The development of anti-bullying, discrimination and harassment guidance: a survey among the Association of Surgeons in Training (ASiT) council members.

INTRODUCTION: Surgical trainees have a reasonable expectation to feel safe and valued in their workplace. Previous reports proved that poor behaviour and misconduct existed in national health systems. This study aimed to conduct a survey among the Association of Surgeons in Training (ASiT) council members to identify the need for guidance to report bullying, discrimination and harassment for trainees who experienced any type of poor behaviour in the workplace. METHODS: Data among executive and council members were collected. Questions were related to trainee demographics, level of training, specialties, and experience of, witnessed or reported poor behaviours including bullying, discrimination and harassment. We asked if participants lacked direction when experiencing poor behaviours, and if support strategies were needed such as a standardised guidance for reports. RESULTS: A total of 58 survey responses were received: 55.17% of participants experienced bullying, 77.58% witnessed it and 67.25% did not report the incidents. Furthermore, 37.93% experienced discrimination, 62.07% witnessed it and 68.97% did not report. A total of 24.14% experienced sexual harassment, 29.69% witnessed it, while 72.41% did not report. Over 80% mentioned they need more guidance to support trainees. Almost all participants (98%) agreed that surgical trainees should be made aware of routes for reporting, and 88% agreed that ASiT should develop the guidance to support trainees against poor behaviours. CONCLUSION: Most of the trainees who experienced or witnessed poor behaviours did not report the incidents. A new standardised anti-bullying, anti-discrimination and anti-harassment guidance was developed based on our study results. We envisage that its use may play a role in eliminating misconduct in surgical training.

Surgeon Understanding and Perceptions of Social Determinants of Health.

INTRODUCTION: Social determinants of health impact surgical outcomes. Characterization of surgeon understanding of social determinants of health is necessary prior to implementation of interventions to address patient needs. The study objective was to explore understanding, perceived importance, and practices regarding social determinants of health among surgeons. METHODS: Surgical residents and attending surgeons at a single academic medical center completed surveys regarding social determinants of health. We conducted semi-structured interviews to further explore understanding and perceived importance. A conceptual framework from the World Health Organization (WHO) Commission on Social Determinants of Health informed the thematic analysis. RESULTS: Survey response rate was 47.9% (n = 69, 44 residents [63.8%], 25 attendings [36.2%]). Respondents primarily reported good (n = 29, 42.0%) understanding of social determinants of health and perceived this understanding to be very important (n = 42, 60.9%). Documentation occurred seldom (n = 35, 50.7%), and referrals occurred seldom (n = 26, 37.7%) or never (n = 20, 29.0%). Residents reported a higher rate of prior training than attendings (95.5% versus 56.0%, P < 0.001). Ten interviews were conducted (six residents, four attendings). Residents demonstrated greater understanding of socioeconomic positions and hierarchies shaped by structural mechanisms than attendings. Both residents and attendings demonstrated understanding of intermediary determinants of health status and linked social determinants to impacting patients' health and well-being. Specific knowledge gaps were identified regarding underlying structural mechanisms including the social, economic, and political context that influence an individual's socioeconomic position. CONCLUSIONS: Self-reported understanding and importance of social determinants of health among surgeons were high. Interviews revealed gaps in understanding that may contribute to limited practices.

Assessment of the well-being of significant others of cardiothoracic surgeons.

OBJECTIVES: We aimed to evaluate how the current working climate of cardiothoracic surgery and burnout experienced by cardiothoracic surgeons influences their spouses and significant others (SOs). METHODS: A 33-question well-being survey was developed by the American Association for Thoracic Surgery Wellness Committee and distributed by e-mail to the SOs of cardiothoracic surgeons and to all surgeon registrants of the 2020 and 2021 American Association for Thoracic Surgery Annual Meetings with a request to share it with their SO. The 5-item Likert-scale survey questions were dichotomized, and associations were determined by χ2 or independent samples t tests, as appropriate. RESULTS: Responses from 238 SOs were analyzed. Sixty-six percent reported that the stress on their cardiothoracic surgeon partner had a moderate to severe influence on their family, and 63% reported that their partner's work demands didn't leave enough time for family. Fifty-one percent reported that their partner rarely had time for intimacy, 27% reported poor work-life balance, and 23% reported that interactions at home were usually or always not good-natured. SOs were most affected when their partner was <5 years out from training, worked in private vs academic practice, and worked longer hours. Having children, particularly younger than age 19 years, and a lack of workplace support resources further diminished well-being. CONCLUSIONS: The current work culture of cardiothoracic surgeons adversely affects their SOs, and the risk for families is concerning. These data present a major area for exploration as we strive to understand and mitigate the factors that lead to burnout among cardiothoracic surgeons.

Current Clinical Practice Patterns in Total Vaginal Hysterectomy.

OBJECTIVES: There are no data on current surgical practice patterns for benign total vaginal hysterectomy (TVH) despite recently published guidelines. The objective was to determine gynecologic surgeon practice patterns regarding TVH perioperative interventions and to assess adherence to clinical practice guidelines. METHODS: A survey to assess TVH practice patterns was distributed to gynecologic surgical society members for completion. The primary outcome was to compare adherence to practice guidelines between fellowship-trained and non-fellowship-trained gynecologic surgeons. Secondary outcomes included comparing adherence based on age, practice location, and hysterectomy volume. RESULTS: Of the 204 respondents, there were 163 (80%) fellowship-trained and 41 (20%) non-fellowship-trained gynecologic surgeons. Fellowship-trained surgeons were more likely than non-fellowship-trained surgeons to use vaginal packing (34% vs 15%, P = 0.028), which is contrary to the recommendations. No cohort followed the guideline recommending a circular cervicovaginal incision. Fellowship-trained surgeons also were more likely than non-fellowship-trained surgeons to use the clamp and suture technique for vessel ligation (88% vs 68%, P = 0.004); otherwise, there were no significant differences between cohorts for adherence to any of the other guidelines. Although fellowship-trained surgeons were adherent to fewer of the guidelines as compared with surgeons without fellowship training, both groups generally adhered to a majority of the clinical practice guidelines for benign TVH. CONCLUSIONS: This information demonstrates a need for the development of targeted education and interventions to increase the use of evidence-based clinical practice guidelines during TVH for both fellowship-trained and non-fellowship-trained gynecologic surgeons.

Needs assessment study of postgraduate surgical education in Sudan: Trainees perspective.

INTRODUCTION: Global interest has increased in improving the quality and increasing the number of graduates from surgical training programmes in countries with limited resources. Needs assessment of stakeholders in the training programmes represent the backbone of such process. The aim of this study was to assess the surgical training in Sudan from trainees' perspective in order to inform training delivery. METHODS: We adopted mixed methods design using focus group discussion for qualitative data collection and questionnaire survey for quantitative data. NVivo 20 Pro was used to organize qualitative data and SPSS 24.0 was used for quantitative data analysis. RESULTS: Thematic analysis of qualitative data identified three themes. Trainees were overall satisfied that they will make good surgeons after completion of the programme. They identified case volume and collaborations with colleagues as the main strengths of the programme and lacking clear objectives for each year of training and academic activities as the main weaknesses. They suggested motivation of trainers and utilization of online resources and meeting platforms as solutions to improve supervision and academic activities during training. CONCLUSION: The gaps in training and their suggested solutions highlighted by trainees in this study should form the base for reforming the surgical training in Sudan and countries with similar circumstances.

Assessment of robotic telesurgery system among surgeons: a single-center study.

The field of robotic-assisted surgery is expanding rapidly; therefore, future robotic surgeons will need to be trained in an organized manner. Here, we aimed to examine surgeon performance on the Sinaflex Robotic Telesurgery System for correlation with training hours spent in training program. This is a prospective study of a single-center experience at the Hasan Sadikin Hospital, Bandung City of West Java, Indonesia. We included 43 surgeons from 11 departments, all invited to train using the Sinaflex Robotic Telesurgery system at the Hasan Sadikin Hospital. All study cohorts have never performed a robotic surgery procedure beforehand and have had at least five years of field experience. The surgeons were free to choose their training duration and simulation. After finishing the training session, they were asked to perform several tasks with increasing difficulty levels. There were nine training tasks in total with increasing levels of difficulty. A total of 43 surgeons from 11 different department were included in this prospective study. Our study was separated into 3 different batches and most surgeons failed to pass the examination (n = 12, 8, and 9, for batches 1, 2, and 3, respectively). The "failed" surgeon, additionally, tended to be older than the "passed" cohort (49.3 ± 7.4 vs 42.1 ± 7.3 years old, p = 0.005). In terms of duration of hours spent training on the robot, there was little difference training hours between the cohort that passed and the cohort that failed cohort (10.0 [8.4-10.1] vs 10.0 [8.0-10.0], respectively) with a p value of 0.265. We found no correlation between the total hours spent in the training program and surgeon performance on the Sinaflex robotic telesurgery system. Structured robot surgical training courses must be incorporated into the training programs.

Describing the decision process of post-operative opioid and pain prescribing patterns in orthopedic and general surgeons.

OBJECTIVE: To describe the post-operative opioid prescribing behaviors of orthopedic and general surgeons through the use of the Integrated Behavioral Model (IBM), and subsequently the steps and logic used by providers in determining post-operative pain prescriptions. DESIGN: This study was a prospective, cross-sectional, cohort study utilizing qualitative methods consisting of semistructured interviews. Data were analyzed using thematic analysis to categorize and identify themes to describe prescriber behavior. SETTING: All participants were from a regional health system in central Appalachia. PATIENTS AND PARTICIPANTS: Mixed population of orthopedic and general surgeons who completed residency training and performed nontraumatic procedures. MAIN OUTCOME MEASURE: Categorization and identification of themes within the constructs of the IBM that described surgeon opioid prescribing. RESULTS: Fifteen surgeons participated in this study. Themes were identified within the context of the IBM. Attitudes by surgeons consisted of blame toward the government, a lack of personal screening of patients, and a theme of the abusing population of patients only being a small group. Norms were identified that included prescribing based on a standard prescribing set, realization of patient fear, and the idea of past mentality. Surgeons believed in their ability to prescribe responsibly and conservatively. CONCLUSIONS: The prescribing patterns of surgeons and their keenness to assess patients for opioid abuse vary. Most surgeons did not actively participate in screening activities but rely on ancillary staff. Surgeons utilize federal and state laws to back prescribing patterns and thwart patient attempts for additional medications. Prescribers maintain a sense of self-confidence with their own knowledge and ability to taper and keep patients from becoming reliant on opioid prescribing.

Gaze behavior is related to objective technical skills assessment during virtual reality simulator-based surgical training: a proof of concept.

PURPOSE: Simulation-based training allows surgical skills to be learned safely. Most virtual reality-based surgical simulators address technical skills without considering non-technical skills, such as gaze use. In this study, we investigated surgeons' visual behavior during virtual reality-based surgical training where visual guidance is provided. Our hypothesis was that the gaze distribution in the environment is correlated with the simulator's technical skills assessment. METHODS: We recorded 25 surgical training sessions on an arthroscopic simulator. Trainees were equipped with a head-mounted eye-tracking device. A U-net was trained on two sessions to segment three simulator-specific areas of interest (AoI) and the background, to quantify gaze distribution. We tested whether the percentage of gazes in those areas was correlated with the simulator's scores. RESULTS: The neural network was able to segment all AoI with a mean Intersection over Union superior to 94% for each area. The gaze percentage in the AoI differed among trainees. Despite several sources of data loss, we found significant correlations between gaze position and the simulator scores. For instance, trainees obtained better procedural scores when their gaze focused on the virtual assistance (Spearman correlation test, N = 7, r = 0.800, p = 0.031). CONCLUSION: Our findings suggest that visual behavior should be quantified for assessing surgical expertise in simulation-based training environments, especially when visual guidance is provided. Ultimately visual behavior could be used to quantitatively assess surgeons' learning curve and expertise while training on VR simulators, in a way that complements existing metrics.

A Video-Based Assessment Tool to Measure Intraoperative Laparoscopic Suturing Using a Modified Script Concordance Methodology.

OBJECTIVES: Laparoscopic suturing (LS) is a challenging laparoscopic skill to teach. Its complexity and nuances are not modeled or measured in current simulation and assessment platforms.The script concordance test (SCT) is used to assess clinical reasoning.The purpose of this study is to provide evidence for validity of this novel SCT based online assessment for LS skills. DESIGN: We designed a video-based online SCT for LS using a cognitive task analysis and expert panelists.The CTA yielded 4 LS domains: needle handling (NH), tissue handling (TH), knot tying techniques (KT) and operative ergonomics (OE). Five-point scales with anchoring descriptors from -2 to +2 were used. Scoring was based on a modified SCT methodology. SETTING AND PARTICIPANTS: The test was administrated to 37 subjects (18 experts and 19 novices). There was no time limit given. A different expert group from the minimal invasive surgery (MIS) panelist were recruited. Experts were defined as surgeons and fellows with LS experience of >25 cases annually. Validity was assessed by comparing SCT scores of experienced and inexperienced surgeons. Cronbach's alpha was used to assess the internal consistency of the test. RESULTS: The survey started off with 47 questions in each of the following domains: 13 NH, 4 TH, 20 KT and 10 OE. Thirty-seven surgeons (18 experts and 19 inexperienced surgeons). Questions that demonstrated a large discrepancy among experts and panelists with a weighted score difference more than 40 were discarded (n = 20). One question was discarded because it received a 100% score from all participants. This yielded 26 remaining questions in the following domains: 8 NH, 2 TH, 11 KT and 5 OE. The test reliability level (Cronbach a) was 0.80. The mean score was 72 ± 9% and 63 ± 15% (p = 0.02) for experts and inexperienced surgeons, respectively. The mean time to complete the test was 21 minutes. CONCLUSION: This study provides validity evidence for a novel intraoperative LS assessment. The variability of responses between experts and panelists suggests that SCT may capture the clinical differences/surgeon preferences in performing LS intraoperatively.

Evidence supporting performance measures of laparoscopic appendectomy through a novel surgical proficiency assessment tool and low-cost laparoscopic training system.

BACKGROUND: Laparoscopic training remains inaccessible for surgeons in low- and middle-income countries, limiting its widespread adoption. We developed a novel tool for assessment of laparoscopic appendectomy skills through ALL-SAFE, a low-cost laparoscopy training system. METHODS: This pilot study in Ethiopia, Cameroon, and the USA assessed appendectomy skills using the ALL-SAFE training system. Performance measures were captured using the ALL-SAFE verification of proficiency tool (APPY-VOP), consisting of a checklist, modified Objective Structured Assessment of Technical Skills (m-OSATS), and final rating. Twenty participants, including novice (n = 11), intermediate (n = 8), and expert (n = 1), completed an online module covering appendicitis management and psychomotor skills in laparoscopic appendectomy. After viewing an expert skills demonstration video, participants recorded their performance within ALL-SAFE. Using the APPY-VOP, participants rated their own and three peer videos. We used the Kruskal-Wallis test and a Many-Facet Rasch Model to evaluate (i) capacity of APPY-VOP to differentiate performance levels, (ii) correlation among three APPY-VOP components, and (iii) rating differences across groups. RESULTS: Checklist scores increased from novice (M = 21.02) to intermediate (M = 23.64) and expert (M = 28.25), with differentiation between experts and novices, P = 0.005. All five m-OSATS domains and global summed, total summed, and final rating discriminated across all performance levels (P < 0.001). APPY-VOP final ratings adequately discriminated Competent (M = 2.0), Borderline (N = 1.8), and Not Competent (M = 1.4) performances, Χ2 (2,85) = 32.3, P = 0.001. There was a positive correlation between ALL-SAFE checklist and m-OSATS summed scores, r(83) = 0.63, P < 0.001. Comparison of ratings suggested no differences across expertise levels (P = 0.69) or location (P = 0.66). CONCLUSION: APPY-VOP effectively discriminated between novice and expert performance in laparoscopic appendectomy skills in a simulated setting. Scoring alignment across raters suggests consistent evaluation, independent of expertise. These results support the use of APPY-VOP among all skill levels inside a peer rating system. Future studies will focus on correlating proficiency to clinical practice and scaling ALL-SAFE to other settings.

Checking Our Blind Spots: Examining Characteristics of Interviewees Versus Matriculants to a Hepatopancreatobiliary Surgical Fellowship Program.

OBJECTIVE: Racial and gender biases exist within academic surgery; bias negatively impacts patient care, reimbursement, student training, and staff retention. Few studies have investigated the potential for bias in surgical fellowship recruitment. We aimed to compare the racial and gender diversity at our hepatopancreatobiliary (HPB) surgery fellowship program to nationwide standards. We further aimed to investigate differences in the demographics of resident interviewees versus matriculants to our HPB fellowship. DESIGN: Retrospective review. SETTING: North American HPB fellowship training programs. PARTICIPANTS: Mayo Clinic's HPB surgery fellowship interviewees and North American HPB surgery fellowship graduates from 2013 to 2020. RESULTS: When compared to general surgery residency graduates during the study period (in 2019), a lower proportion of North American HPB surgery fellowship graduates were female (26% HPB fellowship graduates vs. 43.1% residents, p = 0.005), with no difference in proportion of racially under-represented in medicine (rURM) HPB fellowship graduates (10.7%) compared to rURM proportion of general surgery residents nationally (14.5%). There was an upward trend in female representation among North American HPB fellowship graduates from 11% in 2013 to 32% in 2020, but proportions of rURM HPB fellows remained steadily low. When comparing HPB interviewees at our institution to national general surgery residents, no differences were observed in proportions of female (34.4% interviewees vs. 43.1% residents, p = 0.17) or rURM (interviewees = 6.8%, residents = 14.5%, p = 0.09) applicants. Additionally, there was no significant difference between the proportion of female or rURM interviewees and matriculants to our HPB program. CONCLUSIONS: While fewer female graduating surgeons are pursuing HPB fellowship training than male graduates, this gender gap has narrowed over time. In contrast, the national percentage of rURM HPB fellowship graduates has remained low, mirroring stagnant proportions of rURM surgical residency graduates. When comparing HPB fellowship interviewees at our own institution to North American fellowship graduates, we observed similar proportions of female interviewees but lower proportions of rURM interviewees. Locally, these data will drive process change toward more intentional examination of our interview selection process. Nationally, more work is needed to increase the racial diversity of surgical residency and fellowship trainees to best reflect and serve our diverse patient populations.

An Image Information-Based Objective Assessment Method of Technical Manipulation Skills for Intravascular Interventions.

The clinical success of vascular interventional surgery relies heavily on a surgeon's catheter/guidewire manipulation skills and strategies. An objective and accurate assessment method plays a critical role in evaluating the surgeon's technical manipulation skill level. Most of the existing evaluation methods incorporate the use of information technology to find more objective assessment models based on various metrics. However, in these models, sensors are often attached to the surgeon's hands or to interventional devices for data collection, which constrains the surgeon's operational movements or exerts an influence on the motion trajectory of interventional devices. In this paper, an image information-based assessment method is proposed for the evaluation of the surgeon's manipulation skills without the requirement of attaching sensors to the surgeon or catheters/guidewires. Surgeons are allowed to use their natural bedside manipulation skills during the data collection process. Their manipulation features during different catheterization tasks are derived from the motion analysis of the catheter/guidewire in video sequences. Notably, data relating to the number of speed peaks, slope variations, and the number of collisions are included in the assessment. Furthermore, the contact forces, resulting from interactions between the catheter/guidewire and the vascular model, are sensed by a 6-DoF F/T sensor. A support vector machine (SVM) classification framework is developed to discriminate the surgeon's catheterization skill levels. The experimental results demonstrate that the proposed SVM-based assessment method can obtain an accuracy of 97.02% to distinguish between the expert and novice manipulations, which is higher than that of other existing research achievements. The proposed method has great potential to facilitate skill assessment and training of novice surgeons in vascular interventional surgery.

Capturing fine-grained details for video-based automation of suturing skills assessment.

OBJECTIVES: Manually-collected suturing technical skill scores are strong predictors of continence recovery after robotic radical prostatectomy. Herein, we automate suturing technical skill scoring through computer vision (CV) methods as a scalable method to provide feedback. METHODS: Twenty-two surgeons completed a suturing exercise three times on the Mimic™ Flex VR simulator. Instrument kinematic data (XYZ coordinates of each instrument and pose) were captured at 30 Hz. After standardized training, three human raters manually video segmented suturing task into four sub-stitch phases (Needle handling, Needle targeting, Needle driving, Needle withdrawal) and labeled the corresponding technical skill domains (Needle positioning, Needle entry, Needle driving, and Needle withdrawal). The CV framework extracted RGB features and optical flow frames using a pre-trained AlexNet. Additional CV strategies including auxiliary supervision (using kinematic data during training only) and attention mechanisms were implemented to improve performance. RESULTS: This study included data from 15 expert surgeons (median caseload 300 [IQR 165-750]) and 7 training surgeons (0 [IQR 0-8]). In all, 226 virtual sutures were captured. Automated assessments for Needle positioning performed best with the simplest approach (1 s video; AUC 0.749). Remaining skill domains exhibited improvements with the implementation of auxiliary supervision and attention mechanisms when deployed separately (AUC 0.604-0.794). All techniques combined produced the best performance, particularly for Needle driving and Needle withdrawal (AUC 0.959 and 0.879, respectively). CONCLUSIONS: This study demonstrated the best performance of automated suturing technical skills assessment to date using advanced CV techniques. Future work will determine if a "human in the loop" is necessary to verify surgeon evaluations.

Encouraging Young Pediatric Surgeons and Evaluation of the Effectiveness of a Pediatric Endosurgery Workshop by Self-Assessment and an Objective Skill Validation System.

Background: Japanese pediatric endosurgery experts conducted a workshop for young pediatric surgeons in Russia in collaboration with Russian expert pediatric surgeons. This study was aimed to develop a contributive workshop program and evaluate its impact on young pediatric surgeons. Methods: A 2-day pediatric endosurgery workshop was held in Moscow in February 2020. After conducting a needs assessment survey, Japanese and Russian faculties developed the workshop contents, including pre- and postworkshop skills assessments, lectures, and hands-on training. Skills assessments were performed using the objective skill validation system, the "A-Lap Mini," mimicking intestinal anastomosis. The trainees self-evaluated their knowledge and skills using a five-point scale. Results: Fifteen novice trainee participated and 14 (93.3%) completed the workshop program. The completion rate for the suturing task before and after the workshop was 40.0% (6/15) and 85.7% (12/14), respectively. The following five skill evaluation criteria, which were objectively evaluated: performance time changed from 751.6 ± 247.1 seconds to 780.0 ± 313.3 seconds (P > .05), number of full-thickness sutures improved from 1.0 ± 1.41 to 2.64 ± 0.84 (P = .003), area of wound-opening changed from 0.42 ± 0.83 mm2 to 0.53 ± 1.13 mm2 (P > .05), suture tension improved from 55.48% ± 19.51% to 61.95% ± 23.91% (P > .05), and maximum air leakage pressure improved from 3.76 ± 2.11 kPa to 8.42 ± 7.68 kPa (P > .05). Regarding the self-assessed questionnaire administered before and after the workshop, the confidence in endosurgery skills significantly improved as follows: forceps manipulation ability improved from 2.7 to 3.7 (P < .05), and suturing performance improved from 2.5 to 3.6 (P < .05). The usefulness of the workshop for clinical surgery was scored at 4.3. Conclusions: Quantitative skill evaluation with an automatic feedback function was useful for endosurgery training. Delivering feedback concerning the assessment results to the trainee helps them to determine the specific training requirements needed for clinical endosurgery.

The job market for HPB surgeons: leadership perspectives on surgeon skillsets, training pathways, and hiring.

BACKGROUND: Three tracks prepare Hepato-Pancreato-Biliary (HPB) surgeons: HPB, surgical oncology, and transplant fellowships. This study explored how surgical leaders thought about HPB surgery and evaluated potential candidates for HPB positions. METHODS: This descriptive qualitative study utilized interviews of healthcare leaders whose responsibilities included hiring HPB surgeons. We coded inductively then used thematic network analysis to organize the data. Individual codes formed basic themes, then larger secondary themes, then finally "primary" themes. RESULTS: Primary themes were: (1) What defines an HPB surgical practice?, (2) How do they assess candidates for HPB positions?, and (3) How will HPB practices continue to evolve? Leaders assessed applicants' training, behaviors and cultural fit, technical excellence, and more. Personal recommendations and professional networks significantly influenced the hiring process. HPB surgery needs were growing due to population changes, treatments advances, and changing market conditions. DISCUSSION: Surgical societies should focus on facilitating networking, promoting transparency, sharing quality data, providing evidence of technical skills and teamwork, mentorship, and providing guidance to general surgery residency program directors. There is great interest in unification and cooperation across the profession, protocol standardization enhancing quality, continued workforce diversification, and evaluation of the alignment between training and practice.

Tendencias históricas en la formación de los cirujanos generales a nivel mundial / Historical trends about the training of general surgery specialists worldwide

Introducción: Los avances tecnológicos y educativos en ciencias médicas durante los últimos cincuenta años han sido mayores que en toda la historia de la humanidad. Objetivo: Caracterizar la formación del especialista de cirugía general en el mundo en su devenir histórico y actual. Métodos: Se hizo una revisión bibliográfica en las bases de datos CUMED, SciELO, LILACS, Web of Science y PubMed, mediante el motor de búsqueda de información Google Académico. Fueron seleccionados 23 artículos: 19 (82,6 por ciento) del quinquenio 2016-2020, publicados en español e inglés, concernientes al objetivo propuesto, para lo cual se aplicó el método teórico de investigación científica histórico-lógico. Desarrollo: A partir del siglo xix, la evolución de la cirugía en el mundo discurre desde sus limitaciones ocasionadas por el dolor, las infecciones, las hemorragias y el shock hasta el vertiginoso desarrollo de la anestesiología y la reanimación, la asepsia y antisepsia, los novedosos métodos de diagnóstico y tratamiento, la cirugía de trasplante de órganos y tejidos, la cirugía de mínimo acceso, la simulación y la robótica durante el siglo xx y en el presente. Conclusiones: Los avances educativos en la formación profesional durante el período de especialización en cirugía general no marchan al ritmo del desarrollo tecnológico a escala mundial. De ahí surge la necesidad de potenciar al máximo el proceso de enseñanza y aprendizaje de posgrado mediante el desarrollo de estos avances educativos, de manera que no queden a la zaga de los progresos tecnológicos(AU)

Introduction: Technological and educational advances in medical sciences during the last fifty years have been greater than in the entire history of humanity. Objective: To characterize the training of general surgery specialists worldwide considering its historical and current evolution. Methods: A bibliographic review was carried out in the databases CUMED, SciELO, LILACS, Web of Science and PubMed, using the search engine Google Scholar. Twenty-three articles were selected: 19 (82.6 percent) from the five-year period 2016-2020, published in Spanish and English, concerning the set objective, for which the theoretical method of historical-logical scientific research was applied. Development: From the 19th century on, the evolution of surgery worldwide goes from its limitations caused by pain, infections, bleeding and shock to the dizzying development, during the twentieth century and nowadays, of anesthesiology and resuscitation, asepsis and antisepsis, novel methods for diagnosis and treatment, organ and tissue transplant surgery, minimal access surgery, simulation and robotics. Conclusions: Educational advances in professional training during the period of specialization in general surgery do not go in step with technological development on a global scale, hence the need to maximize the postgraduate teaching and learning process through the development of these educational advances, in order for them not to be left behind technological progress(AU)

Tendencias históricas en la formación de los cirujanos generales a nivel mundial / Historical trends about the training of general surgery specialists worldwide

Introducción: Los avances tecnológicos y educativos en ciencias médicas durante los últimos cincuenta años han sido mayores que en toda la historia de la humanidad. Objetivo: Caracterizar la formación del especialista de cirugía general en el mundo en su devenir histórico y actual. Métodos: Se hizo una revisión bibliográfica en las bases de datos CUMED, SciELO, LILACS, Web of Science y PubMed, mediante el motor de búsqueda de información Google Académico. Fueron seleccionados 23 artículos: 19 (82,6 por ciento) del quinquenio 2016-2020, publicados en español e inglés, concernientes al objetivo propuesto, para lo cual se aplicó el método teórico de investigación científica histórico-lógico. Desarrollo: A partir del siglo xix, la evolución de la cirugía en el mundo discurre desde sus limitaciones ocasionadas por el dolor, las infecciones, las hemorragias y el shock hasta el vertiginoso desarrollo de la anestesiología y la reanimación, la asepsia y antisepsia, los novedosos métodos de diagnóstico y tratamiento, la cirugía de trasplante de órganos y tejidos, la cirugía de mínimo acceso, la simulación y la robótica durante el siglo xx y en el presente. Conclusiones: Los avances educativos en la formación profesional durante el período de especialización en cirugía general no marchan al ritmo del desarrollo tecnológico a escala mundial. De ahí surge la necesidad de potenciar al máximo el proceso de enseñanza y aprendizaje de posgrado mediante el desarrollo de estos avances educativos, de manera que no queden a la zaga de los progresos tecnológicos(AU)

Introduction: Technological and educational advances in medical sciences during the last fifty years have been greater than in the entire history of humanity. Objective: To characterize the training of general surgery specialists worldwide considering its historical and current evolution. Methods: A bibliographic review was carried out in the databases CUMED, SciELO, LILACS, Web of Science and PubMed, using the search engine Google Scholar. Twenty-three articles were selected: 19 (82.6percent) from the five-year period 2016-2020, published in Spanish and English, concerning the set objective, for which the theoretical method of historical-logical scientific research was applied. Development: From the 19th century on, the evolution of surgery worldwide goes from its limitations caused by pain, infections, bleeding and shock to the dizzying development, during the twentieth century and nowadays, of anesthesiology and resuscitation, asepsis and antisepsis, novel methods for diagnosis and treatment, organ and tissue transplant surgery, minimal access surgery, simulation and robotics. Conclusions: Educational advances in professional training during the period of specialization in general surgery do not go in step with technological development on a global scale, hence the need to maximize the postgraduate teaching and learning process through the development of these educational advances, in order for them not to be left behind technological progress(AU)

Differential attainment, socioeconomic factors and surgical training.

INTRODUCTION: Differential attainment (DA) is the gap in levels of achievement between different groups; socioeconomic factors are thought to play a significant role in DA. The aim of this study was to review and assess the evidence for DA in early surgical training and to examine the potential influence of socioeconomic status. METHODS: Data were obtained from the General Medical Council GMC for those taking Membership of the Royal College of Surgeons (MRCS) examinations between 2016 and 2019 and core surgical training annual review of competency progression (ARCP) outcomes between 2017 and 2019. The index of multiple deprivation (IMD) was used as a measure of socioeconomic background. Trainees were then divided into deprivation quintiles (DQ1=most deprived, DQ5=least deprived). MRCS and ARCP outcomes were compared between DQ groups using 95% confidence intervals and chi-square tests. RESULTS: Those from lower socioeconomic backgrounds had significantly lower overall MRCS pass rates (DQ1=45.5%, DQ2=48.9% vs DQ4=59.6%, DQ5=61.5%, p<0.05) and 1st time pass rates (DQ1&2=46.6% vs DQ4&5=63.5%, p<0.001). Additionally, they had a significantly higher number of attempts required to pass MRCS (DQ 1&2=1.86 vs DQ 4&5=1.54, p<0.01). Those from lower socioeconomic backgrounds had a significantly greater proportion of unsatisfactory ARCP outcomes (DQ1&2=24.4% vs DQ 4&5=14.2%, p<0.05). CONCLUSIONS: There is clear evidence of the influence of socioeconomic background on DA in early surgical training. However, the reasons for this are likely complex and more work is required to investigate this relationship.

Royal Australasian College of Surgeons Rural Health Equity Strategic Action Plan: excellence through equity.

Wherever there are people there will be a need for surgical care. Rural people have all kinds of problems and need all kinds of surgeons. The Royal Australasian College of Surgeons (RACS) Rural Health Equity Strategic Action Plan (RHESAP) was endorsed by Council in December 2020. The goal is to increase the rural surgical workforce and increase access to care, through providing motivated surgeons with the training they need to work where they are needed most. The Royal Australasian College of Surgeons Surgical Education and Training Programs (SET) aim to train generalist surgeons across all nine surgical disciplines. To increase the rural surgical workforce and increase access to care, we need to select for rural origin, rural medical school and rural work experience, provide all trainees with the opportunity for positive rural work exposure with an aligned rural curriculum, and we need to support surgeons already living and working in rural areas. In future, with persistent health inequity for underserved populations and the impacts of climate change, we anticipate an increasing need for a culturally and emotionally intelligent, broad-scope surgical workforce, across all surgical disciplines, with the skills, confidence and motivation to work collaboratively and effectively in surgical teams, in areas of need and limited resource environments, including globally.