A multi-institutional survey of newer surgery faculty on the impacts of education debt and debt repayment strategies.

BACKGROUND: The cost associated with becoming a physician is significant, and studies have shown that surgeons, in particular, accrue higher debts than matched controls from other specialties, and the public. These findings, along with the current era of economic turmoil, prompted our investigation into the effects of educational debt on the career, family and lifestyle choices of recently graduated surgeons. Our goal was to query young surgical faculty about the education debt carried, the burden it presents as they embark on a career, and the financial management strategies employed to pay down their debt. STUDY DESIGN: This study is a one-time, cross-sectional survey of regular and adjunct faculty from the University of Minnesota and the Mayo Clinic-Rochester. Participation was voluntary and responses were collected anonymously via SurveyMonkey. Respondents were sorted into two groups: those with and without education debt at the time of residency graduation. We compared these groups on a number of variables. RESULTS: Of the 111 respondents (111/152, 73% response rate), 69 (62.2%) carried debt at the time of graduation from residency. The median educational debt at graduation was $100,000, and surgeons with educational debt carried a significantly higher burden of consumer and total debt than those without educational debt at graduation (p < 0.001). This continued after graduation with 74% (51/69) of residents with debt at graduation falling below the benchmark 36% debt-to-income ratio, and 45% (17/32) of those without debt at graduation in this same high risk financial situation. CONCLUSIONS: Educational debt places a large financial responsibility on the shoulders of most newer faculty. The debt-to-income ratio demonstrated through our results was considerable for both study groups, and unwise according to financial literature. This is of utmost importance to leaders in academe, as salaries are generally lower than private practice colleagues. This can begin in residency with explicit and practical information on surgeon reimbursement, income ranges, and revenue sources (faculty, clinical), debt repayment strategies, and overall training on financial matters early in their residency.

The significant impact of a competency-based preparatory course for senior medical students entering surgical residency.

PURPOSE: Previous data suggest that formal, structured preparation might improve knowledge and skills of senior medical students (SMSs) as they transition to surgical residency. However, subsequent impact on clinical performance has not been demonstrated. METHOD: The authors developed a comprehensive course for SMSs entering surgical residencies and studied the impact of the course on the subsequent performance of 2010 graduates (n = 22) compared with matched peers (16 nonparticipant controls at authors' home institution and 24 nonparticipant peer controls at outside institutions; total n = 62). Through pre- and postcourse surveys, knowledge tests, and technical examinations, they measured confidence and skill acquisition in 32 specific, job-related tasks. They followed participants and matched peers into internship and collected performance evaluations from supervising senior residents to determine whether course graduates would display performance advantages in these same tasks. The authors used t tests for all comparisons, α = 0.05. RESULTS: Participants demonstrated marked improvement in task-specific confidence in all 32 tasks from course beginning to end, with improved scores on written and technical skill examinations. Further, course participants outperformed peers in all 32 tasks in July, with their performance advantage predictably dissipating into the third month of residency. There was a marked correlation between confidence and competence in all tasks. CONCLUSIONS: Competency-based preparation for surgical internship resulted in objective gains in task-specific confidence and test performance at course conclusion, translating to improved performance and better patient care upon residency matriculation. These data emphasize the significant impact of formally preparing SMSs before graduation.

Increasing the lung donor pool: recruitment of the gift of life.

Lungs suitable for organ donation are a scarce resource. Recent efforts with alternative ventilatory strategies have yielded promise to the potential expansion of lungs suitable for transplantation.

Personality profiling of the modern surgical trainee: insights into generation X.

PURPOSE: Surgical education is undergoing a revolution in its approach to training. Duty-hour limitations, the need for strong teamwork, and increased cross-coverage have all impacted the culture of a surgical residency. This, combined with the profound shift in our culture at large has led to the suggestion that our specialty is attracting a different or more "modern" trainee (Generation X) with personality attributes that differ considerably from previous surgical residents. Historically, personality profiling of surgeons (Myers-Briggs Type Indicator (MBTI)) has favored the ESTJ personality type [extroversion (E), sensing (S), thinking (T), and judging (J)]. We hypothesized that the changing surgical training paradigms are attracting a different personality profile. To test this, we administered the MBTI examination to a large cohort of surgical trainees in one academic surgical training program. METHODS: In 2009, with Institutional Review Board (IRB) approval, we administered online MBTI Step I form M tests to all 41 categorical surgery residents from our Accreditation Council for Graduate Medical Education (ACGME)-accredited general surgery program. The test results were distributed by a certified MBTI consultant and compared with previously published data of staff surgeons. The data were analyzed using a χ(2) analysis to determine differences between groups (α = 0.05). RESULTS: Of the 41 categorical surgery residents, 39 (95%) residents completed the MBTI assessment, (54% male). The most frequent preferential personality type of the resident surgeon was ISTJ [introversion (I)], 30.8%, n = 12. When the results were compared with previously published personality profiles of practicing surgeons, there was a significant difference (p = 0.009) between E and I, contrasting the 2 groups (Table 1). However, the preferences of sensing, thinking, and judging (STJ) over all others was not significantly different (p = 0.203). CONCLUSION: Most current surgical trainees demonstrate the I personality type. This finding contrasts with established literature, which showed a preference for the E personality type among surgeons trained under the apprenticeship model of residency. As surgical training continues to evolve, it is imperative that we consider the personality traits of the modern trainee and how they might impact the development and implementation of our educational objectives and affect relationships among staff and resident trainees.

Improving surgery intern confidence through the implementation of expanded orientation sessions.

BACKGROUND: New surgical interns may be unprepared for job-related tasks and harbor anxiety that could interfere with job performance. To address these problems, we extended our intern orientation with the principal aim of demonstrating the need for expanded instruction on execution of daily tasks. Additionally, we sought to show that an enriched orientation curriculum durably augments intern confidence. METHODS: Twenty-one surgical interns participated in an extended orientation program, consisting of interactive didactics, case scenario presentations, and small group discussions. Evaluations collected at completion of orientation and 1-month follow-up assessed self-reported confidence levels on job-related tasks before, immediately afterward, and 1-month after orientation. Statistical analyses were performed using Student t tests (P < .05 significant). RESULTS: Self-reports of confidence on job-related tasks before the orientation sessions were low; however, program participation resulted in immediate confidence increases in all areas. Evaluations at 1-month follow-up showed persistence of these gains. CONCLUSION: Interns reported considerable anxiety in all job-related tasks before orientation. After the sessions, confidence levels were significantly and durably improved in all areas. Our findings suggest the need for specific instruction on job-related tasks of surgical internship and demonstrate the effectiveness of an expanded orientation in improving intern confidence in execution of these tasks.

How to practice evidence-based medicine.

Evidence-based medicine is defined as the conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients. In an effort to emphasize the importance of evidence-based medicine in plastic surgery, the American Society of Plastic Surgeons and Plastic and Reconstructive Surgery have launched an initiative to improve the understanding of evidence-based medicine concepts and provide tools for implementing evidence-based medicine in practice. Through a series of special articles aimed at educating plastic surgeons, the authors' hope is that readers will be compelled to learn more about evidence-based medicine and incorporate its principles into their own practices. As the first of the series, this article provides a brief overview of the evolution, current application, and practice of evidence-based medicine.

Evidence-based patient safety advisory: patient selection and procedures in ambulatory surgery.

Despite the many benefits of ambulatory surgery, there remain inherent risks associated with any surgical care environment that have the potential to jeopardize patient safety. This practice advisory provides an overview of the preoperative steps that should be completed to ensure appropriate patient selection for ambulatory surgery settings. In conjunction, this advisory identifies several physiologic stresses commonly associated with surgical procedures, in addition to potential postoperative recovery problems, and provides recommendations for how best to minimize these complications.

Evidence-based patient safety advisory: liposuction.

Liposuction is considered to be one of the most frequently performed plastic surgery procedures in the United States, yet despite the popularity of liposuction, there is relatively little scientific evidence available on patient safety issues. This practice advisory provides an overview of various techniques, practices, and management strategies that pertain to individuals undergoing liposuction, and recommendations are offered for each issue to ensure and enhance patient safety.

Evidence-based patient safety advisory: patient assessment and prevention of pulmonary side effects in surgery. Part 2. Patient and procedural risk factors.

Several factors may increase a patient's risk for perioperative pulmonary complications. This practice advisory provides an overview of the preoperative steps that should be performed to ensure appropriate patient selection and patient safety with regard to pulmonary complications. Procedural and patient-related risk factors are discussed, as are recommendations for perioperative management and strategies for minimizing complications.

Evidence-based patient safety advisory: patient assessment and prevention of pulmonary side effects in surgery. Part 1. Obstructive sleep apnea and obstructive lung disease.

Obstructive sleep apnea and obstructive lung disease may increase a patient's risk of perioperative pulmonary complications. This practice advisory provides an overview of the preoperative steps that should be performed to ensure appropriate patient selection and the safety of patients with these conditions. Also discussed are recommendations for perioperative management and strategies for minimizing complications.

Evidence-based patient safety advisory: malignant hyperthermia.

As more and more routine plastic surgery procedures move from the hospital to outpatient surgery facilities, plastic surgeons must be aware of the risk factors for life-threatening events that might occur in this setting. This awareness includes recognition of the signs and symptoms and the management of a rare but life-threatening condition, malignant hyperthermia. This article reviews the current understanding of the concepts pertinent to malignant hyperthermia diagnosis and treatment in the outpatient setting and current standards and recommendations for physicians and support personnel regarding malignant hyperthermia preparedness in office-based surgery and anesthesia.

Evidence-based patient safety advisory: blood dyscrasias.

Rarely, patients with blood disorders may seek to undergo plastic surgery. Although plastic surgeons are not expected to diagnose or manage blood disorders, they should be able to recognize which patients are suitable for surgery and which should be referred to a hematologist before a procedure. This practice advisory provides an overview of the perioperative steps that should be completed to ensure appropriate care for patients with blood disorders.