Search

Background: Underrepresented minorities in medicine (URiMs) are disproportionally represented in surgery training programs. Rates of URiMs applying to and completing General Surgery residency remain low. We hypothesized that the patterns of URiMs disparities would persist into surgical critical care (SCC) fellowship applicants, matriculants, and graduates., Methods: We performed a retrospective analysis of SCC applicants, matriculants, and graduates from 2005 to 2020 using the graduate medical education resident survey and analyzed applicant characteristics using the Surgical Critical Care and Acute Care Surgery Fellowship Application Service from 2018 to 2020. The data were stratified by race/ethnicity and sex. Indicator variables were created for Asian, Hispanic, White, and Black trainees. Yearly proportions for each race/ethnicity and sex categories completing or enrolling in a program were calculated and plotted over time with Loess smoothing lines and overlying 95% confidence bands. The yearly rate and statistical significance of change over time were tested with linear regression models with race/ethnicity and sex proportion as the dependent variables and year as the explanatory variable., Results: From 2005 to 2020, there were a total of 2,481 graduates. Black men accounted for 4.7% of male graduates with a significant decline of 0.3% per year for the study period of those completing the fellowship (p = 0.02). Black women comprised 6.4% of female graduates and had a 0.6% decline each year (p < 0.01). A similar trend was seen with Hispanic men, who comprised 3.2% of male graduates and had a 0.3% annual decline (p = 0.02). White men had a significant increase in both matriculation to and graduation from SCC fellowships during the same interval. Similarly, Black and Hispanic applicants declined from 2019 to 2020, while the percentage of White applicants increased., Conclusion: Disparities in URiMs representation remain omnipresent in surgery and extend from residency training to SCC fellowship. Efforts to enhance the recruitment and retention of URiMs in SCC training are warranted., Level of Evidence: Prognostic and Epidemiologic; level IV., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Morbidity and mortality conferences (MMCs) promote patient safety, spur quality improvement (QI) projects, and enhance interprofessional cooperation. The use of MMCs to address the Accreditation Council for Graduate Medical Education's (ACGME's) six core competencies and specialty-specific milestones for surgical critical care (SCC) fellows has yet to be explored., Methods: We developed a monthly, interprofessional, case-based MMC program managed by SCC fellows. We assessed participants' experiences through post-conference surveys and semi-structured interviews., Results: After nine conferences, 95.1% of participants (n = 143) agree or strongly agree that the MMC improved their knowledge and clinical assessment skills. The MMC spurred two QI projects, increased interprofessional cooperation, and addressed all six ACGME core competencies and 16 specialty-specific milestones., Conclusions: Interprofessional, case-based MMCs are an effective educational tool for SCC fellowship programs. They promote patient safety, QI, and interprofessional cooperation, and address ACGME core competencies and specialty-specific milestones for SCC fellows., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Exposure to pain management curriculum in medical school is currently variable. This paper reports on formal prescribing education, self-perceived prescribing readiness, and prescribing practices among incoming surgical residents before and after a pain management training session., Methods: Pre-residency survey of thirty surgical interns at a single urban medical center, followed by a repeat survey after an educational session on prescription writing and opioid abuse., Results: Thirty-three percent of respondents had formal education on prescription writing in medical school. Median subjective preparedness to write an opioid prescription was 1.5 (range 1-10) on a 1-10 Likert scale. Ranges of morphine milligram equivalents (MME) prescribed varied from 420-2700 MME for 8 mock surgical scenarios. Post-training, median subjective preparedness increased to 3.5 (range 1-6) and prescription accuracy (the inclusion of a medication, dose, frequency, and duration) improved from 75% to 97% (p < 0.001). Overall, 90% of interns found the training session useful., Conclusion: Most surgical interns were not trained in prescribing narcotics in medical school. Improved pain management curriculum is necessary to assure safe and consistent opioid prescriptions., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Residency programs now are required to use educational milestones, which has led to the need for new methods of assessment. The literature suggests that narrative cases are a promising tool to track residents' progress. This study demonstrates the process for developing and evaluating narrative cases representing the five levels of the professionalism milestones., Method: In 2013, the authors identified 28 behaviors in the Accreditation Council for Graduate Medical Education general surgery professionalism milestones. They modified previously published narrative cases to fit these behaviors. To evaluate the quality of these cases, the authors developed a 28-item, five-point scale instrument, which 29 interdisciplinary faculty completed. The authors compared the faculty ratings by narrative case and specialty with the authors' initial rankings of the cases by milestone level. They used t tests and analysis of variance to compare mean scores across specialties., Results: The authors developed 10 narrative cases, 2 for each of the 5 milestone levels. Each case contained at least 20 of the 28 behaviors identified in the milestones. Mean faculty ratings matched the milestone levels. Reliability was good (G coefficient = 0.86, phi coefficient = 0.85), indicating consistency in raters' ability to determine the proper milestone level for each case., Conclusions: The authors demonstrate a process for using specialty-specific milestones to develop narrative cases that map to a spectrum of professionalism behaviors. This process can be applied to other competencies and specialties to facilitate faculty awareness of resident performance descriptors and provide a frame of reference for milestones assessment.

Background: Surgery subinternship rotations are clinical rotations intended to provide senior medical students with experiential exposure and increased autonomy during the care of surgical patients in clinical settings. Due to the lack of guidelines from national surgical organizations, these rotations remain largely unstructured and unstandardized with wide variability in the goals and experiences they provide for medical students., Methods: Through synthesis of the literature and by applying an iterative process among members of the subcommittee for surgery subinternship and the curriculum committee of the Association for Surgical Education (ASE) consensus recommendations were established., Recommendations: Five defined domains were identified as essential for establishing surgery subinternship rotations. These are: administrative structure, goals and objectives, curricular elements, instructional methods, and assessment tools., Conclusions: These recommendations should serve as a blue print for establishing a structured, educationally sound, and rewarding clinical rotation for medical students. Applying these recommendations may also provide educators with opportunities for scholarships and academic advancement., (Copyright © 2015 Elsevier Inc. All rights reserved.)