Surgical experiences of final-year undergraduates and the impact on their career aspiration stratified by sex/gender.

Objectives: Surgical undergraduate training takes place in a male-dominated work environment that struggles with recruitment problems. Experiences of cultural and sex/gender-specific barriers of women in surgery have been reported worldwide. Overall, the experiences that students have in coping with the emotional impact of surgery as a profession are thought to be crucial to their subsequent career choices. We investigated whether students' self-reported experiences differed by sex/gender in terms of frequency and content, and whether they were related to their career aspirations. Methods: In Germany, the final year represents the last part of the undergraduate medical study program. At the Mannheim Medical Faculty, a 12-week surgical training is mandatory. After completing their surgical training, the students were asked about their experiences and their later career aspirations. These experiences were analysed using quantitative content analysis. The relationship between the quality of experience and career aspirations as well as sex/gender differences were statistically measured. Results: In the 475 questionnaires analysed (response rate 52%), the number of positive and negative mentions does not differ by sex/gender. However, male students feel more actively involved and female students feel poorly briefed and think that supervisors are less interested in their training. A significant influence on career aspirations was found in the performance category for female and male students, and in the supervision category for female students. Conclusion: The positive experiences that students gain while performing surgical activities have an impact on their subsequent career choices. In particular, a good settling-in period and encouragement to actively participate could help to attract more women to surgery.

Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models.

Importance: Artificial intelligence (AI) has permeated academia, especially OpenAI Chat Generative Pretrained Transformer (ChatGPT), a large language model. However, little has been reported on its use in medical research. Objective: To assess a chatbot's capability to generate and grade medical research abstracts. Design, Setting, and Participants: In this cross-sectional study, ChatGPT versions 3.5 and 4.0 (referred to as chatbot 1 and chatbot 2) were coached to generate 10 abstracts by providing background literature, prompts, analyzed data for each topic, and 10 previously presented, unassociated abstracts to serve as models. The study was conducted between August 2023 and February 2024 (including data analysis). Exposure: Abstract versions utilizing the same topic and data were written by a surgical trainee or a senior physician or generated by chatbot 1 and chatbot 2 for comparison. The 10 training abstracts were written by 8 surgical residents or fellows, edited by the same senior surgeon, at a high-volume hospital in the Southeastern US with an emphasis on outcomes-based research. Abstract comparison was then based on 10 abstracts written by 5 surgical trainees within the first 6 months of their research year, edited by the same senior author. Main Outcomes and Measures: The primary outcome measurements were the abstract grades using 10- and 20-point scales and ranks (first to fourth). Abstract versions by chatbot 1, chatbot 2, junior residents, and the senior author were compared and judged by blinded surgeon-reviewers as well as both chatbot models. Five academic attending surgeons from Denmark, the UK, and the US, with extensive experience in surgical organizations, research, and abstract evaluation served as reviewers. Results: Surgeon-reviewers were unable to differentiate between abstract versions. Each reviewer ranked an AI-generated version first at least once. Abstracts demonstrated no difference in their median (IQR) 10-point scores (resident, 7.0 [6.0-8.0]; senior author, 7.0 [6.0-8.0]; chatbot 1, 7.0 [6.0-8.0]; chatbot 2, 7.0 [6.0-8.0]; P = .61), 20-point scores (resident, 14.0 [12.0-7.0]; senior author, 15.0 [13.0-17.0]; chatbot 1, 14.0 [12.0-16.0]; chatbot 2, 14.0 [13.0-16.0]; P = .50), or rank (resident, 3.0 [1.0-4.0]; senior author, 2.0 [1.0-4.0]; chatbot 1, 3.0 [2.0-4.0]; chatbot 2, 2.0 [1.0-3.0]; P = .14). The abstract grades given by chatbot 1 were comparable to the surgeon-reviewers' grades. However, chatbot 2 graded more favorably than the surgeon-reviewers and chatbot 1. Median (IQR) chatbot 2-reviewer grades were higher than surgeon-reviewer grades of all 4 abstract versions (resident, 14.0 [12.0-17.0] vs 16.9 [16.0-17.5]; P = .02; senior author, 15.0 [13.0-17.0] vs 17.0 [16.5-18.0]; P = .03; chatbot 1, 14.0 [12.0-16.0] vs 17.8 [17.5-18.5]; P = .002; chatbot 2, 14.0 [13.0-16.0] vs 16.8 [14.5-18.0]; P = .04). When comparing the grades of the 2 chatbots, chatbot 2 gave higher median (IQR) grades for abstracts than chatbot 1 (resident, 14.0 [13.0-15.0] vs 16.9 [16.0-17.5]; P = .003; senior author, 13.5 [13.0-15.5] vs 17.0 [16.5-18.0]; P = .004; chatbot 1, 14.5 [13.0-15.0] vs 17.8 [17.5-18.5]; P = .003; chatbot 2, 14.0 [13.0-15.0] vs 16.8 [14.5-18.0]; P = .01). Conclusions and Relevance: In this cross-sectional study, trained chatbots generated convincing medical abstracts, undifferentiable from resident or senior author drafts. Chatbot 1 graded abstracts similarly to surgeon-reviewers, while chatbot 2 was less stringent. These findings may assist surgeon-scientists in successfully implementing AI in medical research.

The usefulness and effectiveness of interactive telemedicine in surgery classes - a survey of Polish medical students.

<b>Introduction:</b> Computer-based interactive techniques are becoming an important tool in medical education. One of the important benefits of the use of telemedicine in surgical training is the reduction of the number of people in the operating room. As shown in the studies, this can lead i.a. to the reduction in the risk of surgical site infections.<b>Aim:</b> The aim of this survey as held among fifth-year medical students at three academic centers was to assess the usefulness and effectiveness of telemedicine as a surgery-teaching tool.<b>Material and methods:</b> A transmission of a surgical procedure was carried out by each of the three participating centers according to a previously prepared schedule. Each transmission was preceded by the diagnostics, indications, and the course of the surgical procedure being discussed by the facilitator physician who also coordinated the transmission throughout the procedure. After the class, students received anonymous surveys consisting of fourteen questions as per the attached protocol so as to evaluate the class using the rating scale of 1 (the lowest rating) through 5 (the highest rating). The survey assessed the educational value (the knowledge acquired from the class), the form (interactivity, facilitator complicity), and the usefulness of the class for overall surgical education.<b>Results:</b> The survey was completed by 232 students, with 95% of respondents rating the usefulness of telemedicine classes in surgical education as very good or good. As many as 97% of students declared that the transmission had been a good or a very good tool in terms of delivery or adding to their knowledge of topographical anatomy and basic aspects of surgical technique. Higher ratings were given to the usefulness of comments and remarks by the facilitating physician (96% of very good or good ratings) who had been watching the procedure along with the students as compared to those provided by the operating physician (81%).<b>Discussion:</b> The use of telemedicine-based teaching models in surgical education facilitates a better view of the operating field for the students, greater accessibility of educational content delivered simultaneously to multiple groups of students, increased safety of the surgical procedure by reducing the number of people in the operating room as well as reduced burden on the operating physician (thanks to the introduction of class facilitator).<b>Conclusions:</b> In our opinion, the advantages of the presented teaching model are: better view (particularly in case of open procedures), ability to pinpoint surgical field structures (on the participants' and operator's monitors), absence of additional people (students) in the operating room (increasing the safety of the procedure and reducing the risk of surgical site infections) and the ability to go back to recorded operations and perform various types of educational analyses.

A lay of the land: a description of academic acute care surgery models in Canada.

BACKGROUND: Patients who require emergency general surgery (EGS) are at a substantially higher risk for perioperative morbidity and mortality than patients undergoing elective general surgery. The acute care surgery (ACS) model has been shown to improve EGS patient outcomes and cost-effectiveness. A recent systematic review has shown extensive heterogeneity in the structure of ACS models worldwide. The objective of this study was to describe the current landscape of ACS models in academic centres across Canada. METHODS: We sent an online questionnaire to the 18 academic centres in Canada. The lead ACS physicians from each institution completed the questionnaire, describing the structure of their ACS models. RESULTS: In total, 16 institutions responded, all of which reported having ACS models, with a total of 29 ACS services described. All services had resident coverage. Of the 29, 18 (62%) had dedicated allied health care staff. The staff surgeon was free from elective duties while covering ACS in 17/29 (59%) services. More than half (15/29; 52%) of the services described protected ACS operating room time, but only 7/15 (47%) had a dedicated ACS room all 5 weekdays. Four of 29 services (14%) had no protected ACS operating room time. Only 1/16 (6%) institutions reported a mandate to conduct ACS research, while 12/16 (75%) found ACS research difficult, owing to lack of resources. CONCLUSION: We saw large variations in the structure of ACS models in academic centres in Canada. The components of ACS models that are most important to patient outcomes remain poorly defined. Future research will focus on defining the necessary cornerstones of ACS models.

A comparative study of learning curves among general surgery residents for intraoperative ultrasound-guided breast-conserving surgery.

Breast-conserving surgery (BCS) followed by radiotherapy is preferred for early-stage breast cancer because its survival rate is equivalent to that of mastectomy. Achieving negative surgical margins in BCS is crucial to minimize the risk of recurrence. Intraoperative ultrasound (IOUS) enhances surgical accuracy, but its efficacy is operator dependent. This study aimed to compare the success of achieving negative margins using IOUS between an experienced breast surgeon and general surgical residents and to evaluate the learning curve for the residents. A prospective study involving 96 patients with BCS who underwent IOUS guidance was conducted. Both the breast surgeon and residents assessed the surgical margins using IOUS, with the breast surgeon making the final margin adequacy decision. Permanent histopathological analysis was used to confirm the status of the margins and was considered the gold standard for comparison. The breast surgeon accurately assessed the margin status in all 96 cases (100% accuracy), with 93 negative and three positive margins. All of these were ductal carcinomas in situ. Initially, the residents demonstrated low accuracy rates in predicting margin positivity using intraoperative ultrasonography. However, the learning curves of the three residents demonstrated that, with an average 12th case onwards, a significant improvement in the cumulative accuracy rates was observed, which reached the level of the breast surgeon. IOUS is an effective tool for accurately predicting the margin status in BCS, with an acceptable learning curve for novice surgeons. Training and experience are pivotal for optimizing surgical outcomes. These findings support the integration of IOUS training into surgical education programs to enhance proficiency and improve patient outcomes.

Patient satisfaction with women vs men surgical interns and senior residents.

BACKGROUND: Patient satisfaction is critical for referrals and reimbursement of surgical faculty but remains poorly characterized for residents. We investigated whether patient evaluations of surgical trainees vary by resident gender. METHODS: Surgical inpatients evaluated surgical resident care postoperatively after positively identifying trainees. Evaluations (Consumer Assessment of Healthcare Providers and Systems Surgical Care Surveys (S-CAHPS)) were scored by the "top-box" method, stratified by training level, and compared between women and men residents. RESULTS: Ninety-one percent of patients participated (n â€‹= â€‹324/357). Patients recognized women interns less than men (75.0 â€‹% vs 87.2 â€‹%, p â€‹= â€‹0.01). S-CAHPS scores for women vs men interns were equivalent except for spending sufficient time with patients (75.6 â€‹% vs 88.0 â€‹%, p â€‹= â€‹0.02). For senior residents, there was no difference in patient recognition of women vs men (83.9 â€‹% vs 85.2 â€‹%, p â€‹= â€‹0.91) or in any S-CAHPS scores (p â€‹> â€‹0.05). CONCLUSIONS: Gendered differences in patient evaluations of surgical trainees exist for interns but resolve by senior years. Future work should explore how patient evaluations can support trainee development while ensuring patients recognize the role of surgical residents regardless of gender.

El cirujano general en las urgencias hepatobiliares en Colombia desde la visión de los expertos: un estudio cualitativo / The general surgeon in hepatobiliary emergencies in Colombia from the experts' perspective: A qualitative study

Introducción. El manejo perioperatorio de las urgencias hepatobiliares por parte del cirujano general es una competencia esperada y se considera un reto por su relativa frecuencia, impacto en la salud del individuo y la economía, así como las implicaciones en el ejercicio clínico confiable y de alta calidad. Se desconocen los aspectos formales de la educación en cirugía hepatobiliar para el cirujano general en Colombia. El objetivo del presente estudio fue explorar la perspectiva de los cirujanos hepatobiliares sobre esta problemática. Métodos. Se realizó un estudio cualitativo, mediante entrevistas semiestructuradas con 14 especialistas en cirugía hepatobiliar colombianos, en donde se exploraron los desafíos del entrenamiento, el tiempo y las características de una rotación, la evaluación de la confiabilidad, el número de procedimientos y el rol de la simulación. Se hizo un análisis temático de la información. Resultados. Los expertos mencionaron la importancia de la rotación obligatoria por cirugía hepatobiliar para los cirujanos en formación. El tiempo ideal es de tres meses, en el último año de residencia, en centros especializados, con exposición activa y bajo supervisión. Conclusiones. Por las características epidemiológicas del país y la frecuencia de enfermedades hepatobiliares que requieren tratamiento quirúrgico, es necesario que el cirujano general cuente con una formación sólida en este campo durante la residencia. El presente estudio informa sobre las características ideales del entrenamiento en este campo desde la visión de los expertos colombianos.

Introduction. The perioperative management of hepatobiliary emergencies by the general surgeon is an expected competence and is considered a challenge due to its relative frequency, impact on the individual health and the economy, as well as the implications for reliable and high-quality clinical practice. The formal aspects of education in hepatobiliary surgery for the general surgeon in Colombia are unknown. The objective of the present study was to explore the perspective of hepatobiliary surgeons on this problem. Methods. A qualitative study was carried out through semi-structured interviews with 14 Colombian hepatobiliary surgery specialists, where the challenges of training, time and characteristics of the rotation, evaluation of reliability, number of procedures and role of simulation. A thematic analysis of the information was carried out. Results. The experts mentioned the importance of mandatory rotation for hepatobiliary surgery for surgeons in training. The ideal duration was three months, during the last year of residency, in specialized centers with active exposure and under supervision. Conclusions. Due to the epidemiological characteristics of the country and the frequency of hepatobiliary diseases that require surgical treatment, it is necessary for the general surgeon to have solid training in this field during residency. The present study reports on the ideal characteristics of training in this field from the perspective of Colombian experts.

Desenredando los nudos en cirugía: creando maestría con un simulador práctico en casa / Untangling the knots in surgery: Creating mastery with a practical at-home simulator

Introducción. Anudar es una de las habilidades quirúrgicas esenciales y de su correcta ejecución dependen procesos de vital importancia. La adquisición de estas competencias requiere trabajo motor, entornos amigables y realistas. Una estrategia para facilitar el aprendizaje de la técnica de anudado es generar instrumentos de simulación accesibles. Métodos. Se presenta un simulador de nudos quirúrgicos, construido con materiales de bajo costo y asequibles para la población en general, con un presupuesto de aproximadamente $5.000 COP (US$ 1,23). Resultados. Se desarrolló un simulador de nudos quirúrgicos que, al fijarse a la extremidad inferior desde una posición sentada, proporciona una superficie estable para llevar a cabo la práctica de anudado de manera efectiva. Conclusión. La cirugía moderna considera la seguridad del paciente como la principal prioridad, por lo que ya no es apropiado adoptar un método de formación de "ver uno, hacer uno, enseñar uno". Es la práctica constante mediante simuladores, el método más adecuado. Este trabajo presenta una alternativa de aprendizaje ininterrumpido de las técnicas quirúrgicas relacionadas con los nudos.

Introduction. Knotting is one of the essential surgical skills and vitally important processes that depends on its correct execution. The acquisition of these skills requires motor work, friendly and realistic environments. A strategy to facilitate learning the knotting technique is to generate accessible simulation instruments. Methods. A surgical knot simulator is presented, built with low-budget materials and affordable for the general population, with a budget of approximately $5,000 COP (US$ 1.23). Results. A surgical knot simulator has been developed in a way that, when attached to the thigh of a lower extremity from a seated position, provides a stable surface to effectively perform knot tying practice. Conclusion. Modern surgery considers patient safety as the top priority, so it is no longer appropriate to adopt a "see one, do one, teach one" training method. Constant practice using simulators is the most appropriate method. This work presents an alternative for uninterrupted learning of surgical techniques related to knots.

Exploring barriers and enabling factors for surgical task sharing with physician assistants in Liberia: a qualitative pre-implementation study.

OBJECTIVES: This study explores potential barriers and enabling factors that may influence the acceptance of implementation of a surgical task-sharing initiative targeting physician assistants (PAs) in Liberia. DESIGN: A qualitative, pre-implementation study using semistructured interviews. Data was analysed in NVivo V.12 using deductive coding and the consolidated framework for implementation research as a guide. SETTING: Liberia has few surgical providers and a poor surgical infrastructure resulting in a very low surgical volume. The research was conducted in the context of an already running surgical task-sharing programme for midwives. PARTICIPANTS: In 2019, a total of 30 key stakeholders in the field of surgery and the PAs training programme were interviewed. RESULTS: The majority of the stakeholders supported the idea of training PAs in surgery. The high unemployment rate among PAs and the need for career advancement of this cadre were important enabling factors. Resistance against surgical task sharing for mid-level clinicians is multifaceted. The Ministry of Health (MOH) did not share a common vision. Opponents within the MOH believed budgetary constraints within the MOH and the lack of surgical infrastructure is a more pressing problem compared with the surgically trained human resources. Another important group of opponents are medical officers (MOs) and their professional bodies. Many of their negative beliefs around surgical task sharing reflect lessons to be drawn from the current surgical training programme for midwives. CONCLUSION: Prior to deciding on implementation of a surgical training programme for PAs, wider support is needed. If surgical task sharing with PAs is to be considered, the intervention should focus on adapting the 'adaptable' periphery of the intervention to broaden the support of the MOH, MOs and their professional bodies. Failing to obtain such support should make the implementors consider alternative strategies to strengthen surgical human resources in rural Liberia.

Public's Perception and Knowledge of Using Robotics in General Surgery in Eastern Region, Saudi Arabia.

BACKGROUND: Robotics in general surgery is a field that involves the use of robotic systems to assist surgeons in performing various types of surgical procedures. OBJECTIVE: The objective of this study was to evaluate the perception and knowledge of robotic surgery among the Eastern Region's population. METHODS: This cross-sectional study used an electronic questionnaire that was developed using Google Docs. It included males and females aged above 18 years who lived in the Eastern Province. Participants who were below 18 or above 65 years of age, or non-Saudi, or people who lived in other than the Eastern Region of Saudi Arabia were excluded from the study. RESULTS: A total of 500 responses were received via the Google Form, and 81 subjects of them were excluded from the study. Approximately half of the participants were aware of the existence of general robotic surgery, while the other half had no prior knowledge about it. When assessing the participants' understanding of how robotic surgery works, a significant proportion provided incorrect responses. In terms of the advantages of general robotic surgery, the most commonly recognized benefit was that it makes the doctor's life easier, followed by more accurate surgical results. However, the participants' understanding of the disadvantages of robotic surgery was not as accurate. A substantial portion of participants were unsure about the disadvantages. CONCLUSION: The general public of the Eastern Region in Saudi Arabia showed a derated level of knowledge about the use of robotics in general surgery. Furthermore, a major portion of people were unaware of the availability of robotic surgery in Saudi Arabia. Educational programs are warranted to facilitate the implantation of robotic surgery in Saudi Arabia.

Résumé Contexte:La robotique en chirurgie générale est un domaine qui implique l'utilisation de systèmes robotiques pour assister les chirurgiens dans la réalisation de divers types de procédures chirurgicales. Objectif : L'objectif de cette étude était d'évaluer la perception et la connaissance de la chirurgie robotique parmi la population de la région orientale.Méthodes:Cette étude transversale a utilisé un questionnaire électronique développé via Google Docs. Il incluait des hommes et des femmes âgés de plus de 18 ans résidant dans la province orientale. Les participants de moins de 18 ans ou de plus de 65 ans, non saoudiens, ou vivant en dehors de la région orientale de l'Arabie Saoudite étaient exclus de l'étude.Résultats:Un total de 500 réponses ont été reçues via le formulaire Google, et 81 sujets parmi eux ont été exclus de l'étude. Environ la moitié des participants étaient au courant de l'existence de la chirurgie robotique générale, tandis que l'autre moitié n'avait aucune connaissance préalable à ce sujet. Lors de l'évaluation de la compréhension des participants sur le fonctionnement de la chirurgie robotique, une proportion significative a fourni des réponses incorrectes. En termes d'avantages de la chirurgie robotique générale, le bénéfice le plus communément reconnu était qu'elle facilite la vie du médecin, suivi par des résultats chirurgicaux plus précis. Cependant, la compréhension des participants concernant les inconvénients de la chirurgie robotique n'était pas aussi précise. Une portion substantielle des participants était incertaine quant aux inconvénients.Conclusion:Le grand public de la région orientale en Arabie Saoudite a montré un niveau de connaissance diminué concernant l'utilisation de la robotique en chirurgie générale. De plus, une grande partie des personnes ignoraient la disponibilité de la chirurgie robotique en Arabie Saoudite. Des programmes éducatifs sont nécessaires pour faciliter l'implantation de la chirurgie robotique en Arabie Saoudite.

Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff.

Importance: Labor unions are a mechanism for employee advocacy, but their role in surgery resident wellness is poorly characterized. Objective: To understand experiences with unionization among general surgery residents and residency program faculty and staff. Design, Setting, and Participants: This exploratory qualitative study included data from the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) trial. In the exploratory phase of the SECOND trial (from March 6, 2019, to March 12, 2020), semistructured interviews about wellness were conducted with residents, faculty (attending physicians), and staff (program administrators) at 15 general surgery residency programs. Unionization was identified as an emergent theme in the interviews. Data analysis was performed from March 2019 to May 2023. Main Outcomes and Measures: The main outcome was resident and faculty experience with resident labor unions. In the qualitative analysis, lexical searches of interview transcripts identified content regarding resident labor unions. A codebook was developed inductively. Transcripts were coded by dyads, using a constant comparative approach, with differences reconciled by consensus. Results: A total of 22 interview transcripts were identified with relevant content. Of these, 19 were individual interviews conducted with residents (n = 10), faculty (n = 4), administrative staff (n = 1), a program director (n = 1), a department chair (n = 1), and designated institutional officials (n = 2), and 3 were from resident focus groups. Residents from all postgraduate year levels, including professional development (ie, research) years, were represented. Interviewees discussed resident unions at 2 programs (1 recently unionized and 1 with a decades-long history). Interviewees described the lack of voice and the lack of agency as drivers of unionization ("Residents…are trying to take control of their well-being"). Increased salary stipends and/or housing stipends were the most concretely identified union benefits. Unanticipated consequences of unionization were described by both residents and faculty, including (1) irrelevance of union-negotiated benefits to surgical residents, (2) paradoxical losses of surgery department-provided benefits, and (3) framing of resident-faculty relationships as adversarial. Union executives were noted to be nonphysician administrators whose participation in discussions about clinical education progression may increase the time and effort to remediate a resident and/or reduce educators' will to meaningfully intervene. Active surgical resident participation within the union allows for an understanding of surgical trainees' unique needs and reduced conflict. Conclusions and Relevance: In this qualitative study, unionization was a mechanism for resident voice and agency; the desire to unionize likely highlighted the lack of other such mechanisms in the training environment. However, these findings suggest that unionization may have had unintended consequences on benefits, flexibility, and teaching. Effective advocacy, whether within or outside the context of a union, was facilitated by participation from surgical residents. Future research should expand on this exploratory study by including a greater number of institutions and investigating the evolution of themes over time.

Do good things really come to those who wait? An analysis of the average time of acceptance in Brazilian surgery journals.

PURPOSE: To analyze the average time between submission and acceptance of national journals in seven Brazilian surgery journals from 2017 to 2022. METHODS: It consists of a cross-sectional and observational study with a quantitative approach to analyze the acceptance time of articles approved by Brazilian journals on general surgery and its subspecialties, including Acta Cirúrgica Brasileira, Jornal Vascular Brasileiro, Arquivos Brasileiros de Cirurgia de Digestiva, Revista do Colégio Brasileiro de Cirurgiões, Journal of Coloproctology, Revista Brasileira de Cirurgia Plástica, and International Brazilian Journal of Urology. RESULTS: The journals with the lowest average waiting times were Revista do Colégio Brasileiro de Cirurgiões, Acta Cirúrgica Brasileira, and Journal of Coloproctology, respectively, and, with the lowest interquartile range there is Acta Cirúrgica Brasileira. There was no significant difference between the pre-pandemic and pandemic periods. The study designs with the highest and lowest means were, respectively, ideas and innovations - also with the highest interquartile range - and expert opinion, while with the lowest interquartile range was technical skill. CONCLUSIONS: The acceptance time for articles in Brazilian surgery journals is extremely variable. Identifying these discrepancies highlights the importance of understanding editorial processes and seeking ways to improve consistency and efficiency in reviewing articles.

Perceptions of general surgery residents at military treatment facilities: Excellent training with crisis of confidence.

BACKGROUND: The declining operative volume at Military Treatment Facilities (MTFs) has resulted in Program Directors finding alternate civilian sites for resident rotations. The continued shift away from MTFs for surgical training is likely to have unintended negative consequences. METHODS: An anonymous survey was generated and sent to the program directors of military general surgery training programs for distribution to their residents. RESULTS: A total of 42 residents responded (response rate 21%) with adequate representation from all PGY years. Ninety-five percent of residents believed that their programs provided the training needed to be a competent general surgeon. However, when asked about career choices, only 30.9% reported being likely/extremely likely to remain in the military beyond their initial service obligation, while 54.7% reported that it was unlikely/extremely unlikely and 19% reported uncertainty. Eighty-eight percent reported that decreasing MTF surgical volume directly influenced their decision to stay in the military, and half of respondents regretted joining the military. When asked to assess their confidence in the military to provide opportunities for skill sustainment as a staff surgeon, 90.4% were not confident or were neutral. CONCLUSION: Although military surgical residents have a generally positive perception of their surgical training, they also lack confidence in their future military surgical careers. Our findings suggest that declining MTF surgical volume will likely negatively impact long-term retention of military surgeons and may negatively impact force generation for Operational Commander. LEVEL OF EVIDENCE: Prognostic and Epidemiological, Level IV.

Robotic versus laparoscopic general surgery in the emergency setting: a systematic review.

Robot-assisted general surgery, an advanced technology in minimally invasive procedures, is increasingly employed in elective general surgery, showing benefits over laparoscopy in specific cases. Although laparoscopy remains a standard approach for common acute abdominal conditions, the role of robotic surgery in emergency general surgery remains uncertain. This systematic review aims to compare outcomes in acute general surgery settings for robotic versus laparoscopic surgeries. A PRISMA-compliant systematic search across MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane Library was conducted. The literature review focused on articles comparing perioperative outcomes of emergency general surgery managed laparoscopically versus robot-assisted. A descriptive analysis was performed, and outcome measures were recorded. Six articles, involving 1,063 patients, compared outcomes of robotic and laparoscopic procedures. Two articles covered cholecystectomies, while the others addressed ileocaecal resection, subtotal colectomy, hiatal hernia and repair of perforated gastrojejunal ulcers. The level of evidence was low. Laparoscopic bowel resection in patients with inflammatory bowel disease (IBD) had higher complications; no significant differences were found in complications for other operations. Operative time showed no differences for cholecystectomies, but robotic approaches took longer for other procedures. Robotic cases had shorter hospital length of stay, although the associated costs were significantly higher. Perioperative outcomes for emergency robotic surgery in selected general surgery conditions are comparable to laparoscopic surgery. However, recommending robotic surgery in the acute setting necessitates a well-powered large population study for stronger evidence.