Geographic maldistribution of general surgery PGYI residents: another US surgical desert

Background

Practicing general surgeons are unevenly distributed across the country. This study evaluates the geographic distribution of categorical, general surgery (GS) PGYI positions per capita.

Methods

Data were obtained from the 2012 National Resident Matching Program match and the 2010 US Census.

Results

The mean for GS PGYI positions per 10⁶ population was 3.85 ± .61; 27 states fell below this value. The 7 American College of Surgeons (ACS) regions ranged from a low of 1.4 ± .50 (Intermountain) to a high of 9.89 ± 4.41 (Northeast). The mean (2.18 ± .34) for the 19 state membership of the Southwestern Surgical Congress was below the mean for the country.

Conclusions

There is a maldistribution of GS PGYI positions compared with state and regional populations, particularly in rural areas. This mirrors the maldistribution of practicing general surgeons across the United States. Additional GS residences and resident positions are urgently needed to correct this “Surgical Desert” of graduate surgical education.     

Perceptions and expectations of cardiothoracic residents and attending surgeons

BackgroundWith our specialty going through a critical phase of re-evaluation and adaptation, our aim was to evaluate and compare the perceptions and expectations among residents and faculty regarding cardiothoracic training.MethodsA content-validated, 13-item survey was distributed electronically from August 14 to August 24, 2010 to 728 cardiothoracic surgery residents, recent program graduates (on or after June 2006), cardiothoracic surgery chairpersons, and program directors identified in the Cardiothoracic Surgery Network database.ResultsThe response rate was 34% (244 of 728). Of the respondents, 76% reported being “satisfied” or “very satisfied” with their program. Faculty willingness to teach in the operating room was ranked as the most valuable aspect of a training program, and strict adherence to the 80-h work week ranked as least valuable. Most respondents believed that a resident performing at least 75% of a case was acceptable for low-complexity procedures (92% of residents, 77% of attending physicians) and at least 25% for high-complexity procedures (91% of residents, 73% of attending physicians). However, residents wanted to perform more of the operations than the attending physicians considered necessary (P < 0.05). Finally, 63% of respondents (73% of residents, 56% of attending physicians) indicated that the increasing scrutiny of outcomes has adversely affected training. Other differences between the residents' and attending physicians' perceptions regarded the importance of participation in preoperative and postoperative care, what constitutes “scut work,” and the value of auxiliary staff.ConclusionsReconciling residents' expectations with the realities of duty-hour restrictions and high-stakes procedures will require the development of novel educational approaches to improve resident learning.     

Nationwide survey on adult type chronic intestinal pseudo-obstruction in surgical institutions in Japan

Background  

No appropriate management of chronic intestinal pseudo-obstruction (CIP) has been established.     

Attitudes and opinions toward surgical research. A survey of surgical residents and their chairpersons.

OBJECTIVE: To learn more about how research in academic surgery is viewed by surgical residents and their chairpersons. SUMMARY BACKGROUND DATA: There is a general perception that a productive experience in a basic science laboratory is an important prerequisite for a successful career in academic surgery. METHODS: An anonymous mail survey of 189 surgical residents entering the laboratory and their chairpersons (n=81) was done. Questions included how a laboratory was chosen by the resident, the importance of a basic science laboratory experience as a prerequisite to an academic career, and the perceived goal or goals of the laboratory experience. Data were analyzed by chi square analysis. RESULTS: The response rate from each group was excellent (80% response for residents, 90% from chairpersons). Of the residents surveyed, 78% were men and 22% were women; 51% entered the laboratory after 2 years of clinical training and 34% after 3 years; 84% did their research at their home institution and 91% worked in a surgeon's laboratory; 51% were scheduled to be in the laboratory for 1 year, 41% for 2 years, and 7% for 3 years. Two thirds of the residents were salaried by the surgery department. Both residents (70%) and chairpersons (86%) felt that the best surgical journal was Annals of Surgery. Both groups ranked Science as the top basic science journal. Twenty-four percent of the residents felt their peers offered the best advice in choosing a laboratory compared to 0% of the chairpersons (p<0.01); chairpersons felt they themselves or the program director were better advisors (chairpersons, 44%, vs. residents, 27%; p<0.01). Chairpersons believed that the principal investigators' previous success with residents was the major factor in determining in which laboratory to work; the residents placed more value on their interest in the project. Eighty-nine percent of women requested to go into the laboratory versus 66% of men (p<0.05). Half of the chairpersons and residents believed the faculty felt pressure on them to get grants; however, 71% of postgraduate year (PGY) residents who were PGY3 sensed this pressure compared to 44% of the PGY2 residents (p<0.01). Being in debt did not adversely influence the decision of 77% of these residents to do research. The residents felt more so than did their chairpersons that basic science research was necessary to be a successful academic surgeon (p<0.01). CONCLUSIONS: Although there are some differences in opinions between surgical residents and surgical chairpersons about the value and purpose of basic science research, these differences should be embraced and serve to enhance openness and discussion. Overall, surgical residents viewed the research experience away from clinical surgery as a positive one. The main reason for going into the laboratory was because of a genuine interest in the scientific method and the academic mission.     

The US AneuRx Clinical Trial: 6-year clinical update 2002

A total of 1193 patients with infrarenal abdominal aortic aneurysms were treated with the AneuRx Stent Graft System at 19 US investigational centers from 1996 to 1999. This report summarizes clinical data collected and analyzed as of August 28, 2002. There have been 10 late (>30 days) aneurysm ruptures, 8 late (>30 days) aneurysm-related deaths, and 38 late (>30 days) surgical conversions, including 8 for rupture. Kaplan-Meier analyses of the primary outcome measures at 4 years indicate the following: a freedom from rupture rate of 98.4%; a freedom from surgical conversion rate of 90.4%; a freedom from aneurysm-related death rate of 96.9%; and a probability of survival rate, based on all-cause mortality, of 62.4%. Secondary outcome measures at 4 years include stent graft patency in 96.4%, endoleak in 13.9%, aneurysm enlargement in 11.5% and stent graft migration in 9.5% of patients. These results provide evidence that the AneuRx Stent Graft System continues to be a safe and effective treatment option for appropriately selected patients with infrarenal abdominal aneurysms.     

Critical care education of surgical residents: a survey of general surgery residency programs

Critical care education may vary in general surgery residency programs because no specific guidelines for this type of training exist. In order to determine the current state of resident education in the ICU, a survey was sent to all general surgery program directors. Of the 217 programs responding, 90% had a dedicated ICU rotation. Surgical residents at the PGY-1 (27%) or PGY-2 (46%) level had a 1- (37%) or 2- (49%) month rotation in the ICU. Teaching formats included: bedside rounds (94% of programs), formal lectures (75%), patient problem-based reading (37%), assigned texts (34%), computers (20%), and videotapes (17%) or audiotapes (10%). Procedures were taught mainly by the senior house staff or faculty. Although the curriculum included a broad spectrum of critical care topics, ventilator management and respiratory failure were the only topics universally covered.Resident education in the ICU varies among general surgery programs. The data from this study establish a baseline for following the educational process as more uniform recommendations are developed and the use of novel educational techniques becomes more common.