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1.
Obstet Gynecol ; 135(2): 268-273, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923067

RESUMO

OBJECTIVE: To characterize trends in self-reported numbers and routes of hysterectomy for obstetrics and gynecology residents using the Accreditation Council for Graduate Medical Education (ACGME) case log database. METHODS: Hysterectomy case log data for obstetrics and gynecology residents completing training between 2002-2003 and 2017-2018 were abstracted from the ACGME database. Total numbers of hysterectomies and modes of approach (abdominal, laparoscopic, and vaginal) were compared using bivariate statistics, and trends over time were analyzed using simple linear regression. RESULTS: Hysterectomy data were collected from 18,982 obstetrics and gynecology residents in a median of 243 (interquartile range 241-246) ACGME-accredited programs. The number of graduating residents increased significantly over time (12.1/year, P<.001), whereas the number of residency programs decreased significantly (0.52 fewer programs per year, P<.001) over the 16-year period. For cases logged as "surgeon," the median number of abdominal hysterectomies decreased by 56.5% from 85 (interquartile range 69-102) to 37 (interquartile range 34-43) (P<.001). The median number of vaginal hysterectomies decreased by 35.5% from 31 (interquartile range 24-39) to 20 (interquartile range 17-25) (P=.002). The median total number of hysterectomies per resident decreased by 6.3% from 112 (interquartile range 97-132) to 105 (interquartile range 92-121) (P=.036). In contrast, the median number of laparoscopic hysterectomies increased by 115% from 20 (interquartile range 13-28) in 2008-2009 to 43 (interquartile range 32-56) in 2017-2018, despite the decrease in overall number of hysterectomies (P<.001). These trends were statistically significant. CONCLUSIONS: The total number of hysterectomies performed by obstetrics and gynecology residents in the United States is decreasing, and the routes are changing with decreases in abdominal and vaginal approaches, and an increase in use of laparoscopic hysterectomy.

2.
N Engl J Med ; 381(18): 1741-1752, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31657887

RESUMO

BACKGROUND: Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS: A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS: Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS: Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.


Assuntos
Esgotamento Profissional/epidemiologia , Cirurgia Geral/educação , Internato e Residência , Abuso Físico/estatística & dados numéricos , Assédio Sexual/estatística & dados numéricos , Discriminação Social/estatística & dados numéricos , Esgotamento Profissional/psicologia , Feminino , Humanos , Masculino , Estado Civil , Corpo Clínico Hospitalar , Recursos Humanos em Hospital , Abuso Físico/psicologia , Relações Médico-Paciente , Relações Profissional-Família , Fatores Sexuais , Assédio Sexual/psicologia , Discriminação Social/psicologia , Ideação Suicida , Inquéritos e Questionários , Estados Unidos/epidemiologia
3.
Ann Surg ; 270(4): 585-592, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31425291

RESUMO

OBJECTIVES: To empirically describe surgical residency program culture and assess program characteristics associated with program culture. SUMMARY BACKGROUND DATA: Despite concerns about the impact of the learning environment on trainees, empirical data have not been available to examine and compare program-level differences in residency culture. METHODS: Following the 2018 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. Survey items were analyzed using principal component analysis to derive composite measures of program culture. Associations between program characteristics and composite measures of culture were assessed. RESULTS: Analysis included 7387 residents at 260 training programs (99.3% response rate). Principal component analysis suggested that program culture may be described by 2 components: Wellness and Negative Exposures. Twenty-six programs (10.0%) were in the worst quartile for both Wellness and Negative Exposure components. These programs had significantly higher rates of duty hour violations (23.3% vs 11.1%), verbal/physical abuse (41.6% vs 28.6%), gender discrimination (78.7% vs 64.5%), sexual harassment (30.8% vs 16.7%), burnout (54.9% vs 35.0%), and thoughts of attrition (21.6% vs 10.8%; all P < 0.001). Being in the worst quartile of both components was associated with percentage of female residents in the program (P = 0.011), but not program location, academic affiliation, size, or faculty demographics. CONCLUSIONS: Residency culture was characterized by poor resident wellness and frequent negative exposures and was generally not associated with structural program characteristics. Additional qualitative and quantitative studies are needed to explore unmeasured local social dynamics that may underlie measured differences in program culture.

5.
J Surg Educ ; 76(6): e92-e101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31130507

RESUMO

OBJECTIVE: The operative experience of today's general surgery resident has changed, but little is known about the modern experience as nonprimary surgeon. We set out to explore changes in the operative experience of general surgery residents as first assistant (FA) and teaching assistant (TA). DESIGN, SETTING, AND PARTICIPANTS: This is a review of ACGME national operative log reports from 1990 to 2018. TA and FA cases were analyzed. Statistical analysis was performed using polynomial regression analysis and Kruskal-Wallis test. Statistical significance was set at p < 0.05. RESULTS: 30,260 individuals completed general surgery residency during the study period with medians of 951 (interquartile range: 929-974) total major, 63 (31-184) FA, and 32 (25-48) TA cases. As a proportion of total cases completed, FA cases decreased from 21.8% of the total operative experience in 1990 to 2.5% in 2018, and TA cases declined from 7.4% of the total operative experience in 1990 to 3.5% in 2018. Regression modeling demonstrated that both operative roles decreased over time, but at a progressively decreasing rate, with FA cases reaching a "floor" around 2010 and TA cases reaching a "breakpoint" in 2008 at which time operative volume rebounded and began to increase. Among the core general surgery domains of abdomen and alimentary tract, compositional analysis revealed a decrease across each of the 11 operative subcategories (all p < 0.05) for FA, and for TA, a decrease in 6 of the 11 operative subcategories (stomach, small intestine, large intestine, anorectal, hernia, and biliary, all p < 0.05). CONCLUSIONS: Over the past 3 decades, the resident operative experience as nonprimary surgeon has decreased dramatically, with today's residents graduating with fewer FA and TA cases. As surgical training has traditionally relied heavily on an apprenticeship model for learning technical skills, it is essential that surgical educators recognize and rectify these trends.

6.
J Am Coll Surg ; 229(4): 431-435, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31103598
7.
J Am Coll Surg ; 229(1): 126-133, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30905854

RESUMO

BACKGROUND: The effect of subspecialty programs on associated general surgery programs is largely undocumented. This study examined the effect of new pediatric surgery fellowship (PSF) programs on the pediatric surgical experience of residents in the associated general surgery programs. STUDY DESIGN: Pediatric surgery fellowship programs established after 2002-2003 (earliest available ACGME caselogs) were identified. The number of pediatric surgery cases reported by each completing resident as surgeon in the associated general surgery programs from academic year (AY)2002-2003 to AY2016-2017 were recorded and examined before and after entry of the first fellow into associated pediatric surgery programs. RESULTS: Fifteen general surgery residency programs associated with new PSF programs were reviewed. First fellows entered the new PSF programs from 2002-2003 to 2013-2014. General surgery caselog availability before and after fellow matriculation varied accordingly. Data were available from 12 programs through the 5 years before matriculation of the first fellow into the associated PSF program. Over that time, the number of pediatric surgery cases performed by residents in those general surgery programs increased from 54.56 ± 2.98 to 68.71 ± 4.12 (p = 0.003). In 12 general surgery programs with resident caselogs available for the first 5 years after matriculation of the first fellow into the associated PSF programs, the mean number of resident pediatric surgery cases declined from 56.75(± 3.42) to 47.15(± 2.73) (p = 0.015). CONCLUSIONS: Establishment of a new PSF program results in a significant decline in the pediatric surgery experience as surgeon for residents in the associated general surgery program. This outcome should be carefully weighed in the decision to establish a new PSF program.

8.
J Am Coll Surg ; 228(4): 525-532, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30639300

RESUMO

BACKGROUND: General surgery (GS) resident vascular surgery (VS) operations have declined significantly in the last 15 years. We hypothesized that initiation of VS fellowship programs (VSFPs) contributes to that decline. This study examined the effect of establishing new VSFPs on VS case volumes of residents in associated GS programs. STUDY DESIGN: General surgery programs were reviewed if associated with VSFPs accredited since July 1, 2002 that had 1 or more matriculants (GS case logs only available since 2002 to 2003). Total VS cases by residents in those programs was analyzed before and after matriculation of first fellow into the associated VSFP. RESULTS: Twenty-two programs were available for analysis. General surgery case-log data were available variably from 0 to 14 years before and 0 to 14 years after first fellows in the associated VSFPs. In 12 programs with 4 years of data before and after matriculation of associated VSFPs' first fellows, VS cases increased from 109.6 ± 32.4 cases to 143.65 ± 78.15 cases in 4 years before matriculation (p = 0.008) of VS fellows and then declined from 143.65 to 114.04 ± 46.97 in 4 years after (p = 0.0134). In all 16 programs with 4 years of data after matriculation of the associated VSFP's first fellow, VS cases declined from 123.37 ± 71.42 to 103.23 ± 44.35 (p = 0.0232). CONCLUSIONS: New VSFPs diminished peak VS operative volume of residents in associated GS programs, thereby contributing to declining national average number of VS cases done by GS residents. Nevertheless, resident VS case volumes remained robust in most GS programs associated with new VSFPs. Additional study is required to determine both resident perception and overall impact of VSFPs on associated GS training.

9.
Ann Surg ; 268(4): 665-673, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30048318

RESUMO

OBJECTIVE: The objective of this study was to document trends in the performance of open arterial vascular surgery procedures (OAVP) by general surgery residents (GSR). BACKGROUND: The ACGME Review Committee for Surgery considers vascular surgery (VS) to be an "essential content area." However, the operative experience in VS for GSRs is threatened by 1) increasing numbers of GSRs, 2) increasing numbers of VS trainees, and 3) the proliferation of endovascular surgery. METHODS: The last 16 years of ACGME national reports of case logs for completing GSRs were reviewed. Total vascular operations and OAVPs performed as "surgeon" were recorded and analyzed. The number of individuals completing ACGME programs in general and vascular surgery annually over that period were also recorded and analyzed. To better understand long-term and more recent trends, trends were analyzed for the 15-year period spanned by the 16 years of data as well as the most recent 10- and 5-year periods. RESULTS: The number of individuals completing both general and vascular surgery programs increased significantly. Over 15 years, the total vascular operations performed by GSRs significantly declined as did the total OAVPs and the OAVPs in 7 of 9 categories. In just the last 5 years, significant declines occurred in 5 OAVP categories. CONCLUSIONS: Operative experience in OAVPs for GSRs has significantly declined. Because fundamental VS skills are necessary for operative general surgery, VS should remain an essential content area. However, programs cannot solely depend on operative experience to teach fundamental VS skills.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Especialidades Cirúrgicas/educação , Procedimentos Cirúrgicos Vasculares/educação , Escolha da Profissão , Competência Clínica , Humanos , Internato e Residência , Estados Unidos , Carga de Trabalho
11.
J Am Coll Surg ; 226(4): 425-431, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29309940

RESUMO

BACKGROUND: The Flexibility in Surgical Training (FIST) consortium project was designed to evaluate the feasibility and resident outcomes of optional subspecialty-focused training within general surgery residency training. STUDY DESIGN: After approval by the American Board of Surgery, R4 and R5 residents were permitted to customize up to 12 of the final 24 months of residency for early tracking into 1 of 9 subspecialty tracks. A prospective IRB-approved study was designed across 7 institutions to evaluate the impact of this option on operative experience, in-service exam (American Board of Surgery In-Training Examination [ABSITE]) and ACGME milestone performance, and resident and program director (PD) perceptions. The FIST residents were compared with chief residents before FIST initiation (controls) as well as residents during the study period who did not participate in FIST (no specialization track, NonS). RESULTS: From 2013 to 2017, 122 of 214 chief residents (57%) completed a FIST subspecialty track. There were no differences in median ABSITE scores between FIST, NonS residents, and controls. The ACGME milestones at the end of the R5 year favored the FIST residents in 13 of 16 milestones compared with NonS. Case logs demonstrated an increase in track-specific cases compared with NonS residents. Resident and PD surveys reported a generally favorable experience with FIST. CONCLUSIONS: In this prospective study, FIST is a feasible option in participating institutions. All FIST residents, regardless of track, met requirements for ABS Board eligibility, despite modifications to rotations and case experience. Future studies will assess the impact of FIST on ABS exam results and fellowship success.


Assuntos
Cirurgia Geral/educação , Internato e Residência/organização & administração , Atitude do Pessoal de Saúde , Competência Clínica , Currículo , Estudos de Viabilidade , Humanos , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos , Carga de Trabalho
13.
Am J Surg ; 214(5): 974-978, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28034439

RESUMO

General surgical residency education is faced with a number of challenges today. Among those are resident duty hour limitations, the fact that residency is hospital-based despite the practice of general surgery being largely outpatient, changing diseases and conditions treated by the general surgeon and changing methods of treatment, development and maintenance of a user friendly curriculum and the support and provision for faculty development. The greatest single barrier, though, to education of the surgical resident is the lack of appropriate supervision. In this article, the author describes some of the factors that have conspired to remove appropriate supervision from general surgery residency programs as well as describing a number of steps which, if accomplished, would allow the return appropriate supervision to those programs.


Assuntos
Cirurgia Geral/educação , Internato e Residência/organização & administração , Docentes de Medicina , Organização e Administração
14.
J Am Coll Surg ; 222(4): 410-6, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27016968

RESUMO

BACKGROUND: The Early Specialization Program (ESP) in surgery was designed by the American Board of Surgery, the American Board of Thoracic Surgery, and the Residency Review Committees for Surgery and Thoracic Surgery to allow surgical trainees dual certification in general surgery (GS) and either vascular surgery (VS) or cardiothoracic surgery (CTS) after 6 to 7 years of training. After more than 10 years' experience, this analysis was undertaken to evaluate efficacy. STUDY DESIGN: American Board of Surgery and American Board of Thoracic Surgery records of VS and CTS ESP trainees were queried to evaluate qualifying exam and certifying exam performance. Case logs were examined and compared with contemporaneous non-ESP trainees. Opinions of programs directors of GS, VS, and CTS and ESP participants were solicited via survey. RESULTS: Twenty-six CTS ESP residents have completed training at 10 programs and 16 VS ESP at 6 programs. First-time pass rates on American Board of Surgery qualifying and certifying exams were superior to time-matched peers; greater success in specialty specific examinations was also found. Trainees met required case minimums for GS despite shortened time in GS. By survey, 85% of programs directors endorsed satisfaction with ESP, and 90% endorsed graduate readiness for independent practice. Early Specialization Program participants report increased mentorship and independence, greater competence for practice, and overall satisfaction with ESP. CONCLUSIONS: Individuals in ESP programs in VS and CTS were successful in passing GS and specialty exams and achieving required operative cases, despite an accelerated training track. Programs directors and participants report satisfaction with the training and confidence that ESP graduates are prepared for independent practice. This documented success supports ESP training in any surgical subspecialty, including comprehensive GS.


Assuntos
Internato e Residência/organização & administração , Especialização , Especialidades Cirúrgicas/educação , Atitude do Pessoal de Saúde , Certificação , Competência Clínica , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estados Unidos
15.
Surg Clin North Am ; 96(1): 15-24, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26612016

RESUMO

Competency is an individual trait. As an agency that accredits programs and institutions, the Accreditation Council for Graduate Medical Education (ACGME) does not define or access competency. However, in the past 15 years the ACGME has promulgated several initiatives to aid programs in the assessment of the competence of their residents and fellows. Those initiatives include the Outcomes Project (which codified the competencies), the Milestones, and the Clinical Learning Environment Review Program. In the near future, the ACGME will implement an initiative by which programs can develop and study the results of competency-based residency curricula.


Assuntos
Competência Clínica/normas , Educação Baseada em Competências/normas , Educação de Pós-Graduação em Medicina/normas , Cirurgia Geral/educação , Internato e Residência/normas , Acreditação , Cirurgia Geral/normas , Humanos , Estados Unidos
18.
JAMA Surg ; 148(5): 413-7, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23677403

RESUMO

IMPORTANCE: With duty hour debates, specialization, and sex distribution changes in the applicant pool, the relative competitiveness for general surgery residency (GSR) is undefined. OBJECTIVE: To determine the modern attributes of top-ranked applicants to GSR. DESIGN Validation cohort, survey. SETTING: National sample of university and community-based GSR programs. PARTICIPANTS: Data were abstracted from Electronic Residency Application Service files of the top 20-ranked applicants to 22 GSR programs. We ranked program competitiveness and blinded review of personal statements. MAIN OUTCOMES AND MEASURES: Characteristics associated with applicant ranking by the GSR program (top 5 vs 6-20) and ranking by highly competitive programs were identified using t and χ2 tests and modified Poisson regression. RESULTS: There were 333 unique applicants among the 440 Electronic Residency Application Service files. Most applicants had research experience (93.0%) and publications (76.8%), and 28.4% had Alpha Omega Alpha membership. Nearly half were women (45.2%), with wide variation by program (20.0%-75.0%) and a trend toward fewer women at programs in the South and West (38.0% and 37.5%, respectively). Men had higher United States Medical Licensing Examination Step 1 scores (238.0 vs 230.1; P < .001) but similar Step 2 scores (245.3 vs 244.5; P = .54). Using bivariate analysis, highly competitive programs were more likely to rank applicants with publications, research experience, Alpha Omega Alpha membership, higher Step 1 scores, and excellent personal statements and those who were male or Asian. However, the only significant predictors were Step 1 scores (relative risk [RR], 1.36 for every 10-U increase), publications (RR, 2.20), personal statements (RR, 1.62), and Asian race (RR, 1.70 vs white). Alpha Omega Alpha membership (RR, 1.62) and Step 1 scores (RR, 1.01) were the only variables predictive of ranking in the top 5. CONCLUSIONS AND RELEVANCE: This national sample shows GSR is a highly competitive, sex-neutral discipline in which academic performance is the most important factor for ranking, especially in the most competitive programs. This study will inform applicants and program directors about applicants to the GSR program.


Assuntos
Avaliação Educacional , Cirurgia Geral/educação , Internato e Residência , Estudantes de Medicina , Adulto , Escolha da Profissão , Estudos de Coortes , Feminino , Humanos , Masculino , Fatores Sexuais , Estados Unidos , Adulto Jovem
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