Advanced degrees, gender, and professional rank in surgery, disparities in academic medicine

INTRODUCTION

Women comprise nearly half of all residents in training, yet there is a significant disparity of women in academic leadership. Surgical subspecialties are dominated by men in both percentages of physicians and leadership positions. We sought to examine the association of advanced non-medical degrees with academic rank and gender in academic surgery departments.

METHODS

Faculty from 126 ACGME-accredited academic medical centers were analyzed to identify faculty gender as described in online biographical information, advanced non-medical degrees, academic rank, and additional leadership positions held. Descriptive statistics and logistic regression models were used for statistical analyses.

RESULTS

4536 surgeons were identified, 69.3% men, 27.3% female, and 3.3% unlisted. Female surgeons were more likely to hold advanced non-doctoral degrees than men (18.2% vs. 13.8%, p ​< ​0.002). Among those with advanced degrees, PhDs were held by 3.3% of women and 5.7% of men (p ​< ​0.001). Female surgeons were less likely to hold the rank of Professor than male surgeons (15.8% vs 30.3%, p ​< ​0.001), and more likely to hold the rank of Assistant Professor than male surgeons (51.9% vs 36.1%, p ​< ​0.001). This likelihood remained true when analyzing only surgeons with one or more advanced non-medical degrees. Men were more likely to be Chair of Surgery (3.0%), Division Chief (9.6%), and Research Chair (0.5%); compared to women (1.3%; 4.8%; 0.2%; p ​= ​0.001, <0.001, 0.21 respectively).

CONCLUSIONS

There continues to be a significant male predominance in general surgery. Gender discrepancy is also seen in professional rank and academic title despite women holding more advanced degrees. Advanced degrees are currently considered academic qualifications, but this does not reflect surgical academic leadership roles or rank.

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.

HIV testing technologies after two decades of evolution

Over the past two decades, HIV diagnostics have been essential in detecting and monitoring infection, and continue to play a major role in saving lives throughout the world. As technology evolved, screening, confirmatory, and HIV monitoring assays have been improved and offer better alternatives to address blood screening, surveillance, diagnosis, and patient management. Molecular methods are critical in detecting early infection and for managing patients on anti retroviral therapy whose viral infection may become resistant to therapy. In addition, modifications to conventional methods have introduced new assays, such as sensitive/less sensitive (detuned) assays that can estimate when someone was infected, thereby providing a useful tool for epidemiologic incidence estimates and enrollment into specific intervention programmes for recently infected persons. Many of the newly evolving technologies are essential for use in resource-limited countries because they can address cost issues, limited infrastructure, and a lack of formally trained personnel. Newer rapid HIV kits can be stored in a wide range of temperatures (2-30 degrees C) to address cold-chain issues, can use easily-collected fingerstick blood and oral fluids, and have one-step procedures that are relatively foolproof. Manual CD4 lymphocyte count assays that require only a light microscope and haemacytometer and more simple assays to estimate viral load are appropriate for developing countries where sophisticated instrumentation cannot be supported. Technologic advances with HIV diagnostics continue to address outstanding and new issues associated with diagnosis and the monitoring of infection by providing more simplified, cost-effective, and accurate testing throughout the world.

[Economic aspects of use of alternative dental alloys]

A cost calculation for different types of dental alloys was carried through all stages of production. Recycling and scrap material values were included. Results showed that over an estimated 20 years of usage, the higher annual cost for bridges cast with a high gold alloy in relation to those with lower gold content alloys is not that significant that from the patients point of view the lower alloys should the choice. Due to the system of health insurance, this cost calculation from the production point of view looks different for the organizations that are reimbursing the patient for his expenses, as these organizations are not entitled to the scrap value of old restorations.

[Long-term results following argon laser trabeculoplasty]

Long-term follow-up findings after argon laser trabeculoplasty are communicated. The coagulation technique employed was that described by Wise and Witter (1979). The circumference of the chamber angle was coagulated over 360 degrees. The indications were chronic open-angle glaucoma, pseudoexfoliation glaucoma, pigmentdispersion glaucoma, glaucoma in aphakia, and glaucoma after ALT or fistulizing surgery with uncontrolled IOP. Glaucoma cases in which IOP exceeded 35 mm Hg were not treated by this method. Therapy was considered successful if a decrease in IOP to below 20 mm Hg was achieved. The difficulties of finding appropriate parameters for the success of glaucoma therapy are discussed. The percentages of normotonic eyes after ALT with a follow-up period of one to four years are reported and compared with results obtained by other authors. After one year, IOP was normal in 89.9% of 881 eyes (chronic open-angle glaucoma 94%, pigment-dispersion glaucoma 91%, pseudoexfoliation glaucoma 86%, glaucoma in aphakia 88%). After two years, it was normal in 72.6% of 237 eyes (chronic open-angle glaucoma 82%, pigment-dispersion glaucoma 50%, pseudoexfoliation glaucoma 53%, glaucoma in aphakia 75%). After three years, it was normal in 60.5% of 76 eyes (chronic open-angle glaucoma 72%, pigment-dispersion glaucoma 25%, pseudoexfoliation glaucoma 37%, glaucoma in aphakia 66%). After four years, it was normal in 95.4% of 128 eyes (chronic open-angle glaucoma 82%, pseudoexfoliation glaucoma 50%). The results of ALT therapy reported by other authors are similar. A decrease in efficiency, initially of 5% to 10% per year, is seen in eyes thus treated, which may necessitate fistulizing surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Argon laser trabeculoplasty. Initial results of a prospective study]

This paper presents the results of a prospective study on argon laser trabeculoplasty with clinical application in 166 cases up to now. So far, patients have been followed up for between 2 and 12 months. Low-intensity coagulation was performed over 360 degrees of the trabecular meshwork. The coagulation site within the trabecular meshwork was chosen according to the outflow facility as measured by tonography. In eyes with high outflow facility (C greater than 0.08) the unpigmented, so-called nonfunctioning trabecular meshwork was coagulated. Where the outflow facility was lower (C less than 0.03), a pigmented area of the trabecular meshwork was aimed at. Where the facility was intermediate (0.08 greater than C greater than 0.03) the border area between pigmented and nonpigmented meshwork was coagulated. Three groups of patients were treated: (1) older patients with insufficient compliance; (2) patients whose intraocular pressure (IOP) was poorly controlled by drugs and was under 35 mm Hg; (3) patients suffering from glaucoma in aphakia or status post trabeculectomy and poor control of IOP. Applying these criteria , IOP was controlled in 26.8% without additional drugs and in 68% in combination with local medication after 6 weeks. Very few complications were seen (8 cases), and they did not lead to deterioration or loss of vision. In the light of theoretical considerations and initial histopathologic findings in human eyes, the authors assume that low-intensity coagulation causes a denaturation and shrinkage of the trabecular collagen, leading to stretching of the surrounding trabecular structures.(ABSTRACT TRUNCATED AT 250 WORDS)

Functional differentiation of the medullary collecting tubule: influence of vasopressin

Medullary collecting tubules of rabbits were dissected from the outer zone at different stages of ontogenetic evolution and perfused in vitro. The hydraulic conductivity coefficient (Lp) was measured in the presence of either hypotonic perfusate and isotonic bath or isotonic perfusate and hypertonic bath. Basal Lp (cm s-1 atm-1 10(-7) was 85 +/- 34 (N = 17) during early functional differentiation of the outer medullary collecting tubule (e-OMCT), 36 +/- 6 (N = 8) in the intermediate state (i-OMCT), and 10 +/- 7 (N = 11) in the final, mature state of function (m-OMCT). Addition of supramaximal concentrations of arginine-vasopressin (AVP) to the bath increased Lp in i-OMCT (250 +/- 36) and m-OMCT (327 +/- 63) but did not activate the osmotic hydraulic conductance in e-OMCT (105 +/- 27). In 11 studies, OMCT were analyzed using isotonic solutions as the perfusate and bath medium. The spontaneous transtubular voltage (PD) was lumen positive, 1.71 +/- 0.3 in e-OMCT, lumen negative 2.43 +/- 0.3 in i-OMCT, and 6.1 +/- 0.4 in m-OMCT. AVP had no effect on PD in e- and i-OMCT but increased the PD significantly (P less than 0.025) to 9.2 +/- 0.6 in m-OMCT. The results indicate that both hydraulic conductivity coefficient and transtubular voltage in the medullary collecting tubule are dependent upon epithelial ontogeny and, particularly, display differential responses to the antidiuretic hormone. The data suggest that the differentiation of water and ion transport in the medullary collecting tubule may contribute to the increasing efficacy of the medullary countercurrent system.

Maturation of diluting capacity in loop of Henle of rat superficial nephrons

The postnatal development of renal diluting capacity was studied by free-flow micropuncture and by microdissection of single superficial loops of Henle in rats kept on a high salt diet. Total renal filtration rate, sodium absorption, total solute excretion, and systemic arterial pressure were monitored during single nephron evaluation at two maturational stages (12-15 days and 27-35 days postnatal). Nephron filtration rates were identical when measured in early distal and late proximal segments of the same nephron. Absolute fluid absorption between these sites increased by a factor of 2.5, whereas loop fractional absorption of the volume load changed from 38.1 +/- 6.9 to 49.8 +/- 4.8% (SD), while proximal volume delivery to the loop increased from 4.33 +/- 1.12 to 7.14 +/- 0.65 nl/min. Simultaneously, the osmolarity of early distal fluid (8.8% of distal length) decreased significantly from 284 + 19.8 to 180.9 +/- 18.2 mosmol/liter during maturation. This study suggests that the ability of the loop of Henle to generate hypotonic fluid is attained only gradually during ontogeny. Volume absorption in the loop of Henle increases disproportionately to the loop volume load.

Visual recovery after central retinal artery occlusion: two cases

Two cases of central retinal artery occlusion of prolonged duration (greater than 6 hours) were treated with retrobulbar anesthesia, anterior chamber paracentesis, and high-dose carbon dioxide and oxygen inhalation. Both cases recovered excellent vision and illustrate that visual recovery after relatively prolonged central retinal artery occlusion is possible.

Acoustic Attenuation and Relaxation Phenomena in Steam at High Temperature and Pressure

The purpose of this investigation is the measurement of ultrasonic attenuation in steam at high temperatures and at pressures above atmospheric in the search for possible relaxation mechanisms. An acoustic fixed path interferometer has been constructed to allow attenuation measurements up to temperatures of the order of 450 deg C and pressures around 100 atmospheres. Relaxation peaks have been identified in the pressure range from 1 to 10 atmospheres and over the temperature range from 235 to 400 deg C. These correspond to relaxation times of the order of 2 × 10−8 sec, which is probably too small to be of significance in the high-speed flow properties of steam under extreme conditions. The results reported here are in order of magnitude agreement with those obtained by Huber and Kantrowitz using the impact tube method.