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INTRODUCTION: Survey fatigue, a phenomenon where respondents lose interest or lack motivation to complete surveys, can undermine rigorously designed studies. Research during the COVID-19 pandemic capitalized on electronic surveys for maximum distribution, but with lower response rates. Additionally, it is unclear how survey fatigue affects surgical education stakeholders. This study aims to determine how response rates to an electronic survey, as a proxy for survey fatigue, differ among medical students (MS), surgery residents, and surgery faculty. METHODS: Electronic surveys evaluating the surgical clerkship educational environment were distributed to third year MS, residents, and faculty at three academic institutions. Two reminder emails were sent. Groups with low response rates (<30%) received additional prompting. Response rates were compared using a chi-square test. Demographics of all survey respondents were collected and discussed. Baseline characteristics of the MS class, residency program, and Department of Surgery faculty from one institution were gathered and compared to respondents. RESULTS: Surveys were sent to 283 third year MS, 190 surgery residents, and 374 surgical faculty. Response rates were 43%, 27%, and 20%, respectively (P < 0.0001). Male respondents, respondents of color, midlevel residents, and assistant professors had lower response rates compared to the baseline cohort. CONCLUSIONS: Our results demonstrate a statistically significant difference in survey response rates among MS, residents, and faculty, and have identified various targets for further investigation. Loss of interest in these groups should be further evaluated with a goal of decreasing survey fatigue, increasing survey response rates, and improving the quality of survey data collected.
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Internato e Residência , Pandemias , Humanos , Masculino , Educação de Pós-Graduação em Medicina/métodos , Inquéritos e Questionários , Fadiga/epidemiologia , Fadiga/etiologiaRESUMO
BACKGROUND: Gaming can serve as an educational tool to allow trainees to practice surgical decision-making in a low-stakes environment. LapBot is a novel free interactive mobile game application that uses artificial intelligence (AI) to provide players with feedback on safe dissection during laparoscopic cholecystectomy (LC). This study aims to provide validity evidence for this mobile game. METHODS: Trainees and surgeons participated by downloading and playing LapBot on their smartphone. Players were presented with intraoperative LC scenes and required to locate their preferred location of dissection of the hepatocystic triangle. They received immediate accuracy scores and personalized feedback using an AI algorithm ("GoNoGoNet") that identifies safe/dangerous zones of dissection. Player scores were assessed globally and across training experience using non-parametric ANOVA. Three-month questionnaires were administered to assess the educational value of LapBot. RESULTS: A total of 903 participants from 64 countries played LapBot. As game difficulty increased, average scores (p < 0.0001) and confidence levels (p < 0.0001) decreased significantly. Scores were significantly positively correlated with players' case volume (p = 0.0002) and training level (p = 0.0003). Most agreed that LapBot should be incorporated as an adjunct into training programs (64.1%), as it improved their ability to reflect critically on feedback they receive during LC (47.5%) or while watching others perform LC (57.5%). CONCLUSIONS: Serious games, such as LapBot, can be effective educational tools for deliberate practice and surgical coaching by promoting learner engagement and experiential learning. Our study demonstrates that players' scores were correlated to their level of expertise, and that after playing the game, most players perceived a significant educational value.
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Inteligência Artificial , Colecistectomia Laparoscópica , Competência Clínica , Aplicativos Móveis , Humanos , Colecistectomia Laparoscópica/educação , Masculino , Feminino , Internato e Residência/métodos , Jogos de Vídeo , Adulto , Educação de Pós-Graduação em Medicina/métodosRESUMO
Amacrine cells of the retina are conspicuously variable in their morphologies, their population demographics, and their ensuing functions. Vesicular glutamate transporter 3 (VGluT3) amacrine cells are a recently characterized type of amacrine cell exhibiting local dendritic autonomy. The present analysis has examined three features of this VGluT3 population, including their density, local distribution, and dendritic spread, to discern the extent to which these are interrelated, using male and female mice. We first demonstrate that Bax-mediated cell death transforms the mosaic of VGluT3 cells from a random distribution into a regular mosaic. We subsequently examine the relationship between cell density and mosaic regularity across recombinant inbred strains of mice, finding that, although both traits vary across the strains, they exhibit minimal covariation. Other genetic determinants must therefore contribute independently to final cell number and to mosaic order. Using a conditional KO approach, we further demonstrate that Bax acts via the bipolar cell population, rather than cell-intrinsically, to control VGluT3 cell number. Finally, we consider the relationship between the dendritic arbors of single VGluT3 cells and the distribution of their homotypic neighbors. Dendritic field area was found to be independent of Voronoi domain area, while dendritic coverage of single cells was not conserved, simply increasing with the size of the dendritic field. Bax-KO retinas exhibited a threefold increase in dendritic coverage. Each cell, however, contributed less dendrites at each depth within the plexus, intermingling their processes with those of neighboring cells to approximate a constant volumetric density, yielding a uniformity in process coverage across the population.SIGNIFICANCE STATEMENT Different types of retinal neuron spread their processes across the surface of the retina to achieve a degree of dendritic coverage that is characteristic of each type. Many of these types achieve a constant coverage by varying their dendritic field area inversely with the local density of like-type neighbors. Here we report a population of retinal amacrine cells that do not develop dendritic arbors in relation to the spatial positioning of such homotypic neighbors; rather, this cell type modulates the extent of its dendritic branching when faced with a variable number of overlapping dendritic fields to approximate a uniformity in dendritic density across the retina.
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Células Amácrinas/fisiologia , Sistemas de Transporte de Aminoácidos Acídicos/fisiologia , Dendritos/fisiologia , Retina/citologia , Retina/fisiologia , Sistemas de Transporte de Aminoácidos Acídicos/genética , Animais , Apoptose/fisiologia , Contagem de Células , Morte Celular , Mapeamento Cromossômico , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Neurônios Aferentes/fisiologia , Locos de Características Quantitativas , Proteína X Associada a bcl-2/genética , Proteína X Associada a bcl-2/fisiologiaRESUMO
BACKGROUND: More patients are turning to the internet for their health information than ever before. This is a growing problem as it is well recognized that medical information on the internet is highly variable. We assessed the quality of information on the internet regarding the anti-reflux procedure, Nissen Fundoplication. Three commonly used measures of website quality are the Health On the Net code, the Journal of the American Medical Association Benchmark criteria, and the DISCERN tool. The HON code is a seal of approval awarded by an independent organization where the JAMA Benchmark and DISCERN Tool are a set of standards that can be utilized by an internet user or webpage creator. METHODS: We performed a Google search using the term "Nissen Fundoplication", where we analyzed the top 75 websites. We included English language websites and excluded advertisements, websites for medical professionals, duplicates, and requiring a login. Each website included was evaluated for presence of the HON seal and scored with the JAMA Benchmark and DISCERN criteria to determine quality. RESULTS: Only 16.28% of websites were found to be HON code certified. The average JAMA benchmark score was 1.23, with 9.3% websites scoring the maximum 4 points and 39.53% receiving a score of 0. The average DISCERN score was 34.65 out of a total possible score of 75, where the mean score for the overall quality of the website (question 16) was 2.19 out of a maximal score of 5. CONCLUSION: This study, using 3 commonly used validated measures, has found that the quality of online information pertaining to Nissen Fundoplication is sorely lacking. The implications of these results are twofold as an important reference for institutions to update their source material and a guide when providing patients with adequate resources.
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Informação de Saúde ao Consumidor , Fundoplicatura , Benchmarking , Humanos , InternetRESUMO
BACKGROUND: Frailty is a common, age-associated syndrome that has been used to predict postoperative outcomes in vascular surgery. This study examines if standard measures of frailty correlate with postoperative outcomes for patients undergoing revascularization for acute limb ischemia (ALI). METHODS: A retrospective study was conducted on all adult patients undergoing revascularization for ALI at an academic medical center between January 2016 and June 2019. Frailty was calculated with the 11-factor modified frailty index (mFI-11), derived from the Canadian Study of Health and Aging Frailty Index. Outcomes examined included in-hospital mortality, major amputation, site of discharge, and ambulatory status at follow-up. RESULTS: Fifty-three ambulatory patients presented with ALI during the study time period, with 13.2% deemed not frail (mFI-11 < 3) and 86.8% deemed frail (mFI-11 ≥ 3). Frailty was significantly correlated with discharge to a skilled nursing facility (P = 0.028) and nonambulation at follow-up (P = 0.002). There was no significant correlation with other outcomes, including mortality and amputation. On multivariate analysis, frailty was the only factor contributing to nonambulation at follow-up (P = 0.012). Endovascular treatment did not mitigate the effects of frailty on discharge site and ambulatory status. CONCLUSIONS: Frailty is exceedingly common in patients with ALI. Although frailty predicts discharge site and nonambulation at follow-up, it is not associated with amputation or death. Therefore, frail patients should not be denied open or endovascular revascularization for ALI.
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Amputação Cirúrgica , Idoso Fragilizado , Fragilidade/complicações , Isquemia/cirurgia , Limitação da Mobilidade , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade/diagnóstico , Fragilidade/mortalidade , Estado Funcional , Avaliação Geriátrica , Humanos , Isquemia/complicações , Isquemia/diagnóstico , Isquemia/mortalidade , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidadeRESUMO
The retina contains two populations of cholinergic amacrine cells, one positioned in the ganglion cell layer (GCL) and the other in the inner nuclear layer (INL), that together comprise â¼1/2 of a percent of all retinal neurons. The present study examined the genetic control of cholinergic amacrine cell number and distribution between these two layers. The total number of cholinergic amacrine cells was quantified in the C57BL/6J and A/J inbred mouse strains, and in 25 recombinant inbred strains derived from them, and variations in their number and ratio (GCL/INL) across these strains were mapped to genomic loci. The total cholinergic amacrine cell number was found to vary across the strains, from 27,000 to 40,000 cells, despite little variation within individual strains. The number of cells was always lower within the GCL relative to the INL, and the sizes of the two populations were strongly correlated, yet there was variation in their ratio between the strains. Approximately 1/3 of that variation in cell ratio was mapped to a locus on chromosome 3, where Sex determining region Y box 2 (Sox2) was identified as a candidate gene due to the presence of a 6-nucleotide insertion in the protein-coding sequence in C57BL/6J and because of robust and selective expression in cholinergic amacrine cells. Conditionally deleting Sox2 from the population of nascent cholinergic amacrine cells perturbed the normal ratio of cells situated in the GCL versus the INL and induced a bistratifying morphology, with dendrites distributed to both ON and OFF strata within the inner plexiform layer.
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Células Amácrinas/fisiologia , Neurônios Colinérgicos/fisiologia , Dendritos/fisiologia , Retina/citologia , Retina/fisiologia , Fatores de Transcrição SOXB1/fisiologia , Animais , Contagem de Células/métodos , Células Cultivadas , Feminino , Masculino , Camundongos , Camundongos da Linhagem 129 , Camundongos Endogâmicos A , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos TransgênicosRESUMO
Programmed cell death contributes to the histogenesis of the nervous system, and is believed to be modulated through the sustaining effects of afferents and targets during the period of synaptogenesis. Cone bipolar cells undergo programmed cell death during development, and we confirm that the numbers of three different types are increased when the pro-apoptotic Bax gene is knocked out. When their cone afferents are selectively eliminated, or when the population of retinal ganglion cells is increased, however, cone bipolar cell number remains unchanged. Programmed cell death of the cone bipolar cell populations, therefore, may be modulated cell-intrinsically rather than via interactions with these synaptic partners.
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Apoptose/fisiologia , Comunicação Celular/fisiologia , Organogênese/fisiologia , Retina/embriologia , Células Fotorreceptoras Retinianas Cones/fisiologia , Sinapses/fisiologia , Animais , Processamento de Imagem Assistida por Computador , Camundongos , Camundongos Knockout , Microscopia Confocal , Proteína X Associada a bcl-2/deficiência , Proteína X Associada a bcl-2/genéticaRESUMO
BACKGROUND: Artificial intelligence (AI) holds significant potential in medical education and patient care, but its rapid emergence presents ethical and practical challenges. This study explored the perspectives of surgical residents on AI's role in medicine. METHODS: We performed a cross-sectional study surveying general surgery residents at a university-affiliated teaching hospital about their views on AI in medicine and surgical training. The survey covered demographics, residents' understanding of AI, its integration into medical practice, and use of AI tools like ChatGPT. The survey design was inspired by a recent national survey and underwent pretesting before deployment. RESULTS: Of the 31 participants surveyed, 24% identified diagnostics as AI's top application, 12% favored its use in identifying anatomical structures in surgeries, and 20% endorsed AI integration into EMRs for predictive models. Attitudes toward AI varied based on its intended application: 77.41% expressed concern about AI making life decisions and 70.97% felt excited about its application for repetitive tasks. A significant 67.74% believed AI could enhance the understanding of medical knowledge. Perception of AI integration varied with AI familiarity (P = .01), with more knowledgeable respondents expressing more positivity. Moreover, familiarity influenced the perceived academic use of ChatGPT (P = .039) and attitudes toward AI in operating rooms (P = .032). Conclusion: This study provides insights into surgery residents' perceptions of AI in medical practice and training. These findings can inform future research, shape policy decisions, and guide AI development, promoting a harmonious collaboration between AI and surgeons to improve both training and patient care.
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Inteligência Artificial , Educação Médica , Humanos , Estudos Transversais , Tomada de Decisões , Hospitais de EnsinoRESUMO
Background: This scoping review identifies existing literature that investigates what factors contribute to success on the American Board of Surgery (ABS) Certifying Exam (CE) to provide practical, evidence-based recommendations. Methods: A Pubmed search was completed utilizing the preferred reporting items for systematic reviews and meta-analysis extension for scoping review (PRISMA-ScR) method. Results: Of 4368 articles identified, 45 articles met criteria for review. Manuscripts were placed into one of five categories: predictors from medical school, program interventions, modifiable candidate factors, the effect of mock oral exams, and those factors shown not to provide benefit for CE preparation. Conclusions: A variety of factors have either been shown to provide benefit for or be predictive of CE performance. Acknowledgement of these factors can provide benefit to both surgery residents as well as surgery programs. Despite these findings, research into these factors is generally of low quality, prompting the need for ongoing, high-quality investigations.
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INTRODUCTION: Obtaining a categorical general surgery residency position is recognized as a highly challenging process, and many aspiring surgeons find themselves matching into a preliminary position. The American Board of Surgery In-Training Examination (ABSITE) is relevant as a discriminator, as it is the only national evaluation metric that compares residents between programs. This study examines the correlation between ABSITE performance and the likelihood of obtaining a categorical position for non-designated preliminary surgery residents. METHODS: Retrospective analysis of preliminary residents who completed the ABSITE between 2011 and 2021 at a single academic training program. RESULTS: 108 preliminary residents were included. Among preliminary residents who were successful in securing a categorical position, the average ABSITE percentile was 59 (SD = 26.7). In contrast, those who were not able to secure a categorical position, the average ABSITE percentile was 23.6 (SD = 25.3). There was a strong significant correlation between ABSITE percentile and securing a categorical position (P < 0.001). There was a significant association between citizenship and gaining a categorical position, with US citizens being significantly more likely to successfully gain a categorical position (P = 0.01; OR 3.32 (95% CI 1.28-8.56)). There was not a significant correlation between citizenship and ABSITE score. CONCLUSION: This study presents compelling evidence that ABSITE percentile score is positively associated with the probability of securing a categorical position for preliminary general surgery residents. It is therefore imperative that both preliminary residents and their programs place a high value on ABSITE performance to enhance successful career progression.
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BACKGROUND: Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. OBJECTIVE: To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. METHODS: LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. RESULTS: Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. CONCLUSIONS: LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees.
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Intussusception is a rare presentation in adults and describes when one portion of the intestine telescopes into another portion. Intussusception is associated with malignancies serving as the lead point in adults. Appendiceal mucinous neoplasms are uncommon tumors often incidentally discovered during appendectomy procedures to manage acute appendicitis. Here we present a case report of an instance of mucinous adenocarcinoma of the appendix that manifested as a large bowel obstruction with intussusception limited to the colon, underscoring the possibility of concurrent intussusception and mucinous neoplasms. The case highlights the importance of meticulous diagnostic evaluation and management, particularly without well-defined treatment protocols. Appropriate diagnostic workup and management, including surgical intervention, are critical for patient outcomes and overall prognosis. The study recommends that patients diagnosed with confirmed or suspected appendiceal neoplasms undergo upfront oncologic resection where aggressive malignancy is a concern. Colonoscopy should be performed postoperatively for all patients to identify synchronous lesions.
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Adenocarcinoma Mucinoso , Neoplasias do Apêndice , Apêndice , Doenças do Ceco , Intussuscepção , Adulto , Humanos , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/cirurgia , Apêndice/patologia , Doenças do Ceco/cirurgia , Apendicectomia/efeitos adversos , Adenocarcinoma Mucinoso/complicações , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirurgia , Colo/patologiaRESUMO
Electronic information is a vital resource used by fellowship applicants. This study aimed to assess the completeness of colon and rectal surgery (CRS) fellowship program online information. Program information on the Association of Program Directors for Colon and Rectal Surgery (APDCRS) website as well as each institutional website was evaluated based on templated criteria. Sixty-eight accredited fellowship programs were identified. Six (9%) programs had complete profiles on the APDCRS platform, with an average of 3.5 details completed per program. Sixty-two (91%) websites were easily accessible. None of these contained all 28 criteria assessed and 47 (69%) contained less than half of assessed content. The most common data point was fellowship program description (96%), while board pass rate (1%) was the least common. Most CRS fellowship websites were grossly incomplete. Electronically available information is vital to fellowship applicants, and programs should try to provide easily accessible information about their program.
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Bolsas de Estudo , Internato e Residência , Humanos , Colo , InternetRESUMO
BACKGROUND: Prejudice towards Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) people continues to decline. Despite this, LGBTQ surgeons still experience discrimination from colleagues, staff, and patients at an alarming rate. The Association of Out Surgeons and Allies (AOSA) was established to address this issue by fostering a more equitable and inclusive surgical environment. AOSA: AOSA is a national surgical organization of LGBTQ students, trainees, faculty, and allies committed to enhancing equity in surgery through education, outreach, mentorship, and sponsorship. AOSA works in collaboration with national efforts and institutional initiatives to promote the inclusion and acceptance of LGBTQ surgeons. FUTURE DIRECTIONS: Achieving these goals will require a community effort of LGBTQ surgeons and allies in addition to the support of prominent academic institutions and national surgical organizations. CONCLUSION: Lesbian, Gay, Bisexual, Transgender, and Queer surgeons continue to face workplace discrimination. This new surgical society will help foster a supportive environment through visibility, mentorship, education, and community.
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Minorias Sexuais e de Gênero , Cirurgiões , Pessoas Transgênero , Feminino , Humanos , Preconceito , MentoresRESUMO
OBJECTIVE: The expansion of Minimally Invasive Surgery (MIS) has been exponential since the introduction of laparoscopic surgery in the late 1980s. This shift in operative technique has led many to believe that surgery residents are not developing the skills needed to adequately perform open operations. METHODS: We performed a retrospective review of the Accreditation Council for Graduating Medical Education national operative case log database of general surgery residents from January 2003 to December 2019. We compared the open vs. laparoscopic case numbers for six different operations, including cholecystectomy, appendectomy, inguinal hernia repair, colectomy, gastrectomy, and Nissen fundoplication. The Cochran-Armitage test was used to assess the linear trend in the procedures performed. RESULTS: Total average residency case volumes for the procedures studied have increased from 270 to 368 (36%) over the 16-year period with MIS steadily representing a greater proportion of these cases. From 2003 to 2018, MIS representation increased in all studied procedures: cholecystectomy (88% to 94%, p = 0.048), inguinal hernia repair (20% to 47%, p ≤ 0.001), appendectomy (38% to 93%, p ≤ 0.001), colectomy (8% to 43%, p ≤ 0.001), gastrectomy (43% to 84%, p = 0.048), and Nissen (71% to 91%, p = 0.21). CONCLUSION: While the overall operative volume has increased nationally for surgical residents, the representation of open cases has steadily declined since the advent of MIS. The experience needed in open surgery during resident training is still to be determined and may be necessary now that laparoscopy is progressively replacing open operations.
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Internato e Residência/tendências , Laparoscopia/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Cirurgia Geral/educação , Humanos , Estudos Retrospectivos , Estados UnidosRESUMO
The sizes of different neuronal populations within the CNS are precisely controlled, but whether neuronal number is coordinated between cell types is unknown. We examined the covariance structure of 12 different retinal cell types across 30 genetically distinct lines of mice, finding minimal covariation when comparing synaptically connected or developmentally related cell types. Variation mapped to one or more genomic loci for each cell type, but rarely were these shared, indicating minimal genetic coregulation of final number. Multiple genes, therefore, participate in the specification of the size of every population of retinal neuron, yet genetic variants work largely independent of one another during development to modulate those numbers, yielding substantial variability in the convergence ratios between pre- and postsynaptic populations. Density-dependent cellular interactions in the outer plexiform layer overcome this variability to ensure the formation of neuronal circuits that maintain constant retinal coverage and complete afferent sampling.