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Douglas S Smink - One of the best experts on this subject based on the ideXlab platform.
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underrepresented minorities are underrepresented among General Surgery applicants selected to interview
Journal of Surgical Education, 2019Co-Authors: Benjamin T Jarman, Douglas S Smink, Kara J Kallies, Amit R T Joshi, George A Sarosi, Lily Chang, John M Green, Jacob A Greenberg, Marc L Melcher, Valentine NfonsamAbstract:Objective Diversity is an ill-defined entity in General Surgery training. The Accreditation Council for Graduate Medical Education recently proposed new common program requirements including verbiage requiring diversity in residency. “Recruiting” for diversity can be challenging within the constraints of geographic preference, type of program, and applicant qualifications. In addition, the Match process adds further uncertainty. We sought to study the self-identified racial/ethnic distribution of General Surgery applicants to better ascertain the characteristics of underrepresented minorities (URM) within the General Surgery applicant pool. Design Program-specific data from the Electronic Residency Application Service was collated for the 2018 medical student application cycle. Data were abstracted for all participating programs’ applicants and those selected to interview. Applicants who did not enter a self-identified race/ethnicity were excluded from analysis. URM were defined as those identifying as Black/African American, Hispanic/Latino/of Spanish origin, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander-Samoan. Appropriate statistical analyses were accomplished. Setting Ten General Surgery residency programs—5 independent programs and 5 university programs. Participants Residency applicants to the participating General Surgery residency programs. Results Ten Surgery residency programs received 10,312 applications from 3192 unique applicants. Seven hundred and seventy-eight applications did not include a self-identified race/ethnicity and were excluded from analysis. The racial/ethnic makeup of applicants in this study cohort was similar to that from 2017 to 2018 Electronic Residency Application Service data of 4262 total applicants to categorical General Surgery. Programs received a median of 1085 (range: 485–1264) applications each and altogether selected 617 unique applicants for interviews. Overall, 2148 applicants graduated from US medical schools, and of those, 595 (28%) were offered interviews. The mean age of applicants was 28.8 ± 3.8 years and 1316 (41%) were female. Hispanic/Latino/of Spanish origin, Black, and American Indian/Alaskan Native/Hawaiian/Pacific Islander-Samoan applicants constituted 12%, 8%, and 1% of total applicants, but only 8%, 6%, and 1% of those selected for interview. Overall, 29% of applicants had United States Medical Licensing Examination (USMLE) Step 1 scores ≤220; 37 (6%) of those selected for interviews had a USMLE Step 1 score of ≤220. A higher proportion of URM applicants had USMLE scores ≤220 compared to White and Asian applicants. Non-white self-identification was a significant independent predictor of a lower likelihood of interview selection. Female gender, USMLE Step 1 score >220, and graduating from a US medical school were associated with an increased likelihood of being selected to interview. Conclusions URM applicants represented a disproportionately smaller percentage of applicants selected for interview. USMLE Step 1 scores were lower among the URM applicants. Training programs that use discreet USMLE cutoffs are likely excluding URM at a higher rate than their non-URM applicants. Attempts to recruit racially/ethnically diverse trainees should include program-level analysis to determine disparities and a focused strategy to interview applicants who might be overlooked by conventional screening tools.
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an appraisal of the learning curve in robotic General Surgery
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Luise I M Pernar, Faith C Robertson, Ali Tavakkoli, Eric G Sheu, David C Brooks, Douglas S SminkAbstract:Background Robotic-assisted Surgery is used with increasing frequency in General Surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic General Surgery to inform adopters of the technology.
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an appraisal of the learning curve in robotic General Surgery
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Luise I M Pernar, Faith C Robertson, Ali Tavakkoli, Eric G Sheu, David C Brooks, Douglas S SminkAbstract:Robotic-assisted Surgery is used with increasing frequency in General Surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic General Surgery to inform adopters of the technology. PubMed and EMBASE searches yielded 3690 abstracts published between July 1986 and March 2016. The abstracts were evaluated based on the following inclusion criteria: written in English, reporting original work, focus on General Surgery operations, and with explicit statistical methods. Twenty-six full-length articles were included in final analysis. The articles described the learning curves in colorectal (9 articles, 35%), foregut/bariatric (8, 31%), biliary (5, 19%), and solid organ (4, 15%) Surgery. Eighteen of 26 (69%) articles report single-surgeon experiences. Time was used as a measure of the learning curve in all studies (100%); outcomes were examined in 10 (38%). In 12 studies (46%), the authors identified three phases of the learning curve. Numbers of cases needed to achieve plateau performance were wide-ranging but overlapping for different kinds of operations: 19–128 cases for colorectal, 8–95 for foregut/bariatric, 20–48 for biliary, and 10–80 for solid organ Surgery. Although robotic Surgery is increasingly utilized in General Surgery, the literature provides few guidelines on the learning curve for adoption. In this heterogeneous sample of reviewed articles, the number of cases needed to achieve plateau performance varies by case type and the learning curve may have multiple phases as surgeons add more complex cases to their case mix with growing experience. Time is the most common determinant for the learning curve. The literature lacks a uniform assessment of outcomes and complications, which would arguably reflect expertise in a more meaningful way than time to perform the operation alone.
Jon B. Morris - One of the best experts on this subject based on the ideXlab platform.
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Looking Beyond the Numbers: Increasing Diversity and Inclusion Through Holistic Review in General Surgery Recruitment.
Journal of surgical education, 2020Co-Authors: Ariel Nehemiah, Sanford E. Roberts, Yun Song, Rachel R. Kelz, Paris D. Butler, Jon B. Morris, Cary B. AaronsAbstract:Objective The purpose of this study is the examine the effect of a holistic review process on the recruitment of women and students underrepresented in medicine (UIM) in a General Surgery residency program. Design A retrospective study comparing the proportion of women and UIM students ranked and matched into categorical positions from 2013 to 2020 before and after the implementation of the holistic application review process. United States Medical Licensing Exam (USMLE) scores and American Board of Surgery In-training Exam (ABSITE) scores were also compared between groups. Setting General Surgery residency program at a tertiary, academic center. Participants Medical students applying for and matriculated to categorical positions. Results After the implementation of holistic review in 2017, there was a statistically significant increase in the proportion of women (42% vs. 61%, p Conclusions Increasing emphasis is being placed on the diversification of residency training to reflect an expanding, diverse patient population. The incorporation of a holistic review process, providing broader assessment of applicants, can play a pivotal role in increasing the proportion of women and UIM students represented in the General Surgery recruitment process.
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perceptions of graduating General Surgery chief residents are they confident in their training
Journal of The American College of Surgeons, 2014Co-Authors: Mark L Friedell, Thomas J Vandermeer, Michael L Cheatham, George M Fuhrman, Paul J Schenarts, John D Mellinger, Jon B. MorrisAbstract:Background Debate exists within the surgical education community about whether 5 years is sufficient time to train a General surgeon, whether graduating chief residents are confident in their skills, why residents choose to do fellowships, and the scope of General Surgery practice today. Study Design In May 2013, a 16-question online survey was sent to every General Surgery program director in the United States for dissemination to each graduating chief resident (CR). Results Of the 297 surveys returned, 76% of CRs trained at university programs, 81% trained at 5-year programs, and 28% were going directly into General Surgery practice. The 77% of CRs who had done >950 cases were significantly more comfortable than those who had done less (p Conclusions Current graduates of General Surgery residencies appear to be confident in their skills, including care of the trauma patient. Fellowships are being chosen primarily because of an interest in the subspecialty. General Surgery residency no longer provides adequate training in esophageal or hepatopancreatobiliary Surgery.
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has the 80 hour work week had an impact on voluntary attrition in General Surgery residency programs
Journal of The American College of Surgeons, 2006Co-Authors: Thomas J Leibrandt, Christopher M Pezzi, Steven A Fassler, Eugene F Reilly, Jon B. MorrisAbstract:Background This article attempts to assess the effect of the duty-hour limitations implemented in 2003 on voluntary withdrawal of General Surgery residents. Study design A questionnaire asked the program directors how many categorical General Surgery residents left voluntarily in 2003 to 2004, their training levels, why they left, and where they went. Results were compared with an identical study of 2000 to 2001 and analyzed statistically using chi-square analysis. Results A total of 215 programs (85%) responded, compared with 206 programs (81%) in the previous study. One hundred two programs (48%) reported voluntary attrition of 148 residents, compared with 110 programs (53%) and 167 residents previously. An average of 1.5 residents per program left in programs that reported attrition and 0.7 residents per program in all responders, compared with 1.5 and 0.8 residents in the previous study. In both studies, most programs with attrition lost one (66% [2000 to 2001] and 65% [2003 to 2004]) or two residents (21% [2000 to 2001] and 27% [2003 to 2004]). Most attrition occurred at PGY1 (47%) and PGY2 (28%) levels; a total of 75% of all attrition occurred at these levels, compared with a total of 76% in the previous study. One hundred eleven residents (75%) entered other medical specialties, and 23 (16%) transferred to other General Surgery programs, compared with 105 residents (63%) and 40 residents (24%) in the previous study. In both studies, personal issues and work hours/lifestyle were cited as the most common reasons for leaving. In each study, the net loss to General Surgery (the number of residents who left voluntarily divided by the total resident population at risk) was 3% for that academic year. Analysis showed no statistically significant difference. Conclusions Rates and patterns of attrition seem to have been unaffected by Accreditation Council for Graduate Medical Education work-hours limitations.
Luise I M Pernar - One of the best experts on this subject based on the ideXlab platform.
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an appraisal of the learning curve in robotic General Surgery
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Luise I M Pernar, Faith C Robertson, Ali Tavakkoli, Eric G Sheu, David C Brooks, Douglas S SminkAbstract:Background Robotic-assisted Surgery is used with increasing frequency in General Surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic General Surgery to inform adopters of the technology.
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an appraisal of the learning curve in robotic General Surgery
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Luise I M Pernar, Faith C Robertson, Ali Tavakkoli, Eric G Sheu, David C Brooks, Douglas S SminkAbstract:Robotic-assisted Surgery is used with increasing frequency in General Surgery for a variety of applications. In spite of this increase in usage, the learning curve is not yet defined. This study reviews the literature on the learning curve in robotic General Surgery to inform adopters of the technology. PubMed and EMBASE searches yielded 3690 abstracts published between July 1986 and March 2016. The abstracts were evaluated based on the following inclusion criteria: written in English, reporting original work, focus on General Surgery operations, and with explicit statistical methods. Twenty-six full-length articles were included in final analysis. The articles described the learning curves in colorectal (9 articles, 35%), foregut/bariatric (8, 31%), biliary (5, 19%), and solid organ (4, 15%) Surgery. Eighteen of 26 (69%) articles report single-surgeon experiences. Time was used as a measure of the learning curve in all studies (100%); outcomes were examined in 10 (38%). In 12 studies (46%), the authors identified three phases of the learning curve. Numbers of cases needed to achieve plateau performance were wide-ranging but overlapping for different kinds of operations: 19–128 cases for colorectal, 8–95 for foregut/bariatric, 20–48 for biliary, and 10–80 for solid organ Surgery. Although robotic Surgery is increasingly utilized in General Surgery, the literature provides few guidelines on the learning curve for adoption. In this heterogeneous sample of reviewed articles, the number of cases needed to achieve plateau performance varies by case type and the learning curve may have multiple phases as surgeons add more complex cases to their case mix with growing experience. Time is the most common determinant for the learning curve. The literature lacks a uniform assessment of outcomes and complications, which would arguably reflect expertise in a more meaningful way than time to perform the operation alone.
Danielle M Hari - One of the best experts on this subject based on the ideXlab platform.
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a survey of robotic Surgery training curricula in General Surgery residency programs how close are we to a standardized curriculum
American Journal of Surgery, 2019Co-Authors: Cynthia M Tom, James D Maciel, Abraham Korn, Junko Ozaochoy, Danielle M HariAbstract:Abstract 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. Methods A web-based survey was sent to 277 General Surgery residency programs to determine characteristics of resident experience and training in robotic Surgery. Results A total of 114 (41%) programs responded. 92% (n = 105) have residents participating in robotic surgeries; 68%(n = 71) of which have a robotics curriculum, 44%(n = 46) track residents’ robotic experience, and 55%(n = 58) offer formal recognition of training completion. Responses from university-affiliated (n = 83) and independent (n = 31) programs were not significantly different. Conclusions Many General Surgery residencies offer robotic Surgery experience, but vary widely in requisite components, formal credentialing, and case tracking. There is a need to adopt a standardized training curriculum and document resident competency.
Kenneth W Gow - One of the best experts on this subject based on the ideXlab platform.
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the General Surgery chief resident operative experience 23 years of national acgme case logs
JAMA Surgery, 2013Co-Authors: Frederick Thurston Drake, Karen D Horvath, Adam B Goldin, Kenneth W GowAbstract:Importance The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. Objective To evaluate changes in operative experience for General Surgery CRs. Design, Setting, and Participants Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. Main Outcomes and Measures Total cases and defined categories were evaluated for changes over time. Results The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P P P Conclusions and Relevance Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based General Surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.