Analysis of Research Productivity and Assessment of Geographical Region in the General Surgery Match: How Much is Enough?

OBJECTIVES

The number of publications of prospective surgical residents has steadily increased over the past decade as the emphasis on research output has become paramount. However, the reported data from the National Resident Matching Program (NRMP) does not discriminate amongst impact, author position, and region of matched residents. This study aimed to evaluate categorical general surgery postgraduate year 1 (PGY-1) residents' research productivity by programs' research impact and region of the United States and support the need for additional public data on research metrics of accepted applicants. We hypothesize that residents accepted to top quartile schools will have more total and first author publications and higher h-index compared to residents in the other quartiles, and research metrics would not differ amongst the regions.

DESIGN

The Doximity Residency Navigator was used to sort general surgery programs based on research output, which was determined by the average h-index of residents. All 2021 matriculating PGY-1 categorical residents from the top two programs from each region and quartile that met study criteria were included in the analysis. Web of Science (WoS) citation database was used to collect prior to residency and current total publications, and the first, last, and corresponding author positions of these publications. Residents' h-index and various research metrics reported by WoS were recorded. Descriptive statistics were used to examine the association between quartile and region.

SETTING

Categorical general surgery residency programs throughout the United States.

PARTICIPANTS

Categorical PGY-1 general surgery residents.

RESULTS

The median total number of publications prior to residency was 1 (IQR = 0-5). The median total number of first-author publications prior to residency was 0 (IQR = 0-1), and the current h-index was 0 (IQR = 0-2). The top quartile had more total and first author publications prior to residency, while the other quartiles had similar metrics. Each region had similar total publications and h-index.

CONCLUSIONS

Research output is significant for applicants applying to top-quartile research programs compared to the other 3 quartiles and is relatively similar throughout all regions of the United States. Public data is limited to future applicants.

Machine learning from concept to clinic: reliable detection of BRAF V600E DNA mutations in thyroid nodules using high-dimensional RNA expression data

The promise of personalized medicine will require rigorously validated molecular diagnostics developed on minimally invasive, clinically relevant samples. Measurement of DNA mutations is increasingly common in clinical settings but only higher-prevalence mutations are cost-effective. Patients with rare variants are at best ignored or, at worst, misdiagnosed. Mutations result in downstream impacts on transcription, offering the possibility of broader diagnosis for patients with rare variants causing similar downstream changes. Use of such signatures in clinical settings is rare as these algorithms are difficult to validate for commercial use. Validation on a test set (against a clinical gold standard) is necessary but not sufficient: accuracy must be maintained amidst interfering substances, across reagent lots and across operators. Here we report the development, clinical validation, and diagnostic accuracy of a pre-operative molecular test (Afirma BRAF) to identify BRAF V600E mutations using mRNA expression in thyroid fine needle aspirate biopsies (FNABs). FNABs were obtained prospectively from 716 nodules and more than 3,000 features measured using microarrays. BRAF V600E labels for training (n=181) and independent test (n=535) sets were established using a sensitive quantitative PCR (qPCR) assay. The resulting 128-gene linear support vector machine was compared to qPCR in the independent test set. Clinical sensitivity and specificity for malignancy were evaluated in a subset of test set samples (n=213) with expert-derived histopathology. We observed high positive- (PPA, 90.4%) and negative (NPA, 99.0%) percent agreement with qPCR on the test set. Clinical sensitivity for malignancy was 43.8% (consistent with published prevalence of BRAF V600E in this neoplasm) and specificity was 100%, identical to qPCR on the same samples. Classification was accurate in up to 60% blood. A double-mutant still resulting in the V600E amino acid change was negative by qPCR but correctly positive by Afirma BRAF. Non-diagnostic rates were lower (7.6%) for Afirma BRAF than for qPCR (24.5%), a further advantage of using RNA in small sample biopsies. Afirma BRAF accurately determined the presence or absence of the BRAF V600E DNA mutation in FNABs, a collection method directly relevant to solid tumor assessment, with performance equal to that of an established, highly sensitive DNA-based assay and with a lower non-diagnostic rate. This is the first such test in thyroid cancer to undergo sufficient analytical and clinical validation for real-world use in a personalized medicine context to frame individual patient risk and inform surgical choice.

Salmonella derby cross-protection study

An avirulent live (AVL), Salmonella choleraesuis vaccine (Salmo Shield Live [Grand Laboratories, Inc.]) was administered to pigs at weaning or 3 weeks of age. Two weeks after vaccination the vaccinated pigs as well as unvaccinated control pigs were challenged intranasally with a commonly isolated environmental Salmonella serotype, S. derby. At 2, 4, and 6 weeks after challenge, pigs were euthanized and cultured for S. derby. Although the number of pigs in this study was too small to draw any definite generalizable conclusions, the vaccinated pigs had significantly reduced reisolation rates of S. derby when compared with the control pigs. Further research in this area is needed.

Duration of immunity and efficacy of an oil emulsion Escherichia coli bacterin in cattle

An oil emulsion Escherichia coli bacterin administered in 1- and 2-dose vaccination regimens was evaluated in beef cattle. Serologic responses to the K99 pilus antigen were monitored, and suckling offspring from vaccinated and nonvaccinated cows were inoculated with virulent, K99-positive, enterotoxigenic Escherichia coli. The degree of protection and duration of immunity conferred were determined in 2 respective studies. In the first study (study A), titers of pregnant cattle were determined from time of vaccination through calving (a 6- to 20-week period). Titers of 24 cows vaccinated with a single 2-ml dose of bacterin were compared with those of 24 cows given a 2-dose regimen and with those of 23 nonvaccinated cattle (contemporary controls). Inoculum consisting of 1.2 X 10(12) viable enterotoxigenic E coli/dose administered to nursing calves from these dams yielded 0% mortality (0 deaths/20 calves) in calves from 1-dose vaccinates, 6% mortality (1 death/18 calves) in calves from 2-dose vaccinates, and 37% mortality (7 deaths/19 calves) in calves from nonvaccinated dams. Study B was an extended evaluation conducted in cattle that were kept in the study up to 87 weeks from initial vaccination until calving. Serologic titers to the K99 pilus antigen were compared in 1-dose, 2-dose, and nonvaccinated cattle in groups of 8, 6, and 6, respectively. Calves from these dams were inoculated with 8.1 X 10(11) viable enterotoxigenic E coli/dose, which resulted in 0% mortality (0 deaths/5 calves) in calves from 1-dose vaccinates, 0% mortality (0 deaths/5 calves) in calves from 2-dose vaccinates, and 80% mortality (5 deaths/6 calves) in calves from nonvaccinated dams.