Gender trends in applicants to general surgery residency programs in Canada

BackgroundSurgical disciplines lag behind non-surgical disciplines in attracting female trainees. Female representation of Canadian General Surgeons has not been evaluated in recent years in the literature. The objectives of this study were to assess gender trends in applicants to Canadian General Surgery residency programs and practicing general surgeons and subspecialists.MethodsThis retrospective cross-sectional study analyzed gender data for residency applicants ranking General Surgery as their first-choice discipline from publicly-available annual Canadian Residency Matching Service (CaRMS) R-1 match reports from 1998 to 2021. Aggregate gender data for practicing female physicians in General Surgery and related subspecialties, including Pediatric Surgery, obtained from annual Canadian Medical Association (CMA) census from 2000 to 2019 was also analysed.ResultsThere was a significant increase in the proportion of female applicants from 34% in 1998 to 67% in 2021 (p < 0.001) and of successfully matched candidates from 39% to 68% (p = 0.002) from 1998 to 2021. Success rates between male and female candidates were significantly different in 1998 (p < 0.001), but not in 2021 (p = 0.29). The proportion of practicing female General Surgeons also significantly increased from 10.1% in 2000 to 27.9% in 2019 (p = 0.0013), with variable trends in subspecialties.ConclusionGender inequality in General Surgery residency matches has normalized since 1998. Despite females representing more than 40% of applicants and successfully matched candidates to General Surgery since 2008, a gender gap still exists amongst practicing General Surgeons and subspecialists. This suggests the need for further cultural and systemic change to mitigate gender disparities.Type of studyOriginal research article, clinical research.Level of evidenceLevel III (Retrospective cross-sectional study).     

Orthopaedic faculty trauma call policies: a survey of accredited orthopaedic residency programs

The purpose of the study was to determine the practices and policies for trauma call for orthopaedic faculty at residency training programs. A 2-page survey was mailed to the chairs of 141 nonmilitary, accredited residency programs. Responses were received from 106 (75% response rate). Of the responders, 97 (91.5%) of the programs were associated with a Level 1 trauma center. All faculty took trauma call in 44% of programs. The chair took trauma call in 60% of the programs. In 35% of programs, full-time faculty earned additional compensation for taking call. The source of this compensation for full-time faculty was the hospital alone in 72%. In 32 programs, a per-diem stipend (mean $696, range $100-1,500) was provided. In 59% of programs, there was a specific orthopaedic "trauma team" that took over patient care from other faculty members after call. Thirty-three percent of programs had a policy concerning age when a full-time faculty member went off trauma call. Of these, faculty came off call at age 50 years in 11% of programs; at age 55 years in 29%; at age 60 years in 40%; at age 65 years in 9%; and "other" in 11%. Twenty percent of chairs responded that trauma call adversely affected the chair's ability to recruit new faculty. There was a wide variety of policies concerning orthopaedic faculty trauma call. Additional studies on faculty trauma call are warranted.     

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.     

Emergency preparedness for biological and chemical incidents: a survey of anesthesiology residency programs in the United States

We surveyed health care professionals about their preparations to manage the clinical problems associated with patients exposed to hazardous substances, including weapons of mass destruction (WMD). Training for WMD is considered a key part of public health policy and preparedness. Although such events are rare, when they do occur, they can cause mass casualties. In many models of mass casualty management, anesthesiology personnel are responsible for treating patients immediately on arrival at the hospital. We studied the extent of training offered to anesthesiology personnel in the use of WMD protective gear and patient management in United States (US) anesthesiology residency programs. Information was obtained via an online survey to all program directors and chair persons of anesthesiology programs. We polled all of the 135 US anesthesiology programs of which 90 (67%) responded. Only 37% had any form of training, and many of them did not repeat training after initial sessions. Twenty-eight percent of programs east of the Mississippi River reported some form of training whereas only 17% of programs west of it reported training available. The majority of anesthesia residency programs in the US that responded to our survey provided little or no training in the management of patients exposed to WMD. IMPLICATIONS: In an attack involving weapons of mass destruction or toxic chemicals, anesthesiologists will provide care. Our survey of United States anesthesiology residency programs demonstrated that there is limited training of residents regarding the anesthetic management of patients injured by weapons of mass destruction. This has serious public health implications.     

Vascular surgery training in general surgery residency programs: the Canadian experience

OBJECTIVES: Vascular surgery is traditionally considered a component of general surgery. There is growing evidence of improved patient outcome related to surgeon volume and vascular certification status. The American Board of Surgery in the United States, as well as until recently the Royal College of Physicians and Surgeons in Canada, requires that vascular surgery be considered an essential content area of general surgery training. This requirement is controversial. The purpose of this study was to describe experience and perceived competence in common vascular surgery procedures during general surgery residency training in Canada. METHODS: This web-based survey was conducted between January and June 2002. General surgery program directors (GSPDs), vascular surgeons involved in general surgery training programs (VSs), and senior general surgery residents (SRs) from the 13 English-speaking general surgery programs in Canada were surveyed. Questions were asked regarding which vascular surgery procedures are appropriate for general surgeons to perform, which procedures SRs are trained to perform, and which procedures SR intend to perform. RESULTS: The response rate was 62% for GSPDs, 57% for VSs, and 45% for SRs. Overall, 49% of SRs did not intend to perform any vascular procedures after training. GSPDs, VSs, and SRs indicated that most SRs should be and are trained to perform varicose vein surgery, leg amputation, and femoral embolectomy (P >.05). In addition, GSPDs, VSs, and SRs indicated that SRs should not be and are not trained to perform infrainguinal bypass grafting, carotid endarterectomy, or abdominal aortic aneurysm (AAA) repair (P >.05). There were significant differences with respect to ruptured AAA repair: 49% of SRs, 25% of PDs, and only 12% of VSs believe that general surgeons should be trained to perform ruptured AAA repair (P <.05). Overall, 76% of VSs believe SRs receive too little vascular training. CONCLUSION: There is similarity between GSPDs, VSs, and SRs with respect to vascular surgery training in Canadian general surgery programs. Vascular surgery training cannot be considered a component of general surgery. More rotations or fellowship training is required to become competent in management of common vascular surgery procedures. Perhaps this level of competence should not be an objective of general surgery training.     

High value care education in general surgery residency programs: A multi-institutional needs assessment

BackgroundThe ACGME mandates that residency programs provide training related to high value care (HVC). The purpose of this study was to explore HVC education in general surgery residency programs.MethodsAn electronic survey was distributed to general surgery residents in geographically diverse programs.ResultsThe response rate was 29% (181/619). Residents reported various HVC components in their curricula. Less than half felt HVC is very important for their future practice (44%) and only 15% felt confident they could lead a QI initiative in practice. Only 20% of residents reported participating in a root cause analysis and less than one-third of residents (30%) were frequently exposed to cost considerations.ConclusionFew residents feel prepared to lead quality improvement initiatives, have participated in patient safety processes, or are aware of patients’ costs of care. This underscores the need for improved scope and quality of HVC education and establishment of formal curricula.     

Evaluation, feedback, and remediation in anesthesiology residency training: a survey of 124 United States programs.

STUDY OBJECTIVE: To provide a review of evaluation, feedback, and remediation methods in United States residency programs during 1995 to 1996. The information gathered is to serve as a framework for discussions within and among programs regarding ways to enhance their current processes of evaluation, feedback, and remediation, and to serve as a baseline for future assessments. DESIGN, SETTING AND SUBJECTS: A three-page survey was mailed to program directors of each of the 145 anesthesiology programs listed in the Accreditation Council for Graduate Medical Education (ACGME/NRMP) Directory. MEASUREMENTS AND MAIN RESULTS: Quantitative and qualitative responses were sought about the resident evaluation process (including techniques of gathering information, frequency of evaluations, faculty compliance, and modes of offering feedback), departmental clinical competence committee, probation and remediation policies for problem residents, and the use of formal examinations. There was an 85.5% response rate. Frequency of evaluation of residents ranged from daily to quarterly: evaluations used both narrative comments and rating scales in 89% of institutions. Faculty compliance in the evaluation process was greater than 75% in 45.1% of programs. Only 25 (20.2%) programs offered formal training about resident evaluation to their faculty. Clinical competence committee meetings averaged five times annually. Ninety-five percent of committees were chaired by someone other than the department chairperson and 27% had resident members. A written policy regarding problem residents was used by 67.7% of programs, a formal probation policy by 82.2%. Standardized tests to provide feedback and guidance to residents existed in 48.3% of programs. CONCLUSIONS: There is a tremendous variety of techniques and methodologies employed among anesthesiology residency programs with regard to evaluation, feedback, and remediation, within the framework of the ACGME guidelines. Faculty training in the assessment of and feedback to residents is one area in which many programs can begin to strengthen their current procedures.     

Survey of implant training in oral and maxillofacial surgery residency programs in the United States.

PURPOSE: The status of implant training in US oral and maxillofacial surgery programs has been reported previously based on data gathered from residency program directors. Since the time of those earlier surveys, however, many new technological and surgical developments have occurred in implant therapy. The purpose of this study was to evaluate the current status of implant training in oral and maxillofacial surgery residency programs in the United States. MATERIALS AND METHODS: E-mail invitations were sent to 559 resident members of the American Association of Oral and Maxillofacial Surgeons asking them to participate in an online survey between January 23 and February 6, 2006. Each survey invitation was assigned a unique URL so that each resident could respond only once to the survey during the specified interval. The survey contained 17 questions assessing various aspects of training in implant placement. RESULTS: A total of 201 completed surveys were received by the specified deadline. The participation rate was roughly similar in residents of 4-year certificate programs and those of 6-year MD combined programs (56% vs 44%). In total, 48% of residents reported receiving less than 20 hours of didactic training in implantology per year, and 57% reported using 2 or fewer implant systems. Some 57% estimated that they would place fewer than 20 implants in the coming year, whereas 52% reported that they would place more than 50 implants during their residency. Interestingly, 98% of the residents reported that implant dentistry would be an important part of their practice, but 28% felt inadequately prepared by residency training. CONCLUSIONS: There is a broad range of experience in implant training in US oral and maxillofacial surgery residency programs. Almost all oral and maxillofacial surgery residents feel that implant dentistry will be an important part of their practice; however, many residents feel that their training during residency has not adequately prepared them for implant surgery. Our findings identify a potential need for additional training in implant surgery during oral and maxillofacial surgery residency.     

Characteristics of pediatric non-cardiac eCPR programs in United States and Canadian hospitals: A cross-sectional survey

ObjectiveTo characterize practices surrounding pediatric eCPR in the U.S. and Canada.MethodsCross-sectional survey of U.S. and Canadian hospitals with non-cardiac eCPR programs. Variables included hospital and surgical group demographics, eCPR inclusion/exclusion criteria, cannulation approaches, and outcomes (survival to decannulation and survival to discharge).ResultsSurveys were completed by 40 hospitals in the United States (37) and Canada (3) among an estimated 49 programs (82% response rate). Respondents tended to work in >200 bed free-standing children's hospitals (27, 68%). Pediatric general surgeons respond to activations in 32 (80%) cases, with a median group size of 7 (IQR 5,9.5); 8 (20%) responding institutions take in-house call and 63% have a formal back-up system for eCPR. Dedicated simulation programs were reported by 22 (55%) respondents. Annual eCPR activations average approximately 6/year; approximately 39% of patients survived to decannulation, with 35% surviving to discharge. Cannulations occurred in a variety of settings and were mostly done through the neck at the purview of cannulating surgeon/proceduralist. Exclusion criteria used by hospitals included pre-hospital arrest (21, 53%), COVID+ (5, 13%), prolonged CPR (18, 45%), lethal chromosomal anomalies (15, 38%) and terminal underlying disease (14, 35%).ConclusionsWhile there are some similarities regarding inclusion/exclusion criteria, cannulation location and modality and follow-up in pediatric eCPR, these are not standard across multiple institutions. Survival to discharge after eCPR is modest but data on cost and long-term neurologic sequela are lacking. Codification of indications and surgical approaches may help clarify the utility and success of eCPR.Level of evidence4     

The state of general surgery residency in the United States: program director perspectives, 2001

HYPOTHESIS: Current demographic patterns and lifestyle factors of general surgery residents may contribute to recent changes in recruitment patterns. DESIGN: Survey addressing the characteristics of general surgery residency, including demographic data, 3-year recruitment and retention trends, and working conditions of general surgery residents. PARTICIPANTS: A convenience sample of all residency program directors in attendance at the 2001 Surgical Education Week was given the opportunity to voluntarily complete the survey. RESULTS: A total of 109 program directors responded to the survey. Women constitute 25% of all current general surgery residents: 66% of the program directors perceived a decline in the number of applicants for general surgery residency. Recruitment patterns differ significantly between small (< or =4 categorical residents per year) and large (>4 categorical residents per year) residency programs. Residents at large programs averaged a 95-hour workweek, whereas those at small programs averaged an 88-hour workweek (P =.01). The mean 1-year attrition rate for general surgery residents was 20.2% in 2000, and attrition showed no relationship to program size, gender composition, or working conditions. CONCLUSIONS: Women remain underrepresented in general surgery residency. Recruitment and match statistics show some variation, but the relevance of a shrinking applicant pool to these changes is unclear. Resident working conditions remain a difficult issue, and attrition rates continue to be significant. A substantial research agenda remains in graduate surgical education.     

Laparoscopy training in United States obstetric and gynecology residency programs.

OBJECTIVES: To assess laparoscopic training curriculums in US Obstetrics and Gynecology residency programs. METHODS: A list of E-mail addresses was obtained for the accredited Obstetrics and Gynecology residency programs in the US from the CREOG Directory of Obstetric-Gynecologic Residency Programs and Directors. An E-mail survey containing 8 questions regarding laparoscopy training was sent to all residency directors with current E-mail addresses. RESULTS: Seventy-four residency directors responded to the survey for a response rate of 41%. Residency programs from all sections of the US were included in the study. Results of the survey indicate that 69% of residency programs had implemented a formal laparoscopy training program. At least half of the program directors surveyed stated that lack of faculty time and funds were the main barriers to laparoscopic surgery training. Seventy-two percent of those surveyed thought that in the future the health-care industry would demand proof of competency in laparoscopy as standard of care. CONCLUSIONS: Most US Obstetrics and Gynecology residency programs have implemented a formal laparoscopy training curriculum, use more than one method to train their residents, and involve almost half of their faculty on average in training residents to perform laparoscopic surgery.     

A survey of robotic surgery training curricula in general surgery residency programs: How close are we to a standardized curriculum?

Background

Robotic surgery is increasingly adopted into surgical practice, but it remains unclear what level of robotic training general surgery residents receive. The purpose of our study was to assess the variation in robotic surgery training amongst general surgery residency programs in the United States.

Controlled substance dispensing and accountability in United States anesthesiology residency programs.

Controlled substance dependence (CSD) among anesthesiology personnel, particularly residents, has become a matter of increasing concern. Opinions vary as to the effectiveness of controlled substances (CS) accountability in deterring, identifying, or confirming CSD. A survey of program directors of American anesthesiology training programs was conducted in the summer of 1990 to determine the level of CS dispensing and accountability within their programs. The survey demonstrated that CS dispensing and accountability varied considerably among programs, among hospitals associated with individual programs, and within geographically distinct anesthesia delivery areas within the separate hospitals. Nevertheless, most institutions were moving toward improved methods of CS dispensing and providing more and better CS accountability. The presence of significant CSD, particularly among anesthesiology residents, was reconfirmed. We were unable to correlate the level of accountability of CS with the incidence of CSD. It remains to be seen to what extent CS accountability will continue to develop and whether CSD prevalence will then be changed.     

A comparison of Internet usage between two residency programs in the United Kingdom and the United States

STUDY OBJECTIVE: To survey the pattern of use and availability of the Internet among anesthesia residents. DESIGN: Survey questionnaire. SETTING: University hospital. MEASUREMENTS: A postal questionnaire of Internet attitudes and usage was sent to trainees in Anesthesiology in two training programs: the University of New Mexico, Albuquerque, NM (UNM) and the North West Regional Health Authority, Manchester, UK (NWR). A repeat questionnaire was sent to nonresponders after 4 weeks. Telephone interviews were conducted with hospital administration to determine availability and cost of the Internet. MAIN RESULTS: Response rates were 67% (82/122) from the NWR and 83% (25/31) from UNM. Compared with NWR, residents at UNM used the Internet longer for general (median 3 vs. 2 yrs; p < 0.001) and medical (median 2 vs. 1.2 yrs; p < 0.001) purposes. All (31/31) UNM trainees and 73% (89/122) of NWR trainees had Internet access. More NWR trainees who had Internet access at work (60/61; 98%) used it for medically related purposes than those without work access (17/21, 81%; p < 0.001). More UNM trainees (19/25; 76%) accessed web sites other than those of official national organizations than did NWR trainees (40/82, 49%; p = 0.046). Approximately 75% of all trainees access web sites of the Association of Anesthetists and Royal College of Anesthetists (in the NWR) the American Society of Anesthesiologists (ASA) and American Board of Anesthesiology (in UNM) and online journals. The most popular sites were GASNET (Global Anesthesiology Server Network; NWR) and ASA (American Society of Anesthesiologists; UNM). Both UNM and NWR trainees perceived the Internet as supplying useful and accurate information. CONCLUSIONS: If the reported survey results are representative of Internet use among anesthesia residents in the United States and UK, Internet access at work is associated with greater Internet use for medical purposes, perhaps in part because residents perceive it to be a convenient and accurate resource.     

Acute general surgery in Canada: a survey of current handover practices

Background

Today’s acute care surgery (ACS) service model requires multiple handovers to incoming attending surgeons and residents. Our objectives were to investigate current handover practices in Canadian hospitals that have an ACS service and assess the quality of handover practices in place.

Methods

We administered an electronic survey among ACS residents in 6 Canadian general surgery programs.

Results

Resident handover of patient care occurs frequently and often not under ideal circumstances. Most residents spend less than 5 minutes preparing handovers. Clinical uncertainty owing to inadequate handover is most likely to occur during overnight and weekend coverage. Almost one-third of surveyed residents rate the overall quality of the handovers they received as poor.

Conclusion

Handover skills must be taught in a systematic fashion. Improved resident communication will likely decrease loss of patient information and therefore improve ACS patient safety.     

MIS training in Canada: a national survey of general surgery residents

Background  

General surgery trainees’ perceptions regarding their own laparoscopic training remain poorly defined. The objective of this survey was to identify and evaluate learner experiences with laparoscopic procedures in general surgery programs on a national level.     

The status of ultrasonography training and use in general surgery residency programs

BACKGROUND: Effective use of ultrasonography (US) by surgeons was demonstrated a decade ago. Major surgical organizations now require its incorporation into surgical training and practice. But little information about the teaching of US to surgical residents exists. This study assesses the current status of US training in general surgery residency programs. STUDY DESIGN: A survey was mailed to the directors of 255 Accreditation Council for Graduate Medical Education-accredited general surgery residency programs. It questioned whether and how US was taught, who performed the examinations, and the types of US performed. Data were analyzed using chi-square tests comparing university versus community programs and training and practice in trauma US versus training in other US modalities. RESULTS: The response rate was 51% (130 of 255). Ninety-six percent of the programs responding taught US, with no differences between university- and community-based training programs in presence of training. Focused Assessment for the Sonography of Trauma (FAST) instruction was done by 79% (hands-on) and 68% (didactic) of programs that responded. Abdominal, laparoscopic, breast, endocrine, and vascular US were each taught less frequently (22% to 55%). Program directors at university programs reported that their attending surgeons performed FAST and abdominal US more often than their community counterparts (71% and 31% versus 47% and 14%). Program directors reported that university trainees performed laparoscopic, endocrine, and vascular US more often than community surgery residents (47%, 17%, 35% versus 29%, 3%, 19%). Program directors reported that surgery attendings or residents performed trauma and laparoscopic US more often than their radiology counterparts, and radiology attendings or residents performed more abdominal, breast, endocrine, and vascular US. CONCLUSIONS: The majority of general surgery residency programs whose directors responded to this survey are teaching US, but most of the training is in FAST. There is no difference in the reported presence of overall US training between university and community programs. But university programs report that their surgeons or residents performed more US in all areas (other than breast) than their community counterparts reported.