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Background Professionalism is a core competency that is difficult to assess. We examined the incidence of publication inaccuracies in Electronic Residency Application Service applications to our training program as potential indicators of unprofessional behavior. Study Design We reviewed all 2019-2020 National Resident Matching Program applicants being considered for interview. Applicant demographic characteristics recorded included standardized examination scores, gender, medical school, and medical school ranking (2019 US News & World Report). Publication verification by a medical librarian was performed for peer-reviewed journal articles/abstracts, peer-reviewed book chapters, and peer-reviewed online publications. Inaccuracies were classified as “nonserious” (eg incorrect author order without author rank promotion) or “serious” (eg miscategorization, non-peer-reviewed journal, incorrect author order with author rank promotion, nonauthorship of cited existing publication, and unverifiable publication). Multivariate logistic regression analysis was performed for demographic characteristics to identify predictors of overall inaccuracy and serious inaccuracy. Results Of 319 applicants, 48 (15%) had a total of 98 inaccuracies; after removing nonserious inaccuracies, 37 (12%) with serious inaccuracies remained. Seven publications were reported in predatory open access journals. In the regression model, none of the variables (US vs non-US medical school, gender, or medical school ranking) were significantly associated with overall inaccuracy or serious inaccuracy. Conclusions One in 8 applicants (12%) interviewing at a general surgery residency program were found to have a serious inaccuracy in publication reporting on their Electronic Residency Application Service application. These inaccuracies might represent inattention to detail or professionalism transgressions.

A sports medicine physician manages musculoskeletal (MSK) injuries and sport-related medical and MSK conditions of patients of all ages and abilities. Physical medicine and rehabilitation physicians (physiatrists) must be adequately trained to provide this care for all patients including, but not limited to, athletes participating in organized sports, the weekend warrior as well as athletes with disabilities. Accreditation Council of Graduate Medical Education core requirements and basic guidelines help physiatry residency training programs develop and implement residency curriculums. The goal of this article is to provide suggested curricular guidelines to optimize physiatrist training in MSK and sports medicine.

INTRODUCTION The training pathway for plastic surgery has evolved in recent years with the adoption and rise in popularity of the integrated model. Studies have demonstrated that there may be differences between integrated graduates and independent graduates, specifically in career choices and type of practice. This study seeks to understand if there are differences in representation at academic and leadership positions between graduates of the 2 pathways. METHODS A cross-sectional study was conducted in June of 2018 to assess integrated and independent pathway graduate's representation in academic plastic surgery in the United States. Factors examined were career qualifications, academic productivity, faculty positions, and influence of pathway on career advancement. RESULTS A total of 924 academic plastic surgeons were analyzed, 203 (22.0%) of whom were integrated graduates and 721 (78.0%) of whom were independent graduates. Independent graduates had greater National Institutes of Health funding (integrated, $40,802; independent, $257,428; P = 0.0043), higher h-index (integrated, 7.0; independent, 10.0; P < 0.001), and higher publication number (integrated, 17; independent, 25; P = 0.0011). Integrated graduates were more likely to be assistant professors (integrated, 70%; independent, 40.7%; P < 0.001) and required a shorter postresidency time to reach all positions examined compared with independent graduates. CONCLUSIONS Residency training pathway influences academic plastic surgeons in research output, qualifications, and academic positions. This is likely due to the relatively new nature of the integrated program compared with the independent, as well as the shorter length of training for integrated graduates. However, trends are moving toward integrated graduates showing increased interest and productivity in academic medicine.

Chairs/chiefs of plastic surgery departments/divisions are responsible for directing activities at academic institutions and thus help determine the direction of academic plastic surgery. Other studies have characterized this group but have not shown which characteristics separate them from other surgeons in the field. To study this relationship, a cross-sectional analysis of plastic surgery faculty affiliated with United States residency training programs (n = 99) was initiated. Data were collected from public online websites. Univariate and multivariate logistic regression were used to identify factors independently associated with chairs/chief status. Sub-analyses were performed within Tiers stratified by residency program rank of chair/chief's current institution. Among 943 plastic surgeons, 98 chairs/chiefs were identified. In accordance with prior literature, most are male (89%) and fellowship-trained (62%), and they have a median H-index of 17. Compared to other surgeons, chair/chiefs have more years in practice (odds ratio [OR]: 1.026, confidence interval [CI]: 0.002-0.049, P = 0.034), higher H-index (OR: 1.103, CI: 0.048-0.147, P

Introduction:Surgical experience requires skills traditionally taught through real-time operating room education and a variety of supplemental educational strategies. Video-based coaching i...

Background Linton A. Whitaker is a pioneer of craniofacial surgery. He served as chief of plastic surgery at the Children's Hospital of Philadelphia and University of Pennsylvania and director of the craniofacial training program. Herein, the authors reflect on his legacy by studying the accomplishments of his trainees. Methods Dr Whitaker's trainees who completed (a) craniofacial fellowship training while he was director of the program or (b) residency training while he was chief were identified. Curricula vitae were reviewed. Variables analyzed included geographic locations, practice types, academic leadership positions, scholarly work, and bibliometric data. Results Between 1980 and 2011, 34 surgeons completed craniofacial fellowship training under Dr Whitaker, and 11 completed plastic surgery training under his chairmanship and subsequent craniofacial fellowship. The majority had active craniofacial practices after training (83.3%) and practice in an academic setting (78.0%). Most settled in the northeast (31.1%) and south (31.1%) but across 24 states nationally. Overall, the mean ± SD number of publications was 76 ± 81 (range, 2-339); book chapters, 23 ± 29 (0-135); H-index, 18 ± 12 (1-45); and grants, 13 ± 16 (0-66). Of those who pursued academia, 53.1% were promoted to full professor, 46.9% had a program director role, 75.0% directed a craniofacial program, and 53.1% achieved the rank of chief/chair. Conclusions Equally important to Dr Whitaker's clinical contributions in plastic and craniofacial surgery is the development and success of his trainees who will undoubtedly continue the legacy of training the next generation of craniofacial surgeon leaders.

Coronavirus disease (COVID-19) has profoundly impacted residency training and education. To date, there has not been any broad assessment of urological surgery residency changes and concerns during the COVID-19 pandemic.The Society of Academic Urologists distributed a questionnaire to urology residency program directors on March 30, 2020 exploring residency program changes related to the COVID-19 pandemic. Descriptive statistics are presented. A qualitative analysis of free response questions was undertaken. A post hoc analysis of differences related to local COVID-19 incidence is described.The survey was distributed to 144 residency programs with 65 responses for a 45% response rate. Reserve staffing had started in 80% of programs. Patient contact time had decreased significantly from 4.7 to 2.1 days per week (p0.001). Redeployment was reported by 26% of programs. Sixty percent of programs reported concern that residents will not meet case minimums due to COVID-19. Wellness activities centered on increased communication. All programs had begun to use videoconferencing and the majority planned to continue. Programs in states with a higher incidence of COVID-19 were more likely to report resident redeployment (48% vs 11%, p=0.002) and exposure to COVID-19 positive patients (70% vs 40%, p=0.03), and were less likely to report concerns regarding exposure (78% vs 97%, p=0.02) and personal protective equipment availability (62% vs 89%, p=0.02).As of April 1, 2020 the COVID-19 pandemic had resulted in significant changes in urology residency programs. These findings inform a rapidly changing landscape and aid in the development of best practices.

Supplemental digital content is available in the text., SIGNIFICANCE Men earn at least 6.5% more than women in their first full-time jobs as optometrists. For current salaries, the gender wage gap is more than 13%. This study details the gender wage gap that remains after controlling for practice ownership, residency training, and employer-defined full-time work. PURPOSE The purpose of this study was to measure the gender wage gap by region and practice type for full-time optometrists who did not complete a residency and do not own their practice. METHODS Participants completed an online survey, providing data for their first and current optometry positions and demographic information. Respondents who reported full-time employment in the United States, not completing a residency, and not owning their practice were selected for further analysis by census region and practice type. In each category, the gender wage gap was calculated. RESULTS In all regions and practice types, men were paid higher starting salaries than women. For current salaries, men were paid higher in almost all regions and practice types. The wage gap increased from starting salary to current salary, although not in all regions and practice types. CONCLUSIONS When practice ownership, residency completion, and full-time work are controlled for, there remains a difference in the pay received by men and women in optometry. The salary data presented in this study may help optometrists narrow the wage gap.

BACKGROUND The management of battlefield trauma requires a specific skill set, which is optimized by regular trauma experience. As military casualties from the prolonged conflicts in the Middle East decrease, challenges exist to maintain battlefield trauma readiness. Military surgeons must therefore depend on the Military Health System. The purpose of the study was to evaluate the frequency of surgical cases relevant to deployed combat casualty care performed at military treatment facilities (MTFs). METHODS Combat casualty care relevant cases (CCC-RCs) were defined as emergent, open surgical cases in which the patient required a blood transfusion. Case logs from four military treatment centers with surgical residency training programs were used. Twenty-four months of case records between January 1, 2017, and January 1, 2019, were included to determine total numbers of CCC-RCs at each institution. The results were compared with San Antonio Military Medical Center's, the Department of Defense's only American College of Surgeons-verified level 1 trauma center. RESULTS Fifty-one trauma/general surgeons and six vascular surgeons case logs were examined. Thirty (0.3%) of 10,529 cases performed by trauma/general and vascular surgeons over the 2-year study period were considered CCC-RCs. These results were in contrast to San Antonio Military Medical Center, which had a significantly higher proportion of CCC-RCs (113 of 320 cases, 35.3%, p < 0.0001). CONCLUSION A cross-section of MTF surgical case complexity demonstrates a lack of cases considered to be CCC-RCs. At the MTFs evaluated, surgical case surrogates for combat trauma and combat casualty care is close to zero. These data are potentially representative of other military treatment centers, which focus on beneficiary care. For readiness purposes, MTFs that care primarily for Tricare beneficiaries without a significant trauma population should not be considered meaningful sources of CCC-RCs for trauma/general and vascular surgeons. LEVEL OF EVIDENCE Therapeutic/care management study, level V.

The practice of plastic surgery has become more complex. As plastic surgeons face the post-graduate realities of contracts, negotiations, and health system employment, they are frequently unprepared to effectively manage these challenges. Further, many plastic surgery training programs do not emphasize real-world business and policy concerns in residency training. Plastic and Reconstructive Surgery endeavors to provide robust conceptual education and guidance in business and policy in order to help both private practice and academic plastic surgeons participate in, lead, and shape the future of healthcare.

Purpose of review This review aims to describe the influence of changes in obstetrics and gynecology on residency training and how tracking may help address emerging concerns around quality and safety in gynecologic surgery. Recent findings As has been shown in a variety of other surgical fields, recent evidence confirms that surgeries with higher volume gynecologists are associated with fewer complications, decreased cost, and an increase in use of minimally invasive surgery. Attending physicians and residents feel graduating obstetrics and gynecology (OB/GYN) trainees are unprepared to perform major surgery independently. Tracking has demonstrated tremendous success in general surgery, enriching trainee careers, allowing for increased operative and clinical experiences, enhancing autonomy, and improving mentorship, all while achieving equivalent or improved milestone achievement, case numbers, and board certification. A majority of medical students, residents, and OB/GYN residency program directors support tracking in OB/GYN. Currently, a single OB/GYN program provides tracking in the United States, with measurable success similar to that seen in general surgery. Summary Enhanced surgical volume results in better outcomes in gynecologic surgery, but current training models are insufficient to meet these volume demands. Tracking provides an attractive solution to create a more appropriate practicing model for physicians in women's health.

INTRODUCTION Current microsurgical training courses average 5 consecutive 8-hour days and cost US $1500 to US $2500/individual, making training a challenge for residents who are unable to take leave from clinical duties. This residency-integrated microsurgery course was designed for integration with a residency program, averaging 3 hours/week over 7 weeks. This allows for one-on-one training, beginning with synthetic tissue and concluding with in vivo stimulation. This study was performed to validate this longitudinal training course. METHODS After recruitment and before the start of coursework, subjects completed a baseline anastomosis without guidance and a survey regarding microsurgical experience. Subjects completed approximately 3 hours/week of practical exercises. Weeks 1 to 5 used synthetic models, whereas 6 to 7 used in vivo rodent models. Nine minimum anastomoses of increasing complexity were completed and assessed with the Anastomosis Lapse Index and the Stanford Microsurgery and Residency Training scale. Scoring was performed by 3 independent reviewers and averaged for comparison. RESULTS Five subjects completed the course for study. Presurvey results showed an average confidence in theoretical knowledge of 2/5; technical ability to perform procedures, 1.8/5; and ability to manage complications, 1.8/5. Postsurvey revealed confidence in theoretical knowledge of 2.5/5; technical ability to perform procedures, 2.25/5; and ability to manage complications, 2.25/5. None of these differences were significant. Each individual component of the Stanford Microsurgery and Residency Training scale scoring system improved postcourse with P < 0.05, and overall performance score improved from an average of 2.6 to 3.9 (P = 0.006). The total number of errors recorded using the Anastomosis Lapse Index reduced from 6.58 to 3.41 (P = 0.02). Time to completion reduced from an average of 28 minutes, 8 seconds to 24 minutes, 5 seconds (P = 0.003). CONCLUSIONS Despite a lack in significant confidence improvement, completion of the residency-integrated microsurgery course leads to significant and quantifiable improvement in resident microsurgical skill and efficiency.

Purpose A previous study found that milestone ratings at the end of training were higher for male than for female residents in emergency medicine (EM). However, that study was restricted to a sample of 8 EM residency programs and used individual faculty ratings from milestone reporting forms that were designed for use by the program's Clinical Competency Committee (CCC). The objective of this study was to investigate whether similar results would be found when examining the entire national cohort of EM milestone ratings reported by programs after CCC consensus review. Method This study examined longitudinal milestone ratings for all EM residents (n = 1,363; 125 programs) reported to the Accreditation Council for Graduate Medical Education every 6 months from 2014 to 2017. A multilevel linear regression model was used to estimate differences in slope for all subcompetencies, and predicted marginal means between genders were compared at time of graduation. Results There were small but statistically significant differences between males' and females' increase in ratings from initial rating to graduation on 6 of the 22 subcompetencies. Marginal mean comparisons at time of graduation demonstrated gender effects for 4 patient care subcompetencies. For these subcompetencies, males were rated as performing better than females; differences ranged from 0.048 to 0.074 milestone ratings. Conclusions In this national dataset of EM resident milestone assessments by CCCs, males and females were rated similarly at the end of their training for the majority of subcompetencies. Statistically significant but small absolute differences were noted in 4 patient care subcompetencies.

Background: The purpose of this study was to evaluate the trends in adult spinal cases performed by E-Da hospital graduating neurological surgery residents, then comparing the case volumes against the national means in the US. Materials and Methods: The E-Da surgical case volumes were extracted using the hospital billing system for the years 2008–2017. These logs were coded according to the Accreditation Council for Graduate Medical Education guideline, providing a fair comparison against US national means. Linear regression analyses were conducted to identify changes in spinal categories. Finally, an unpaired student t-test was performed to compare E-Da case volumes to America's national means. Results: An average of 781.5 total spinal procedures were performed in the past 4 years of residency training for each of the four graduated E-Da neurosurgical residents, with the individual total caseload increasing by 38.07 cases each year (r2 = 0.40). The US national average was 427.72 spinal procedures for each of the 877 graduating residents, increasing by 19.96 cases every year (r2 = 0.95). E-Da has significantly more thoracic/lumbar instrumentation fusion procedures (mean 486.00 ± 90.27) and anterior cervical approach for decompression/stabilization and fusion procedures (mean 182.75 ± 42.91) than the US (means 145.95 ± 3.07 and 72.66 ± 4.62, respectively). The US has significantly more lumbar discectomy procedures (mean 125.70 ± 2.89), posterior cervical approach for decompression/stabilization and fusion procedures (mean 56.98 ± 3.73) and peripheral nerve procedures (mean 26.2 ± 0.79) than E-Da (means 64.5 ± 8.54, 39.75 ± 4.99, and 8.50 ± 5.07, respectively). Conclusion: Neurosurgical residents' surgical case exposures to different spinal categories were very different in E-Da and the US. Case entry logs provide valuable information nationally and internationally.

The obstetric issues and management styles in China are different from that in Western countries. Chinese medical education, residency training, obstetric care structure, and management of common obstetric complications are briefly reviewed and compared to the United States. Maternal-fetal medicine (MFM) is rapidly developing in China, but the development of MFM may not follow the same trajectory as in the West. Understanding the difference between China and the West may facilitate communication and foster mutual development. Key words: Education; Internship and residency; Maternal fetal medicine; Medical; Obstetric care; Prenatal care

With a difficult National Institutes of Health (NIH) funding climate, the pipeline of physician-scientists in Anesthesiology is continuing to get smaller with fewer new entrants. This article studies current NIH funding trends and offers potential solutions to continue the historical trend of academic innovation and research that has characterized academic Anesthesiology. Using publicly available data, specifically the NIH REPORTeR and Blue Ridge Institute for Medical Research, we examined NIH trends in funding in academic Anesthesiology departments that have Anesthesiology residency training programs. When adjusted for inflation, median NIH funding of departments of Anesthesiology declined approximately 15% between 2008 and 2017. The majority (55%) of NIH funding to academic Anesthesiology departments, including R01 and K-series grants, went to 10 departments in the United States. This trend has remained relatively constant for the 9-year period we studied (2009-2017). There is an inequitable distribution of NIH funding to Anesthesiology departments. Arguably, this may be a case of the "rich get richer," but the implications for those who are trying to become or remain NIH-funded investigators are that success may depend, in part, on securing a faculty position in one of these well-funded departments.

Burnout has become commonplace in residency training, affecting more than half of residents and having negative implications for both their well-being and their ability to care for patients. During the authors’ year as chief medical residents at Brigham and Women’s Hospital in 2017–2018, they became intimately familiar with the burnout epidemic in residency training. The authors argue that addressing resident burnout requires residency programs and teaching hospitals to focus not on the individual contributors to burnout, but instead on fostering meaning within residency to help residents find purpose and professional satisfaction in their work. In this Perspective, they highlight four important elements of residency that provide meaning: patient care, intellectual engagement, respect, and community. Patient care, intellectual engagement, and community provide residents with a focus that is larger than themselves, while respect is necessary for a resident’s sense of belonging. The authors provide examples from their own experiences and from the literature to suggest ways in which residency programs and teaching hospitals can strengthen each of these elements within residency and curb the epidemic of burnout.

INTRODUCTION AND OBJECTIVE: Didactic lectures are a commonly used educational tool during urology residency training. Although all residency programs are expected to provide didactic content for their residents, the format of these sessions vary by presenter and institution. Currently, it is not clear which didactic format provides the most educational benefit. Herein, we aimed to evaluate which attributes of didactic education are most preferred by contemporary urology trainees. METHODS: Urology trainees during the 2020-21 academic year were invited to complete an online choice-based conjoint analysis exercise assessing four attributes associated with didactic education: method of delivery, presentation style, presenter credentials, and curriculum design. The survey was distributed via social media platforms and the Urology Collaborative Online Video Didactics (COViD) website. A sensitivity analysis (Sawtooth Software, Inc. Utah USA) was used to determine relative importance of each attribute and predict trainee preferences in didactic format (online/virtual vs. inperson). RESULTS: Of the 431 trainees who received the survey, 73 (17%) completed the conjoint analysis exercise, including 60 participants from the United States and 11 from international training programs. Nearly all trainees (72/73) preferred at least 1 hour of dedicated didactic education per week, with 67% responding that 2-3 hours of didactic time per week is ideal. Overall, the majority of respondents preferred online/virtual presentations (77%, 95% CI 70-84%) compared to in-person presentations. Respondents placed the most importance on presenter credentials, preferring national experts from visiting institutions to faculty members from their local institutions. Conjoint analysis revealed a preference trend toward an online didactic curriculum by increasing PGY year, with senior residents and fellows showing stronger preferences for online didactics compared to more junior trainees (Figure 1). CONCLUSIONS: Contemporary urology trainees prefer didactic education that is available in an online/virtual format, standardized across training institutions, and organized and presented by national experts in the field. This data should inform national educational efforts to standardize didactic learning for urology trainees. (Figure Presented).

BACKGROUND: The field of orthopaedic surgery is not free from sexual harassment, with one recent study revealing that 47% of surveyed American Academy of Orthopaedic Surgeons (AAOS) members reported experiencing sexual harassment during their careers. Further characterization of the reported sexual harassment experienced by orthopaedic surgeons is warranted, especially as it relates to women trainees. QUESTIONS/PURPOSES: (1) What is the overall proportion of women orthopaedic surgeons who reported having experienced sexual harassment during their orthopaedic residency? (2) Is the proportion of current orthopaedic trainees who report having experienced sexual harassment at work lower than the proportion of women attending orthopaedic surgeons who recall having been sexually harassed during their residency years? (3) Does this finding differ based on location of residency training? METHODS: An anonymous 12-question online survey was distributed between October 2019 and December 2019 to the 682 active and resident members of the Ruth Jackson Orthopaedic Society, a professional society for women orthopaedic surgeons. The survey was created by Speak Up, an organization that is dedicated to identifying and correcting sources of workplace sexual harassment. Though not validated, the authors felt that this survey was the most easily adaptable to reflect orthopaedic training, and the authors felt it had good face validity for the purpose in a study of this kind. A total of 37% (250 of 682) of those contacted returned completed surveys. Twenty percent (51 of 250) were current residents, and 80% (199 of 250) were currently in fellowship or in practice. All survey respondents self-identified as women. Survey data were analyzed using descriptive and comparative statistics to determine the differences in proportions of sexual harassment among current residents and attendings, as well as differences in geographic locations. RESULTS: Sixty-eight percent (171 of 250) of women reported having experienced sexual harassment during their orthopaedic training. We found no differences between current and past trainees in terms of the proportion who reported having experienced sexual harassment during residency training (59% [30 of 51] versus 71% [141 of 199], odds ratio 0.59 [95% CI 0.31 to 1.11]; p = 0.10). Compared with the northeast region of the United States, we found no differences in the proportion of women who reported having experienced sexual harassment during residency training in the South region (65% [55 of 84] versus 67% [36 of 54], OR 1.06 [95% CI 0.51 to 1.17]; p = 0.89), the Midwest region (75% [53 of 71], OR 1.55 [95% CI 0.77 to 3.12); p = 0.22), or the West region 66% [27 of 41], OR 1.02 [95% CI 0.46 to 2.23); p = 0.97). CONCLUSIONS: We found that a high proportion of women orthopaedic trainees report having experienced sexual harassment during orthopaedic residency. Residency programs should take steps to further identify and combat the sources of sexual harassment by increasing the number of women in leadership roles within the department and by ensuring that women trainees have adequate mentorship from both women and men attendings. After such measures are implemented, future studies should aim to evaluate their efficacy. LEVEL OF EVIDENCE: Level II, prognostic study.

Research training equips residents with the skills to consume and produce research evidence and deliver evidence-based care. Within Physical Medicine and Rehabilitation, studies have historically demonstrated low rates of resident research productivity. Although Canadian residency requirements mandate research participation, little is known about Canadian residents' research productivity. Using standard systematic review search strategies, we evaluated the rate and type of peer-reviewed publications produced by resident physicians during postgraduate medical training for a historic cohort of Physical Medicine and Rehabilitation residents who successfully passed the Canadian Royal College Fellowship examination in 2015, 2016, and 2017 (N = 74). Resident physicians produced 62 peer-reviewed publications during the study period. A total of 43.2% of resident physicians produced at least one such publication and 20.3% produced more than one. The resident physician was the first author for 51.6% of publications. Reviews were the most frequent publication type (19.4%), followed by observational studies (16.1%) and case reports (16.1%). Musculoskeletal conditions (11.3%) and stroke (9.7%) were the most frequent areas of study. Most publications were in nonrehabilitation journals. These findings demonstrate modest research productivity despite mandatory research participation; although research productivity is higher than in previous cohorts, publications of convenience, such as reviews and case reports, are similarly frequent.

BACKGROUND The authors sought to identify factors associated with current chiefs and chairpersons in academic plastic surgery to encourage and shape future leaders of tomorrow. METHODS Academic chairpersons in plastic surgery (n = 94) were identified through an Internet-based search of all Accreditation Council for Graduate Medical Education-accredited residency training programs during the year 2015. Sex, ethnicity, academic rank, board certification, time since certification, medical school attended, residency program attended, fellowships training, advanced degrees, obtaining leadership roles at trainee's institution, and h-index were analyzed. RESULTS Of the 94 chiefs and chairpersons, 96 percent were male and 81 percent obtained full professor status, and 98 percent were certified by the American Board of Plastic Surgery. Mean time since certification was 22 years (range, 7 to 45 years). Fifty-one percent graduated from 20 medical schools, whereas 42 percent graduated from only nine plastic surgery training programs. Fifty-six percent had pursued fellowship beyond their primary plastic surgery training. Eighteen percent had obtained advanced degrees. Twenty-nine percent of chiefs and chairpersons obtained leadership roles at the institution where they had completed plastic surgery training. The mean h-index was 17.6 (range, 1 to 63). Graduates of the nine most represented residency programs had a mean h-index of 21 versus 15 when compared with the remaining chief/chairpersons (p < 0.0062). CONCLUSION Leaders in plastic surgery are more likely to be male, hold academic rank of professor, and have completed a fellowship after residency.

BACKGROUND Originally developed for resident self-assessment, the Plastic Surgery In-Service Examination has been administered for over 45 years. The Accreditation Council for Graduate Medical Education requires that at least 70 percent of graduates pass the American Board of Plastic Surgery Written Examination on their first attempt. This study evaluates the role of In-Service Exam scores in predicting Written Exam success. METHODS In-Service Exam scores from 2009 to 2015 were collected from the National Board of Medical Examiners. Data included residency training track, training year, and examination year. Written Exam data were gathered from the American Board of Plastic Surgery. Multivariate analysis was performed and receiver operating characteristic curves were used to identify optimal In-Service Exam score cut-points for Written Exam success. RESULTS Data from 1364 residents were included. Residents who failed the Written Exam had significantly lower In-Service Exam scores than those who passed (p < 0.001). Independent residents were 7.0 times more likely to fail compared with integrated/combined residents (p < 0.001). Residents who scored above the optimal cut-points were significantly more likely to pass the Written Exam. The optimal cut-point score for independent residents was the thirty-sixth percentile and the twenty-second percentile for integrated/combined residents. CONCLUSIONS Plastic Surgery In-Service Exam scores can predict success on the American Board of Plastic Surgery Written Exam. Residents who score below the cut-points are at an increased risk of failing. These data can help identify residents at risk for early intervention.

Securing a residency training position in plastic surgery is highly competitive each year with a limited quota of positions and numerous qualified applicants. Although previous studies have highlighted the importance of residency programs and applicants seeking a "good fit," it remains poorly understood what influences a medical student's impression and desire to train at a certain program over others. The objective of this cross-sectional study was to identify which specific potentially modifiable factors during elective rotations and program interviews were most important to Canadian medical students when ranking plastic surgery programs.An electronic survey with 42 questions was administered to Canadian final year medical students who applied through the 2017 Canadian Residency Match Service to the plastic surgery training program at the University of Toronto. The survey consisted of 7-point Likert scale questions related to demographics, general factors affecting impression of a plastic surgery program, and specific factors related to the elective and interview experiences. Survey responses were collected anonymously for analysis.Twenty-three of 46 applicants completed the survey (50% response rate). The most important general factors affecting a medical student's impression and desire to train at a residency program were mentors at a specific program (weighted average, 6.39) and geographic location of a program (weighted average, 5.65). During elective rotations, the most important factors identified were overall impression of resident and staff collegiality (weighted average, 6.57), overall impression of resident happiness (weighted average, 6.52), and having a formal rotation-end debrief evaluation with the supervising staff (weighted average, 6.04). At program interviews, perceiving an atmosphere of collegiality (weighted average, 6.45) and opportunities to interact with residents and faculty at an organized social event (weighted average, 5.95) were considered of greatest importance.Current applicants to plastic surgery in Canada prioritize resident happiness, program collegiality, and meaningful faculty relationships, such as those with a mentor, when ranking residency programs. Although finding a mutually "good fit" between applicant and program will remain a major aim, these findings indicate the importance of certain tangible, potentially modifiable factors that affect how medical students ultimately perceive and rank plastic surgery programs.

Once the accepted norm during Harvey Cushing's time, the mantra of work to the exclusion of family and lifestyle is now recognized as deleterious to overall well-being. A number of neurosurgical residency training programs have implemented wellness programs to enhance the physical, mental, and emotional well-being of trainees and faculty. This manuscript highlights existing organized wellness education within neurosurgery residency programs in order to describe the motivations behind development, structure, and potential implementation strategies, cost of implementation, and identify successes and barriers in the integration process. This manuscript is designed to serve as a "how-to" guide for other programs who may identify a need in their own trainees and begins the discussion of how to develop wellness, leadership, grit, and resiliency within our future generation of neurosurgeons.

There is a demonstrated need for access to plastic surgical care in low- and middle-income countries worldwide. Recently, there is increasing interest in promoting transcontinental partnerships between academic institutions to improve training opportunities for local surgeons while increasing access to care for patients. Before such programs can be established, it is crucial for US-based surgeons and educators to understand the existing training models in different countries. The aim of this study is to identify the current plastic surgery training model in the College of Surgeons of East, Central, and Southern Africa (COSECSA) group of African nations and compare this to training in the United States. The curricula of 2 accrediting bodies of plastic surgery, COSECSA and the Accreditation Council for Graduate Medical Education of the United States, were compared. Similarities included the length of dedicated plastic surgery training, curriculum content, and final evaluation structure. Differences include training pathways, assessment methodology, and regulation regarding specific competencies, program requirements, and resident benefits. These findings establish a baseline understanding of how plastic surgical training is organized, delivered, and evaluated in Africa, highlight opportunities for educational initiatives, and serve as a foundation for future efforts to develop collaborative partnerships in these communities. Future research will include a survey sent to program directors and plastic surgery attendings in the COSECSA regions to gather additional information.

Supplemental Digital Content is available in the text., Background: The COVID-19 pandemic has significantly impacted residency application process for all specialties, including plastic surgery residency. Almost all plastic surgery residency programs have suspended visiting sub-internship rotations. This study quantifies the impact of a webinar through an analysis of poll questions and a post-webinar survey sent to all registered participants. Methods: A dedicated webinar was organized and held by the Harvard Plastic Surgery Residency Training Program. All attendees were asked several poll questions during the webinar. The 192 participants were also sent a post-webinar survey. Results: The response rate was 68.2% (n = 131). Respondents were more confident about matching into a plastic surgery residency program at the end of the webinar compared with before the webinar (P < 0.001). Respondents who did not have a plastic surgery residency program at their home institution were less confident at the start of the webinar (P = 0.009). In addition, respondents who had not taken time off for research or for other endeavors during or after medical school were less confident about their chances to match at the start of the webinar (P = 0.034). Conclusions: An online webinar program increased confidence levels of medical students interested in applying for residency positions in plastic surgery. Residency programs should consider webinars as a method to inform and assist medical students during the upcoming application season.

Objective:To obtain feedback from early career adult and child neurologists about the psychiatry component of residency training.Methods:A survey was developed and administered electronically to four cohorts of recently certified American Board of Psychiatry and Neurology diplomates.Results:The response rate was 16% (431/2,677) and included 330 adult neurologists and 101 child neurologists. Less than half of the respondents described themselves as extremely or quite satisfied with their psychiatry training while 26% of the adult neurologists and 33% of the child neurologists felt slightly or not at all prepared for this component of practice. Four themes were identified in the respondents’ suggestions for improving psychiatry training: provide more outpatient experience; provide more time/teaching in psychiatry; provide more experience with both pharmacological and non-pharmacological psychiatric treatments; and provide more exposure to patients with conditions likely to be encountered in neurology/child neurology practice.Conclusion:These recent graduates of adult and child neurology residency programs felt under prepared for the psychiatric issues they encountered in their patients. They suggested a number of strategies for better alignment of psychiatry training with the likely demands of practice, and a model curriculum recently developed by the American Academy of Neurology’s Consortium of Neurology Program Directors and the American Association of Directors of Psychiatric Residency Training also provides guidance for both neurology and psychiatry program directors.

INTRODUCTION AND OBJECTIVE:There is no standardized and up-to-date education model for urology residents in our country. We aimed to describe our National E learning education model for urology res...

INTRODUCTION AND OBJECTIVE:Urology workforce projections predict an alarming shortage of urologists in upcoming decades. Survey data also suggest recently graduated urology residents do not feel re...

INTRODUCTION AND OBJECTIVE:The Accreditation Council for Graduate Medical Education (ACGME) has mandated that knowledge of patient safety (PS) principles be a core competency of residency training....

INTRODUCTION AND OBJECTIVE:As a means to improve resident surgical education, alternative teaching strategies including didactics, web-based learning and simulation labs have been used. However, th...

BACKGROUND Transitioning to competency-based surgical training will require consensus regarding the scope of plastic surgery and expectations of operative ability for graduating residents. Identifying surgical procedures experts deemed most important in preparing graduates for independent practice (i.e., "core" procedures), and those that are less important or deemed more appropriate for fellowship training (i.e., "noncore" procedures), will focus instructional and assessment efforts. METHODS Canadian plastic surgery program directors, the Canadian Society of Plastic Surgeons Executive Committee, and peer-nominated experts participated in an online, multiround, modified Delphi consensus exercise. Over three rounds, panelists were asked to sort 288 procedural competencies into five predetermined categories within core and noncore procedures, reflecting increasing expectations of ability. Eighty percent agreement was chosen to indicate consensus. RESULTS Two hundred eighty-eight procedures spanning 13 domains were identified. Invitations were sent to 49 experts; 37 responded (75.5 percent), and 31 participated (83.8 percent of respondents). Procedures reaching 80 percent consensus increased from 101 (35 percent) during round 1, to 159 (55 percent) in round 2, and to 199 (69 percent) in round 3. The domain "burns" had the highest rate of agreement, whereas "lower extremity" had the lowest agreement. Final consensus categories included 154 core, essential; 23 core, nonessential; three noncore, experience; and 19 noncore, fellowship. CONCLUSIONS This study provides clarity regarding which procedures plastic surgery experts deem most important for preparing graduates for independent practice. The list represents a snapshot of expert opinion regarding the current training environment. As our specialty grows and changes, this information will need to be periodically revisited.

Introduction Leadership is an integral component of medical practice. Nevertheless, during residency minimal attention is paid to developing this important domain. Therefore, we report on our experience with a formal leadership curriculum for senior urology residents. Methods In consultation with a leadership expert a curriculum was developed with readings and discussion questions focusing on understanding and applying leadership theory. A symposium was then organized to discuss leadership theory as applied to clinical practice and debate how to be a successful leader in urology. Results Our first cohort of residents completed the curriculum in 2015. Due to its success it was repeated for a second cohort of residents in 2016. A formal assessment of the curriculum showed that 91% (10 of 11) and 73% (8 of 11) of residents strongly or somewhat agreed that they will adopt new leadership strategies and are more confident as leaders, respectively. Conclusions We developed and successfully implemented a leadership curriculum for urology residents. The curriculum goals were met with participants reporting that they acquired new leadership strategies and had increased confidence as a leader. We now expand on these initial efforts by proposing the core leadership dimensions for residents of managing the self, managing the clinical experience and managing the clinical team. In each dimension there are specific competencies that can be mapped to measure resident performance over time. It is our hope that this conceptual framework will help guide future local and national surgical leadership training.

Burnout and stress in medical settings have been associated with despondent staff and decreased productivity. Although Program Coordinators (PCs) play an integral role in residency training programs, there exist few, if any, interventions aimed at addressing their burnout.A longitudinal study design was used to evaluate data from residency/fellowship training PCs who participated in a wellness retreat held at a single institution in August 2016. Subjects completed anonymous, pre- and post-retreat questionnaires in addition to a 3-month follow-up questionnaire, which included questions used to assess aspects of job demand, resiliency, and well-being. The seven-item Physician Well-Being Index and a logistic regression model were used to assess well-being. Mean values and SDs were reported to examine changes in mental health scores and participants' job satisfaction over the course of the intervention.Nineteen of the 45 (43%) invited residency/fellowship training PCs completed data collection. Coordinators ranged in age from 25 to 64 years; all were female. Well-being, sleep, resiliency, and employee satisfaction scores improved over the assessment period. Well-being scores initially decreased by 0.37 at the postassessment, but increased at follow-up (mean: 2.0; SD 1.7). Stress scores increased from baseline to post, but decreased from baseline to follow-up: 0.2 and -0.2, respectively.Residency PCs experienced improvements in mental quality of life, resiliency, stress, and sleep scores on attending the wellness program. Attention to such findings may have important implications, as we address the burnout crisis in the medical education community.

To describe the residents who chose to train in teaching health centers (THCs), which are community-based ambulatory patient care sites that sponsor primary care residencies, and their intentions to practice in underserved settings.The authors surveyed all THC residents training in academic years 2013-2014, 2014-2015, and 2015-2016, comparing their demographic characteristics with data for residents nationally, and examined THC residents' intentions to practice in underserved settings using logistic regression analysis.The overall survey response rate was 89% (1,031/1,153). THC resident respondents were similar to residents nationally in family medicine, geriatrics, internal medicine, obstetrics-gynecology, pediatrics, and psychiatry in terms of gender, age, race, and ethnicity. Twenty-nine percent (283) of respondents came from a rural background, and 46% (454) had an educationally and/or economically disadvantaged background. More than half (524; 55%) intended to practice in an underserved setting on completion of their training. Respondents were more likely to intend to practice in an underserved area if they came from a rural background (odds ratio 1.58; 95% confidence interval 1.08, 2.32) or disadvantaged background (odds ratio 2.81; 95% confidence interval 1.91, 4.13).THCs attract residents from rural and/or disadvantaged backgrounds who seem to be more inclined to practice in underserved areas than those from urban and economically advantaged roots. THC residents' intentions to practice in underserved areas indicate that primary care training programs sponsored by community-based ambulatory patient care sites represent a promising strategy to improve the U.S. health care workforce distribution.

As part of a scheduled review of the Common Program Requirements, the Accreditation Council for Graduate Medical Education (ACGME) recently implemented amendments to Section VI, “Resident Duty Hours in the Learning and Working Environment,” which went into effect on July 1, 2017.1 Prior to July 1, changes to Section VI of the Common Program Requirements were last implemented by the ACGME in 2011. The purpose of this review is to discuss the recent changes to Section VI of the ACGME Common Program Requirements.

The 2017 Louis and Artur Lucian award for research in circulatory disease, established by a bequest to McGill University in 1965, has been awarded to John J.J.V. McMurray, MD, of the University of Glasgow. McMurray has dedicated much of his career to heart failure, with more than 900 publications ranging from basic research and epidemiology to the design and completion of numerous clinical trials that have altered our understanding of the condition and its treatment and prognosis. > “He’s done a tremendous amount that is clinically relevant and has resulted in new medications for heart failure. He was head and shoulders above the other applicants this year, with an incredible track record and extensive publications,” says James Martin, MD, chair of the McGill University department of medicine and chair of the Lucian Committee . As McMurray was completing medical school, American and European investigators were beginning to understand the disease mechanisms of heart failure and to identify targets for treatment other than digoxin and diuretics. At that time, there was no way to directly influence the weakness in cardiac contraction underlying heart failure, but inappropriate and sustained activation of the renin–angiotensin–aldosterone system (RAAS) helped explain why the function of blood vessels, kidneys, and heart muscle deteriorated over time. Shortly after the introduction of the angiotensin-converting enzyme (ACE) inhibitor captopril, McMurray witnessed the Lazarus-like recovery and discharge from the hospital of an extremely ill woman with heart failure after she was given the new drug—spurring a career-long interest in heart failure. After 2 years of residency training, McMurray obtained a cardiovascular research fellowship in Dundee, Scotland, where physician scientist Allan Struthers was studying cardiac natriuretic peptides, newly described hormones produced by the heart, which helped that organ protect itself and the whole body from volume and pressure overload by, among other things, …

This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy.The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role.Attendings in 14 General Surgery programs were trained to use a) the 5-level System for Improving and Measuring Procedural Learning (SIMPL) Performance scale to assess resident readiness for independent practice and b) the 4-level Zwisch scale to assess the level of guidance (ie, autonomy) they provided to residents during specific procedures. Ratings were collected immediately after cases that involved a categorical GS resident. Data were analyzed using descriptive statistics and supplemented with Bayesian ordinal model-based estimation.A total of 444 attending surgeons rated 536 categorical residents after 10,130 procedures. Performance: from the first to the last year of training, the proportion of Performance ratings for Core procedures (n = 6931) at "Practice Ready" or above increased from 12.3% to 77.1%. The predicted probability that a typical trainee would be rated as Competent after performing an average Core procedure on an average complexity patient during the last week of residency training is 90.5% (95% CI: 85.7%-94%). This falls to 84.6% for more complex patients and to less than 80% for more difficult Core procedures. Autonomy: for all procedures, the proportion of Zwisch ratings indicating meaningful autonomy ("Passive Help" or "Supervision Only") increased from 15.1% to 65.7% from the first to the last year of training. For the Core procedures performed by residents in their final 6 months of training (cholecystectomy, inguinal/femoral hernia repair, appendectomy, ventral hernia repair, and partial colectomy), the proportion of Zwisch ratings (n = 357) indicating near-independence ("Supervision Only") was 33.3%.US General Surgery residents are not universally ready to independently perform Core procedures by the time they complete residency training. Progressive resident autonomy is also limited. It is unknown if the amount of autonomy residents do achieve is sufficient to ensure readiness for the entire spectrum of independent practice.

Burnout is a syndrome defined by 3 principal components: emotional exhaustion, depersonalization, and diminished feelings of personal accomplishment.1 Burnout negatively affects patient care, affects patient safety, and results in deleterious effects on practitioners.2 A recently published article reports that 73% of neurology residents describe at least one symptom of burnout.3

Dermatology residency training is not standardized internationally, and each country dictates how training is conducted within its own borders. This article highlights the types of variability in training that can occur from country to country by comparing dermatology residency training programs in the United States and India. This article specifically analyzes the differences that pertain to application and selection, residency program structure, and post-residency opportunities. Keywords: India, dermatology residency, medical education

Introduction:Selection of a career specialty by medical students is a complex and individualized decision. Our goals were to understand the factors that influenced medical students in selecting their career specialty, identify the stage at which this decision was made, and understand the role of dem

Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology.

The transition from undergraduate medical education to graduate medical education (GME) involves a process rooted in the final year of medical school. Students file applications through the Electronic Residency Application System platform, interview with residency training (GME) programs from which they have received invitations, and generate a rank-ordered preference list. The National Resident Matching Program reconciles applicant and program rank lists with an eye towards matching students and GME programs. This process has effectively served generations of graduating medical students. However, the past several decades have seen an intensification of the residency placement process that is exemplified by an inexorable increase in the number of applications filed and number of interviews accepted and attended by each student. The authors contend that this trend has untoward effects on both applicants and departments that are home to GME programs. Relevant information in the peer-reviewed literature on the consequences and benefits of the intensification of the residency placement process is scant. The authors address factors that may contribute to the intensity of the residency placement process, and the relative paucity of data. They propose approaches to reverse current trends, and conclude that any reevaluation of the process will have to include the generation of outcome data in order to afford medical educators the opportunity to explore changes in an evidence-based manner.

The University of Kansas School of Medicine established a rural regional campus in Salina, Kansas, in 2011. The creation of a four-year medical campus of only 32 total students in a town of less than 50,000 inhabitants appeared to contradict all previous practices where medical schools have been situated in large metropolitan cities with student bodies frequently in the hundreds. The rationale to open the Salina campus was to attract medical students with a desire to train in a rural environment, hoping that many would eventually elect to practice primary care in rural Kansas. The authors evaluated the admission demographics, academic performance, campus satisfaction, and graduate medical education choices of students at Kansas University School of Medicine-Salina (KUSM-S) during its first four years of existence. To date, the Salina campus has succeeded in its mission to train students from rural communities in a rural environment to eventually become rural-based physicians. KUSM-S students have adjusted well to the rigors of medical school, have shown steady improvement in academic performance as measured by United States Medical Licensing Examination scores, and have been overwhelmingly positive about the Salina medical education program. The initial cohort of students has now successfully graduated and secured residency training positions, and most KUSM-S graduates are either continuing their training in primary care in Kansas or intend to return to Kansas to practice following residency training.

Neurosurgery in Uganda was virtually non-existent up until late 1960s. This changed when Dr. Jovan Kiryabwire spearheaded development of a neurosurgical unit at Mulago Hospital in Kampala. His work ethic and vision set the stage for rapid expansion of neurosurgical care in Uganda.At the beginning of the 2000s, Uganda was a country of nearly 30 million people, but had only 4 neurosurgeons. Neurosurgery's progress was plagued by challenges faced by many developing countries, such as difficulty retaining specialists, lack of modern hospital resources, and scarce training facilities. To combat these challenges 2 distinct programs were launched: 1 by Dr. Benjamin Warf in collaboration with CURE International, and the other by Dr. Michael Haglund from Duke University. Dr. Warf's program focused on establishing a facility for pediatric neurosurgery. Dr. Haglund's program to increase neurosurgical capacity was founded on a "4 T's Paradigm": Technology, Twinning, Training, and Top-Down. Embedded within this paradigm was the notion that Uganda needed to train its own people to become neurosurgeons, and thus Duke helped establish the country's first neurosurgery residency training program.Efforts from overseas, including the tireless work of Dr. Benjamin Warf, have saved thousands of children's lives. The influx of the Duke Program caused a dynamic shift at Mulago Hospital with dramatic effects, as evidenced by the substantial increase in neurosurgical capacity. The future looks bright for neurosurgery in Uganda and it all traces back to a rural village where 1 man had a vision to help the people of his country.