Updates on Diversity Among Cardiology-Related Fellowships.

Within the United States (US) medical system, diversity in healthcare is a growing concern although studies have shown improved patient outcomes when healthcare teams are diverse. We were interested in cardiology-related fellowships from internal medicine and surgical specialties to understand how females, osteopaths (DOs), and non-US graduates were represented compared to males, allopathic medical doctors (MD), and US-graduated peers. We obtained data about accredited cardiology fellowship programs from the Fellowship and Residency Electronic Interactive Database Access System (FRIEDA™) for 2022-2023 and determined statistical significance for male/female, DO/MD, and US/non-US graduate status by reviewing program sites. Statistical analysis utilized SAS Studio 3.8, version 9.4 (SAS Institute, Inc., Cary, NC) and Wilson score for confidence intervals. Cardiology-related fellowships from internal medicine and surgery backgrounds showed generalized marked disparities (p<0.001) with only a couple of exceptions. For Interventional Cardiology, non-US graduates were well represented (p=0.3775), and for Heart Failure & Transplant Cardiology, females were represented equally (p=0.0863). For all other specialties and values, females, DOs, and non-US graduates were underrepresented. Despite conversations about diversity, underrepresentation persists. We encourage further steps to address barriers preventing underrepresented groups from advancing to their full potential in leadership and careers. Increasing diversity promotes competence, empathy, communication, and inclusive patient care.

Diversity Differences Among Cardiovascular Fellowships Across Five Geographic Regions in the United States.

Introduction Diversity and inclusion in cardiovascular fellowships are necessary for addressing the healthcare needs of diverse patient populations. However, regional disparities in the diversity of these programs persist, diminishing efforts to create a representative workforce. We observe the regional differences in the diversity of cardiovascular fellowship programs, focusing on gender, doctorate designation, and graduation within the United States (US) or other. We hypothesized that males, medical doctors (MD), and US graduates would be in majority across all regions. Methods Data for cardiovascular fellowships from the Fellowship and Residency Electronic Database Access (FREIDA) system for the matriculation year 2022-2023 was obtained to assess the representation of male vs female gender, MD vs osteopathic doctor (DO) designation, and US vs non-US graduate. We then compared these backgrounds to five defined regions (Midwest, Northeast, Southeast, Southwest, and West) in the United States to define representation for backgrounds across geographic areas. Statistical significance was determined by p<0.05 with the use of SAS Studio 3.8, version 9.4 (Cary, NC: SAS Institute, Inc.), and Wilson score for confidence intervals. Results We found significant disparities across all background factors for all regions. This includes that females, DOs, and non-US graduates were underrepresented among Midwest, Northeast, Southeast, Southwest, and West regions, and the p-value was <0.001 for all variations. Specifically for Midwest, the female frequency was 155 (23.81%; CI: 21, 27; p<0.001), DO frequency was 101 (15.51%; CI: 13, 19; p<0.001), and non-US graduate frequency was 206 (31.84%; CI: 28, 36; p<0.001). For Northeast, the female frequency was 231 (29.62; CI: 27, 33; p<0.001), DO frequency was 72 (9.22; CI: 7, 11; p<0.001), and non-US graduate frequency was 239 (30.68; CI 28, 34; p<0.001). For Southeast, the female frequency was 178 (25.99; CI: 23, 29; p<0.001), DO frequency was 67 (9.78; CI: 8, 12; p<0.001), and non-US graduate frequency 279 (41.46; CI: 38, 45; p<0.001). For Southwest, the female frequency was 74 (26.71; CI: 22, 32; p<0.001), DO frequency was 21 (7.58; CI 5, 11; p<0.001), and non-US graduate frequency was 110 (39.71; CI: 34,46; p<0.001). For West, the female frequency was 107 (31.75; CI 27, 37; p<0.001), DO frequency was 15 (4.45; CI: 3, 7; p<0.001), and non-US graduate frequency was 54 (16.07; CI: 13, 20; p<0.001). Conclusion We emphasize the regional disparities for females, DOs, and non-US graduates within cardiovascular fellowships in the past matriculation year. Understanding that we have not reached diversity goals allows for further reflection and implementation of targeted interventions and initiatives aimed at promoting equal opportunities for applicants. This is true for all regions of the United States. By addressing these disparities, fellowship programs can more effectively mirror the diverse patient populations they serve and foster a healthcare environment that is inclusive and accommodating. This, in turn, contributes to the overall enhancement of healthcare outcomes.

Increasing Social Media Presence for Graduate Medical Education Programs.

Virtual residency interviews during COVID-19 pandemic created a need for residency programs to use social media to increase their visibility and connect with potential applicants. This was, however, new and a road never travelled for many programs. This report describes how our General Surgery Residency Program increased its presence through social media by using various exposure methods and approaches, including diversifying presence and developing candid personalized content. Results suggest that these methods have increased our exposure and reach from an average of 7 people per post to posts reaching over 4500 people. Moreover, the video posts introducing our residents and faculty provided the highest activity and reach. Thus, appropriate use of social media with described interventions and new content creation could exponentially increase the visibility of a residency program. Moreover, educating faculty and residents on the use and importance of social media could increase their interest and participation as well.

Perception versus Reality: A Review of Narcotic Prescribing Habits After Common Laparoscopic Surgeries.

INTRODUCTION: Data on how surgeons perceive their habits of prescribing narcotics compared to their actual practice are scarce. This study examines the perception and actual narcotic prescribing habits of surgeons and advanced practitioners. METHODS: Surgical residents, attendings, and advanced practice providers (APPs) were surveyed to assess their perceived prescribing habits at discharge for laparoscopic appendectomy and laparoscopic cholecystectomy. Data on narcotics prescription for patients receiving either of the procedures from January 2017 to August 2020 were extracted from electronic health records. Prescribed narcotics were converted to morphine equivalent doses (MEQs) for comparison. RESULTS: Of the 52 participants, the majority were residents (57.7%). Approximately 90% of residents, 72% of attendings, and 18% of APPs reported regularly prescribing narcotics at discharge. Approximately 67% (889/1332) of patients were discharged with narcotics. Of those, the majority of patients' narcotics were prescribed by surgery residents (71.2%). However, 72% of residents, 80% of attendings, and 72% of APPs were confident on prescribing the correct regimen of narcotics. There were no differences in average daily MEQs among the groups. However, the number of narcotics prescribed was higher among APPs compared to that in the other groups (P < 0.0001). CONCLUSIONS: Most participants self-reported routinely prescribing narcotics at discharge. Although not the current recommendation, participants felt confident they were prescribing the correct regimen, but were observed to prescribe more than the recommended number of total narcotics which indicates a discrepancy between perception and actual habits of prescribing narcotics. Our findings suggest a need for education in the general surgery residency and continuing medical education setting.

The Oregon District Shooting: Reviewing the Pre-Hospital Protocols and the Role of the Resident During a Multiple Casualty Event.

Background: Review of multiple casualty events (MCEs) protocols in an academic trauma center and more importantly role of residents in management of MCEs has not been discussed. Also, no real-world examples have been described. This study reviews utilization of multiple casualty protocols by the area hospitals and EMS along with role of residents in one such real-world MCEMethods: A mass shooting event in the Oregon District in Dayton, Ohio from 2019 was reviewed. MCE protocols from a Level I trauma center were reviewed as well as patient outcomes and role of residents.Results: A total of 10 casualties were observed and 38 patients presented to hospitals throughout the city. There were 25 patients presented to the Level I trauma center, 1 to the Level II trauma center, and 12 to the Level III trauma centers in the community. Surgical and Emergency residents performed initial triage upon arrival to the ED, managed resuscitation, and performed various procedures under supervision of attending staff. A total of 5 patients required emergent surgery and 4 patients required tourniquets. All patients that were presented to the hospitals survived.Conclusion: MCEs are going to continue, and healthcare systems should have protocols in place. Residents are a valuable resource to hospital systems that provide trauma services. Creation of a protocol with the assistance of EMS will allow first responders to utilize resources available. We recommend testing of this protocol, as an MCE in your area may not be a matter of if, but when.

Neonatal Intestinal Anastomosis Using a 5 mm Laparoscopic Stapler.

Recently, a 5 mm laparoscopic stapler entered the market and is currently used for a wide variety of pediatric applications. The aim of this article is to be the first report of the use of this 5 mm laparoscopic stapler for open neonatal intestinal anastomosis in humans. We used JustRight (Justright Surgical) 5 mm laparoscopic stapler® in 5 patients, with a total of six anastomoses being constructed. Enteroenterostomies after bowel resection were performed in these neonates with diagnoses of closed gastroschisis with ileal atresia, multiple intestinal atresia, ileal atresia, and jejunal atresia. Side-to-side, functional end-to-end, stapled anastomoses were performed in the standard antimesenteric manner. Using 2.5 cm long staple loads, the anastomoses approximated 1.5 cm. Minimal staple line overlap was incurred. Enteral feedings were initiated, and nutritional goals met, on postoperative days 8 and 15.2, respectively (means). Postoperative recovery was uneventful, notably without anastomotic complications of leak or stenosis. No long-term follow-up was done. The 5 mm laparoscopic stapler offers an attractive alternative in open neonatal intestinal anastomosis, particularly in both ease and time of anastomosis. Its more generalized use in neonatal intestinal reconstruction awaits further scientific investigation.