Influence of Applicant Interview Format Choice on Demographics and Outcomes from the Residency Match.

BACKGROUND: Studies of virtual interviews (VI) for residency lack contemporaneous In-person Interview (IPI) comparators, leaving uncertain the impact of interview mode on the match process. The study aims to evaluate the effect of allowing candidates to choose interview format, the VI versus IPI, on demographic characteristics of candidates and on rank order list (ROL) position. STUDY DESIGN: A Cohort study of residency applicants (2022-2023 recruiting season) to a general surgery training program. 105 applicants were invited for interview, of whom 84 candidates were interviewed. Invited candidates were allowed to choose between the following interview options: 1) In person only, 2) Virtual only, 3) In person, but would accept virtual, 4) Virtual, but would accept in-person, and 5) No preference/either. The main outcomes were the differences in demographics of candidates and relative ROL position based on interview format. RESULTS: Most candidates preferred VI (63%), while 26% preferred IPI and 11% had no preference. 43 VI and 41 IPI were conducted. VI candidates were more likely female (62.8% vs. 31.7%, p = 0.004), attended more distant medical schools (609 [207.5, 831] miles vs. 161 [51, 228] miles, p < 0.001), had higher USMLE scores, and better letters of recommendation. IPI candidates were more likely to have signaled interest (19.5% vs. 4.7%, p = 0.037) and were scored higher for interest in the program/area (4.34 ± 0.48 vs. 4.00 ± 0.62, p = 0.007). The format of interview was not associated with ultimate rank position by either univariate or multivariable analysis. CONCLUSION: Among applicants for residency training positions, allowing a choice of interview format was associated with significant demographic and academic differences between those interviewing virtually versus in-person but had little ultimate effect on ROL position.

Interhospital transfer (IHT) in emergency general surgery patients (EGS): A scoping review.

Background/Aims of study: Interhospital transfer of emergency general surgery patients continues to rise, and no system for transfer of emergency general surgery patients exists. This has major implications for cost of care and patient experience. We performed a scoping review to understand outcomes related to transfer and the associated factors and to identify any opportunities for improvement. Methods: Studies involving emergency general surgery patients with interhospital transfer were identified by searching OVID MEDLINE, EMBASE, Cochrane Library, and Scopus. There were 1,785 records identified. After duplicates were removed, there were 1,303 articles screened in the initial phase. Fifty-eight articles were included in the second phase. Eventually, 21 articles were included in the review. Thirty-seven articles were removed during the full-text screening phase due to the following: wrong publication type (2), wrong population (8), abstract (11), outside the United States (3), and wrong study design (6). Results: Transferred patients had a higher mortality rate, were older, were more likely to be male and to undergo reoperation, and had higher resource utilization compared to patients who were not transferred. All emergency general surgery patients had a high burden of chronic disease. Unnecessary transfer, typically defined by lack of intervention and discharge within 72 hours, was reported to be 8.8% to 19%. Conclusion: Emergency general surgery patients have a high rate of comorbidities. Limited physiologic status information prior to patient transfer limits understanding of the necessity for transfer. Areas for improvement include assigning a physiologic status for all patients and utilizing telehealth. More detailed information needs to be captured to determine the appropriateness of transfer.

Association of Demographic Factors and Medical School Experiences With Students' Intention to Pursue a Surgical Specialty and Practice in Underserved Areas.

Importance: The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown. Objective: To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas. Design, Setting, and Participants: This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020. Main Outcomes and Measures: Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas. Results: Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas. Conclusions and Relevance: This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.

Diversity, Equity and Inclusion in Medicine: Why It Matters and How do We Achieve It?

Diversifying the medical work force is critical to reducing health care disparity and improving patient outcomes. This manuscript offers a comprehensive review of best practices to improve both the recruitment and the retention of underrepresented minorities in training programs and beyond.

Rural Legal Deserts Are a Critical Health Determinant.

We introduce "rural legal deserts," or rural areas experiencing attorney shortages, as a meaningful health determinant. We demonstrate that the absence of rural attorneys has significant impacts on public health-impacts that are rapidly exacerbated by COVID-19.Our work builds on recent scholarship that underscores the public health relevance of attorneys in civil and criminal contexts. It recognizes attorneys as crucial to interprofessional health care teams and to establishing equitable health-related laws and policies. Attorney interventions transform institutional practices and help facilitate the stability necessary for health maintenance and recovery. Yet, critically, many rural residents cannot access legal supports.As more individuals experience unemployment, eviction, and insecure benefits amid the COVID-19 pandemic, there is a need for attorneys to address these social determinants of health as legal needs. Accordingly, the growing absence of attorneys in the rural United States proves particularly consequential-because of this pandemic context but also because of rural health disparities. We argue that unless a collaborative understanding of these interrelated phenomena is adopted, justice gaps will continue to compound rural health inequities.

Outcomes and influences of rural-focused integrated clerkship programs in general surgery.

BACKGROUND: A shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery. METHODS: An institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship. Telephone interviews were conducted on a portion of these surgeons. RESULTS: Fifty-seven students (3.6%) completing the rural-focused longitudinal integrated clerkship became general surgeons. Of those participating in phone interviews, most (90%) decided to become surgeons during their experience while all stated that preclinical years did not influence their specialty decision. CONCLUSIONS: A substantial portion of these surgeons went on to practice in rural communities. Pre-existing rural and primary care-focused education could help to address the future projected shortage of rural general surgeons.

Creating a Rural Surgery Track and a Review of Rural Surgery Training Programs.

OBJECTIVE: The objective of this study was to present the process of developing a rural surgery training track within an established residency program and review the current rural surgery training programs in the nation. DESIGN: This study reviews current rural surgery training opportunities at Accreditation Council for Graduate Medical Education accredited surgical residencies in the United States and presents the process of creating the University of Minnesota's rural surgery training track. SETTING: This study was performed at the University of Minnesota, in Minneapolis, Minnesota, and at Essentia Health-Saint Mary's Medical Center, in Duluth, Minnesota. PARTICIPANTS: Accredited general surgery residencies were reviewed. The creation of a designated rural surgery training track added an additional rural-designated surgical resident during each postgraduation year and created a required postgraduation year 2 rural surgery rotation for all categorical surgical residents. RESULTS: Two hundred sixty-eight surgery residency programs were reviewed. Twenty-seven had required rural rotations, 10 offered only elective rural rotations, and 4 had dedicated National Resident Matching Program codes for rural training tracks. After review of national rural surgery training opportunities, the University of Minnesota's process of creating a designated rural surgery training program required attention to 5 main components: needs assessment and review of local opportunities, surgery residency review committee approval, funding, surgical education, and clinical/operative education. CONCLUSIONS: Increasing opportunities for surgical residents to train in rural settings may help with recruitment of medical students and retention of surgeons pursuing careers in rural surgery.

Understanding ACGME Scholarly Activity Requirements for General Surgery Programs in the Era of Single Accreditation and the Next Accreditation System.

Becoming compliant with the Accreditation Council for Graduate Medical Education (ACGME) requirements for scholarly activity and remaining compliant over time requires time and attention to the development of an environment of inquiry, which is reflected in detailed documentation submitted in program applications and annual updates. Since the beginning of the next accreditation system, all ACGME programs have been required to submit evidence of scholarly activity of both residents and faculty on an annual basis. Since 2014, American Osteopathic Association-accredited programs have been able to apply for ACGME accreditation under the Single Graduate Medical Education Accreditation initiative. The Residency Program Director, Chair, Designated Institutional Official, Faculty, and coordinator need to work cohesively to ensure compliance with all program requirements, including scholarly activity in order for American Osteopathic Association-accredited programs to receive Initial ACGME Accreditation and for current ACGME-accredited programs to maintain accreditation. Fortunately, there are many ways to show the type of scholarly activity that is required for the training of surgeons. In this article, we will review the ACGME General Surgery Program Requirements and definitions of scholarly activity. We will also offer suggestions for how programs may show evidence of scholarly activity.

Assessing the 16 hour intern shift limit: Results of a multi-center, mixed-methods study of residents and faculty in general surgery.

BACKGROUND: The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts. METHODS: Questionnaire response rates were 76% for residents (N = 291) and 71% for faculty (N = 279) in 13 general surgery residency programs. Results include means, percentage in agreement, and statistical tests for 15 questionnaire items. Semi-structured interviews conducted with 39 residents and 43 faculty were analyzed for main themes. RESULTS: Few view the intern shift limit as a positive change. Views differ (P < 0.01) for residents and faculty on 12 of 15 item means and across PGY levels on all 15 items. Interviews indicate concerns about losses with respect to education and professional development, difficulties when interns transition to their second year, and how intern shifts may be more fatiguing than expected. CONCLUSIONS: The 16-h limit on intern shifts has remained a source of concern and an educational challenge for residents and faculty.

The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty.

BACKGROUND: Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems. METHODS: General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns. RESULTS: NPPs reduce faculty and resident workloads and teach residents. NPPs also reduce resident exposure to educationally valuable activities, and faculty sometimes round, make decisions, and operate with NPPs instead of residents. Interviews indicate that NPPs can overly reduce resident involvement in patient care, diminish resident responsibility and decision making, disrupt team dynamics, and compete for procedures. CONCLUSIONS: NPPs both enhance and hinder surgical education and highlight the need to more clearly articulate learning outcomes for residents and activities necessary to achieve those outcomes.

Surgical Residency Recruitment-Opportunities for Improvement.

INTRODUCTION: The Association of Program Directors in Surgery convened a panel during Surgical Education Week 2016 to discuss the current state of the general surgery residency application process and to review alternative ways to evaluate the suitability of each applicant to a residency program. METHODS/RESULTS: Over 40,000 applicants registered for the National Resident Matching Program's 2016 Main Residency Match. General Surgery had 2345 applicants for 1241 categorical postgraduate year (PGY)-1 positions, and 1239 of those positions were filled when the matching algorithm was processed. Program Directors reported that only 33% of applications received an in-depth review, and 62% were rejected with minimal review. Eventually (after all applications had been reviewed), only 13% of applicants were invited to interview. CONCLUSIONS: There are several opportunities for improvement within the current application process. These included standardized letter of recommendation and personal statements, refinement of the interview process, and recalibration of the Medical Student Performance Evaluation.

Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies.

PURPOSE: Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism. METHOD: Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews. RESULTS: A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient. CONCLUSIONS: Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.

Requirements for Certification in Surgery: A Comparison of the American Board of Surgery and the American Osteopathic Board of Surgery.

In early 2014, the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, and the American Association of Colleges of Osteopathic Medicine agreed to a memorandum of understanding describing a single accreditation system for graduate medical education in the United States. Although there are many benefits, such as consistent quality of graduate medical education, alignment of competency standards, alignment with policymakers' expectations, unification of voices on graduate medical education access and funding issues, and visibility of osteopathic medicine, there are also many challenges in creating a uniform system of graduate medical education. The authors review the pathways to initial certification for both the American Board of Surgery and the American Osteopathic Board of Surgery and discuss recertification and maintenance of certification.

Changes in Thoracic Surgery Experience During General Surgery Residency: A Review of the Case Logs From the Accreditation Council for Graduate Medical Education.

BACKGROUND: Although exposure to thoracic surgery is mandated in general surgery residency, little is known about the mix of cases that residents use to meet this requirement and how this has changed over time. We report the experience of general thoracic surgery among general surgery residents using the Accreditation Council for Graduate Medical Education (ACGME) database. METHODS: We performed a retrospective review of the prospectively maintained ACGME resident case log database from 2003 to 2013. Thoracic cases were categorized by procedure type, year, and level of resident participation. A linear regression model was used to determine if there was a significant trend in case volumes over time. RESULTS: First assist volumes decreased in the 90th (-1.46 cases/year, p = 0.0012), 70th (-0.77 cases/year, p = 0.0005), 50th (-0.46 cases/year, p = 0.0013), and 30th percentiles (-0.16 cases/year, p = 0.0187). Pneumonectomy volumes decreased for surgeons junior (-0.01 cases/year, p = 0.0013) and chief residents (-0.01 cases/year, p = 0.005), as did open lobectomy (surgeon junior, -0.202 cases/year, p < 0.0001; chief, -0.08 cases/year, p ≤ 0.0013). Video-assisted (VATS) lobectomy increased for the surgeons junior (0.22 cases/year, p < 0.0001) and chief residents (0.045 cases/year, p < 0.0001). Surgeons junior also had increased volumes of VATS exploratory thoracoscopy (0.11 cases/year, p = 0.0003) and VATS pleurodeisis (0.13 cases/year, p < 0.0001). CONCLUSIONS: Whereas total thoracic volumes on the whole have not changed significantly, resident participation as a first assistant and in key thoracic cases has decreased over the last 11 years, while participation in VATS and minor cases has increased.

Transition to surgical residency: a multi-institutional study of perceived intern preparedness and the effect of a formal residency preparatory course in the fourth year of medical school.

PURPOSE: To evaluate interns' perceived preparedness for defined surgical residency responsibilities and to determine whether fourth-year medical school (M4) preparatory courses ("bootcamps") facilitate transition to internship. METHOD: The authors conducted a multi-institutional, mixed-methods study (June 2009) evaluating interns from 11 U.S. and Canadian surgery residency programs. Interns completed structured surveys and answered open-ended reflective questions about their preparedness for their surgery internship. Analyses include t tests comparing ratings of interns who had and had not participated in formal internship preparation programs. The authors calculated Cohen d for effect size and used grounded theory to identify themes in the interns' reflections. RESULTS: Of 221 eligible interns, 158 (71.5%) participated. Interns self-reported only moderate preparation for most defined care responsibilities in the medical knowledge and patient care domains but, overall, felt well prepared in the professionalism, interpersonal communication, practice-based learning, and systems-based practice domains. Interns who participated in M4 preparatory curricula had higher self-assessed ratings of surgical technical skills, professionalism, interpersonal communication skills, and overall preparation, at statistically significant levels (P < .05) with medium effect sizes. Themes identified in interns' characterizations of their greatest internship challenges included anxiety or lack of preparation related to performance of technical skills or procedures, managing simultaneous demands, being first responders for critically ill patients, clinical management of predictable postoperative conditions, and difficult communications. CONCLUSIONS: Entering surgical residency, interns report not feeling prepared to fulfill common clinical and professional responsibilities. As M4 curricula may enhance preparation, programs facilitating transition to residency should be developed and evaluated.

Predicting academic performance in surgical training.

INTRODUCTION: During surgical residency, trainees are expected to master all the 6 competencies specified by the ACGME. Surgical training programs are also evaluated, in part, by the residency review committee based on the percentage of graduates of the program who successfully complete the qualifying examination and the certification examination of the American Board of Surgery in the first attempt. Many program directors (PDs) use the American Board of Surgery In-Training Examination (ABSITE) as an indicator of future performance on the qualifying examination. Failure to meet an individual program's standard may result in remediation or a delay in promotion to the next level of training. Remediation is expensive in terms of not only dollars but also resources, faculty time, and potential program disruptions. We embarked on an exploratory study to determine if residents who might be at risk for substandard performance on the ABSITE could be identified based on the individual resident's behavior and motivational characteristics. If such were possible, then PDs would have the opportunity to be proactive in developing a curriculum tailored to an individual resident, providing a greater opportunity for success in meeting the program's standards. METHODS: Overall, 7 surgical training programs agreed to participate in this initial study and residents were recruited to voluntarily participate. Each participant completed an online assessment that characterizes an individual's behavioral style, motivators, and Acumen Index. Residents completed the assessment using a code name assigned by each individual PD or their designee. Assessments and the residents' 2013 ABSITE scores were forwarded for analysis using only the code name, thus insuring anonymity. Residents were grouped into those who took the junior examination, senior examination, and pass/fail categories. A passing score of ≥70% correct was chosen a priori. Correlations were performed using logistic regression and data were also entered into a neural network (NN) to develop a model that would explain performance based on data obtained from the TriMetrix assessments. RESULTS: A total of 117 residents' TriMetrix and ABSITE scores were available for analysis. They were divided into 2 groups of 64 senior residents and 53 junior residents. For each group, the pass/fail criteria for the ABSITE were set at 70 and greater as passing and 69 and lower as failing. Multiple logistic regression analysis was complete for pass/fail vs the TriMetrix assessments. For the senior data group, it was found that the parameter Theoretical correlates with pass rate (p < 0.043, B = -0.513, exp(B) = 0.599), which means increasing theoretical scores yields a decreasing likelihood of passing in the examination. For the junior data, the parameter Internal Role Awareness correlated with pass/fail rate (p < 0.004, B = 0.66, exp(B) = 1.935), which means that an increasing Internal Role Awareness score increases the likelihood of a passing score. The NN was able to be trained to predict ABSITE performance with surprising accuracy for both junior and senior residents. CONCLUSION: Behavioral, motivational, and acumen characteristics can be useful to identify residents "at risk" for substandard performance on the ABSITE. Armed with this information, PDs have the opportunity to intervene proactively to offer these residents a greater chance for success. The NN was capable of developing a model that explained performance on the examination for both the junior and the senior examinations. Subsequent testing is needed to determine if the NN is a good predictive tool for performance on this examination.

Multi-institutional study of self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking.

PURPOSE: Correlation exists between people who engage in academic dishonesty as students and unethical behavior once in practice. Previously, we assessed the attitudes of general surgery residents and ethical practices in test taking at a single institution. Most residents had not participated in activities they felt were unethical, yet what constituted unethical behavior was unclear. We sought to verify these results in a multi-institutional study. METHODS: A scenario-based survey describing potentially unethical activities related to the American Board of Surgery In-training Examination (ABSITE) was administered. Participants were asked about their knowledge of or participation in the activities and whether the activity was unethical. Program directors were surveyed about the use of ABSITE results for resident evaluation and promotion. RESULTS: Ten programs participated in the study. The resident response rate was 67% (186/277). Of the respondents, 43% felt that memorizing questions to study for future examinations was unethical and 50% felt that using questions another resident memorized was unethical. Most felt that buying (86%) or selling (79%) questions was unethical. Significantly more senior than junior residents have memorized (30% vs 16%; p = 0.04) or used questions others memorized (33% vs 12%; p = 0.002) to study for future ABSITE examinations and know of other residents who have done so (42% vs 20%; p = 0.004). Most programs used results of the ABSITE in promotion (80%) and set minimum score expectations and consequences (70%). CONCLUSION: Similar to our single-institution study, residents had not participated in activities they felt to be unethical; however the definition of what constitutes cheating remains unclear. Differences were identified between senior and junior residents with regard to memorizing questions for study. Cheating and unethical behavior is not always clear to the learner and represents an area for further education.

Benign breast disease.

This article presents an overview of the benign conditions that affect the breast for the practicing surgeon. The authors discuss the diagnosis and management of a variety of breast pathologic conditions, including those associated with infection and inflammation as well as proliferative and nonproliferative disorders. The authors also offer their experience with the integration of nurse practitioners in the care of patients with benign breast disease.

Open versus laparoscopic liver resection: looking beyond the immediate postoperative period.

BACKGROUND: Laparoscopic liver resection for malignant disease has shown short-term benefit. This study aimed to compare in-house, 30-day, and 1-year morbidity between laparoscopic and open liver resections. METHODS: The charts for all patients who underwent liver resection for malignant disease between April 2006 and October 2009 were reviewed. Patient, operative, and outcomes data at 30 days and 1 year were collected. RESULTS: For 76 patients, 49 open and 27 laparoscopic resections were performed. The two groups were similar in terms of age, gender, body mass index (BMI), extent of liver resection, use of ablation therapy, and tumor pathology (P > 0.05). The laparoscopic group had less blood loss (P = 0.004) and shorter hospital stays (P = 0.002). During their hospital stay, patients treated laparoscopically had fewer complications, but the difference was not significant. Home disposition was similar in the laparoscopic (96%) and open (90%) groups. More patients were readmitted at 30 days (2 vs. 9; P = 0.31) and 1 year (4 vs. 19; P = 0.04) in the open group. The all-cause 1-year mortality rates were similar between the laparoscopic and open groups (14.8% vs. 10.2%). CONCLUSION: The benefits of laparoscopic liver resection may extend beyond the initial postoperative period, with fewer readmissions despite shorter hospital stays. This also may suggest lower long-term hospital costs.

Novel senescence associated gene, YPEL3, is repressed by estrogen in ER+ mammary tumor cells and required for tamoxifen-induced cellular senescence.

Estrogen signaling plays an important role in breast carcinogenesis. An increased understanding of estrogen gene targets and their effects will allow for more directed and effective therapies for individuals with breast cancer, particularly those with estrogen receptor positive tumors resistant to tamoxifen therapy. Here, we identify YPEL3 as a growth suppressive protein downregulated by estrogen in estrogen receptor positive breast cancer cell lines. Estrogen repression of YPEL3 expression was found to be independent of p53 but dependent on estrogen receptor alpha expression. Importantly, YPEL3 expression, which is induced by the removal of estrogen or treatment with tamoxifen triggers cellular senescence in MCF-7 cells while loss of YPEL3 increases the growth rate of MCF-7 cells. Taken together these findings suggest that YPEL3 may represent a potential target for directed hormonal therapy for estrogen receptor positive breast cancer patients.