Women in Surgical Residency Programs in Brazil: A Trend Analysis.

INTRODUCTION: There is a gender gap in the surgical field worldwide. Brazil and low- and middle-income countries generally tend to have a more profound gap. Therefore, we aim to assess the gender distribution in Brazilian surgical residencies. METHODS: From a national residencies' database, we collected residency entering years, names, and surgical subspecialties. We classified gender from the names using Gender API software and performed linear regression, binomial, and chi-square tests. RESULTS: From 81,979 doctors (1931-2020), 36.6% were women (P < 0.001). Of 13 subspecialties, regarding the absolute numbers of women, only neurosurgery and plastic surgery did not significantly differ between gender per year. There was a statistically significant growth in the proportional rates of female representation among most of the surgical residencies analyzed. Overall, the least women's representation was in urology (3.8%). From all subspecialties analyzed, both genders had a significant linear absolute increase over the years (P < 0.05), except for obstetrics-gynecology and pediatric surgery for men. Until 1990, all surgical programs had at least one woman resident, except for colorectal surgery. CONCLUSIONS: Although there is an overall lack of women surgeons in Brazil, we observed an increase in women in surgical residencies. Therefore, the study may demonstrate a future change in the Brazilian gender equity scenario and reflect the growing representation of women in medicine in Brazil, except for some surgical specialties.

Barriers to Academic Surgery in the US Armed Forces: A Study of the AAS Military Committee.

INTRODUCTION: The purpose of this study is to explore current perceptions within the military surgery community to stratify key obstacles to pursuing a career in academic surgery and identify opportunities for mitigation. METHODS: After receiving institutional review board approval, an anonymous electronic survey was distributed to military surgeons across all branches. Survey response data were collected and analyzed using chi-square test. RESULTS: The response rate was approximately 22%. Of those who responded to the survey, most are interested in an academic career (61.5%); however, 64% believe this to be much more difficult as a military surgeon than as a civilian surgeon. The top three perceived obstacles include administrative obstacles (76.4%), operational commitments (65.8%), and lack of funding for academic pursuits (62.7%). Most respondents indicated that they have never received formal education regarding how to apply for research funding (84.5%) and most do not have a research mentor (60.9%). Additionally, 42.9% state that obstacles to an academic career in surgery impact their decision to leave the military. Younger surgeons were more likely to leave the military upon completion of their service commitment (67.9% versus 46.4% aged 20-39 y, P = 0.02). CONCLUSIONS: We characterized the perceived challenges to academic surgery within the military. These barriers between academic surgery and military service risk medical force attrition, particularly in future generations of surgeons. Dedicated faculty billets (positions) with limited operational demands as well as associated mentorship and research funding may enhance the retention and productivity of military surgeons.

Defining the Disparity: A Multi-Institutional Analysis of Factors Associated With Decreased Resident Operative Experience.

INTRODUCTION: Technical learning in surgical training is multifaceted and existing literature suggests a positive relationship between case volume and proficiency. Little is known about factors associated with a decreased volume of operative experience. This study aimed to identify resident and program factors associated with general surgery residents (GSR) in the bottom quartile of logged case volume upon program completion. METHODS: A post hoc analysis of a multicenter study was used to examine case logs for categorical GSR. Participants included graduates between 2010 and 2020 from 20 programs. Residents below and above the 25th percentile for total operative volume were compared. RESULTS: The present study includes 1343 GSR who graduated over the 11-y period. In total, 336 residents were below the 25th percentile and 1007 residents were above the 25th percentile. Those below the 25th percentile were more likely to be female (41% versus 34%, P = 0.02), identify as underrepresented in medicine (22% versus 14%, P < 0.01), and pursue fellowship (86% versus 80%, P = 0.01) compared to those above the 25th percentile. Residents below the 25th percentile were more likely to have graduated from a low volume program (55% versus 25%, P < 0.01) and from top National Institutes of Health funded institutions (57% versus 52%, P = 0.01). CONCLUSIONS: This study identified individual and program characteristics associated with lower operative volume of GSR. Understanding such characteristics will aid surgical educators to achieve better equity in training.

The Power and Potential of Photography as a Therapeutic Modality for Children with Life-Impacting Illnesses.

Objectives: Art is being increasingly appreciated for its healing capacity in pediatric medicine. However, while mediums like music and painting have already been widely integrated into children's health institutions across the nation, photography is an artform that is greatly understudied in its application to medicine. As a non-profit organization with a 17-year history of providing free in-hospital/in-hospice photography sessions to the families of children with life-impacting illnesses, we set out to evaluate the therapeutic capacity of this intervention. Methods: Individuals having received Moment by Moment Photography's services from June 2022 to January 2023 were invited to complete a five-question survey assessing the nature and quality of their photography session and the resulting photographs they received. Results: All but one of the 177 participants found the photographs impactful, and the overwhelming majority (95.5%) of participants rated the value of the photographs as high as possible (5/5 on a Likert scale). Further, a dozen themes, including love, share, connect, and fight, among others, were identified that articulate the diversity of ways that "impact" manifested in families. Conclusion: Together, these results clearly support the benefit of photography as a legacy making and therapeutic medium.

Introduction to Computational Biomedicine.

The domain of computational biomedicine is a new and burgeoning one. Its areas of concern cover all scales of human biology, physiology, and pathology, commonly referred to as medicine, from the genomic to the whole human and beyond, including epidemiology and population health. Computational biomedicine aims to provide high-fidelity descriptions and predictions of the behavior of biomedical systems of both fundamental scientific and clinical importance. Digital twins and virtual humans aim to reproduce the extremely accurate duplicate of real-world human beings in cyberspace, which can be used to make highly accurate predictions that take complicated conditions into account. When that can be done reliably enough for the predictions to be actionable, such an approach will make an impact in the pharmaceutical industry by reducing or even replacing the extremely laboratory-intensive preclinical process of making and testing compounds in laboratories, and in clinical applications by assisting clinicians to make diagnostic and treatment decisions.

Finding Comfort in Discomfort Reflecting on Stories Told.

INTRODUCTION: The 2022 Presidential Address for the Association for Academic Surgery was focused on better understanding the personal and professional challenges faced by surgeons during the COVID-19 pandemic. METHODS: As part of this work, we embarked on a listening tour, inviting surgeons from all over the country to tell us their stories. This led to forming a panel of five selected participants based on how their stories crosscut many of the most prevalent themes during those conversations. Here, we present thematic excerpts of the 2022 presidential panel, intending to capture that moment and challenge surgeons to contribute to an ever-evolving movement that pushes us to unpack some of our greatest areas of discomfort. RESULTS: We found that, in many ways, the COVID-19 pandemic brought into focus what many surgeons from marginalized groups have historically struggled with. Dominant themes from these conversations included the role of surgery in informing identity, the tensions between personal and professional identity, the consequences of maintaining medicine as an apolitical space, and reflections on initiatives to address inequities. Panelists also reflected on the hope that these conversations are part of a movement that leads to sustained change rather than a passing moment. CONCLUSIONS: The primary goal of this work was to center voices and experiences in a way that challenges us to become comfortable with topics that often cause discomfort, validate experiences, and foster a community that allows us to rethink what and whom we value in surgery. We hope this work serves as a guide to having these conversations in other institutions.

The founding of the UPJS Faculty of Medicine from the memories of the first dean Prof. MUDr. Jan Knazovicky. 75th anniversary of the UPJS Faculty of Medicine in Kosice.

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Public Awareness on Perio-systemic Interplay: A Cross-Sectional Survey in South India.

BACKGROUND: The oral cavity has been referred to as "the gateway to overall health." It is also said to be the meeting point of medicine and dentistry. AIMS: Our study sought to determine the extent to which the public was aware of the connection between oral/periodontal conditions and general health. SETTINGS AND DESIGN: The observational cross-sectional study's questionnaire was sectioned into oral health awareness, systemic influence on oral health, and personal oral health assessment. MATERIALS AND METHODS: A total of 994 responses were recorded and a Chi-square test was performed to uncover the relationships using SPSS version 22.0. According to responses, 70% of the population on average comprehended the responses to the majority of the oral health awareness-related questions. RESULTS: It has been noticed that only 30% of the general public was aware of the prevalent health issues like diabetes, hypertension, and malnutrition's impact on dental health. However, more than 60% had confidence in their oral health and gave a rating of at least 5. CONCLUSION: The study indicates that a good number of the population was prioritizing their oral health. However, there exists a definitive need to improve oral health awareness thereby ameliorating the overall health of an individual.

The Choice! The challenges of trying to improve medical students' satisfaction with their specialty choices.

The authors describe the residency match as a two-step process. The first step, the Choice, is where students use a combination of intuitive and analytic information processing to select the specialty that they believe will provide fulfilment and work-life balance over their entire career. The second step, the Match, uses a "deferred-acceptance" algorithm to optimize pairing of students and their specialty choices. Despite being the rate-limiting step, in the minds of students and other stakeholders, the outcomes of the Choice have typically been eclipsed by the outcomes of the Match. A recently published study found that during their second year of residency training, one in 14 physicians reported specialty choice regret, which associates with symptoms of burnout in residents. While the obvious solution is to design interventions that improve the specialty choices of students, this approach faces significant challenges, including the fact that: 1) satisfaction with specialty choice is a difficult-to-define construct; 2) specialty choice regret may be misattributed to a poor choice; and 3) choosing is a more complicated process than matching. The authors end by suggesting that if we hope to improve satisfaction with specialty choice then we should begin by defining this, deciding when to assess it, and then creating assessment tools for which there is validity evidence and that can identify the underlying causes of specialty choice regret.

Les auteurs décrivent le jumelage des résidents comme un processus en deux étapes. La première étape, le Choix, est celle où les étudiants utilisent une combinaison de traitement intuitif et analytique de l'information pour sélectionner la spécialité qui, selon eux, leur apportera l'épanouissement et l'équilibre entre leur vie professionnelle et leur vie privée tout au long de leur carrière. La deuxième étape, le Match, utilise un algorithme « d'acceptation différée ¼ pour optimiser le jumelage des étudiants et de leurs choix de spécialité. Bien qu'ils soient l'étape limitante du processus, selon les étudiants et d'autres parties prenantes, les résultats du Choix sont généralement éclipsés par ceux du jumelage. Une étude récemment publiée a révélé que, durant leur deuxième année de résidence, un médecin sur quatorze regrette d'avoir choisi une spécialité, ce qui est associé à des symptômes d'épuisement professionnel chez les résidents. Bien que la solution évidente soit de développer des interventions qui améliorent les choix de spécialité des étudiants, cette approche pose des défis importants, notamment le fait que : 1) la satisfaction à l'égard du choix de la spécialité est un concept difficile à définir ; 2) le regret du choix de la spécialité peut être attribué à tort à un mauvais choix ; et 3) le choix est un processus plus complexe que le jumelage. Les auteurs concluent en suggérant que si nous espérons améliorer la satisfaction à l'égard du choix de la spécialité, nous devrions commencer par définir ce concept, décider quand l'évaluer, puis créer des outils d'évaluation pour lesquels il existe des preuves de validité et qui peuvent identifier les causes sous-jacentes des regrets à l'égard du choix de la spécialité.

Geographic Reach of Surgery Residency Applicants During In-Person and Virtual Interviews.

Background Virtual interviews for surgery residency may improve interview opportunities for applicants from underrepresented in medicine (UIM) and lower socioeconomic backgrounds. Objective To compare the geographic reach of surgical residency applicants during in-person versus virtual interviews. Methods This study compared applicants for the 2019 (in-person) and 2020 (virtual interviews) application cycle for surgery residency. Geographic reach (GR) was defined as the distance between applicants' current location and the program. Federal Financial Institutions Examination Council's website supplied socioeconomic data using applicants' geographic locations. Applicant demographics, United States Medical Licensing Examination (USMLE) scores, and geographic distance to program were collected. Multivariable analyses examined GR with interaction terms between interview type, UIM status, and socioeconomic status, while controlling for USMLE scores. Results A total of 667 (2019) and 698 (2020) National Resident Matching Program applications were reviewed. Overall, there was no difference in GR for applicants during in-person and virtual interviews in multivariable testing. UIM status had no association with GR for in-person interviews, but virtual interviews were associated with an increased GR for UIM applicants compared to non-UIM applicants (235.17; 95% CI 28.87-441.47; P=.02). For in-person interviews, applicants living in communities with poverty levels ≥7% had less GR vs those in communities with levels <7% (-332.45; 95% CI -492.10, -172.79; P<.001), an effect not observed during virtual interviews. Conclusions There was no difference in overall GR, or the proportion of UIM applicants or those from higher poverty level communities, but virtual survey interviews during the COVID-19 pandemic were associated with increased GR for UIM and from lower socioeconomic backgrounds applicants.

Posterior Cruciate Ligament Agenesis Requiring Surgical Reconstruction.

Agenesis of the posterior cruciate ligament (PCL) is a rare disorder often found in conjunction with various other abnormalities within the knee. A 15-year-old adolescent boy presented with an absent PCL, leading to intermittent symptoms. At the age of 20 years, the patient underwent arthroscopically assisted PCL reconstruction. The patient was permitted to weightbear immediately after the procedure and started physical therapy 4 weeks after the procedure. No complications were encountered at the 2-year follow-up.

John Greenwood's sidenotes on a 1778 John Hunter text at The New York Academy of Medicine.

John Greenwood (1760-1819) was George Washington's preferred dentist. He practiced in New York and made at least one of eight sets of dentures Washington wore (currently in the collection of the New York Academy of Medicine (NYAM). We know very little about John Greenwood's (JG) formal education, except that he came from a famous family of dentists. He inherited from his father, Isaac Greenwood, one important book of the time, John Hunter's 1778 treatise, A Natural History of the Human Teeth. That copy was donated to the New York Academy of Medicine by descendants of John Greenwood. Recently, we became aware of extensive marginalia that John Greenwood wrote in this book. The present article describes John Greenwood's opinion on a variety of dental subjects such as the causes and mechanisms of tooth destruction and gum disease and the presence of microscopic annamalcula that were thought to be connected to poor oral hygiene. Although John Greenwood was self-educated, his observations are surprisingly insightful and at least 37 years ahead of what was described in the contemporary literature.

Brief History of Oral and Maxillofacial Pathology in Colombia: Milestones and Current State.

Oral and maxillofacial pathology, the branch of dentistry concerning clinical and histopathological diagnosis of pathologies of the oral and maxillofacial region, started to develop in Colombia in the mid- 19th century. Since 1950s, dedicated dental clinicians from different dental schools played an important role in its inception and subsequent development. The first significant wave of progress occurred in the 1970s with the appearance of the first formally trained oral pathologists. It was sometime in the late 1980s and early 1990s that dentists Ines Velez and Benjamin Herazo had separate initiatives and created the first oral pathology postgraduate programs in Bogotá. It was in the late 80's and early 90's that dentists Ines Velez and Benjamin Herazo had their own initiatives and created the first oral pathology postgraduate programs in the city of Bogotá. A concomitant of their achievements was the establishment of the first on-site oral pathology biopsies units and registers at Colegio Odontãlogico Colombiano, Pontificia Universidad Javeriana and Escuela Colombiana de Medicina dental schools. The programs have trained many dentists in the field over the years and two of them remain active and fully accredited. The past and present contributions and leaderships of some academic figures and graduates have allowed a steady evolution of the specialty nationwide. Currently, the ability to manage and overcome educational and professional challenges is necessary to advance the growth of this specialty in this country.

History of Orthodontics in Brazil - Postgraduate Education.

Orthodontics in Brazil underwent significant transformations in the 1950s when several dentists returned to the country after completing advanced education courses in the specialty abroad. The first two orthodontic associations, in Rio de Janeiro and São Paulo, were constituted in 1955 and 1959. The specialty's first event with characteristics of a professional meeting occurred in São Paulo in 1957, and Postgraduate Orthodontic education became available. This paper aims to describe the central insights of the constitution and evolving of the education of Orthodontics in Brazil.

[Anaesthesia, a process common to all living organisms]. / L'anesthésie, un processus commun à tout le vivant.

Because of their interest in medicine, most studies of anaesthesia focus on the nervous system of metazoans, and the fact that any life form can be anaesthetised is often underlooked. If electrical signalling is an essential phenomenon for the success of animals, it appears to be widespread beyond metazoans. Indeed, anaesthesia targets Na+/Ca2+ voltage-gated channels that exist in a wide variety of species and originate from ancestral channels that predate eukaryotes in the course of evolution. The fact that the anaesthetic capacity that leads to loss of sensitivity is common to all phyla may lead to two hypotheses: to be investigated is the evolutionary maintenance of the ability to be anaesthetised due to an adaptive advantage or to a simple intrinsic defect in ion channels? The study of anaesthesia in organisms phylogenetically distant from animals opens up promising prospects for the discovery of new anaesthetic treatments. Moreover, it should also lead to a better understanding of a still poorly understood phenomenon that yet unifies all living organisms. We hope that this new understanding of the unity of life will help humans to assume their responsibilities towards all species, at a time when we are threatening biodiversity with mass extinction.

Title: L'anesthésie, un processus commun à tout le vivant. Abstract: Du fait de leur intérêt en médecine, la majeure partie des études actuelles sur les anesthésiques se concentrent sur le système nerveux des animaux et négligent le fait que toute forme de vie peut être anesthésiée. En effet, l'anesthésie cible des canaux dépendants du voltage, canaux qui existent dans un grand nombre d'espèces diverses et qui proviennent de canaux ancestraux antérieurs à l'apparition même des eucaryotes. La question demeure : le maintien au cours de l'évolution de la capacité à être anesthésié est-il dû à un avantage adaptatif ou à un simple défaut intrinsèque des canaux ioniques ? Le regain d'intérêt actuel pour les modèles non animaux ouvre l'espoir non seulement de découvrir de nouvelles molécules anesthésiantes, mais aussi de progresser dans notre connaissance fondamentale de ce phénomène encore mal compris.

Providing health sciences education through virtual reality experiences.

In 2020 - 2021 the Robert B. Greenblatt, M.D. Library at Augusta University implemented two projects leveraging virtual reality (VR) technology to provide immersive experiential learning opportunities for health sciences students. The projects shared some commonalities in spite of having differing objectives and desired outcomes. These common facets led to the success of both projects and will be helpful for other institutions considering implementing VR projects.

Journals accepting case reports.

Background: Few resources exist to support finding journals that accept case reports by specialty. In 2016, Katherine Akers compiled a list of 160 journals that accepted case reports, which many librarians continue to use 7 years later. Because journals' editorial policies and submission guidelines evolve, finding publication venues for case reports poses a dynamic problem, consisting of reviewing a journal's author guidelines to determine if the journal accepts case report manuscripts. This project aimed to create a more up to date and extensive list of journals that currently accept case reports. Case Presentation: 1,874 journal titles were downloaded from PubMed. The team reviewed each journal and identified journal titles that accept case reports. Additional inclusion factors included being indexed in MEDLINE, accessible on the internet, and accepting and publishing English language submissions. Discussion: The new journal list includes 1,028 journals covering 129 specialties and is available on the Open Science Framework public page.

Recognizing the value of meta-research and making it easier to find.

Meta-research is a bourgeoning field studying topics with significant relevance to health sciences librarianship, such as research reproducibility, peer review, and open access. As a discipline that studies research itself and the practices of researchers, meta-research spans disciplines and encompasses a broad spectrum of topics and methods. The breadth of meta-research presents a significant challenge for identifying published meta-research studies. Introducing a subject heading for meta-research in the controlled vocabularies of literature databases has the potential to increase the visibility of meta-research, further advance the field, and expand its impact on research practices. Given the relatively recent designation of meta-research as a field and its expanding use as a term, now is the time to develop appropriate indexing vocabulary. We seek to call attention to the value of meta-research for health sciences librarianship, describe the challenges of identifying meta-research literature with currently available key terms, and highlight the need to establish controlled vocabulary specific to meta-research.