Pregnancy and Parenthood Among US Surgical Residents.

Importance: The ability to pursue family planning goals is integral to gender equity in any field. Procedural specialties pose occupational risks to pregnancy. As the largest procedural specialty, general surgery provides an opportunity to understand family planning, workplace support for parenthood, obstetric outcomes, and the impact of these factors on workforce well-being, gender equity, and attrition. Objective: To examine pregnancy and parenthood experiences, including mistreatment and obstetric outcomes, among a cohort of US general surgical residents. Design, Setting, and Participants: This cohort study involved a cross-sectional national survey of general surgery residents in all programs accredited by the Accreditation Council for Graduate Medical Education after the 2021 American Board of Surgery In-Training Examination. Female respondents who reported a pregnancy and male respondents whose partners were pregnant during clinical training were queried about pregnancy- and parenthood-based mistreatment, obstetric outcomes, and current well-being (burnout, thoughts of attrition, suicidality). Main Outcomes and Measures: Primary outcomes included obstetric complications and postpartum depression compared between female residents and partners of male residents. Secondary outcomes included perceptions about support for family planning, pregnancy, or parenthood; assisted reproductive technology use; pregnancy/parenthood-based mistreatment; neonatal complications; and well-being, compared between female and male residents. Results: A total of 5692 residents from 325 US general surgery programs participated (81.2% response rate). Among them, 957 residents (16.8%) reported a pregnancy during clinical training (692/3097 [22.3%] male vs 265/2595 [10.2%] female; P < .001). Compared with male residents, female residents more frequently delayed having children because of training (1201/2568 [46.8%] females vs 1006/3072 [32.7%] males; P < .001) and experienced pregnancy/parenthood-based mistreatment (132 [58.1%] females vs 179 [30.5%] males; P < .001). Compared with partners of male residents, female residents were more likely to experience obstetric complications (odds ratio [OR], 1.42; 95% CI, 1.04-1.96) and postpartum depression (OR, 1.63; 95% CI, 1.11-2.40). Pregnancy/parenthood-based mistreatment was associated with increased burnout (OR, 2.03; 95% CI, 1.48-2.78) and thoughts of attrition (OR, 2.50; 95% CI, 1.61-3.88). Postpartum depression, whether in female residents or partners of male residents, was associated with resident burnout (OR, 1.93; 95% CI, 1.27-2.92), thoughts of attrition (OR, 2.32; 95% CI, 1.36-3.96), and suicidality (OR, 5.58; 95% CI, 2.59-11.99). Conclusions and Relevance: This study found that pregnancy/parenthood-based mistreatment, obstetric complications, and postpartum depression were associated with female gender, likely driving gendered attrition. Systematic change is needed to protect maternal-fetal health and advance gender equity in procedural fields.

Contemporary Evaluation of Work-Life Integration and Wellbeing in US Surgical Residents: A National Mixed-Methods Study.

BACKGROUND: The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand how programs support WLI. STUDY DESIGN: A cross-sectional national survey conducted after the 2020 American Board of Surgery In-Training Examination queried 4 WLI items. Multivariable regression models evaluated factors associated with (1) work-life conflicts and (2) well-being (career dissatisfaction, burnout, thoughts of attrition, suicidality). Semi-structured interviews conducted with faculty and residents from 15 general surgery programs were analyzed to identify strategies for supporting WLI. RESULTS: Of 7,233 residents (85.5% response rate) 5,133 had data available on work-life conflicts. 44.3% reported completing non-educational task-work at home, 37.6% were dissatisfied with time for personal life (e.g., hobbies), 51.6% with maintaining healthy habits (e.g., exercise), and 48.0% with performing routine health maintenance (e.g., dentist). In multivariable analysis, parents and female residents were more likely to report work-life conflicts (all p<0.05). After adjusting for other risk factors (e.g., duty-hour violations, and mistreatment), residents with work-life conflicts remained at increased risk for career dissatisfaction, burnout, thoughts of attrition, and suicidality (all p<0.05). Qualitative analysis revealed interventions for supporting WLI including (1) protecting time for health maintenance (e.g., therapy); (2) explicitly supporting life outside of work (e.g., prioritizing time with family); and (3) allowing meaningful autonomy in scheduling (e.g., planning for major life events). CONCLUSIONS: Work-life conflicts are common among surgical residents and are associated with poor resident well-being. Well-designed program-level interventions have the potential to support WLI in surgical residency.

Blue Ribbon Committee I Review: Findings and Impact.

OBJECTIVE: Review the subsequent impact of recommendations made by the 2004 American Surgical Association Blue Ribbon Committee (BRC I) Report on Surgical Education. BACKGROUND: Current leaders of the American College of Surgeons and the American Surgical Association convened an expert panel to review the impact of the BRC I report and make recommendations for future improvements in surgical education. METHODS: BRC I members reviewed the 2004 recommendations in light of the current status of surgical education. RESULTS: Some of the recommendations of BRC I have gained traction and have been implemented. There is a well-organized national curriculum and numerous educational offerings. There has been greater emphasis on preparing faculty to teach and there are ample opportunities for professional advancement as an educator. The number of residents has grown, although not at a pace to meet the country's needs either by total number or geographic distribution. The number of women in the profession has increased. There is greater awareness and attention to resident (and faculty) well-being. The anticipated radical change in the educational scheme has not been adopted. Training in surgical research still depends on the resources and interests of individual programs. Financing student and graduate medical education remains a challenge. CONCLUSIONS: The medical landscape has changed considerably since BRC I published its findings in 2005. A contemporary assessment of surgical education and training is needed to meet the future needs of the profession and our patients.

The Blue Ribbon Committee II Report and Recommendations on Surgical Education and Training in the United States: 2024.

OBJECTIVE: An expert panel made recommendations to optimize surgical education and training based on the effects of contemporary challenges. BACKGROUND: The inaugural Blue Ribbon Committee (BRC I) proposed sweeping recommendations for surgical education and training in 2004. In light of those findings, a second BRC (BRC II) was convened to make recommendations to optimize surgical training considering the current landscape in medical education. METHODS: BRC II was a panel of 67 experts selected on the basis of experience and leadership in surgical education and training. It was organized into subcommittees which met virtually over the course of a year. They developed recommendations, along with the Steering Committee, based on areas of focus and then presented them to the entire BRC II. The Delphi Method was chosen to obtain consensus, defined as>80% agreement amongst the panel. Cronbach alpha was computed to assess the internal consistency of three Delphi rounds. RESULTS: Of 50 recommendations, 31 obtained consensus in the following aspects of surgical training (# consensus recommendation /# proposed): Workforce (1/5), Medical Student Education (3/8), Work Life Integration (4/6), Resident Education (5/7), Goals, Structure and Financing of Training (5/8), Education Support and Faculty Development (5/6), Research Training (7/9), and Educational Technology and Assessment (1/1). The internal consistency was good in Rounds 1 and 2 and acceptable in Round 3. CONCLUSIONS: BRC II used the Delphi approach to identify and recommend 31 priorities for surgical education in 2024. We advise establishing a multidisciplinary surgical educational group to oversee, monitor and facilitate implementation of these recommendations.

Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness.

Importance: Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness. Objectives: To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship. Design, Setting, and Participants: A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022. Exposure: Residents were asked, "Do you have a mentor who genuinely cares about you and your career?" Main Outcomes and Measures: Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic. Results: A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship. Conclusions and Relevance: One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents.

The Blue Light Hazard Versus Blue Light Hype.

PURPOSE: The blue light hazard is the experimental finding that blue light is highly toxic to the retina (photic retinopathy), in brief abnormally intense exposures, including sungazing or vitreoretinal endoillumination. This term has been misused commercially to suggest, falsely, that ambient environmental light exposure causes phototoxicity to the retina, leading to age-related macular degeneration (AMD). We analyze clinical, epidemiologic, and biophysical data regarding blue-filtering optical chromophores. DESIGN: Perspective. METHODS: Analysis and integration of data regarding the blue light hazard and blue-blocking filters in ophthalmology and related disciplines. RESULTS: Large epidemiologic studies show that blue-blocking intraocular lenses (IOLs) do not decrease AMD risk or progression. Blue-filtering lenses cannot reduce disability glare because image and glare illumination are decreased in the same proportion. Blue light essential for optimal rod and retinal ganglion photoreception is decreased by progressive age-related crystalline lens yellowing, pupillary miosis, and rod and retinal ganglion photoreceptor degeneration. Healthful daily environmental blue light exposure decreases in older adults, especially women. Blue light is important in dim environments where inadequate illumination increases risk of falls and associated morbidities. CONCLUSIONS: The blue light hazard is misused as a marketing stratagem to alarm people into using spectacles and IOLs that restrict blue light. Blue light loss is permanent for pseudophakes with blue-blocking IOLs. Blue light hazard misrepresentation flourishes despite absence of proof that environmental light exposure or cataract surgery causes AMD or that IOL chromophores provide clinical protection. Blue-filtering chromophores suppress blue light critical for good mental and physical health and for optimal scotopic and mesopic vision.

Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US.

Importance: Mistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions. Objective: To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US. Design, Setting, and Participants: This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible. Exposures: Specific types, sources, and factors associated with gender-based discrimination and sexual harassment. Main Outcomes and Measures: Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual- and program-level factors using gender-stratified multivariable logistic regression models. Results: The survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experiencing sexual harassment than interns (postgraduate years 4 and 5 vs postgraduate year 1: OR, 1.77 [95% CI, 1.40-2.24] among female residents; 1.31 [95% CI, 1.01-1.70] among male residents). Conclusions and Relevance: In this study, gender discrimination and sexual harassment were common experiences among surgical residents and were frequently reported by women. These phenomena warrant multifaceted context-specific strategies for improvement.

The American College of Surgeons Response to the COVID-19 Pandemic (Part I): Cancer Care, COVID-19 Registry, Surgeon Wellness.

From the onset of the COVID-19 global pandemic of 2020, the American College of Surgeons has been a leader in disseminating reliable information on the nature of the crisis and assuring quality of surgical care during the enforced lockdown of inpatient and outpatient care.

Gender Representation by Specialty Track at Surgical Meetings: The American and Australasian Experiences.

BACKGROUND: We compared the representation of women panelists at two large, general interest surgical meetings: the American College of Surgeons (ACS) Clinical Congress and Royal Australasian College of Surgeons (RACS) Scientific Congress. MATERIALS AND METHODS: We performed comprehensive analyses of panels and panelists at ACS and RACS meetings (2013-2018). Manual review was conducted to determine counts and proportions of invited panelists by gender. We made within- and between-meeting comparisons regarding gender representation by specialty track. Tracks were characterized after our review of meeting programs. RESULTS: There were 4542 panelists and 1390 panels at RACS from 2013 to 2018. At ACS, there were 3363 panelists over 693 panels. The specialty tracks with the highest proportion of men-only panels were transplant (75%) and cardiothoracic (63%) at ACS and cardiothoracic (83%) and multidisciplinary (81%) at RACS. The lowest proportions of men-only panels were in breast and pediatric surgery at ACS (5% and 11%, respectively) and breast and rural surgery at RACS (24% and 36%, respectively). At ACS, the highest proportions of women panelists were on panels in breast (63%) and endocrine surgery (48%) and in breast (44%) and rural surgery (33%) at RACS, while the lowest proportion of women panelists were in transplant (10%) and cardiothoracic (14%) at ACS and multidisciplinary (8%) and cardiothoracic (7%) at RACS. CONCLUSIONS: There is a persistent difference in gender representation at surgical meetings, particularly within certain subspecialties. Program chairs and committees could increase the proportion of women by focusing on who serves as panelists overall and within specialty tracks.

Survey of the US Surgeon Workforce: Practice Characteristics, Job Satisfaction, and Reasons for Leaving Surgery.

BACKGROUND: An impending surgeon shortage looms in the US due to increasing demand and a stagnant number of surgeons entering practice. We sought to evaluate the state of our surgical workforce by exploring current practice patterns, job satisfaction, and reasons why surgeons consider leaving surgery. STUDY DESIGN: In 2018, a link to a detailed survey was distributed by email to Fellows of the American College of Surgeons (ACS) who actively practice in the US and have completed a general surgery residency or integrated cardiothoracic, vascular, or plastic surgery fellowship. Detailed questions regarding practice attributes, surgical training, professional choices, and career satisfaction were included. Nonresponse weights were adjusted for respondent sex, age, and presence of subspecialty training between respondents and the total surveyed ACS population. All estimates and analyses were weighted to account for potential nonresponse bias. RESULTS: There were 3,807 surgeons who responded (15% response rate). Overall, 81% reported career satisfaction and 80% would choose surgery over again. Twenty-six percent were considering leaving surgery within the next 2 years. Stratified by age groups 40 to 49, 50 to 59, and 60 to 69 years, the survey found that 9%, 17%, and 45% of respondents were considering leaving surgery within the next 2 years, respectively. Thirteen percent of surgeons less than 60 years old were considering leaving surgery, and only 49% of these surgeons reported career satisfaction. Among surgeons less than 60 years old who were considering leaving surgery, the top 3 reasons rated as very important were overall stress (79%), work time demands (77%), and personal time requirements (73%). CONCLUSIONS: Reported surgeon job satisfaction was high, but a surprising number of surgeons reported that they were considering leaving surgery. Work time requirements and lack of personal time are leading factors contributing to surgeons leaving practice.

Postoperative surgical trainee opioid prescribing practices (POST-OPP): A national survey.

BACKGROUND: Increasing opioid-related deaths have heightened focus on combating the opioid epidemic. The impact of surgical trainees on opioid-related deaths is unclear, and there is little data examining the association between trainee pain management education and opioid prescribing practices. METHODS: An anonymous, online survey was distributed to members of the Resident and Associate Society of the American College of Surgeons. The survey covered five themes: education and knowledge, prescribing practices, clinical case scenarios, policy, and beliefs and attitudes. Linear mixed models were used to evaluate the influence of respondent characteristics on reported morphine milligram equivalents (MME) prescribed for common general surgery clinical scenarios. RESULTS: Of 427 respondents, 54 percent indicated receiving training in postoperative pain management during medical school and 66 percent during residency. Only 35 percent agreed that they had received adequate training in prescribing opioids. There was a significant association between undergoing formal pain management training in medical school and prescribing fewer MME for common outpatient general surgery scenarios (94 ± 15.2 vs 108 ± 15.0; p = 0.003). Similarly, formal pain management training in residency was associated with prescribing fewer MME in the survey scenarios (92.6 ± 15.2 vs 109 ± 15.2; p = 0.002). CONCLUSION: In this survey, nearly two-thirds of surgical residents felt that they were inadequately trained in opioid pre-scribing. Our findings additionally suggest that improving education may result in increased resident comfort with man-aging surgical pain, potentially leading to more responsible opioid prescribing. Further work will facilitate residency pro-grams' development of educational curricula for opioid prescribing best practices.

Trends in Gender Representation at the American College of Surgeons Clinical Congress and the Academic Surgical Congress: A Mixed Picture of Progress.

BACKGROUND: There has been increasing attention to gender inequity in speakers at professional meetings. The aim of this study was to evaluate temporal trends in representation of women at the Academic Surgical Congress (ASC) and American College of Surgeons Clinical Congress (CC), 2 prominent general interest, national surgical meetings. STUDY DESIGN: We reviewed ASC (2014-2019) and CC (2013-2018) meeting programs to determine counts and proportions of invited panelists and moderators by gender, including the frequency of men-only panels. We conducted trend analyses to assess for temporal change in gender representation and univariate tests of association between different measures of gender representation. RESULTS: The overall proportions of women panelists were 35% (ASC) and 28% (CC). There was a significant increase in the proportion of women panelists over the study period at the CC (23% to 34%, p = 0.007) but not at the ASC (37% to 36%, p = 0.79). The proportion of men-only panels decreased significantly over time at the CC (38% to 23%, p = 0.04), but not at the ASC (23% to 17%, p = 0.50), while the proportion of moderators at the ASC increased significantly (31% to 43%, p = 0.01), but not at the CC (29% to 37%, p = 0.40). CONCLUSIONS: Women remain in the minority of panelists and moderators at the ASC and CC meetings, and approximately 1 in 5 panels are composed entirely of men. Although progress has been made at both meetings, ongoing and deliberate attention is needed to ensure continued progress toward the goal of equitable gender representation in academic surgery.

Leadership in American Surgery: Women are Rising to the Top.

OBJECTIVE: To celebrate the increasing representation of women as leaders in American surgery and provide suggestions for increasing diversity in leadership. BACKGROUND: Women were barred from entering the practice of medicine or surgery until the mid 1800's when Elizabeth Blackwell led the way as the first woman admitted to medical school. Although the numbers of women practicing medicine and surgery have increased exponentially since Dr Blackwell graduated, the number of women in leadership positions has remained low until recently. METHODS: An analysis of the literature on the history of women in surgery and the websites of the major surgical societies. RESULTS: More women are now rising to leadership positions in surgery, both in academics and within surgical organizations. The American College of Surgeons and many other surgical societies, as well as an increasing number of academic departments of surgery have realized that women can be inspiring and capable leaders. However, increasing the number of under-represented minority women in leadership positions remains an opportunity for improvement. CONCLUSIONS: Great progress has been made in the advancement of women into leadership positions in surgery. To continue this trend and increase the number of under-represented minority women in surgery will require attention to recruitment, mentorship, and sponsorship.

International Scholarship Programs of the American College of Surgeons: Expansion of the Global Surgical Network.

BACKGROUND: The American College of Surgeons has always promoted education and collaborations with other countries and their scientific organizations. The International Guest Scholarship program was established in 1968 to support the travel of foreign surgeons to medical Institutions in the USA and Canada. The program has grown substantially over time and now includes different categories of scholarships and surgeons. The objective of this article is to describe the experiences gained by the international scholars who visited US and Canadian institutions through these ACS programs. STUDY DESIGN: In order to collect information regarding these scholarships from the surgeons who have already participated in the program, an Internet-based survey was e-mailed to alumni. The surveys were constructed to gather career information on former scholars and to analyze the perceived impact of these programs on their careers. RESULTS: Among the international scholarships alumni, most are now Fellows of the American College of Surgeons. The majority of respondents maintained contact with their host surgeons in the USA or Canada; they began or continued research, surgical education and surgical quality improvement initiatives in their country of origin based upon their experiences as international scholars. Most of the alumni reported that the experience they had during the scholarship was inspiring, opened their minds and broadened their horizons. CONCLUSIONS: The overall effect of ACS international scholarship program should be considered as positive, as 80-90% of respondent alumni consider their experience very helpful and feel that it provided them with opportunities that would not have been possible without it. It is incumbent upon the ACS to continue along this path by identifying funding and donation sources, as well as enriching the content and goals.