Graduate Medical Education "Trainee in difficulty" current remediation practices and outcomes.

BACKGROUND: Trainees in difficulty require additional support to complete training program and become successful physicians. This study reviewed the current remediation practices and outcomes of trainees in difficulty. METHODS: A PRISMA-based literature review was performed. Meta-analyses were performed using random effects model. RESULTS: 30 studies met inclusion criteria. Sixteen studies surveyed program directors and 14 were observational. Prevalence and attrition of trainees in difficulty ranged widely from 2.0% to 30.7% and 0.0%-50.0%, respectively, with significant heterogeneity. Pooled odds of attrition was higher for trainees in difficulty, however, the confidence interval crossed one and there was statistically significant heterogeneity. Residents in difficulty were significantly less likely to become board certified (OR = 0.08, 95%-CI = 0.04-0.18; I2 = 0%, P = .70). CONCLUSION: Trainees in difficulty were less likely to be board certified but attrition rate did not differ. Future studies with standardized criteria for trainees in difficulty and better reporting of the outcomes can better guide our remediation practices.

Deep Venous Arterialization for Chronic Limb Threatening Ischemia in Atherosclerosis Patients - A Meta-Analysis.

BACKGROUND: Venous arterialization is an upcoming and novel alternative in chronic limb threatening ischemia (CLTI) patients in the absence of standard revascularization options. The aim of this study is to systematically review and analyze outcomes of venous arterialization. METHODS: A systematic literature search was performed in 5 databases using the PRISMA methodology. Inclusion criteria were English language original research papers on CLTI patients treated with venous arterialization. EXCLUSION CRITERIA: absence of CLTI due to atherosclerosis, duplicate study or reporting of patients, meeting abstract only. Quality and risk of bias were evaluated. Meta-analysis was performed using random effects model on articles that have a sample size of equal or greater than 10. RESULTS: Twelve studies included 442 patients that underwent treatment for 445 limbs (374 patients and 377 limbs underwent venous arterialization while remainder underwent traditional bypass and served as control subjects). Average age was 66 [18 studies, range 37 -91 years], 68% were male [271/366, 15 studies] and 67% diabetic [271/406, 16 studies]). Most limbs (88%, 352/398, 16 studies) had tissue loss. Pooled 30-day mortality was 3.7% (95%-confidence interval [CI] 0.8 -6.6%), 30-day morbidity was 15.5% (95%-CI 3.2 -27.8%), 30-day major adverse cardiovascular event was 5.2% (95%-CI 1.7 -8.6%) and 30-day major adverse limb event was 16.7% (95%-CI 1.5 -31.9%). Pooled 1-year limb-salvage rate was 79.0% (95%-CI 68.7 -90.7) and 1-year survival rate was 85.7% (95%-CI 76.2 -96.4). Studies quality varied significantly across studies. CONCLUSION: Venous arterialization has an acceptable a 1-year limb salvage rate of 79%, however, this is based on low levels of evidence. More randomized controlled trials or high-quality cohort studies are needed to further define the effectiveness of this procedure for CLTI.