Surgical rotations: the good, the bad, and the ugly.

BACKGROUND: Every surgeon's career begins with a surgical residency. Each residency has dreaded rotations as well as those that seem ideal, but to date, no objective criteria exist to define such rotations. The aim of this study is to establish objective criteria that, when applied to a specific rotation, will define it as a "dream" or a "dreaded" rotation and, in the process, elucidate the good, the bad, and the ugly of surgical rotations in general. METHODS: All 39 residents from a multi-institutional residency program were asked to collaboratively identify the criteria they felt necessary for a dream rotation. Each resident evaluated 16 rotations at 4 hospitals using the identified criteria on a scale of "Inadequate," "Optimal," and "Ideal/Dream Rotation." Residents then gave an overall evaluation of each rotation as a dream rotation on a scale of "No," "For the Most Part," or "Yes." Finally, each resident was asked whether the individual rotations were following ACGME recommendations on duty hours. RESULTS: The best correlations with a dream rotation were: clinical experience - quality and quantity of cases (r = 0.83), operative experience (r = 0.83), patient management responsibilities (r = 0.78), and outpatient office experience (r = 0.77). All p-values were < 0.05. The following correlated less with a dream rotation: conferences (r = 0.56, p < 0.05), medical student experience (r = 0.56, p < 0.05), and hospital facilities (r = 0.28, not significant.). Scut work was the only category for which there was a negative correlation with a dream rotation (r = -0.53, p < 0.05). Eighty-six percent of residents reported compliance with ACGME work hour recommendations, with no apparent correlation with a dream rotation.

Faculty evaluations: diagnostic and therapeutic.

PURPOSE: An excellent teaching program is one that creates an atmosphere of mentorship, leadership, and professional development. The key to all of these may lie in the faculty evaluation. Currently, favorable faculty evaluations are often rewarded, whereas the more critical evaluations are downplayed and seldom used for faculty development. The purpose of this study is to investigate the efficacy of the faculty evaluation as a diagnostic tool to objectively identify individual strengths and weaknesses. Can such a tool then be used as a therapeutic modality to improve and enhance the faculty as a whole? METHODS: Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. They then anonymously evaluated each of the 44 teaching attendings on each of the 9 criteria. The results of the evaluations, which consisted of the overall mean scores and SD for each of the 9 criteria, the attending's score and SDs above or below the mean, as well as whether the residents considered them to be a Role Model, were sent to each faculty member as an intervention. Six months after the intervention, the residents evaluated the attendings using the same 9 criteria. Evaluations were collected and analyzed following the same procedure as 6 months prior. T-tests and p-values were calculated to determine any significant differences between the 2 data sets. RESULTS: Based on the results of the pre-intervention evaluations, we were able to delineate faculty members into 3 groups based on their Role Model score. Of the 10 faculty members with the lowest scores (defined as >1 SD below average), 7 improved after the intervention, 3 of them were statistically significant (2 with p < 0.05 and 1 with p < 0.10). In the middle group of 26 faculty members, 1 showed statistically significant improvement (p < 0.05). Interestingly, this was the faculty member with the lowest score in this group. Six faculty originally in the middle group improved to a score greater than 1 SD above average, defining them as a Role Model. The remaining 8 faculty members originally designated as Role Models showed no statistically significant changes in their scores after the intervention. After the intervention, the average score improved for all of the 9 criteria that make a faculty Role Model. Statistically significant improvements were seen in the categories of Provides Feedback (p < 0.05) and Didactic Teaching, Attendance at Didactic activities, and Stimulates Critical Thinking with the Use of Literature (all p < 0.10). CONCLUSIONS: (1) Faculty evaluations are a diagnostic tool with the ability to select out Role Models from the lower scoring groups. (2) After the intervention, the overall average score improved for all of the 9 criteria that make a Role Model, showing improvement of the faculty as a whole. (3) The therapeutic benefits of faculty evaluations were best seen in the faculty with the lowest scores.

Are you a surgical role model?

PURPOSE: Multiple papers have examined the recent decline in the number of surgical residency applicants. Many have concluded that a lack of role models in surgery is at least partially responsible for this decline. However, to date, the definition of a surgical role model does not exist. This paper defines a surgical role model based on criteria determined by surgery residents. METHODS: Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. The 9 criteria as defined by the residents were didactic teaching, teaching rounds, attendance at didactic activities, demonstrates skills and decision making in the operating room with confidence and virtuosity, allows [resident] to do procedures according to ability, allows autonomy to make independent decisions, provides feedback, stimulates critical thinking with use of literature, and assists [resident] to find and complete research for publication. Each resident in the program was then given a questionnaire and asked to evaluate each of the 49 teaching attendings on each of the 9 criteria, on a 3-point scale. Finally, residents evaluated each attending based on professionalism and mutual respect on a scale of I Don't Want To Emulate Him/Her, OK, or Role Model. These categories were also assigned a number (1, 2, and 3, respectively). Pearson correlation and stepwise multiple regression were used to determine the relationship between "Role Model" and the 9 criteria. The unit of analysis was the mean rating given each attending on each of the 10 scales. RESULTS: A total of 847 questionnaires were analyzed. Each of the 9 criteria correlated significantly with the Role Model rating (all p < 0.01). The average correlation was 0.73 (range, 0.64 to 0.78). Of the 9 criteria, 4 correlated best with the Role Model, as shown in. The stepwise regression indicates that 3 of the 9 criteria are uniquely associated with the Role Model variable. These 3 criteria are stimulates critical thinking with use of literature, allows autonomy to make independent decisions, and attendance at didactic activities. CONCLUSIONS: All of the 9 criteria are important factors in residents' perception of the Role Model characteristics of attending faculty. A parsimonious, operational definition of the surgical attending role model is one who stimulates the resident to think, gives the resident the opportunity to think and act independently, and is available to the resident.

The effects of coffee on enzymes involved in metabolism of the dietary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine in rats.

The effects of coffee on the metabolism and genotoxicity of the dietary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) were investigated. Coffee diminished the bacterial mutagenicity of PhIP in the Ames reversion assay through inhibition of cytochrome P450 1A2 (CYP1A2), a key enzyme involved in the metabolic activation of PhIP. When given as part of the diet (0, 1 or 5% w/w) to male Fischer-344 rats for 2 weeks, coffee affected the expression of hepatic enzymes involved in PhIP metabolism. Coffee increased the expression of CYP1A2 by 16-fold in the 5% coffee-treated group, and approximately half of this inductive effect was attributed to caffeine. Coffee also increased the expression of enzymes involved in the detoxication of PhIP. A 2-fold increase in expression of glutathione S-transferase alpha was observed, UDP-glucuronosyl transferase (UGTs) activities of p-nitrophenol increased 2-fold, while N(2)-and N3-glucuronidation of the genotoxic metabolite 2-hydroxyamino-1-methyl-6-phenylimidazo[4,5-b]pyridine (HONH-PhIP) increased by 1.3-fold in the 5% coffee-treated over the control group. The amount of PhIP (0.75 mg/kg, 24 h) eliminated in urine as the N(2)-and N3-glucuronide conjugates of HONH-PhIP increased by 1.8- and 2.5-fold, respectively, in the 5% coffee-treated group over control rats, suggesting either increased rates of N-oxidation of PhIP or N-glucuronidation of HONH-PhIP. Despite the strong induction of CYP1A2, there was no increase in PhIP-DNA adduct formation in colon and pancreas while liver adducts decreased by 50% over control animals. These data suggest that the effect of coffee on inhibition of PhIP N-oxidation and ensuing DNA damage is more important in vivo than its effect on induction of PhIP N-hydroxylation.