American Board of Surgery In-Training Exam Performance Predicted by Question Bank Use While Unassociated With Other Learning Strategies.

INTRODUCTION: There is no consensus regarding optimal curricula to teach cognitive elements of general surgery. The American Board of Surgery In-Training Exam (ABSITE) aims to measure trainees' progress in attaining this knowledge. Resources like question banks (QBs), Surgical Council on Resident Education (SCORE) curriculum, and didactic conferences have mixed findings related to ABSITE performance and are often evaluated in isolation. This study characterized relationships between multiple learning methods and ABSITE performance to elucidate the relative educational value of learning strategies. METHODS: Use and score of QB, SCORE use, didactic conference attendance, and ABSITE percentile score were collected at an academic general surgery residency program from 2017 to 2022. QB data were available in the years 2017-2018 and 2021-2022 during institutional subscription to the same platform. Given differences in risk of qualifying exam failure, groups of ≤30th and >30th percentile were analyzed. Linear quantile mixed regressions and generalized linear mixed models determined factors associated with ABSITE performance. RESULTS: Linear quantile mixed regressions revealed a relationship between ABSITE performance and QB questions completed (1.5 percentile per 100 questions, P < 0.001) and QB score (1.2 percentile per 1% score, P < 0.001), but not with SCORE use and didactic attendance. Performers >30th percentile had a significantly higher QB score. CONCLUSIONS: Use and score of QB had a significant relationship with ABSITE performance, while SCORE use and didactic attendance did not. Performers >30th percentile completed a median 1094 QB questions annually with a score of 65%. Results emphasize success of QB use as an active learning strategy, while passive learning methods warrant further evaluation.

The Right Way to Teach Lefties - Exploring the Experiences of Left-Handed Trainees and Surgeons.

OBJECTIVE: This study describes the educational experiences of left-handed (LH) surgeons and provides recommendations for educating LH trainees, who face challenges due to their handedness. DESIGN, SETTING, AND PARTICIPANTS: A mixed methods analysis was performed. Semi-structured interviews were conducted with LH trainees, LH attendings, and right-handed (RH) attendings representing 4 hospitals within a large academic hospital system. Questions were curated from current literature to explore the educational experiences of LH trainees. Inductive and iterative coding techniques were employed to manually generate themes. Laterality questionnaires for skills in daily life and surgery were collected and analyzed. RESULTS: Laterality questionnaires demonstrate that LH trainees and surgeons are more mixed-handed and use their nondominant hand to a greater extent in surgery compared to daily life than RH attendings. Key themes were identified in the dimension of learning, including that initial decisions for which hand to use remain fixed throughout career, LH learning is largely self-directed, forced conformation to RH norms and microaggressions are common, LH instruments are rarely practical, and LH surgeons are advantaged with situational ambidexterity. Key themes related to teaching include that communication regarding handedness is lacking, RH surgeons are often unaware of/resistant to a LH approach, the onus is on the trainee to suggest accommodations to use their left hand, and attendings rarely effectively mentor LH learners in using their left hand. CONCLUSIONS: Left-handed surgeons face challenges in an environment designed for RH individuals, represented by themes regarding learning and teaching experiences of LH surgeons told by themselves and their teachers. Recommendations were created for LH trainees in learning, all attendings in teaching, LH attendings in their opportunity to mentor, and surgical societies in supporting LH trainees. Development of resources for LH trainees could fill a substantial gap. Exploration of how LH surgeons evolve situational ambidexterity could benefit all surgeons.

Female Representation at the Association of Program Directors in Surgery Annual Meeting: Moving Towards Gender Equality.

OBJECTIVE: This study aims to evaluate the state and changes over time of female representation in Association of Program Directors in Surgery (APDS) leadership and annual meeting presenters and session leaders. DESIGN, SETTING, AND PARTICIPANTS: APDS conference programs from 2013 to 2022 were reviewed to identify society leadership and meeting presenters and session leaders. Verified online profiles were used to gather professional role and reported gender. Descriptive statistics and t-tests compared female representation in the first half (2013-2017, prior) and second half of data (2018-2022, current). RESULTS: Leadership of APDS was an average 22% women, increasing from 13% in 2013 to 37% in 2022, and significantly increased from prior to current period (p = 0.0004). Conference presenters and session leaders were 42% women overall, increasing from 30% in 2013 to 52% in 2022. An average 33% staff surgeons, 54% trainees, 64% education scientists, and 51% medical student participants were female. Staff were 44% female in 2022 from 24% in 2013, significantly increased from prior to current period (p = 0.021). Comparing prior and current period cohorts, female presenters for paper sessions increased from 38% to 55% (p = 0.011), moderators from 15% to 39% (p = 0.046), and last author listed on presentation sessions from 18% to 32% (p = 0.010), while panelists, workshop directors, and presenters at all sessions increased without statistical significance. Female poster presenters decreased over time. CONCLUSIONS: Female representation at APDS meetings has increased over time. Women are well represented compared to the 2022 member population of 36% women. While positions typically held by more senior members, such as leadership, panelists, moderators, and last authors remain lower than other roles, increases over time are encouraging. APDS female representation compares favorably to many other surgical societies. Translation of successful practices regarding gender representation utilized by APDS to other surgical organizations could expedite progress toward gender parity in the field.

Paving a Path to Gender Parity: Recent Trends in Participation of Women in an Academic Surgery Society (Society for Surgery of the Alimentary Tract).

INTRODUCTION: The proportion of women surgeons is increasing, although women in surgical leadership and research has not kept pace. The Society for Surgery of the Alimentary Tract (SSAT) pledged its commitment to diversity and inclusion in 2016. Our study sought to evaluate the temporal trend of gender representation in leadership, speakership, and research at SSAT. METHODS: Publicly available SSAT meeting programs from 2010 to 2022 were reviewed to assess gender proportions within leadership positions (officers and committee chairs); invited speakerships, multidisciplinary symposia, and committee panel session moderators and speakers; and contributions to scientific sessions (moderator, first author and senior author). Verified individual professional profiles were analyzed to categorize gender as woman, man, or unavailable. Descriptive and trend analyses using linear regression and chi-squared testing were performed. RESULTS: A total of 5506 individuals were reviewed; 1178 (21.4%) were identified as women and 4328 (78.6%) as men or did not have available data. The absolute proportion of total female participation increased by 1.05% per year (R2=0.82). There was a statistically significant difference in the total proportion of women participation before and after 2016 (18.5% vs. 27.1%, p<0.01). Increases in the proportion of women were demonstrated in leadership, invited speakerships, multidisciplinary symposia, committee panel sessions, research session moderators, and abstract first authors. The proportion of women senior authors remained stagnant. CONCLUSION: Though this upward trajectory in SSAT women participation is encouraging, current trends predict that gender parity will not be reached until 2044.

The impact of enteric fistulas on US hospital systems.

BACKGROUND: There is limited characterization of patients with enteric fistula. Our objective is to determine the incidence of the disease, and characterize demographics, healthcare costs, co-diagnoses, and procedures in this population. METHODS: The National Inpatient Sample database 2004-2014 was queried to identify patients with enteric fistula using ICD-9 code 569.81. RESULTS: There were 317,000 admissions with a diagnosis of enteric fistula from 2004 to 2014, accounting for 230,000 hospital days annually. Costs totaled $500 million with charges of $1.5 billion annually. Inpatient mortality is 4.1%. Patients had significant comorbidities and 3 procedures or surgical interventions per admission. CONCLUSIONS: This descriptive study elucidates the impact of enteric fistula on patients and hospitals by characterizing incidence, clinical associations, and admission characteristics. There is significant financial impact with 28,000 admissions and $500 million dollars in annual costs. This study lays the groundwork for future research by characterizing the impact of enteric fistula.

Fibroblast growth factor 21, fibroblast growth factor receptor 1, and ß-Klotho expression in bovine growth hormone transgenic and growth hormone receptor knockout mice.

OBJECTIVE: Although growth hormone (GH) and fibroblast growth factor 21 (FGF21) have a reported relationship, FGF21 and its receptor, fibroblast growth factor receptor 1 (FGFR1) and cofactor ß-Klotho (KLB), have not been analyzed in chronic states of altered GH action. The objective of this study was to quantify circulating FGF21 and tissue specific expression of Fgf21, Fgfr1, and Klb in mice with modified GH action. Based on previous studies, we hypothesized that bovine GH transgenic (bGH) mice will be FGF21 resistant and GH receptor knockout (GHR-/-) mice will have normal FGF21 action. DESIGN: Seven-month-old male bGH mice (n=9) and wild type (WT) controls (n=10), and GHR-/- mice (n=8) and WT controls (n=8) were used for all measurements. Body composition was determined before dissection, and tissue weights were measured at the time of dissection. Serum FGF21 levels were evaluated by ELISA. Expression of Fgf21, Fgfr1, and Klb mRNA in white adipose tissue (AT), brown AT, and liver were evaluated by reverse transcription quantitative PCR. RESULTS: As expected, bGH mice had increased body weight (p=3.70E-8) but decreased percent fat mass (p=4.87E-4). Likewise, GHR-/- mice had decreased body weight (p=1.78E-10) but increased percent fat mass (p=1.52E-9), due to increased size of the subcutaneous AT depot when normalized to body weight (p=1.60E-10). Serum FGF21 levels were significantly elevated in bGH mice (p=0.041) and unchanged in GHR-/- mice (p=0.88). Expression of Fgf21, Fgfr1, and Klb mRNA in white AT and liver were downregulated or unchanged in both bGH and GHR-/- mice. The only exception was Fgf21 expression in brown AT of GHR-/-, which trended toward increased expression (p=0.075). CONCLUSIONS: In accordance with our hypothesis, we provide evidence that circulating FGF21 is increased in bGH animals, but remains unchanged in GHR-/- mice. Downregulation or no change in Fgf21, Fgfr1, and Klb expression are seen in white AT, brown AT, and liver of bGH and GHR-/- mice when compared to their respective controls, except for an increase in brown AT Fgf21 expression in GHR-/- mice, which could suggest a possible link to increased thermogenic potential in these mice. Overall, these results suggest possible modulation of FGF21 by GH resulting in FGF21 resistance or changes in FGF21 levels due to GH induced changes in liver size or kidney function.