Are surgical progeny more likely to pursue a surgical career?

BACKGROUND: For nearly two decades, interest in general surgery has been declining among U.S. medical school graduates. Many factors appear to be important in a medical student's choice of a surgical residency and career. We hypothesized that previous exposure to family members who are surgeons would significantly influence a student's decision to pursue a career in surgery. METHODS: Since 2001, nearly 600 third-year medical students completing the general surgery clerkship were issued a pre- and post-clerkship survey. Responses were collected, retrospectively analyzed, and correlated to the 2001-2007 National Residency Matching Program match results. RESULTS: The response rate of students completing both surveys was 87% (n = 510). Based on a numeric scale, surgical progeny (SP) indicated a significantly higher likelihood than nonsurgical progeny (NSP) of pursing a surgical career/residency in the pre-clerkship period (SP mean, 5.1 +/- 0.42; NSP mean, 3.7 +/- 0.11; P = 0.0005). Post-clerkship, SPs noted no more enjoyment from the surgical clerkship than NSPs (SP mean, 7.2 +/- 0.25; NSP mean, 6.9 +/- 0.96; P = 0.91); furthermore, there was no difference in the percentage of students pursuing a surgical residency (categorical or surgical subspecialty) in the National Residency Matching Program match (SP, 12.5%; NSP, 12.7%; P = 1.00). CONCLUSION: These data suggest that previous exposure to a surgeon within the family positively influences a medical student's pre-clerkship interest in pursuing a surgical career. However, this interest is not sustained; SPs and NSPs match into surgical residencies at equivalent rates. Clearly, further studies are needed to identify the factors responsible for this phenomenon.     

The adoption of advanced surgical techniques: are surgical masterclasses enough?

BackgroundThe surgical master class is a traditional method for a surgeon to learn new operations. However, there is limited evidence to support that it can help a surgeon adopt a new technique. The aim of this study was to investigate the adoption of surgical techniques after attendance at a surgical master class.MethodsA questionnaire was sent to surgeons attending surgical master classes in laparoscopic bariatric and colorectal surgery. The questionnaire examined operative experience before attending the master class and the consequent adoption of techniques.ResultsThere was a significant adoption of colorectal procedures, from 33% to 79% (P = .00011), and bariatric procedures, from 27% to 66% (P = .014), after attendance at the surgical master classes.ConclusionsThis study shows a significant increase in surgeons' performing advanced surgical procedures after attendance at a surgical master class. This is the first study to demonstrate the effectiveness of the master class in terms of surgeons' adopting new techniques.     

Picking apart surgical pick lists – Reducing variation to decrease surgical costs

Background

Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity.

Laparoscopic surgical education--the experience of the first surgical unit Iaşi

The classic apprenticeship model for surgical training takes place into the operating theater under the strict coordination of a senior surgeon. During the time and especially after the introduction of minimally invasive techniques as gold standard treatment for many diseases, other methods were developed to successful fulfill the well known three stages of training: skill-based behavior, rule-based behavior and knowledge-based behavior. The skills needed for minimally invasive surgery aren't easily obtained using classical apprenticeship model due to ethical, medico-legal and economic considerations. In this way several types of simulators have been developed. Nowadays simulators are worldwide accepted for laparoscopic surgical training and provide formative feedback which allows an improvement of the performances of the young surgeons. The simulators currently used allow assimilating only skill based behavior and rule-based behavior. However, the training using animal models as well as new virtual reality simulators and augmented reality offer the possibility to achieve knowledge-based behavior. However it isn't a worldwide accepted laparoscopic training curriculum. We present our experience with different types of simulators and teaching methods used along the time in our surgical unit. We also performed a review of the literature data.     

Is surgical clipping becoming underused?

Summary Coil embolization is a treatment for intracranial aneurysms with a particular appeal for posterior circulation aneurysms. However, although this procedure is effective in well-selected intracranial aneurysms, it has a series of limitations that may be overlooked as a result of its rapid technological evolution and its minimally invasive appearance. The author analyses the data that lead him to consider that since the introduction of coil embolisation in 1991 and its progressive diffusion, the technique of surgical clipping risks being underused as a therapeutic procedure for intracranial aneurysms because of the shortage of vascular neurosurgeons trained and experienced in its use.     

What predicts surgical internship performance?

BACKGROUND: Variables associated with postgraduate year 1 (PGY-l) performance in surgical training have not been fully defined. METHODS: Mean composite PGY-l evaluation scores were calculated from responses to questionnaires mailed to surgical program directors of 87 surgical graduates from 1997 to 2001. We analyzed evaluation scores for associations with sex, surgical specialty choice, United States Medical Licensing Examination (USMLE) step 1 and step 2 scores, Alpha Omega Alpha (AOA) election, and third-year clerkships' grade point average (GPA). RESULTS: There were significant first-order associations between PGY-l performance evaluation score and each of USMLE step 2 score and GPA. In a multiple linear regression model that included sex, surgical specialty choice, USMLE step l and step 2 scores, AOA, and GPA, USMLE step 2 score was the only significant predictor of PGY-l performance. CONCLUSIONS: Multiinstitutional studies are warranted to determine the predictive value of USMLE step 2 scores in residency performance beyond PGY-l and to identify other predictors of surgical PGY-l performance.     

Severe hepatic trauma：surgical strategies

Objective:To probe into effective surgical procedures and improve the outcome of treatment for patients with severe hepatic injury.Methods:A retrospective study involving 113 patients with severe hepatic trauma(AAST grade IV and V) during the past 12 years was carried out.Ninety-eight patients underwent surgical treatment.Surgical interventions including hepatectomy or direct control of bleeding vessels by finger fracture technique with Pringle maneuver, selective ligation of hepatic artery,retrohepatic caval repair with total hepatic vascular occlusion,and perihepatic packing were mainly used.Results:In the 98 patients treated operatively,the survival rate was 69.4%(68/98).Among 40 patients with juxtahepatic venous injury(JHVI),15 were cured with the maximum blood transfusion of 12 000 ml.Eight cases of Grade IV injury treated nonoperatively were cured.The percentage of failure of nonoperative management was 42.9%(6/14).The overall mortality rate was 32.7%(37/113),and 57% of the deaths were due to exsanguinations.Conclusions:Reasonable surgical procedures based on classification of hepatic injuries can increase the survival rate of severe liver trauma.Accurate perlihepatic packing is effective in dealing with JHVI.     

Calcific parasite or surgical miscellany?

This article highlights the difficulties posed by initial radiological investigations that misleadingly interpreted a linear opacity in the ascending colon of a 2-year-old to be a complicating calcified Ascaris. Final surgical management revealed an unusual cause for the tram tracking effect so pathognomonic of Ascaris infestation. Of interest are the images of the abdominal x-ray, ultrasound scan, and barium study.     

What is a surgical oncologist?

Editorial

What is a surgical oncologist?     

Primer: cognitive motor learning for teaching surgical skill--how are surgical skills taught and assessed?

As the practice of surgery evolves, the modalities by which future surgeons are trained must also develop. Traditionally, surgical trainees have learned through a mentorship model, with the majority of cognitive motor learning for surgical skill being initiated and practiced within the operating room. This, however, is no longer the ideal environment in which to acquire surgical skills and, subsequently, many surgical training programs are incorporating the use of other surgical models within their curricula. Training on simulators, ranging from low-fidelity bench models to complex, high-fidelity virtual reality models, seems to be transferable and might prove to be a crucial supplement to the traditional curriculum. Models that are reliable and valid, coupled with objective instruments that measure technical skill, might prove to be useful for evaluation. For a simulator to provide a good assessment of competency, it should either correlate to or predict the person's technical performance in the operating room. More research is, therefore, needed regarding the validity and transferability of various training models, particularly if they are to become a form of assessment for certification or licensure.     

Pediatric surgical capacity building – a pathway to improving access to pediatric surgical care in Haiti

Purpose

Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region.