The current state of pediatric transplant hepatology fellowships: A survey of recent graduates.

BACKGROUND: The number of programs offering a PTH fellowship has grown rapidly over the last 10 years. This study aimed to describe the clinical, didactic, procedural, and research experiences of recent PTH fellowship graduates. In addition, we sought to understand graduates' post-fellowship professional responsibilities and their perception about the utility of the PTH fellowship. METHODS: An anonymous survey was distributed from February to October 2020 through REDCap to all recent graduates (2015-2019) of an ACGME-approved PTH fellowship program. The survey consisted of 49 questions focused on the PTH fellowship experience. Results were summarized using descriptive statistics. RESULTS: Thirty-eight of 43 graduates (88%) responded to the survey representing 12 PTH fellowship programs. The didactic experience varied; 97% received pathology lectures, 81% radiology lectures, 54% organ allocation lectures, 54% procedural lectures, 57% immunology lectures, and 43% live donation lectures. During the PTH fellowship, the majority of fellows performed >10 liver biopsies (82%) and >5 variceal bandings (58%); however, 63%, 32%, 8%, and 8% never performed paracentesis, variceal sclerotherapy, variceal banding, and liver biopsies, respectively. The majority of fellows (95%) completed a research project during PTH fellowship. Currently, 84% of graduates are employed at a transplant academic institution. All graduates recommended the fellowship. CONCLUSIONS: There is variability in the didactic, clinical, and procedural training among PTH fellowship programs. Although uniformly viewed as a beneficial fellowship year, there is an opportunity to collaborate to create a more standardized training experience.

Gendered Differences in Letters of Recommendation for Transplant Surgery Fellowship Applicants.

BACKGROUND: No published study has explored gender differences in letters of recommendation for applicants entering surgical subspecialty fellowships. METHODS: We conducted a retrospective review of letters of recommendation to a transplant surgery fellowship written for residents finishing general surgery residency programs. A dictionary of communal and agentic terms was used to explore differences of the letters based on applicant's gender as well as the academic rank and gender of the author. RESULTS: Of the 311 reviewed letters, 228 were letters of recommendation written for male applicants. Male surgeons wrote 92.4% of the letters. Male applicant letters were significantly more likely to contain agentic terms such as superb, intelligent, and exceptional (p = 0.00086). Additionally, male applicant letters were significantly more likely to contain "future leader" (p = 0.047). Letters written by full professors, division chiefs, and program directors were significantly more likely to describe female applicants using communal terms like compassionate, calm, and delightful (p = 0.0301, p = 0.036, p = 0.036, respectively). In letters written by assistant professors, female letters of recommendation had significantly more references to family (p = 0.036). CONCLUSIONS: Gendered differences exist in letters of recommendation for surgical fellowship applicants. This research may provide insight into the inherent gender bias that is revealed in letters supporting candidates entering the field.

Attitudes and Knowledge of Healthcare Professionals Regarding Organ Donation. A Survey of the Saolta University Health Care Group.

Organ donation saves lives and healthcare professionals (HCPs) play a vital role in that process. Therefore, the purpose of this study was to assess the attitudes and level of knowledge of HCPs regarding organ donation. An online anonymous self-administered questionnaire containing 40 questions on organ donation using google forms was created. The survey was distributed to HCPs working in the Saolta University Health Care Group. A hundred and thirty-nine responses were received giving a response rate of 11.8%. HCPs willingness to donate their organs was at 93% compared to 97% willing to receive a transplant. More HCPs understood or had knowledge of the term donation after brain death (64%) than donation after circulatory death (49%). HCPs working in intensive care knew more about the management of brain dead donors than other specialties (p<0.0001). Over 60% of HCPs when asked either disagreed or strongly disagreed with the adequacy of training in organ donation and transplant. Overall, HCPs surveyed had positive attitudes towards organ donation but there was a lack of knowledge particularly among non-intensive care professionals. This study highlights the need to increase awareness along with implementation of educational programmes among HCPs regarding organ donation and transplant.

Preparation is the Only Shortcut You Need in Surgery: A Guide to Surgical Rehearsals for Hand and Upper Extremity Transplantation.

As upper extremity transplantation is becoming more accepted worldwide, the demand for a fresh tissue cadaveric training model for this procedure is increasing and necessary to assure surgical success. Surgical rehearsals can decrease operative time, improve technique, and reduce errors made on the actual day of surgery. The purpose of this article is to describe a method for surgical rehearsal of upper extremity transplantation using cadaveric specimens based on the clinical experience of an academic institution with an active transplantation program. The logistics of rehearsal setup, equipment, and modified version of procedural checklists are described.

Trainee Needs in Pediatric Transplant Infectious Diseases Education.

BACKGROUND: Pediatric transplant infectious diseases (PTID) is emerging as an area of expertise within pediatric infectious diseases. Although guidelines for training in PTID have been published, no prior national survey has been conducted to identify trainee-described needs for instruction in PTID. METHODS: A survey was designed through collaboration between the American Society of Transplantation and the Pediatric Infectious Diseases Society, to assess trainee exposure, self-knowledge, and self-competency in PTID. RESULTS: Sixty of 169 trainees replied (response rate 35%) with 93% of respondents from centers that performed transplants. Eighty-two percent of trainees were unaware of the recommended curriculum for PTID. Although a majority of trainees (78%) indicated they had received structured teaching in PTID, most (>50%) ranked their knowledge in donor selection, donor-derived infections, and candidate risk assessment as poor or fair. A majority (>50%) also reported their competency in areas regarding pre- and posttransplant guidance as poor or fair. Trainees identified the following strategies to augment their PTID training: additional rotations, teaching by experts, case-based learning, and a reference guide. CONCLUSIONS: This survey highlights significant trainee-identified gaps in PTID knowledge and competency. Limitations include low survey response rate but appears weighted towards centers with transplantation. Suggested strategies can inform the development of learner-specific initiatives and curriculum in PTID.

Translational microsurgery. A new platform for transplantation research.

PURPOSE: Clinical microsurgery has been introduced in many fields, while experimental microsurgery has the cross-disciplinary features of the sciences and techniques for growth of medicine, pharmacology, veterinary, engineering etc. Training protocol, proposing a new name as Translational Microsurgery, was introduced. METHODS: Reconstructive skills of hepatic artery in pediatric living donor liver transplantation were summarized. Ex vivo training protocol using artificial blood vessel for surgeons was proposed. RESULTS: Clinical microsurgery requires anastomosis with delicate arteries and limited field of view. Our training protocol revealed that the relation between the score and speed was seen, while not all the surgeons with enough experience got high score. This training led to muster clinical skills and to apply excellent experimental works. CONCLUSIONS: Our microsurgical training protocol has been planned from the points of clinical setting. Training for vascular anastomosis led to rodent transplantation models. These models were used for immunology and immunosuppressant research. Microsurgical techniques led to master catheter technique and to inject various drugs or gene vectors.

Translational microsurgery. A new platform for transplantation research

ABSTRACT PURPOSE: Clinical microsurgery has been introduced in many fields, while experimental microsurgery has the cross-disciplinary features of the sciences and techniques for growth of medicine, pharmacology, veterinary, engineering etc. Training protocol, proposing a new name as Translational Microsurgery, was introduced. METHODS: Reconstructive skills of hepatic artery in pediatric living donor liver transplantation were summarized. Ex vivo training protocol using artificial blood vessel for surgeons was proposed. RESULTS: Clinical microsurgery requires anastomosis with delicate arteries and limited field of view. Our training protocol revealed that the relation between the score and speed was seen, while not all the surgeons with enough experience got high score. This training led to muster clinical skills and to apply excellent experimental works. CONCLUSIONS: Our microsurgical training protocol has been planned from the points of clinical setting. Training for vascular anastomosis led to rodent transplantation models. These models were used for immunology and immunosuppressant research. Microsurgical techniques led to master catheter technique and to inject various drugs or gene vectors.

Recommended Curriculum for Training in Pediatric Transplant Infectious Diseases.

A working group representing the American Society of Transplantation, Pediatric Infectious Diseases Society, and International Pediatric Transplant Association has developed a collaborative effort to identify and develop core knowledge in pediatric transplant infectious diseases. Guidance for patient care environments for training and core competencies is included to help facilitate training directed at improving the experience for pediatric infectious diseases trainees and practitioners in the area of pediatric transplant infectious diseases.

Program directors' perspective of transplant training during general surgery residency.

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) began to mandate "a formal transplant experience" rather than a formal rotation to allow programs more flexibility. What constitutes a "transplant experience" or how to optimize such education remains unclear. The objectives of this study were to identify changes in residents' transplant exposure and determine the opinions of program directors (PDs) in response to the new requirements. A 15-item questionnaire was sent to all general surgery PDs. Demographics, resident experiences, and PDs' opinions regarding transplant rotations were collected. The response rate was 50 per cent from university and community programs at transplant and nontransplant centers. Although 55 per cent of PDs felt transplant should not be a required rotation, 92 per cent of programs reported having a formal rotation. Transplant rotations should be four months or less, according to 97 per cent of PDs. Most PDs (93%) think there should not be a minimum number of required transplant operations. Whether residencies were based at transplant centers or size of residencies did not affect PDs' responses. Transplant requirements were similar between residency programs regardless of PD opinions. Survey participants provided diverse feedback regarding this controversial topic. The new ACGME requirements have made little impact on program requirements. Most programs still mandate a formal transplant rotation. Diverse opinions exist regarding whether such a rotation should be required, highlighting the controversial nature of this issue. To facilitate education in an era of limited work hours, the ACGME changed requirements of general surgery programs to mandate "a formal transplant experience" rather than a transplant rotation. A survey of program directors revealed that although only 45 per cent of support mandatory transplant rotations, 93 per cent of programs still require transplant rotations despite the more lax ACGME requirements. This finding suggests a lack of suitable alternative to provide exposure to the concepts fundamental to transplant surgery, which are valuable in general surgery education.

[Transplantation and hepatic, pancreatic, and biliary (HPB) surgery fellowship--a pilot project for a structured training in Germany]. / Fellowship für Transplantation und hepato-pankreatiko-biliäre (HPB) Chirurgie - Pilotprojekt für eine strukturierte Weiterbildung in Deutschland.

Currently, there is no structured training plan to become a transplant surgeon in Germany. Similar to the Anglo-Saxonian educational system we have implemented a 3-year fellowship in transplant and hepatic-, pancreatic-, biliary (HPB) surgery. The educational curriculum is based on the guidelines of the European Board of Surgery (EBS) for transplant and HPB surgery. Here, we describe the underlying thoughts, the selection process, structure and curriculum for this fellowship. Furthermore, we critically compare our programme to the established international training standards. So far, our programme has proven valuable. We believe a fellowship for transplant and HPB surgery is a reasonable approach to ensure a high quality training of the following generations of surgeons in this field.

Morte encefálica e cuidados na manutenção do potencial doador de órgãos e tecidos para transplante / Brain death and care in maintaining the potential of organ and tissue transplant donors / Muerte encefálica y cuidados en el mantenimiento del potencial donante de órganos y tejidos para transplante

Este trabalho trata-se de estudo exploratório-descritivo com abordagem quantitativa e dados prospectivos que objetivou verificar o conhecimento dos profissionais de enfermagem sobre a Morte Encefálica (ME) e a manutenção do Potencial Doador (PD). A população constou de 55 profissionais de enfermagem. Destes, a maioria eram técnicos em enfermagem (74,5%); 78,2% informaram já ter trabalhado com PDs e 50,9% afirmaram estar preparados para cuidar desses pacientes. Das condições indispensáveis para a abertura do protocolo de ME, 49,1% afirmaram erroneamente a temperatura superior a 36ºC. No manejo dos distúrbios hidroeletrolíticos, 50,9% optaram incorretamente sobre a reposição de sódio, potássio e magnésio. Nos cuidados com córneas, 58,2% optaram erradamente sobre a proteção com gaze. E 52,7% afirmaram corretamente que o PD pode ser reanimado. O conhecimento sobre o diagnóstico de ME e manutenção ao PD era insuficiente entre os pesquisados, necessitando de educação sobre o tema a fim de aumentar a oferta de órgãos/tecidos para transplantes...

This is an exploratory-descriptive study performed using a quantitative approach and prospective data, with the objective to identify the knowledge of nursing professionals regarding brain death (BD) and maintaining the Potential Donor (PD). The study population consisted of 55 nursing professionals, mostly nursing technicians (74.5%); 78.2% reported having worked with PDs and 50.9% stated being prepared to take care of those patients. Among the conditions considered indispensible to open a BD protocol, 49.1% made a wrong statement of body temperature above 36ºC. Regarding the management of hydroelectrolytic disorders, 50.9% made a wrong choice concerning the reposition of sodium, potassium and magnesium. Regarding cornea care, 58.2% made a wrong decision about the protection using gauzes. Furthermore, 52.7% made the correct statement that the PD can be reanimated. It was observed that the subjects had insufficient knowledge regarding the diagnosis of BD and PD maintenance, thus requiring education on the topic in order to increase the offer of organs/tissue for transplants...

Estudio exploratorio, descriptivo, cuantitativo, con datos prospectivos, objetivando verificar el conocimiento de los profesionales de enfermería sobre Muerte Encefálica (ME) y el mantenimiento del Potencial Donante (PD). Población constituida por 55 profesionales de Enfermería. La mayoría (74,5%), técnicos de Enfermería; 72,8% refirió haber trabajado con PDs y 50,9% afirmó estar preparado para cuidar de tales pacientes. De las condiciones indispensables para apertura de protocolo de ME, 49,1% mencionó erróneamente temperatura superior a 36°C. En el manejo de disturbios hidroelectrolíticos, 50,9% optó incorrectamente sobre la reposición de sodio, potasio y magnesio. En el cuidado de córneas, 58,2% sugirió erróneamente sobre protección con gasas. Finalmente, 52,7% afirmó correctamente que el PD puede ser reanimado. El conocimiento sobre diagnóstico de ME y mantenimiento del PD fue insuficiente entre los investigados, necesitando ellos de educación sobre el punto, a efectos de aumentar la oferta de órganos y tejidos para transplantes...

Program directors' views on general surgery resident travel for transplant rotations.

BACKGROUND: Some program directors in surgery (PDs) must maintain transplant rotations at nonintegrated (away) hospitals. This study investigated the opinions of PDs related to resident travel for transplant surgery experience. METHODS: An Internet-based survey was e-mailed to 251 PDs in the United States. RESULTS: Altogether, 131 PDs (52%) responded. Of those, 66% have a transplant service at integrated hospitals. Small majorities of PDs believed transplant rotations offer a good educational experience (59%) and comply with duty hours (71%). Few PDs believed transplant rotations provide excellent operative experience (47%) and mandate service over education (38%). PDs leading community-affiliated and smaller programs employed away rotations more commonly. Affected PDs used commuting (48%) and purchased temporary housing (52%). Most believed travel is a poor aspect of the experience (78%) and transplant rotations should become an optional component of residency training (60%). PDs using away hospitals more often believed this content area should be eliminated. CONCLUSIONS: Although away transplant rotations minimally impact opinions of PDs related to select educational issues, most PDs challenge the existing paradigm of transplant surgery as essential content.

Recommended curriculum for subspecialty training in transplant infectious disease on behalf of the American Society of Transplantation Infectious Diseases Community of Practice Educational Initiatives Working Group.

The American Society of Transplantation Infectious Diseases (ID) Community of Practice has established an education workgroup to identify core components of a curriculum for training specialists in transplant ID. Clinical, laboratory, and research training form the triad of components on which an additional year of ID training, dedicated to the care of solid organ and hematopoietic stem cell transplant recipients, should be based. The recommended training environment would have access to adequate numbers of transplant patients, along with qualified faculty committed to teaching specialized fellows in this area. The learning objectives for both inpatient and outpatient clinical training are presented. The laboratory component requires trainees to attain expertize in utilizing and interpreting cutting-edge diagnostics used in transplant medicine. The research component may involve basic science, and translational or clinical research individualized to the trainee. Finally, suggestions for evaluation of both the fellows and the training program are provided.