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1.
Acad Med ; 95(10): 1483-1484, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32675794

RESUMO

Women continue to be underrepresented in academic surgery, especially at the leadership level. Surgical culture has been historically male dominated and recently received negative attention for higher rates of mistreatment, sexual harassment, and attrition of women compared with other medical specialties. The authors examine factors that contribute to challenges in academic surgery, making it a potentially difficult environment for women and underrepresented minorities; these include surgical culture, work-life balance, and historic promotion timelines. Efforts to change social norms and structural biases are critical to improving gender parity in academic surgery.


Assuntos
Docentes de Medicina/tendências , Cultura Organizacional , Médicas/tendências , Sexismo , Especialidades Cirúrgicas/tendências , Escolha da Profissão , Mobilidade Ocupacional , Docentes de Medicina/organização & administração , Feminino , Humanos , Masculino , Médicas/organização & administração , Especialidades Cirúrgicas/organização & administração
3.
J Pediatr Surg ; 55S: 51-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31662193

RESUMO

Pediatric surgeons are collectively passionate about prioritizing the healthcare needs of children. We contend that this passion is deeply ingrained in how we drive clinical care and influence scientific discovery. Thus, the future of clinical research in our field will be deeply embedded in our history as a "patient-centric" profession. Service to pediatric patients requires an understanding of their needs and expectations, and designing research that acknowledges both. In this article we detail how future pragmatic clinical research will look in the evolving and learning health system.


Assuntos
Pesquisa Biomédica/tendências , Sistema de Aprendizagem em Saúde , Pediatria/tendências , Especialidades Cirúrgicas/tendências , Criança , Previsões , Humanos
7.
J Pediatr Surg ; 54(5): 1009-1012, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30795911

RESUMO

BACKGROUND: In 2014, a survey study of the Canadian pediatric surgery workforce predicted a need for 2 new pediatric surgeons/yr. in Canada. We sought to assess these predictions and evaluate the status of the workforce. METHODS: With IRB approval, a web-based survey was sent to pediatric surgery division chiefs in Canada each year (2013-2017). The survey data included: number of practicing pediatric surgeons, full time equivalent (FTE) positions, and fellowship graduates. RESULTS: There was a 100% response rate (18 divisions). From 2013 to 2017, the number of practicing pediatric surgeons and FTE positions increased (73 to 78, and 64.6 to 67.5, respectively). Eleven positions were vacated (4 retirement, 7 new practice), and 18 were filled. Eight were filled by new Canadian graduates, 7 by Canadians previously working in Canada or abroad, and 3 by European surgeons. Thirty-eight fellows completed training in Canada, including 24 non-Canadians who all left Canada. Nine Canadians who started practicing immediately after fellowship took positions in Canada (5) and the US (4). CONCLUSIONS: Predictions made in 2014 were largely accurate. There has been modest growth in the Canadian pediatric surgery workforce over the last 5 years. A significant mismatch continues to exist between Canadian pediatric surgery graduates and attending staff positions. TYPE OF STUDY: Survey. LEVEL OF EVIDENCE: V.


Assuntos
Mão de Obra em Saúde/tendências , Pediatria/tendências , Especialidades Cirúrgicas/tendências , Cirurgiões/provisão & distribução , Canadá , Educação de Pós-Graduação em Medicina/tendências , Bolsas de Estudo/tendências , Feminino , Humanos , Masculino , Pediatria/organização & administração , Estudos Prospectivos , Especialidades Cirúrgicas/organização & administração , Cirurgiões/tendências , Inquéritos e Questionários
8.
J Am Acad Orthop Surg ; 27(16): e725-e733, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30676512

RESUMO

BACKGROUND: The representation of minorities among medical students has increased over the past two decades, but diversity among orthopaedic residents lags behind. This phenomenon has occurred despite a recent focus by the American Academy of Orthopaedic Surgeons on the recruitment of minorities and women. OBJECTIVE: To analyze the impact of recent efforts on diversity in orthopaedic residents in comparison with other surgical specialties from 2006 to 2015. METHODS: Data from the American Association of Medical Colleges on residents in surgical specialty programs in the years 2006 to 2015 were analyzed. Linear regression models were used to estimate trends in diversity among orthopaedic residents and residents in other surgical specialties. A mixed model analysis of variance was used to compare rates of diversification among different specialties over time. RESULTS: Female representation in orthopaedic programs increased from 10.9% to 14.4% between 2006 and 2015. However, the rate of increase was significantly lower compared with other specialties (all P < 0.05) studied, except for urology (P = 0.64). Minority representation in orthopaedics averaged 25.6% over the 10-year period. Residents of Hispanic origin in orthopaedic programs increased (P = 0.0003) but decreased for Native Hawaiian/Pacific Islander (P < 0.0001). During the same period, white representation increased (P = 0.004). No significant changes were found in African Americans or Asian American representation. Diversity decreased among orthopaedic residents over the period studied (P = 0.004). CONCLUSIONS: Recruitment efforts have not reversed the sex, racial, and ethnic disparities in orthopaedic residents. Orthopaedics has the lowest representation of women and minorities among residencies studied. The rate of increase in women lags behind all surgical subspecialties, except for urology.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Internato e Residência/tendências , Grupos Minoritários/estatística & dados numéricos , Ortopedia/educação , Ortopedia/tendências , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Distribuição por Sexo , Especialidades Cirúrgicas/educação , Especialidades Cirúrgicas/estatística & dados numéricos , Especialidades Cirúrgicas/tendências
9.
J Surg Educ ; 76(4): 1015-1021, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30638794

RESUMO

OBJECTIVE: Assessing workforce diversity over time is essential to understanding how it has evolved and anticipating its future. We conducted the current study to evaluate gender, racial/ethnic, and duty trends over the past decade in general surgery and surgical subspecialties. DESIGN: This is a cross-sectional study. We calculated ratios and relative changes to assess potential differences of physicians' characteristics across time and surgical subspecialties. SETTING: We evaluated data acquired by the Association of American Medical Colleges. PARTICIPANTS: We extracted data from the 2000 to 2013 including the overall number of surgeons, surgeon race/ethnicity, gender, and primary professional activity. RESULTS: During 2000 to 2013, the total number of surgeons increased 11.5%, reaching 172,062 active surgeons and residents, the majority of whom were White (64%) or male (75%). However, from 2000 to 2013, most specialties showed some improvement in terms of including minorities and females. Most surgeons (98%) participate in patient care while a small portion are devoted to other activities (e.g., administrative, research, teaching; 2%). Both groups increased over the study period. CONCLUSIONS: Our findings suggest that the face of surgery is changing. Continuous monitoring of the surgical workforce is important to anticipate future needs and to serve a diverse patient population.


Assuntos
Escolha da Profissão , Grupos Étnicos/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Especialidades Cirúrgicas/estatística & dados numéricos , Cirurgiões/provisão & distribução , Recursos Humanos/estatística & dados numéricos , Estudos Transversais , Educação de Pós-Graduação em Medicina/métodos , Feminino , Previsões , Humanos , Incidência , Internato e Residência/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores Sexuais , Sociedades Médicas/organização & administração , Especialidades Cirúrgicas/tendências , Estados Unidos , Recursos Humanos/tendências
10.
J Surg Res ; 233: 41-49, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502279

RESUMO

BACKGROUND: The Physician Payments Sunshine Act mandates the submission of payment records between medical providers and industry. We used the Open Payments Program database to compare industry payments to surgeons and nonsurgeons, as well as among surgical specialties, and to identify geographic distribution of payments. MATERIALS AND METHODS: We included all reported industry payments in the Centers for Medicare and Medicaid Services' Open Payments Program in the United States, 2014-2015. Multivariable regression fixed effects panel analysis of total payments was conducted among surgeons, adjusting for surgeon specialty, payor type, payment category, and state. A geographic heat map was created. RESULTS: Of 2,097,150 subjects meeting criteria, 1,957,528 (45.66%) were physicians. The mean standard deviation (SD) payment overall was $232.64 ($6262.00), and the state with the highest mean (SD) payment was Vermont at $2691.61 ($11,508.40). Surgeons numbered 153,916 (7.86%). The specialty with the highest mean (SD) payment was orthopedic surgery at $2811.50 ($33,632.71, P < 0.001). Among 2,097,150 subjects meeting criteria, in multivariable regression fixed effects panel analysis, orthopedic compared to general surgeons were significantly likely to receive more industry payments (beta $1065.34 [95% CI $279.00-1851.00, P = 0.008), even controlling for payor, payment type, and state. Significant geographic disparities in payment were noted as 12 states received the top mean ($24.52-$500,000.00), leaving seven states with the lowest ($0.00-$12.56). CONCLUSIONS: There are significant differences in industry payments to surgeons versus nonsurgeons and among surgical specialties, as well geographic distribution of payments. These data may prompt further investigation into trends and their causality and effects on research and practice.


Assuntos
Setor de Assistência à Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/economia , Especialidades Cirúrgicas/economia , Centers for Medicare and Medicaid Services, U.S./estatística & dados numéricos , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Setor de Assistência à Saúde/estatística & dados numéricos , Setor de Assistência à Saúde/tendências , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/tendências , Análise Espacial , Especialidades Cirúrgicas/estatística & dados numéricos , Especialidades Cirúrgicas/tendências , Estados Unidos
12.
J Surg Res ; 231: 179-185, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30278927

RESUMO

BACKGROUND: Minimally invasive pediatric surgery has increased in breadth and complexity over the past several decades, with little data on minimally invasive surgery (MIS) training in US and Canadian pediatric surgery fellowship programs. METHODS: We performed a time series analysis of Accreditation Council for Graduate Medical Education pediatric surgery fellow case logs from 2003 to 2016. Proportions of cases performed in an MIS fashion as well as per-fellow MIS case averages were recorded over time. RESULTS: There was a 30.9% increase in average number of MIS cases per fellow over the study time period. Twenty-three recorded procedures included MIS and open options (17 abdominal, three thoracic, and three genitourinary). The proportion of cases performed using a minimally invasive approach increased by an average of 29.0%, 14.6%, and 47.0% for each of these categories, respectively. Significant variability was observed in specific cases such as laparoscopic and open inguinal hernias, ranging from 0 to 85 and nine to 152 per trainee, respectively, in the final year of data collection. When examining pyloromyotomy, a high-volume procedure with a known increase in the MIS approach, the proportion of cases performed MIS increased by 83.3%. The minimum and maximum number of cases per fellow recorded ranged from 0 to 114 during the eight years in which MIS pyloromyotomy was recorded. CONCLUSIONS: MIS case exposure among graduating US and Canadian pediatric survey fellows increased substantially during the study period. More granular data, however, are needed to better define the current operative experience and criteria for determination of competency in advanced MIS.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/educação , Pediatria/educação , Especialidades Cirúrgicas/educação , Humanos , Pediatria/tendências , Especialidades Cirúrgicas/tendências
13.
Cir. Esp. (Ed. impr.) ; 96(8): 466-472, oct. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-176648

RESUMO

La necesidad de cooperación sanitaria en países de bajo desarrollo es conocida y se implementa día a día. Sin embargo, la asistencia sanitaria quirúrgica en estos países, en el siglo XXI, es más discutida, y se encuentra por debajo de niveles deseables y con soluciones más complejas. Por otra parte, el número de cirujanos que buscan implicarse aumenta progresivamente. Se analizan las causas que originan estos bajos niveles de asistencia, como la falta de personal cualificado, fuga de profesionales, coste de la asistencia o la falta de cuantificación de las necesidades. Las oportunidades de mejora, como el hermanamiento institucional, las misiones quirúrgicas de corta duración o la realización de acciones dirigidas a la educación, evaluación, evidencia y formación son algunas de las posibilidades propuestas


The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed


Assuntos
Humanos , Políticas e Cooperação em Ciência, Tecnologia e Inovação , Cooperação Internacional , Assistência à Saúde/organização & administração , Especialidades Cirúrgicas/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Missões Médicas , Cooperação Técnica , Países Baixos , Voluntários
17.
Chirurgia (Bucur) ; 112(5): 566-572, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29088556

RESUMO

Introduction: Over the past three decades, there has been a recognised need for emergency surgery (ES). Studies of ES have demonstrated variation in patient outcomes depending on admission time or day. ES as a subspecialty is still under consideration in Europe despite being recognised as such in the US. This article reviews this need and addresses the issues required to develop ES as a separate surgical subspecialty in Europe. METHOD: A survey on ES was developed by the Educational Committee of the European Society for Trauma and Emergency Surgery (ESTES) and sent to all ESTES members with 102 responses received. Results: Of the responses, 93.1% had completed training. 75.3% of respondents report that ES should be a recognised subspecialty and 79% report that ES is capable of offering a rewarding career. 90% report that ES should have dedicated post-graduate training programme with 69.8% in agreement that dedicated emergency surgeons have improved outcomes following ES. CONCLUSION: Developing ES as a subspecialty in Europe would improve patient outcomes and facilitate resource allocation. This advancement is, however, still in its infancy and its evolution would require overhaul of our current European system, training methods and understanding of the role of emergency surgeons in ES.


Assuntos
Emergências , Cirurgia Geral/tendências , Ferimentos e Lesões/cirurgia , Adulto , Serviço Hospitalar de Emergência , Europa (Continente) , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Especialidades Cirúrgicas/tendências , Inquéritos e Questionários , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico
18.
World J Surg ; 41(12): 3046-3053, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29038829

RESUMO

BACKGROUND: This study assesses the retention of specialist surgical graduates from training programmes across eight countries in East, Central and Southern Africa from 1974 to 2013. It addresses the gap in existing data by analysing retention rates of surgical graduates by comparing graduating institution to current location. Data were assessed by country, region, specialty and gender with a view to informing national and regional healthcare and education strategies. METHODS: Twenty-five institutions train surgeons in the ten countries covered by the College of Surgeons of East, Central and Southern Africa (COSECSA)-24 Universities and the College itself. These institutions were requested in November 2014 to supply details of graduates from their postgraduate surgical training programmes. Complete graduate lists were returned by the College and 14 universities by March 2016. These surgical graduates were compared against the database of current practising surgeons in the region held by COSECSA. Data were cross-checked against medical council registers, surgical society records, and with members and fellows of COSECSA. RESULTS: Data were incomplete for 126 surgical graduates. Of the remaining 1038 surgical graduates, 85.1% were retained in the country they trained in, while 88.3% were retained within the COSECSA region. Ninety-three per cent (93.4%) were retained within Africa. Of the eight countries, Malawi had the highest retention rate with 100% of surgical graduates remaining in country, while Zimbabwe had the lowest rate with 65.5% remaining. CONCLUSION: High surgical graduate retention rates across the region indicate that the expansion of national surgical training initiatives is an effective solution to addressing the surgical workforce shortage in East, Central and Southern Africa and counters long-held arguments regarding brain drain in this region.


Assuntos
Emigração e Imigração , Especialidades Cirúrgicas , Cirurgiões/provisão & distribução , África ao Sul do Saara , Feminino , Humanos , Masculino , Especialidades Cirúrgicas/tendências , Recursos Humanos
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