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BACKGROUND: Ratios of women graduating from the only US military medical school and entering surgical internships were reviewed and compared with national trends. METHODS: Data were obtained from the Uniformed Services University of the Health Sciences graduation announcements from 2002 to 2012. RESULTS: There were 1,771 graduates from 2002 to 2012, with 508 female (29%) and 1,263 male (71%) graduates. Female graduates increased over time (21% to 39%; P = .014). Female general surgery interns increased from 3.9% to 39% (P = .025). Female overall surgical subspecialty interns increased from 20% in 2002 to 36% in 2012 (P = .046). Women were represented well in obstetrics (57%), urology (44%), and otolaryngology (31%), but not in neurosurgery, orthopedics, and ophthalmology (0% to 20%). CONCLUSIONS: The sex disparity between military and civilian medical students occurs before entry. Once in medical school, women are just as likely to enter general surgery or surgical subspecialty as their male counterparts. Increased ratio of women in the class is unlikely to lead to a shortfall except in specific subspecialties. [ABSTRACT FROM AUTHOR]

BACKGROUND: An operative anatomy course was developed within the construct of a surgical internship preparatory curriculum. This course provided fourth-year medical students matching into a surgical residency the opportunity to perform intern-level procedures on cadavers under the guidance of surgical faculty members. METHODS: Senior medical students performed intern-level procedures on cadavers with the assistance of faculty surgeons. Students' confidence, anxiety, and procedural knowledge were evaluated both preoperatively and postoperatively. Preoperative and postoperative data were compared both collectively and based on individual procedures. - RESULTS: Student confidence and procedural knowledge significantly increased and anxiety signif- icantly decreased when preoperative and postoperative data were compared (P < .05). Students reported moderate to significant improvement in their ability to perform a variety of surgical tasks. CONCLUSIONS: The consistent improvement in confidence, knowledge, and anxiety justifies further development of an operative anatomy course, with future assessment of the impact on performance in surgical residency. [ABSTRACT FROM AUTHOR]

BACKGROUND: Medical students commonly enroll in courses known as "subinternships" before residency application. This study investigated the experiences and needs of students completing subinternships in surgery. METHODS: Electronic surveys were sent to medical students applying to the surgery residency program at our institution and to medical student clerkship directors for distribution nationally. Approximately 700 surveys were distributed with 275 completed (39%). RESULTS: Sixty-one percent of respondents indicated subinternships influenced specialty choice, and 82% of this group applied in general surgery. General surgery applicants rated mentorship (93%) and clerkship experience (92%) as important factors for specialty choice. Technical skills education was rated as beneficial by 89% of respondents, but formal laboratories were included only in 21% of courses. Only 49% received course objectives, and less than 10% were given a reading schedule. CONCLUSIONS: Opportunity exists to define a curriculum for surgical subinternships in order to address student needs for specific didactics for residency preparation and technical skill enhancement. [ABSTRACT FROM AUTHOR]

BACKGROUND: On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) eliminated 30-hour call in an attempt to improve resident wakefulness. We surveyed interns on the Newton Wellesley Hospital (NWH) surgery service before and after the transition from Q4 overnight call to a night float schedule. METHODS: For 15 weeks, interns completed weekly surveys including the Epworth Sleepiness Scale (ESS). The service changed to a night float schedule after 3 weeks (ie, first to 3-4 and then to 6 nights in a row). RESULTS: The average ESS score rose from 9.8 ± 5.2 to 14.9 ± 3.1 and 14.4 ± 4.5 (P =.042) on the 3/4 and 6/1 schedules, respectively. Interns were more likely to be abnormally tired on either night float schedule (relative risk = 2.86; 95% confidence interval, 1.17-6.97, P = .029). CONCLUSIONS: The new ACGME work hours increased the ESS scores among interns at NWH and caused interns to be more tired than interns on the Q4 schedule. This is likely caused by the multiple nights of poor sleep without a post-call day to make up sleep. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Fundamentals of Surgery Curriculum (FSC) is an interactive system that engages interns in case-based scenarios that involve identifying symptoms, ordering tests, and formulating treatment plans. In this study, we examined the usefulness of the FSC as a knowledge preparatory tool for incoming interns. METHODS: Twenty incoming interns participated in this study. Half were asked to complete 96 FSC cases before internship orientation (ie, the experimental group). The other half did not receive FSC accounts (ie, the control group). During orientation, all interns completed an examination that was representative of the FSC cases. Interns completed a survey to assess the usefulness of the FSC cases. American Board of Surgery In-Training Examination (ABSITE) scores were also examined. RESULTS: Interns in the experimental group completed an average of 71.1 cases before taking the examination and had higher median examination percent correct scores (P < .011). Interns rated the FSC cases as "extremely helpful." There were no differences in terms of ABSITE percentile rank or the basic science and clinical management sections of the ABSITE. CONCLUSIONS: The FSC is a useful preparatory tool for interns when administered before starting internship; however, this benefit may not extend to the ABSITE. [ABSTRACT FROM AUTHOR]

Abstract: Political initiatives and European health and safety working time regulations have combined to reduce the time available for surgical training in the United Kingdom in the future by a third. For the safety of patient care, surgeons must evolve strategies to cope with these reduced training times so that they preserve the current high level of competence exhibited by UK trainees when they attain the right to independent surgical practice recognized by appointment as a Consultant Surgeon. Such strategies include a focus on dedicated training time, the use of simulators, and a move towards progression based on satisfactory completion of a defined curriculum and competency assessment rather than the amount of time served. With insufficient time to train in every aspect of general surgery, a move towards fragmentation into its sub-speciality components seems unavoidable. Such a move offers an opportunity to re-evaluate conventional surgical training and to consider the evolution of a system-specific vascular specialist with patient-focused expertise in vascular surgery, endovascular radiology, and vascular medicine. [Copyright &y& Elsevier]

: BackgroundStudies have provided little evidence that critical appraisal skills improve with focused courses. However, outcome measures in these studies have been questionable. The goal of this study was to develop a feasible, reliable, and valid assessment of critical appraisal skills.: MethodsForty-four surgery residents read three articles and then responded to short answer questions and provided 7-point ratings regarding various methodological aspects of each article. Reliability and validity of the examination were assessed.: ResultsThe mean score was 52.4% (SD 8.6%). Internal consistency of the 55-question examination was 0.77. Interrater reliability of clinician markers was 0.91. Mean score for residents with more intensive critical appraisal training was significantly higher than for those with little or no training (56.6% versus 49.3%, t35 = 2.31, P = 0.02), suggesting construct validity.: ConclusionsThis examination has promising psychometric properties, and may be useful in evaluating critical appraisal curricula. [Copyright &y& Elsevier]

: BackgroundThis study was performed to determine the impact of an endovascular program (EVP) on open and endovascular abdominal aortic aneurysm (AAA) operations in a residency training institution.: MethodsOver an 8-year period ending in September 2001, hospital records of all patients undergoing open or endovascular AAA repair were retrospectively reviewed. Data were analyzed to determine the changing patterns of case volume, type of operative repair, and complexity of open repair with regards to the training of both general surgical chief residents and vascular fellows.: ResultsA total of 849 AAA operations were performed during the study period. The initiation of the EVP in 1997 resulted in a steady increase in the total annual AAA cases (P < 0.05), due in part to an increase in endovascular AAA operations despite a decrease in the annual open AAA volume. EVP had a positive impact on the overall operative experience of vascular fellows owing to the large increase in their endovascular AAA experience (annual mean pre-EVP 3 ± 0.8 versus post-EVP 47 ± 9.6, P < 0.01). A significant reduction occurred in the vascular fellows’ open AAA experience (annual mean pre-EVP 40 ± 12.7 versus post-EVP 19 ± 9.4, P < 0.05). EVP did not affect the endovascular AAA experience of general surgery chief residents (annual mean pre-EVP 1 ± 0.8 versus post-EVP 3 ± 1.5, not significant). A significant reduction occurred in chief residents’ open AAA experience (annual mean pre-EVP 39 ± 9.7 versus post-EVP 18 ± 7.4, P < 0.05). EVP did not affect the operative experience of complex open AAA operations in either vascular fellows or general surgery residents.: ConclusionsAn endovascular program has a positive impact on the aortic aneurysm practice in an academic institution, as evidenced by the significant increase in annual endovascular AAA cases despite a decrease in open AAA operations. Although vascular fellows continued to maintain sufficient experience in both open and endovascular AAA operations, general surgery chief residents suffered a significant decrease in their open AAA experience. Further evaluation of the residency system is warranted to better optimize the training paradigm of both vascular fellowship and general surgery residency. [Copyright &y& Elsevier]

: BackgroundResident work hours may impact patient care. We hypothesized that “call-associated” acute sleep deprivation has no effect on technical dexterity as measured on a minimally invasive surgery trainer, virtual reality (MIST VR) surgical simulator.: MethodsThirty-five surgical residents were prospectively evaluated pre-call (rested), on-call (rested), and post-call (acutely sleep deprived). Participants completed questionnaires regarding sleep hours and level of fatigue. Technical skill was assessed using the MIST VR. Speed, errors, and economy of motion were automatically recorded by the MIST VR computer simulator. Data were analyzed by paired Student t test and analysis of variance.: ResultsEstimated hours of sleep and subjective indicators of fatigue were different between rested and sleep-deprived residents. The number of errors and time to complete all tasks increased at the post-call assessment.: ConclusionsResident work schedules lead to sleep deprivation and fatigue. Call-associated sleep deprivation and fatigue are associated with increased technical errors in the performance of simulated laparoscopic surgical skills. [Copyright &y& Elsevier]

: BackgroundThis study was undertaken to determine the impact that a resident teaching model for advanced laparoscopic skills has on performance, using outcome for laparoscopic colectomy as an indicator of efficacy.: MethodsSix senior surgical residents took part in a model for teaching advanced laparoscopic procedures over 3 years. Animal laboratory sessions, tutorial sessions, and feedback were the principle components of this model with residents evaluating each component and their operative experiences. Conversion rates, hospital length of stay, and operating time during the 3 years (n = 100) were compared with a previous year (baseline year) where the faculty performed most of a procedure (n = 20).: ResultsEach resident performed an average of 17 cases, being the primary surgeon after the sixth case. There were no differences in operative time for both right and left colectomies compared with the baseline year. Postoperative length of stay was less than 5 days by year 3, with a 14% conversion rate to open surgery. Feedback and tutorials were deemed most important for strategic planning and for reducing operative time.: ConclusionsResident participation in advanced laparoscopic surgery, concurrent with structured skills development and feedback, portends very favorable outcomes. [Copyright &y& Elsevier]

: BackgroundThis study was a formative evaluation of a 2-year Surgical Skills Center Curriculum (SSCC) using objective measures of surgical performance and self-reported process-oriented evaluations.: MethodsFifty postgraduate third-year (PGY-3) residents participated in an Objective Structured Assessment of Technical Skills (OSATS) examination. Nineteen residents underwent the SSCC and 31 residents did not. During the SSCC, self-reported student and faculty evaluations were completed after each session.: ResultsFor the OSATS examination, scores were not significantly different between treatment and control groups, on either the checklist (66.4 ± 6.1 versus 64.1 ± 10.8) or global rating scale scores (66.9 ± 6.9 versus 68.0 ± 9.6). Further comparisons between groups on individual OSATS stations revealed no significant differences between groups. The majority of student and faculty evaluation remarks were highly positive.: ConclusionsThe OSATS results failed to support our hypothesis that training on a core procedure in a single session during a SSCC would have an appreciable and sustained effect after 2 years. Self-reported process-oriented evaluations support the utility of our SSCC. [Copyright &y& Elsevier]

Background: A system for obtaining learner feedback on surgical faculty teaching is a program-specific resource for recognizing faculty accomplishments as well as being a requirement of the Accreditation Council for Graduate Medical Education (ACGME). This investigation uses 5 years of feedback from residents to identify surgical teaching behaviors that define teaching excellence.Methods: Between 1995 and 1999 full-time surgeons in a division of general surgery were evaluated biannually by every resident on their services, using two 10-item Likert scales to assess frequency of performing selected teaching behaviors. Response categories ranged from 0 (does not demonstrate) to 4 (demonstrates the behavior to a very high degree). Mean scores > or =3.7 (1 SD above the mean) were categorized as evidence of superior teaching, whereas mean scores < or =2.4 (1 SD below the mean) were categorized as mediocre. Residents wrote statements identifying teaching strengths.Results: There were 753 individual resident assessments of 16 faculty. The overall mean rating for operating room and clinic teaching was 3.1, with 24% of the ratings > or =3.7 and 14% of the ratings < or =2.4. For operating room, discriminant behaviors were: demonstrates sensitivity to resident learning needs (3.85 versus 1.62, P <0.01) and provides direct feedback (3.60 versus 1.27, P <0.01). Residents' statements yielded themes tied to superior teaching: demonstrates technical expertise, allows resident participation, and maintains a learning climate of respect.Conclusions: A resident-based teaching assessment system can offer a reasonable and valid form of feedback to academic surgeons. The use of mixed methods to identify teaching behaviors that characterize excellence informs faculty of how they are perceived as educators and provides examples of specific behaviors that merit commendation. [ABSTRACT FROM AUTHOR]

Surgeon scientists are a vanishing group, a reason for which may be an initially frustrating experience in the laboratory. This essay proposes a specific plan to improve the first time researcher’s bench research experience. [Copyright &y& Elsevier]