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Brigmon EP, Ciaraglia A, Scherer EP, Schwartz DL, Nicholson S, Dent DL. Surgical critical care: Is work-life expectancy increasing? An analysis of American Board of Surgery recertification rates across subspecialties. Trauma Surg Acute Care Open 2024; 9:e001299. [PMID: 38666009 PMCID: PMC11043675 DOI: 10.1136/tsaco-2023-001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
The practice of surgical critical care (SCC) has traditionally necessitated additional in-house, extended night and weekend clinical commitments, which can be viewed as less desirable for many surgeons. Therefore, the authors have observed that some SCC surgeons elect to transition their practice to focus solely on general surgery (GS) rather than continuing practicing both SCC and GS. We hypothesized that surgeons with a practice focused on SCC are more likely to make the transition to a GS practice than those who have certification in other subspecialties that are certified through the American Board of Surgery.
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Affiliation(s)
- Erika Paola Brigmon
- Trauma and Emergency General Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Angelo Ciaraglia
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Elizabeth P Scherer
- Trauma and Emergency General Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Deborah L Schwartz
- General Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Susannah Nicholson
- Trauma and Emergency General Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Daniel L Dent
- Trauma and Emergency General Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Ibáñez B, Jones AT, Jeyarajah DR, Dent DL, Prendergast C, Barry CL. A Look at Demographics and Transition to Virtual Assessments: An Analysis of Bias in the American Board of Surgery General Surgery Certifying Exams. J Surg Educ 2024; 81:578-588. [PMID: 38402095 DOI: 10.1016/j.jsurg.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/16/2023] [Accepted: 01/04/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE The goals of this study were (1) to assess if examiner ratings in the American Board of Surgery (ABS) General Surgery Cetifying Exam (CE) are biased based on the gender, race, and ethnicity of the candidate or the examiners, and (2) if the format of delivering of the exams, in-person or virtual, affects how examiners rate candidates. DESIGN We included every candidate-examiner combination for first time takers of the general surgery oral exam. Total scores and pass/fail outcomes based on the 4 scores given by examiners to candidates were analyzed using multilevel models, with candidates as random effects. Explanatory variables included the gender, race, and ethnicity of candidates and examiners, and the format of the exam (in-person or virtual). Candidates' first attempt scores on the ABS General Surgery Qualifying Exam (QE) were also included in the models to control for the baseline knowledge of the candidate. Three sets of models were evaluated for each demographic variable (gender, race, ethnicity) due to missingness in data. p-values and coefficients of determination R2 were used to quantify the statistical and practical significance of the model coefficients (an existent relationship between the explored variables on CE scores was considered statistically and practically significant if the p-value was lower than 0.01 and R2 higher than 1%). PARTICIPANTS All first-time takers of the American Board of Surgery General Surgery Certifying Exam from 2016 to 2022 that had demographic data, and the examiners that participated in those exams. RESULTS The number of candidates/examiners for the 3 sets of models was 8665/514 (gender), 5906/465 (race), and 4678/295 (ethnicity). The demographic variables, format of the exam, or their interactions were not found to significantly relate to examiner-candidate ratings or pass/fail outcomes. The only variable that was significantly related to CE scores was candidates' QE scores, which was added to the models as a measure of candidates' initial knowledge; this held for all models for total scores (F[1,8659] = 1069.89, p-value < 0.01, R2 = 5% [gender models], F(1,5696.3) = 589.13, p-value < 0.01, R2 = 5% [race models], F(1,4459.5) = 278.33, p-value < 0.01, R2 = 5% [ethnicity models]), and pass/fail outcomes (CI = 1.61-1.73, p-value < 0.01, R2 = 3% [gender models], CI = 1.67-1.85, p-value < 0.01, R2 = 3% [race models], CI = 2.17-2.90, p-value < 0.01, R2 = 3% [ethnicity models]). CONCLUSIONS This study shows that there is not a relationship between candidate and examiner gender, race, or ethnicity, and exam outcomes based on statistical models looking at examiner-candidate ratings and pass/fail outcomes. In addition, the delivery of the certifying exam in a virtual format appears to have no statistical impact on outcomes compared to in-person delivery. This suggests that the ABS is performing well in both demographic bias and virtual space.
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Affiliation(s)
| | | | | | | | | | - Carol L Barry
- American Board of Surgery, Philadelphia, Pennsylvania
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Jones AT, Brethauer SA, Dent DL, Desai DM, Jeyarajah R, Barry CL, Ibáñez B, Buyske J. How Does the Sequence of the American Board of Surgery Examinations Impact Pass/Fail Outcomes? Ann Surg 2024; 279:187-190. [PMID: 37470170 DOI: 10.1097/sla.0000000000006023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Historically, the American Board of Surgery required surgeons to pass the qualifying examination (QE) before taking the certifying examination (CE). However, in the 2020-2021 academic year, with mitigating circumstances related to COVID-19, the ABS removed this sequencing requirement to facilitate the certification process for those candidates who were negatively impacted by a QE delivery failure. This decoupling of the traditional order of exam delivery has provided a natural comparator to the traditional route and an analysis of the impact of examination sequencing on candidate performance. METHODS All candidates who applied for the canceled July 2020 QE were allowed to take the CE before passing the QE. The sample was then reduced to include only first-time candidates to ensure comparable groups for performance outcomes. Logistic regression was used to analyze the relationship between the order of taking the QE and the CE, controlling for other examination performance, international medical graduate status, and gender. RESULTS Only first-time candidates who took both examinations were compared (n=947). Examination sequence was not a significant predictor of QE pass/fail outcomes, OR=0.54; 95% CI, 0.19-1.61, P =0.26. However, examination sequence was a significant predictor of CE pass/fail outcomes, OR=2.54; 95% CI, 1.46-4.68, P =0.002. CONCLUSIONS This important study suggests that preparation for the QE increases the probability of passing the CE and provides evidence that knowledge may be foundational for clinical judgment. The ABS will consider these findings for examination sequencing moving forward.
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Affiliation(s)
| | - Stacy A Brethauer
- The Ohio State University, Department of Surgery, Division of General and Gastrointestinal Surgery, Columbus, OH
| | - Daniel L Dent
- UT Health San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, San Antonio, TX
| | - Dev M Desai
- UT Southwestern Medical Center, Department of Surgery, Department of Pediatrics, Dallas, TX
| | | | | | | | - Jo Buyske
- American Board of Surgery, Philadelphia, PA
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Dent DL, Patnaik R, Atkinson A, Shomette JD, Mascitelli JR, Page-Ramsey SM, Basler JW, Carpenter AJ, Kempenich JW, Rose RA, Anderson KL, Botros-Brey S, Jones WS. Implementation of entrustable professional activities in multiple surgical residencies: A quality improvement approach. Am J Surg 2023; 226:868-872. [PMID: 37507253 DOI: 10.1016/j.amjsurg.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/25/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic decreased the operative case volume for surgical residents. Our institution implemented Entrustable Professional Activities (EPAs) in all core surgical training programs to document the competency of graduating residents. Continuation of this project aimed to improve implementation. METHODS This project occurred at a large academic center with eight surgical specialties during the 2020-21 (Year 1) and 2021-22 (Year 2) academic years. Each specialty chose five EPAs, and residents were asked to obtain three micro-assessments per EPA. After the initial pilot year, program directors were surveyed regarding perceptions of EPA utility and barriers to implementation. RESULTS Seventy senior residents completed 732/906 (80.8%) micro-assessments. Of these, 99.6% were deemed practice ready. Total micro-assessment completion rates in four specialties, four specific EPAs (including one EPA identified "at risk" due to the COVID-19 pandemic), and overall were significantly higher in Year 2 than Year 1 (p < 0.05) CONCLUSIONS: Implementing EPAs in all core surgical specialties at an institution is achievable, though expectedly initially imperfect. An ongoing quality collaborative initiative focused on barriers to implementation can improve completion rates.
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Affiliation(s)
- Daniel L Dent
- Division of Trauma and Emergency Surgery, University of Texas Health, San Antonio, USA
| | - Ronit Patnaik
- Department of General Surgery at University of Texas Health, San Antonio, USA
| | - Angela Atkinson
- Department of General Surgery at University of Texas Health, San Antonio, USA.
| | - Jamie D Shomette
- Graduate Medical Education Office at University of Texas Health, San Antonio, USA
| | | | - Sarah M Page-Ramsey
- Department of Obstetrics and Gynecology at University of Texas Health, San Antonio, USA
| | - Joseph W Basler
- Department of Urology at University of Texas Health, San Antonio, USA
| | - Andrea J Carpenter
- Department of Cardiothoracic Surgery at University of Texas Health, San Antonio, USA
| | - Jason W Kempenich
- Department of General Surgery at University of Texas Health, San Antonio, USA
| | - Ryan A Rose
- Department of Orthopaedics at University of Texas Health, San Antonio, USA
| | - Kent L Anderson
- Department of Ophthalmology at University of Texas Health, San Antonio, USA
| | - Sylvia Botros-Brey
- Department of Urology and Obstetrics-Gynecology at University of Texas Health, San Antonio, USA
| | - Woodson S Jones
- Graduate Medical Education at University of Texas Health, San Antonio, USA
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Coppersmith NA, Chung M, Esposito AC, Flom E, Dent DL, Morris-Wiseman L, Rosenkranz KM, Terhune KP, Yoo PS. How Did We Get Here and Where Are We Going? Career Trajectories of United States General Surgery Residency Program Directors. J Surg Educ 2023; 80:1653-1662. [PMID: 37355404 DOI: 10.1016/j.jsurg.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/15/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To develop the future of United States (US) surgical education leadership, surgical trainees and early career faculty who aspire to become program directors (PDs) must understand the potential career pathways and requisite skills and experience to become a general surgery residency PD. The objective of this study was to understand the demographics, career experiences, and professional satisfaction of US PDs in general surgery. DESIGN An anonymous, cross-sectional survey utilizing a novel instrument. SETTING An electronic survey distributed to US general surgery PDs between June and November 2022 PARTICIPANTS: PDs of US general surgery residency programs. A list of the Accrediting Council for Graduate Medical Education (ACGME)-accredited general surgery PDs was created from the ACGME list from the 2022 to 23 academic year. RESULTS The survey achieved a response rate of 46.2% (159/344). Only 32.1% of PDs identified as female and 67.3% identified as male with 1 respondent preferring not to identify their gender. PDs were White or Caucasian (68.6%), Asian (13.8%), and Black (3.7%); 4.4% were Hispanic or Latino. Only 83.7% of PDs completed fellowship training. PDs have been in the role for an average of 5.5 ± 4.9 years. The PDs were compensated for an average of 54.7% (±14.9% SD, 0%-100% range) of their time towards clinical duties. They were compensated on average for 35.7% (±12.6%, 0%-100%) of effort for residency-related administrative duties. Only 5% of PDs had obtained or were enrolled in an education-related degree. Only 55.4% of PDs had received formal surgical education training in teaching and assessment. 54.1% of PDs were interested in obtaining a more senior leadership position in the future. Most PDs (38.4%) expect to serve as PD for 5 to 8 years in total. Overall, the majority of PDs were very satisfied (29.6%) or satisfied (51.6%) professionally; similarly 28.9% were very satisfied and 48.4% satisfied personally. CONCLUSIONS This study represents the most up-to-date characterization of the personal, academic, and career-related features of current surgical residency PDs across the US. PDs enjoy a high degree of professional and personal satisfaction and most aspire to increasing leadership within their organizations. Compared to prior data, PDs have become more diverse in terms of both gender and race over time. Opportunities exist for increased mentorship of aspiring and current PDs as well as increased training in teaching and assessment.
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Affiliation(s)
| | - Mark Chung
- Yale College, Yale University, New Haven, Connecticut
| | - Andrew C Esposito
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Emily Flom
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Daniel L Dent
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | | | - Kari M Rosenkranz
- Department of Surgery, Geisel School of Medicine, Hanover, New Hampshire
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt School of Medicine, Nashville, Tennessee
| | - Peter S Yoo
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
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Patnaik R, Mueller D, Dyurich A, Hutcherson LR, Kempenich JW, Dent DL, Botros-Brey S. Forum Theatre to Address Peer-to-Peer Mistreatment in General Surgery Residency. J Surg Educ 2023; 80:563-571. [PMID: 36529663 DOI: 10.1016/j.jsurg.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/23/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Mistreatment is widespread in graduate medical education, and much attention has been generated on this topic and its relationship to burnout in general surgery residency. In particular, peer-to-peer mistreatment poses a developmental dilemma - as junior residents find themselves mistreated and some turn around and perpetuate that mistreatment. There is a paucity of effective interventions. Forum Theatre (FT) is a novel educational tool to engage participants in solving difficult situations. We present the use of FT as a tool to explore solutions to address peer-to-peer mistreatment in a surgery residency. FT starts with the performance of a culture-specific conflict scenario and then invites the audience to participate in renditions of the situation ending in a collective solution. DESIGN Stakeholder support was obtained from the general surgery program leadership. Time was protected during two 1-hour scheduled wellness didactic sessions. First, focus groups with each PG year identified the residents' experience of mistreatment. Themes regarding peer-to peer mistreatment were identified and presented to a group of 3 volunteer actor residents who chose to focus on the unintended consequences of public, corrective feedback with the understanding this would be presented to the residency at large. Following this, they developed a scenario for enactment which was implemented during the second didactic session. The enacted scenario posed a problem with public feedback ending unsatisfactorily. The audience was then invited to engage the actors and participate in replays of the situation until a collective solution was identified. Retrospective pre-post survey and a 6-month post survey were administered. SETTING General surgery residency at University of Texas Health San Antonio. PARTICIPANTS General surgery residents. 32 of 66 (48.5%) residents participated. RESULTS Participants noted an improved understanding of mistreatment, felt more confident in recognizing mistreatment, reported improved confidence in their ability to intervene when witnessing mistreatment and to recognize when they themselves were involved in mistreatment (p < 0.001 for all). In fact, of the residents who reported participating in mistreatment, 100% reported directing it towards peers. After the FT, 89% of residents said they "definitely" or "most likely" recommended participating in a FT to address mistreatment. 85.7% reported that the intervention was moderately to extremely effective for teaching topics in professionalism. These trends remained steady in the survey 6 months after the intervention as well. CONCLUSIONS We found FT was feasible to implement in a busy general surgery residency and well received with sustained, self- reported behavior change. FT is a novel tool to engage residents to self-evaluate and participate in methods to address mistreatment. FT interventions can be tailored to the local culture to address conflicts specific to that setting.
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Affiliation(s)
- Ronit Patnaik
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas.
| | - Deborah Mueller
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Adriana Dyurich
- Office for Graduate Medical Education, University of Texas Health San Antonio, San Antonio, Texas
| | - Lisa R Hutcherson
- Office for Graduate Medical Education, University of Texas Health San Antonio, San Antonio, Texas
| | - Jason W Kempenich
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Sylvia Botros-Brey
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas
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Alam Khan MT, Patnaik R, Laffoon AN, Krokar L, Ince SR, Hurtado E, Kitano M, Fritze DM, Dent DL. Gender Discrepancies in Middle Author Publications in US Academic General Surgery. J Surg Res 2023; 288:43-50. [PMID: 36948032 DOI: 10.1016/j.jss.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION To explore gender discrepancies in publications at general surgery departments, we performed a cross-sectional comparing the number of women and men at each academic rank and their number of first author (FA), middle author (MA), last author (LA), and total publications. METHODS Thirty academic general surgery departments were randomly selected. For each faculty, we tabulated: first, middle, last names, gender, academic rank, educational leadership, year of medical school graduation, and additional graduate degrees. Bibliography, H-index, and citations were downloaded from the Scopus database. RESULTS One thousand three hundred twenty-six faculty sampled, 881 (66.4%) men and 445 (33.5%) women. Men outnumbered women at all ranks, with increasing disparity at higher ranks. Men outnumbered women in all subspecialties-largest difference in transplant surgery (84.4% versus 15.6%, P < 0.001). Men at all ranks had more MA publications: assistant professor (rate ratio 1.20; 95% confidence interval, 1.01-1.43, P = 0.024), associate professor (1.65; 1.31-2.06, P < 0.001), and professor (1.50; 1.20-1.91, P = 0.008). Men associate professors had more LA publications (1.74; 1.34-2.37, P < 0.001). No differences found in FA publications at any rank, nor LA publications at assistant professor and professor ranks. At subspecialty level, men in surgical oncology (1.95; 1.55-2.45, P < 0.001) and transplant surgery (1.70; 1.09-2.66, P = 0.02) had more MA publications. CONCLUSIONS While FA and LA publications did not differ significantly across genders, the largest difference lies in MA publications, beginning at junior ranks and persisting with seniority. Discrepancies in MA publications may reflect gender discrepancies in collaborative opportunities, hence total publications should be used cautiously when determining academic productivity.
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Affiliation(s)
| | - Ronit Patnaik
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Allison N Laffoon
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Lucijana Krokar
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Spencer R Ince
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | | | - Mio Kitano
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Danielle M Fritze
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
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Jensen RM, Kearse LE, Anand A, Dent DL, Korndorffer JR. The Program Director Perspective: Perceptions of PGY5 Residents' Operative Self-Efficacy and Entrustment. Am Surg 2023:31348231157862. [PMID: 36802912 DOI: 10.1177/00031348231157862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
INTRODUCTION A 2020 survey of post-graduate year 5 (PGY5) general surgery residents linked to the American Board of Surgery In-Training Examination (ABSITE) revealed significant deficits in self-efficacy (SE), or personal judgment of one's ability to complete a task, for 10 commonly performed operations. Identifying whether this deficit is similarly perceived by program directors (PDs) has not been well established. We hypothesized that PDs would perceive higher levels of operative SE compared to PGY5s. METHODS A survey was distributed through the Association of Program Directors in Surgery listserv; PDs were queried about their PGY5 residents' ability to perform the same 10 operations independently and their accuracy of patient assessments and operative plans for components of several core entrustable professional activities (EPAs). Results of this survey were compared to PGY5 residents' perception of their SE and entrustment based on the 2020 post-ABSITE survey. Chi-squared tests were used for statistical analysis. RESULTS 108 responses were received, representing ∼32% (108/342) of general surgery programs. Perceptions from PDs of PGY5 residents' operative SE were highly concordant with resident perceptions; no significant differences were observed for 9 of 10 procedures. Both PGY5 residents and PDs perceived adequate levels of entrustment; no significant differences were observed for 6 of 8 EPA components. CONCLUSIONS These findings show concordance between PDs and PGY5 residents in their perceptions of operative SE and entrustment. Though both groups perceive adequate levels of entrustment, PDs corroborate the previously described operative SE deficit, illustrating the importance of improved preparation for independent practice.
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Affiliation(s)
| | - LaDonna E Kearse
- Department of Surgery, 8369Howard University, Washington, DC, USA
| | - Ananya Anand
- Department of Surgery, 6429Stanford University, CA, USA
| | - Daniel L Dent
- Department of Surgery, 14742University of Texas Health San Antonio, TX, USA
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Butler PD, Wexner SD, Alimi YR, Dent DL, Fayanju OM, Gantt NL, Johnston FM, Pugh CM. Society of Black Academic Surgeons (SBAS) diversity, equity, and inclusion series: Microaggressions - Lessons Learned from Black Academic Surgeons. Am J Surg 2023; 225:136-148. [PMID: 36155676 PMCID: PMC9772234 DOI: 10.1016/j.amjsurg.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 01/03/2023]
Abstract
Background: Microaggressions can target individuals based on a variety of differences and these can include sexual orientation, nationality, gender, or personal traits and are often disruptors in the healthcare setting. Methods: To address this issue, The Society of Black Academic Surgeons (SBAS) convened a series of presentations and a panel discussion by leaders from SBAS regarding the issue of microaggressions in the surgical workplace. This program was part of a monthly diversity, equity, and inclusion series produced by the Advances in Surgery Channel in alliance with the American College of Surgeons. Dr. Yewande Alimi addresses microaggressions in surgical training, Dr. Fabian Johnston talks about microaggressions in the black male physician, Dr. Lola Fayanju speaks to microaggressions and the black female surgeon, Dr. Carla Pugh discusses microaggressions in the surgical workplace, and Dr. Paris Butler presents on allyship, policies, and real solutions. Results: Specifically, through the lens of the Black surgeon experience, SBAS leaders candidly articulate and elaborate on microaggressions’ pervasiveness and the deleterious impact on the profession. Authentic opinions are rendered and constructive techniques to mitigate this challenge are provided. The concept of majority allyship is also introduced, and recommendations on how this can be operationalized is also examined. Conclusions: There are a lot of experiences that contribute to our understanding of microaggressions. We look forward to finding new ways to partner with our allies and continuing the conversation.
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Affiliation(s)
- Paris D. Butler
- Corresponding author. MPH 330 Cedar Street, BB330, New Haven, CT, 06519, USA. (P.D. Butler)
| | - Steven D. Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Yewande R. Alimi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Daniel L. Dent
- Department of Surgery, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Oluwadamilola M. Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy L. Gantt
- Department of Surgery, Northeast Ohio Medical University, Mercy St. Elizabeth Youngstown Hospital, Youngstown, OH, USA
| | | | - Carla M. Pugh
- Department of Surgery, Stanford University, Stanford, CA, USA
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10
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Schmiederer IS, Kearse LE, Jensen RM, Anderson TN, Dent DL, Payne DH, Korndorffer JR. The fundamentals of laparoscopic surgery in general surgery residency: fundamental for junior residents' self-efficacy. Surg Endosc 2022; 36:8509-8514. [PMID: 36109359 DOI: 10.1007/s00464-022-09443-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Implementation of the Fundamentals of Laparoscopic Surgery (FLS) by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has served a need for educational structure for laparoscopic skill within General Surgery training since 2004. This study looks at how FLS affects resident self-efficacy (SE) with laparoscopic procedures. METHODS We conducted a national survey, linked to the 2020 American Board of Surgery In-Training Examination (ABSITE), in which 9275 residents from 325 US General Surgery Training Programs participated. The online survey included multimodal questions that analyzed whether participants felt they could perform the most commonly-logged laparoscopic operations among residents [Laparoscopic Appendectomy (LA), Laparoscopic Cholecystectomy (LC), Laparoscopic Right Hemicolectomy (LRH), Diagnostic Laparoscopy (DL)] without faculty assistance. This used a 5-point scaled assessment, ranging from "not able to" to "definitely able to." Multivariate analyses determined if completion of FLS made a difference for resident self-efficacy, stratified by post-graduate year (PGY). RESULTS At the time of the survey, 2300 reported completion of FLS. The percentage of FLS completion increased from PGY1 to PGY5 (4.2% n = 59 vs 85.8% n = 893). PGY1 residents who completed FLS, from 48 diverse institutions, demonstrated the most significant increases in SE (p < 0.05) with significantly higher perceived self-efficacy in LA (p = 0.001) and LRH (p = 0.012). PGY2 and PGY3 residents indicated increased SE in DL (p = 0.037, p = 0.015, respectively), based on FLS completion. These FLS effects were less evident in the more senior classes. CONCLUSIONS Completion of FLS arguably has the greatest benefits for more junior residents, as it establishes a foundation of laparoscopic knowledge and skill, upon which further residency training can build. Successful completion of the curriculum and assessment offered by the Fundamentals of Laparoscopic Surgery leads to greater sense of ability in early trainees.
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Affiliation(s)
- Ingrid S Schmiederer
- Department of Surgery, New York Presbyterian-Queens, Queens, NY, USA.
- Goodman Surgical Education Center at Stanford University, 300 Pasteur Drive, H3591, Stanford, CA, 94305-5655, USA.
| | - LaDonna E Kearse
- Goodman Surgical Education Center at Stanford University, 300 Pasteur Drive, H3591, Stanford, CA, 94305-5655, USA
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Rachel M Jensen
- Goodman Surgical Education Center at Stanford University, 300 Pasteur Drive, H3591, Stanford, CA, 94305-5655, USA
- Department of Surgery, Stanford University, Stanford, CA, USA
| | | | - Daniel L Dent
- Department of Surgery, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Davis H Payne
- Department of Surgery, Methodist Dallas Medical Center, Dallas, TX, USA
| | - James R Korndorffer
- Goodman Surgical Education Center at Stanford University, 300 Pasteur Drive, H3591, Stanford, CA, 94305-5655, USA
- Department of Surgery, Stanford University, Stanford, CA, USA
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11
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Willis RE, Kempenich JW, Patnaik R, Dent DL. Identifying Potential Attrition during the Residency Applicant Screening Process Using a Situational Judgment Test. J Surg Educ 2022; 79:e103-e108. [PMID: 35970719 DOI: 10.1016/j.jsurg.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE As USMLE Step 1 moves to pass/fail, residency programs are seeking alternate interview selection processes. Attrition in general surgery is reported as high as 26%. Thus, it is important to ensure that programs are selecting and matching applicants with shared values. Situational judgment tests (SJTs) measure educational and cultural values by posing ambiguous situations and individuals rate the effectiveness of possible reactions. SJTs have previously been shown to identify job applicants with shared values while promoting diversity. Scoring categories are high, moderate, or low values congruence. We sought to explore predictive validity of the SJT relative to program attrition. DESIGN Residents who matched into our program between 2018 and 2021 completed the SJT. We tracked attrition. SETTING UT Health San Antonio, Texas PARTICIPANTS: Fifty-six categorical general surgery residents RESULTS: Per SJT ratings, the numbers of residents who had high, moderate, and low values congruence were 27, 16, and 13, respectively. Attrition numbers for residents who scored high and moderate congruence were similar, indicating that these ratings were indistinguishable. As such, we combined those 2 categories to create a 2 × 2 matrix and used signal detection theory as a framework for analysis. Overall attrition was 16.1% (9/56). Of the 43 residents who scored high or moderate congruence, 90.7% remained in the program. There was a 9.3% chance of attrition for these residents. Of the 13 residents who scored low congruence, 38.5% attrited. While scoring as low congruence on the SJT does not definitively indicate attrition, it does indicate that attrition is 4.14 times more likely for these residents (chi-square, p = 0.0121). CONCLUSIONS One of the most important aspects of residency applicant selection and interviewing is mitigating risk by identifying applicants who carry a high risk of attrition. The SJT significantly identifies at-risk applicants.
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Affiliation(s)
- Ross E Willis
- Department of Surgery, UT Health San Antonio, San Antonio, Texas.
| | | | - Ronit Patnaik
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
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12
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Kearse LE, Jensen RM, Schmiederer IS, Zeineddin A, Anderson TN, Dent DL, Payne DH, Korndorffer JR. Diversity, Equity, and Inclusion: A Current Analysis of General Surgery Residency Programs. Am Surg 2022; 88:414-418. [PMID: 34730421 DOI: 10.1177/00031348211048824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Local, regional, and national diversity, equity, and inclusion (DEI) initiatives have been established to combat barriers to entry and promote retention in surgery residency programs. Our study evaluates changes in diversity in general surgery residency programs. We hypothesize that diversity trends have remained stable nationally and regionally. MATERIALS AND METHODS General surgery residents in all postgraduate years were queried regarding their self-reported sex, race, and ethnicity following the 2020 ABSITE. Residents were then grouped into geographic regions. Data were analyzed utilizing descriptive statistics, Kruskal-Wallis test, and chi-square analyses. RESULTS A total of 9276 residents responded. Nationally, increases in female residents were noted from 38.0 to 46.0% (P < .001) and in Hispanic or Latinx residents from 7.3 to 8.3% (P = .031). Across geographic regions, a significant increase in female residents was noted in the Northwest (51.9 to 58.3%, P = .039), Midwest (36.9 to 43.3%, P = .006), and Southwest (35.8 to 47.5%, P = .027). A significant increase in black residents was only noted in the Northwest (0 to 15.8%, P = .031). The proportion of white residents decreased nationally by 8.9% and in the Mid-Atlantic, Southeast, and Southwest between 5.5 and 15.9% (P < .05). DISCUSSION In an increasingly diverse society, expanding the numbers of underrepresented surgeons in training, and ultimately in practice, is a necessity. This study shows that there are region-specific increases in diversity, despite minimal change on a national level. This finding may suggest the need for region-specific DEI strategies and initiatives. Future studies will seek to evaluate individual programs with DEI plans and determine if there is a correlation to changing demographics.
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Affiliation(s)
- LaDonna E Kearse
- Department of Surgery, 10624Stanford University, Stanford, CA, USA
| | - Rachel M Jensen
- Department of Surgery, 10624Stanford University, Stanford, CA, USA
| | | | - Ahmad Zeineddin
- Department of Surgery, 20814Howard University, Washington, DC, USA
| | - Tiffany N Anderson
- Department of Surgery, 440202University of Florida, Gainesville, FL, USA
| | - Daniel L Dent
- Department of Surgery, 14742University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Davis H Payne
- Department of Surgery, 14742University of Texas Health at San Antonio, San Antonio, TX, USA
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13
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Kearse LE, Schmiederer IS, Anderson TN, Dent DL, Payne DH, Korndorffer JR. American Board of Surgery Entrustable Professional Activities (EPAs): Assessing Graduating Residents' Perception of Preoperative Entrustment. J Surg Educ 2021; 78:e183-e188. [PMID: 34602378 DOI: 10.1016/j.jsurg.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine if graduating surgical residents are achieving entrustment of surgical entrustable professional activities (EPAs). We hypothesize that postgraduate year 5 (PGY5) residents are achieving evaluation and management entrustment in the selected EPAs. DESIGN In January 2020, surgical residents completed a survey following the American Board of Surgery In-Training Examination (ABSITE) to measure their levels of entrustment in 4 of the 5 ABS-selected EPAs. A Resident Entrustability Index (REI) score was developed to ascertain PGY5 residents' levels of entrustment (range 1-5). Residents indicated how often their assessments and operative plans were modified in the prior 6 months for each EPA (1=Always, 2=Frequently, 3=Occasionally, 4=Rarely, 5=Never). An independent clinical decision-making score (ICDM) was developed with subsequent evaluation of its relationships to intrinsic, resident-related and extrinsic, program-dependent factors. SETTING A national post-ABSITE survey. PARTICIPANTS All general surgery residents participating in ABSITE were invited to participate. Of the 1367 PGY5 residents that completed the survey, 1049 residents (76.7%) responded to the surgical EPA items. RESULTS Residents achieved an average REI of 4, indicating rare modification of assessments and operative plans for the 4 EPAs assessed. Complete entrustment was reported for inguinal hernias and penetrating abdominal trauma (Median REI = 5, IQR 4, 5) indicating assessments and operative plans were never modified. Lack of entrustment (REI ≤3) was reported by a minority of residents (ranging from 8.6% for operative plan of right lower quadrant pathology to 12.8% for operative plan of blunt abdominal trauma). Significant resident-related and program-dependent factors associated with achievement of expected ICDM was socializing with a co-resident (p = 0.001), while training in one's hometown (p < 0.001) and policies that mandate attendings be scrubbed in (p = 0.022) were associated with decreased achievement of expected ICDM. Overall, 89.2% and 90.3% of PGY5 residents are attaining appropriate levels of entrustment and ICDM abilities, respectively, within 6 months of graduating. CONCLUSIONS Of the EPAs evaluated, PGY5 residents are achieving appropriate levels of entrustment in evaluation and management. Although this is the case for a vast majority of PGY5 residents, there is still work to be done to ensure that all PGY5 residents are attaining entrustment prior to graduation. Our study also provides content validity for the surgical EPAs in assessing levels of entrustment in PGY5 residents.
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Affiliation(s)
- LaDonna E Kearse
- Department of Surgery, Stanford University, Stanford, California
| | | | | | - Daniel L Dent
- Department of Surgery, University of Texas Health at San Antonio, San Antonio, Texas
| | - Davis H Payne
- Department of Surgery, University of Texas Health at San Antonio, San Antonio, Texas
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14
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Anderson TN, Payne DH, Dent DL, Kearse LE, Schmiederer IS, Korndorffer JR. Defining the Deficit in US Surgical Training: The Trainee's Perspective. J Am Coll Surg 2020; 232:623-627. [PMID: 33385569 DOI: 10.1016/j.jamcollsurg.2020.11.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Self-efficacy is the personal judgment of how well one can successfully complete a task. The goal of this study was to assess self-efficacy of PGY5 residents for common general surgery operations. We hypothesized there are deficits in self-efficacy of PGY5 residents, and self-efficacy of a given operation correlates with experience performing the operation without attending assistance (independently) and teaching the operation from start to finish. METHODS A survey was linked to the 2020 American Board of Surgery In-Training Examination. From the ACGME case log's 15 most commonly performed surgeon-chief operations and AHRQ's 15 most common operations, 10 operations were selected. Residents evaluated their ability to perform these operations independently using a 5-point self-efficacy scale. Residents were asked whether they had experience performing these operations independently or teaching the operation from start to finish. Descriptive statistics and Pearson correlation were used to examine the relationship between self-efficacy and operative experience. RESULTS In all, 1,145 of 1,367 PGY5 residents (84%) responded. Highest self-efficacy was in performing wide-local excision (90.24%) and lowest was in performing open thyroidectomy (19.58%). Eighty-eight (7.7%) reported self-efficacy in all procedures. Statistically significant positive correlations were identified between experience and self-efficacy for cases performed without assistance (r = 0.98, p < 0.01) and cases taught (r = 0.91, p < 0.01). CONCLUSIONS With 5 months left in training, 92.3% of residents report deficits in preparation for practice, as defined by self-efficacy to complete common procedures independently. Resident self-efficacy increased in direct relation to performed cases and cases taught.
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Affiliation(s)
| | - Davis H Payne
- Long School of Medicine, UT Health San Antonio, San Antonio, TX
| | - Daniel L Dent
- Department of Surgery, UT Health San Antonio, San Antonio, TX.
| | - LaDonna E Kearse
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
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15
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Beale KG, Kempenich JW, Willis RE, Al Fayyadh MJ, Reed CC, Paccione C, Ebeling PA, Dao Campi HE, Dent DL. Surgical Inpatient's Attitudes Toward Resident Participation: All About Expectations. J Surg Educ 2020; 77:e28-e33. [PMID: 32245717 DOI: 10.1016/j.jsurg.2020.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 02/18/2020] [Accepted: 02/23/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Determine whether an educational video can improve surgical inpatients' attitudes toward resident participation in their care. METHODS Patients admitted to the Trauma/Emergency General Surgery Service at University Hospital (San Antonio, Texas) were randomly divided into control and intervention groups. Patients in the intervention group viewed a short educational video about the role and responsibilities of medical students, residents, and attending surgeons. All patients then completed a previously published survey. RESULTS A total of 140 patients responded to the survey (control = 81 and intervention = 59 patients). Overall, 86.4% of patients were welcoming of resident participation. Patients who were expecting residents to be involved in their care had attitudes that are more favorable on almost all survey questions regardless of their study condition. However, patients in the intervention group who expected resident involvement in their care had more favorable attitudes about senior residents (postgraduate year 3-5) assisting in routine or complicated surgery than those in the control group who were expecting resident involvement (both p ≤ 0.001). This same group of patients also had more favorable attitudes about surgical outcomes and overall surgical health when residents are involved (p = 0.004, p = 0.001, respectively). Most patients (79%) said they had no residents previously involved in their care, or they were unsure if residents were previously involved. CONCLUSIONS Patient expectation of resident involvement is one of the most important factors influencing perceptions of inpatients about resident participation in surgery. Our goal should be early and frequent discussion with patients about resident involvement in order to foster an atmosphere of trust, including full transparency regarding resident involvement in surgical procedures. An educational video may help introduce the roles of trainees and attending surgeons but should not be used in lieu of direct discussion with patients.
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Affiliation(s)
- Katherine G Beale
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jason W Kempenich
- University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ross E Willis
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Charles C Reed
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Carmen Paccione
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Peter A Ebeling
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Haisar E Dao Campi
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
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16
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Ebeling PA, Dent DL, Kempenich JW. The millennials have arrived: What the surgeon educator needs to know to teach millennials. Surgery 2020; 167:265-268. [DOI: 10.1016/j.surg.2019.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
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17
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Payne DH, Dent DL, Al Fayyadh MJ, Kempenich JW, Willis RE, Stewart RM, Potts Iii JR. Surgery Program Director Turnover Correlates With Residency Graduate Failure on American Board of Surgery Examinations in Civilian Residency Programs. J Surg Educ 2019; 76:e24-e29. [PMID: 31606375 DOI: 10.1016/j.jsurg.2019.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/30/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The Review Committee for Surgery requires a minimum program director (PD) tenure of 6 years. The impact of PD turnover on the performance of program graduates is unknown. We hypothesize that (1) the majority of PDs step down before 6-year tenure and (2) higher PD turnover is associated with higher failure rate on American Board of Surgery (ABS) examinations. METHODS Start and stop dates of all surgery PDs between January 1, 2000 and December 31, 2017 were obtained for civilian surgery programs. A Kaplan-Meier curve of PD "survival" was constructed. Programs were divided into High Turnover (HT; ≥4 PD changes, n = 33) and Low Turnover (LT; ≤3 PD changes, n = 191) groups. Five-year (2013-2017) ABS pass rates were also obtained. Pass rates and compliance with current standards were compared between groups. RESULTS Kaplan-Meier analysis revealed that 40% of PDs do not comply with ACGME policy and serve <6 years. HT programs had lower mean pass rates on ABS certifying exam than LT programs (76% vs 83%, p < 0.01), but not qualifying exam (88% vs 88%). HT programs are less likely to meet the current 65% pass rate standard (82% vs 93%, p < 0.05). CONCLUSIONS (1) An estimated 40% of general surgery PDs had tenures of <6 years. (2) Greater PD turnover is associated with lower ABS pass rates among general surgery graduates.
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Affiliation(s)
- Davis H Payne
- Long School of Medicine, UT Health San Antonio, San Antonio, Texas.
| | - Daniel L Dent
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | | | | | - Ross E Willis
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | - Ronald M Stewart
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | - John R Potts Iii
- Surgical Accreditation, Accreditation Council for Graduate Medical Education, Chicago, Illinois
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18
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Ebeling PA, Ghali AN, McDermott R, Caron JLR, Dent DL. Survival After a Transcranial Bihemispheric Stabbing with a Knife: Case Report and Literature Review. Cureus 2019; 11:e5512. [PMID: 31687288 PMCID: PMC6818735 DOI: 10.7759/cureus.5512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022] Open
Abstract
Low-velocity penetrating brain injuries (PBIs), also referred to as nonmissile brain injuries, typically result from stabbings, industrial or home accidents, or suicide attempts. A great deal of literature has focused on the injury patterns and management strategies of high-velocity PBIs. However, there are substantially fewer large, contemporary studies focused solely on low-velocity PBIs. Here, we present an interesting and uncommon case of a patient who suffered a bihemispheric stab wound involving the basal ganglia. A 22-year-old man presented to the hospital with a stab wound to the left calvarium. His initial Glasgow Coma Scale (GCS) score was 13, but he rapidly declined to a six and was intubated. He was emergently taken to the operating room for craniectomy, knife removal, and external ventricular drain placement. On the first postoperative day, the patient was following commands with all extremities. He was discharged to a rehabilitation facility 13 days postinjury. One year after the injury, the patient was free of major neurologic sequelae. This report illustrates a rare case of a good functional outcome after a transcranial stabbing with multiple imaging and exam findings usually associated with poor outcomes.
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Affiliation(s)
- Peter A Ebeling
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Abdullah N Ghali
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Ryan McDermott
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Jean-Louis R Caron
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Daniel L Dent
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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19
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Ebeling PA, Clark C, Erwin D, Beale K, Dent DL. Femoral Head Dislocation into the Rectum Following Blunt Trauma. Cureus 2019; 11:e4596. [PMID: 31309021 PMCID: PMC6609309 DOI: 10.7759/cureus.4596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Traumatic hip dislocations require prompt diagnosis and treatment to prevent avascular necrosis of the femoral head. This injury is further complicated when there is an ipsilateral femur fracture. Here, we present what is likely the first reported case of a patient with traumatic hip dislocation and ipsilateral femur fracture with transrectal displacement of the femoral head. The patient presented to a level one trauma center in 2006 as a transfer from another facility after being thrown from a pickup truck. Upon initial evaluation, a foreign body was palpated in the rectum. Computed tomography (CT) imaging showed that the right femoral head was lodged within the pelvis. In the operating room, an exploratory laparotomy was performed, and anoscopy confirmed the placement of the femoral head within the rectal lumen. The femoral head was extracted from the rectum transanally. The operation was abbreviated, as the patient became hemodynamically unstable, and he was taken to the intensive care unit. He returned to the operating room the following day for a repeat washout and proximal diversion. Despite numerous orthopedic procedures and operative washouts, he ultimately underwent a right hip disarticulation. Physicians should be aware that intracorporeal femoral head displacement is possible in select patients who have experienced a high-energy trauma mechanism. This is a complicated, highly morbid injury that poses various management challenges to orthopedic and acute care surgeons.
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Affiliation(s)
- Peter A Ebeling
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Clarence Clark
- Surgery, Morehouse School of Medicine and Grady Memorial Hospital, Atlanta, USA
| | - Dylan Erwin
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Katherine Beale
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Daniel L Dent
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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Abstract
PURPOSE Though the total fatality and injury count in mass shootings is known, the burden on the pediatric population remains undefined. We sought to define the impact of domestic vs. public mass shootings in the pediatric population. METHODS Open-source databases, Everytown for Gun Violence, and Mother Jones were cross-referenced and used to review domestic and public mass shootings from 2009 to 2016. Mass shootings were defined as four or more fatalities and any injuries. Domestic mass shootings were defined as ones that occurred in the home where the assailant was either a family member or a past or present intimate partner of a family member. Public mass shootings occurred in a public space where the shooter was unknown to the victim. The number of incidents in each group, fatalities and injuries, and effect on children <18 years were analyzed along with perpetrator characteristics. Categorical data were analyzed using Fisher's Exact test. RESULTS There were 71 Domestic and 31 Public mass shootings accounting for 331 vs. 281 fatalities and 28 vs. 217 injuries (p < 0.0001). Children <18 years accounted for 44% of Domestic and 10% of Public fatalities (p < 0.0001) and 46% vs. 2% of all injuries (p < 0.0001). The assailant was prohibited from owning or possessing a firearm in 32% of Domestic and 39% of Public mass shootings accounting for 54 vs. 25 fatalities. CONCLUSION The pediatric fatality rate in mass shootings is alarming, especially among Domestic shooting events. This is a public health issue and requires vigilance to protect at-risk youth. TYPE OF STUDY Epidemiology study, retrospective review. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Marc Levy
- Arnold Palmer Hospital for Children, Orlando, FL.
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21
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Abstract
Background General surgery chief residents are typically well equipped for board examinations but poorly trained to deal with the business challenges of surgical practice. We began a business leadership course to better prepare them for their careers. Methods Chief residents were given one-hour lectures with topics that included: Differences between private/academic practice, personal finances, contracts, practice management, legal issues and health law, and time management. Results Initial evaluations revealed that the topics covered and the presentations were well received. Subsequently, the course was moved to earlier in the academic year to prepare them for contract negotiations and then to Sunday nights to decrease interruptions and allow spouse participation. Conclusions The course evolved into a program that the chief residents feel is an important addition to their education. Moving the meetings to a weekend evening improved attendance, decreased interruptions, and allowed participation by spouses and significant others.
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Affiliation(s)
- Adham R Saad
- Surgery, University of South Florida, Tampa, USA
| | - Clinton E Baisden
- Surgery, University of Texas Health Science Center, San Antonio, USA
| | - Daniel L Dent
- Surgery, University of Texas Health Science Center, San Antonio, USA
| | - Leen Khoury
- Surgery, Staten Island University Hospital, Staten Island, USA
| | - Melissa Panzo
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| | - Stephen M Cohn
- Surgery, Staten Island University Hospital, Staten Island, USA
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22
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Kempenich JW, Willis RE, Fayyadh MA, Campi HD, Cardenas T, Hopper WA, Giovannetti CA, Reed CC, Dent DL. Video-Based Patient Education Improves Patient Attitudes Toward Resident Participation in Outpatient Surgical Care. J Surg Educ 2018; 75:e61-e67. [PMID: 30217778 DOI: 10.1016/j.jsurg.2018.07.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/28/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Decipher if patient attitudes toward resident participation in surgical care can be improved with patient education using a video-based modality. DESIGN A survey using a 5-pt Likert scale was created, piloted, and distributed in general and colorectal surgery outpatient clinics that had residents involved with patient care at 2 facilities, both with control and intervention groups. The intervention group viewed a short video (∼4 min) explaining the role, education, and responsibilities of medical students, residents, and attending surgeons prior to answering the survey. SETTING General and colorectal surgery outpatient clinics at the University of Texas Health San Antonio, Texas. PARTICIPANTS A total of 383 responses were collected, all clinic patients were eligible. RESULTS The majority of patients (82%) welcomed resident participation in their health care. Eighteen percent of patients did not expect residents to be involved in their care. Patients had favorable views of residents participating during their surgical procedures with 77% responding "agree" or "strongly agree" to a senior resident assisting with a complicated procedure. Patients who viewed the video versus control were less concerned with how much of the procedure the resident would perform (76% vs 86%, p = 0.010). Patients who viewed the video felt less inconvenienced (p = 0.004). CONCLUSIONS The majority of patients are welcoming to resident participation in their surgical care but only 54% were expecting resident involvement at their clinic visit. Early explanation with an educational video of resident roles, education, and responsibilities may help bridge the gap and improve patient experience.
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Affiliation(s)
- Jason W Kempenich
- University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ross E Willis
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mohammed Al Fayyadh
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Haisar Dao Campi
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Tatiana Cardenas
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - William A Hopper
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Charles C Reed
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Dent DL, Al Fayyadh M, Willis RE. We are the Gatekeepers Or "Your Residency is Only as Good as Your Worst Graduate". J Surg Educ 2018; 75:e1-e10. [PMID: 30037652 DOI: 10.1016/j.jsurg.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Daniel L Dent
- Department of Surgery, UT Health San Antonio, San Antonio, Texas.
| | | | - Ross E Willis
- Department of Surgery, UT Health San Antonio, San Antonio, Texas.
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24
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Dent DL, Al Fayyadh MJ, Rawlings JA, Hassan RA, Kempenich JW, Willis RE, Stewart RM. Failure on the American Board of Surgery Examinations of General Surgery Residency Graduates Correlates Positively with States’ Malpractice Risk. Am Surg 2018. [DOI: 10.1177/000313481808400324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been suggested that in environments where there is greater fear of litigation, resident autonomy and education is compromised. Our aim was to examine failure rates on American Board of Surgery (ABS) examinations in comparison with medical malpractice payments in 47 US states/ territories that have general surgery residency programs. We hypothesized higher ABS examination failure rates for general surgery residents who graduate from residencies in states with higher malpractice risk. We conducted a retrospective review of five-year (2010–2014) pass rates of first-time examinees of the ABS examinations. States’ malpractice data were adjusted based on population. ABS examinations failure rates for programs in states with above and below median malpractice payments per capita were 31 and 24 per cent ( P < 0.01) respectively. This difference was seen in university and independent programs regardless of size. Pearson correlation confirmed a significant positive correlation between board failure rates and malpractice payments per capita for Qualifying Examination ( P < 0.02), Certifying Examination ( P < 0.02), and Qualifying and Certifying combined index ( P < 0.01). Malpractice risk correlates positively with graduates’ failure rates on ABS examinations regardless of program size or type. We encourage further examination of training environments and their relationship to surgical residency graduate performance.
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Affiliation(s)
- Daniel L. Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Mohammed J. Al Fayyadh
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Jeremy A. Rawlings
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Ramy A. Hassan
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Jason W. Kempenich
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Ross E. Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Ronald M. Stewart
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
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Dent DL, Al Fayyadh MJ, Rawlings JA, Hassan RA, Kempenich JW, Willis RE, Stewart RM. Failure on the American Board of Surgery Examinations of General Surgery Residency Graduates Correlates Positively with States' Malpractice Risk. Am Surg 2018; 84:398-402. [PMID: 29559055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
It has been suggested that in environments where there is greater fear of litigation, resident autonomy and education is compromised. Our aim was to examine failure rates on American Board of Surgery (ABS) examinations in comparison with medical malpractice payments in 47 US states/territories that have general surgery residency programs. We hypothesized higher ABS examination failure rates for general surgery residents who graduate from residencies in states with higher malpractice risk. We conducted a retrospective review of five-year (2010-2014) pass rates of first-time examinees of the ABS examinations. States' malpractice data were adjusted based on population. ABS examinations failure rates for programs in states with above and below median malpractice payments per capita were 31 and 24 per cent (P < 0.01) respectively. This difference was seen in university and independent programs regardless of size. Pearson correlation confirmed a significant positive correlation between board failure rates and malpractice payments per capita for Qualifying Examination (P < 0.02), Certifying Examination (P < 0.02), and Qualifying and Certifying combined index (P < 0.01). Malpractice risk correlates positively with graduates' failure rates on ABS examinations regardless of program size or type. We encourage further examination of training environments and their relationship to surgical residency graduate performance.
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Coverdill JE, Shelton JS, Alseidi A, Borgstrom DC, Dent DL, Dumire R, Fryer J, Hartranft TH, Holsten SB, Nelson MT, Shabahang MM, Sherman SR, Termuhlen PM, Woods RJ, Mellinger JD. The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty. Am J Surg 2018; 215:222-226. [DOI: 10.1016/j.amjsurg.2017.10.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/12/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
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Schwed AC, Lee SL, Salcedo ES, Reeves ME, Inaba K, Sidwell RA, Amersi F, Are C, Arnell TD, Damewood RB, Dent DL, Donahue T, Gauvin J, Hartranft T, Jacobsen GR, Jarman BT, Melcher ML, Mellinger JD, Morris JB, Nehler M, Smith BR, Wolfe M, Kaji AH, de Virgilio C. Association of General Surgery Resident Remediation and Program Director Attitudes With Resident Attrition. JAMA Surg 2018; 152:1134-1140. [PMID: 28813585 DOI: 10.1001/jamasurg.2017.2656] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Previous studies of resident attrition have variably included preliminary residents and likely overestimated categorical resident attrition. Whether program director attitudes affect attrition has been unclear. Objectives To determine whether program director attitudes are associated with resident attrition and to measure the categorical resident attrition rate. Design, Setting, and Participants This multicenter study surveyed 21 US program directors in general surgery about their opinions regarding resident education and attrition. Data on total resident complement, demographic information, and annual attrition were collected from the program directors for the study period of July 1, 2010, to June 30, 2015. The general surgery programs were chosen on the basis of their geographic location, previous collaboration with some coauthors, prior work in surgical education and research, or a program director willing to participate. Only categorical surgical residents were included in the study; thus, program directors were specifically instructed to exclude any preliminary residents in their responses. Main Outcomes and Measures Five-year attrition rates (2010-2011 to 2014-2015 academic years) as well as first-time pass rates on the General Surgery Qualifying Examination and General Surgery Certifying Examination of the American Board of Surgery (ABS) were collected. High- and low-attrition programs were compared. Results The 21 programs represented different geographic locations and 12 university-based, 3 university-affiliated, and 6 independent program types. Programs had a median (interquartile range [IQR]) number of 30 (20-48) categorical residents, and few of those residents were women (median [IQR], 12 [5-17]). Overall, 85 of 966 residents (8.8%) left training during the study period: 15 (17.6%) left after postgraduate year 1, 34 (40.0%) after postgraduate year 2, and 36 (42.4%) after postgraduate year 3 or later. Forty-four residents (51.8%) left general surgery for another surgical discipline, 21 (24.7%) transferred to a different surgery program, and 18 (21.2%) exited graduate medical education altogether. Each program had an annual attrition rate ranging from 0.73% to 6.0% (median [IQR], 2.5% [1.5%-3.4%]). Low-attrition programs were more likely than high-attrition programs to use resident remediation (21.0% vs 6.8%; P < .001). Median (IQR) Qualifying Examination pass rates (93% [90%-98%] vs 92% [86%-100%]; P = .92) and Certifying Examination pass rates (83% [68%-84%] vs 81% [71%-86%]; P = .47) were similar. Program directors at high-attrition programs were more likely than their counterparts at low-attrition programs to agree with this statement: "I feel that it is my responsibility as a program director to redirect residents who should not be surgeons." Conclusions and Relevance The overall 5-year attrition rate of 8.8% was significantly lower than previously reported. Program directors at low-attrition programs were more likely to use resident remediation. Variations in attrition may be explained by program director attitudes, although larger studies are needed to further define program factors affecting attrition.
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Affiliation(s)
- Alexander C Schwed
- Department of Surgery, Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance
| | - Steven L Lee
- Department of Surgery, Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance.,Los Angeles BioMedical Research Institute, Torrance, California
| | | | - Mark E Reeves
- Department of Surgery, Loma Linda University, Loma Linda, California
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles
| | - Richard A Sidwell
- Department of Surgery, Central Iowa Health System, Iowa Methodist Medical Center, Des Moines
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Center, Omaha
| | - Tracey D Arnell
- Department of Surgery, Columbia University, New York, New York
| | | | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio
| | | | - Jeffrey Gauvin
- Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Thomas Hartranft
- Department of Surgery, Mount Carmel Health System, Columbus, Ohio
| | - Garth R Jacobsen
- Department of Surgery, University of California, San Diego, San Diego
| | - Benjamin T Jarman
- Department of Surgery, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin
| | - Marc L Melcher
- Department of Surgery, Stanford University, Palo Alto, California
| | - John D Mellinger
- Department of Surgery, Southern Illinois University School of Medicine, Springfield
| | - Jon B Morris
- Department of Surgery, University of Pennsylvania, Philadelphia
| | - Mark Nehler
- Department of Surgery, University of Colorado, Denver, Aurora
| | - Brian R Smith
- Department of Surgery, University of California, Irvine, Irvine
| | - Mary Wolfe
- Department of Surgery, University of San Francisco at Fresno, Fresno, California
| | - Amy H Kaji
- Los Angeles BioMedical Research Institute, Torrance, California.,Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Christian de Virgilio
- Department of Surgery, Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance.,Los Angeles BioMedical Research Institute, Torrance, California
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Al Fayyadh MJ, Hassan RA, Tran ZK, Kempenich JW, Bunegin L, Dent DL, Willis RE. Immediate Auditory Feedback is Superior to Other Types of Feedback for Basic Surgical Skills Acquisition. J Surg Educ 2017; 74:e55-e61. [PMID: 28865902 DOI: 10.1016/j.jsurg.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/15/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We examined the effect of timing and type of feedback on medical students' knot-tying performance using visual versus auditory and immediate versus delayed feedback. We hypothesized that participants who received immediate auditory feedback would outperform those who received delayed and visual feedback. METHODS Sixty-nine first- and second-year medical students were taught to tie 2-handed knots. All participants completed 3 pretest knot-tying trials without feedback. Participants were instructed to tie a knot sufficiently tight to stop the "blood" flow while minimizing the amount of force applied to the vessel. Task completion time was not a criterion. Participants were stratified and randomly assigned to 5 experimental groups based on type (auditory versus visual) and timing (immediate versus delayed) of feedback. The control group did not receive feedback. All groups trained to proficiency. Participants completed 3 posttest trials without feedback. RESULTS There were fewer trials with leak (p < 0.01) and less force applied (p < 0.01) on the posttest compared to the pretest, regardless of study group. The immediate auditory feedback group required fewer trials to achieve proficiency than each of the other groups (p < 0.01) and had fewer leaks than the control, delayed auditory, and delayed visual groups (p < 0.02). CONCLUSIONS In a surgical force feedback simulation model, immediate auditory feedback resulted in fewer training trials to reach proficiency and fewer leaks compared to visual and delayed forms of feedback.
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Affiliation(s)
- Mohammed J Al Fayyadh
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas.
| | - Ramy A Hassan
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Zachary K Tran
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Jason W Kempenich
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Leonid Bunegin
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas
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Rehim SA, DeMoor S, Olmsted R, Dent DL, Parker-Raley J. Tools for Assessment of Communication Skills of Hospital Action Teams: A Systematic Review. J Surg Educ 2017; 74:341-351. [PMID: 27771338 DOI: 10.1016/j.jsurg.2016.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/07/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Hospital action teams comprise interdisciplinary health care providers working simultaneously to treat critically ill patients. Assessments designed to evaluate communication effectiveness or "nontechnical" performance of these teams are essential to minimize medical errors and improve team productivity. Although multiple communication tools are available, the characteristics and psychometric validity of these instruments have yet to be systematically compared. OBJECTIVE To identify assessments used to evaluate the communication or "nontechnical" performance of hospital action teams and summarize evidence to develop and validate these instruments. METHOD A literature search was conducted using MEDLINE/PubMed database to identify original articles related to assessment of communication skills in teams working in acute care medicine not exclusive to emergency room, operating room, prehospital air and ground transport, or code blue/rapid response resuscitations. RESULTS Ten communication assessment tools were identified. Six tools (60%) were designed to measure communication performance of the whole team, whereas 4 tools (40%) were created to assess individual team member's communication skills. Regardless of the type of analysis, the most commonly assessed behavior domains were Leadership, Teamwork, Communication, and Situation awareness. Only 1 of 16 articles describing a particular communication assessment tool reported all the validation criteria, other authors underreported efforts to validate their instruments. CONCLUSION A number of tools designed to measure the communication or "nontechnical" performance of hospital action teams are available. Unfortunately, limited reported validity evidence may hamper the utility of these tools in actual clinical practice until further validation studies are performed.
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Affiliation(s)
- Shady A Rehim
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Stephanie DeMoor
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Richard Olmsted
- University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Daniel L Dent
- University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Jessica Parker-Raley
- Division of Trauma, University of Texas Health Science Center San Antonio, San Antonio, Texas.
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Al Fayyadh MJ, Rawlings JA, Willis RE, Falcone JL, Stewart RM, Dent DL. The American Board of Surgery examinations: how are the Southwestern Surgical Congress programs performing compared to the rest of the United States? Am J Surg 2016; 212:1243-1247. [DOI: 10.1016/j.amjsurg.2016.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/27/2016] [Accepted: 08/27/2016] [Indexed: 10/20/2022]
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Lewis AM, Sordo S, Weireter LJ, Price MA, Cancio L, Jonas RB, Dent DL, Muir MT, Aydelotte JD. Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma. Am Surg 2016; 82:1227-1231. [PMID: 28234189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals' and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.
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Affiliation(s)
- Aaron M Lewis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Lewis AM, Sordo S, Weireter LJ, Price MA, Cancio L, Jonas RB, Dent DL, Muir MT, Aydelotte JD. Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma. Am Surg 2016. [DOI: 10.1177/000313481608201231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals’ and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.
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Affiliation(s)
- Aaron M. Lewis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Salvador Sordo
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Leonard J. Weireter
- Shock Trauma Center, Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Michelle A. Price
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Leopoldo Cancio
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Rachelle B. Jonas
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L. Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mark T. Muir
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Coverdill JE, Alseidi A, Borgstrom DC, Dent DL, Dumire RD, Fryer J, Hartranft TH, Holsten SB, Nelson MT, Shabahang M, Sherman S, Termuhlen PM, Woods RJ, Mellinger JD. Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies. Acad Med 2016; 91:S31-S36. [PMID: 27779507 DOI: 10.1097/acm.0000000000001358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism. METHOD Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews. RESULTS A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient. CONCLUSIONS Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.
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Affiliation(s)
- James E Coverdill
- J.E. Coverdill is associate professor, Department of Sociology, University of Georgia, Athens, Georgia. A. Alseidi is associate director, General Surgery Residency Program, and director, HPB Fellowship, HPB and Endocrine Surgery, Virginia Mason Medical Center, Seattle, Washington. D.C. Borgstrom is associate professor, Department of Surgery, West Virginia University, Morgantown, West Virginia. D.L. Dent is professor of surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas. R.D. Dumire is general surgery residency program director and medical director of trauma services, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania. J. Fryer is professor of surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. T.H. Hartranft is clinical professor of surgery, Ohio University, and general surgery residency program director, Mount Carmel Health System, Columbus, Ohio. S.B. Holsten is associate professor and general surgery residency program director, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia. T. Nelson is chief of general surgery and executive physician, Health System Surgical Services, University of New Mexico, Albuquerque, New Mexico. M. Shabahang is director, Department of General Surgery, and general surgery residency program director, Geisinger Medical Center, Danville, Pennsylvania. S. Sherman is associate clinical professor and associate director, General Surgery Residency Program, Michigan State University / Grand Rapids Medical Education Partners, Wyoming, Michigan. P.M. Termuhlen is regional campus dean, University of Minnesota Medical School, Duluth, Minnesota. R.J. Woods is associate professor and general surgery residency program director, Wright State University Boonshoft School of Medicine, Dayton, Ohio. J.D. Mellinger is professor, chair of general surgery, and general surgery residency program director, Southern Illinois University School of Medicine, Springfield, Illinois
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Kempenich JW, Willis RE, Blue RJ, Al Fayyadh MJ, Cromer RM, Schenarts PJ, Van Sickle KR, Dent DL. The Effect of Patient Education on the Perceptions of Resident Participation in Surgical Care. J Surg Educ 2016; 73:e111-e117. [PMID: 27663084 DOI: 10.1016/j.jsurg.2016.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To decipher if patient attitudes toward resident participation in their surgical care can be improved with patient education regarding resident roles, education, and responsibilities. DESIGN An anonymous questionnaire was created and distributed in outpatient surgery clinics that had residents involved with patient care. In total, 3 groups of patients were surveyed, a control group and 2 intervention groups. Each intervention group was given an informational pamphlet explaining the role, education, and responsibilities of residents. The first pamphlet used an analogy-based explanation. The second pamphlet used literature citations and statistics. SETTING Keesler Medical Center, Keesler AFB, MS. University of Texas Health Science Center at San Antonio, San Antonio, TX. PARTICIPANTS A total of 454 responses were collected and analyzed-211 in the control group, 118 in the analogy pamphlet group, and 125 in the statistics pamphlet group. RESULTS Patients had favorable views of residents assisting with their surgical procedures, and the majority felt that outcomes were the same or better regardless of whether they read an informational pamphlet. Of all the patients surveyed, 80% agreed or strongly agreed that they expect to be asked permission for residents to be involved in their care. Further, 52% of patients in the control group agreed or strongly agreed to a fifth-year surgery resident operating on them independently for routine procedures compared to 62% and 65% of the patients who read the analogy pamphlet and statistics pamphlet, respectively (p = 0.05). When we combined the 2 intervention groups compared to the control group, this significant difference persisted (p = 0.02). CONCLUSION Most patients welcome resident participation in their surgical care, but they expect to be asked permission for resident involvement. Patient education using an information pamphlet describing resident roles, education, and responsibilities improved patient willingness to allow a chief resident to operate independently.
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Affiliation(s)
- Jason W Kempenich
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi.
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert J Blue
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Mohammed J Al Fayyadh
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert M Cromer
- Department of General Surgery, Keesler Medical Center, Keesler AFB, Biloxi, Mississippi
| | - Paul J Schenarts
- Division of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kent R Van Sickle
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Al Fayyadh MJ, Heller SF, Rajab TK, Gardner AK, Bloom JP, Rawlings JA, Mullen JT, Smink DS, Farley DR, Willis RE, Dent DL. Predicting Success of Preliminary Surgical Residents: A Multi-Institutional Study. J Surg Educ 2016; 73:e77-e83. [PMID: 27395396 DOI: 10.1016/j.jsurg.2016.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE A nondesignated preliminary surgery (NDPS) position encompasses 1 year of training provided by many general surgery residencies. Our aim was to assess factors predicting success and provide evidence for program directors to support career guidance to preliminary residents. METHODS Retrospective cohort study of 221 NDPS residents who entered 5 university-based institutions were identified from 2009 to 2013. Records for trainees were reviewed. We defined primary success as obtaining a categorical position in the specialty of choice and secondary success as obtaining a categorical position in any specialty immediately after finishing their NDPS training. Statistical evaluation was performed using chi-square analysis, independent t-test and logistic regression using α <0.05. RESULTS Of the 221 NDPS residents, 217 (98%) completed postgraduate year (PGY)-1 and 65 (29%) completed PGY-2. Totally, 90 (41%) obtained categorical general surgery positions, 89 (40%) obtained categorical positions in other specialties, and 42 (19%) failed to obtain a categorical position immediately after their NDPS years. Ultimately, 139 (63%) of residents achieved primary success and 40 (18%) additional residents obtained categorical positions in specialties other than their first choice, resulting in a total of 179 (81%) of residents obtaining categorical positions. Mean United States Medical Licensing Examination step 1 and step 2 scores for those who obtained secondary success were 227 and 234 vs. 214 and 219, respectively, for those who failed to secure a categorical position (p < 0.01). United States Medical Licensing Examination step 2 score was a significant predictor of primary (p < 0.03) and secondary success (p < 0.02). Of 65 PGY-2 NDPS residents, 32 (49%) achieved primary success, and 11 (17%) others achieved secondary success for a total of 43 (66%). For PGY-2 NDPS, American Board of Surgery In-Training Examination was the only significant predictor of primary and secondary success (p < 0.02 and p < 0.05). CONCLUSIONS NDPS training provides a viable and successful opportunity for at least 81% of young physicians to pursue their career goals even after an unsuccessful first match.
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Affiliation(s)
- Mohammed J Al Fayyadh
- Department of Surgery, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | | | - Taufiek Konrad Rajab
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aimee K Gardner
- Department of Surgery, University of Texas Southwestern, Dallas, Texas
| | - Jordan P Bloom
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeremy A Rawlings
- Department of Surgery, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David R Farley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ross E Willis
- Department of Surgery, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel L Dent
- Department of Surgery, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Sordo S, Holloway TL, Woodard RL, Conway BE, Liao LF, Eastridge BJ, Myers JG, Stewart RM, Dent DL. Small Bowel Perforations by Metallic Grill Brush Bristles: Clinical Presentations and Opportunity for Prevention. Am Surg 2016; 82:412-5. [DOI: 10.1177/000313481608200515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increasing reports on the incidental ingestion of metallic bristles from barbeque grill cleaning brushes have been reported. We sought to describe the clinical presentation and grilling habits of patients presenting after ingesting metallic bristles in an attempt to identify risk factors. We performed a chart review of six patients with documented enteric injury from metallic bristles. Subjects were contacted and administered a survey focused on the events surrounding the bristle ingestion. We arranged for in-home visits to inspect the grill and grill brush whenever possible. Of the six subjects identified, three (50%) were male, five (83%) were white, and they ranged in age from 18 to 65 years (mean 42.5). All complained of abdominal pain. All bristles were identified by CT scan. Three patients underwent laparoscopic enterorrhaphy, and two underwent laparotomy. The remaining patients did not require intervention. None had replaced their grill brush in at least two years. Surgeon's awareness of this unusual injury is important to identify and manage this problem. Alternative methods to clean the grill should be sought and grill brushes should be replaced at least every two years.
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Affiliation(s)
- Salvador Sordo
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, Texas
| | - Travis L. Holloway
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, Texas
| | - Russell L. Woodard
- General Surgical Associates, Methodist Health Care Ministries, San Antonio, Texas
| | - Bruce E. Conway
- General Surgical Associates, Methodist Health Care Ministries, San Antonio, Texas
| | - Lillian F. Liao
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, Texas
| | - Brian J. Eastridge
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, Texas
| | - John G. Myers
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, Texas
| | - Ronald M. Stewart
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, Texas
| | - Daniel L. Dent
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, Texas
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Damewood R, Morris JB, Mellinger J, Friedell ML, Borman KR, Dent DL, Schenarts PJ, Jarman BT. Association of Program Directors in Surgery Position Response to ACGME for Position on Accreditation Requirements. J Surg Educ 2016; 73:363-369. [PMID: 27068188 DOI: 10.1016/j.jsurg.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Richard Damewood
- President, Association of Program Directors in Surgery, Department of Surgery, WellSpan Health York Hospital, York, Pennsylvania.
| | - Jon B Morris
- Immediate Past President, Association of Program Directors in Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Mellinger
- Association of Program Directors in Surgery, Department of Surgery, SIU School of Medicine, Springfield, Illinois
| | - Mark L Friedell
- Past President, Association of Program Directors in Surgery, University of Missouri Kansas City, School of Medicine, Kansas City, Missouri
| | - Karen R Borman
- Past President, Association of Program Directors in Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Daniel L Dent
- President Elect, Association of Program Directors in Surgery, UT Health Science Center, San Antonio, Texas
| | - Paul J Schenarts
- Secretary, Association of Program Directors in Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Benjamin T Jarman
- Treasurer, Association of Program Directors in Surgery, Gundersen Medical Foundation, La Crosse, Wisconsin
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Dietch ZC, Duane TM, Cook CH, O'Neill PJ, Askari R, Napolitano LM, Namias N, Watson CM, Dent DL, Edwards BL, Shah PM, Guidry CA, Davies SW, Willis RN, Sawyer RG. Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection. Surg Infect (Larchmt) 2016; 17:412-21. [PMID: 27027416 DOI: 10.1089/sur.2015.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obesity and commonly associated comorbidities are known risk factors for the development of infections. However, the intensity and duration of antimicrobial treatment are rarely conditioned on body mass index (BMI). In particular, the influence of obesity on failure of antimicrobial treatment for intra-abdominal infection (IAI) remains unknown. We hypothesized that obesity is associated with recurrent infectious complications in patients treated for IAI. METHODS Five hundred eighteen patients randomized to treatment in the Surgical Infection Society Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated. Patients were stratified by obese (BMI ≥30) versus non-obese (BMI≥30) status. Descriptive comparisons were performed using Chi-square test, Fisher exact test, or Wilcoxon rank-sum tests as appropriate. Multivariable logistic regression using a priori selected variables was performed to assess the independent association between obesity and treatment failure in patients with IAI. RESULTS Overall, 198 (38.3%) of patients were obese (BMI ≥30) versus 319 (61.7%) who were non-obese. Mean antibiotic d and total hospital d were similar between both groups. Unadjusted outcomes of surgical site infection (9.1% vs. 6.9%, p = 0.36), recurrent intra-abdominal infection (16.2% vs. 13.8, p = 0.46), death (1.0% vs. 0.9%, p = 1.0), and a composite of all complications (25.3% vs. 19.8%, p = 0.14) were also similar between both groups. After controlling for appropriate demographics, comorbidities, severity of illness, treatment group, and duration of antimicrobial therapy, obesity was not independently associated with treatment failure (c-statistic: 0.64). CONCLUSIONS Obesity is not associated with antimicrobial treatment failure among patients with IAI. These results suggest that obesity may not independently influence the need for longer duration of antimicrobial therapy in treatment of IAI versus non-obese patients.
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Affiliation(s)
- Zachary C Dietch
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Therese M Duane
- 3 Department of Surgery, Virginia Commonwealth University , Richmond, Virginia
| | - Charles H Cook
- 4 Department of Surgery, Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Patrick J O'Neill
- 5 Department of Surgery, Maricopa Integrated Health System , Phoenix, Arizona
| | - Reza Askari
- 6 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts
| | - Lena M Napolitano
- 7 Department of Surgery, University of Michigan , Ann Arbor, Michigan
| | - Nicholas Namias
- 8 Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Christopher M Watson
- 9 Department of Surgery, University of South Carolina , Columbia, South Carolina
| | - Daniel L Dent
- 10 Department of Surgery, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Brandy L Edwards
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Puja M Shah
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Christopher A Guidry
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Stephen W Davies
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Rhett N Willis
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia
| | - Robert G Sawyer
- 1 Department of Surgery, The University of Virginia Health System , Charlottesville, Virginia.,2 Division of Patient Outcomes, Policy and Population Research, Department of Public Health Sciences, The University of Virginia Health System , Charlottesville, Virginia
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Willis RE, Dent DL, Love JD, Kempenich JW, Uecker J, Brown KM, Thomas JS, Gomez PP, Adams AJ, Admire JR, Sprunt JM, Kahrig KM, Wiggins-Dohlvik K. Predicting and enhancing American Board of Surgery In-Training Examination performance: does writing questions really help? Am J Surg 2015; 211:361-8. [PMID: 26687960 DOI: 10.1016/j.amjsurg.2015.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/20/2015] [Accepted: 08/19/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The generative learning model posits that individuals remember content they have generated better than materials created by others. The goals of this study were to evaluate question generation as a study method for the American Board of Surgery In-Training Examination (ABSITE) and determine whether practice test scores and other data predict ABSITE performance. METHODS Residents (n = 206) from 6 general surgery programs were randomly assigned to one of the two study conditions. One group wrote questions for practice examinations. All residents took 2 practice examinations. RESULTS There was not a significant effect of writing questions on ABSITE score. Practice test scores, United States Medical Licensing Examination Step 1 scores, and previous ABSITE scores were significantly correlated with ABSITE performance. CONCLUSIONS The generative learning model was not supported. Performance on practice tests and other data can be used for early identification of residents at risk of performing poorly on the ABSITE.
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Affiliation(s)
- Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Joseph D Love
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - John Uecker
- University of Texas Southwestern at Austin, Austin, TX, USA
| | | | | | - Pedro P Gomez
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Andrew J Adams
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - John R Admire
- Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Julie M Sprunt
- University of Texas Southwestern at Austin, Austin, TX, USA
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Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL, Cook CH, O'Neill PJ, Mazuski JE, Askari R, Wilson MA, Napolitano LM, Namias N, Miller PR, Dellinger EP, Watson CM, Coimbra R, Dent DL, Lowry SF, Cocanour CS, West MA, Banton KL, Cheadle WG, Lipsett PA, Guidry CA, Popovsky K. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 2015; 372:1996-2005. [PMID: 25992746 PMCID: PMC4469182 DOI: 10.1056/nejmoa1411162] [Citation(s) in RCA: 416] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear. METHODS We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections. RESULTS Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, -0.5 percentage point; 95% confidence interval [CI], -7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, -4.0 days; 95% CI, -4.7 to -3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes. CONCLUSIONS In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.).
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Affiliation(s)
- Robert G Sawyer
- From the Department of Surgery, University of Virginia Health System, Charlottesville (R.G.S., C.A.G., K.P.); the Department of Surgery, Virginia Commonwealth University, Richmond (T.M.D.); the Department of Surgery, Case Western Reserve University, Cleveland (J.A.C.); the Department of Surgery, University of Toronto, Toronto (A.B.N., O.D.R.); the Department of Surgery, University of Washington, Seattle (H.L.E., E.P.D.); the Department of Surgery, Beth Israel Deaconess Medical Center (C.H.C.), and the Department of Surgery, Brigham and Women's Hospital (R.A.) - both in Boston; the Department of Surgery, Maricopa Integrated Health System, Phoenix, AZ (P.J.O.); the Department of Surgery, Washington University, St. Louis (J.E.M.); the Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh (M.A. Wilson); the Department of Surgery, University of Michigan, Ann Arbor (L.M.N.); the Department of Surgery, University of Miami Miller School of Medicine, Miami (N.N.); the Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC (P.R.M.); the Department of Surgery, University of South Carolina, Columbia (C.M.W.); University of California, San Diego, San Diego (R.C.), the Department of Surgery, UC Davis Medical Center, Sacramento (C.S.C.), and the Department of Surgery, University of California, San Francisco, San Francisco (M.A. West) - all in California; the Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio (D.L.D.); the Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark (S.F.L.); the Department of Surgery, University of Minnesota Medical School, Minneapolis (K.L.B.); the Department of Surgery, University of Louisville School of Medicine, Louisville, KY (W.G.C.); and the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (P.A.L.)
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Abstract
Despite the multiple causes of the shock state, all causes possess the common abnormality of oxygen supply not meeting tissue metabolic demands. Compensatory mechanisms may mask the severity of hypoxemia and hypoperfusion, since catecholamines and extracellular fluid shifts initially compensate for the physiologic derangements associated with patients in shock. Despite the achievement of normal physiologic parameters after resuscitation, significant metabolic acidosis may continue to be present in the tissues, as evidenced by increased lactate levels and metabolic acidosis. This review discusses the major endpoints of resuscitation in clinical use.
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Affiliation(s)
- Ramon F Cestero
- Division of Trauma and Emergency Surgery, Department of Surgery, UT Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7740, San Antonio, TX 78229-3900, USA.
| | - Daniel L Dent
- Division of Trauma and Emergency Surgery, Department of Surgery, UT Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7740, San Antonio, TX 78229-3900, USA
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Harrison HB, Smith WZ, Salhanick MA, Higgins RA, Ortiz A, Olson JD, Schwacha MG, Harrison CR, Aydelotte JD, Stewart RM, Dent DL. An experimental model of hemothorax autotransfusion: impact on coagulation. Am J Surg 2014; 208:1078-82; discussion 1082. [DOI: 10.1016/j.amjsurg.2014.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/16/2022]
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Minter RM, Dunnington GL, Sudan R, Terhune KP, Dent DL, Lentz AK. Can This Resident Be Saved? Identification and Early Intervention for Struggling Residents. J Am Coll Surg 2014; 219:1088-95. [DOI: 10.1016/j.jamcollsurg.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
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Corneille MG, Willis R, Stewart RM, Dent DL. Performance on brief practice examination identifies residents at risk for poor ABSITE and ABS qualifying examination performance. J Surg Educ 2011; 68:246-249. [PMID: 21481811 DOI: 10.1016/j.jsurg.2010.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 11/15/2010] [Accepted: 12/26/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Performance on the American Board of Surgery (ABS) Qualifying Exam (QE) correlates well with chief resident American Board of Surgery In-Training Exam (ABSITE) scores. Yearly ABSITE performance is a useful gauge of resident fund of knowledge and can identify residents at risk of QE failure. We hypothesize that a brief practice exam administered 1-3 times each academic year can identify residents at risk of poor ABSITE performance and also identify early in the chief resident year those at risk for poor QE performance. METHODS In 2005 we began administering 2-3 times/year an approximately 50 question exam consisting of questions authored by residents and edited by faculty based on the ABSITE exam keywords. The exam was considered mandatory and educational time was allotted. Data were analyzed by determining an individual's score deviation from the mean within PGY class. The standard deviation was then compared to the corresponding years ABSITE percentile and in the final year, QE performance using the Spearman rank correlation test. RESULTS A total of 710 individual practice exams were offered and 462 (65.1%) were completed in 9 sessions. Two hundred sixty-three residents completed both a practice examination and ABSITE in the year preceding the administration of the ABSITE. Twenty-six chief residents completed a practice examination in the year immediately preceding the ABS QE. Correlations between practice exam scores and ABSITE score percentile were statistically significant (p= 0.01-0.05) for each year the test was administered. The correlation between the practice exam score for chief residents preceding the QE and first attempt QE score was also significant (r =0.416, p<0.05). CONCLUSIONS A resident's performance on a brief practice exam administered throughout the year is significantly correlated with both ABSITE performance and ABS QE performance. Such a test can be a useful adjunct for identifying residents at risk for poor ABSITE performance as well as identify prior to return of ABSITE scores those residents at risk for poor ABS QE performance.
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Affiliation(s)
- Michael G Corneille
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
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Stewart RM, Geoghegan K, Myers JG, Sirinek KR, Corneille MG, Mueller D, Dent DL, Wolf SE, Pruitt BA. Malpractice Risk and Cost Are Significantly Reduced after Tort Reform. J Am Coll Surg 2011; 212:463-7, 467.e1-42; discussion 467-9. [DOI: 10.1016/j.jamcollsurg.2010.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 12/15/2010] [Indexed: 11/25/2022]
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Corneille MG, Villa C, Wolf S, Michalek JE, Jung I, Wade CE, Myers JG, Dent DL, Mueller D, Stewart RM. Time and degree of glycemic derangement are associated with increased mortality in trauma patients in the setting of tight glycemic control. Am J Surg 2011; 200:832-7; discussion 837-8. [PMID: 21146029 DOI: 10.1016/j.amjsurg.2010.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 07/28/2010] [Accepted: 07/28/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND Tight glucose control (TGC) may reduce mortality in critically ill trauma patients. We hypothesize that euglycemia is beneficial, and a measure considering time and degree of hyperglycemia is most associated with mortality. METHODS We performed a review of intensive care unit trauma patients admitted for more than 3 days between January 2005 and December 2007 on a TGC protocol with a goal of 80 to 110 mg/dL. Hyperglycemic, hypoglycemic, and euglycemic time ranges, and area of interpolated curves above and below 80 to 110 mg/dL were assessed. Associations with mortality were based on logistic regression models adjusted for age, injury severity score, and admission Glasgow Coma Scale score. RESULTS A total of 546 patients were identified, and 68 (13%) died. Time spent as hyperglycemic (P = .29) and hyperglycemic area under the curve (P = .58) were not associated with mortality; hyperglycemic area/time (P = .01) was associated with mortality. Regarding hypoglycemia, area over the curve (P = .009) and time spent as hypoglycemic (P = .002) were associated with mortality. CONCLUSIONS TGC prevents prolonged, high degrees of hyperglycemia; avoiding hypoglycemia likely provides mortality benefit for trauma patients.
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Affiliation(s)
- Michael G Corneille
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Cohn SM, McCarthy J, Stewart RM, Jonas RB, Dent DL, Michalek JE. Impact of Low-dose Vasopressin on Trauma Outcome: Prospective Randomized Study. World J Surg 2010; 35:430-9. [DOI: 10.1007/s00268-010-0875-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sreeramoju P, Porbandarwalla NS, Arango J, Latham K, Dent DL, Stewart RM, Patterson JE. Recurrent skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus requiring operative debridement. Am J Surg 2010; 201:216-20. [PMID: 20832054 DOI: 10.1016/j.amjsurg.2009.12.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 12/09/2009] [Accepted: 12/09/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to examine clinical factors associated with the recurrence of community-onset skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus. METHODS An observational case-comparison study based on a retrospective review of medical records was conducted in a public health system. All patients with community-onset skin and soft tissue infections caused by methicillin-resistant S aureus who underwent operative debridement from January 1999 to December 2003 were included. The outcome of interest was recurrence within 1 year. RESULTS Two hundred fifty-three patients met the criteria for inclusion. Fifty-three (21%) patients returned with recurrent episodes. These patients were compared with 200 patients (79%) who did not develop recurrence. On multivariate analysis, factors independently predictive of recurrence were medical history of abscess requiring surgical debridement within the previous year (adjusted odds ratio, 2.6; 95% confidence interval, 1.4-5.0; P = .002) and obesity (adjusted odds ratio, 3.4; 95% confidence interval, 1.4-8.8; P = .008). CONCLUSIONS Patients with obesity or histories of methicillin-resistant S aureus infection are at significantly increased risk for recurrent soft tissue infection.
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Affiliation(s)
- Pranavi Sreeramoju
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
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Corneille MG, Gallup TM, Bening T, Wolf SE, Brougher C, Myers JG, Dent DL, Medrano G, Xenakis E, Stewart RM. The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy. Am J Surg 2010; 200:363-7. [DOI: 10.1016/j.amjsurg.2009.09.022] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 08/17/2009] [Accepted: 09/21/2009] [Indexed: 01/26/2023]
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50
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Abstract
Traumatic diaphragmatic injuries are uncommon events but are associated with a high mortality. We hypothesize that injury pattern has changed over time with increasing prevalence of blunt injuries. A retrospective chart review was performed of 124 patients who sustained traumatic diaphragmatic injuries over the 20-year period between January 1,1986 and December 31, 2005. Penetrating trauma accounted for 65 per cent (80/124) of all diaphragm injuries, and blunt trauma for 35 per cent (44/124). Mean Injury Severity Scores of 19 ± 9 and 34 ± 13 were observed for the penetrating and blunt trauma groups, respectively ( P = 0.001). Blunt traumatic diaphragm injuries increased from 13 per cent in the first 10-year period to 66 per cent in the second 10-year period ( P = 0.001). The overall mortality was 9 per cent (11/124) with 10 deaths resulting from blunt trauma and one resulting from penetrating trauma ( P < 0.001). The mortality rate increased from 3 to 17 per cent over the two decades ( P = 0.007). Our data suggests that over the last 20 years, the increase in mortality associated with traumatic diaphragmatic injury is primarily related to an increase in the proportion of patients with blunt trauma as a cause of their diaphragmatic injury and associated injuries.
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Affiliation(s)
- Peter P. Lopez
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
| | - Jorge Arango
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
| | - Theresa M. Gallup
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
| | - Stephen M. Cohn
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
| | - John Myers
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
| | - Michael Corneille
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
| | - Ronald Stewart
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
| | - Daniel L. Dent
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, University of Texas Health Science Center, San Antonio, Texas
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