Best poster award: Accuracy of surgery residents' interpretation of computed tomography scans in trauma

Background

We evaluated the accuracy of surgery residents in interpreting computed axial tomography (CT) scans of trauma patients as compared with attending radiologists.

Methods

Residents listed injuries they identified on initial CT scans of trauma patients in a time-stamped computerized system before the official report becoming available. Head, chest, and abdomen/pelvis CT scans were included. We compared the accuracy of these reads with final radiology reports.

Results

There were 84 injuries in 31 patients. Residents correctly identified 25 of 26 (96%) injuries to the head, 28 of 42 (67%) chest injuries, and 15 of 16 (94%) injuries to the abdomen and pelvis. The accuracy of resident reads of chest CT scans was lower (P = .035) than for other body areas. Radiologists' identified 23 of 26 (89%) head injuries, 38 of 42 (90%) chest injuries, and 14 of 16 (88%) injuries in the abdomen and pelvis CT scans. None of the missed injuries were life threatening or required immediate attention.

Conclusions

Surgical residents accurately identify acute injuries on the CT scans of trauma victims.     

Collaboration based on the clinical model can help grow the physician-scientist

Surgeon scientists are a vanishing group, a reason for which may be an initially frustrating experience in the laboratory. This essay proposes a specific plan to improve the first time researcher's bench research experience.     

The role of academic achievements and psychometric measures in the ranking process

Introduction

Ranking candidates for residency positions is challenging. We hypothesize that applicant academic achievements and performance during the interview are equally important in the ranking process.

Is there a need for guidelines for OB/GYN residents to use the laser?

Background and Objective: With the developing technologies and the extensive use of different wavelength lasers for treatment of some gynecologic conditions, many residencies in the United States face pressure to give credentialing to residents wishing to utilize the laser(s). The objective of this study was to assess the need for credentialing. Study Design/Materials and Methods: A survey was sent to all U.S. program directors of obstetrics and gynecology. Results: Of 281 surveys mailed, 138 responded (49.1%); 136 utilized some wavelength laser in the treatment of some gynecologic conditions. The most commonly used laser was the carbon dioxide (CO₂), and the least used was the argon laser. Eighty-four programs (61.8%) had a written policy; 54 (38.2%) did not. Postgraduate courses were necessary in 81 programs (59.6%), leading to some form of credentialing. Conclusions: The vast majority of programs (98.6%) utilized some wavelength laser as a therapeutic modality in gynecology, and 73.5% of the residency programs would like standardized guidelines for residents. © 1995 Wiley-Liss, Inc.     

Medical student operative experience correlates with a match to a categorical surgical program

BACKGROUND: Interest in general surgical residencies has decreased significantly. Because medical student clerkship experiences may affect specialty preferences, we attempted to determine if the degree of exposure to surgical procedures influenced career choices. METHODS: Operations observed by students who completed the third-year surgical clerkship between 1998 and 1999 were reviewed. These 146 medical students, who matched to residency training programs in March 2000, were then divided into three groups based upon residency fields. Surgical case exposures were then compared between the groups. RESULTS: The total number of operations observed was similar between the groups. However, students who matched into categorical general surgical programs participated in significantly more abdominal and general surgical procedures than those matching in surgical subspecialty or nonsurgical residencies (P < 0.01). CONCLUSIONS: There appears to be a correlation between surgical case exposure during the third-year clerkships and future residency fields. Thus, the degree of exposure to surgical procedures may influence medical student career choices.     

Thoracic surgery residency program and health care system in the United States

The Japanese Board of General Surgery as well as the Japanese Board of Thoracic Surgery voted to change the educational and training requirements for certification eligibility. The health care system has been modified due to a reduction of the budget for national health care, such as introduction of Diagnosis Related Groups (DRG)/Prospective Payment System (PPS). Several problems regarding the system have already been discussed in the United States, ranging from 30-year experience of residency program to 20-year experience of health care system. In a residency requirement, training period became longer in Japan than in the United States, although number of cases required is ten times less in Japan. The General Surgery Board now became mandatory in Japan, whereas optional in the United States. Inter-program transfer is possible in the United States, but not in Japan. Quality control has been organized for Thoracic Surgery in the United States, but the Japanese counterpart needs more work. In health care system, health insurance is mandatory and operated publicly in Japan while the United States counterpart is mostly optional and managed privately. Malpractice suits are 7–8 times more frequent in the United States. DRG/PPS health care system was temporarily useful in reducing the national budget for health care in the United States. However, an incentive to treat patients with uncomplicated diseases and short hospital stay increased the expenditure. In order to control this, Peer Review Organization has been established and restricted the physician’s activities. Because health insurance is optional in the United States, people opt for cheaper health insurance with greater benefits. So the health insurance companies with huge number of customers have had strong opinions over physicians and hospitals. This also has created restrictions on practice. These potential problems may occur shortly in the Japanese residency program and health care system as well. Thus, preventive strategies may be needed. Read at the Fifty-sixth Annual Meeting of the Japanese Association for Thoracic Surgery, Symposium, Tokyo, November 19–21, 2003.     

The longitudinal study of surgical residents, 1994 to 1996

Background: The American College of Surgeons (ACS) has conducted a detailed annual survey of residents enrolled in surgical graduate medical education (GME) programs since 1982 and has regularly published the resulting data as the Longitudinal Study of Surgical Residents. This report documents surgical resident enrollment and graduation for the academic years 1994–95 and 1995–96.

Study Design: The Medical Education Research and Information Database of the American Medical Association was supplemented by the existing ACS Resident Masterfile and by personal contact with program directors and their staffs to verify accuracy and completeness of reporting. Each resident was tracked individually through surgical GME.

Results: The total number of surgical residents graduating from surgical GME in 1995 and 1996 has not changed since 1982. Most graduates of surgical residency programs are in obstetrics and gynecology, followed by general surgery; demographic analysis of the graduating cohort shows that most are Caucasian male graduates of US or Canadian medical schools, and that their age at graduation is 33 to 35 years. International medical graduates (IMG) make up 8.9% of entering surgical residents and 6% of graduates. Osteopathic medical school graduates account for 1.2% to 1.3% of entering and graduating surgical residents.

Women represent 27% of entering and 23% to 24% of graduates of surgical GME. The largest number and proportion of women in surgical GME are enrolled in obstetrics and gynecology residency programs, where they make up the majority of entering and graduating classes. When all other surgical residency program enrollments are considered together, women make up 17% and 16% of entering residents in 1994 and 1995, respectively, and 13% and 14% of graduates in those years.

Conclusions: Surgical GME enrollment and graduation is stable. Few women and ethnic minorities are enrolled in surgical residency programs. IMG enrollment and graduation in surgical GME is low.     

The integration of laparoscopy into a surgical residency and implications for the training environment

Although laparoscopic cholecystectomy is now an accepted part of resident training, the impact of operative laparoscopy (OL) upon the residency environment has not been examined in detail. We reviewed the first 3 years' experience with OL and the process by which it was introduced into our residency program. Data were obtained from our prospective computerized surgical laparoscopic registry as well as from a survey conducted midway in this experience. At that time, a questionnaire was sent to current residents in the program and residents who graduated after the inception of the OL program were interviewed by telephone.OL cases increased each year and comprised a progressively greater percentage of total cases. Residents performed over 97% of cases, with attending surgeons as first assistants. Initially, only senior-level residents participated as surgeons; however, after the first year we noted a significant tendency for cases to filter down the ranks. Junior-level residents have already participated in more laparoscopic than open cholecystectomies and expressed considerable concern about training in open procedures. Graduated residents without exception were able to obtain privileges to perform OL without additional training. They did not feel that resident education was compromised by the advent of laparoscopy. Both current and graduated residents considered didactic sessions including animal laboratories and simulators an important part of training.With appropriate use of didactic sessions, simulators, and animal laboratories, a radically new procedure (OL) can be successfully introduced into a surgical residency program and subsequently taught through conventional means.F. F. Muakkassa is presently in practice in Akron, OHP. B. Wilton is presently in practice in St. Paul, MNPresented at the annual meeting of the Association of Program Directors in Surgery, Dallas, Texas, USA, 27 February 1993     

Integrated residency is associated with an increase in women among vascular surgery trainees

BackgroundDuring the past decade, the proportion of women within graduate medical education has increased. Correspondingly, the proportion of women in almost every specialty has increased, including surgical specialties. We sought to evaluate the effect of establishing vascular surgery integrated residencies (VSIRs) on the proportion of women in vascular surgery training programs.MethodsResident data were obtained from the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book for the academic years 2007 to 2016. Data were collected on overall ACGME residency numbers as well as on the following surgical subspecialties: vascular, general, thoracic, neurologic, orthopedic, otolaryngologic, and urologic surgery. The number and proportion of women per year in VSIRs and vascular surgery fellowships were compared with those in the other surgical specialties.ResultsDuring the study period, the proportion of women in ACGME-accredited residency programs increased from 0.41 (n = 43,695/107,851) to 0.44 (n = 57,130/129,720) of residents. Since the advent of the VSIR, the number of trainees within vascular surgery has increased by 56% from 221 to 501 trainees. The proportion of women in vascular surgery training programs has increased from 0.12 (n = 27/221) to 0.33 (n = 164/501) of trainees. This increase during the 9-year study period was greater than in any other surgical subspecialty and greatest within the VSIR. Compared with fellowship training programs, integrated surgical training programs within the same subspecialty had a higher proportion of women, although variability between surgical subspecialties remained notable.ConclusionsAlthough it is lower than the proportion of women within all graduate medical education training programs, an increasing proportion of women have entered vascular surgery training during the study period. This appears to be related to the introduction of VSIRs and exceeds the proportion of women entering almost all other surgical subspecialties at a rate of change faster than in all other surgical subspecialties. Further work to understand surgical specialty preferences and choice of careers after training is warranted.     

What is needed to become a good surgeon?

This lecture has been delivered as a part of the RBSS-BAST symposium ‘What does it need to become a good surgeon’. The lecture relates to the evolution that has taken place over the last decades in relation to the training in surgery. It also gives some hints to younger colleagues how to make a successful career in surgery.     

Handoffs in general surgery residency,an observation of intern and senior residents

Background

Handoffs have become an area of concern as duty-hour restrictions impose an increasing number of shift changes. The objective of this study was to study handoffs in a general surgery residency and identify problems that exist in the current handoff process in preparation for a standardized implemented protocol.

Methods

A resident researcher observed resident-to-resident handoffs for 5 surgical service teams, Monday through Friday, for the middle 2 weeks of the 3rd month of the academic year. Each handoff was observed for the presence, absence, or inconsistency of code status; anticipated problems; active problems; current baseline status; pending tests or consults; and closed-loop communication.

Results

Thirty-eight residents in 2010 were observed, with a total of 52 handoffs ranging from 1 to 27 minutes in length. Five handoffs (10%) were by phone, 47 handoffs (90%) were observed in person, 10 handoffs (19%) were by senior residents, and 37 handoffs (71%) were performed by junior residents. Of the 47 in-person handoffs, code status was mentioned in 2 (4%), and 6 (12%) were given written notes. Of the 37 intern handoffs, the presence of measured criteria occurred in the following percentages: 59% for anticipated problems, 70% for active problems, 51% for current baseline status, 64% for pending tests or consults, and 81% for closed-loop communication. Of the 10 senior-level handoffs observed, all consistently included the previously mentioned criteria.

Conclusions

This study demonstrates the lack of consistency and propensity for error in unstructured handoffs among junior residents. The finding that senior-level residents exhibited consistently proficient handoffs demonstrates that handoffs are a learned skill. Therefore, teaching junior residents a structured handoff supervised by senior residents would most likely reduce the inconsistency and error-prone nature of the junior-level handoffs observed in our study.