Medical Student Perceptions of Academic Surgery: Rose-Colored Glasses or Jaded Prism?

OBJECTIVE: Stereotypes of surgeons are pervasive and play a role in medical students' decisions about pursuing a surgical career. This study aimed to determine: (1) how medical students' perceptions of surgery and surgeons changed following exposure to surgery during clerkship rotations; and (2) if gender and racial/ethnic identification played a role in this process. DESIGN, SETTING, AND PARTICIPANTS: In this mixed-method study, clerkship students at one U.S. medical school were asked to anonymously contribute words and phrases that they associated with surgery to an online "word cloud" at the beginning and end of their 12-week surgery clerkship. In addition, an end-of-year, anonymous survey of their perceptions was administered and analyzed using a Grounded Theory approach. RESULTS: Of 154 students invited to complete the online survey, analysis of 24 completed surveys suggested that students believe surgical culture to be toxic, with unfriendly attitudes, strict hierarchy, and lack of work-life balance. Analysis of 678 Word Cloud responses, however, indicated that the frequency of complimentary responses increased following surgery clerkships (25% vs 36%; z = -3.26; p = 0.001), while the proportion of responses describing surgery/surgeons as male-dominated, egotistical, and scary decreased (5% vs 1%, z = 2.86, p = 0.004; 9% vs 4%, z = 2.78, p = 0.005; 3% vs 0.3%, z = 2.56, p = 0.011, respectively). The association between surgeons and being White disappeared entirely. Female students were more likely than male students to state that their perceptions did not change following exposure (40% vs 0%; z = 2.19; p = 0.029). CONCLUSIONS: With exposure to surgery, students' preconceived notions may be positively influenced. However, students continue to hold negative perceptions, and this effect may be stratified by gender identification. Institutions should work to address these perceptions in pre-clerkship years to attract a more diverse pool of future surgeons.

Louise Eisenhardt (1891-1967): World Renowned Neuropathologist, Brain Tumor Registry Director, First Editor-In-Chief of Journal of Neurosurgery, and President of Harvey Cushing Society.

BACKGROUND: This historical account reviews the course and lasting impact of Dr. Louise Eisenhardt (1891-1967) in neurosurgery. METHOD: The writing of this project was sparked by the discovery of original scientific and bibliographical information about Eisenhardt, testimony on personal relationships, and viewpoints after comprehensive compilation of information. It is a thorough review of literature on Eisenhardt and reflects the scope and depth of these prior works. RESULTS: It begins with the decisive influence of Harvey Cushing's mentorship and academic; follows Eisenhardt's impact on the development of modern neuropathology; discusses the Eisenhardt-Percival-Bailey-Cushing collaboration on gross brain specimens and histological classification of brain tumors; recounts Cushing's creation of a neuropathologist team for the Brain Tumor Registry working asynchronously with the Pathology Department at Peter Bent Brigham Hospital; Eisenhardt's aid in the development of intraoperative analysis of brain tumors; her career as a neuropathologist; her contributions as Editor-in-Chief of the Journal of Neurosurgery; and her preservation of the Brain Tumor Registry at Yale University School of Medicine estimated the largest and most valuable databank of information in the history of medicine. Eisenhardt served as President, Historian, and Secretary-Treasurer of the Harvey Cushing Society, the professional organization now known as the American Association of Neurological Surgeons, and was senior lecturer for members of the Congress of Neurological Surgeons, constituents of NEUROSURGERY Publications. CONCLUSIONS: Our article provides glimpses into the personality of Dr. Louise Eisenhardt and her marked impact on neurosurgery and allied neurosciences.

Development and public release of the Penn Reading Assessment Computerized Adaptive Test (PRA-CAT) for premorbid IQ.

An important component of neuropsychological testing is assessment of premorbid intelligence to estimate a patient's ability independent of neurological impairment. A common test of premorbid IQ-namely, the Reading section of the Wide Range Achievement Test (WRAT)-has been shown to have high measurement error in the high ability range, is unnecessarily long (55 items), and is proprietary. We describe the development of an alternative, nonproprietary, computerized adaptive test for premorbid IQ, the Penn Reading Assessment (PRA-CAT). PRA-CAT items were calibrated using a 1-parameter item response theory model in a large community sample (N = 9,498), Ages 8 to 21, and the resulting parameters were used to simulate computerized adaptive testing sessions. Simulations demonstrated that the PRA-CAT achieves low measurement error (0.25; equivalent to Cronbach's alpha = .94) and acceptable measurement error (0.40; Cronbach's alpha = .84) after only 18 and 6 items, respectively (on average). Correlation of WRAT and PRA-CAT scores with numerous clinical, cognitive, demographic, and neuroimaging criteria suggests that validity of PRA-CAT score interpretation is comparable (and sometimes superior) with the WRAT. The fully functioning PRA-CAT for public use (including item parameter estimates reported here) has been built using the open-source program Concerto, and can be installed by anyone on a local computer or on the "cloud." Given the length and proprietary nature of the WRAT, the PRA-CAT shows promise as a potential alternative (and with minimal or no cost). Further validation in the context of neurological injury is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).