Recommendations of the Blue Ribbon Committee II for the Optimization of Surgical Education and Training in the United States: The Surgical Trainee Perspective.

OBJECTIVE: This study aims to appraise recommendations from an expert panel of surgical educators on optimizing surgical education and training in the setting of contemporary challenges. BACKGROUND: The Blue Ribbon Committee (BRC II), a group of surgical educators, was convened to make recommendations to optimize surgical training considering the current changes in the landscape of surgical education. Surgical trainees were recruited to assess their impressions of the recommendations. METHODS: A mixed-methods study design was employed, with a survey, followed by focus group interviews. Participating residents and fellows were recruited through a purposeful sampling approach. Descriptive statistics were applied to analyze the survey data, and a thematic data analysis on interview transcripts was employed. RESULTS: The majority of trainee respondents (n=16) thought that all of the subcommittee recommendations should be included in the final BRC II recommendations and paper. According to the interviews, overall, the feedback from the trainees was positive, with particular excitement around work-life integration, education support and faculty development, and funding pitfalls. Some themes about concerns included a lack of clarity about the recommendations, concern about some recommendations being in conflict with one another, and a disconnect between the initial BRC II survey and the subsequent recommendations. CONCLUSIONS: The residents gathered for this focus group were encouraged by the thought, effort, and intention that gathered the surgical leaders across the country to make the recommendations. While there were areas the trainees wanted clarity on, the overall opinion was in agreement with the recommendations.

BASE Jumping Injuries Presenting to Emergency Departments in the United States: an Assessment of Morbidity, Emergency Department, and Inpatient Costs.

BACKGROUND: BASE (building, antenna, span, earth) jumping involves jumping from fixed objects with specialized parachutes. BASE jumping is associated with less aerodynamic control and flight stability than skydiving because of the lower altitude of jumps. Injuries and fatalities are often attributed to bad landings and object collision. METHODS: We performed a retrospective analysis of the 2010-2014 National Emergency Department Sample database, a nationally representative sample of all visits to US emergency departments (EDs). BASE jumping-associated injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes [E004.0]. Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed. RESULTS: After weighting, 1790 BASE-associated ED presentations were identified with 358±28 injuries annually. A total of 1313 patients (73%) were aged 18 to 44 y, and 1277 (71%) were male. Nine hundred seventy-six (55%) multiple body system injuries and 677 (38%) isolated extremity injuries were reported. There were 1588 (89%) patients discharged home from the ED; only 144 (7%) were admitted as inpatients. On multivariate logistic regression, only anatomic site of injury was associated with inpatient admission (odds ratio=0.6, P<0.001, 95% CI 0.5-0.8). Including ED and inpatient costs, BASE injuries cost the US healthcare system approximately $1.7 million annually. No deaths were identified within the limitations of the survey design. CONCLUSIONS: Although deemed one of the most dangerous extreme sports, many patients with BASE injuries surviving to arrival at definitive medical care do not require inpatient admission.

Resident-Applicant Buddy Program Increases Applicant Interest and Program Transparency.

OBJECTIVE: Resident-Applicant Buddy Programs (RABPs) are a new initiative designed to improve resident recruitment. This study aims to evaluate the impact and perceived value of RABPs and to identify areas for improvement for future recruitment cycles. DESIGN: Anonymous online survey study of RABP participants with mixed-methods approach to evaluate participants' experience and perceived impact of the program. The survey queried demographics, Likert responses, and open-ended responses. Qualitative thematic analysis of open-ended responses was performed with inductive coding in an iterative fashion by 2 raters. SETTING: This study was conducted at a general surgery residency program at a tertiary academic institution during 2022-2023 recruitment cycle. PARTICIPANTS: Of 125 RABP participants (n = 39 residents and n = 86 interviewed applicants), surveys from n = 45 participants (n = 19 residents, 66%; n = 26 applicants, 30%) were completed and analyzed. RESULTS: Applicants were predominantly female (65%) and first-generation physicians (69%). Buddy pairings were 65% gender concordant and 48% race/ethnicity concordant. Many applicants (60%) participated in RABPs at other institutions. Buddies connected for a mean (SD) of 52 (28) minutes. Majority of applicants agreed the program decreased stress/apprehension about interviewing (70%, 4.0 [1.1]), helped understand resident life at the program (91%, 4.3 [1.0]), and increased desire to match in the program (65%, 4.0 [1.1]). Residents agreed they enjoyed participation (89%, 4.5 [0.7]), the program should be continued (100%, 4.8 [0.4]), and desired to participate again (100%, 4.8 [0.4]). Thematic analysis revealed applicants valued the program as an approachable source of information, illumination of program culture, aid in interview preparation, and connection between applicant and program. Applicants appreciated the intentionality of the program to create a RABP. CONCLUSIONS: RABP decreased applicants' stress, improved understanding of resident life, and for the majority, increased desire to match at the program. Resident engagement and desire for ongoing participation in the RABP was high. Overall, RABPs can increase applicant interest and program transparency.

Association Between High-Deductible Health Plans and Hernia Acuity.

IMPORTANCE: About half of people younger than 65 years with private insurance are enrolled in a high-deductible health plan (HDHP). While these plans entail substantially higher out-of-pocket costs for patients with chronic medical conditions who require ongoing care, their effect on patients undergoing surgery who require acute care is poorly understood. It is plausible that higher out-of-pocket costs may lead to delays in care and more complex surgical conditions. OBJECTIVE: To determine the association between enrollment in HDHPs and presentation with incarcerated or strangulated hernia. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort analysis included privately insured patients aged 18 to 63 years from a large commercial insurance claims database who underwent a ventral or groin hernia operation from January 2016 through June 2019 and classified their coverage as either a traditional health plan or an HDHP per the Internal Revenue Service's definition. Multivariable regression, adjusting for demographic and clinical covariates, was used to examine the association between enrollment in an HDHP and the primary outcome of presentation with an incarcerated or strangulated hernia. EXPOSURES: Traditional health plan vs HDHP. MAIN OUTCOMES AND MEASURES: Presence of an incarcerated or strangulated hernia per International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. RESULTS: Among 83 281 patients (71.9% men and 28.1% women; mean [SD] age, 48.7 [10.9] years) who underwent hernia surgery, 27 477 (33.0%) were enrolled in an HDHP and 21 876 (26.2%) had a hernia that was coded as incarcerated or strangulated. The mean annual deductible was considerably higher for those in the HDHP group than their traditional health plan counterparts (unadjusted mean [SD], $3635 [$2094] vs $705 [$737]; adjusted, -$2931; P < .001). Patients in the HDHP group were more likely to present with an incarcerated or strangulated hernia (adjusted odds ratio, 1.07; 95% CI, 1.03-1.11; P < .001). CONCLUSIONS AND RELEVANCE: In this cohort study, enrollment in an HDHP was associated with higher odds of presenting with an incarcerated or strangulated hernia, which is more likely to require emergency surgery that precludes medical optimization. These data suggest that, among patients with groin and ventral hernias, enrollment in an HDHP may be associated with delays in surgical care that result in complex disease presentation.

Self-efficacy Toward a Healthcare Career Among Minority High School Students in a Surgical Pipeline Program: A Mixed Methods Study.

OBJECTIVE: While many barriers to healthcare careers exist for URM students, a strong sense of self-efficacy may help mitigate these obstacles. This study explores how URM high school students describe their academic challenges and compares their descriptions across self-efficacy scores. DESIGN: We conducted a convergent mixed methods study of URM high school students. Students completed a validated self-efficacy questionnaire and participated in semi-structured focus group interviews to discuss their approach to academic challenges, goal setting, and achievement. The primary outcome was academic, social, and emotional self-efficacy, measured using the Self-Efficacy Questionnaire for Children. We separated participants into high and low self-efficacy groups based on scores in each domain. Using thematic analysis, we identified and compared common themes associated with academic challenges and goal setting. SETTING: Surgical exposure pipeline program sponsored by Stanford University Department of Surgery PARTICIPANTS: Low-income, high academic achieving URM high school students interested in science, technology, engineering and mathematics, and/or healthcare careers. RESULTS: Thirty-one high school students completed the focus groups and self-efficacy questionnaire. Most students scored in the high self-efficacy group for at least one domain: 65% for academic self-efficacy, 56% for social self-efficacy, and 19% for emotional self-efficacy. Four emergent themes highlighted participants' perspectives toward educational success: fulfillment in academic challenges, focus on future goals, failing forward, and asking for help. Compared to students with low self-efficacy scores, students in the high-scoring self-efficacy groups more often discussed strategies and concrete behaviors such as the importance of seeking support from teachers and peers and learning from failure. CONCLUSIONS: Students in high self-efficacy groups were more comfortable utilizing approaches that helped them succeed academically. Additional efforts are needed to bolster student self-efficacy, particularly in students from URM backgrounds, to increase diversity in medical schools.