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PubMed1998

Gender-related attrition in a general surgery training program.

BACKGROUND: Attracting and retaining highly qualified applicants to careers in surgery is a goal of residency training programs. Few studies of attrition in residency exist. This study examines the hypothesis that reasons for attrition during general surgery training are different for male and female trainees. MATERIALS AND METHODS: NRMP matching information was used to evaluate attrition rates in a categorical general surgery (CGS) residency program from 1984 through 1996. The records of all matched residents were examined to determine the association between gender and attrition outcomes. Outcome variables included: voluntary vs involuntary withdrawal and the reasons for withdrawal. RESULTS: During the study period 132 candidates matched (103 men and 29 women) into CGS positions. Of that group, 18 residents, 11 (10.7%) from the male and 7 (24.1%) from the female cohorts withdrew. Only three involuntary withdrawals occurred. Women were 2.26 times more likely to withdraw than men, a finding that is not statistically significant (P = 0. 073). Women rarely left for preference of other specialty (relative risk 0.25), whereas men were 4 times more likely to leave for this reason. CONCLUSION: These numbers suggest that women are at higher risk of leaving general surgery training than men. When women do leave, it is more likely for family reasons such as lifestyle considerations or to join a spouse in another geographic location. Such findings support the conclusion that fundamental differences exist in decisions regarding attrition between genders. National studies of attrition and the reasons for leaving are needed to develop specific strategies promoting retention for both genders.

Career Choice↗
PubMed2001

Do future general surgery residents have adequate exposure to endocrine surgery during medical school?

During their general surgical rotations, medical students should ideally have exposure to a wide breadth of surgical procedures, especially if they are interested in pursuing surgical careers. To determine their exposure to endocrine surgery during medical school, we surveyed students from more than 20 medical schools who interviewed for general surgery residency positions at our institution over a 2-year period. Questions focused on the total number of index surgical procedures observed during all of their medical school education. Of 211 surveys sent, 146 were returned (66%). The mean age of the students was 26.0 +/- 0.3 years, and 21% were women. The average times spent on general surgery and surgery subspecialty rotations during medical school were 11.1 +/- 0.6 weeks and 7.6 +/- 0.4 weeks, respectively. The mean number of thyroidectomies (2.8 +/- 0.3), parathyroidectomies (1.9 +/- 0.3), and adrenalectomies (0.5 +/- 0.1) observed by the medical students were significantly lower than operations such as mastectomies (9.4 +/- 0.3), coronary bypass surgeries (8.7 +/- 1.4), and laparoscopic cholecystectomies (10.0 +/- 0.7). Furthermore, of these 146 future surgical residents, 34% failed to observe a single thyroid resection, 42% did not see a parathyroidectomy, and 65% failed to see an adrenalectomy. In conclusion, future general surgery residents seem to observe a wide variety of surgical cases, but most have little or no exposure to endocrine surgery. This paucity of exposure may have significant educational and career ramifications.

Adrenalectomy↗
PubMed1990

Effectiveness and safety of the low-molecular-weight heparin CY 216 in the prevention of fatal pulmonary embolism and thromboembolic death in general surgery. A multicentre, double-blind, randomized, controlled clinical trial versus placebo (STEP). STEP Study Group.

Deep venous thrombosis is very frequent after general surgery, and its major complication, pulmonary embolism, is today the most frequent cause of postoperative death. The reduction of this cause of mortality is mainly based on its prevention rather than its therapy. This purpose was achieved by using physical and pharmacological means. During the past 15 years, low-dose heparin has been one of the most important means in the prevention of deep venous thrombosis, associated with early mobilization of surgical patients, but its actual efficacy against fatal pulmonary embolism was never statistically proved. In the early 80s new heparins became available, and their first experimental and clinical use demonstrated a longer half-life, a higher anti-Xa activity, and a lower haemorrhagic risk. On the basis of these data, we started a study in order to assess efficacy and tolerance of the new low-molecular-weight heparin CY 216 in preventing fatal pulmonary and thromboembolic death in patients undergoing general surgery. The study was designed as a multicentre, double-blind, randomized, controlled clinical trial versus placebo. A total of 4,498 patients, aged over 40 years undergoing general surgery, with anaesthesia lasting at least 45 min, were consecutively enrolled in the 18 centres which took part in the trial. 2,247 accounted for the CY-216-treated group and 2,251 for the placebo group. The patients received either subcutaneous injections of 0.3 ml of CY 216, equivalent to 7,500 anti-Xa units, or of 0.3 ml of a saline solution supplied in an identical form. The first dose was administered 2 h before surgery, the second 12 h later, and then once daily for at least 7 days. A post-mortem examination was carried out in every patient who died. The trial began in February 1986 and ended in June 1988. Statistical analysis showed that the two groups of patients were well matched for age, sex, type of disease, site and duration of operations, as well as for the incidence of risk factors which could predispose to the thromboembolic disease. Twenty-six deaths were recorded and validated. Eight (0.36%) belonged to the CY 216 group and 18 (0.80%) to the placebo group. In the CY 216 group, pulmonary embolism was the direct cause of death in 2 patients (0.09%), while the remaining 6 deaths could not be ascribed either directly or indirectly to thrombosis. In the placebo group, pulmonary embolism was the cause of death in 4 cases (0.18%; p less than 0.05) and contributed to death in 4.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1995

General surgery in an era of superspecialisation--what is the future?

The present century has seen extraordinary scientific advances and enormous social changes unparalleled in all medical history. Of these, specialisation and superspecialisation are significant developments that have made major impact on the practice of surgery. While specialisation is intended to improve the quality of care, excessive specialisation resulting in separation into narrow areas can have a deleterious effect on the total care of the patient, teaching, training and surgical research. General Surgery which is the foundation of surgical practice has been affected more than any other in this process and the problem has received world wide attention. General Surgery is a broad speciality responsible for the care of the surgical patient as a whole including diagnosis, preoperative, operative and postoperative management of all common surgical conditions. In addition, it requires the special expertise to manage the surgical problems of the alimentary tract, abdomen, endocrines, vascular and head and neck and comprehensive care of trauma and critical care. The general surgeon will continue to play a major role in future to suit the changing trends in surgical practice especially with the recent advances in endoscopic and laparoscopic surgery. The general surgeon of the future should continue to have a broad based training, be knowledgeable in basic sciences and responsible for total care of the patient and at the same time, have a special interest and expertise in subspecialty. General Surgery should continue to provide the basic training for all specialties, foster basic and clinical research and provide a solid foundation for all surgical trainees and above all continue the leadership role in the teaching of undergraduate students.

Forecasting↗
PubMed1999

Monitoring of antimicrobial prophylaxis in general surgery.

The incidence of infections in general surgery is related to different factors. Cost-benefit analysis of antimicrobic prophylaxis is positive, even though incorrect use may be even dangerous (development of resistance and/or superinfections, for instance). The authors report data on a study concerning a total of 316 patients divided into two series, who had antimicrobic prophylaxis before a surgical operation. 274 patients out of 316 (or 86.7%) had an ultra-short (one-shot-only) or short (<24 hours) prophylaxis, 42 (13.3%) standard (>24 hours). The operations performed were classified following class of contamination, i.e. I (clean), II (potentially contaminated), III (contaminated). Antibiotics used were ceftizoxime, cefepime, ceftriaxone, piperacillin and gentamicin in combination. A total of 16 postoperative infections was observed (5%); 11 of these 16 belonged to class III operations. Escherichia coli and Staphylococcus aureus were isolated in most of the infected wounds. The data confirm what is reported in the literature. The authors conclude that a preoperative single-shot 3rd or 4th generation cephalosporin reduces the incidence of wound infections in clean and clean-contaminated surgery.

Antibiotic Prophylaxis↗
PubMed1980

[Use of althesin in general surgery with particular reference to ophthalmic surgery].

Personal experience with Althesin in general surgery, with particular regard to eye surgery, is reported. Ocular tonometry was carried out in all patients. This showed that a diminution is a constant feature of Althesin anaesthesia. In 80% of patients, the diminution in O.T. values was 50% compared to basal levels. The O.T. reduction brought on by Althesin was also significant after administration of succinylcholine which is well known to cause a rise in ocular tension. Results also show a reduction in curare consumption in all anaesthesias carried out with Althesin. It is concluded that the drug is completely reliable in all branches of surgery.

Adolescent↗
PubMed2001

Intraoperative cholangiography in laparoscopic cholecystectomy during residency in general surgery.

BACKGROUND: The role of laparoscopic intraoperative cholangiography (IC) in the diagnosis of asymptomatic choledocholithiasis is still controversial. The aim of this study was to evaluate the diagnostic-therapeutic impact and the educational implications of this method for residents specializing in general surgery. METHODS: We reviewed the records of 835 patients who underwent laparoscopic cholecystectomy for cholecystolithiasis without choledocholithiasis. IC was routinely performed by both expert surgeons and residents in general surgery. RESULTS: The cholecystectomy was completed laparoscopically in 804 cases, but conversion to open surgery was required in 31 cases. IC was not completed in 140 cases (17.4%), and in 44 cases it revealed a suspected choledocholithiasis. The stones were treated via laparoscopy in 36 cases, laparotomy in six cases, and endoscopic retrograde cholangiopancreatography (ERCP) in two cases. Five patients were not diagnosed wit h choledocholithiasis. In one case, a lesion of the choledochus was discovered and treated laparoscopically. A total of 610 IC were done by expert surgeons and 225 by residents. The duration of the cholecystectomy with IC was significantly different between the two groups (76.9 +/- 12 vs 92.4 +/- 11), as was the feasibility index (88.6% vs 80.6%). CONCLUSIONS: Laparoscopic IC is a safe and accurate procedure for the diagnosis of unrecognized choledocholithiasis. Teaching of this procedure as part of the specialization in general surgery would be opportune because it would provide surgical residents with an additional tool for the diagnosis and treatment of this pathology of the common bile duct.

Adolescent↗
PubMed2006

The status of ultrasonography training and use in general surgery residency programs.

BACKGROUND: Effective use of ultrasonography (US) by surgeons was demonstrated a decade ago. Major surgical organizations now require its incorporation into surgical training and practice. But little information about the teaching of US to surgical residents exists. This study assesses the current status of US training in general surgery residency programs. STUDY DESIGN: A survey was mailed to the directors of 255 Accreditation Council for Graduate Medical Education-accredited general surgery residency programs. It questioned whether and how US was taught, who performed the examinations, and the types of US performed. Data were analyzed using chi-square tests comparing university versus community programs and training and practice in trauma US versus training in other US modalities. RESULTS: The response rate was 51% (130 of 255). Ninety-six percent of the programs responding taught US, with no differences between university- and community-based training programs in presence of training. Focused Assessment for the Sonography of Trauma (FAST) instruction was done by 79% (hands-on) and 68% (didactic) of programs that responded. Abdominal, laparoscopic, breast, endocrine, and vascular US were each taught less frequently (22% to 55%). Program directors at university programs reported that their attending surgeons performed FAST and abdominal US more often than their community counterparts (71% and 31% versus 47% and 14%). Program directors reported that university trainees performed laparoscopic, endocrine, and vascular US more often than community surgery residents (47%, 17%, 35% versus 29%, 3%, 19%). Program directors reported that surgery attendings or residents performed trauma and laparoscopic US more often than their radiology counterparts, and radiology attendings or residents performed more abdominal, breast, endocrine, and vascular US. CONCLUSIONS: The majority of general surgery residency programs whose directors responded to this survey are teaching US, but most of the training is in FAST. There is no difference in the reported presence of overall US training between university and community programs. But university programs report that their surgeons or residents performed more US in all areas (other than breast) than their community counterparts reported.

General Surgery↗
PubMed1992

Specialism and generalism in the future of general surgery.

The progressive specialism that has characterized the practice of medicine over the last 100 years has occurred almost entirely in a scientific context. Societal needs and social changes have had little influence. As we near the end of the 20th century the benefits of scientific specialism are being questioned. New historical studies of specialism have shown that factors other than new knowledge are the driving force for the creation of some subspecialties. The process by which a new subspecialty is established requires both a national institute and a certification examination. Certification is intended to identify those with specific knowledge and skill by inclusion, but is being perceived increasingly as a process that works by exclusion. General surgery, one of the few "generalist" disciplines, finds itself at a crossroads. Further subspecialization with certification will fragment and destroy the discipline. There are cogent arguments, based on economics and care-delivery issues, to preserve general surgery. Making this choice will commit general surgeons to accept the concept of scientific generalism and to the development of the specialty of general surgery in a social context.

Canada↗
PubMed1992

[Familiarity with diseases of the esophagus, stomach and pancreas among trainees who applied for specialization in general surgery].

The range of knowledge of the diseases of oesophagus, stomach and pancreas amongst 277 trainees in general surgery has been investigated by means of the 180 multiple-choice question examination. Analysis of the results revealed that the knowledge of the above subject with constituted 19% of the questions, does not differ from that of the rest of general surgery problems, distributed in the remaining 81% of the test's content.

Education, Medical↗
PubMed2006

The effect of the 80-hour work week on general surgery resident operative case volume.

To meet the new duty hour restrictions on July 1, 2003, our general surgery residency program underwent many changes. The purpose of this study was to examine whether the implementation of these changes, made in part to comply with new duty hour restrictions, would adversely impact general surgery residents' operative volume. The operative cases of categorical surgical residents were recorded from July 1, 2000 to December 31, 2004. The main outcome measure was the median number of operative cases performed by each resident per quarter (a 3-month period). The number of in-house calls each resident took per quarter was also recorded. From 2000 to 2004, the median number of in-house calls per quarter significantly decreased (27, 25, 15, 10, and 14, respectively; P < 0.001). The median number of operative procedures performed did not vary from quarter to quarter (P = 0.49). There was a trend toward an increase in number of cases performed at the postgraduate year (PGY) 1 (P = 0.07) and 2 (P = 0.04) levels, a decrease at the PGY3 level (P = 0.058), and no change at the PGY4 and 5 years. The 80-hour work week did not adversely affect the operative experience of our categorical surgical residents despite significant reductions of in-house call.

California↗
PubMed1980

[Problems of general surgery in the cardiosurgical patient].

The preoperative problem is analysed with proposal of a heart risk index table and assessment of the manifold problems involved. Stress is thenn laid on the importance of careful postoperative treatment, establishing rules of surgical and resuscitatory behaviour to be followed in the general surgery of the heart patient. These rules of behaviour permit prevention of surgical complications, which are fully illustrated. Particular attention is paid to the selection of those conditions of pertinence to general surgery which have treatment of choice prior to heart surgery. Personal experience of 75 general surgery operations between 1977 and 1979 in the Villa Pia Clinic is then reviewed.

Cardiac Surgical Procedures↗
PubMed2003

General surgery residents improve efficiency but not outcome of trauma care.

BACKGROUND: Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents. METHODS: Our urban Level I trauma center has traditionally used 24-hour in-house postgraduate year-4 general surgery residents in conjunction with at-home trauma attending backup to provide trauma care. As of July 1, 2000, general surgery residents no longer participated in trauma patient care, leaving sole responsibility to an in-house trauma attending. Data regarding patient outcome and resource use with and without surgery resident participation were tabulated and analyzed. Continuous data were compared using Student's t test if normally distributed and the Mann-Whitney U test if nonparametric. Categorical data were compared using chi2 analysis or Fisher's exact test as appropriate. RESULTS: During the 5-month period with resident participation, 555 trauma patients were admitted. In the identical time period without residents, 516 trauma patients were admitted. During the period without housestaff, patients were older and more severely injured. Mechanism was not different during the two time periods. Mortality was not affected; however, time in the emergency department and hospital lengths of stay were significantly shorter with residents. Multiple regression confirmed these findings while controlling for age, mechanism, and Injury Severity Score. CONCLUSION: Although resident participation in trauma care at a Level I trauma center does not affect outcome, it does significantly improve the efficiency of trauma care delivery.

Adult↗
PubMed1990

Specialisation in general surgery.

This survey was designed to determine the current status of specialisation within general surgery amongst newly appointed consultants in the United Kingdom, and to document the extent of specialist training on programmes of higher surgical training. It was carried out in 1988 under the auspices of the Association of Surgeons in Training, to determine whether consultants appointed in recent years had maintained, developed, or abandoned subspecialist practice. A separate survey of senior registrars in general surgery examined their attitudes to the apparent need to offer a special interest at the time of consultant appointment, and afterwards in practice. Although a majority of general surgical trainees and newly appointed consultants support specialist training as a part of higher surgical training programmes, this survey suggests that some programmes are not achieving this ideal.

Attitude of Health Personnel↗
PubMed1995

Does research during general surgery residency correlate with academic pursuits after pediatric surgery residency?

A study was designed to evaluate whether successful candidates in pediatric surgery have performed laboratory research with publication, and if such preparation leads to continued investigations. We requested a curriculum vitae from the 248 pediatric surgeons who began their pediatric surgery residencies (PSR) between 1979 and 1992. For nonresponders, data were collected from physician directories. Indicators of academic status, personal information, and publication data were obtained. Responders had more publications before, during, and after PSR. Those who published during general surgery residency (GSR) had more research years during their residency. Among responders, 59% had spent time in the laboratory, and the percentage with laboratory time increased over the study period. Those with laboratory experience had more laboratory and clinical papers before PSR. Ninety-four percent were from university-based GSRs and 6% were from community GSRs. University general surgery residents did not have more publications during GSR or PSR but had a greater number of publications after PSR. University general surgery residents had more laboratory publications during GSR and after PSR, but did not have more clinical publications. Publications during GSR and after PSR increased during the study period, but not during PSR. Time in the laboratory during GSR did not independently predict continued laboratory research. Those with laboratory papers during GSR did not publish more basic science papers after PSR. Several surgeons had basic science publications that were initiated only after their PSR. In a recent study that compared successful and unsuccessful PSR candidates, the successful candidates were found to have more publications.(ABSTRACT TRUNCATED AT 250 WORDS)

Achievement↗
PubMed2006

Internal medicine and general surgery residents' attitudes about the ACGME duty hours regulations: a multicenter study.

PURPOSE: To assess internal medicine and general surgery residents' attitudes about the effects of the Accreditation Council for Graduate Medical Education duty hours regulations on medical errors, quality of patient care, and residency experiences. METHOD: In 2005, the authors surveyed 200 residents who trained both before and after duty hours reform at six residency programs (three internal medicine, three general surgery) at five academic medical centers in the United States. Residents' attitudes about the effects of the duty hours regulations on the quality of patient care, residency education, and quality of life were measured using a survey instrument containing 19 Likert scale questions on a scale of 1 to 5. Survey responses were compared using the Student's t-test. RESULTS: The response rate was 80% (159 residents). Residents reported that whereas fatigue-related errors decreased slightly, errors related to reduced continuity of care significantly increased. Additionally, duty hours regulations somewhat decreased opportunities for formal education, bedside learning, and procedures, but there was no consensus that graduates would be less well trained after duty hours reform. Residents, particularly surgical trainees, reported improvements in quality of life and reduced burnout. CONCLUSIONS: Residents in medicine and surgery had similar opinions about the effects of duty hours reform, including improved quality of life. However, resident opinions suggest that reduced fatigue-related errors have been offset by errors related to decreased continuity of care and that the quality of the educational experience may have declined. Quantifying the degree to which regulating duty hours affected errors related to discontinuity of care should be a focus of future research.

Attitude↗
PubMed1991

[Role of the A2 hospital in general surgery training in Switzerland].

A full training in general surgery is difficult to achieve and involves an important professional commitment. In Switzerland, surgical theoretical and operative knowledge is mainly acquired in University Hospitals (A1 hospitals). A2 hospitals (smaller teaching hospitals) can be the best complement for this training. In these departments, general surgeons have a broad field of activity, including gastrointestinal, chest, vascular, outpatient surgery, conservative treatment and internal fixation of fractures and, sometimes, surgical endoscopy. Operative activity is intense. These departments thus allow privileged teaching positions for surgical residents and chief residents.

Curriculum↗