Does exposure to anatomy education in medical school affect surgical residency applications? An analysis of Canadian residency match data

Background: The time dedicated to teaching gross anatomy, including cadaveric dissection, has been decreasing in North American medical schools. The impact of this trend on surgical residency applications is unknown. We sought to identify trends in surgical residency applications in Canada and to determine if medical schools with more gross anatomy instruction and mandatory cadaveric dissection produced more applicants ranking surgical residency programs as their first choice. Methods: Canadian Resident Matching Service (CaRMS) data from 1997 to 2016 were analyzed. A questionnaire was distributed to Canadian medical schools requesting current and historic information on their anatomy curricula and the number of hours of anatomy instruction. Results: The survey response rate was 35% (6 of the 17 Canadian medical schools responded); partial data were available for 16 (94%) of the 17 Canadian medical schools. A total of 4.3% of graduating students ranked general surgery as their first choice in the CaRMS match and 17.2% ranked any surgical program first. Over time, the percentage of graduating students who ranked surgical programs as their first choice decreased (p < 0.001). Three schools were significantly more likely than the others to produce graduates ranking general surgery as their first choice. Between 2012 and 2016 the percentage of graduating students ranking surgical programs first was significantly higher (2.2%, p = 0.024) in schools with mandatory cadaver dissection. There was no correlation between the number of hours of gross anatomy instruction and the percentage of graduates ranking any surgical program or a general surgical program first. Conclusion: The number of applications to surgical programs has decreased in Canada over the past 20 years. Certain schools are more likely than others to produce graduates ranking general surgery as their first choice. Programs with mandatory cadaver dissection produced more graduates favouring surgical programs.

Contexte: Le temps alloué à l'enseignement de l'anatomie macroscopique, y compris la dissection cadavérique, est en baisse dans les facultés de médecine nord-américaines. Les répercussions de cette tendance sur le nombre de demandes dans les programmes de résidence en chirurgie sont encore inconnues. Nous avons cherché à dégager des tendances concernant les demandes aux programmes de résidence en chirurgie au Canada et à déterminer si les facultés de médecine intégrant une plus grande proportion d'enseignement de l'anatomie macroscopique et de dissection cadavérique obligatoires produisaient plus de candidats indiquant la résidence en chirurgie comme premier choix. Méthodes: Nous avons analysé les données du Service canadien de jumelage des résidents (CaRMS) de 1997 à 2016. Un questionnaire recueillant les données actuelles et historiques sur la matière enseignée en anatomie et le nombre d'heures d'enseignement consacrées à la discipline a été distribué aux facultés de médecine canadiennes Résultats: Le taux de réponse au sondage était de 35 % (6 des 17 facultés de médecine canadiennes ont répondu), et des données partielles ont été recueillies pour 16 (94 %) des 17 facultés. Au total, 4,3 % des finissants ont mis la chirurgie générale comme premier choix au jumelage du CaRMS, et 17,2 % ont mis un programme de chirurgie comme premier choix. Le pourcentage de finissants ayant mis les programmes chirurgicaux comme premier choix a diminué avec le temps (p < 0,001). Trois écoles étaient toutefois significativement plus susceptibles que les autres de produire des étudiants indiquant la chirurgie générale comme premier choix. Entre 2012 et 2016, le pourcentage d'étudiants inscrivant un programme chirurgical comme premier choix était significativement plus élevé (2,2 %, p = 0,024) dans les facultés ayant des dissections cadavériques obligatoires. Aucune corrélation n'a été observée entre le nombre d'heures d'enseignement de l'anatomie macroscopique et le pourcentage d'étudiants mettant un programme chirurgical comme premier choix. Conclusion: Le nombre de demandes pour les programmes chirurgicaux est en baisse au Canada depuis les 20 dernières années. Certaines écoles sont toutefois plus susceptibles que les autres de produire des finissants indiquant la chirurgie générale comme premier choix de programme de résidence. Les programmes intégrant la dissection cadavérique obligatoire produisent plus d'étudiants choisissant les programmes chirurgicaux pour la résidence.

The effect of simethicone on postoperative ileus in patients undergoing colorectal surgery (SPOT), a randomized controlled trial.

BACKGROUND: Postoperative ileus is a poorly understood multifactorial outcome following colorectal surgery that presents significant clinical challenges and contributes to increased morbidity, length of stay, and healthcare cost. To date, there are few pharmacological interventions that shorten the duration of postoperative ileus. OBJECTIVE: This study is the first to evaluate the efficacy of simethicone in treating postoperative ileus symptoms in patients undergoing colorectal surgery. DESIGN: A multicenter, double-blinded, placebo controlled randomized controlled trial. SETTINGS: This trial was conducted at two academic tertiary care centres in Ontario, Canada. PARTICIPANTS: 118 patients undergoing colorectal surgery. INTERVENTIONS: Patients were randomized to receive either a five-day course of oral simethicone (n = 58) or a placebo (n = 60). MAIN OUTCOME MEASURES: The primary outcome was time to first passage of flatus. Secondary outcomes included time to first bowel movement, postoperative length of stay, and postoperative pain. Statistical analyses were performed on an intention-to-treat basis. Statistical significance set at p = 0.05. RESULTS: The median time to first passage of flatus in simethicone arm was 25.2 h and 26.7 h in controls (P = 0.98). There were no significant differences in the median time to first bowel movement (simethicone = 41.1 h vs. control = 42.9 h, P = 0.91) or median length of hospital stay (simethicone = 4.5 days vs. control = 4.0 days, P = 0.63). CONCLUSIONS: This study failed to show a difference in return of gastrointestinal motility in patients receiving simethicone following colorectal surgery. Postoperative ileus remains a significant clinical and economic burden to the healthcare system and further research is needed to identify a reliable and effective method of treatment.