Effect of an Oncology Focused High School Outreach Event in Increasing Interest in Cancer Care and Healthcare Careers.

Despite widely heralded efforts to improve diversity, equity, and inclusion in oncology, few outreach programs exist to inspire high school students to pursue a career in medicine. Doctors' Day is an event developed and organized by medical trainees that features both didactic and hands-on learning components to provide high school students with exposure to the healthcare field and knowledge about cancer and cancer screening. We investigated in the influence of Doctors' Day on students' interest in healthcare careers and oncology. On March 30, 2023, health professions students and residents organized and led Doctors' Day, a half-day educational program for eight public high schools in Nashville, TN. After the event, high school student participants were invited to complete a 21-item survey. The questionnaire collected demographic information, feedback regarding the session, and comfort with various activities related to the program. Among the 8 public high schools involved in Doctors' Day, 91 participants completed the survey. Few (9, 9.9%) participants were White or European American, and 30 (33.0%) and 23 (25.3%) were Black and Hispanic, respectively. There were 20 (22.0%) participants who identified as LGBTQI+ with 2 (2.2%) indicating they were unsure. Feedback regarding the program was positive across all domains, and students reported increased interest in healthcare careers and oncology along with an increased comfort level in describing the importance of cancer screening. Our community outreach program for high school students with backgrounds underrepresented in medicine was effective in increasing interest in healthcare careers and oncology.

National patterns in the use of International Statistical Classification of Diseases and Health Related Problems, tenth revision Z codes in ambulatory surgery from 2016 to 2019.

BACKGROUND: In the tenth revision of the International Statistical Classification of Disease and Health Related Problems (ICD-10), Z codes were added to improve documentation and understanding of health-related social needs. We estimated national Z code use in the ambulatory surgery setting from 2016 to 2019. METHODS: Using the Nationwide Ambulatory Surgery Sample (NASS), we identified encounters for ambulatory surgery with an ICD-10 code between Z55.0 and Z65.9. Data were stratified by Z code domains from the Centers for Medicare and Medicaid Services (CMS). RESULTS: This analysis of 41,827 ambulatory surgery encounters with documented Z codes found that the most documented determinants of health related to multiparity or unwanted pregnancy, homelessness, and incarceration. There was a 16.1% increase in the use of Z codes from 2016 to 2019. CONCLUSION: Rates of Z code use in the ambulatory surgery setting are increasing with current documentation serving as a specific but not sensitive measure of socioeconomic need.

The Kidney Transplant: Maintaining Excellent Outcomes While Increasing Skills Acquisition.

OBJECTIVE/BACKGROUND: Kidney transplantation is a complex operation that incorporates multiple fundamental surgical techniques and is an excellent opportunity for surgical skill development during residency training. We hypothesized that increasing resident competency, measured as anastomosis time, could be demonstrated while maintaining high-quality surgical outcomes during the learning process. METHODS: We performed a retrospective cohort study of surgical resident involvement in kidney transplantation and recorded the anastomosis time. The study population comprised adult, single organ kidney transplants (n = 2052) at a large academic transplant center between 2006 and 2019. Descriptive statistics included frequencies, medians, and means. A mixed model of anastomosis time on number of procedures was fitted. Poisson models were fitted with outcomes of the number of patients with delayed graft function and number of patients that underwent reoperation postoperatively, with the exposure being number of kidney transplants performed by resident. RESULTS: Results from the mixed model suggest that as the number of times a resident performs the surgery increases, the time to conduct the operation decreases with statistical significance. The Poisson regression demonstrated no significant relationship between the operative volume of a resident and postoperative complications. CONCLUSION: This study demonstrated statistical evidence that with an increase in the number of renal transplantations performed by a surgical resident, anastomosis time decreased. It also demonstrated no significant relationship between number of kidney transplants performed by a resident and postoperative complications, suggesting that patient outcomes for this operation are not adversely affected by resident involvement.

How Did We Get Here and Where Are We Going? Career Trajectories of United States General Surgery Residency Program Directors.

OBJECTIVE: To develop the future of United States (US) surgical education leadership, surgical trainees and early career faculty who aspire to become program directors (PDs) must understand the potential career pathways and requisite skills and experience to become a general surgery residency PD. The objective of this study was to understand the demographics, career experiences, and professional satisfaction of US PDs in general surgery. DESIGN: An anonymous, cross-sectional survey utilizing a novel instrument. SETTING: An electronic survey distributed to US general surgery PDs between June and November 2022 PARTICIPANTS: PDs of US general surgery residency programs. A list of the Accrediting Council for Graduate Medical Education (ACGME)-accredited general surgery PDs was created from the ACGME list from the 2022 to 23 academic year. RESULTS: The survey achieved a response rate of 46.2% (159/344). Only 32.1% of PDs identified as female and 67.3% identified as male with 1 respondent preferring not to identify their gender. PDs were White or Caucasian (68.6%), Asian (13.8%), and Black (3.7%); 4.4% were Hispanic or Latino. Only 83.7% of PDs completed fellowship training. PDs have been in the role for an average of 5.5 ± 4.9 years. The PDs were compensated for an average of 54.7% (±14.9% SD, 0%-100% range) of their time towards clinical duties. They were compensated on average for 35.7% (±12.6%, 0%-100%) of effort for residency-related administrative duties. Only 5% of PDs had obtained or were enrolled in an education-related degree. Only 55.4% of PDs had received formal surgical education training in teaching and assessment. 54.1% of PDs were interested in obtaining a more senior leadership position in the future. Most PDs (38.4%) expect to serve as PD for 5 to 8 years in total. Overall, the majority of PDs were very satisfied (29.6%) or satisfied (51.6%) professionally; similarly 28.9% were very satisfied and 48.4% satisfied personally. CONCLUSIONS: This study represents the most up-to-date characterization of the personal, academic, and career-related features of current surgical residency PDs across the US. PDs enjoy a high degree of professional and personal satisfaction and most aspire to increasing leadership within their organizations. Compared to prior data, PDs have become more diverse in terms of both gender and race over time. Opportunities exist for increased mentorship of aspiring and current PDs as well as increased training in teaching and assessment.

Outcomes of the 2021-2022 APDS General Surgery Recruitment Process Recommendations.

BACKGROUND: In recent years, mounting challenges for applicants and programs in resident recruitment have catapulted this topic into a top priority in medical education. These challenges span all aspects of recruitment-from the time an applicant applies until the time of the Match-and have widespread implications on cost, applicant stress, compromise of value alignment, and holistic review, and equity. In 2021-2022, the Association of Program Directors in Surgery (APDS) set forth recommendations to guide processes for General Surgery residency recruitment. OBJECTIVES: This work summarizes the APDS 2021-2022 resident recruitment process recommendations, along with their justification and program end-of-cycle program feedback and compliance. This work also outlines the impact of these data on the subsequent 2022-2023 recommendations. METHODS: After a comprehensive review of the available literature and data about resident recruitment, the APDS Task Force proposed recommendations to guide 2021-2022 General Surgery resident recruitment. Following cycle completion, programs participating in the categorical General Surgery Match were surveyed for feedback and compliance. RESULTS: About 122 of the 342 programs (35.7%) participating in the 2022 categorical General Surgery Match responded. Based on available data in advance of the cycle, recommendations around firm application and interview numbers could not be made. About 62% of programs participated in the first round interview offer period with 86% of programs limiting offers to the number of slots available; 95% conducted virtual-only interviews. Programs responded they would consider or strongly consider the following components in future cycles: holistic review (90%), transparency around firm requirements (88%), de-emphasis of standardized test scores (54%), participation in the ERAS Supplemental application (58%), single first round interview release period (69%), interview offers limited to the number of available slots (93%), 48-hour minimum interview offer response time (98%), operationalization of applicant expectations (88%), and virtual interviews (80%). There was variability in terms of the feedback regarding the timing of the single first round offer period as well as support for a voluntary, live site visit for applicants following program rank list certification. CONCLUSIONS: The majority of programs would consider implementing similar recommendations in 2022-2023. The greatest variability around compliance revolved around single interview release and the format of interviews. Future innovation is contingent upon the ongoing collection of data as well as unification of data sources involved in the recruitment process.

Parental Support Policies and Benefits: A Surgical Training Program Report Card of Transparency.

OBJECTIVE: This study aimed to investigate the transparency of parental benefits available to US surgical residency applicants. BACKGROUND: Medical students prioritize work-family balance in specialty selection. Those applying to surgical residency programs also place a significant value on parental leave policies when deciding where to train. However, little is known about the amount of information that surgical training programs publicly offer to potential applicants regarding family support policies. METHODS: Publicly available websites for 264 general surgery training programs were accessed to determine the availability of information on parental benefits. Twenty-six "items of transparency" included types of leave, contract flexibility, salary, lactation, and childcare support. Programs with fewer than the median items of transparency were contacted to inquire about additional public resources. Academic programs were stratified by their associated medical school rankings in the US News & World Report. RESULTS: A total of 144 (54%) programs were academic and 214 (81.4%) had male program directors. The median number of items of transparency was 8 (29.6%). Of the 131 programs contacted, 33 (25.9%) replied, and 2 (6.1%) improved their transparency score. Academic programs associated with medical schools in the upper third of the rankings were more likely to have ≥8 items of transparency (70.8% vs. 45.6%; P =0.002). In the adjusted analysis, academic programs [odds ratio (OR): 3.44, 95% confidence interval (95% CI): 1.87-6.34], those with female program directors (OR: 2.09, 95% CI: 1.01-4.33), and those located in the Western (OR: 3.13, 95% CI: 1.31-7.45) and Southern (OR: 2.45, 95% CI: 1.21-4.98) regions of the country were more likely to have ≥8 items of transparency. CONCLUSIONS: There are significant deficits in publicly available information related to parental benefits for many surgical training programs, which may impact applicants' decision making. Attracting the most talented candidates requires programs to create and share policies that support the integration of professional and personal success.

The use of an educational time-out in thyroid and parathyroid surgery to move the needle in periprocedural education.

BACKGROUND: As surgical training shifts toward a competency-based paradigm, deliberate practice for procedures must be a point of focus. The purpose of this study was to assess the impact of an educational time-out intervention on educational experience and operative performance in endocrine surgery. METHODS: For 12 months, third-year general surgery residents used the educational time-out to establish an operative step of focus for thyroidectomy and parathyroidectomy procedures. Data were collected using the System for Improving and Measuring Procedural Learning application and post-rotation surveys. The Zwisch scale was used to classify supervision, with meaningful autonomy defined as passive help or supervision only. RESULTS: Eight residents and 3 attending surgeons performed the educational time-out for a total of 211 operations (93% completion rate). At the end of each rotation, there was improvement in the frequency of goal setting. There was strong agreement (90%) that the intervention strengthened the educational experience. For most cases (52%), the residents were rated at active help. Residents performed a median of 3/6 thyroidectomy steps at meaningful autonomy and a median of 2/5 parathyroidectomy steps at meaningful autonomy. Review of the qualitative data revealed that optimal feedback was provided in 46% of cases. CONCLUSION: The educational time-out strengthened educational experiences. Stepwise procedural data revealed the varying levels of supervision that exist within an operation. Broader implementation of this intervention could facilitate competency-based procedural education.

Reshaping Residency Recruitment: Achieving Alignment Between Applicants and Programs in Surgery.

OBJECTIVE: The residency recruitment process has become increasingly challenging for both applicants and program directors, in part, due to the inflation in the number of applications per student. As a result, it has become more daunting for programs to design processes that evaluate applicants holistically. Furthermore, the existing methods used to evaluate and select applicants do not necessarily predict success in residency and may inadvertently lend to gender, racial, and ethnic bias. This narrative review aims to identify innovative tools used in residency recruitment that will allow programs and applicants to better determine concordance of interests and achieve value alignment while supporting improved, objective evaluation of an applicant's unique attributes and experiences. DESIGN: PubMed was used to conduct a narrative review of recruitment strategies in admission processes of undergraduate and graduate medical education between 1975 and June 2021, using the designated Medical Subject Heading (MeSH0 terms. Inclusion criteria were established surrounding innovative tools to better objectively screen, evaluate, or select applicants. Strategies relying primarily on traditional metrics (United States Medical Licensing Examination (USMLE) scores, Alpha Omega Alpha status, and clerkship grades) were excluded. RESULTS: Forty-two articles met specific inclusion criteria. Using these articles, a framework was created with two specific aims: (1) to allow applicants and programs to express or assess interest and (2) to foster objective review of unique applicant attributes, skills, experiences, and competencies that align with program mission and values. The following five innovative tools for recruitment were identified: preference signaling, secondary applications, standardized letters of recommendation, situational judgment testing, and surgical simulation. CONCLUSIONS: As the number of applications continues to rise, strategies must be implemented to allow applicants and institutions to achieve better alignment or "fit," while also giving balanced consideration to all of an applicant's unique characteristics. A more holistic approach to applicant selection is a necessary tool in order to increase diversity and inclusion within the field of surgery.

Does Intentional Support of Degree Programs in General Surgery Residency Affect Research Productivity or Pursuit of Academic Surgery? A Multi-Institutional Study.

OBJECTIVE: To determine whether pursuit of an advanced degree during dedicated research time (DRT) in a general surgery residency training program impacts a resident's research productivity. DESIGN: A retrospective, multi-institutional cohort study. SETTING: General surgery residency programs that were approved to graduate more than 5 categorical residents per year and that offered at least 1 year of DRT were contacted for participation in the study. A total of 10 general surgery residency programs agreed to participate in the study. PARTICIPANTS: Residents who started their residency between 2000 and 2012 and spent at least one full year in DRT (n = 511) were included. Those who completed an advanced degree were compared on the following parameters to those who did not complete one: total number of papers, first-author papers, the Journal Citation Reports impact factors of publication (2018, or most recent), and first position after residency or fellowship training. RESULTS: During DRT, 87 (17%) residents obtained an advanced degree. The most common degree obtained was a Master of Public Health (MPH, n = 42 (48.8%)). Residents who did not obtain an advanced degree during DRT published fewer papers (median 8, [interquartile range 4-12]) than those who obtained a degree (9, [6-17]) (p = 0.002). They also published fewer first author papers (3, [2-6]) vs (5, [2-9]) (p = 0.002) than those who obtained a degree. Resident impact factor (RIF) was calculated using Journal Citation Reports impact factor and author position. Those who did not earn an advanced degree had a lower RIF (adjusted RIF, 84 ± 4 vs 134 ± 5, p < 0.001) compared to those who did. There was no association between obtaining a degree and pursuit of academic surgery (p = 0.13) CONCLUSIONS: Pursuit of an advanced degree during DRT is associated with increased research productivity but is not associated with pursuit of an academic career.

Ad astra per aspera (Through Hardships to the Stars): Lessons Learned from the First National Virtual APDS Meeting, 2020.

OBJECTIVE: After COVID-19 rendered in-person meetings for national societies impossible in the spring of 2020, the leadership of the Association of Program Directors in Surgery (APDS) innovated via a virtual format in order to hold its national meeting. DESIGN: APDS leadership pre-emptively considered factors that would be important to attendees including cost, value, time, professional commitments, education, sharing of relevant and current information, and networking. SETTING: The meeting was conducted using a variety of virtual formats including a web portal for entry, pre-ecorded poster and oral presentations on the APDS website, interactive panels via a web conferencing platform, and livestreaming. PARTICIPANTS: There were 298 registrants for the national meeting of the APDS, and 59 participants in the New Program Directors Workshop. The registrants and participants comprised medical students, residents, associate program directors, program directors, and others involved in surgical education nationally. RESULTS: There was no significant difference detected for high levels of participant satisfaction between 2019 and 2020 for the following items: overall program rating, topics and content meeting stated objectives, relevant content to educational needs, educational format conducive to learning, and agreement that the program will improve competence, performance, communication skills, patient outcomes, or processes of care/healthcare system performance. CONCLUSIONS: A virtual format for a national society meeting can provide education, engagement, and community, and the lessons learned by the APDS in the process can be used by other societies for utilization and further improvement.

Global Surgery Electives: A Strategy to Improve Care to Domestic Underserved Populations?

BACKGROUND: In the United States, a shortage of general surgeons exists, primarily in rural, poor, and minority communities. Identification of strategies that increase resident interest in underserved regions provides valuable information in understanding and addressing this shortage. In particular, surgical experience abroad exposes residents to practice in low-resource and rural settings. As residency programs increasingly offer global surgery electives, we explore whether the presence of an international surgical rotation affects graduates' future practice patterns in underserved communities domestically. METHODS: We surveyed general surgery residency graduates at a single academic institution. Those who finished general surgery residency from 2001 to 2018 were included. Participant demographics, current practice demographics, and perceptions related to global surgery and underserved populations were collected. Respondents were stratified based on whether they did ("after") or did not ("before") have the opportunity to participate in the Kijabe rotation (started in 2011), defined by graduation year. RESULTS: Out of 119 eligible program graduates, 64 (53.7%) completed the survey, and 33 (51.6%) of the respondents graduated following the implementation of the Kijabe rotation. Two participants defined their primary current practice location as international. Fifteen (45.5%) in the "After" group indicated an interest in working with underserved populations following residency, compared to 5 (17.8%) of the "Before" group (P = 0.074). Furthermore, 20 (60.6%) respondents in the "After" group expressed interest in working with underserved populations even if it meant making less money. In the "Before" group, only 13 (46.4%) responded similarly (P = 0.268). Eleven (9.2%) residents rotated at Kijabe. Those who participated in the Kijabe rotation reported an uninsured rate of 36.7% for their current patient population, compared to rate of 13.9% in those who did not rotate there (P = 0.22). CONCLUSIONS: At a single institution, our results suggest that participation in an international surgical rotation in a resource-constrained setting may be associated with increased care for underserved populations in future clinical practice. These results could be due to self-selection of residents who prioritize global surgery as part of their residency experience, or due to increased exposure to underserved patients through global surgery.

A Preoperative Educational Time-Out is Associated with Improved Resident Goal Setting and Strengthens Educational Experiences.

OBJECTIVE: The purpose of this study was to assess the impact of a preoperative Educational Time-Out (ETO) with structured postoperative feedback on resident preoperative goal-setting and the educational experience of a clinical rotation. DESIGN: A preoperative ETO was developed during which trainees and faculty jointly identified an operative goal and discussed the trainee's operative autonomy. Postoperative feedback with a smartphone application was encouraged. From November 2016 to October 2017, the intervention was piloted with 1 surgical service. Outcomes included ETO completion rate, goal setting rate, and subjects' perception of the impact of the ETO on identification of performance deficits, trainee autonomy, and receipt of feedback. Data were analyzed using descriptive statistics. SETTING: This study was performed in an institutional hospital setting. PARTICIPANTS: Third-year general surgery residents and surgical faculty in the Department of Hepatobiliary Surgery and Liver Transplantation at Vanderbilt University Medical Center took part in the intervention. RESULTS: Seven residents and 7 attending surgeons participated in this study. Residents performed a median of 15 procurements during an average of 6.5 weeks each on service. The ETO completion rate was 83%. Resident-reported preoperative goal setting increased after the intervention (from 36% to 78%, p = 0.015). Subjects reported a positive impact of the intervention, with high resident agreement that the ETO helped identify deficits (82% median agreement), increased autonomy (82% median agreement), and increased receipt of feedback (84% median agreement). Residents and attendings agreed that the educational experience was stronger due to the ETO (median 81% and 77%, respectively). CONCLUSIONS: The ETO intervention improved rates of resident preoperative goal setting and strengthened perceived educational experiences. Resident participants also reported improvements in autonomy and rates of postoperative feedback. Broader implementation of this brief preoperative pause is an easy way to emphasize procedural education in the operating room.

Career advancement in surgical education.

Having been inspired by prior master surgeon educators, many seek careers as surgeon educators. However, the definition of surgeon educator has developed into a complex and exciting career trajectory that requires delineation beyond master surgeon teacher. The integration of the science of knowledge and skill acquisition into surgical training and administration has led to multiple career paths within the areas previously associated broadly with surgical education. In this article, we define the many paths of the surgeon educator and take the reader through a potential framework for establishing a mission while simultaneously taking steps in personal and professional development that promote career advancement in surgical education.

The effect of gender on operative autonomy in general surgery residents.

BACKGROUND: Despite an increasing number of women in the field of surgery, bias regarding cognitive or technical ability may continue to affect the experience of female trainees differently than their male counterparts. This study examines the differences in the degree of operative autonomy given to female compared with male general surgery trainees. METHODS: A smartphone app was used to collect evaluations of operative autonomy measured using the 4-point Zwisch scale, which describes defined steps in the progression from novice ("show and tell") to autonomous surgeon ("supervision only"). Differences in autonomy between male and female residents were compared using hierarchical logistic regression analysis. RESULTS: A total of 412 residents and 524 faculty from 14 general surgery training programs evaluated 8,900 cases over a 9-month period. Female residents received less autonomy from faculty than did male residents overall (P < .001). Resident level of training and case complexity were the strongest predictors of autonomy. Even after controlling for potential confounding factors, including level of training, intrinsic procedural difficulty, patient-related case complexity, faculty sex, and training program environment, female residents still received less operative autonomy than their male counterparts. The greatest discrepancy was in the fourth year of training. CONCLUSION: There is a sex-based difference in the autonomy granted to general surgery trainees. This gender gap may affect female residents' experience in training and possibly their preparation for practice. Strategies need to be developed to help faculty and residents work together to overcome this gender gap.

Peer-led Surgical Clerkship Programming Support Through the General Surgery Interest Group at the Vanderbilt University School of Medicine.

OBJECTIVE: We present a systematic, sustainable, student-led model for supporting the Surgical Clerkship experience. DESIGN: Our model includes student-led suturing and knot-tying classes, operating room tours, skills sessions, and shelf review sessions provided systematically for each of 5 Surgical Clerkship blocks in the 2017 to 2018 academic year. SETTING: Vanderbilt University School of Medicine. PARTICIPANTS: Vanderbilt University School of Medicine Surgical Clerkship students and senior medical student instructors. RESULTS: Successful implementation of a peer-led support program for the Surgical Clerkship with a majority of students rating the helpfulness of both the operating room tours and the skills sessions a 4 or 5 on a Likert scale. CONCLUSION: Our student-led model for a Surgical Clerkship support program can be successfully implemented and demonstrates positive initial indicators of effectiveness.

Preoperative goal setting and perioperative communication in an academic training institution: Where do we stand?

BACKGROUND: We collected data regarding specific aspects of perioperative surgical education within our institution's Section of Surgical Sciences as a needs assessment. METHODS: Categorical general surgery residents and attending surgeons were queried regarding their perceptions of resident preoperative planning and perioperative communication. RESULTS: The overall response rate was 81%, with 35 resident and 54 faculty respondents. Residents reported selecting an operative learning objective a median of 50% (IQR 36-67) of the time, whereas attending surgeons perceived this to be the case a median of 26% (IQR 15-35) of the time (P < 0.001). The group reported median frequencies of 20% (IQR 9-31) for preoperative discussion of learning objectives, 12% (IQR 4-27) for preoperative discussion of competence and 27% (IQR 17-55) for postoperative debriefing. CONCLUSIONS: This study demonstrates deficits in resident goal setting and perioperative communication within our program, which are targets for future intervention. We share these results as a potential tool for other programs.

Is the operative autonomy granted to a resident consistent with operative performance quality.

BACKGROUND: We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality. METHODS: Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as "practice ready performance/meaningfully autonomous" or "not practice ready/not meaningfully autonomous." Discordant circumstances were practice ready/not meaningfully autonomous or not practice ready/meaningfully autonomous. Resident training level, patient-related case complexity, procedure complexity, and procedure commonality were investigated to determine impact on autonomy. RESULTS: A total of 8,798 assessments were collected from 429 unique surgeons assessing 496 unique residents. Practice-ready and exceptional performances were 20 times more likely to be performed under meaningfully autonomous conditions than were other performances. Meaningful autonomy occurred most often with high-volume, easy and common cases, and less complex procedures. Eighty percent of assessments were concordant (38% practice ready/meaningfully autonomous and 42% not practice ready/not meaningfully autonomous). Most discordant assessments (13.8%) were not practice ready/meaningfully autonomous. For fifth-year residents, practice ready/not meaningfully autonomous ratings (9.7%) were more frequent than not practice ready/meaningfully autonomous ratings (7.5%). Ten surgeons (2.3%) failed to afford residents meaningful autonomy on any occasion. CONCLUSION: Resident operative performance quality is the most important determinant in attending surgeon decisions regarding resident autonomy.

Incorporation of a Global Surgery Rotation into an Academic General Surgery Residency Program: Impact and Perceptions.

INTRODUCTION: Global surgery is increasingly recognized as a vital component of international public health. Access to basic surgical care is limited in much of the world, resulting in a global burden of treatable disease. To address the lack of surgical workforce in underserved environments and to foster ongoing interest in global health among US-trained surgeons, our institution established a residency rotation through partnership with an academic hospital in Kijabe, Kenya. This study evaluates the perceptions of residents involved in the rotation, as well as its impact on their future involvement in global health. MATERIALS AND METHODS: A retrospective review of admission applications from residents matriculating at our institution was conducted to determine stated interest in global surgery. These were compared to post-rotation evaluations and follow-up surveys to assess interest in global surgery and the effects of the rotation on the practices of the participants. RESULTS: A total of 78 residents matriculated from 2006 to 2016. Seventeen participated in the rotation with 76% of these reporting high satisfaction with the rotation. Sixty-five percent had no prior experience providing health care in an international setting. Post-rotation surveys revealed an increase in global surgery interest among participants. Long-term interest was demonstrated in 33% (n = 6) who reported ongoing activity in global health in their current practices. Participation in global rotations was also associated with increased interest in domestically underserved populations and affected economic and cost decisions within graduates' practices.

Utility of a Standardized Fourth-Year Medical Student Surgical Preparatory Curriculum: Program Director Perceptions.

OBJECTIVE: Each July, surgical interns arrive to residency with variable skills, knowledge, and clinical experience. To standardize and improve intern preparation, the American College of Surgeons (ACS), Association of Program Directors in Surgery, and Association for Surgical Education developed a pilot Resident Prep Curriculum (RPC). To date, no studies have analyzed these efforts. We aimed to discern program director (PD) perceptions of RPC participants as an initial means of analysis. DESIGN: A 17-question PD survey was designed to assess variable preparedness and performance between RPC participants and nonparticipants. PDs reporting matriculation of a RPC participant were first asked to globally compare the participant to nonparticipants. Using a 5-point Likert scale, PDs were then asked to compare participants to nonparticipants in 7 distinct categories, which were based on course objectives that parallel the Accreditation Council for Graduate Medical Education competencies. Descriptive statistics and tests of significance were performed to evaluate the responses. PARTICIPANTS: The survey was sent via electronic mail to 245 accredited general surgery residency PDs. RESULTS: A total of 103 (42.0%) PDs responded. Of the respondents, 27 (26.2%) reported matriculation of a RPC participant. When assessing efficiency in intern responsibilities, 26.9% of PDs noted participant advantage, and when gauging comfort in intern-role, 25.9% of PDs reported participant benefit. Across the 7 queried course objectives, there was a statistically significant improvement in the technical skill domain (p = 0.007) and a nonsignificant trend toward improvement in several of the other 6 domains: interpersonal skills (p = 0.055), medical knowledge (p = 0.067), patient care (p = 0.081), systems-based practice (p = 0.085), problem-based learning (p = 0.106), and professionalism (p = 0.357). CONCLUSIONS: PD perceptions revealed global advantage to RPC participation Furthermore, 1/4 of the time and specific competency performance showed substantial improved performance in technical skills. Survey timing and washout may bias this study, and the results should be compared to learner and senior resident perceptions, where observations may be more granular.