Building a gender-affirming surgery service: The fundamentals.

BACKGROUND: As the healthcare needs of transgender patients become increasingly recognized and supported, gender-affirming surgery services are in increasing demand. However, establishing a gender-affirming surgery service is unlike many other surgical specialties and requires unique expertise and administrative support. The aim of this article is to outline the considerations for starting a gender-affirming surgery service and identify pearls for success. METHODS: In this article, we describe the critical components of building and maintaining a successful gender-affirming surgery service. We intersperse findings from our own experiences developing a gender-affirming surgery service. RESULTS: A successful gender-affirming surgery service starts by developing a clear vision of the patient population within your hospital system's area, as well as the design of your center. Establishing a center relies on early engagement of hospital administration and its continued support. A multidisciplinary team with intensive interpersonal and operative training offers the best patient experience and surgical outcomes. By following these steps, our service has been able to provide gender-affirming surgery to more than 200 patients since its inception. Future goals entail partnerships with other institutions and continued outcomes evaluation to ensure sustained success of all gender-affirming surgery services. CONCLUSION: Although there are unique challenges and considerations for establishing a gender-affirming surgery service, careful planning and stakeholder engagement allow providers to deliver high-quality care. We hope that our experience can serve as a model for future much needed gender-affirming surgery services.

The evolution of surgical virtual education and telementoring: One surgeon's journey.

The first era of the global proliferation of surgical advancements involved surgical infection rate and technique breakthroughs by Lister, Halsted, and others. This was propagated by letters, academic papers, and international visits. While success was achieved, it was at a suboptimal pace. In the current era of minimally invasive surgical approaches, these methods are inadequate. This paper chronicles the development and application of virtual learning and telementoring as force multipliers to speed procedural adoption and proliferation.

Does the quality of the presentation influence the outcome of a submitted manuscript? A plea for including "How to submit" in medical education.

INTRODUCTION: Our goal was to study the influence of the author's compliance with the Instructions for Authors for a submitted manuscript to a journal, on the final outcome of the submission. MATERIAL AND METHODS: 1200 consecutive submissions to the journal Surgical and Radiologic Anatomy have been evaluated and divided into four groups: A: Accepted, R: Rejected, I + : Instructions for Authors followed, I - : Instructions for Authors not followed. The quantity of manuscripts in the groups was measured and compared through statistical tests. We tried to determine if a specific category of authors was more likely to incorrectly follow the Instructions for Authors by verifying the lists of authors and the tables of contributions of co-authors. 322 (26.83%) manuscripts were accepted, 248 were I + , 74 were I - ; 878 (73.16%) were rejected, 526 were I + ; 352 were I - . RESULTS: The comparisons of the observed values and percentages showed significant differences between the groups. We could not identify a specific type of author associated with non-compliance with the Instructions for Authors. CONCLUSION: Most of the guidelines that have been published concern the preparation of the scientific contents of the manuscript (How to write), but the submission process (How to submit) has rarely been explained. We suggest including the rules of submitting a manuscript in graduate and post-graduate medical education.

Best Approaches to Evaluation and Feedback in Post-Graduate Medical Education.

PURPOSE OF REVIEW: The objectives of this literature review are to appraise current approaches and assess new technologies that have been utilized for evaluation and feedback of residents, with focus on surgical trainees. RECENT FINDINGS: In 1999, the Accreditation Council for Graduate Medical Education introduced the Milestone system as a tool for summative evaluation. The organization allows individual program autonomy on how evaluation and feedback are performed. In the past, questionnaire evaluations and informal verbal feedback were employed. However, with the advent of technology, they have taken a different shape in the form of crowdsourcing, mobile platforms, and simulation. Limited data is available on new methods but studies show promise citing low cost and positive impact on resident education. No one "best approach" exists for evaluation and feedback. However, it is apparent that a multimodal approach that is based on the ACGME Milestones can be effective and aid in guiding programs.

Optimizing Resources in Children's Surgical Care: An Update on the American College of Surgeons' Verification Program.

Surgical procedures are performed in the United States in a wide variety of clinical settings and with variation in clinical outcomes. In May 2012, the Task Force for Children's Surgical Care, an ad hoc multidisciplinary group comprising physicians representing specialties relevant to pediatric perioperative care, was convened to generate recommendations to optimize the delivery of children's surgical care. This group generated a white paper detailing the consensus opinions of the involved experts. Following these initial recommendations, the American College of Surgeons (ACS), Children's Hospital Association, and Task Force for Children's Surgical Care, with input from all related perioperative specialties, developed and published specific and detailed resource and quality standards designed to improve children's surgical care (https://www.facs.org/quality-programs/childrens-surgery/childrens-surgery-verification). In 2015, with the endorsement of the American Academy of Pediatrics (https://pediatrics.aappublications.org/content/135/6/e1538), the ACS established a pilot verification program. In January 2017, after completion of the pilot program, the ACS Children's Surgery Verification Quality Improvement Program was officially launched. Verified sites are listed on the program Web site at https://www.facs.org/quality-programs/childrens-surgery/childrens-surgery-verification/centers, and more than 150 are interested in verification. This report provides an update on the ACS Children's Surgery Verification Quality Improvement Program as it continues to evolve.

Mexican surgery in 20th century.

It is a remembrance about the main surgeons who have made that surgery have reached levels of excellence in Mexico, which worked mainly during the 1st half of the 20th century, although some of them are out of this period, the surgical specialties in which they stood out, as well as in which institutions they worked, and some of the surgical techniques recommended by them. Some great doctors who were their students are mentioned.

Se hace un recuerdo de los principales cirujanos que han hecho que la cirugía en México haya alcanzado niveles de excelencia, que trabajaron principalmente en la primera mitad del siglo XX (aunque algunos de ellos se salgan de este periodo), las especialidades quirúrgicas en que destacaron, así como en qué instituciones trabajaron, y algunas de las técnicas quirúrgicas preconizadas por ellos. Se mencionan algunos grandes médicos que fueron sus alumnos.

Stanford's Biodesign Innovation program: Teaching opportunities for value-driven innovation in surgery.

The Stanford Biodesign Innovation process, which identifies meaningful clinical needs, develops solutions to meet those needs, and plans for subsequent implementation in clinical practice, is an effective training approach for new generations of healthcare innovators. Continued success of this process hinges on its evolution in response to changes in healthcare delivery and an ever-increasing demand for economically viable solutions. In this article, we provide perspective on opportunities for value-driven innovation in surgery and relate these to value-related teaching elements currently integrated in the Stanford Biodesign process.

What Procedures Are Rural General Surgeons Performing and Are They Prepared to Perform Specialty Procedures in Practice?

Rural surgeons are performing operations typically performed by "specialists." This study describes specialty procedures performed by general surgeons operating in a rural state and how prepared the surgeons felt starting their rural practice after residency A survey was sent to all exclusively rural surgeons actively practicing in the state, inquiring about their perception of preparedness for rural practice and specialty procedures performed. The survey had a 65.2 per cent response rate. Responders felt well prepared for rural practice after residency (mean response 4.6 ± 0.8 on a Likert scale from 1 to 5; 5 = "well prepared"). Noteworthy, specialty procedures performed by rural surgeons included hysterectomies (51.2%), thyroidectomies (81.4%), parathyroidectomies (60.5%), carotid endarterectomies (11.6%), video-assisted thoracoscopic surgery (37.2%), and lobectomies (23.3%). Prominent write-ins included nephrectomies (n = 1), ileal conduits (n = 1), open and endovascular abdominal aortic aneurysm repair (n = 1), Whipples (n = 3), and liver resections (n = 2). Rural general surgeons perform many major operations usually performed by specialists. These surgeons felt well prepared for these operations out of residency.

Telemedicine in pediatric surgery.

IMPORTANCE: Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. OBJECTIVE: To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery. DESIGN: Review and opinion design. SETTING: n/a. PARTICIPANTS: n/a. MAIN OUTCOMES AND MEASURES: n/a. RESULTS: n/a. CONCLUSIONS AND RELEVANCE: Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services. BRIEF ABSTRACT: Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program. TYPE OF STUDY: Review. LEVEL OF EVIDENCE: Level V.

Five-year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015.

BACKGROUND: Red blood cell (RBC) transfusion can be life-saving; however, the risks of RBC transfusion have been increasingly recognized, and current guidelines recommend restrictive transfusion in most patients. We hypothesized that RBC transfusions are decreasing in surgical patients. STUDY DESIGN AND METHODS: A retrospective review of the National Surgical Quality Improvement Program database was performed from 2011 to 2015. Index cases in five surgical specialties were studied: neurosurgery, thoracic surgery, gynecologic surgery, orthopedic surgery, and vascular surgery. Patient characteristics, preoperative laboratory values, and surgery details were compared between years. The study's primary outcome was perioperative RBC transfusion, which was compared over the 5-year period for each specialty. Secondary outcomes were myocardial infarction and renal failure after surgery. In addition, trends in RBC transfusion between low-risk and high-risk patients and between emergency and elective surgery were examined. RESULTS: RBC transfusion decreased in all surgical specialties except for thoracic and gynecologic surgery. RBC transfusion decreased substantially in orthopedic surgery, falling from 22.4% in 2011 to 6.3% in 2015 (p ≤ 0.0001). High-risk patients had greater reductions in the receipt of RBC transfusion than low-risk patients, and there were no increases in myocardial infarction or renal failure after surgery in any specialty. CONCLUSION: RBC transfusion appears to be decreasing across multiple surgical specialties, with no apparent increase in myocardial infarctions or renal failure. This likely represents an important improvement in patient care. Continued efforts are needed to develop patient blood management programs and further reduce RBC transfusion.

Telemedicine in the perioperative experience.

Telemedicine, the remote diagnosis and treatment of patients by means of technology, provides an alternative means for patients to gain access to health care services. Telemedicine is a general term that includes the use of various communication technologies, including telephone, email, or videoconferencing. Telemedicine has the potential to reduce inefficiencies in the delivery of healthcare, diminish patient travel and wait times, and increase access to specialists for patients in rural settings. We review the use of telemedicine in the perioperative phase of care for pediatric surgical patients, their caregivers, and surgical providers, including pre-operative assessments, and post-operative follow-up. We also discuss physician billing compliance with remote telemedicine consultation and explore the barriers to adoption among the caregivers of pediatric surgery patients.