The Association Between Altmetric Attention Scores and Public Engagement in the Medical Literature.

INTRODUCTION: With the advent of social media and the associated increase in connectivity between scientists and the lay public, the Altmetric Attention Score has been created as a way to measure these interactions between scholarly publications and media dissemination. Little is known, however, whether these types of media exchanges measured by Altmetrics may serve as a proxy for public engagement. As such, we have sought to determine whether or not an association exists between Altmetric scores and public engagement, as measured by article citation in a health policy document. METHODS: The top 100 highest scoring articles in the medical and health sciences with respect to Altmetric Attention Scores were selected from each of 3 y (2014, 2015, and 2016). Each article was then matched to an article from the same year and journal with the highest Relative Citation Ratio (RCR) for comparison. Bivariate analysis compared article groups with respect to citation in a public policy document, open-access status, and funding status, as well as Altmetric and RCR scores. A multivariable model was then constructed to identify significant factors associated with citation in a public policy document. Finally, a contour plot was generated in order to estimate the interaction between Altmetric Scores and RCR and their comparative effects on the probability of inclusion in a health policy document. RESULTS: Of the 600 articles included in the analysis, 286 (48%) had been cited by a public policy article. The only difference that existed between the cohorts was for funding status, with 55 articles (40%) in the RCR cohort having received funding compared to 81 (60%) in the Altmetric cohort (P = 0.011). On bivariate analysis, both Altmetric (P = 0.0018) and RCR (P < 0.0001) scores were independently predictive of policy citation. In a multivariable model, the interaction between Altmetric Scores and RCR with respect to policy inclusion was significant (OR = 1.22; 95% CI = 1.08-1.38) and a contour plot demonstrates that either high Altmetric score or RCR alone is sufficient to generate a high probability of policy inclusion. CONCLUSIONS: Scholarly article Altmetric Scores may serve as a novel means to explore public engagement in scientific research and health policy. In addition, journals that aim to impact public policy through article dissemination may benefit from engagement in social media avenues in addition to traditional citation pathways in order to encourage broader inclusion.

Prevalence and Outcomes of Endovascular Infrapopliteal Interventions for Intermittent Claudication.

BACKGROUND: Although endovascular peripheral vascular interventions (PVI) are typically limited to vessels above the knee in intermittent claudication (IC), some patients have concomitant or isolated infrapopliteal disease with IC. The benefits and risks of undergoing tibial intervention remain unclear in IC patients. The purpose of this study is to evaluate the prevalence and outcomes of infrapopliteal PVI for IC. METHODS: The Vascular Quality Initiative was queried for PVI procedures performed for IC between 2003 and 2018. Patients were divided into 3 groups: isolated femoropopliteal (FP), isolated infrapopliteal (IP), and combined above and below knee interventions (COM). Multivariable logistic regression models identified predictors of minor and major amputation, as well as freedom from reintervention. Kaplan-Meier plots estimate amputation-free survival. RESULTS: We identified 34,944 PVI procedures for IC. There were 31,110 (89.0%) FP interventions, 1,045 (3.0%) IP interventions, and 2,789 (8.0%) COM interventions. Kaplan-Meier plots of amputation-free survival revealed that patients with any IP intervention had significantly higher rates of both minor and major amputation (log rank <0.001). Freedom from reintervention at 1-year was 89.2% for the FP group, 91.3% for the IP group, and 85.3% for the COM group (P < 0.0001). In multivariable analysis, factors associated with an increased risk of major amputation included isolated IP intervention (OR 6.47, 95% CI, 6.45-6.49; P < 0.0001), COM interventions (OR 2.32, 95% CI, 2.31-2.33; P < 0.0001), dialysis dependence (OR 3.34, 95% CI, 3.33-3.35; P < 0.0001), CHF (OR 1.86, 95% CI, 1.85-1.86; P = 0.021) and, nonwhite race (OR 1.64, 95% CI, 1.63-1.64; P = 0.013). CONCLUSIONS: PVI in the infrapopliteal vessels for IC is associated with higher amputation rates. This observation may suggest the need for more careful patient selection when performing PVI in patients with IC where disease extends into the infrapopliteal level.

Do Internal or External Characteristics More Reliably Predict Burnout in Resident Physicians: A Multi-institutional Study.

INTRODUCTION: Surgical residents have been shown to experience high rates of burnout. Whether this is influenced predominately by intrinsic characteristics, external factors, or is multifactorial has not been well studied. The aim of this study was to explore the relationship between these elements and burnout. We hypothesized that residents with higher emotional intelligence scores, greater resilience and mindfulness, and better work environments would experience lower rates of burnout. METHODS: General surgery residents at 7 sites in the US were invited to complete an electronic survey in 2019 that included the 2-item Maslach Burnout Inventory, Brief Emotional Intelligence Scale, Revised Cognitive and Affective Mindfulness Scale, 2-Item Connor-Davidson Resilience Scale, Utrecht Work Engagement Scale, and Job Resources scale of the Job Demands-Resources Questionnaire. Individual constructs were assessed for association with burnout, using multivariable logistic regression models. Residents' scores were evaluated in aggregate, in groups according to demographic characteristics, and by site. RESULTS: Of 284 residents, 164 completed the survey (response rate 58%). A total of 71% of respondents were at high risk for burnout, with sites ranging from 57% to 85% (p = 0.49). Burnout rates demonstrated no significant difference across gender, PGY level, and respondent age. On bivariate model, no demographic variables were found to be associated with burnout, but the internal characteristics of emotional intelligence, resilience and mindfulness, and the external characteristics of work engagement and job resources were each found to be protective against burnout (p < 0.001 for all). However, multivariable models examining internal and external characteristics found that no internal characteristics were associated with burnout, while job resources (coeff. -1.0, p-value <0.001) and work engagement (coeff. -0.76, p-value 0.032) were significantly protective factors. Rates of engagement overall were high, particularly with respect to work "dedication." CONCLUSIONS: A majority of residents at multiple institutions were at high risk for burnout during the study period. Improved work engagement and job resources were found to be more strongly associated with decreased burnout rates when compared to internal characteristics. Although surgical residents appear to already be highly engaged in their work, programs should continue to explore ways to increase job resources, and further research should be aimed at elucidating the mediating effect of internal characteristics on these external factors.

Repeat Attending Exposure Influences Operative Autonomy in Endocrine Surgical Procedures.

PURPOSE: There is concern that graduating surgery residents are not prepared for independent practice. This study aimed to identify predictors of performance, autonomy, and readiness for independence ratings of trainees by attendings for thyroidectomy and parathyroidectomy with respect to repeated resident-attending exposure. We hypothesized that increased exposure with a particular attending increases resident autonomy. METHODS: All residents and faculty at a single institution performing parathyroidectomy or thyroidectomy were invited to complete an operative performance evaluation at case competition using the Zwisch scale to measure performance and autonomy for individual operative steps. In addition, each survey evaluated the trainee's readiness for practice in a straightforward procedure as a binary variable. Categorical variables were evaluated via Chi-squared or Fisher's exact tests and ordinal variables were evaluated with Wilcoxon or Kruskal-Wallis tests. Multivariable analysis was conducted with random effects logistic regression, and learning curves were generated for each procedure. RESULTS: Operative performance evaluations were obtained from 36 individual learners and 6 faculty members, with a total of 145 evaluations for parathyroidectomy and 116 for thyroidectomy. On bivariate analysis, readiness for practice ratings was significantly associated with increasing chronologic procedure number, but not resident gender or case difficulty. The multivariable model demonstrated that increasing chronologic procedure number, while a significant predictor without accounting for exposure, did not remain a significant predictor of practice-readiness for parathyroidectomy when accounting for resident-attending exposure. Bivariate analysis comparing resident and attending ratings showed no difference between the 2, but there were significant differences in autonomy and performance scores for both groups of raters. Trainees rated by attendings as independence ready completed a median of 7 parathyroidectomies and 5 thyroidectomies. Descriptive learning curves generated serve as a model of the multistate nature that residents undergo when moving from novice to proficiency. CONCLUSIONS: Not surprisingly, the more operations residents perform with a single attending, the higher their ratings for performance and autonomy from that individual, with increased exposure allowing improved performance with less attending autonomy. By contrast, our data also show that repeated exposure between resident and attending may confound the use of procedural numbers alone when predicting resident ability in the operating room.

Factors Associated With the Highest and Lowest Cited Research Articles in General Surgery Journals.

BACKGROUND: Citation count is a common bibliometric tool used to determine the long-term impact and performance of journal articles. Many of the other potential factors associated with highly and lowly cited articles in the general surgery literature, however, remain unknown. The purpose of this study was to attempt to identify characteristics of articles that may predict or correlate with article citation counts and, consequently, article impact. METHODS: We identified articles from Annals of Surgery, British Journal of Surgery, and Journal of the American College of Surgeons between 1998 and 2008 that had 0-5 total citations. We then matched these articles to an identical number of the highest cited articles from these same journals for comparison. Student's t-tests, Wilcoxon rank-sum tests, chi-squared tests, and Fisher's exact tests were used to determine the significance of difference between data sets at a predetermined level of significance set to P < 0.05. RESULTS: Significant differences of article characteristics between the two cohorts included higher prevalence of clinical studies (P = 0.3919), multi-institutional (P = 0.0007) and multi-national (P = 0.0023) studies, surgical oncology (P < 0.0001) or hepatobiliary focus (P < 0.0001) and published in Annals of Surgery (P < 0.0001) for the highly cited cohort. Highly cited articles were also more likely to have larger sample sizes (P = 0.0009), more authors (P < 0.0001), presence of statistically significant results (P < 0.0001), more references (P < 0.0001), more tables (P < 0.0001), more figures (P = 0.0001), and higher word counts for manuscript (P < 0.0001), abstract (P < 0.0001), and title (P < 0.0001). CONCLUSIONS: There are a relatively small number of articles with 0-5 citations after 10 y for these major general surgery journals. This indicates that journals are consistently able to select articles that will be impactful in aiding future research. Certain factors, however, are associated with being highly cited as opposed to lowly cited, and an understanding of these factors can aid researchers and journals in designing and reporting future studies.

Examining the Correlation Between Altmetric Score and Citations in the General Surgery Literature.

BACKGROUND: With the emergence of social media platforms, new bibliometric profiles measuring impact and exposure of scientific research online have been introduced as an alternative to traditional bibliometric outcomes. The objective of this article is to evaluate relationships between Altmetric scores, journal impact factor, and citation counts among the surgical literature. METHODS: We analyzed the top 10 highest cited articles for the 10 general surgery journals with the highest impact factors for 2013 and 2016 by noting citation counts and Altmetric scores for each article. We also identified the journal impact factor and age of journal associated Twitter accounts. Variables were assessed for correlation using Pearson's correlation testing via Microsoft Excel. RESULTS: A total of 240 articles were analyzed. For 2013, Altmetrics score analysis demonstrated a significant, positive correlation with citation number (r = 0.462, P < 0.0001) and journal impact factor (r = 0.439, P < 0.0001). The 2016 cohort also demonstrated significant, positive correlations between Altmetric scores and citation count after the removal of one outlier (r = 0.182, P = 0.047) and journal impact factor when considering all articles (r = 0.425, P < 0.0001). From 2013 to 2016, the total number of citations for all articles decreased from 11,027 to 7661, but cumulative Altmetric scores increased from 1078 to 4782. Age of creation for a journal's Twitter account did not significantly affect Altmetric score or traditional bibliometric measures in either 2013 (r = 0.370, P = 0.293) or 2016 (r = 0.441, P = 0.202). CONCLUSIONS: Altmetric scores, while significantly associated with citation count in the surgical literature, should not necessarily be used as a surrogate marker for evaluating research performance, impact, or exposure. It is possible, however, that as the use of social media for distributing and sharing scientific research continues to expand, that exposure on such platforms could impact future interest or studies.

An assessment of the online presentation of MIS fellowship information for residents.

INTRODUCTION: Residents often utilize internet resources to evaluate and search for fellowship programs within their desired field. The presence of these resources and the information available through them has the potential to influence applicant decisions. The objective of this study was to analyze the online MIS fellowship information relevant to resident applicants provided by the Fellowship Council Directory (FCD) and institutionally based program webpages. MATERIALS AND METHODS: The programs evaluated were chosen based on their inclusion in the FCD, the accrediting body for MIS fellowships. The FCD provides each program a template through which program directors detail information for applicants. This information is publicly accessible through the directory, with each program having a specific page. These webpages were assessed for the presence or absence of 21 previously established individual content criteria. In addition, the presence or absence of a functional link to an institutionally based, program-specific webpage was determined. These program-specific, institutional webpages were then independently accessed via Google® search and separately assessed for the presence or absence of the same 21 previously established content criteria. RESULTS: In total, the FCD listed 144 programs. Each program had a dedicated page within the directory itself with 104 (72%) having functional links listed. Ninety-six (66.6%) of the FCD links were identified as being specific webpages to the fellowship program, verified through a Google® search. Less than half of the programs fulfilled over 50% of identified criteria through the FCD templated directory, with one-third of programs listed failing to provide any program-specific information via a webpage outside the FCD. CONCLUSION: Information available online for MIS fellowship programs is lacking, with many institutionally supported webpages absent altogether outside of the FCD. Templated formats seem to assist in this deficiency, but should be used cautiously as they also can potentially omit relevant information.