Program Directors’ Perspective of Transplant Training during General Surgery Residency

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) began to mandate “a formal transplant experience” rather than a formal rotation to allow programs more flexibility. What constitutes a “transplant experience” or how to optimize such education remains unclear. The objectives of this study were to identify changes in residents’ transplant exposure and determine the opinions of program directors (PDs) in response to the new requirements. A 15-item questionnaire was sent to all general surgery PDs. Demographics, resident experiences, and PDs’ opinions regarding transplant rotations were collected. The response rate was 50 per cent from university and community programs at transplant and nontransplant centers. Although 55 per cent of PDs felt transplant should not be a required rotation, 92 per cent of programs reported having a formal rotation. Transplant rotations should be four months or less, according to 97 per cent of PDs. Most PDs (93%) think there should not be a minimum number of required transplant operations. Whether residencies were based at transplant centers or size of residencies did not affect PDs’ responses. Transplant requirements were similar between residency programs regardless of PD opinions. Survey participants provided diverse feedback regarding this controversial topic. The new ACGME requirements have made little impact on program requirements. Most programs still mandate a formal transplant rotation. Diverse opinions exist regarding whether such a rotation should be required, highlighting the controversial nature of this issue. To facilitate education in an era of limited work hours, the ACGME changed requirements of general surgery programs to mandate “a formal transplant experience” rather than a transplant rotation. A survey of program directors revealed that although only 45 per cent of support mandatory transplant rotations, 93 per cent of programs still require transplant rotations despite the more lax ACGME requirements. This finding suggests a lack of suitable alternative to provide exposure to the concepts fundamental to transplant surgery, which are valuable in general surgery education.

Simulation training improves resident performance in hand-sewn vascular and bowel anastomoses

BACKGROUND

Surgical training has recently emphasized simulation-based training of core surgical skills and tasks such as bowel and vascular anastomoses. This may increase efficiency of training within the operating room. Objective data regarding the effectiveness of instruction or monitoring progress in simulating vascular and bowel anastomoses are lacking. The aim of this study is to provide subjective and objective assessments of simulation-based training among residents in hand-sewn vascular and bowel anastomoses.

METHODS

Residents received vascular and bowel anastomoses training. Each resident fashioned anastomoses on both cadaveric saphenous veins and small bowel. The residents repeated the anastomoses 1 week later. Performances were assessed subjectively and objectively by questionnaire, operative time, objective structured assessment of technical skills (OSATS) score, and leak pressures of the finished anastomosis.

RESULTS

Of 14 residents, 12 felt more confident with bowel anastomoses after the laboratory session, and 10 were more confident with vascular anastomoses. For vascular anastomoses, the operating time decreased (15.4 vs 14.2 minutes, p = 0.3), OSATS scores improved (14.9 vs 15.6, p = 0.15), and leak pressures improved (38.9 vs 71.8psi, p = 0.001) from the first to the second workshop. For bowel anastomoses, the operating time decreased (23 vs 18 minutes, p < 0.001), OSATS scores improved (12.9 vs 14.4, p < 0.001), and leak pressures improved (17.7 vs 26.9psi, p < 0.001).

DISCUSSION

After simulation-based training, residents performed vascular and bowel anastomoses more adeptly, quickly, and with a higher quality end product. Laboratory training can effectively improve residents' ability to perform anastomoses, which may result in increased efficiency of teaching in the operating room.

The Internet School of Medicine: use of electronic resources by medical trainees and the reliability of those resources

BACKGROUND

Electronic sources of medical information are plentiful, and numerous studies have demonstrated the use of the Internet by patients and the variable reliability of these sources. Studies have investigated neither the use of web-based resources by residents, nor the reliability of the information available on these websites.

METHODS

A web-based survey was distributed to surgical residents in Michigan and third- and fourth-year medical students at an American allopathic and osteopathic medical school and a Caribbean allopathic school regarding their preferred sources of medical information in various situations. A set of 254 queries simulating those faced by medical trainees on rounds, on a written examination, or during patient care was developed. The top 5 electronic resources cited by the trainees were evaluated for their ability to answer these questions accurately, using standard textbooks as the point of reference.

RESULTS

The respondents reported a wide variety of overall preferred resources. Most of the 73 responding medical trainees favored textbooks or board review books for prolonged studying, but electronic resources are frequently used for quick studying, clinical decision-making questions, and medication queries. The most commonly used electronic resources were UpToDate, Google, Medscape, Wikipedia, and Epocrates. UpToDate and Epocrates had the highest percentage of correct answers (47%) and Wikipedia had the lowest (26%). Epocrates also had the highest percentage of wrong answers (30%), whereas Google had the lowest percentage (18%). All resources had a significant number of questions that they were unable to answer.

DISCUSSION

Though hardcopy books have not been completely replaced by electronic resources, more than half of medical students and nearly half of residents prefer web-based sources of information. For quick questions and studying, both groups prefer Internet sources. However, the most commonly used electronic resources fail to answer clinical queries more than half of the time and have an alarmingly high rate of inaccurate information.

Short-term surgical mission to the Dominican Republic: a cost-benefit analysis

OBJECTIVE

This study determines the cost-effectiveness of a recurring short-term surgical mission trip to the Dominican Republic.

BACKGROUND

The global burden of surgical disease is significant. Recent investigations have shown surgical treatment to be cost-effective at established hospitals within low- or middle-income countries (LMIC), drawing attention to surgical diseases world-wide. Another method of providing general surgical care in LMIC is short-term mission trips, but no studies have examined their cost-effectiveness.

METHODS

Consecutive week-long trips by the Midwest Medical Missions Michigan Chapter to the Dominican Republic were studied in 2010 and 2012. All costs were recorded, and operative logs were maintained. Costs of identical procedures carried out at the authors' host institution were estimated. Direct comparisons were made between the cost of surgeries performed in the USA and the estimated amount of money spent on the mission trips attributable to each procedure. Disability-adjusted life years (DALYs) averted were calculated for both trips.

RESULTS

The cost for all cases in 2010 would have been $255,187 if performed at the United States hospital and $398,177 in 2012. The amount actually spent on the trips was $61,924 in 2010 and $82,368 in 2012 - a relative cost-reduction of 79%. 473 DALYs were averted. An average of 6.9 DALYs were averted per patient, and the cost per DALY averted was $304.88.

CONCLUSIONS

The procedures on a surgical mission trip to the Dominican Republic were less expensive than similar care provided in the United States. The cost per DALY averted is low, demonstrating the cost-effectiveness of the trips.

Program directors' perspective of transplant training during general surgery residency

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) began to mandate "a formal transplant experience" rather than a formal rotation to allow programs more flexibility. What constitutes a "transplant experience" or how to optimize such education remains unclear. The objectives of this study were to identify changes in residents' transplant exposure and determine the opinions of program directors (PDs) in response to the new requirements. A 15-item questionnaire was sent to all general surgery PDs. Demographics, resident experiences, and PDs' opinions regarding transplant rotations were collected. The response rate was 50 per cent from university and community programs at transplant and nontransplant centers. Although 55 per cent of PDs felt transplant should not be a required rotation, 92 per cent of programs reported having a formal rotation. Transplant rotations should be four months or less, according to 97 per cent of PDs. Most PDs (93%) think there should not be a minimum number of required transplant operations. Whether residencies were based at transplant centers or size of residencies did not affect PDs' responses. Transplant requirements were similar between residency programs regardless of PD opinions. Survey participants provided diverse feedback regarding this controversial topic. The new ACGME requirements have made little impact on program requirements. Most programs still mandate a formal transplant rotation. Diverse opinions exist regarding whether such a rotation should be required, highlighting the controversial nature of this issue. To facilitate education in an era of limited work hours, the ACGME changed requirements of general surgery programs to mandate "a formal transplant experience" rather than a transplant rotation. A survey of program directors revealed that although only 45 per cent of support mandatory transplant rotations, 93 per cent of programs still require transplant rotations despite the more lax ACGME requirements. This finding suggests a lack of suitable alternative to provide exposure to the concepts fundamental to transplant surgery, which are valuable in general surgery education.

The different effects of structurally related sulfakinins on Drosophila melanogaster odor preference and locomotion suggest involvement of distinct mechanisms

Sulfakinins are myoactive peptides and antifeedant factors. Naturally occurring drosulfakinin I (DSK I; FDDYGHMRFNH(2)) and drosulfakinin II (DSK II; GGDDQFDDYGHMRFNH(2)) contain sulfated or nonsulfated tyrosine. We discovered sDSK II and nsDSK II influenced Drosophila melanogaster larval odor preference. However, sDSK I, nsDSK I, MRFNH(2), and saline did not influence odor preference. We discovered sDSK I and nsDSK I influenced larval locomotion. However, sDSK II, nsDSK II, MRFNH(2), and saline did not influence locomotion. Our novel data suggest distinct mechanisms underlie the effects of DSK I and DSK II peptides on odor preference and locomotion, parameters important to many facets of animal survival.