Virtual Interactions and the 2020-2021 Residency Application Cycle in General Surgery: A Look Ahead.

INTRODUCTION: General surgery residency training programs adapted to the COVID-19 pandemic by going online instead of in-person, through virtual interviews, social media engagement, and virtual open houses. The impact of these virtual interactions is unknown. We sought to understand their effectiveness as per residency program directors and assistant program directors. MATERIALS AND METHODS: An institutional review board approval was obtained to conduct this anonymous survey. A Qualtrics XM survey containing multiple-choice and short-answer questions was distributed to 590 residency program and assistant program directors through the Association of Program Directors in Surgery (APDS) listserv on July 6, July 13, and July 20. RESULTS: We observed a response rate of approximately 11% across the 590 surgeons contacted. Nearly all (90%) respondents offered virtual preinterview interactions, primarily virtual open houses, virtual facility tours, and virtual question and answer (Q&A) sessions with residents and faculty; 48% of respondents were unsure of the utility of virtual interactions and the majority (54%) felt that virtual interaction limits a program's ability to evaluate applicants. Virtual Q&As were ranked to be the most effective interaction (7.6/10); 80% of respondents felt that visiting rotations were "somewhat important" to "very important," the two highest options available. In addition, 74% felt that applicants missed out on fully experiencing the program by forgoing these rotations. Most respondents (78%) noted that evaluation of applicants' preinterview did not change as a result of virtual interactions. Nearly half (48%) of the respondents offered more interview days due to the virtual format. A fifth (21%) of respondents stated that virtual interactions resulted in a change in the rank position of an applicant. Respondents ranked Twitter and Instagram higher in applicant engagement than Facebook. Factors that impacted interview or rank order list the most were late/absent step two CK scores (33%) and a lack of away rotations (31%), both being limitations largely due to the pandemic. With respect to future application cycles, most (71%) raised concerns regarding disparities between applicants applying in-person and virtually if both or either are offered. CONCLUSIONS: Our study suggests that program directors and associate program directors have reservations about the use of virtual interactions with applicants. Interestingly, these data suggest that visiting subinternships are useful for programs in evaluating applicants. This may encourage students to pursue rotations at other institutions at the expense of already-limited resources. It remains unclear whether virtual interactions will be used in the future, but respondents largely agreed that the virtual means of interacting with and disseminating information to the applicants of the 2020-2021 general surgery Match were a success.

Comparison of Two Laparoscopic Techniques in Management of Pediatric Inguinal Hernias.

Introduction: Many studies focus on comparing outcomes of the open method for inguinal hernia repair (IHR) and the laparoscopic method. However, few studies compare different laparoscopic techniques. With over a dozen different techniques described in the literature for laparoscopic IHR, significant opportunities exist to study the efficacy of each technique. We investigated outcomes of a subcutaneous endoscopically assisted transfixion ligation (SEATL) technique and a percutaneous internal ring suturing (PIRS). Materials and Methods: After receiving institutional review board approval, we completed a retrospective chart review of IHR performed at our pediatric tertiary care center between September 2015 and May 2020. We included all patients under the age of 18 years. We separated laparoscopic repairs from total repairs. Laparoscopic repairs were further divided into their respective techniques. Factors involving patient demographics, operative details, and postoperative complications were statistically analyzed using SPSS. Results: There was a total of 131 IHRs performed with SEATL and 124 IHRs performed with PIRS. Median operative time (minutes) differed significantly (P = .001) with SEATL at 49 (28-66) and PIRS at 55 (37-76)] minutes. Significantly more incarcerated hernias were repaired with PIRS (n = 13) than with SEATL (n = 3, P = .006). SEATL had a higher number of postoperative complications; the most significant were granulomas (n = 3, P = .09) and recurrent hernias (n = 12, P < .001). Conclusion: SEATL had a significantly higher number of postoperative complications. This may be a result of multiple factors including but not limited to the absence of electrocautery, a shorter median operative time, and utilization of absorbable suture. Modifications have been made to this technique to reduce risk of postoperative complications.

Improving surgical patient education materials using informational design with visual elements.

Patient education materials (PEMs) serve as a foundation for educating patients and families across all surgical fields but are often not understandable. The National Institute of Health (NIH) recommends that PEMs be written at a grade 6-7 reading level; however, most current materials exceed that measure.3 Lack of understandable and appropriate surgical PEMs compounds the difficulties that low health literacy patients face with resultant poor surgical outcomes.2,3 The challenge for surgeons is to adequately educate patients pre-operatively and post-operatively on the complexities of surgery. Another challenge is to compact decades of education and training into an easy-to-understand medium for patients. To address this challenge, many physicians have utilized visual aids to improve PEM efficacy. While visual aids are a critical piece of education materials, they must be designed intentionally to be effective. The most important consideration is that the PEM communicates the information clearly to users. With this in mind, we created a framework for productive utilization of visual aids by integrating the C.A.R.P. graphic design technique into an existing surgical PEM to enhance communication and understandability.