the effect of various factors on receipt of ALND. Yearly procedural rates for residents were extracted from surgical case log reports for comparison against procedural rates. RESULTS 1,131,363 patients were identified; 255,306 received ALND, 876,057 underwent non-ALND management. ALND rates declined from 2004 (32%) to 2014 (16%, p < 0.001), with the largest decline occurring between 2010 and 2011 (24%-20%). After adjustment, this effect was maintained, with ALND rates decreasing with each additional year (OR = 0.90, 95% CI 0.89-0.90). Resident procedure volumes similarly declined from 1999 to 2017 (p < 0.001). CONCLUSIONS Significant declines in both ALND rates and procedural volume in residency may impact outcomes, as ALNDs are being performed in ever more challenging oncologic scenarios by potentially less-experienced surgeons.
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Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA; Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Terry Hyslop
- Duke Cancer Institute, Duke University, Durham, NC, USA; Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
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14
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Zhao B, Tsai C, Hunt KK, Blair SL. Adherence to surgical and oncologic standards improves survival in breast cancer patients. J Surg Oncol 2019; 120:148-159. [PMID: 31172534 DOI: 10.1002/jso.25506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/27/2019] [Accepted: 05/03/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Adherence to evidence-based standards can lead to improved outcomes for patients with breast cancer. However, adherence rates to standards and their effects on patient outcomes are unknown. OBJECTIVES To examine adherence rates to standards compiled by the American College of Surgeons Clinical Research Program and its effects on patient outcomes. METHODS Using the National Cancer Database (2004-2015), we identified cohorts of breast cancer patients: clinical T1N0M0 under age of 70 (cT1), clinical T2N0M0 or T3N0M0 (cT2/3), and clinical M0 and pathologic N2 or N3 (pN2/3). Standards included negative margins, any adjuvant therapy, and two or more lymph nodes (LNs) examined (for cT1 or cT2/3 patients) or more than 10 LNs examined (for pN2/3 patients). We performed Kaplan-Meier and Cox proportional hazards analysis. RESULTS We identified 318 853 (65.0%) cT1, 164 593 (67.3%) cT2/3, and 77 626 (67.7%) pN2/3 patients who met the standards. More than 90% of patients had negative margins and adjuvant therapy, but less than 80% met LN standards. The median overall survival (OS) was significantly longer for patients who met the standards. Individual components of the standards were predictors of improved OS. CONCLUSIONS One-third of patients did not meet the evidence-based standards in their treatment for breast cancer. Efforts to improve the knowledge of and adherence to these standards should be emphasized.
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Affiliation(s)
- Beiqun Zhao
- Department of Surgery, University of California, San Diego, California
| | - Catherine Tsai
- Department of Surgery, University of California, San Diego, California
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Sarah L Blair
- Department of Surgery, University of California, San Diego, California
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15
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Kim DJ, Kim SG. Comparative study of the operative experience of surgical residents before and after 80-hour work week restrictions. Ann Surg Treat Res 2018; 95:233-239. [PMID: 30402441 PMCID: PMC6204326 DOI: 10.4174/astr.2018.95.5.233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/06/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose In Korea, the working-hour limitation regulation has been implemented in December 2017. We aimed to define the difference in operative experience of surgical residents before and after implementing this policy in 2 hospitals among 8 affiliated hospitals of the Catholic Medical Center where implemented the 80 working-hour limitation policy since March 2015. Methods All the operation records were reviewed, and the number of resident-participated surgeries between March and August in 2002 and 2017 were compared. Operations performed or participated in by residents as first assistants were defined as resident participated surgery. Results After 2 years from the initiation of the resident work-hour limitations, the number of resident participated surgery has slightly decreased in both hospitals (Yeouido St. Mary's Hospital [YSM]: 317 to 302, St. Paul Hospital [SPH]: 635 to 461). For each resident, changes were like followings: 0 → 21 cases for R1, 65 → 72 cases for R2, 83 → 192 cases for R3, and 169 → 17 cases for R4 in YSM. In SPH, number of resident participating surgery was changed like followings: 4 → 32 cases for R1, 222 → 100 cases for R2, 317 → 300 cases for R3, and 92 → 29 cases for R4. In both hospital, while, total number of resident participating oncologic surgery has been decreased, number of resident participating appendectomy has been far increased. Activity of each grade resident is different according to hospital. Conclusion Although total number of resident participating surgery decreased, variable changes were observed in each grade of resident according to each type of surgery and different hospitals. It is believed that comparisons of experiences from more hospitals in the future would be helpful in establishing the guidelines for surgical experience requirement of residents in Korea.
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Affiliation(s)
- Dong Jin Kim
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Geun Kim
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Cortez AR, Katsaros GD, Dhar VK, Drake FT, Pritts TA, Sussman JJ, Edwards MJ, Quillin RC. Narrowing of the surgical resident operative experience: A 27-year analysis of national ACGME case logs. Surgery 2018; 164:577-582. [PMID: 29929755 DOI: 10.1016/j.surg.2018.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/17/2018] [Accepted: 04/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although overall operative volume has remained stable since the implementation of duty hours, more detailed analyses suggest shifts in the resident operative experience. Understanding these differences allows educators to better appreciate the impact of the current training environment on resident preparation for practice. METHODS National Accreditation Council for Graduate Medical Education case logs from 1990 to 2016 were reviewed. Statistical analysis was performed using analysis of variance and linear regression analysis. RESULTS Over the study period there was no change in total major cases. Subcategory analysis revealed an increase in skin and soft tissue, alimentary tract, abdomen, and endocrine with a concurrent decrease in breast, pediatrics, and trauma. During this time, residents completed fewer cases during their chief year, operated more during non-chief years, taught fewer operations, and assisted in minimal cases. Finally, a decrease in the variability of overall operative volume for total major cases was found as a result of 90th and 10th percentiles converging toward the median. CONCLUSION Although total major cases logged by residents have remained stable, the operative experience of general surgery residents has narrowed significantly. Residents are operating earlier and performing fewer teaching and first assistant cases. Surgical educators must look beyond total case numbers and be aware of these changes to ensure all residents achieve technical competency on graduation.
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Affiliation(s)
| | | | - Vikrom K Dhar
- Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - F Thurston Drake
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | | | | | | | - R Cutler Quillin
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY
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