Autonomy Maps: Building a Shared Mental Model for Progressive Resident Operative Autonomy on the Road to Entrustable Professional Activities (EPAs).

Our residents expressed dissatisfaction with operative autonomy and faculty feedback regarding technical skills. They reported variability among faculty regarding allowed operative autonomy. Our goals were to establish a shared mental model among residents and faculty regarding intraoperative performance expectations. We asked faculty to assign a level of expected autonomy (Zwisch scale) for various steps of common procedures according to the resident post-graduate year. Through an iterative process, the maps were standardized across service lines. The resulting "Autonomy Maps" were distributed to the faculty and residents. We held educational sessions and set expectations for use. Selected benchmarks were incorporated into resident end-of-rotation assessment forms. Initial operative case mapping identified variability in faculty expectations for a given post-graduate year and procedure. Residents reported improved satisfaction with understanding expectations regarding operative performance. Establishing autonomy benchmarks facilitated more specific feedback regarding residents' technical skills. Faculty expectations for resident operative autonomy are variable. Autonomy Maps provide structure for a shared mental model between faculty and residents for progressive operative autonomy and serve as a framework for expectations that improve resident satisfaction. Case-specific technical benchmarks are useful tools for assessing residents' technical milestones.

Addressing Surgeon Burnout Through a Multi-level Approach: A National Call to Action.

Purpose of Review: Physician burnout is an epidemic and there are unique aspects of surgery that dictate rates of burnout among general surgeons and surgical trainees. This review characterizes the scope of burnout and its drivers within the field of surgery and advocates for strategies to address burnout at the individual, institutional, and national levels. Recent Findings: Rates of burnout in surgery are increasing with higher numbers of young and female surgeons affected. Contributing factors are generally related to work-life balance, longer hours, and mistreatment in the workplace. Attempts have been made at implementing structured initiatives in an effort to combat work dissatisfaction and emotional exhaustion. Still, rates of burnout continue to increase. Summary: General surgeons and trainees are at high risk for burnout with resulting attrition, depression, and suicidal ideation. The solution to burnout must be addressed at individual, institutional, and national levels. Further research into the factors leading to surgeon burnout and enactment of effective strategies to mitigate burnout must be pursued.

Cutis Laxa Acquisita After Urticarial Vasculitis in SLE Patients.

Cutis laxa is a rare connective tissue disease involving damage to dermal elastic fibers creating a clinical appearance of loose, sagging skin. The condition can be either acquired or genetic. Autoimmune diseases, neoplasms, infections, and medications have been proposed as the cause of, or in association with, the acquired form. In nearly 50% of cases, erythematous plaques present before the onset of cutis laxa. Separately, urticarial vasculitis and systemic lupus erythematosus have been linked to cutis laxa acquisita. Our case is the first in the literature documenting a coexistence of cutis laxa acquisita, hypocomplementemic urticarial vasculitis, and systemic lupus erythematosus.

Gender-specific analysis of outcomes from endoscopic sinus surgery for chronic rhinosinusitis.

BACKGROUND: Women electing endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) report higher symptom burden but have lower computed tomography (CT) scores. Gender-specific analysis of outcomes from ESS therefore merits further study. The objective of this work was to study gender-specific differences in outcomes from ESS for CRS by analyzing preoperative and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores. METHODS: Data from adult CRS patients electing ESS (2011-2013) were retrospectively collected. SNOT-22 total, rhinologic/nonrhinologic subdomain, and individual item scores were analyzed for gender-specific differences. RESULTS: Two hundred and forty-eight patients met study criteria (mean age 55.4 years; 49.6% female). Preoperatively, mean Lund-Mackay CT score was 11.1; average total SNOT-22 score was 41.9. Compared to men, women had lower CT score (10.2 vs 12.0; p = 0.004) but higher total SNOT-22 score (44.7 vs 39.1; p = 0.02). Both genders showed significant improvement in total SNOT-22 scores at 3, 6, 12, and 24 months following ESS (p < 0.001), with largely similar slopes of improvement. The greatest improvement occurred at 3 months (SNOT-22 decreased by 25.4 points), with stable improvement after 12 months (SNOT-22 decreased by 21.3 points). Higher total SNOT-22 scores in females were noted preoperatively and until 6 months post-ESS; these were driven by rhinologic and nonrhinologic-otolaryngic subdomain items. No gender differences in anxiety/depression prevalence or psychological subdomain scores were noted preoperatively or postoperatively. CONCLUSION: Both male and female CRS patients showed significant and durable symptom relief following ESS. Women reported higher symptom burden prior to surgery, and in the early postoperative period. However, after 1-year post-ESS, both genders showed similar symptom scores. The trend and magnitude of improvement were similar in both genders.