Diversity, Equity, and Inclusion: A Current Analysis of General Surgery Residency Programs.

BACKGROUND: Local, regional, and national diversity, equity, and inclusion (DEI) initiatives have been established to combat barriers to entry and promote retention in surgery residency programs. Our study evaluates changes in diversity in general surgery residency programs. We hypothesize that diversity trends have remained stable nationally and regionally. MATERIALS AND METHODS: General surgery residents in all postgraduate years were queried regarding their self-reported sex, race, and ethnicity following the 2020 ABSITE. Residents were then grouped into geographic regions. Data were analyzed utilizing descriptive statistics, Kruskal-Wallis test, and chi-square analyses. RESULTS: A total of 9276 residents responded. Nationally, increases in female residents were noted from 38.0 to 46.0% (P < .001) and in Hispanic or Latinx residents from 7.3 to 8.3% (P = .031). Across geographic regions, a significant increase in female residents was noted in the Northwest (51.9 to 58.3%, P = .039), Midwest (36.9 to 43.3%, P = .006), and Southwest (35.8 to 47.5%, P = .027). A significant increase in black residents was only noted in the Northwest (0 to 15.8%, P = .031). The proportion of white residents decreased nationally by 8.9% and in the Mid-Atlantic, Southeast, and Southwest between 5.5 and 15.9% (P < .05). DISCUSSION: In an increasingly diverse society, expanding the numbers of underrepresented surgeons in training, and ultimately in practice, is a necessity. This study shows that there are region-specific increases in diversity, despite minimal change on a national level. This finding may suggest the need for region-specific DEI strategies and initiatives. Future studies will seek to evaluate individual programs with DEI plans and determine if there is a correlation to changing demographics.

Factors associated with general surgery residents' decisions regarding fellowship and subspecialty stratified by burnout and quality of life.

BACKGROUND: Although most surgery residents pursue fellowships, data regarding those decisions are limited. This study describes associations with interest in fellowship and specific subspecialties. METHODS: Anonymous surveys were distributed to 607 surgery residents at 19 US programs. Subspecialties were stratified by levels of burnout and quality of life using data from recent studies. RESULTS: 407 (67%) residents responded. 372 (91.4%) planned to pursue fellowship. Fellowship interest was lower among residents who attended independent or small programs, were married, or had children. Residents who received AOA honors or were married were less likely to choose high burnout subspecialties (trauma/vascular). Residents with children were less likely to choose low quality of life subspecialties (trauma/transplant/cardiothoracic). CONCLUSIONS: Surgery residents' interest in fellowship and specific subspecialties are associated with program type and size, AOA status, marital status, and having children. Variability in burnout and quality of life between subspecialties may affect residents' decisions.

Tools for Assessment of Communication Skills of Hospital Action Teams: A Systematic Review.

BACKGROUND: Hospital action teams comprise interdisciplinary health care providers working simultaneously to treat critically ill patients. Assessments designed to evaluate communication effectiveness or "nontechnical" performance of these teams are essential to minimize medical errors and improve team productivity. Although multiple communication tools are available, the characteristics and psychometric validity of these instruments have yet to be systematically compared. OBJECTIVE: To identify assessments used to evaluate the communication or "nontechnical" performance of hospital action teams and summarize evidence to develop and validate these instruments. METHOD: A literature search was conducted using MEDLINE/PubMed database to identify original articles related to assessment of communication skills in teams working in acute care medicine not exclusive to emergency room, operating room, prehospital air and ground transport, or code blue/rapid response resuscitations. RESULTS: Ten communication assessment tools were identified. Six tools (60%) were designed to measure communication performance of the whole team, whereas 4 tools (40%) were created to assess individual team member's communication skills. Regardless of the type of analysis, the most commonly assessed behavior domains were Leadership, Teamwork, Communication, and Situation awareness. Only 1 of 16 articles describing a particular communication assessment tool reported all the validation criteria, other authors underreported efforts to validate their instruments. CONCLUSION: A number of tools designed to measure the communication or "nontechnical" performance of hospital action teams are available. Unfortunately, limited reported validity evidence may hamper the utility of these tools in actual clinical practice until further validation studies are performed.

Malpractice risk and cost are significantly reduced after tort reform.

BACKGROUND: Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center. We compared malpractice prevalence, incidence, and liability costs before and after comprehensive state tort reform measures were implemented. STUDY DESIGN: Two prospectively maintained institutional databases were used to calculate and characterize malpractice risk: a surgical operation database and a risk management and malpractice database. Risk groups were divided into pretort reform (1992 to 2004) and post-tort reform groups (2004 to the present). Operative procedures were included for elective, urgent, and emergency general surgery procedures. RESULTS: During the study period, 98,513 general surgical procedures were performed. A total of 28 lawsuits (25 pre-reform, 3 postreform) were filed, naming general surgery faculty or residents. The prevalence of lawsuits filed/100,000 procedures performed is as follows: before reform, 40 lawsuits/100,000 procedures, and after reform, 8 lawsuits/100,000 procedures (p < 0.01, relative risk 0.21 [95% CI 0.063 to 0.62]). Virtually all of the liability and defense cost was in the pretort reform period: $595,000/year versus $515/year in the postreform group (p < 0.01). CONCLUSIONS: Implementation of comprehensive tort reform in Texas was associated with a significant decrease in the prevalence and cost of surgical malpractice lawsuits at one academic medical center.

Educational debt of physicians-in-training: determining the level of interest in a loan repayment program for service in a medically underserved area.

PURPOSE: The amount of financial debt incurred by Texas medical students and residents during training was examined as well as the impact of this debt on these trainees' career choices. METHOD: An invitation to participate was sent in a Web-based survey to medical students and residents at 6 university programs in Texas during the 2005-2006 academic year. RESULTS: Overall, 818 students (20%) and 529 residents (14%) responded to the survey. Of these, 96% of students and 85% of residents had taken out educational loans, and approximately 62% of students and residents expected their debt to exceed $100,000. More than half of students and residents expected educational debt to influence their choice of practice type and practice area and to affect important personal decisions. Approximately 52% of students and 38% of residents indicated an interest in participating in a loan repayment program that involved service in a medically underserved area. In general, women and members of minority groups were more likely to express such an interest. CONCLUSIONS: Medical students and residents incur considerable financial debt, which seems to affect their career choices. Approximately half of the students and one third of the residents surveyed indicated that they would consider participating in a loan repayment program that required practice in an underserved area.

Laparoscopic appendectomy is superior to open appendectomy in obese patients.

BACKGROUND: There are minimal data comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in obese patients. METHODS: We reviewed consecutive adult patients from 2003 to 2005 who underwent an appendectomy at a University-affiliated teaching hospital. Obesity was defined as a body mass index of 30 or greater. Outcome measures included length of stay, surgical times, intra-abdominal abscesses, wound infections, and hospital charges. RESULTS: There were 116 patients with a mean body mass index of 35. Eighty-five patients underwent LA, 12 were converted to open, 4 of 12 (31%) were perforated. Thirty-one patients underwent OA. Overall, 21 (18%) were perforated. Length of stay for LA was better, 3.4 days versus 5.5 days for OA (P = .02), and wound closure rate was better, 90% for LA versus 68% for OA (P < .01). Other outcome measures were equivalent. CONCLUSIONS: LA is associated with shorter lengths of stay, fewer open wounds, and equivalent hospital charges and intra-abdominal abscess rates; and should be considered the procedure of choice for obese patients with appendicitis.

Perceptions and attitudes of critical care training and careers among United States surgical residents: who wants to be a surgical intensivist?

Less than 50 per cent of surgical critical care (SCC) fellowship positions are filled each year. We surveyed senior surgical residents to determine their opinions regarding a career in SCC and acute care surgery. A survey was sent to 1348 postgraduate year 3, 4, and 5 residents in the United States. Two hundred fifty-one surveys were returned (19% response rate). Whereas 78 per cent were planning to complete a fellowship, 21 per cent expressed interest in SCC. Fifty-six per cent plan to handle SCC problems only for their own patients, whereas 39 per cent plan to turn this management over to a critical care provider. SCC fellowships were considered to be potentially more appealing if the following changes could be made to the existing structure: adding more general surgery (70% of respondents); adding more trauma experience (50%); adding emergency neurosurgery (44%); adding more emergency orthopedics (42%); or decreasing months of critical care (36%). Increasing salary enhanced appeal for 82 per cent. SCC has limited appeal for most senior surgical residents. Theoretical expansion of surgical critical fellowships to include more general or trauma surgery (acute care surgery) increased the level of interest among senior surgical residents.

Trauma surgery malpractice risk: perception versus reality.

OBJECTIVE: We set out to compare the malpractice lawsuit risk and incidence in trauma surgery, emergency surgery, and elective surgery at a single academic medical center. SUMMARY AND BACKGROUND DATA: The perceived increased malpractice risk attributed to trauma patients discourages participation in trauma call panels and may influence career choice of surgeons. When questioned, surgeons cite malpractice risk as a rationale for not providing trauma care. Little data substantiate or refute the perceived high trauma malpractice risk. We hypothesized that the malpractice risk was equivalent between an elective surgical practice and a trauma/emergency practice. METHODS: Three prospectively maintained institutional databases were used to calculate and characterize malpractice incidence and risk: a surgical operation database, a trauma registry, and a risk management/malpractice database. Risk groups were divided into elective general surgery (ELECTIVE), urgent/emergent, nontrauma general surgery (URGENT), and trauma surgery (TRAUMA). Malpractice claims incidence was calculated by dividing the total number of filed lawsuits by the total number of operative procedures over a 12-year period. RESULTS: Over the study period, 62,350 operations were performed. A total of 21 lawsuits were served. Seven were dismissed. Three were granted summary judgments to the defendants. Ten were settled with payments to the plaintiffs. One went to trial and resulted in a jury verdict in favor of the defendants. Total paid liability was 4.7 million dollars(391,667 dollars/year). Total legal defense costs were 1.3 million dollars(108,333 dollars/year). The ratio of lawsuits filed/operations performed and incidence in the 3 groups is as follows: ELECTIVE 14/39,080 (3.0 lawsuits/100,000 procedures/year), URGENT 5/17,958, (2.3 lawsuits/100,000 procedures/year), and TRAUMA 2/5312 (3.1/100,000 procedures/year). During the study period, there were an estimated 49,435 trauma patients evaluated. The incidence of malpractice lawsuits using this denominator is 0.34 lawsuits/100,000 patients/year. CONCLUSIONS: These data demonstrate no increased risk of lawsuit when caring for trauma patients, and the actual risk of a malpractice lawsuit was low.