Garza, Rebecca M; Weston, Jane S; Furnas, Heather J
Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.
Silvestre, Jason; Lin, Ines C; Levin, Lawrence Scott; Chang, Benjamin
Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof
Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we
Ovadia, Steven A; Gishen, Kriya; Desai, Urmen; Garcia, Alejandro M; Thaller, Seth R
Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin
Operative experience in aesthetic surgery is an important issue affecting plastic surgery residents. This study addresses the variability of aesthetic surgery experience during plastic surgery residency. National operative case logs of chief residents in independent/combined and integrated plastic surgery residency programs were analyzed (2011-2015). Fold differences between the bottom and top 10th percentiles of residents were calculated for each aesthetic procedure category and training model. The number of residents not achieving case minimums was also calculated. Case logs of 818 plastic surgery residents were analyzed. There was marked variability in craniofacial (range, 6.0-15.0), breast (range, 2.4-5.9), trunk/extremity (range, 3.0-16.0), and miscellaneous (range, 2.7-22.0) procedure categories. In 2015, the bottom 10th percentile of integrated and independent/combined residents did not achieve case minimums for botulinum toxin and dermal fillers. Case minimums were achieved for the other aesthetic procedure categories for all graduating years. Significant variability persists for many aesthetic procedure categories during plastic surgery residency training. Greater efforts may be needed to improve the aesthetic surgery experience of plastic surgery residents. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org
Colton H. L. McNichols, MD
Conclusions:. There is an increase in dedicated cosmetic surgery rotations and fewer residents believe they need a fellowship to practice cosmetic surgery. However, the comfort level of performing facial aesthetic and body contouring procedures remains low particularly among independent residents.
Fan, Kenneth; Kawamoto, Henry K; McCarthy, Joseph G; Bartlett, Scott P; Matthews, David C; Wolfe, S Anthony; Tanna, Neil; Vu, Minh-Thien; Bradley, James P
Despite increasing specialization of craniofacial surgery, certain craniofacial techniques are widely applicable. The authors identified five such craniofacial techniques and queried American Society of Plastic Surgeons members and plastic surgery program directors regarding their comfort level with the procedures and their opinion on resident training for these selected procedures. First, a select group of senior craniofacial surgeons discussed and agreed on the top five procedures. Second, active American Society of Plastic Surgeons were surveyed regarding their opinion on training and their comfort level with each procedure. Third, plastic surgery residency program directors were studied to see which of the top five procedures are taught as part of the plastic surgery residency curriculum. The top five widely applicable craniofacial procedures are technically described and include the following: (1) cranial or iliac bone graft for nasal reconstruction, (2) perialar rim bone graft, (3) lateral canthopexy, (4) osseous genioplasty, and (5) bone graft harvest for orbital floor defects. For practicing plastic surgeons, comfort level in all procedures increased with advancing years in practice (except those with 75 percent), especially those with craniofacial fellowship training, felt competent in all procedures except osseous genioplasty (53 percent). Plastic surgery program directors agreed that all top five procedures should be mastered by graduation. Although program directors felt that all five selected craniofacial procedures should be taught and mastered during residency training, plastic surgeons without craniofacial fellowship training were less comfortable with the techniques. Residency training goals should include competence in core craniofacial techniques.
Khansa, Ibrahim; Janis, Jeffrey E
Modern plastic surgery resident education demands the acquisition of an ever-increasing fund of knowledge and familiarity with more surgical techniques than ever before. This all must take place within the context and boundaries of Accreditation Council for Graduate Medical Education-mandated restrictions on work hours as well as balance of education and service. Technological resources have been developed and can be used to complement the skills that residents acquire while performing their day-to-day activities such as taking care of patients, reading textbooks and journal articles, and assisting or performing surgical procedures. Those complementary resources provide the benefits of portability and accessibility, and can thus be conveniently incorporated into the hectic daily life of a resident. This article presents a summary of the most commonly used currently available advanced technologies in plastic surgery resident education, and suggestions for integration of those technologies into a curriculum.
Chetta, Matthew D; Sugg, Kristoffer B; Diaz-Garcia, Rafael J; Kasten, Steven J
Plastic surgery residency program directors have an interest in recruiting applicants who show an interest in an academic practice. Medical school achievements (ie, United States Medical Licensing Examination® scores, publications, and Alpha Omega Alpha status) are metrics assessed to grade applicants but may not correlate with ultimately choosing an academic career. This study was designed to investigate factors influencing residents' choices for or against academic careers. A 25-item online questionnaire was designed to measure baseline interest in academic plastic surgery and factors that influence decisions to continue on or abandon that career path. This questionnaire was disseminated to the integrated/combined plastic surgery residents during the 2013 to 2014 academic year. One hundred twenty-five respondents indicated that they were currently interested in pursuing academic practice (n = 78) or had lost interest in academic practice (n = 47). Among all respondents, 92.8% (n = 116) stated they were interested in academic careers at the time of residency application, but one-third (n = 41) subsequently lost interest. Those residents who retained interest in academic careers indicated resident/medical student educational opportunities (57%) and complexity of patients (52%) as reasons. Those who lost interest cited a lack of autonomy (43%), publishing requirements (32%), and income discrepancy (26%) as reasons. Many residents report losing interest in academics during residency. Traditional metrics valued in the recruitment process may not serve as positive predictors of an academic career path. Reasons why residents lose interest are not easily correctable, but mentorship, adequate career counseling, and research opportunities during training remain factors that can be addressed across all residency programs.
Noland, Shelley S; Fischer, Lauren H; Lee, Gordon K; Friedrich, Jeffrey B; Hentz, Vincent R
This study was designed to establish the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. This framework can then be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach technical skills in hand surgery. Ten expert hand surgeons were surveyed regarding the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. The top 10 procedures from this survey were then used to survey all 89 Accreditation Council for Graduate Medical Education-approved plastic surgery program directors. There was a 69 percent response rate to the program director survey (n = 61). The top nine hand surgery procedures included open carpal tunnel release, open A1 pulley release, digital nerve repair with microscope, closed reduction and percutaneous pinning of metacarpal fracture, excision of dorsal or volar ganglion, zone II flexor tendon repair with multistrand technique, incision and drainage of the flexor tendon sheath for flexor tenosynovitis, flexor tendon sheath steroid injection, and open cubital tunnel release. Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method for accomplishing this task. There has been no consensus regarding which hand surgery procedures should be mastered by graduating plastic surgery residents. The authors have identified nine procedures that are overwhelmingly supported by plastic surgery program directors. These nine procedures can be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach and document technical skills in hand surgery.
Zheng, Jianmin; Zhang, Boheng; Yin, Yiqing; Fang, Taolin; Wei, Ning; Lineaweaver, William C; Zhang, Feng
Residency training is internationally recognized as the only way for the physicians to be qualified to practice independently. China has instituted a new residency training program for the specialty of plastic surgery. Meanwhile, plastic surgery residency training programs in the United States are presently in a transition because of restricted work hours. The purpose of this study is to compare the current characteristics of plastic surgery residency training in 2 countries. Flow path, structure, curriculum, operative experience, research, and evaluation of training in 2 countries were measured. The number of required cases was compared quantitatively whereas other aspects were compared qualitatively. Plastic surgery residency training programs in 2 countries differ regarding specific characteristics. Requirements to become a plastic surgery resident in the United States are more rigorous. Ownership structure of the regulatory agency for residency training in 2 countries is diverse. Training duration in the United States is more flexible. Clinical and research training is more practical and the method of evaluation of residency training is more reasonable in the United States. The job opportunities after residency differ substantially between 2 countries. Not every resident has a chance to be an independent surgeon and would require much more training time in China than it does in the United States. Plastic surgery residency training programs in the United States and China have their unique characteristics. The training programs in the United States are more standardized. Both the United States and China may complement each other to create training programs that will ultimately provide high-quality care for all people.
... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...
Silvestre, Jason; Abbatematteo, Joseph M; Chang, Benjamin; Serletti, Joseph M
Recent studies have demonstrated low levels of National Institutes of Health funding for surgical research. The authors compared the funding in plastic surgery with the funding for other surgical specialties. A query of National Institutes of Health grants awarded to departments of surgical specialties was performed using the National Institutes of Health RePORTER database (2008 to 2016). Trends in funding were compared by specialty and adjusted for the number of active physicians in each specialty. Plastic surgery residency program characteristics were correlated with funding procurement. Eight hundred eighty-nine faculty at 94 plastic surgery residency programs were queried. Forty-eight investigators (5.4 percent) at 23 programs (24.4 percent) had National Institutes of Health funding. From 2008 to 2016, a total of $84,142,138 was awarded through 81 grants. Funding supported translational (44.6 percent), clinical (26.4 percent), basic science (27.2 percent), and educational (1.7 percent) research. In 2016, plastic surgery received the least amount of National Institutes of Health funding per active physician ($1,530) relative to orthopedic surgery ($3124), obstetrics and gynecology ($3885), urology ($5943), otolaryngology ($9999), general surgery ($11,649), ophthalmology ($11,933), and neurologic surgery ($20,874). Plastic surgery residency program characteristics associated with National Institutes of Health funding were high ranking and had more than 10 clinical faculty (p < 0.05). Plastic surgery receives the least National Institutes of Health funding among the surgical specialties. Departments and divisions of plastic surgery should support investigators applying for research grants to increase future National Institutes of Health funding.
Sinna, R; Harris, P G; Danino, A M
Learning plastic surgery in Montreal is different from learning plastic surgery in a French university. In Canada, all residency programs are accredited by a national structure: the Royal College of Physicians and Surgeons. We tried to highlight the differences that exist between the French and a North American academic system. With the different rules and law that governs academic education in both countries, we analyzed the following elements: the residency selection, the program of plastic surgery (content and organisation), the system of evaluation and the diplomas. The training of a Canadian plastic surgeon is very controlled. The recommendations of the Royal College guarantee to the resident who enters a program to have the means to acquire a complete training in quantity and in quality. On the four studied items, none is completely similar between both countries. Each having advantages and inconveniences as, for example, the selection of residency by interview or by the classifying national exam. Actually, few French plastic surgery programs could satisfy the requirements of the Royal College on several points, however without failing the training of French plastic surgeons. Nevertheless, we could be inspired by several elements (rotation in private practice,grouping together several academic hospitals. . .) to improve our system of training.
Chandawarkar, Akash A; Gould, Daniel J; Stevens, W Grant
Ethical guidelines for appropriate use of social media are beginning to be delineated. As social media becomes ingrained in plastic surgery culture, education of residents on appropriate use of social media is increasingly important. Recently, plastic surgery residency programs have begun to utilize social media. This study characterizes the trends and content of plastic surgery residency-associated Instagram accounts. Active individual residency program Instagram accounts were identified for integrated plastic surgery programs. Metrics for each account were retrieved on September 16, 2017, including date of first post, number of posts, and followers. Individual posts were analyzed for content of post. Fourteen of 67 (21%) integrated plastic surgery programs were found to have active Instagram accounts. There has been an exponential growth of programs adopting Instagram since August 2015. A total of 806 posts were created. Thirty-two (3.97%) posts had intraoperative photos and only one (0.12%) showed a patient image. There were 4466 followers of plastic surgery residency programs. A linear correlation was found between number of posts and number of followers, while there was no correlation of number of followers and time since account start. Instagram use by plastic surgery integrated programs continues to grow exponentially, and programs are appropriately using the platform. Active use of the resident social media results in increased influence. Resident use of social media has many benefits. We propose social media guidelines for plastic surgery trainees and advocate for continued appropriate use and auto-regulation by plastic surgery trainees.
C. Scott Hultman, MD, MBA, FACS
Conclusions: RACs are an important component of plastic surgery education. Most clinics are financially viable but carry high malpractice risk and consume significant resources. Best practices, to maximize patient safety and optimize resident education, include use of accredited procedural rooms and direct faculty supervision of all components of care.
Simmons, Brian J; Zoghbi, Yasmina; Askari, Morad; Birnbach, David J; Shekhter, Ilya; Thaller, Seth R
Objective structured clinical examinations (OSCEs) have proven to be a powerful tool. They possess more than a 30-year track record in assessing the competency of medical students, residents, and fellows. Objective structured clinical examinations have been used successfully in a variety of medical specialties, including surgery. They have recently found their way into the subspecialty of plastic surgery. This article uses a systematic review of the available literature on OSCEs and their recent use in plastic surgery. It incorporates survey results assessing program directors' views on the use of OSCEs. Approximately 40% of programs surveyed use OSCEs to assess the Accreditation Council for Graduate Medical Education core competencies. We found that 40% use OSCEs to evaluate specific plastic surgery milestones. Objective structured clinical examinations are usually performed annually. They cost anywhere between $100 and more than $1000 per resident. Four milestones giving residents the most difficulties on OSCEs were congenital anomalies, noncancer breast surgery, breast reconstruction, and practice-based learning and improvement. It was determined that challenges with milestones were due to lack of adequate general knowledge and surgical ward patient care, as well as deficits in professionalism and system-based problems. Programs were able to remediate weakness found by OSCEs using a variety of methods. Objective structured clinical examinations offer a unique tool to objectively assess the proficiency of residents in key areas of the Accreditation Council for Graduate Medical Education core competencies. In addition, they can be used to assess the specific milestones that plastic surgery residents must meet. This allows programs to identify and improve identified areas of weakness.
Simien, Christopher; Holt, Kathleen D; Richter, Thomas H; Whalen, Thomas V; Coburn, Michael; Havlik, Robert J; Miller, Rebecca S
Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included. Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs. The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.
Drolet, Brian C; Brower, Jonathan P; Lifchez, Scott D; Janis, Jeffrey E; Liu, Paul Y
Although nearly all medical students pursuing integrated plastic surgery residency participate in elective rotations away from their home medical school, the value and costs of these "away" rotations have not been well studied. The authors surveyed all integrated plastic surgery program directors and all applicants in the 2015 National Residency Matching Program. Forty-two program directors and 149 applicants (64 percent and 70 percent response rate, respectively) completed the survey. Applicants reported 13.7 weeks spent on plastic surgery rotations during medical school, including a mean of 9.2 weeks on away rotations. Average reported cost for away rotations was $3591 per applicant. Both applicants and program directors most commonly reported "making a good impression" (44.6 percent and 36.6 percent, respectively) or finding a "good-fit" program (27.7 percent and 48.8 percent, respectively) as the primary goal for away rotations. Almost all applicants (91.1 percent) believed an away rotation made them more competitive for matching to a program at which they rotated. Program directors ranked a strong away rotation performance as the most important residency selection criterion. Twenty-seven percent of postgraduate year-1 positions were filled by an away rotatorm and an additional 17 percent were filled by a home medical student. Away rotations appear to be mutually beneficial for applicants and programs in helping to establish a good fit between students and training programs through an extended interaction with the students, residents, and faculty. In addition, making a good impression on a senior elective rotation (home or away) may improve an applicant's chance of matching to a residency program.
Kobraei, Edward M; Bohnen, Jordan D; George, Brian C; Mullen, John T; Lillemoe, Keith D; Austen, William G; Liao, Eric C
Milestones evaluations in plastic surgery reflect a shift toward competency-based training but have created a number of challenges. The authors have incorporated the smartphone application evaluation tool, System for Improving and Measuring Procedural Learning (SIMPL), that was recently developed by a multi-institutional research collaborative. In this pilot study, the authors hypothesize that SIMPL can improve resident evaluation and also collect granular performance data to simplify compliance with the plastic surgery Milestones. SIMPL was prospectively piloted with a plastic surgery resident and faculty surgeon at Massachusetts General Hospital in this institutional review board-approved study. The study period was a 2-month interval corresponding to the resident's rotation. The resident-faculty combination performed 20 cases together. All cases were evaluated with SIMPL. SIMPL evaluations uniformly took under 1 minute to submit. The average time to completed evaluation from surgery completion was 5 hours (technology will support a shared vocabulary between residents and faculty to enhance intraoperative education.
Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.
Sinno, Sammy; Mehta, Karan; Squitieri, Lee; Ranganathan, Kavitha; Koeckert, Michael S; Patel, Ashit; Saadeh, Pierre B; Thanik, Vishal
The National Residency Matching Program Match is a very unique process in which applicants and programs are coupled to each other based on a ranking system. Although several studies have assessed features plastic surgery programs look for in applicants, no study in the present plastic surgery literature identifies which residency characteristics are most important to plastic surgery applicants. Therefore, we sought to perform a multi-institutional assessment as to which factors plastic surgery residency applicants consider most important when applying for residency. A validated and anonymous questionnaire containing 37 items regarding various program characteristics was e-mailed to 226 applicants to New York University, Albany, University of Michigan, and University of Southern California plastic surgery residency programs. Applicants were asked to rate each feature on a scale from 1 to 10, with 10 being the most important. The 37 variables were ranked by the sum of the responses. The median rating and interquartile range as well as the mean for each factor was then calculated. A Wilcoxon signed rank test was used to compare medians in rank order. A total of 137 completed questionnaires were returned, yielding a 61% response rate. The characteristics candidates considered most important were impressions during the interview, experiences during away rotations, importance placed on resident training/support/mentoring by faculty, personal experiences with residents, and the amount of time spent in general surgery. The characteristics candidates considered least important were second-look experiences, compensation/benefits, program reputation from Internet forums, accessibility of program coordinator, opportunity for laboratory research, and fellowship positions available at the program. Applicants value personal contact and time spent in general surgery when selecting residency programs. As the number of integrated programs continues to grow, programs will benefit
Parikh, Rajiv P; Snyder-Warwick, Alison; Naidoo, Sybill; Skolnick, Gary B; Patel, Kamlesh B
The Accreditation Council for Graduate Medical Education and Plastic Surgery Milestone Project has identified practice-based learning and improvement, which involves systematically analyzing current practices and implementing changes, as a core competency in residency education. In surgical care, complication reporting is an essential component of practice-based learning and improvement as complications are analyzed in morbidity and mortality conference for quality improvement. Unfortunately, current methods for capturing a comprehensive profile of complications may significantly underestimate the true occurrence of complications. Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program. This is a preintervention and postintervention study evaluating resident reporting of complications on a plastic surgery service. The intervention was an online event reporting system developed by department leadership and patient safety experts. The cohorts consisted of all patients undergoing surgery during two separate 3-month blocks bridged by an implementation period. A trained reviewer recorded complications, and this served as the reference standard. Fisher's exact test was used for binary comparisons. There were 32 complications detected in 219 patients from June to August of 2015 and 35 complications in 202 patients from October to December of 2015. The proportion of complications reported in the preintervention group was nine of 32 (28.1 percent). After the intervention, this significantly increased to 32 of 35 (91.4 percent) (p < 0.001). An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents.
Krähenbühl, Swenn Maxence; Čvančara, Paul; Stieglitz, Thomas; Bonvin, Raphaël; Michetti, Murielle; Flahaut, Marjorie; Durand, Sébastien; Deghayli, Lina; Applegate, Lee Ann; Raffoul, Wassim
Successful Plastic Surgery Residency training is subjected to evolving society pressure of lower hourly work weeks imposed by external committees, labor laws, and increased public awareness of patient care quality. Although innovative measures for simulation training of surgery are appearing, there is also the realization that basic anatomy training should be re-enforced and cadaver dissection is of utmost importance for surgical techniques.In the development of new technology for implantable neurostimulatory electrodes for the management of phantom limb pain in amputee patients, a design of a cadaveric model has been developed with detailed steps for innovative transfascicular insertion of electrodes. Overall design for electrode and cable implantation transcutaneous was established and an operating protocol devised.Microsurgery of the nerves of the upper extremities for interfascicular electrode implantation is described for the first time. Design of electrode implantation in cadaver specimens was adapted with a trocar delivery of cables and electrodes transcutaneous and stabilization of the electrode by suturing along the nerve. In addition, the overall operating arena environment with specific positions of the multidisciplinary team necessary for implantable electrodes was elaborated to assure optimal operating conditions and procedures during the organization of a first-in-man implantation study.Overall importance of plastic surgery training for new and highly technical procedures is of importance and particularly there is a real need to continue actual cadaveric training due to patient variability for nerve anatomic structures.
Background: Plastic surgery is the most competitive specialty in medicine. We sought to identify factors associated with the successful match of generation Y applicants into integrated plastic surgery residency. Methods: We utilized the most recent data from the Charting Outcomes in the Match published by the National Resident Matching Program in 2011. We had data on US senior or independent applicant status, Alpha Omega Alpha (AOA) status, attendance of top 40 medical schools, advanced degree status, and number of contiguous ranks within plastic surgery. Our main outcome measure was match status. Results: A total of 81 out of 197 applicants (41.1%) successfully matched into integrated plastic surgery in the 2011 main match. US seniors matched at a significantly higher rate compared to independent applicants (44.0% vs 24.1%, P = 0.044). Matched US seniors were more likely to have AOA membership compared to unmatched US seniors (45.9% vs 27.7%, P = 0.014) and attend a top 40 medical school (52.7% vs 35.1%, P = 0.022). There were no differences in terms of advanced degrees between matched and unmatched US seniors. Unmatched US seniors were more likely to have 3 or fewer contiguous ranks of plastic surgery residency programs than matched US seniors (86.2% vs 68.9%, P = 0.007). Conclusions: US senior status, AOA membership, and attendance at a top 40 medical school are predictors of matching into integrated plastic surgery. Program directors need to be aware of the background of the millennial applicants to recruit and maintain top residents. PMID:25289227
Davis, Drew; Lee, Gordon
As of 2006, the Accreditation Council for Graduate Medical Education had defined six "core competencies" of residency education: interpersonal communication skills, medical knowledge, patient care, professionalism, practice-based learning and improvement, and systems-based practice. Objective structured clinical examinations using standardized patients are becoming effective educational tools, and the authors developed a novel use of the examinations in plastic surgery residency education that assesses all six competencies. Six plastic surgery residents, two each from postgraduate years 4, 5, and 6, participated in the plastic surgery-specific objective structured clinical examination that focused on melanoma. The examination included a 30-minute videotaped encounter with a standardized patient actor and a postencounter written exercise. The residents were scored on their performance in all six core competencies by the standardized patients and faculty experts on a three-point scale (1 = novice, 2 = moderately skilled, and 3 = proficient). Resident performance was averaged for each postgraduate year, stratified according to core competency, and scored from a total of 100 percent. Residents overall scored well in interpersonal communications skills (84 percent), patient care (83 percent), professionalism (86 percent), and practice-based learning (84 percent). Scores in medical knowledge showed a positive correlation with level of training (86 percent). All residents scored comparatively lower in systems-based practice (65 percent). The residents reported unanimously that the objective structured clinical examination was realistic and educational. The objective structured clinical examination provided comprehensive and meaningful feedback and identified areas of strengths and weakness for the residents and for the teaching program. The examination is an effective assessment tool for the core competencies and a valuable adjunct to residency training.
Basu, Chandrasekhar Bob; Chen, Li-Mei; Hollier, Larry H; Shenaq, Saleh M
The Accreditation Council for Graduate Medical Education (ACGME) Work-Hours Duty Policy became effective on July 1, 2003, mandating the reduction of resident duty work hours. The Baylor College of Medicine Multi-Institutional Integrated Plastic Surgery Program instituted a resident duty work-hours policy on July 1, 2002 (1 year ahead of the national mandate). Outcomes data are needed to facilitate continuous improvements in plastic surgical residency training while maintaining high-quality patient care. To assess the effect of this policy intervention on plastic surgery resident education as measured through the six core competencies and patient/resident safety, the investigators surveyed all categorical plastic surgery residents 6 months after implementation of the policy. This work represents the first empiric study investigating the effect of duty hours reduction on plastic surgery training and education. The categorical plastic surgery residents at the Baylor College of Medicine Multi-Institutional Integrated Plastic Surgery Program completed a 68-item survey on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). Residents were asked to rate multiple parameters based on the ACGME six core competencies, including statements on patient care and clinical/operative duties, resident education, resident quality of life, and resident perceptions on this policy. All surveys were completed anonymously. The sample size was n = 12 (program year 3 through program year 6), with a 100 percent response rate. Univariate and bivariate statistical analysis was conducted with SPSS version 10.0 statistical software. Specifically, interquartile deviations were used to find consensus among resident responses to each statement. Descriptive statistics indicated higher percentages of agreement on a majority of statements in three categories, including patient care and clinical/operative duties, academic duties, and resident quality of life. Using interquartile
Arneja, Jugpal S; Narasimhan, Kailash; Bouwman, David; Bridge, Patrick D
In-training evaluations in graduate medical education have typically been challenging. Although the majority of standardized examination delivery methods have become computer-based, in-training examinations generally remain pencil-paper-based, if they are performed at all. Audience response systems present a novel way to stimulate and evaluate the resident-learner. The purpose of this study was to assess the outcomes of audience response systems testing as compared with traditional testing in a plastic surgery residency program. A prospective 1-year pilot study of 10 plastic surgery residents was performed using audience response systems-delivered testing for the first half of the academic year and traditional pencil-paper testing for the second half. Examination content was based on monthly "Core Quest" curriculum conferences. Quantitative outcome measures included comparison of pretest and posttest and cumulative test scores of both formats. Qualitative outcomes from the individual participants were obtained by questionnaire. When using the audience response systems format, pretest and posttest mean scores were 67.5 and 82.5 percent, respectively; using traditional pencil-paper format, scores were 56.5 percent and 79.5 percent. A comparison of the cumulative mean audience response systems score (85.0 percent) and traditional pencil-paper score (75.0 percent) revealed statistically significantly higher scores with audience response systems (p = 0.01). Qualitative outcomes revealed increased conference enthusiasm, greater enjoyment of testing, and no user difficulties with the audience response systems technology. The audience response systems modality of in-training evaluation captures participant interest and reinforces material more effectively than traditional pencil-paper testing does. The advantages include a more interactive learning environment, stimulation of class participation, immediate feedback to residents, and immediate tabulation of results for the
Noland, Shelley S; Lee, Gordon K
The Accreditation Council for Graduate Medical Education emphasizes outcome-based residency education. This project is an outcomes study on graduates of the Stanford University Integrated Plastic Surgery Residency. A survey assessing various outcomes, including practice profile, financial, personal, and educational issues, was electronically distributed to all 130 graduates between 1966 and 2009. There was a 65% response rate. Nearly all respondents are currently in practice. Popular fellowships included hand and microsurgery. Most respondents participated in research and held leadership roles. Adequate residency education was noted in areas of patient care, board preparation, and ethical and legal issues. Inadequate residency education was noted in areas of managing a practice, coding, and cost-effective medicine. This is the first long-term outcomes study of plastic surgery graduates. Most are in active, successful practice. We have incorporated educational content related to running a small business, contract negotiating, and marketing to better prepare our residents for future practice.
Pećanac, Marija Đ
Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.
Silvestre, Jason; Levin, L Scott; Serletti, Joseph M; Chang, Benjamin
Designing an effective hand rotation for plastic surgery residents is difficult. The authors address this limitation by elucidating the critical components of the hand curriculum during plastic surgery residency. Hand questions on the Plastic Surgery In-Service Training Exam for six consecutive years (2008 to 2013) were characterized by presence of imaging, vignette setting, question taxonomy, answer domain, anatomy, and topic. Answer references were quantified by source and year of publication. Two hundred sixty-six questions were related to hand surgery (22.7 percent of all questions; 44.3 per year) and 61 were accompanied by an image (22.9 percent). Vignettes tended to be clinic- (50.0 percent) and emergency room-based (35.3 percent) (p < 0.001). Questions required decision-making (60.5 percent) over interpretation (25.9 percent) and recall skills (13.5 percent) (p < 0.001). Answers focused on interventions (57.5 percent) over anatomy/pathology (25.2 percent) and diagnoses (17.3 percent) (p < 0.001). Nearly half of the questions focused on the digits. The highest yield topics were trauma (35.3 percent), reconstruction (24.4 percent), and aesthetic and functional problems (14.2 percent). The Journal of Hand Surgery (American volume) (20.5 percent) and Plastic and Reconstructive Surgery (18.0 percent) were the most-cited journals, and the median publication lag was 7 years. Green's Operative Hand Surgery was the most-referenced textbook (41.8 percent). These results will enable trainees to study hand surgery topics with greater efficiency. Faculty can use these results to ensure that tested topics are covered during residency training. Thus, a benchmark is established to improve didactic, clinical, and operative experiences in hand surgery.
Fernandes, Julio Wilson; Metka, Susanne
The roots of science and art of plastic surgery are very antique. Anatomy, drawing, painting, and sculpting have been very important to the surgery and medicine development over the centuries. Artistic skills besides shape, volume, and lines perception can be a practical aid to the plastic surgeons' daily work. An overview about the interactions between art and plastic surgery is presented, with a few applications to rhinoplasty, cleft lip, and other reconstructive plastic surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
will succeed. First impressions tend to last, and if young people's first impression of plastic surgeons is that they spend much of their time doing cosmetic surgery then this is a first impression that might be long ... Res 2014;4 Suppl S3:169‑70. Access this article online. Quick Response Code: Website: www.amhsr.org. DOI:.
Ramesh Kumar Sharma
Full Text Available Background: The currently available training models are being put to scrutiny in India today, both by the residents and the teachers. Plastic surgery specialty was created primarily for reconstructive purposes but the society always perceived it from a cosmetic angle, particularly in the post second world war era. As a result, there is a need to redefine the goals of plastic surgery training in the present times so that the plastic surgeon is "future ready" to meet the needs of society and the market forces. Materials and Methods: The author has reviewed the currently available literature on plastic surgery training from India and the western countries. An attempt has been made to study opinions from the teachers and the trainees. The modules currently available in India and abroad have been analyzed and a suggestion has been made for drafting training programs that would meet the demands of the society as well as prepare the resident both for the aesthetic and reconstructive practice. Conclusions: The plastic surgery training needs to be more vibrant and in tune with the changing times. While maintaining its core nature, the current predominantly reconstructive modules need to incorporate the aesthetic content. The evaluation should be both knowledge and competence based. The teachers need to be educated in the various teaching methods that are more applicable to grown up residents. There is a need to find ways to attract talented people in the academic plastic surgery.
Sharma, Ramesh Kumar
The currently available training models are being put to scrutiny in India today, both by the residents and the teachers. Plastic surgery specialty was created primarily for reconstructive purposes but the society always perceived it from a cosmetic angle, particularly in the post second world war era. As a result, there is a need to redefine the goals of plastic surgery training in the present times so that the plastic surgeon is "future ready" to meet the needs of society and the market forces. The author has reviewed the currently available literature on plastic surgery training from India and the western countries. An attempt has been made to study opinions from the teachers and the trainees. The modules currently available in India and abroad have been analyzed and a suggestion has been made for drafting training programs that would meet the demands of the society as well as prepare the resident both for the aesthetic and reconstructive practice. The plastic surgery training needs to be more vibrant and in tune with the changing times. While maintaining its core nature, the current predominantly reconstructive modules need to incorporate the aesthetic content. The evaluation should be both knowledge and competence based. The teachers need to be educated in the various teaching methods that are more applicable to grown up residents. There is a need to find ways to attract talented people in the academic plastic surgery.
The Nigerian Journal of Plastic Surgery has its objectives in publishing original articles about developments in all areas related to plastic and reconstructive surgery as well as to trauma surgery. It also serves as a means of providing a forum for correspondence, information and discussion. It also accepts review articles that ...
Yao, Caroline A; Swanson, Jordan; McCullough, Meghan; Taro, Trisa B; Gutierrez, Ricardo; Bradshaw, Allison; Campbell, Alex; Magee, William P; Magee, William P
The emphasis on cultural competency for physicians and surgeons is increasingly important, as communication with both patients and other providers significantly affects individual and system-wide outcomes. International surgical training has been shown to improve leadership skills, cultural competency, and technical proficiency of participants in short-term follow-up. This study explores the long-term impact of international surgical mission experiences on developing participants' core competencies, professional outcomes, and commitment to global health. All 208 plastic and reconstructive surgeons who completed the Operation Smile Regan/Stryker fellowship programs between 2006 and 2015 were surveyed electronically. One hundred sixty-five surveys were returned, for an overall response rate of 79.3 percent. The majority of participants reported that the fellowship positively impacted all six Accreditation Council for Graduate Medical Education core competencies. Most participants who were attending physicians at the time of the survey were practicing general plastic surgery, with 42 percent in an academic/teaching environment, 32 percent in assistant/associate professor positions, and 6 percent in either a program director or department chairman position. The majority currently volunteer on local or international missions, and all respondents would consider volunteering again. Carefully structured and rigorously proctored programs such as the Regan/Stryker Fellowship offer plastic surgery residents the opportunity to gain valuable professional and personal experiences that benefit them long after their service experience. Programs of this nature can not only effectively improve cultural competency of physicians, but also positively influence their attitudes toward leadership and direct that potential to meet the growing need for surgical care in low- and middle-income countries.
Silvestre, Jason; Lin, Ines C; Serletti, Joseph M; Chang, Benjamin
The integrated plastic surgery match is among the most competitive residency matches in recent years. Although previous studies have correlated applicant characteristics with successful match outcomes, none have comprehensively investigated the role of geography in the match. This study elucidates regional biases in the match. Plastic surgery residents who matched during 2011-2015 were eligible for study inclusion. Names of residents were obtained from official residency program websites and cross-referenced with data obtained from the Student Doctor Network. For each resident, region of residency program and medical school were compared. From 67 programs, 622 residents were identified. Most graduated from US medical schools (97.9%). A total of 94 residents matched at a home institution (15.1%). Half of the residents matched in the same region as their medical school (48.9%). Programs in the South matched the greatest number of residents from the same region (60.8%), whereas West programs matched the least (30.8%, p < 0.001). No regional differences existed regarding residents matching at their home institution (p = 0.268). More women matched at West programs (43.1%) versus East programs (30.6%, p < 0.05). A significant number of residents matched at their home institution. Roughly, half matched at a program in the same region as their medical school. Whether this regional phenomenon stems from applicant or program factors remains unknown. Yet, given the limited number of interviews and the high costs of interviewing, applicants and programs can use these data to help optimize the match process. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Nicolai, J. -P. A.; Banic, A.; Molea, G.; Mazzola, R.; Poell, J. G.
The architecture of European Plastic Surgery was published in 1996 [Nicolai JPA, Scuderi N. Plastic surgical Europe in an organogram. Eur J Plast Surg 1996; 19: 253-6.] It is the objective of this paper to update information of that article. Continuing medical education (CME), science, training,
Body dysmorphic disorder is a mental disorder characterized by a preoccupation with some aspect of one's appearance. In cosmetic surgery, this preoccupation can be overlooked by practitioners resulting in a discrepancy between expected and realistic outcome. Identifying the characteristics of this disorder may be crucial to the practitioner-patient relationship in the plastic surgery setting.
Papas, Athanasios; Montemurro, Paolo; Hedén, Per
Plastic Surgery is one of the most competitive specialties in the field of medicine. However, this specialty has a unique particularity: the difficulties in Aesthetic Surgery training within the residency program. Despite the fact that the full title of the specialty is Plastic, Reconstructive, and Aesthetic Surgery and that Aesthetic Surgery is a part of the examination syllabus, the actual training in the specific area is limited. One of the solutions to this problem is Fellowships. The first author describes his personal experience with Aesthetic training and how it enhanced his knowledge in the area as well as the status of Fellowships in various training programs. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Full Text Available Background : According to Chinese medicine, the acupuncture-points′ (acupoints locations are proportionally and symmetrically distributed in well-defined compartment zones on the human body surface Oriental Anthropometry" (OA. Acupoints, if considered as aesthetic-loci, might be useful as reference guides in plastic surgery (PS. Aim: This study aimed to use aesthetic-loci as anatomical reference in surgical marking of Aesthetic Plastic Surgery. Method: This was an observational study based on aesthetic surgeries performed in private clinic. This study was based on 106 cases, comprising of 102 women and 4 men, with ages varying from 07 to 73 years, and with heights of between 1.34 m and 1.80 m. Patients were submitted to aesthetic surgical planning by relating aesthetic-loci to conventional surgical marking, including breast surgeries, abdominoplasty, rhytidoplasty, blepharoplasty, and hair implant. The aesthetic-surgical-outcome (ASO of the patients was assessed by a team of plastic surgeons (who were not involved in the surgical procedures over a follow-up period of one year by using a numeric-rating-scale in percentage (% terms. A four-point-verbal-rating-scale was used to record the patients′ opinion of therapeutic-satisfaction (TS. Results: ASO was 75.3 ± 9.4% and TS indicated that most patients (58.5% obtained "good" results. Of the remainder, 38.7% found the results "excellent", and 2.8% found them "fair". Discussion and Conclusion : The data suggested that the use of aesthetic-loci may be a useful tool for PS as an anatomical reference for surgical marking. However, further investigation is required to assess the efficacy of the OA by providing the patients more reliable balance and harmony in facial and body contours surgeries.
Chung, Susan; Zimmerman, Amanda; Gaviria, Andres; Dayicioglu, Deniz
Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.
Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin
Increased diversity of U.S. physicians can improve patient communication and mitigate health disparities for racial minorities. This study analyzes trends in racial and ethnic diversity of plastic surgery residents. Demographic data of surgical residents, medical students, and integrated plastic surgery residency applicants were obtained from the Association of American Medical Colleges. Data for college students and the general population were obtained from the U.S. Census for comparison with plastic surgery. Interspecialty differences and temporal trends in racial composition were analyzed with chi-square tests. From 1995 to 2014, Asian and Hispanic plastic surgery residents increased nearly 3-fold (7.4%-21.7%, p < 0.001) and 2-fold (4.6%-7.9%, p < 0.001), respectively. African American plastic surgery residents did not increase significantly (3.0%-3.5%, p = 0.129). Relative to the U.S. population, Hispanics (range: 0.1-0.5-fold) and African Americans (range: 0.1-0.4-fold) were underrepresented, whereas Asians (range: 2.2-5.3-fold) were overrepresented in plastic surgery. A "bottleneck" existed in the pipeline of African American and Hispanic plastic surgery residents. Significant differences in racial composition existed between plastic surgery and other surgical disciplines, which varied over time. The percentage of Hispanic (10.6% vs 7.0%, p = 0.402) and African American (6.4% vs 2.1%, p < 0.001) plastic surgery residency applicants exceeded those in residency. Hispanics and African Americans are underrepresented in plastic surgery residency relative to whites and Asians. This study underscores the need for greater initiatives to increase diversity in plastic surgery residency. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Miller, S H
Economic constraints developing as a result of rising health care costs in the United States pose significant challenges for and threats to the survival of academic plastic surgery. Declining clinical revenues, competition for patients and resources from other health care providers, and reductions in support of its education and research efforts necessitate a paradigm shift if it is to survive. Questionnaires were used to collect data from 92 of the 100 postgraduate training program directors of plastic surgery in the United States. The most common source of clinical income on a national basis was indemnity insurance. Sources of clinical income varied by region. The majority of programs, 80 percent, report that at least 75 percent of the income support for faculty came from practice income. Financial support for ancillary and research personnel, in large part, came from this same source. Resident salaries and benefits came largely from other resources. Generally as population density within the metropolitan area in which a program was located increased, so too did the number of competing plastic surgeons, including graduates of the program and nonacademic cosmetic and hand surgeons. However, levels of competition for cosmetic surgery in smaller metropolitan areas of some regions seem to be similar to those reported by programs in larger communities. Plastic surgery programs in very competitive communities received significantly greater amounts of their income from indemnity insurance and self-paying patients than did programs in less competitive metropolitan areas. Internal competition from other surgical and nonsurgical specialists within the same institution is likewise keen. Virtually all respondents, 93 percent, report that their institutions provided patient care in a least one designated center of excellence in the following disciplines: hand, microsurgery, craniofacial, cleft lip and palate, burn, and cosmetic surgery. This study suggests that centers of
Ahmad, Muhammad; Mohmand, Humayun; Ahmad, Nabila
Various studies have been conducted in many countries to determine the perception/awareness about plastic surgery. The present study assessed the views of college students about plastic surgery. A questionnaire consisted of nine questions regarding the basic knowledge about plastic surgery was randomly distributed among college students. The students were given 20 minutes to fill out the forms. A total of 250 male and 250 female college students were randomly included in the study. The mean age of the male students was 21.1 years as compared to 20.7 years of female students. The top five conditions named were related to hair (89.8%) followed by face scars (88%). The most common procedure named by the students was liposuction (88.2%) followed by hair transplantation. 80.2% of the students opted not to be a plastic surgeon if given an opportunity to select the profession. 33.8% of the students had seen some kinds of plastic surgery operation. Only 5.6% of the students (3.4% male and 2.2% female) had seen some kinds of plastic surgery procedure. 68% of male students and 48% of female students wished to have a plastic surgery procedure sometime in their lives. Majority of the students (88%) got the information from the internet. The second most common source was magazines (85.2%). Majority of the students (53.4%) had an idea of an invisible scar as a result of having a plastic surgery procedure. Only 22% thought to have no scar. Late Michael Jackson was at the top of the list of celebrities having a plastic surgery procedure (97.8%) followed by Nawaz Shariff (92.4%). Despite the rapid growth of plastic surgery in the last two decades, a large portion of population remains unaware of the spatiality. It is essential to institute programs to educate healthcare consumers and providers about the plastic surgery.
Lussiez, Alisha; Bevins, Jack; Plaska, Andrew; Rosin, Vadim; Reddy, Rishindra M
General surgery residents' exposure to cardiothoracic (CT) surgery rotations has decreased, which may affect resident satisfaction. We surveyed general surgery graduates to assess the relationships among rotation satisfaction, CT disease exposure, rotation length, mentorship, and mistreatment. A survey assessing CT curriculum, exposure, mentorship, and satisfaction was forwarded to general surgery graduates from 17 residency programs. A Wilcoxon rank-sum test was used to assess statistical significance of ordinal level data. Statistical significance was defined as p surgery residency programs who graduated between the years of 1999 to 2014. A total of 94 responses were completed and received. Receiving adequate exposure to CT procedures and disease management was significantly associated with higher satisfaction ratings for all procedures, particularly thoracotomy incisions (p Surgery. Published by Elsevier Inc. All rights reserved.
Richard M Kwasnicki
Full Text Available BackgroundInnovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years.MethodsPatents and publications related to plastic surgery (1960 to 2010 were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expert-derived technologies outside of the top performing patents areas were additionally explored.ResultsBetween 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, non-invasive techniques, and tissue engineering. Of these areas and other expert-derived technologies, those currently undergoing growth include surgical instruments, implants, non-invasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued.ConclusionsThe application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active.
Nielsen, Lea Juul; Matzen, Steen H
BACKGROUND: Venous thromboembolism is a well-documented complication of surgery, including plastic surgery. However, few consensus guidelines on thromboembolism prophylaxis exist in plastic surgery and, thus, the different approaches in the public as well as the private clinics in Denmark were...... investigated using a web-based survey. METHODS: Forty-two clinics were contacted and 45% responded. RESULTS: The collected data reveals a lack of consensus in plastic surgery in Denmark, not only regarding the use of mechanical and chemical prophylaxis, but also which type of prophylaxis to apply, the duration...... of prophylaxis, and how to risk stratify the patients. CONCLUSION: The development of a guideline, based on plastic surgical data, using a validated risk assessment model, which combines the surgical risk with the patient related risk and recommends guidelines for mechanical as well as chemoprophylaxis...
based on principles rather than limited procedures, with surgical interventions ranging from complex microsurgery-based reconstructions to aesthetic procedures. However, medical students' perceptions of the field of plastic surgery are limited and underestimate the versatility of services offered by plastic surgeons.[1,2] In ...
The present thesis was designed to evaluate the qualitative and quantitative aspects of plastic surgery research by means of a bibliometric citation analysis of plastic surgical presentations and publications. Citations to such published work provides an indication of the impact and the relevance of
Bartlett, Erica L; Zavlin, Dmitry; Friedman, Jeffrey D; Abdollahi, Aariane; Rappaport, Norman H
With a focus on providing high quality care and reducing facility based expenses there has been an evolution in perioperative care by way of enhanced recovery after surgery (ERAS). ERAS allows for a multidisciplinary and multimodal approach to perioperative care which not only expedites recovery but maximizes patient outcomes. This paradigm shift has been generally accepted by most surgical specialties, including plastic surgery. The goal of this study was to evaluate the impact of ERAS on outcomes in cosmetic plastic surgery. A prospective study consisting of phone call questionnaires was designed where patients from two senior plastic surgeons (N.H.R. and J.D.F.) were followed. The treatment group (n = 10) followed an ERAS protocol while the control group (n = 12) followed the traditional recovery after surgery which included narcotic usage. Patients were contacted on postoperative days (POD) 0 through 7+ and surveyed about a number of outcomes measures. The ERAS group demonstrated a significant reduction in postoperative pain on POD 0, 1, 2, and 3 (all P plastic surgery. The utility lies in the ability to expedite patient's recovery while still providing quality care. This study showed a reduction in postoperative complaints by avoiding narcotics without an increase in complications. Our findings signify the importance of ERAS protocols within cosmetic plastic surgery. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: email@example.com
Silvestre, Jason; Wu, Liza C; Lin, Ines C; Serletti, Joseph M
An increasing number of women are entering the medical profession, but plastic surgery remains a male-dominated profession, especially within academia. As academic aspirations and advancement depend largely on research productivity, the authors assessed the number of articles authored by women published in the journal Plastic and Reconstructive Surgery. Original articles in Plastic and Reconstructive Surgery published during the years 1970, 1980, 1990, 2000, 2004, and 2014 were analyzed. First and senior authors with an M.D. degree and U.S. institutional affiliation were categorized by gender. Authorship trends were compared with those from other specialties. Findings were placed in the context of gender trends among plastic surgery residents in the United States. The percentage of female authors in Plastic and Reconstructive Surgery increased from 2.4 percent in 1970 to 13.3 percent in 2014. Over the same time period, the percentage of female plastic surgery residents increased from 2.6 percent to 32.5 percent. By 2014, there were more female first authors (19.1 percent) than senior authors (7.7 percent) (p < 0.001). As a field, plastic surgery had fewer female authors than other medical specialties including pediatrics, obstetrics and gynecology, general surgery, internal medicine, and radiation oncology (p < 0.05). The increase in representation of female authors in plastic surgery is encouraging but lags behind advances in other specialties. Understanding reasons for these trends may help improve gender equity in academic plastic surgery.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Plastic surgery kit and accessories. 878.3925... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3925 Plastic surgery kit and accessories. (a) Identification. A plastic surgery kit and accessories is a device intended to...
Liodaki, Eirini; Eirini, Liodaki; Liodakis, Emmanouil; Emmanouil, Liodakis; Papadopoulos, Othonas; Othonas, Papadopoulos; Machens, Hans-Günther; Hans-Günther, Machens; Papadopulos, Nikolaos A; Nikolaos, Papadopulos A
In this report we highlight the use of PET scan in plastic and reconstructive surgery. PET scanning is a very important tool in plastic surgery oncology (melanoma, soft-tissue sarcomas and bone sarcomas, head and neck cancer, peripheral nerve sheath tumors of the extremities and breast cancer after breast esthetic surgery), as diagnosis, staging, treatment planning and follow-up of cancer patients is based on imaging. PET scanning seems also to be useful as a flap monitoring system as well as an infection's imaging tool, for example in the management of diabetic foot ulcer. PET also contributes to the understanding of pathophysiology of keloids which remain a therapeutic challenge.
Chan, Kevin; Petrisor, Brad; Bhandari, Mohit
Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.
Diaz-Siso, J Rodrigo; Plana, Natalie M; Stranix, John T; Cutting, Court B; McCarthy, Joseph G; Flores, Roberto L
Contemporary plastic surgery residents are increasingly challenged to learn a greater number of complex surgical techniques within a limited period. Surgical simulation and digital education resources have the potential to address some limitations of the traditional training model, and have been shown to accelerate knowledge and skills acquisition. Although animal, cadaver, and bench models are widely used for skills and procedure-specific training, digital simulation has not been fully embraced within plastic surgery. Digital educational resources may play a future role in a multistage strategy for skills and procedures training. The authors present two virtual surgical simulators addressing procedural cognition for cleft repair and craniofacial surgery. Furthermore, the authors describe how partnerships among surgical educators, industry, and philanthropy can be a successful strategy for the development and maintenance of digital simulators and educational resources relevant to plastic surgery training. It is our responsibility as surgical educators not only to create these resources, but to demonstrate their utility for enhanced trainee knowledge and technical skills development. Currently available digital resources should be evaluated in partnership with plastic surgery educational societies to guide trainees and practitioners toward effective digital content.
Full Text Available Objective To summarize the recent advancements and developmental prospects of plastic surgery worldwide,and to describe the future directions,aims,and highlights of Chinese military plastic surgery.Methods Relevant articles published in the last five years were retrieved through a search in PubMed,Medline,and CMCC.A statistical survey was conducted to summarize the achievements obtained by the Chinese military plastic surgery unit in the last five years.Results Considerable progress has been achieved in both clinical treatment and basic research of plastic surgery in the past five years.Its important role in the early treatment of combat injury and trauma has been recognized and emphasized.Chinese military plastic surgery has achieved considerable accomplishments in the last five years,especially in chronic wound repair;mechanism,prevention,and treatment of explosive soft tissue injuries and seawater immersion wounds;and new remedies of maxillofacial traumatic deformity,composite facial tissue allograft,and so on.Conclusions The repair and reconstruction of tissue defect and deformity caused by war injury and trauma will be the future major research direction of military plastic surgery.Research work should focus on tissue engineering,composite tissue allograft,stem cell therapy,mechanism of abnormal scar formation,among others,to solve the clinical problems of destructive facial injuries,extensive thora-abdominal wall defects,chronic ulcer,abnormal scars,and so on.Furthermore,plastic surgeons should fully utilize their special skills and take active part in the early treatment of war injury and trauma.
Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan
Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading ...
Raman, Tina; Alrabaa, Rami George; Sood, Amit; Maloof, Paul; Benevenia, Joseph; Berberian, Wayne
More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty. Do preresidency selection factors serve as predictors of success in residency? Specifically, we asked which preresidency selection factors are associated or correlated with (1) objective measures of resident knowledge and performance; and (2) subjective ratings by faculty. Charts of 60 orthopaedic residents from our institution were reviewed. Preresidency selection criteria examined included United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Medical College Admission Test (MCAT) scores, number of clinical clerkship honors, number of letters of recommendation, number of away rotations, Alpha Omega Alpha (AOA) honor medical society membership, fourth-year subinternship at our institution, and number of publications. Resident performance was assessed using objective measures including American Board of Orthopaedic Surgery (ABOS) Part I scores and Orthopaedics In-Training Exam (OITE) scores and subjective ratings by faculty including global evaluation scores and faculty rankings of residents. We tested associations between preresidency criteria and the subsequent objective and subjective metrics using linear correlation analysis and Mann-Whitney tests when appropriate. Objective measures of resident performance namely, ABOS Part I scores, had a moderate linear correlation with the USMLE Step 2 scores (r = 0.55, p communication skills" subsection of the global evaluations. We found that USMLE Step 2, number of honors in medical school clerkships, and AOA membership demonstrated the strongest correlations with resident performance. Our
Correia, N; Binet, A; Caliot, J; Poli Merol, M-L; Bodin, F; François-Fiquet, C
Balneology can be part of the plastic surgery care sector. The objectives of this study were firstly to the state of knowledge about the hydrotherapy and specify the place reserved for hydrotherapy by surgeons as an adjunct in plastic and reconstructive surgery (adult and child). Multicentric national study by poll (Google Drive®) focused at plastic and/or pediatric surgeons. The following information was analyzed: frequency, timing of prescription, indications, the surgeon's feelings towards hydrotherapy and the differences between adult's and children's prescriptions. Fifty-four teams were contacted: 22 responses were received (15 "adult" plastic surgeons, 9 "pediatric" plastic surgeons, 6 pediatric surgeons, with 12 out of 22 working with burnt patients). Eighteen out of 22 prescribed hydrotherapy. Twenty out of 22 thought that hydrotherapy had a role as adjuvant therapy in plastic surgery. The indications were: burns (11/20), skin-graft hypertrophy (10/20), inflammatory and pruritic scar and cutaneous trophic disorders (9/20), psychological (3/20), retractions (2/20), weight loss and smoking (1/20). The timing of the prescription was: 6 months and 1 year (8/20) after surgery/trauma. Twenty out of 22 found a beneficial effect: physical (19/20): reduction of inflammatory signs, pruritus and pain, scar maturation, skin thinning improvement; psychological (14/20): positive for patient/family. Five out of 17 made the difference between child/adult, 10/17 made no difference but only treated adults or children. The respondents in the study are probably more sensitive to the effects of hydrotherapy that non-respondents. It is difficult to assess the real impact of hydrotherapy in plastic surgery because distinguishing spontaneous favorable evolution of a scar from one only due to the hydrotherapy or multidisciplinary management is difficult. However, hydrotherapy seems to have its role among multidisciplinary management. Copyright © 2015 Elsevier Masson SAS. All
The history of pediatric plastic surgery is linked to that of paediatrics. Until the early 19th century, there was no children's hospital. Only some operations were performed before the discovery of anesthesia, aseptic and antisepsis: cleft lip repair, amputation for polydactyly. Many operations were described in the 19th century for cleft lip and palate repair, hypospadias, syndactylies. The first operation for protruding ears was performed in 1881. Pediatric plastic surgery is diversified in the 2nd half of the 20th century: cleft lip and palate, burns, craniofacial surgery, hand surgery become separate parts of the speciality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Sorice, Sarah C; Li, Alexander Y; Gilstrap, Jarom; Canales, Francisco L; Furnas, Heather J
Many plastic surgeons use social media as a marketing tool to attract and retain patients, but information about how patients use social media and their preferred types of plastic surgery posts have been lacking. To investigate patients' preferred social media networks and the type of posts they wished to see, a cross-sectional study was conducted in a single aesthetic practice of two plastic surgeons by surveying 100 consecutive patients. The age of the patients averaged 44.4 years (range, 17 to 78 years). Facebook had the greatest patient use and engagement, with YouTube second in use, and Instagram second in number of engaged users. Over half used Pinterest, but with little daily engagement. Only one-fourth used Snapchat, but the percentage of users who were highly engaged was second only to Facebook. The least popular network was Twitter, with the fewest patient users and least engagement. Social media played a minor role compared with the practice's Web site in both influencing patients to choose the practice and providing information on the day of the appointment. Patients most wanted to see posts on a plastic surgeon's social media platform related to practice information, before-and-after photographs, and contests. Articles about plastic surgery held the least interest. Among five types of Web site content, patients expressed most interest in before-and-after photographs. This study is the first to articulate the plastic surgery patient perspective regarding social media. The findings aim to help plastic surgeons maximize their influence on their target audience.
Hsu, Chi-Hsin; Lin, I-Chan; Shen, Yun-Dun; Hsu, Wen-Ming
We describe in this paper the current status of ophthalmic plastic and orbital surgery in Taiwan. Data were collected from the Bureau of National Health Insurance of Taiwan, the Bulletin of the Taiwan Ophthalmic Plastic and Reconstructive Society, and the Statistics Yearbook of Practicing Physicians and Health Care Organizations in Taiwan by the Taiwan Medical Association. We ascertained that 94 ophthalmologists were oculoplastic surgeons and accounted for 5.8% of 1621 ophthalmologists in Taiwan. They had their fellowship training abroad (most ophthalmologists trained in the United States of America) or in Taiwan. All ophthalmologists were well trained and capable of performing major oculoplastic surgeries. The payment rates by our National Health Insurance for oculoplastic and orbital surgeries are relatively low, compared to Medicare payments in the United States. Ophthalmologists should promote the concept that oculoplastic surgeons specialize in periorbital plastic and aesthetic surgeries. However, general ophthalmologists should receive more educational courses on oculoplastic and cosmetic surgery. Copyright © 2014. Published by Elsevier B.V.
Eirini, L.; Emmanouil, L.; Othonas, P.; Hans-Guenther, M.; Nikolaos, P.A.
In this report we highlight the use of position emission tomography (PET) scan in plastic and reconstructive surgery. PET scanning is a very important tool in plastic surgery oncology (melanoma, soft-tissue sarcomas and bone sarcomas, head and neck cancer, peripheral nerve sheath tumors of the extremities and breast cancer after breast esthetic surgery), as diagnosis, staging, treatment planning and follow-up of cancer patients is based on imaging. PET scanning seems also to be useful as a flap monitoring system as well as an infection's imaging tool, for example in the management of diabetic foot ulcer. PET also contributes to the understanding of pathophysiology of keloids which remain a therapeutic challenge. (author)
Gerstle, Theodore L; Ibrahim, Ahmed M S; Kim, Peter S; Lee, Bernard T; Lin, Samuel J
Three-dimensional printing represents an evolving technology still in its infancy. Currently, individuals and small business entities have the ability to manufacture physical objects from digital renderings, computer-aided design, and open source files. Design modifications and improvements in extrusion methods have made this technology much more affordable. This article explores the potential uses of three-dimensional printing in plastic surgery. A review was performed detailing the known uses of three-dimensional printing in medicine. The potential applications of three-dimensional printing in plastic surgery are discussed. Various applications for three-dimensional printing technology have emerged in medicine, including printing organs, printing body parts, bio-printing, and computer-aided tissue engineering. In plastic surgery, these tools offer various prospective applications for surgical planning, resident education, and the development of custom prosthetics. Numerous applications exist in medicine, including the printing of devices, implants, tissue replacements, and even whole organs. Plastic surgeons may likely find this technology indispensable in surgical planning, education, and prosthetic device design and development in the near future.
Full Text Available Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading to these legal claims. Materials and Methods: We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients’ demographic data, surgeons’ specialty and experience, and method of anesthesia were also collected. Results: One hundred twenty six patients entered the study among which 77 (61% were female and 49 (39% male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients’ age and sex, and also with the surgeons’ experience. Conclusion: There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians’ malpractice and some to the patients’ social and personal circumstances.
Razmpa, Ebrahim; Saedi, Babak; Safavi, Amin; Shahsavari, Ebrahim; Arvin Sazgar, Amir; Massihi, Farzaneh; Tofighi, Hasan
Introduction: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients’ expectations. This article aims to clarify the aspects of causes leading to these legal claims. Materials and Methods: We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients’ demographic data, surgeons’ specialty and experience, and method of anesthesia were also collected. Results: One hundred twenty six patients entered the study among which 77 (61%) were female and 49 (39%) male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients’ age and sex, and also with the surgeons’ experience. Conclusion: There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians’ malpractice and some to the patients’ social and personal circumstances. PMID:24303371
Tchantchaleishvili, Vakhtang; LaPar, Damien J; Stephens, Elizabeth H; Berfield, Kathleen S; Odell, David D; DeNino, Walter F
After approval by the Thoracic Surgery Residency Review Committee in 2007, 6-year integrated cardiothoracic surgery (I-6) residency programs have gained in popularity. We sought to assess and objectively quantify the level of satisfaction I-6 residents have with their training and to identify areas of improvement for future curriculum development. A completely anonymous, electronic survey was created by the Thoracic Surgery Residents Association that asked the responders to provide demographic information, specialty interest, and lifestyle priorities, and to rate their experience and satisfaction with I-6 residency. The survey was distributed nationwide to all residents in I-6 programs approved by the Accreditation Council for Graduate Medical Education. Of a total of 88 eligible I-6 residents, 49 completed the survey (55.7%). Career choice satisfaction was high (75.5%), as was overall satisfaction with integrated training (83.7%). The majority (77.6%) were interested in cardiac surgery. Overall, the responders reported sufficient time for life outside of the hospital (57.1%), but experienced conflicts between work obligations and personal life at least sometimes (75.5%). Early exposure to cardiothoracic surgery was reported as the dominant advantage of the I-6 model, whereas variable curriculum structure and unclear expectations along with poor integration with general surgery training ranked highest among perceived disadvantages. Current I-6 residents are largely satisfied with the integrated training model and report a reasonable work/life balance. The focused nature of training is the primary perceived advantage of the integrated pathway. Curriculum variability and poor integration with general surgery training are identified by residents as primary areas of concern. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Espinoza G, Ricardo; Danilla E, Stefan; Valdés G, Fabio; San Francisco R, Ignacio; Llanos L, Osvaldo
The profile of the general surgeon has changed, aiming to incorporate new skills and to develop new specialties. To assess the quality of postgraduate General Surgery training programs given by Chilean universities, the satisfaction of students and their preferences after finishing the training period. A survey with multiple choice and Likert type questions was designed and applied to 77 surgery residents, corresponding to 59% of all residents of general surgery specialization programs of Chilean universities. Fifty five per cent of residents financed with their own resources the specialization program. Thirty nine percent disagreed partially or totally with the objectives and rotations of programs. The opportunity to perform surgical interventions and the support by teachers was well evaluated. However, 23% revealed teacher maltreatment. Fifty six percent performed research activities, 73% expected to continue training in a derived specialty and 69% was satisfied with the training program. Residents considered that the quality and dedication of professors and financing of programs are issues that must be improved. The opportunity to perform surgical interventions, obtaining a salary for their work and teacher support is considered of utmost importance.
Silvestre, Jason; Zhang, Alicia; Lin, Samuel J
The Plastic Surgery In-Service Training Exam is a knowledge assessment tool widely used during plastic surgery training in the United States. This study analyzed literature supporting correct answer choices to determine highest yield sources, journal publication lag, and journal impact factors. Digital syllabi of 10 consecutive Plastic Surgery In-Service Training Exam administrations (2006 to 2015) were reviewed. The most-referenced articles, journals, and textbooks were determined. Mean journal impact factor and publication lag were calculated and differences were elucidated by section. Two thousand questions and 5386 references were analyzed. From 2006 to 2015, the percentage of journal citations increased, whereas textbook references decreased (p < 0.001). Plastic and Reconstructive Surgery was cited with greatest frequency (38.5 percent), followed by Clinics in Plastic Surgery (5.6 percent), Journal of Hand Surgery (American volume) (5.1 percent), and Annals of Plastic Surgery (3.8 percent). There was a trend toward less publication lag over the study period (p = 0.05), with a mean publication lag of 9.1 ± 9.0 years for all journal articles. Mean journal impact factor was 2.3 ± 4.3 and lowest for the hand and lower extremity section (1.7 ± 2.8; p < 0.001). The highest yield textbooks were elucidated by section. Plastic surgery faculty and residents may use these data to facilitate knowledge acquisition during residency.
Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin
The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.
Denis Souto Valente
Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.
Mornet, O; Grolleau, J-L; Garrido, I; Bekara, F; Herlin, C; Chaput, B
The objective of this study is to describe plastic surgery publications in terms of methodology, level of evidence, approval by institutional review board, method of consent, and subspecialty. The 8 top-ranked plastic surgery journals were selected. We manually reviewed the last 40 original articles in each plastic surgery journal, to represent more than 2 months of publications for all journals (range: 3-17 months). Only clinical original articles on human subjects were included. Each article was read at least twice by two different reviewers to ensure accurate data transcription, and then graded by written criteria. One of the senior authors was asked to make a final decision in case of doubt. Among the articles reviewed, 320 were analyzed. The geographical origin of these publications were Asia (32.5%), Europe (30%), US (28.4%), South America (5.6%), Africa (2.5%), and finally Oceania (1%). Reconstructive surgery remains the specialty area most represented in the journals with almost half of the publications, followed by breast surgery (24%) and plastic surgery (19%). A total of 75.6% were retrospective studies. Nearly 80% of the studies were of low level of evidence. Only 3.5% were randomized trials. Less than 40% of the publications mentioned approval by an institutional committee, and 22.6% a patient's informed consent. This study aimed to analyze the quality of plastic surgery publications, taking into account the criteria of Evidence Based Medicine. This work showed that more than half of the studies did not mention an institutional review board approval (Ethics Committee), and that three quarter of the studies did not indicate the presence of patient's informed consent. Ultimately, over 80% of the studies were of low level of evidence. The top-ranked journals have already imposed guidelines corresponding to the methodology requirements to publish clinical studies in their pages, such as EQUATOR criteria for the PRS journal. Efforts are therefore to be done
Wigley, Catrin H
Dr Jerome Pierce Webster is best remembered as the 'founder of plastic surgery education in the United States' on the basis of developing his nation's first plastic surgery residency programme, his role in the founding of the American Board of Plastic Surgery, and, more generally, his influence in professionalising this subspecialty. He also deserves to be remembered for his extensive missionary work in China, his publications as a successful bibliographer, and as an accomplished historian. © The Author(s) 2016.
Full Text Available Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020, previous percutaneous coronary intervention (PCI (OR, 2.69; CI, 1.21-5.97; P=0.015, hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001, bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046, American Society of Anesthesiologists (ASA class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004, and obesity (body mass index ≥30 (OR, 1.43; CI, 1.09-1.88, P=0.011 to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.
Smith, Brigitte K; Greenberg, Jacob A; Mitchell, Erica L
Since their introduction several years ago, integrated (0 + 5) vascular surgery residency programs are being increasingly developed across the country. To date, however, there is no defined "universal" curriculum for these programs and each program is responsible for creating its own curriculum. The aim of this study was to review the experiences of current 0 + 5 program directors (PDs) to determine what factors contributed to the curricular development within their institution. Semistructured interviews were conducted with 0 + 5 PDs to explore their experiences with program development, factors influencing the latter, and rationale for current curricula. The interview script was loosely structured to explore several factors including time of incoming residents' first exposure to the vascular surgical service, timing and rationale behind the timing of core surgical rotations throughout the 5 year program, educational value of nonsurgical rotations, opportunities for leadership and scholarly activity, and influence the general surgery program and institutional climate had on curricular structure. All interviews were conducted by a single interviewer. All interviews were qualitatively analyzed using emergent theme analysis. Twenty-six 0 + 5 PDs participated in the study. A total of 69% believed establishing professional identity early reduces resident attrition and recommend starting incoming trainees on vascular surgical services. Sixty-two percent spread core surgical rotations over the first 3 years to optimize general surgical exposure and most of the programs have eliminated specific rotations, as they were not considered valuable to the goals of training. Factors considered most important by PDs in curricular development include building on existing institutional opportunities (96%), avoiding rotations considered unsuccessful by "experienced" programs (92%), and maintaining a good working relationship with general surgery (77%). Fifty-eight percent of
Zetrenne, Eleonore; Kosins, Aaron M; Wirth, Garrett A; Bui, Albert; Evans, Gregory R D; Wells, James H
The objectives of this study were (1) to evaluate the role of a full-time academic plastic surgeon, (2) to define the indicators predictive of a successful career in academic plastic surgery, and (3) to understand the current issues that will affect future trends in the practice of academic plastic surgery. A questionnaire was developed to evaluate the role of current full-time academic plastic surgeons and to understand the current issues and future challenges facing academic plastic surgery. Each plastic surgery program director in the United States was sent the survey for distribution among all full-time academic plastic surgeons. Over a 6-week period, responses from 143 full-time academic plastic surgeons (approximately 31%) were returned. Fifty-three percent of respondents had been academic plastic surgeons for longer than 10 years. Seventy-three percent of respondents defined academic plastic surgeons as clinicians who are teachers and researchers. However, 53% of respondents believed that academic plastic surgeons were not required to teach or practice within university hospitals/academic centers. The 3 factors reported most frequently as indicative of a successful career in academic plastic surgery were peer recognition, personal satisfaction, and program reputation. Dedication and motivation were the personal characteristics rated most likely to contribute to academic success. Forty-four percent of respondents were unable to identify future academic plastic surgeons from plastic surgery residency applicants, and 27% were not sure. Most (93%) of the respondents believed that academic surgery as practiced today will change. The overall job description of a full-time academic plastic surgeon remains unchanged (teacher and researcher). Whereas peer recognition, personal satisfaction, and program reputation were most frequently cited as indicative of a successful plastic surgery career, financial success was rated the least indicative. Similarly, whereas the
Chuang, Jessica; Barnes, Christian; Wong, Brian J. F.
Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques. PMID:28824978
Matusiak, C; De Runz, A; Maschino, H; Brix, M; Simon, E; Claudot, F
Smoking increases perioperative risk regarding wound healing, infection rate and failure of microsurgical procedures. There is no present consensus about plastic and aesthetic surgical indications concerning smoking patients. The aim of our study is to analyze French plastic surgeons practices concerning smokers. A questionnaire was send by e-mail to French plastic surgeons in order to evaluate their own operative indications: patient information about smoking dangers, pre- and postoperative delay of smoking cessation, type of intervention carried out, smoking cessation supports, use of screening test and smoking limit associated to surgery refusing were studied. Statistical tests were used to compare results according to practitioner activity (liberal or public), own smoking habits and time of installation. In 148 questionnaires, only one surgeon did not explain smoking risk. Of the surgeons, 49.3% proposed smoking-cessation supports, more frequently with public practice (P=0.019). In total, 85.4% of surgeons did not use screening tests. Years of installation affected operative indication with smoking patients (P=0.02). Pre- and postoperative smoking cessation delay were on average respectively 4 and 3 weeks in accordance with literature. Potential improvements could be proposed to smoking patients' care: smoking cessation assistance, screening tests, absolute contraindication of some procedures or level of consumption to determine. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Waltzman, Joshua T; Tadisina, Kashyap K; Zins, James E
Over the past decade there has been a dramatic rise in the use of technology. Evaluating our use of technology is crucial to advancing the next generation of plastic surgeons. The goals of this study were to assess the current use of technology by residents, help Program Directors allocate financial resources, and predict the future of technology and education. A 17-question online survey was emailed to American Society for Aesthetic Plastic Surgery resident/fellow members (n = 447). The survey evaluated current use of technology, preferred use of educational resources, and directions for the future. Ample space was allocated for free response questions. The response rate was 40%. The average age of respondents was 32 years old (standard deviation 3.7). The majority (86.5%) of residents own iPhones, and 90% of residents own tablets. There was a heavy daily reliance on smartphone technology. Sixty percent of residents used physical textbooks on a weekly basis. The Plastic Surgery Education Network was used on a weekly basis by 42% of residents. In contrast, 78% of residents were not aware of, or had never used, the readily available digital aesthetic resource (RADAR) Resource iPad application. In order to remain at the forefront of education, we as a specialty need to adapt with technology. Program Directors should support integrating technology with electronic access to educational materials. There exists an opportunity in resident education to increase awareness and utilization of the RADAR Resource. The future of plastic surgery education will be reliant on platforms like the iPhone and iPad to conveniently provide large volumes of information with only a finger touch. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org.
(The) 3rd December 1952, 11 surgeons and other specialists found the French Society of Plastic and Reconstructive Surgery (SFCPR) which was officially published on (the) 28 September 1953. The first congress was during October 1953 and the first president as Maurice Aubry. The first secretary was Daniel Morel Fatio. The symposiums were after about three of four times each year and the thematic subjects were initially according the reconstructive surgery. The review "Annales de chirurgie plastique" was free in 1956. The members of the Society were about 30 initially, but their plastic surgery in the big hospitals at Paris and other big towns in France. The "specialty" of plastic surgery was created in 1971. On "syndicate", one French board of plastic reconstructive and aesthetic surgery, the increasing of departments of plastic surgery were the front of increasing of the plastic surgery in French and of the number of the French Society of Plastic Reconstructive surgery (580 in 2003). The French Society organized the International Congress of Plastic Surgery in 1975. The society SFCPR became the French Society of plastic reconstruction and Aesthetic Surgery (SFCPRE) in 1983 and the "logo" (front view) was in the 1994 SOF.CPRE.
Lutz, Kristina; Yazdani, Arjang; Ross, Douglas
Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training. A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction. The response rate was 100% (11/11). Using the average rankings of program directors, 26 "core" skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies. Overall, 26 competencies have been identified as "core" for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Silvestre, Jason; Basta, Marten N; Serletti, Joseph M; Chang, Benjamin
To facilitate the training of plastic surgery residents, we analyzed a knowledge-based curriculum for plastic and reconstructive surgery of the lower extremity. The Plastic Surgery In-Service Training Exam (PSITE) is a commonly used tool to assess medical knowledge in plastic surgery. We reviewed the lower extremity content on 6 consecutive score keys (2008-2013). Questions were classified by taxonomy, anatomy, and subject. Answer references were quantified by source and relative year of publication. Totally, 107 questions related to the lower extremity (9.1% of all questions) and 14 questions had an associated image (13.1%). Questions required decision making (49%) over interpretation (36%) and direct recall (15%) skills (p < 0.001). Conditions of the leg (42.1%) and thigh (24.3%) constituted most of the questions. Subject matter focused on flap reconstruction (38.3%), nerve injury (8.4%), and congenital deformity (6.5%). Analysis of 263 citations to 66 unique journals showed that Plastic and Reconstructive Surgery (54.9%) was the highest yield primary source. The median year of publication relative to PSITE administration was 6 (range: 1-58) with a mode of 2 years. Plastic Surgery by Mathes et al. was the most referenced textbook (21.9%). These data establish a benchmark for lower extremity training during plastic surgery residency. Study efforts focused on the most common topics and references will enhance trainee preparation for lower extremity PSITE questions. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Struk, S; Qassemyar, Q; Leymarie, N; Honart, J-F; Alkhashnam, H; De Fremicourt, K; Conversano, A; Schaff, J-B; Rimareix, F; Kolb, F; Sarfati, B
Robot-assisted surgery is more and more widely used in urology, general surgery and gynecological surgery. The interest of robotics in plastic and reconstructive surgery, a discipline that operates primarily on surfaces, has yet to be conclusively proved. However, the initial applications of robotic surgery in plastic and reconstructive surgery have been emerging in a number of fields including transoral reconstruction of posterior oropharyngeal defects, nipple-sparing mastectomy with immediate breast reconstruction, microsurgery, muscle harvesting for pelvic reconstruction and coverage of the scalp or the extremities. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
Rakhorst, Hinne A; Badran, Hassan; Clarke, Howard M; Cooter, Rodney; Evans, Gregory R D; Kirschbaum, Julio Daniel; Koh, Kyung Suk; Lazier, Carol; Murphy, Robert X; Nakatsuka, Takashi; Piccolo, Nelson Sarto; Perks, Graeme
This article describes the formation of the International Confederation of Plastic Surgery Societies (ICOPLAST) as a novel, transparent, dynamic, and proactive confederation of national plastic surgery societies. ICOPLAST aspires to provide a voice for the entire international community of plastic surgeons. ICOPLAST has been designed to benefit the patient, plastic surgery as a profession, and each individual plastic surgeon. Its principal objective is to enhance international communication, education, and advocacy processes to ultimately improve patient outcomes for plastic surgery patients globally. The new ICOPLAST's focus is to add true value for patients. ICOPLAST's evolution, philosophy, governance, and bylaws are explained and all societies worldwide are encouraged and cordially invited to join. An open and warm invitation is provided. Additional information is found at www.ICOPLAST.org.
The 200th anniversary of K. F. Graefe's "Rhinoplasty," E. Zeis' naming of the specialty of plastic surgery in 1838, and the continuing discussion on what is plastic surgery have prompted this historical-conceptual review with a semantic insight into the meaning of the word "plastic." A literature search has revealed that this term contains dual aspects: artistic and philosophical. The progressive development of these two connotations can be traced from their origin in the ceramics and the myths of ancient Greeks to their metamorphoses in fine arts, science, and philosophy of plasticity of the modern day. Although the names of plastic procedures and the title of the specialty carry both the artistic and philosophical features, the philosophical notion is less evident. This article underlines the importance of etymology in the interpretation of the concept of plastic surgery. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Shridharani, Sachin M; Magarakis, Michael; Manson, Paul N; Rodriguez, Eduardo D
The authors sought to review the various types of patients with psychological abnormalities who may present to the plastic surgeon and the psychological impact of various plastic surgery procedures on these patients. After systematically searching the Embase and PubMed databases and following further refinement (based on the authors' inclusion and exclusion criteria), the authors identified 65 studies. In addition, the authors felt that important information was contained in four textbooks, two press releases, and one Internet database. The inclusion criteria were studies that investigated the psychological outcomes, background, and personality types of patients seeking specific plastic surgery procedures. In addition, studies that addressed the impact of plastic surgery on patients' psychological status and quality of life were also included. The authors excluded studies with fewer than 30 patients, studies that did not pertain to the particular plastic surgery procedures, and studies that addressed psychological sequelae of revision operations. Narcissistic and histrionic personality disorders and body dysmorphic disorder are the three most common psychiatric conditions encountered in patients seeking cosmetic surgery. Overall, plastic surgery not only restores the appearance and function of the disfigured body unit but also alleviates psychological distress. Identifying the psychologically challenging patient before surgical intervention will allow the patient to obtain the appropriate psychological assistance and may result in a healthier individual with or without associated plastic surgery procedures.
Larson, Kelsey E; Gastman, Brian
In the last several years, federal funding has become increasingly difficult to obtain. The purpose of this project was to define the level of federal funding among plastic surgeons in the modern era. The authors evaluated members of the Plastic Surgery Research Council because of their expected invested interested in research. The authors collected information from 1998 to 2012 on funding using curricula vitae and publically available online tools. Data on Plastic Surgery Foundation funding was also collected to determine its role in supporting federally funded investigators. Of 256 individuals, the authors found 41 to be primary investigators on federally funded grants, with the majority receiving one to two awards. Common subtypes of awards included National Institutes of Health R01 (n = 15), K08 (n = 9), and R21 (n = 6). Limited funding from the National Science Foundation and the Department of Defense was identified. Despite a steady number of available National Institutes of Health awards, plastic surgery recipients have grown in number over the past 15 years. In a review of 20 years of Plastic Surgery Foundation awards, 113 Plastic Surgery Research Council members (44.1 percent) were awardees, averaging 1.8 awards per person. Twenty-nine Plastic Surgery Foundation awardees were also recipients of federal funding; 12 individuals received federal funding without prior Plastic Surgery Foundation funding. A search of plastic surgeons indicates a limited but increasing number of individuals receive federal funding. Plastic Surgery Foundation awards appear to be helpful in supporting investigators as they move to larger federal awards.
Full Text Available Background Plastic surgery as a major subspecialty of surgery has existed in Nigeria for several decades but the populace including medical practitioners are yet to fully appreciate its scope. This leads to very late presentation/referral of cases and management of cases that should have been referred by less qualified practitioners with attendant poor outcomes and complications. Most people still regard plastic surgery as being synonymous with cosmetic/aesthetic surgery but the scope goes far beyond this entity. It is therefore important that the public including medical practitioners who are the main sources of referral to the subspecialty are aware of the range of cases handled by plastic surgery units. The plastic surgeon in Nigeria is also faced with a lot of challenges ranging from the arduous task of one having to manage very many different and complicated cases to being very poorly equipped and appreciated. Objectives To educate the populace especially the medical practitioners on the scope of plastic surgery and the extent of development of the subspecialty in Nigeria and solicit for colleague′s cooperation in order to move plastic surgery forward. To also highlight the difficulties faced by the plastic surgeon in Nigeria and seeking help from appropriate quarters which will help to reduce unnecessary referrals abroad while improving the services rendered to patients locally. Conclusion Plastic surgery in Nigeria has developed significantly both in scope and manpower but it is still faced with a lot of challenges. Knowledge of its scope will help to reduce unnecessary referrals abroad while improving services/skill here in Nigeria.
Oladeji, Lasun O; Yu, Jonathan C; Oladeji, Afolayan K; Ponce, Brent A
Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program. Copyright © 2015 Association of Program Directors in Surgery. Published by
Conclusion: The level of awareness is high in the sampled population with associated increase in acceptance of its practice and willing utilization. All public hospitals should be encouraged to employ the services of plastic surgeons. Appropriate branding of specialized hospitals where plastic surgery service is available will ...
Fishman, Jordan E; Pang, John Henry Y; Losee, Joseph E; Rubin, J Peter; Nguyen, Vu T
Many aspire to leadership in academic plastic surgery yet there is no well-documented pathway. Information regarding plastic surgery residencies and program directors was obtained from the American Medical Association's FREIDA database. The division chief or department chair (academic head) of every academic plastic surgery program was identified. One Internet-based survey was distributed to academic heads; another, to program directors. Ninety academic heads were identified, 35 of whom also serve as program director. Sixty-seven unique program directors were identified. There was a 51 percent academic head response rate and a 65 percent program director response rate. Academic plastic surgery is overwhelmingly administered by midcareer men. The average program director was appointed at age 45 and has served for 7 years. She or he was trained through the independent track, completed additional training in hand surgery, and is a full professor. She or he publishes two or three peer-reviewed manuscripts per year and spends 9 hours per week in administration. The average academic head was appointed at age 45 and has held the position for 12 years. She or he was trained in the independent model, completed fellowship training, and is a full professor. She or he publishes five peer-reviewed manuscripts per year and spends 12 hours per week involved in administration. Program directors and academic heads serve nonoverlapping roles. Few program directors will advance to the role of academic head. Successful applicants to the program director position often serve as an associate program director and are seen as motivated resident educators. In contrast, those faculty members selected for the academic head role are academically accomplished administrators with business acumen.
Giunta, R E; Machens, H-G
Plastic surgery has passed through a very positive evolution in the last decades on the solid fundament of constantly developing academic plastic surgery. Aim of this paper is an objective evaluation of the current status of academic plastic surgery regarding research topics, currently available ressources and scientific outcome based on a questionnaire. The return rate of the questionnaire in academic departments was 92%. Main topics in research besides wound healing were topics from regenerative medicine such as tissue engineering, biomaterials, genetherapy and angiogenesis with the main focus on skin and fat tissues. In the past five years a total of 25 million Euros of third party research grants were raised. Research relied mainly on interdisciplinary research facilities. Regarding the scientific outcome more than 200 scientific papers were published in basic science research journals having an impactfactor higher than two. These results clearly demonstrate that plastic surgery is scientifically highly productive in academic surroundings where independent departments are established. Considering that independent units of plastic surgery exist in a relatively small number of all 36 university hospitals in germany, it has to be claimed for further independent departments so to provide adequate research facilities for further evolution of academic plastic surgery.
Lopez, Joseph; Calotta, Nicholas; Doshi, Ankur; Soni, Ashwin; Milton, Jacqueline; May, James W; Tufaro, Anthony P
The purpose of this study is to determine and characterize the scientific and nonscientific factors that influence the rate of article citation in the field of plastic surgery. Cross-sectional study. We reviewed all entries in Annals of Plastic Surgery and Journal of Plastic, Reconstructive, and Aesthetic Surgery from January 1, 2007 to December 31, 2007; and Plastic and Reconstructive Surgery from January 1, 2007 to December 31, 2008. All scientific articles were analyzed and several article characteristics were extracted. The number of citations at 5 years was collected as the outcome variable. A multivariable analysis was performed to determine which variables were associated with higher citations rates. A total of 2456 articles were identified of which only 908 fulfilled the inclusion criteria. Most studies were publications in the fields of reconstructive (26.3%) or pediatric/craniofacial (17.6%) surgery. The median number of citations 5 years from publication was 8. In the multivariable analysis, factors associated with higher citations rates were subspecialty field (p = 0.0003), disclosed conflict of interest (p = 0.04), number of authors (p = 0.04), and journal (p = 0.02). We have found that higher level of evidence (or other study methodology factors) is not associated with higher citation rates. Instead, conflict of interest, subspecialty topic, journal, and number of authors are strong predictors of high citation rates in plastic surgery. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Zhu, Victor Zhang; Tuggle, Charles Thompson; Au, Alexander Francis
The use of "Big Data" in plastic surgery outcomes research has increased dramatically in the last 5 years. This article addresses some of the benefits and limitations of such research. This is a narrative review of large database studies in plastic surgery. There are several benefits to database research as compared with traditional forms of research, such as randomized controlled studies and cohort studies. These include the ease in patient recruitment, reduction in selection bias, and increased generalizability. As such, the types of outcomes research that are particularly suited for database studies include determination of geographic variations in practice, volume outcome analysis, evaluation of how sociodemographic factors affect access to health care, and trend analyses over time. The limitations of database research include data which are limited only to what was captured in the database, high power which can cause clinically insignificant differences to achieve statistical significance, and fishing which can lead to increased type I errors. The National Surgical Quality Improvement Project is an important general surgery database that may be useful for plastic surgeons because it is validated and has a large number of patients after over a decade of collecting data. The Tracking Operations and Outcomes for Plastic Surgeons Program is a newer database specific to plastic surgery. Databases are a powerful tool for plastic surgery outcomes research. It is critically important to understand their benefits and limitations when designing research projects or interpreting studies whose data have been drawn from them. For plastic surgeons, National Surgical Quality Improvement Project has a greater number of publications, but Tracking Operations and Outcomes for Plastic Surgeons Program is the most applicable database for plastic surgery research.
Ismail, Tarek; Sarraf, Namita; Epple, Christian; Schaefer, Kristin Marit; Schaefer, Dirk J.
Summary: The Swiss Plastic Surgery Association (https://plasticsurgery.ch/en/) decided to produce a corporate video to illustrate the concept of "plastic surgery of confidence" to the public. We show the diversity of specializations and the vast range of tasks that surgeons passionately handle day in and day out. We wanted to convey 2 main messages: first, that plastic surgery is more than just cosmetic surgery, and second, that plastic surgery in Switzerland is synonymous with quality and confidence. We selected 17 topics that we felt had good filmic potential and would best explain to the public what plastic surgery is about. This included the selection of appropriate patients, experts, and locations from all over the country. We thought it crucial to show the initial preoperative situation, as only in this case would the achievement of reconstruction be evident and comprehensive to the layman audience. The actual production was filmed in 5 different locations and took 5 days of shooting. We recorded 17 surgeons, 9 patients, and about 30 voluntary background actors. From 23 hours of footage, we created a 7 minute, 22 second corporate video, recorded in 3 of the Swiss national languages. The video was presented to the public online in June 2016, on the same day as the National Open Day of Plastic Surgery in Switzerland. The video is available online. We evaluated the impact of the video using a questionnaire for lay people and observed that it could substantially improve the perception of our specialty, especially regarding the reconstructive aspect. We feel that a freely available corporate video is a very useful means to promote plastic surgery and help patients better understand what it is all about. PMID:29062635
Alexander Lunger, MD
Full Text Available Summary:. The Swiss Plastic Surgery Association (https://plasticsurgery.ch/en/ decided to produce a corporate video to illustrate the concept of "plastic surgery of confidence" to the public. We show the diversity of specializations and the vast range of tasks that surgeons passionately handle day in and day out. We wanted to convey 2 main messages: first, that plastic surgery is more than just cosmetic surgery, and second, that plastic surgery in Switzerland is synonymous with quality and confidence. We selected 17 topics that we felt had good filmic potential and would best explain to the public what plastic surgery is about. This included the selection of appropriate patients, experts, and locations from all over the country. We thought it crucial to show the initial preoperative situation, as only in this case would the achievement of reconstruction be evident and comprehensive to the layman audience. The actual production was filmed in 5 different locations and took 5 days of shooting. We recorded 17 surgeons, 9 patients, and about 30 voluntary background actors. From 23 hours of footage, we created a 7 minute, 22 second corporate video, recorded in 3 of the Swiss national languages. The video was presented to the public online in June 2016, on the same day as the National Open Day of Plastic Surgery in Switzerland. The video is available online. We evaluated the impact of the video using a questionnaire for lay people and observed that it could substantially improve the perception of our specialty, especially regarding the reconstructive aspect. We feel that a freely available corporate video is a very useful means to promote plastic surgery and help patients better understand what it is all about.
Lunger, Alexander; Ismail, Tarek; Sarraf, Namita; Epple, Christian; Schaefer, Kristin Marit; Schaefer, Dirk J
The Swiss Plastic Surgery Association (https://plasticsurgery.ch/en/) decided to produce a corporate video to illustrate the concept of "plastic surgery of confidence" to the public. We show the diversity of specializations and the vast range of tasks that surgeons passionately handle day in and day out. We wanted to convey 2 main messages: first, that plastic surgery is more than just cosmetic surgery, and second, that plastic surgery in Switzerland is synonymous with quality and confidence. We selected 17 topics that we felt had good filmic potential and would best explain to the public what plastic surgery is about. This included the selection of appropriate patients, experts, and locations from all over the country. We thought it crucial to show the initial preoperative situation, as only in this case would the achievement of reconstruction be evident and comprehensive to the layman audience. The actual production was filmed in 5 different locations and took 5 days of shooting. We recorded 17 surgeons, 9 patients, and about 30 voluntary background actors. From 23 hours of footage, we created a 7 minute, 22 second corporate video, recorded in 3 of the Swiss national languages. The video was presented to the public online in June 2016, on the same day as the National Open Day of Plastic Surgery in Switzerland. The video is available online. We evaluated the impact of the video using a questionnaire for lay people and observed that it could substantially improve the perception of our specialty, especially regarding the reconstructive aspect. We feel that a freely available corporate video is a very useful means to promote plastic surgery and help patients better understand what it is all about.
Krieger, Lloyd M
Periods of economic downturn place special demands on the plastic surgeon whose practice involves a large amount of cosmetic surgery. When determining strategy during difficult economic times, it is useful to understand the macroeconomic background of these downturns and to draw lessons from businesses in other service industries. Business cycles and monetary policy determine the overall environment in which plastic surgery is practiced. Plastic surgeons can take both defensive and proactive steps to maintain their profits during recessions and to prepare for the inevitable upturn. Care should also be taken when selecting pricing strategy during economic slowdowns.
Sanan, Akshay; Quinn, Candace; Spiegel, Jeffrey H
Plastic surgeons are competing for their share of a growing but still limited market, thus making advertising an important component in a successful plastic surgery practice. The authors evaluate the variables, characteristics, and presentation features that make print advertisements most effectively pique the interest of individuals selecting a plastic surgeon. An online survey was administered to 404 individuals with active interest in plastic surgery from 10 major metropolitan areas. Participants were presented with 5 different advertisements from plastic surgeons throughout the country and were asked a series of both closed- and open-ended questions to assess verity, quality, and marketability of each advertisement. Reponses to open-ended questions were analyzed using the Wordle program (www.wordle.net). The most frequent themes identified for all 5 ads were "Being beautiful is possible" (41%), "I could be beautiful" (24%), "Some people need surgery to be beautiful" (16%), and "Being beautiful is important" (14%). Advertisement 1-featuring 3 women and no pre- or posttreatment photography, no physician photography, and a listing of the 3 physicians' credentials but not a list of the services provided-received the highest overall preference rating. Factors including emotions felt while reading, unique qualities of the advertisement, list of procedures performed, use of models versus actual patients, and pictures of the plastic surgeons were found to contribute to the respondents' overall perception of advertisements used to market a plastic surgery practice.
Denadai, Rafael; Araujo, Karin Milleni; Samartine Junior, Hugo; Denadai, Rodrigo; Raposo-Amaral, Cassio Eduardo
The purpose of this survey was to assess the influence of aesthetic surgery "reality television" shows viewing on the public's perception of the scope of plastic surgery practice. Perceptions of the scope of plastic surgery (33 scenarios), aesthetic surgery "reality television" viewing patterns ("high," "moderate," or "low" familiarity, similarity, confidence, and influence viewers), sociodemographic data, and previous plastic surgery interaction were collected from 2148 members of the public. Response patterns were created and bivariate and multivariate analyses were applied to assess the possible determinants of overall public choice of plastic surgeons as experts in the plastic surgery-related scenarios. Both "plastic surgeons" and "plastic surgeons alone" were the main response patterns (all p television" viewing negatively influences the public perception of the broad scope of plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Ganesh Kumar, Nishant; Benvenuti, Michael A; Drolet, Brian C
In-service training examinations (ITEs) are used to assess residents across specialties. However, it is not clear how they are integrated with the Accreditation Council for Graduate Medical Education Milestones and competencies. This study explored the distribution of specialty-specific milestones and competencies in ITEs for plastic surgery and orthopaedic surgery. In-service training examinations were publicly available for plastic surgery (PSITE) and orthopaedics (OITE). Questions on the PSITE for 2014-2016 and the OITE for 2013-2015 were mapped to the specialty-specific milestones and the 6 competencies. There was an uneven distribution of milestones and competencies in ITE questions. Nine of the 36 Plastic Surgery Milestones represented 52% (341 of 650) of questions, and 3 were not included in the ITE. Of 41 Orthopaedic Surgery Milestones, 7 represented 51% (201 of 394) of questions, and 5 had no representation on the ITE. Among the competencies, patient care was the most common (PSITE = 62% [403 of 650]; OITE = 59% [233 of 394]), followed by medical knowledge (PSITE = 34% [222 of 650]; OITE = 31% [124 of 394]). Distribution of the remaining competencies differed between the 2 specialties (PSITE = 4% [25 of 650]; OITE = 9% [37 of 394]). The ITEs tested slightly more than half of the milestones for the 2 specialties, and focused predominantly on patient care and medical knowledge competencies.
Honaker, Michael Drew; Paton, Beverly L; Stefanidis, Dimitrios; Schiffern, Lynnette M
Robotic surgery is a rapidly growing area in surgery. In an era of emphasis on cost reduction, the question becomes how do you train residents in robotic surgery? The aim of this study was to determine if there was a difference in operative time and complications when comparing general surgery residents learning robotic cholecystectomies to those learning standard laparoscopic cholecystectomies. A retrospective analysis of adult patients undergoing robotic and laparoscopic cholecystectomy by surgical residents between March 2013 and February 2014 was conducted. Demographic data, operative factors, length of stay (LOS), and complications were examined. Univariate and multivariate analyses were performed. The significance was set at p robotic cholecystectomy group and 40 in the laparoscopic group). Age, diagnosis, and American Society of Anesthesiologists score were not significantly different between groups. There was only 1 complication in the standard laparoscopic group in which a patient had to be taken back to surgery because of an incarcerated port site. LOS was significantly higher in the standard laparoscopic group (mean = 2.28) than in the robotic group (mean = 0.56; p robotic group (mean = 97.00 minutes; p = 0.4455). When intraoperative cholangiogram was evaluated, OR time was shorter in the robotic group. Robotic training in general surgery residency does not amount to extra OR time. LOS in our study was significantly longer in the standard laparoscopic group. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Schlitzkus, Lisa L; Vogt, Kelly N; Sullivan, Maura E; Schenarts, Kimberly D
Workplace bullying is at the forefront of social behavior research, garnering significant media attention. Most of the medical research has addressed bullying of nurses by physicians and demonstrates that patient care and outcomes may suffer. The intent of this study was to determine if general surgery residents are bullied by nurses. A survey instrument previously validated (Negative Acts Questionnaire-Revised) to evaluate for workplace bullying was modified to reflect the resident-nurse relationship. After institutional review board approval, the piloted online survey was sent to general surgery program directors to forward to general surgery residents. Demographic data are presented as percentages, and for negative acts, percentages of daily, weekly, and monthly frequencies are combined. Allopathic general surgery residencies in the United States. General surgery residents. The response rate was 22.1% (n = 452). Most respondents were men (55%) and had a mean age of 29 years (standard deviation = 7). Although 27.0% of the respondents were interns, the remaining classes were equally represented (12%-18% of responses/class). The respondents were primarily from medium-sized residency programs (45%), in the Midwest (28%), training in university programs (72%), and rotating primarily in a combined private and county hospital that serves both insured and indigent patients (59%). The residents had experienced each of the 22 negative acts (11.5%-82.5%). Work-related bullying occurs more than person-related bullying and physical intimidation. Ignoring of recommendations or orders by nurses occurs on a daily, weekly, or monthly basis for 30.2% of residents (work-related bullying). The most frequent person-related bullying act is ignoring the resident when they approach or reacting in a hostile manner (18.0%), followed by ignoring or excluding the resident (17.1%). Workplace bullying of general surgery residents by nurses is prominent. Future research is needed to determine
Ginther, David Nathan; Dattani, Sheev; Miller, Sarah; Hayes, Paul
Attrition rates in general surgery training are higher than other surgical disciplines. We sought to determine the prevalence with which Canadian general surgery residents consider leaving their training and the contributing factors. An anonymous survey was administered to all general surgery residents in Canada. Responses from residents who considered leaving their training were assessed for importance of contributing factors. The study was conducted at the Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, a tertiary academic center. The response rate was approximately 34.0%. A minority (32.0%) reported very seriously or somewhat seriously considering leaving their training, whereas 35.2% casually considered doing so. Poor work-life balance in residency (38.9%) was the single-most important factor, whereas concern about future unemployment (16.7%) and poor future quality of life (15.7%) were next. Enjoyment of work (41.7%) was the most frequent mitigating factor. Harassment and intimidation were reported factors in 16.7%. On analysis, only intention to practice in a nonacademic setting approached significant association with thoughts of leaving (odds ratio = 1.92, CI = 0.99-3.74, p = 0.052). There was no association with sex, program, postgraduate year, relationship status, or subspecialty interest. There was a nonsignificant trend toward more thoughts of leaving with older age. Canadian general surgery residents appear less likely to seriously consider quitting than their American counterparts. Poor work-life balance in residency, fear of future unemployment, and anticipated poor future quality of life are significant contributors to thoughts of quitting. Efforts to educate prospective residents about the reality of the surgical lifestyle, and to assist residents in securing employment, may improve completion rates. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Hadzikadic, Lejla; Burke, Peter A; Esposito, Thomas J; Agarwal, Suresh
Presenting the opinions of surgical residents about the appeal of trauma surgery as a specialty may influence current reform. Survey study. Academic research. General surgery residents (postgraduate years 1-5 and recent graduates) registered with the American College of Surgeons. A 22-item survey. Career plans and perceptions about trauma surgery as a specialty. Of 6006 mailed surveys, we had a 20.1% response rate. Midlevel residents comprised most of the respondents, and most were undecided about their career choice or planned to enter general surgical private practice. The typical residency programs represented were academic (81.7%), urban (90.6%), and level I trauma centers (78.7%), and included more than 6 months of trauma experience (77.6%). Most respondents (70.6%) thought that trauma surgery was unappealing. The most important deterrents to entering the field were lifestyle, poor reimbursement, and limited operating room exposure, while increased surgical critical care was not seen as a restriction. When questioned about the future of trauma surgery, they believed that trauma surgeons should perform elective (86.8%) and nontrauma emergency (91.5%) cases and would benefit from active association with an outpatient clinic (76.0%). Intellectual challenge and exciting nature of the field were listed as the most appealing aspects, and ideal practice characteristics included guaranteed salary and time away from work. As demand for trauma surgeons increases, resident interest has dwindled. As a specialty, trauma surgery must undergo changes that reflect the needs of the incoming generation. We present a sampling of current surgical resident opinion and offer these data to assist the changing discipline and the evolving field of acute care surgery.
Kim, Youngjun; Kim, Hannah; Kim, Yong Oock
Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.
Finnerty, Brendan M; Afaneh, Cheguevara; Aronova, Anna; Fahey, Thomas J; Zarnegar, Rasa
While robotic-assisted operations have become more prevalent, many general surgery residencies do not have a formal robotic training curriculum. We sought to ascertain how well current general surgery training permits acquisition of robotic skills by comparing robotic simulation performance across various training levels. Thirty-six participants were categorized by level of surgical training: eight medical students (MS), ten junior residents (JR), ten mid-level residents (MLR), and eight senior residents (SR). Participants performed three simulation tasks on the da Vinci (®) Skills Simulator (MatchBoard, EnergyDissection, SutureSponge). Each task's scores (0-100) and cumulative scores (0-300) were compared between groups. There were no differences in sex, hand dominance, video gaming history, or prior robotic experience between groups; however, SR was the oldest (p Robotic skillsets acquired during general surgery residency show minimal improvement during the course of training, although laparoscopic experience is correlated with advanced robotic task performance. Changes in residency curricula or pursuit of fellowship training may be warranted for surgeons seeking proficiency.
Tan, Aaron; Chawla, Reema; G, Natasha; Mahdibeiraghdar, Sara; Jeyaraj, Rebecca; Rajadas, Jayakumar; Hamblin, Michael R; Seifalian, Alexander M
The rapid ascent of nanotechnology and regenerative therapeutics as applied to medicine and surgery has seen an exponential rise in the scale of research generated in this field. This is evidenced not only by the sheer volume of papers dedicated to nanotechnology but also in a large number of new journals dedicated to nanotechnology and regenerative therapeutics specifically to medicine and surgery. Aspects of nanotechnology that have already brought benefits to these areas include advanced drug delivery platforms, molecular imaging and materials engineering for surgical implants. Particular areas of interest include nerve regeneration, burns and wound care, artificial skin with nanoelectronic sensors and head and neck surgery. This study presents a review of nanotechnology and regenerative therapeutics, with focus on its applications and implications in plastic surgery. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.
Best, Al M; Laskin, Daniel M
The purpose of this study was to evaluate residents' understanding of biostatistics and interpretation of research results. A questionnaire previously used in internal medicine residents was modified to include oral and maxillofacial surgery (OMS) examples. The survey included sections to identify demographic and educational characteristics of residents, attitudes and confidence, and the primary outcome-knowledge of biostatistics. In 2009 an invitation to the Internet survey was sent to all 106 program directors in the United States, who were requested to forward it to their residents. One hundred twelve residents responded. The percentage of residents who had taken a course in epidemiology was 53%; biostatistics, 49%; and evidence-based dentistry, 65%. Conversely, 10% of OMS residents had taken none of these classes. Across the 6-item test of knowledge of statistical methods, the mean percentage of correct answers was 38% (SD, 22%). Nearly half of the residents (42%) could not correctly identify continuous, ordinal, or nominal variables. Only 21% correctly identified a case-control study, but 79% correctly identified that the purpose of blinding was to reduce bias. Only 46% correctly interpreted a clinically unimportant and statistically nonsignificant result. None of the demographic or experience factors of OMS residents were related to statistical knowledge. Overall, OMS resident knowledge was below that of internal medicine residents (Pbiostatistics and the interpretation of research and are thus unprepared to interpret the results of published clinical research. Residency programs should include effective biostatistical training in their curricula to prepare residents in evidence-based dentistry. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Silvestre, Jason; Abbatematteo, Joseph M; Serletti, Joseph M; Chang, Benjamin
Decreasing funding rates and increasing competition for National Institutes of Health research grants have prompted diverse interventions in various fields of biomedicine. Currently, the state of National Institutes of Health funding for plastic surgery research is poorly understood. The purpose of this study was to describe the portfolio of National Institutes of Health grants in academic plastic surgery. Plastic surgery faculty at integrated and independent programs were queried individually in the National Institutes of Health RePORTER database for grants awarded in 2014. Funding totals, mechanisms, and institutes were calculated. Abstracts were categorized by research type and field of interest. Characteristics of National Institutes of Health-funded principal investigators were elucidated. Eight hundred sixty-one academic plastic surgeons at 94 programs were queried, and only 18 investigators (2.1 percent) were funded at 12 programs (12.8 percent). National Institutes of Health-funded investigators were predominately male (72 percent), fellowship-trained (61 percent), and aged 49.3 ± 7.8 years. A total of 20 awards amounted to $6,916,886, with an average award of $345,844 ± $222,909. Costs were primarily awarded through the R01 mechanism (77.2 percent). The top three National Institutes of Health institutes awarded 72.9 percent of the entire portfolio. Funding supported clinical (41.1 percent), translational (36.9 percent), and basic science (22.0 percent) research. Craniofacial (20.5 percent), hand (18.7 percent), and breast (16.2 percent) had the greatest funding. Few programs and faculty drive the National Institutes of Health portfolio of plastic surgery research. These data suggest a tenuous funding situation that may be susceptible to future spending cuts. Future research is needed to identify barriers to National Institutes of Health funding procurement in academic plastic surgery.
Janes, Lindsay; Lanier, Steven T; Evans, Gregory R D; Kasten, Steven J; Hume, Keith M; Gosain, Arun K
Although recent estimates predict a large impending shortage of plastic surgeons, graduate medical education funding through the Centers for Medicare and Medicaid Services remains capped by the 1997 Balanced Budget Act. The authors' aim was to develop a plan to stimulate legislative action. The authors reviewed responses of the American Society of Plastic Surgeons, American College of Surgeons, and American Medical Association from January of 2015 to a House Energy & Commerce Committee request for input on graduate medical education funding. In addition, all program directors in plastic surgery were surveyed through the American Council of Academic Plastic Surgeons to determine their graduate medical education funding sources. All three organizations agree that current graduate medical education funding is inadequate to meet workforce needs, and this has a significant impact on specialty selection and distribution for residency training. All agreed that funding should be tied to the resident rather than to the institution, but disagreed on whether funds should be divided between direct (allocated to residency training) and indirect (allocated to patient care) pools, as is currently practiced. Program directors' survey responses indicated that only 38 percent of graduate medical education funds comes from the Centers for Medicare and Medicaid Services. Organized medicine is at risk of losing critically needed graduate medical education funding. Specific legislation to support additional graduate medical education positions and funding (House Resolutions 1180 and 4282) has been proposed but has not been universally endorsed, in part because of a lack of collaboration in organized medicine. Collaboration among major organizations can reinvigorate these measures and implement real change in funding.
Stojkovic, Christa A.; Smeulders, Mark J. C.; van der Horst, Chantal M.; Khan, Sameena M.
Wound drains are often used after plastic and reconstructive surgery of the breast, in order to reduce potential complications. It is unclear whether there is any evidence to support this practice and we therefore undertook a systematic review of the best evidence available. To compare the safety
Khan, Sameena M.; Smeulders, Mark J. C.; van der Horst, Chantal M.
Wound drains are often used after plastic and reconstructive surgery of the breast, in order to reduce potential complications. It is unclear whether there is any evidence to support this practice and we therefore undertook a systematic review of the best evidence available. To compare the safety
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Full Text Available Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients include body dysmorphic disorder (BDD, narcissistic personality disorder and histrionic personality disorders. BDD is of particular importance to plastic surgeons. Because outrageous dissatisfaction with one's appearance may conceal psychopathologic traits that are not always easily recognizable, and which, if neglected, may result in serious iatrogenic and medicolegal consequences, we hope that this paper will help plastic surgeons in ultimately preventing patient and surgeon dissatisfaction within the population of patients with psychiatric disorders, and should recognize the diagnostic features of body dysmorphic disorder and screen psychologically unstable patients who may never be satisfied with surgery. [Arch Clin Exp Surg 2013; 2(2.000: 109-115
Schwed, Alexander C; Lee, Steven L; Salcedo, Edgardo S; Reeves, Mark E; Inaba, Kenji; Sidwell, Richard A; Amersi, Farin; Are, Chandrakanth; Arnell, Tracey D; Damewood, Richard B; Dent, Daniel L; Donahue, Timothy; Gauvin, Jeffrey; Hartranft, Thomas; Jacobsen, Garth R; Jarman, Benjamin T; Melcher, Marc L; Mellinger, John D; Morris, Jon B; Nehler, Mark; Smith, Brian R; Wolfe, Mary; Kaji, Amy H; de Virgilio, Christian
Previous studies of resident attrition have variably included preliminary residents and likely overestimated categorical resident attrition. Whether program director attitudes affect attrition has been unclear. To determine whether program director attitudes are associated with resident attrition and to measure the categorical resident attrition rate. This multicenter study surveyed 21 US program directors in general surgery about their opinions regarding resident education and attrition. Data on total resident complement, demographic information, and annual attrition were collected from the program directors for the study period of July 1, 2010, to June 30, 2015. The general surgery programs were chosen on the basis of their geographic location, previous collaboration with some coauthors, prior work in surgical education and research, or a program director willing to participate. Only categorical surgical residents were included in the study; thus, program directors were specifically instructed to exclude any preliminary residents in their responses. Five-year attrition rates (2010-2011 to 2014-2015 academic years) as well as first-time pass rates on the General Surgery Qualifying Examination and General Surgery Certifying Examination of the American Board of Surgery (ABS) were collected. High- and low-attrition programs were compared. The 21 programs represented different geographic locations and 12 university-based, 3 university-affiliated, and 6 independent program types. Programs had a median (interquartile range [IQR]) number of 30 (20-48) categorical residents, and few of those residents were women (median [IQR], 12 [5-17]). Overall, 85 of 966 residents (8.8%) left training during the study period: 15 (17.6%) left after postgraduate year 1, 34 (40.0%) after postgraduate year 2, and 36 (42.4%) after postgraduate year 3 or later. Forty-four residents (51.8%) left general surgery for another surgical discipline, 21 (24.7%) transferred to a different surgery
Elmore, Leisha C; Jeffe, Donna B; Jin, Linda; Awad, Michael M; Turnbull, Isaiah R
Background Burnout is a complex syndrome of emotional distress that can disproportionately affect individuals who work in healthcare professions. Study Design For a national survey of burnout in US general surgery residents, we asked all Accreditation Council for Graduate Medical Education-accredited general surgery program directors to email their general surgery residents an invitation to complete an anonymous, online survey. Burnout was assessed with the Maslach Burnout Inventory; total scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) subscales were calculated. Burnout was defined as having a score in the highest tertile for EE or DP or lowest tertile for PA. Chi-square tests and one-way analyses of variance were used to test associations between burnout tertiles for each subscale and various resident and training-program characteristics as appropriate. Results From April–December, 2014, 665 residents actively engaged in clinical training had data for analysis; 69% met the criterion for burnout on at least one subscale. Higher burnout on each subscale was reported by residents planning private practice compared with academic careers. A greater proportion of women than men reported burnout on EE and PA. Higher burnout on EE and DP was associated with greater work hours per week. Having a structured mentoring program was associated with lower burnout on each subscale. Conclusions The high rates of burnout among general surgery residents are concerning given the potential impact of burnout on the quality of patient care. Efforts to identify at-risk populations and to design targeted interventions to mitigate burnout in surgical trainees are warranted. PMID:27238875
Vardanian, Andrew J; Kusnezov, Nicholas; Im, Daniel D; Lee, James C; Jarrahy, Reza
Social media platforms have revolutionized the way human beings communicate, yet there is little evidence describing how the plastic surgery community has adopted social media. In this article, the authors evaluate current trends in social media use by practicing plastic surgeons. An anonymous survey on the use of social media was distributed to members of the American Society of Plastic Surgeons. Prevalent patterns of social media implementation were elucidated. One-half of respondents were regular social media users. Reasons for using social media included the beliefs that incorporation of social media into medical practice is inevitable (56.7 percent), that they are an effective marketing tool (52.1 percent), and that they provide a forum for patient education (49 percent). Surgeons with a primarily aesthetic surgery practice were more likely to use social media. Most respondents (64.6 percent) stated that social media had no effect on their practice, whereas 33.8 percent reported a positive impact and 1.5 percent reported a negative impact. This study depicts current patterns of social media use by plastic surgeons, including motivations driving its implementation and impressions on its impact. Many feel that social media are an effective marketing tool that generates increased exposure and referrals. A small number of surgeons have experienced negative repercussions from social media involvement. Our study reveals the presence of a void. There is a definite interest among those surveyed in developing best practice standards and oversight to ensure ethical use of social media platforms throughout the plastic surgery community. Continuing discussion regarding these matters should be ongoing as our experience with social media in plastic surgery evolves.
Sandler, Britt J; Tackett, John J; Longo, Walter E; Yoo, Peter S
Although family and lifestyle are known to be important factors for medical students choosing a specialty, there is a lack of research about general surgery residency program policies regarding pregnancy and parenthood. Similarly, little is known about program director attitudes about these issues. We performed a cross-sectional survey of United States (US) general surgery residency program directors. Sixty-six respondents completed the survey: 70% male, 59% from university-based programs, and 76% between 40 and 59 years of age. Two-thirds (67%) reported having a maternity leave policy. Less than half (48%) reported having a leave policy for the non-childbearing parent (paternity leave). Leave duration was most frequently reported as 6 weeks for maternity leave (58%) and 1 week for paternity leave (45%). Thirty-eight percent of general surgery residency program directors (PDs) reported availability of on-site childcare, 58% reported availability of lactation facilities. Forty-six percent of university PDs said that the research years are the best time to have a child during residency; 52% of independent PDs said that no particular time during residency is best. Sixty-one percent of PDs reported that becoming a parent negatively affects female trainees' work, including placing an increased burden on fellow residents (33%). Respondents perceived children as decreasing female trainees' well-being more often than male trainees' (32% vs 9%, p leave, length of leave, as well as inconsistency in access to childcare and availability of spaces to express and store breast milk. Program directors perceived parenthood to affect the training and well-being of female residents more adversely than that of male residents. Copyright © 2016 American College of Surgeons. All rights reserved.
Linn, John G; Hungness, Eric S; Clark, Sara; Nagle, Alexander P; Wang, Edward; Soper, Nathaniel J
To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change. Copyright © 2011 Mosby, Inc. All rights reserved.
Gil, Joseph A; Waryasz, Gregory R; Owens, Brett D; Daniels, Alan H
To examine orthopaedic surgery case logs for arthroscopy case volume during residency training and to evaluate trends in case volume and variability over time. Publicly available Accreditation Council for Graduate Medical Education surgical case logs from 2007 to 2013 for orthopaedic surgery residency were assessed for variability and case volume trends in shoulder, elbow, wrist, hip, knee, and ankle arthroscopy. The national average number of procedures performed in each arthroscopy category reported was directly compared from 2009 to 2013. The 10th and 90th percentile arthroscopy case volume was compared between 2007 and 2013 for shoulder and knee arthroscopy procedures. Subsequently, the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2007 was compared with the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2013. From 2007 to 2013, shoulder arthroscopy procedures performed per resident increased by 43.1% (P = .0001); elbow arthroscopy procedures increased by 28.0% (P = .00612); wrist arthroscopy procedures increased by 8.6% (P = .05); hip arthroscopy procedures, which were first reported in 2012, increased by 588.9%; knee arthroscopy procedures increased by 8.5% (P = .0435); ankle arthroscopy increased by 27.6% (P = .00149). The difference in knee and shoulder arthroscopy volume between residents in the 10th and 90th percentile in 2007 and residents in the 10th and 90th percentile in 2013 was not significant (P > .05). There was a 3.66-fold difference in knee arthroscopy volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 3.36-fold in 2013 (P = .70). There was a 5.86-fold difference in shoulder arthroscopy case volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 4.96-fold in 2013 (P = .29). The volume of arthroscopy cases performed by graduating orthopaedic surgery residents has
Edwards, Janet P; Schofield, Adam; Paolucci, Elizabeth Oddone; Schieman, Colin; Kelly, Elizabeth; Servatyari, Ramin; Dixon, Elijah; Ball, Chad G; Grondin, Sean C
To identify core thoracic surgery procedures that require increased emphasis during thoracic surgery residency for residents to achieve operative independence and to compare the perspectives of residents and program directors in this regard. A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents (12) and program directors (8) addressing the residents' ability to perform 19 core thoracic surgery procedures independently after the completion of residency. Residents were also questioned about the adequacy of their operative exposure to these 19 procedures during their residency training. A descriptive summary including calculations of frequencies and proportions was conducted. The perceptions of the 2 groups were then compared using the Fisher exact test employing a Bonferroni correction. The relationship between residents' operative exposure and their perceived operative ability was explored in the same fashion. The response rate was 100% for residents and program directors. No statistical differences were found between residents' and program directors' perceptions of residents' ability to perform the 19 core procedures independently. Both groups identified lung transplantation, first rib resection, and extrapleural pneumonectomy as procedures for which residents were not adequately prepared to perform independently. Residents' subjective ratings of operative exposure were in good agreement with their reported operative ability for 13 of 19 procedures. This study provides new insight into the perceptions of thoracic surgery residents and their program directors regarding operative ability. This study points to good agreement between residents and program directors regarding residents' surgical capabilities. This study provides information regarding potential weaknesses in thoracic surgery training, which may warrant an examination of the curricula of existing programs as well as a
Hansson, E; Tegelberg, E
The French language is less and less used as an international scientific language and many French researchers publish their work in English. Nowadays, Annales de Chirurgie Plastique Esthétique is the only international plastic surgical journal published completely in French. The use of English loan words in French plastic surgery has never been studied. The aim of this study was to describe the frequency and types of English loan words in French plastic surgery. A corpus consisting of all the articles in a number of Annales de Chirurgie Plastique Esthethique, chosen by default, was created. The frequency of English loan words was calculated and the types of words were analysed. The corpus contains 367 (0.8%) English loan words. Most of them are non-integrated loan words and calques. The majority of the plastic surgical loan words describe surgical techniques. The French plastic surgical language seems to be influenced by English. The usage of loan words does not always follow the recommendations and the usage is sometimes ambiguous. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Cyr-Taro, Amy E; Kotwall, Cyrus A; Menon, Rema P; Hamann, M Sue; Nakayama, Don K
Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons. To review employment patterns and job satisfaction among general surgery residents from a single university-affiliated institution. All general surgery residents graduating from 1986 to 2006, inclusive, were mailed an Institutional Review Board-approved survey, which was then returned anonymously. Information on demographics, fellowship training, practice characteristics, job satisfaction and change, and perceived shortcomings in residency training was collected. A total of 31 of 34 surveys were returned (91%). Most of those surveyed were male (94%) and Caucasian (87%). Sixty-one percent of residents applied for a fellowship, and all but 1 were successful in obtaining their chosen fellowship. The most frequent fellowship chosen was plastic surgery, followed by minimally invasive surgery. Seventy-one percent of residents who applied for fellowship felt that the program improved their competitiveness for a fellowship. Most of the sample is in private practice, and of those, 44% are in groups with more than 4 partners. Ninety percent work less than 80 hours per week. Only 27% practice in small towns (population job. Twenty-three percent agreed that they had difficulty finding their first job, and 30% had fewer job offers than expected. Thirty-five percent of the graduates have changed jobs: 29% of the residents have changed jobs once, and 6% have changed jobs at least twice since completing training. Reasons for leaving a job included colleague issues (82%), financial issues (82%), inadequate referrals (64%), excessive trauma (64%), and marriage or family reasons (55% and 55%, respectively). One half to three fourths of the graduates wished they had more teaching on postresidency business and financial issues, review of contracts, and suggestions for a timeline for finding a job. Although general surgical residencies prepare
Walker, Jessica L; Nathwani, Jay N; Mohamadipanah, Hossein; Laufer, Shlomi; Jocewicz, Frank F; Gwillim, Eran; Pugh, Carla M
The aim of this study was to assess performance measurement validity of our newly developed robotic surgery task trainer. We hypothesized that residents would exhibit wide variations in their intercohort performance as well as a measurable difference compared to surgeons in fellowship training. Our laboratory synthesized a model of a pelvic tumor that simulates unexpected bleeding. Surgical residents and fellows of varying specialties completed a demographic survey and were allowed 20 minutes to resect the tumor using the da Vinci robot and achieve hemostasis. At a standardized event in the simulation, venous bleeding began, and participants attempted hemostasis using suture ligation. A motion tracking system, using electromagnetic sensors, recorded participants' hand movements. A postparticipation Likert scale survey evaluated participants' assessment of the model's realism and usefulness. Three of the seven residents (postgraduate year 2-5), and the fellow successfully resected the tumor in the allotted time. Residents showed high variability in performance and blood loss (125-700 mL) both within their cohort and compared to the fellow (150 mL blood). All participants rated the model as having high realism and utility for trainees. The results support that our bleeding pelvic tumor simulator has the ability to discriminate resident performance in robotic surgery. The combination of motion, decision-making, and blood loss metrics offers a multilevel performance assessment, analyzing both technical and decision-making abilities. Copyright © 2017 Elsevier Inc. All rights reserved.
Okike, Kanu; Utuk, Mekeme E; White, Augustus A
Although the U.S. population is increasingly diverse, the field of orthopaedic surgery has historically been less diverse. The purpose of this study was to quantify the representation of racial and ethnic minorities among orthopaedic surgery residents compared with those in other fields of medicine and to determine how these levels of diversity have changed over time. We determined the representation of minorities among residents in orthopaedic surgery and in other fields by analyzing the Graduate Medical Education reports published annually by the Journal of the American Medical Association (JAMA), which provided data for African-Americans from 1968 to 2008, Hispanics from 1990 to 2008, Asians from 1995 to 2008, and American Indians/Alaskan Natives and Native Hawaiians/Pacific Islanders from 2001 to 2008. During the 1990s and 2000s, representation among orthopaedic residents increased rapidly for Asians (+4.53% per decade, p < 0.0001) and gradually for Hispanics (+1.37% per decade, p < 0.0001) and African-Americans (+0.68% per decade, p = 0.0003). Total minority representation in orthopaedics averaged 20.2% during the most recent years studied (2001 to 2008), including 11.7% for Asians, 4.0% for African-Americans, 3.8% for Hispanics, 0.4% for American Indians/Alaskan Natives, and 0.3% for Native Hawaiians/Pacific Islanders. However, orthopaedic surgery was significantly less diverse than all of the other residencies examined during this time period (p < 0.001). This was due primarily to the lower representation of Hispanics and Asians in orthopaedic surgery than in any of the other fields of medicine. Minority representation in orthopaedic residency programs has increased over time for Asians, Hispanics, and African-Americans. In spite of these gains, orthopaedic surgery has remained the least diverse of the specialty training programs considered in this study. While further efforts are needed to determine the factors underlying this lack of representation, we
Morselli, Paolo Giovanni; Micai, Alessandro; Boriani, Filippo
Eumorphic Plastic Surgery aims at improving the severe psychosocial pain caused by a deformity. Dysmorphopathology is an increasingly relevant problem facing the plastic surgeon. The aim of this study is to describe the perioperative questionnaires created by the senior author and to present a cohort of plastic surgery patients suffering from dysmorphopathies. These patients were prospectively followed and evaluated with the proposed questionnaires through their surgical pathway to explore the degree of satisfaction or disappointment compared to expectations. All candidates for plastic surgery procedures between April 2011 and June 2013 were included in the study. Preoperatively, all patients completed the Patient Expectation Questionnaire (E-pgm). Twelve months postoperatively, they completed the Patient Satisfaction Questionnaire (S-pgm). The E-pgm and S-pgm were compared to evaluate the consistency between the patient's preoperative expectations and postoperative evaluations. A total of 158 patients were included in the study. Out of them, 79 % experienced an improvement or no variation between preoperative expectations and postoperative satisfaction. With regard to the motivation for undergoing surgery, 91 % showed that the surgical procedure met the motivation. An overall positive perioperative change in life was experienced by 93 % of patients. The E-pgm questionnaire proved to be a valid and reliable tool for the selection of suitable candidates for surgery and for identification of dysmorphophobic patients. Enhancing the doctor-patient relationship and communication can reduce ambiguity and avoid troublesome misunderstandings, litigation and other legal implications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Gas, Becca L; Buckarma, EeeLN H; Mohan, Monali; Pandian, T K; Farley, David R
Surgical training programs often lack objective assessment strategies. Complicated scheduling characteristics frequently make it difficult for surgical residents to undergo formal assessment; actually having the time and opportunity to remediate poor performance is an even greater problem. We developed a novel methodology of assessment for residents and created an efficient remediation system using a combination of simulation, online learning, and self-assessment options. Postgraduate year (PGY) 2 to 5 general surgery (GS) residents were tested in a 5 station, objective structured clinical examination style event called the Surgical X-Games. Stations were 15 minutes in length and tested both surgical knowledge and technical skills. Stations were scored on a scale of 1 to 5 (1 = Fail, 2 = Mediocre, 3 = Pass, 4 = Good, and 5 = Stellar). Station scores ≤ 2 were considered subpar and required remediation to a score ≥ 4. Five remediation sessions allowed residents the opportunity to practice the stations with staff surgeons. Videos of each skill or test of knowledge with clear instructions on how to perform at a stellar level were offered. Trainees also had the opportunity to checkout take-home task trainers to practice specific skills. Residents requiring remediation were then tested again in-person or sent in self-made videos of their performance. Academic medical center. PGY2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN. A total of, 35 residents participated in the Surgical X-Games in the spring of 2015. Among all, 31 (89%) had scores that were deemed subpar on at least 1 station. Overall, 18 (58%) residents attempted remediation. All 18 (100%) achieved a score ≥ 4 on the respective stations during a makeup attempt. Overall X-Games scores and those of PGY2s, 3s, and 4s were higher after remediation (p remediation. Despite difficulties with training logistics and busy resident schedules, it is feasible to objectively assess most GS trainees and
Tan, Aaron; Chawla, Reema; Natasha, G; Mahdibeiraghdar, Sara; Jeyaraj, Rebecca; Rajadas, Jayakumar; Hamblin, Michael R.; Seifalian, Alexander M.
Summary The rapid ascent of nanotechnology and regenerative therapeutics as applied to medicine and surgery has seen an exponential rise in the scale of research generated in this field. This is evidenced not only by the sheer volume of papers dedicated to nanotechnology but also in a large number of new journals dedicated to nanotechnology and regenerative therapeutics specifically to medicine and surgery. Aspects of nanotechnology that have already brought benefits to these areas include advanced drug delivery platforms, molecular imaging and materials engineering for surgical implants. Particular areas of interest include nerve regeneration, burns and wound care, artificial skin with nanoelectronic sensors and head and neck surgery. This study presents a review of nanotechnology and regenerative therapeutics, with focus on its applications and implications in plastic surgery. PMID:26422652
Broholm, Malene; Rosenberg, Jacob
PURPOSE: Implementation of a robotic system may influence surgical training. The aim was to report the charge of the operating surgeon and the bedside assistant at robot-assisted procedures in urology, gynecology, and colorectal surgery. MATERIALS AND METHODS: A review of hospital charts from...... performed. In 10 (1.3%) of these procedures, a resident attended as bedside assistant and never as operating surgeon in the console. CONCLUSIONS: Our results demonstrate a severe problem with surgical education. Robot-assisted surgery is increasingly used; however, robotic surgical training during residency...... surgical procedures during a 1-year period from October 2013 to October 2014. All robot-assisted urologic, gynecologic, and colorectal procedures were identified. Charge of both operating surgeon in the console and bedside assistant were registered. RESULTS: A total of 774 robot-assisted procedures were...
Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W
Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.
Although the exact time of performing plastic surgery is not addressed in the medical and historical literature, it can be supposed that these surgical procedures have a long and fascinating history. Recent excavations provided many documents regarding the application of medical instruments, surgical and even reconstructive procedures during the pre-historic and ancient periods. Actually, there is no historical definite time-zone separating general and cosmetic operations in the pre-modern time; however, historically there have been many surgeons who tried to perform reconstructive procedures during their usual medical practice. This article presents a brief look at the history of plastic surgery form the ancient to the contemporary era, with a special focus on Iran.
Full Text Available Recently, virtual reality (VR and augmented reality (AR have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.
Edwards, J C; Currie, M L; Wade, T P; Kaminski, D L
This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members and four senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research.
Sieffert, Michelle R; Johnson, R Michael; Fox, Justin P
A history of smoking confers additional risk of complications following plastic surgical procedures, which may require hospital-based care to address. To determine if patients with a smoking history experience higher rates of complications leading to higher hospital-based care utilization, and therefore greater healthcare charges, after common outpatient plastic surgeries. Using ambulatory surgery data from California, Florida, Nebraska, and New York, we identified adult patients who underwent common facial, breast, or abdominal contouring procedures from January 2009 to November 2013. Our primary outcomes were hospital-based, acute care (hospital admissions and emergency department visits), serious adverse events, and cumulative healthcare charges within 30 days of discharge. Multivariable regression models were used to compare outcomes between patients with and without a smoking history. The final sample included 214,761 patients, of which 10,426 (4.9%) had a smoking history. Compared to patients without, those with a smoking history were more likely to have a hospital-based, acute care encounter (3.4% vs 7.1%; AOR = 1.36 [1.25-1.48]) or serious adverse event (0.9% vs 2.2%; AOR = 1.38 [1.18-1.60]) within 30 days. On average, these events added $1826 per patient with a smoking history. These findings were consistent when stratified by specific procedure and controlled for patient factors. Patients undergoing common outpatient plastic surgery procedures who have a history of smoking are at risk for more frequent complications, and incur higher healthcare charges than patients who are nonsmokers. © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: email@example.com
Sclafani, Anthony P; Saman, Masoud
Platelets are known primarily for their role in hemostasis, but there is increasing interest in the effect of platelets on wound healing. Platelet isolates such as platelet-rich plasma have been advocated to enhance and accelerate wound healing. This article describes the use of a novel preparation, platelet-rich fibrin matrix (PRFM), for facial plastic surgery applications such as volume augmentation, fat transfer supplementation, and as an adjunct to open surgical procedures. Copyright © 2012 Elsevier Inc. All rights reserved.
Chae, Michael P.; Rozen, Warren M.; McMenamin, Paul G.; Findlay, Michael W.; Spychal, Robert T.; Hunter-Smith, David J.
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embrac...
Phillips, Nicole A; Tannan, Shruti C; Kalliainen, Loree K
Although explicit sex-based discrimination has largely been deemed unacceptable in professional settings, implicit gender bias persists and results in a significant lack of parity in plastic surgery and beyond. Implicit gender bias is the result of a complex interplay of cultural and societal expectations, learned behaviors, and standardized associations. As such, both male and female surgeons are subject to its influence. A review of the literature was conducted, examining theories of gender bias, current manifestations of gender bias in plastic surgery and other fields, and interventions designed to address gender bias. Multiple studies demonstrate persistent gender bias that impacts female physicians at all levels of training. Several institutions have enacted successful interventions to identify and address gender bias. Explicit gender bias has largely disappeared, yet unconscious or implicit gender bias persists. A wide-scale commitment to addressing implicit gender bias in plastic surgery is necessary and overdue. Recommendations include immediate actions that can be undertaken on an individual basis, and changes that should be implemented at a national and international level by leaders in the field.
Eichhorn, Mitchell George; Karadsheh, Murad Jehad; Krebiehl, Johanna Ruth; Ford, Dawn Marie; Ford, Ronald D
Patients can experience significant pain during routine procedures in the plastic surgery clinic. Methods for clinical pain reduction are often impractical, time-consuming, or ineffective. Vibration is a safe, inexpensive, and highly applicable modality for pain reduction that can be readily utilized for a wide variety of procedures. This study evaluated the use of vibration as a viable pain-reduction strategy in the clinical plastic surgery setting. Patients requiring at least 2 consecutive procedures that are considered painful were enrolled in the study. These included injections, staple removal, and suture removal. In the same patient, one half of the procedures were performed without vibration and the other half with vibration. After completing the procedures, the patients rated their pain with vibration and without vibration. The patient and the researcher also described the experience with a short questionnaire. Twenty-eight patients were enrolled in the study. Patients reported significantly less pain on the Numeric Rating Scale pain scale when vibration was used compared with the control group (p reduction. It significantly reduces the pain experienced by patients during minor office procedures. Given its practicality and ease of use, it is a welcome tool in the plastic surgery clinic.
Caldart, Adriano Ulisses; Terruel, Igor; Enge, Dair Jocely; Kurogi, Adriana Sayuri; Buschle, Maurício; Mocellin, Marcos
Surgery of the stapedius remains the established treatment for otosclerosis. Recent publications have showed that success in surgeries done by residents have decreased and hearing results are worse than those obtained by experienced otologic surgeons. To evaluate the experience of the otorhinolaryngology unit, Parana University, relative to stapes surgery done in the residency training program. A retrospective study of 114 stapes surgeries done in the past 9 years in 96 patients. Audiometric results were analysed according to the Committee on Hearing and Equilibrium guidelines and the Amsterdam Hearing Evaluation Plots. The improvement of the airway postoperative gap and thresholds were taken into account. 96 patients were included, most of them female adults (67.7%) and white (93.7%). Stapedectomy was done in 50.9% of cases, mostly under local anesthesia and sedation (96.5%), using mostly the Teflon prosthesis (37.7%). The surgical success rate was 50.88%, there was an 11.4% complication rate. Postoperative hearing gains considered as surgical success were inferior to published results in the literature, done by experienced surgeons.
Vaporciyan, Ara A; Reed, Carolyn E; Erikson, Clese; Dill, Michael J; Carpenter, Andrea J; Guleserian, Kristine J; Merrill, Walter
Applications to cardiothoracic surgery (CTS) training programs have declined precipitously. The viewpoints of potential applicants, general surgery residents, have not yet been assessed. Their perceptions are crucial to understanding the cause and formulating appropriate changes in our educational system. An initial survey instrument was content-validated, and the final instrument was distributed electronically between March 24 and May 2, 2008 through 251 general surgery program directors to all Accreditation Council for Graduate Medical Education-accredited general surgery residents (7508). The response rate was 29% (2153 residents; 89% programs). Respondent's demographics matched existing data; 6% were committed to CTS, and 26% reported prior or current interest in CTS. Interest waned after postgraduate year 3. Interest correlated with CTS rotation duration. Of the respondents committed to CTS, 76% had mentors (71% were cardiothoracic surgeons). CTS had the most shortcomings among 9 subspecialties. Job security and availability accounted for 46% of reported shortcomings (3 to 14 times higher than other subspecialties). Work schedule accounted for 25%. Length of training was not a very important factor, although it was identified as an option to increase interest in CTS. Residents who were undecided or uninterested in CTS were twice as likely to cite the ability to balance work and personal life as important than residents who chose CTS. The dominant concern documented in the survey is job security and availability. The importance of mentorship and exposure to CTS faculty in promoting interest was also evident. Decision makers should consider these findings when planning changes in education and the specialty.
Smith, Brigitte K; Kang, P Chulhi; McAninch, Chris; Leverson, Glen; Sullivan, Sarah; Mitchell, Erica L
Integrated (0 + 5) vascular surgery (VS) residency programs must include 24 months of training in core general surgery. The Accreditation Council for Graduate Medical Education currently does not require specific case numbers in general surgery for 0 + 5 trainees; however, program directors have structured this time to optimize operative experience. The aim of this study is to determine the case volume and type of cases that VS residents are exposed to during their core surgery training. Accreditation council for graduate medical education operative logs for current 0 + 5 VS residents were obtained and retrospectively reviewed to determine general surgery case volume and distribution between open and laparoscopic cases performed. Standard statistical methods were applied. A total of 12 integrated VS residency programs provided operative case logs for current residents. A total of 41 integrated VS residents in clinical years 2 through 5. During the postgraduate year-1 training year, residents participated in significantly more open than laparoscopic general surgery cases (p surgery cases are hernia repair (20%), skin and soft tissue (7.4%), and breast (6.3%). Residents in programs with core surgery over 3 years participated in significantly more general surgery operations compared with residents in programs with core surgery spread out over 4 years (p = 0.035). 0 + 5 VS residents perform significantly more open operations than laparoscopic operations during their core surgery training. The majority of these operations are minor, nonabdominal procedures. The 0 + 5 VS residency program general surgery operative training requirements should be reevaluated and case minimums defined. The general surgery training component of 0 + 5 VS residencies may need to be restructured to meet the needs of current and future trainees. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Semer, Nadine B; Sullivan, Stephen R; Meara, John G
The global burden of surgical disease is estimated as being 11% of the total global burden of disease. In this article we discuss the portion of this burden which could be ameliorated with plastic surgical expertise. Although not necessarily seen as a major player in issues related to global health, plastic surgeons are uniquely qualified to decrease the burden of surgical disease afflicting people in the developing world. Burns, traumatic injuries, and congenital anomalies are some of the areas where the presence of plastic surgical expertise can make a significant difference in patient outcomes and thereby decrease the years of life lost due to disability due to these highly treatable conditions. In light of the severe shortage of plastic surgeons throughout the developing world, it falls to those concentrated in the developed world to harness their skills and address the vast unmet needs of the developing world so as to enhance global health. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Albert, Mark G; Rothkopf, Douglas M
Operating rooms (ORs), combined with labour and delivery suites, account for approximately 70% of hospital waste. Previous studies have reported that recycling can have a considerable financial impact on a hospital-wide basis; however, its importance in the OR has not been demonstrated. To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery. The authors identified disposable supplies and instruments that are routinely opened and wasted in common plastic and hand surgery procedures, and calculated the savings that can result from eliminating extraneous items. A cost analysis was performed, which compared the expense of OR waste versus single-stream recycling and the benefit of recycling HIPAA documents and blue wrap. Fifteen total items were removed from disposable plastic packs and seven total items from hand packs. A total of US$17,381.05 could be saved per year from these changes alone. Since initiating single-stream recycling, the authors' institution has saved, on average, US$3,487 per month at the three campuses. After extrapolating at the current savings rate, one would expect to save a minimum of US$41,844 per year. OR waste reduction is an effective method of decreasing cost in the surgical setting. By revising the contents of current disposable packs and instrument sets designated for plastic and hand surgery, hospitals can reduce the amount of opened and unused material. Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling.
Wong, Wendy W; Gupta, Subhas C
"Social media" describes interactive communication through Web-based technologies. It has become an everyday part of modern life, yet there is a lack of research regarding its impact on plastic surgery practice. The authors evaluate and compare the prevalence of classic marketing methods and social media in plastic surgery. The Web sites of aesthetic surgeons from seven US cities were compared and evaluated for the existence of Facebook, Twitter, or MySpace links and promotions. To find the sites, the authors conducted a Google search for the phrase "plastic surgery" with the name of each city to be studied: Beverly Hills, California; Dallas, Texas; Houston, Texas; Las Vegas, Nevada; Miami, Florida; New York City, New York; and San Francisco, California. The trends of social networking memberships were also studied in each of these cities. In comparison to aesthetic surgeons practicing in other cities, those in Miami, Florida, favored social media the most, with 50% promoting a Facebook page and 46% promoting Twitter. Fifty-six percent of New York City aesthetic surgeons promoted their featured articles in magazines and newspapers, whereas 54% of Beverly Hills aesthetic surgeons promoted their television appearances. An increase in the number of new Facebook memberships among cosmetic providers in the seven cities began in October 2008 and reached a peak in October, November, and December 2009, with subsequent stabilization. The increase in the number of new Twitter memberships began in July 2008 and remained at a steady rate of approximately 15 new memberships every three months. Social media may seem like a new and unique communication tool, but it is important to preserve professionalism and apply traditional Web site-building ethics and principles to these sites. We can expect continued growth in plastic surgeons' utilization of these networks to enhance their practices and possibly to launch direct marketing campaigns.
Michael P Chae
Full Text Available Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D reconstructions, are limited by their representation on 2D workstations. 3D printing has been embraced by early adopters to produce medical imaging-guided 3D printed biomodels that facilitate various aspects of clinical practice. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. With increasing accessibility, investigators are now able to convert standard imaging data into Computer Aided Design (CAD files using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography (SLA, multijet modeling (MJM, selective laser sintering (SLS, binder jet technique (BJT, and fused deposition modeling (FDM. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without out-sourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. In this review the existing uses of 3D printing in plastic surgery practice, spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative aesthetics, are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, patient and surgical trainee education, and the development of intraoperative guidance tools and patient-specific prosthetics in everyday surgical practice.
Chae, Michael P; Rozen, Warren M; McMenamin, Paul G; Findlay, Michael W; Spychal, Robert T; Hunter-Smith, David J
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing
Chae, Michael P.; Rozen, Warren M.; McMenamin, Paul G.; Findlay, Michael W.; Spychal, Robert T.; Hunter-Smith, David J.
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing
Symer, Matthew M; Abelson, Jonathan S; Yeo, Heather L; Sosa, Julie A; Rosenthal, M Zachary
There is limited understanding of the wide variation in attrition rates among general surgery residencies. We used the validated Behavior Inhibitory System/Behavior Approach System (BIS/BAS) instrument to compare motivational traits among residents who did and not complete surgical training. All US general surgery categorical interns in the class of 2007-2008 were surveyed with a validated motivational trait assessment tool. American Board of Surgery records from 2008-2016 were used to determine who completed training. Motivation, an aspect of personality, was assessed with the BIS/BAS, which correlates with an individual's tendency to approach pleasant stimuli (BAS) or avoid negative stimuli (BIS). Subscale mean scores were compared with regard to the primary end point, attrition. Eight hundred and one (76.5%) interns completed the survey and had matching records. Six hundred and forty-five (80.5%) completed training. Men had lower scores than women in the BAS Drive subscale (12.0 vs 12.5; p scale (19.3 vs 20.9; p academic 17.3 vs community 17.6 vs military 16.6; p motivational personality traits. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Lista, Frank; Mistry, Bhavik D; Singh, Yashoda; Ahmad, Jamil
The demand for female aesthetic labiaplasty surgery continues to rapidly increase. Several questions have been raised regarding the safety and effectiveness of female aesthetic genital surgery. The purpose of this study is to review our experience with aesthetic labiaplasty and describe the type and frequency of complications that have been experienced. A retrospective chart review was performed on all patients who had primary aesthetic labia minora reduction surgery from August 2007 to April 2014. A chart review of the electronic medical record was performed to examine demographic, procedural, and outcome data. In the study period, 113 patients underwent aesthetic labiaplasty. Of these, 29 patients (25.6%) had labiaplasty performed in combination with another procedure. A total of 15 patients (13.3%) reported transient symptoms, including swelling, bruising, and pain. There was one patient (0.8%) that experienced bleeding. Four patients (3.5%) required revision surgery. All revisions were performed to excise further tissue to address persistent redundancy or asymmetry. No major complications were reported. In our experience, aesthetic surgery of the labia minora using an edge excision technique has a very low complication rate and provides satisfactory aesthetic outcomes for our patients. More studies examining the impact of labiaplasty on a woman's self-image and quality of life would add to our understanding of the motivations and expectations of women undergoing this aesthetic surgery. This information will allow us to help our patients make well-informed decisions when considering this aesthetic genital surgery. 4 Risk. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org.
Wagenblast, Lene; Laessoe, Line; Printzlau, Andreas
, since some of the patients will experience problems due to excess skin. Foreign studies estimate that ∼30% of all bariatric surgery patients will at some point seek plastic surgical correction of excess skin. The aim of this study is to investigate to what extent the GB patients themselves consider......In the affluent part of the world, there is an increasing occurrence of obesity with Body Mass Index (BMI) above 40, which has resulted in an increasing number of operations such as gastric bypass (GB). After massive weight loss there will often be a need for subsequent plastic surgical correction...... plastic surgery for removal of excess skin, and their reasons and motivations for this. The investigation was performed as an anonymous questionnaire handed out to 150 patients at the 1-year standard consultation for GB patients at a private hospital. The questionnaire contained information about...
Zarrabi, Bahar; Burce, Karen K; Seal, Stella M; Lifchez, Scott D; Redett, Richard J; Frick, Kevin D; Dorafshar, Amir H; Cooney, Carisa M
Rising health care costs, decreasing reimbursement rates, and changes in American health care are forcing physicians to become increasingly business-minded. Both academic and private plastic surgeons can benefit from being educated in business principles. The authors conducted a systematic review to identify existing business curricula and integrated a business principles curriculum into residency training. The authors anonymously surveyed their department regarding perceived importance of business principles and performed a systematic literature review from 1993 to 2013 using PubMed and Embase to identify residency training programs that had designed/implemented business curricula. Subsequently, the authors implemented a formal, quarterly business curriculum. Thirty-two of 36 physicians (88.9 percent; 76.6 percent response rate) stated business principles are either "pretty important" or "very important" to being a doctor. Only 36 percent of faculty and 41 percent of trainees had previous business instruction. The authors identified 434 articles in the systematic review: 29 documented formal business curricula. Twelve topics were addressed, with practice management/administration (n = 22) and systems-based practice (n = 6) being the most common. Four articles were from surgical specialties: otolaryngology (n = 1), general surgery (n = 2), and combined general surgery/plastic surgery (n = 1). Teaching formats included lectures and self-directed learning modules; outcomes and participant satisfaction were reported inconsistently. From August of 2013 to June of 2015, the authors held eight business principles sessions. Postsession surveys demonstrated moderately to extremely satisfied responses in 75 percent or more of resident/fellow respondents (n = 13; response rate, 48.1 percent) and faculty (n = 9; response rate, 45.0 percent). Business principles can be integrated into residency training programs. Having speakers familiar with the physician audience and a
Full Text Available Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.
Fabié, A; Delay, E; Chavoin, J-P; Soulhiard, F; Seguin, P
As, quest for beauty has always been an aim. There is a need to define the "ideal" beautifull breast with objective caracteristics, usable in plastic, reconstructive and aesthetic surgery. After, we have defined the necessary parameters usable in breast surgery. We realized an anthropomorphic study including 70 volunteer women and one molded model. Multiple pictures have been taken for each volunteer, that were evaluated and noted by five plastic surgeon, five doctors from other speciality, five women, five men. A twenty notation was used for this study. The main values for the ten women that obtained best notation (>or=14/20) were used in order to defined the ideal measures for surgery. Breast arrow and breast arrow over the trunck height were the most significant factors. According statistical studies, this fraction is about 0,387 (P=0,000969). The nice breast has a round shape and look like juvenile breast. Bra size, cup size, base, segments II and III, fraction II/III are not significant in our series of (non operated) natural breast. The ideal breast is in harmony and proportional to the trunck height, with the main fraction of breast arrow on the trunck height about 0,387 in our serie.
Hani Sinno, MD, MEng
Full Text Available Summary: Outcome studies help provide the evidence-based science rationalizing treatment end results that factor the experience of patients and the impact on society. They improve the recognition of the shortcoming in clinical practice and provide the foundation for the development of gold standard care. With such evidence, health care practitioners can develop evidence-based justification for treatments and offer patients with superior informed consent for their treatment options. Furthermore, health care and insurance agencies can recognize improved cost-benefit options in the purpose of disease prevention and alleviation of its impact on the patient and society. Health care outcomes are ultimately measured by the treatment of disease, the reduction of symptoms, the normalization of laboratory results and physical measures, saving a life, and patient satisfaction. In this review, we outline the tools available to measure outcomes in plastic surgery and subsequently allow the objective measurements of plastic surgical conditions. Six major outcome categories are discussed: (1 functional measures; (2 preference-based measures and utility outcome scores; (3 patient satisfaction; (4 health outcomes and time; (5 other tools: patient-reported outcome measurement information system, BREAST-Q, and Tracking Operations and Outcomes for Plastic Surgeons; and (6 cost-effectiveness analysis. We use breast hypertrophy requiring breast reduction as an example throughout this review as a representative plastic surgical condition with multiple treatments available.
Nejadsarvari, Nasrin; Ebrahimi, Ali; Ebrahimi, Azin; Hashem-Zade, Haleh
Currently, cosmetic surgery is spread around the world. Several factors are involved in this rapidly evolving field such as socio-economic development, changes in cultural norms, globalization and the effects of Western culture, advertising, media, and mental disorders. Nowadays the cosmetic surgery is becoming a profitable business, which deals exclusively with human appearance and less from the perspective of beauty based on physical protests and considering factors such as sex, age, and race. The morality of plastic surgery subspecialty has undergone many moral dilemmas in the past few years. The role of the patient regardless of his unrealistic dreams has questionable ethical dimension. The problem is the loss of human values and replacing them with false values, of pride and glory to a charismatic person of higher status, that may underlie some of the posed ethical dilemmas. Cosmetic surgery has huge difference with the general principle of legal liability in professional orientation, because the objective for cosmetic surgeries is different from common therapeutic purposes. To observe excellence in the medical profession, we should always keep in mind that these service providers, often as a therapist (healer) must maintain a commitment and priority for patient safety and prior to any action, a real apply for this service recipient should be present. Also, patient-physician confidentiality is the cornerstone of medical ethics. In this review, we study the issues addressed and the ways that they can be resolved.
Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; Araújo, Thiago Cavalcante Vila Nova de; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S
Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.
Hollis, Robert H; Theiss, Lauren M; Gullick, Allison A; Richman, Joshua S; Morris, Melanie S; Grams, Jayleen M; Porterfield, John R; Chu, Daniel I
Emotional intelligence (EI) has been associated with improved work performance and job satisfaction in several industries. We evaluated whether EI was associated with higher measures of work performance and job satisfaction in surgical residents. We distributed the validated Trait EI Questionnaire and job satisfaction survey to all general surgery residents at a single institution in 2015. EI and job satisfaction scores were compared with resident performance using faculty evaluations of clinical competency-based surgical milestones and standardized test scores including the United States Medical Licensing Examination (USMLE) and American Board of Surgery In-Training Examination (ABSITE). Statistical comparison was made using Pearson correlation and simple linear regression adjusting for postgraduate year level. The survey response rate was 68.9% with 31 resident participants. Global EI was associated with scores on USMLE Step 2 (r = 0.46, P = 0.01) and Step 3 (r = 0.54, P = 0.01) but not ABSITE percentile scores (r = 0.06, P = 0.77). None of the 16 surgical milestone scores were significantly associated with global EI or EI factors before or after adjustment for postgraduate level. Global EI was associated with overall job satisfaction (r = 0.37, P = 0.04). Of the facets of job satisfaction, global EI was significantly associated with views of supervision (r = 0.42, P = 0.02) and nature of work (r = 0.41, P = 0.02). EI was associated with job satisfaction and USMLE performance but not ACGME competency-based milestones or ABSITE scores. EI may be an important factor for fulfillment in surgical training that is not currently captured with traditional in-training performance measures. Published by Elsevier Inc.
This correspondence comments on the challenges of plastic reconstructive and aesthetic surgery on the facial recognition algorithms employed by biometric passports. The limitations of facial recognition technology in patients who have undergone facial plastic surgery are also discussed. Finally, the advice of the UK HM passport office to people who undergo facial surgery is reported.
Golub, Justin S; Ossoff, Robert H; Johns, Michael M
Assess fellowship and academic/private practice career track preferences in residents of otolaryngology-head and neck surgery. Cross-sectional survey. A total of 1,364 U.S. otolaryngology residents were surveyed. Questions addressed demographics, work hours and sleep, fellowship preference, and career track preference (academic/private practice). Trends in fellowship and career track preference were analyzed by year of clinical otolaryngology training. Data were additionally analyzed after stratification by sex. The response rate was 50%. The desire to complete a fellowship declined from 62% (year 2) to 58% (year 5), whereas the desire to not complete a fellowship increased from 31% (year 2) to 41% (year 5). Fellowship interest increased for rhinology and head and neck surgery by training year, whereas interest declined for neurotology and facial plastics. Expectation of an academic path increased from 29% (year 2) to 38% (year 5), whereas expectation of private practice declined slightly from 59% (year 2) to 57% (year 5). Women were initially more interested in both completing a fellowship (69% women, 60% men) and academics (40% women, 27% men). At the end of training, these sex differences were eliminated or reversed (59% men, 54% women for fellowship; 39% men, 35% women for academics). Residents interested in pursuing fellowship or academics reported working 2 hr/week more than those interested in no fellowship or private practice, respectively (P career track preferences suggest trends that may be useful to residency/fellowship program directors and residents making career choices. Inequalities producing differences according to sex should be addressed. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Krieger, L M; Shaw, W W
The laws of microeconomics explain how prices affect consumer purchasing decisions and thus overall revenues and profits. These principles can easily be applied to the behavior aesthetic plastic surgery patients. The UCLA Division of Plastic Surgery resident aesthetics clinic recently offered a radical price change for its services. The effects of this change on demand for services and revenue were tracked. Economic analysis was applied to see if this price change resulted in the maximization of total revenues, or if additional price changes could further optimize them. Economic analysis of pricing involves several steps. The first step is to assess demand. The number of procedures performed by a given practice at different price levels can be plotted to create a demand curve. From this curve, price sensitivities of consumers can be calculated (price elasticity of demand). This information can then be used to determine the pricing level that creates demand for the exact number of procedures that yield optimal revenues. In economic parlance, revenues are maximized by pricing services such that elasticity is equal to 1 (the point of unit elasticity). At the UCLA resident clinic, average total fees per procedure were reduced by 40 percent. This resulted in a 250-percent increase in procedures performed for representative 4-month periods before and after the price change. Net revenues increased by 52 percent. Economic analysis showed that the price elasticity of demand before the price change was 6.2. After the price change it was 1. We conclude that the magnitude of the price change resulted in a fee schedule that yielded the highest possible revenues from the resident clinic. These results show that changes in price do affect total revenue and that the nature of these effects can be understood, predicted, and maximized using the tools of microeconomics.
Shah, Dhruvil R; Galante, Joseph M; Bold, Richard J; Canter, Robert J; Martinez, Steve R
There is little information about the use of text messaging (texting) devices among resident and faculty physicians for patient-related care (PRC). To determine the prevalence, frequency, purpose, and concerns regarding texting among resident and attending surgeons and to identify factors associated with PRC texting. E-mail survey. University medical center and its affiliated hospitals. Surgery resident and attending staff. Prevalence, frequency, purpose, and concerns regarding patient-related care text messaging. Overall, 73 (65%) surveyed physicians responded, including 45 resident (66%) and 28 attending surgeons (62%). All respondents owned a texting device. Majority of surgery residents (88%) and attendings (71%) texted residents, whereas only 59% of residents and 65% of attendings texted other faculty. Most resident to resident text occurred at a frequency of 3-5 times/d (43%) compared with most attending to resident texts, which occurred 1-2 times/d (33%). Most resident to attending (25%) and attending to attending (30%) texts occurred 1-2 times/d. Among those that texted, PRC was the most frequently reported purpose for resident to resident (46%), resident to attending (64%), attending to resident (82%), and attending to other attending staff (60%) texting. Texting was the most preferred method to communicate about routine PRC (47% of residents vs 44% of attendings). Age (OR: 0.86, 95% CI: 0.79-0.95; p = 0.003), but not sex, specialty/clinical rotation, academic rank, or postgraduate year (PGY) level predicted PRC texting. Most resident and attending staff surveyed utilize texting, mostly for PRC. Texting was preferred for communicating routine PRC information. Our data may facilitate the development of guidelines for the appropriate use of PRC texting. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Rosa, Simone Corrêa; Macedo, Jefferson Lessa Soares DE; Casulari, Luiz Augusto; Canedo, Lucas Ribeiro; Marques, João Vitor Almeida
to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (pprofile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.
Rodrigues, Maria A; Tedesco, Ana C B; Nahas, Fabio X; Ferreira, Lydia M
The aim of this study was to assess the correlation between impact factor and the level of evidence of articles in plastic surgery journals. The four plastic surgery journals with the top impact factors in 2011 were selected. Articles were selected using the PubMed database between January 1 and December 31, 2011. The journal evidence index was calculated by dividing the number of randomized clinical trials by the total number of articles published in the specific journal, multiplied by 100. This index was correlated to the impact factor of the journal and compared with the average of the other journals. Two investigators independently evaluated each journal, followed by a consensus and assessment of the interexaminer concordance. The kappa test was used to evaluate the concordance between the two investigators and Fisher's exact test was used to evaluate which journal presented the highest number of randomized clinical trials. The journal evidence index values were as follows: Plastic and Reconstructive Surgery, 1.70; Journal of Plastic, Reconstructive and Aesthetic Surgery, 0.40; Aesthetic Plastic Surgery, 0.56; and Annals of Plastic Surgery, 0.35. The impact factors of these journals in 2011 were as follows: Plastic and Reconstructive Surgery, 3.382; Journal of Plastic, Reconstructive and Aesthetic Surgery, 1.494; Aesthetic Plastic Surgery, 1.407; and Annals of Plastic Surgery, 1.318. After consensus, the quantity of adequate studies was low and similar between these journals; only the journal Plastic and Reconstructive Surgery showed a higher journal evidence index. The journal Plastic and Reconstructive Surgery exhibited the highest journal evidence index and had the highest impact factor. The number of adequate articles was low in all of the assessed journals.
Wardzynska, K.; Wesolowska, E.
Breast cancer is the most frequent malignant neoplasm in women. Due to the growing knowledge and self- consciousness about the disease itself as well as regarding treatment options among breast cancer patients. Main indications for reconstruction after mastectomy include fear of both physical and psychological damage and, in a broader sense, the lack of contraindications for the procedure. Altogether, these factors are in fact directly responsible for the increase in the number of reconstructive procedures, which have become one of the important elements in breast cancer treatment. Year by year, the number of plastic surgery procedures has been growing. Assessment of the breast aimed at discerning the presence diminishing procedures. In women with prostheses implanted for cosmetic reasons, mamsaography provides an opportunity to correctly diagnose and confirm implant damage. Women who have undergonew such procedures should be screened mammographically in the same way as the rest of the female population is. The aim of this paper is to summarize the value of diagnostic mammagraphy after plastic and reconstructive surgery. (authors)
Leem, So Yeon
New beauty ideals and particular types of plastic surgery beauty have emerged in South Korea from the early twenty-first century. By defining Gangnam-style plastic surgery as a hybrid of old Westernized beauty ideals and a new science of beauty with variations and contradictions, I intend to twist the simplistic understanding of non-Western plastic surgery as an effort to resemble the white westerner's body. I also draw political implications from a case of monstrous Gangnam-style beauty made by excessive plastic surgery.
Merchant, Shaila; Hameed, Morad; Melck, Adrienne
Interest in general surgery has declined, and lack of adequate accommodation for pregnancy and parenting may be a deterrent. We explored resident experiences with these issues within a single general surgery program. We surveyed residents enrolled in the University of British Columbia general surgery program from 1997 to 2009 using a Web-based survey tool. Information regarding demographics, pregnancy, postpartum issues and issues pertaining to maternity/parenting policies was obtained. We used the Student t test, Z test and Fisher exact test for statistical comparisons. Of the 81 residents surveyed, 53 responded (65% response rate). There were fewer pregnancies during residency among female residents than among partners of male residents (PMRs; 9 pregnancies for 6 of 25 residents v. 23 pregnancies for 15 of 28 PMRs, p = 0.002). One of 9 pregnancies among female residents and 5 of 23 among PMRs ended in miscarriage (p > 0.99). Female residents and PMRs reported pregnancy-related complications with equal frequency. All female residents breastfed for at least 6 months; however, 67% (4 of 6) felt their resident role prevented them from breastfeeding as long as they would have liked. Most (5 of 6, 83%) pursued a graduate degree or research during their "maternity leave." More than 50% of residents reported that their own workload increased because of a colleague's pregnancy. Many (36 of 53, 68%) were unaware of the existence of any maternity/parenting policy, and most were in favour of instituting such a policy. Resident mothers do not breastfeed for the desired duration, and precluding factors must be explored. Contingency plans are needed so colleagues are not overburdened when pregnant residents cannot perform clinical duties. General surgery programs must have a formal policy addressing these issues.
Tomlinson, Corey; Labossière, Joseph; Rommens, Kenton; Birch, Daniel W
Surgery training programs in Canada and the United States have recognized the need to modify current models of training and education. The shifting demographic of surgery trainees, lifestyle issues and an increased trend toward subspecialization are the major influences. To guide these important educational initiatives, a contemporary profile of Canadian general surgery residents and their impressions of training in Canada is required. We developed and distributed a questionnaire to residents in each Canadian general surgery training program, and residents responded during dedicated teaching time. In all, 186 surveys were returned for analysis (62% response rate). The average age of Canadian general surgery residents is 30 years, 38% are women, 41% are married, 18% have dependants younger than 18 years and 41% plan to add to or start a family during residency. Most (87%) residents plan to pursue postgraduate education. On completion of training, 74% of residents plan to stay in Canada and 49% want to practice in an academic setting. Almost half (42%) of residents identify a poor balance between work and personal life during residency. Forty-seven percent of respondents have appropriate access to mentorship, whereas 37% describe suitable access to career guidance and 40% identify the availability of appropriate social supports. Just over half (54%) believe the stress level during residency is manageable. This survey provides a profile of contemporary Canadian general surgery residents. Important challenges within the residency system are identified. Program directors and chairs of surgery are encouraged to recognize these challenges and intervene where appropriate.
de Runz, A; Simon, E; Brix, M; Sorin, T; Brengard-Bresler, T; Pineau, V; Guyon, G; Claudot, F
Photography in plastic surgery is omnipresent. Through its various uses, it may present both ethical and forensic risks. The objective of this study is to analyze the use of medical photography by the plastic surgeon, the perception of this use by the patient, and consequence of such use. A questionnaire about the use of medical photography was assessed to 629 plastic surgeons. A questionnaire was given to patients, about their perception of the use of photography by their surgeon. One hundred and seventy-six surgeon's questionnaires and 93 patient's questionnaires were analyzed. For 97.7% of the responding surgeons, the proportion of patients refusing to be photographed was less then 1/20. The objective of the photography was especially medicolegal for 62.5% of the surgeons, especially for following the patient progress (87.5%), partially for the formation (72.1%), partially for scientific publications (57.8%) and not at all for the personal publicity (73.1%). Surgeons often share his photographs with others surgeons (71.1%), sometimes with others medical personnel (48.8%). The security and the access to photographs were determined to be correct for 67.6% of the surgeons and perfect for 23.3%. In total, 17.2% of the surgeons obtained a written consent, 41.4% obtained an oral consent, and 38.5% did not request patient consent. It was found that 48.3% of the surgeons and 40.2% of the patients think that the right to the photographic images belong to the patient. Medical photographs expose the plastic surgeon to medico-legal risks. He must know and follow the law in order to prevent eventual legal proceedings. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Knecht, Charles D.; And Others
Written goals of a small animal residency program established by Purdue University are identified and an elaborate list of methodology for goals is provided. Tables include: summary of required activities of residents, checklist of residency progress, and comparable effort for surgery residency and masters program. (Author/MLW)
Hatch, Quinton; McVay, Derek; Johnson, Eric K; Maykel, Justin A; Champagne, Bradley J; Steele, Scott R
Acute care surgical teams (ACSTs) have limited data in residency. We sought to determine the impact of an ACST on the depth and breadth of general surgery resident training. One year prior to and after implementation of an ACST, Accreditation Council for Graduate Medical Education case logs spanning multiple postgraduate year levels were compared for numbers, case types, and complexity. We identified 6,009 cases, including 2,783 after ACST implementation. ACSTs accounted for 752 cases (27%), with 39.2% performed laparoscopically. ACST cases included biliary (19.4%), skin/soft tissue (10%), hernia (9.8%), and appendix (6.5%). Second-year residents performed a lower percentage of laparoscopic cases after the creation of the ACST (20.4% vs 26.3%; P = .003), while chief residents performed a higher percentage (42.1 vs 37.4; P = .04). Case numbers and complexity following ACST development were unchanged within all year groups (P > .1). ACST in a residency program does not sacrifice resident case complexity, diversity, or volume. Published by Elsevier Inc.
Sood, Aditya; Therattil, Paul J; Chung, Stella; Lee, Edward S
The impact of subspecialty fellowship training on research productivity among academic plastic surgeons is unknown. The authors' aim of this study was to (1) describe the current fellowship representation in academic plastic surgery and (2) evaluate the relationship between h-index and subspecialty fellowship training by experience and type. Academic plastic surgery faculty (N = 590) were identified through an Internet-based search of all ACGME-accredited integrated and combined residency programs. Research output was measured by h-index from the Scopus database as well as a number of peer-reviewed publications. The Kruskal-Wallis test, with a subsequent Mann-Whitney U test, was used for statistical analysis to determine correlations. In the United States, 72% (n = 426) of academic plastic surgeons had trained in 1 or more subspecialty fellowship program. Within this cohort, the largest group had completed multiple fellowships (28%), followed by hand (23%), craniofacial (22%), microsurgery (15%), research (8%), cosmetic (3%), burn (2%), and wound healing (0.5%). Higher h-indices correlated with a research fellowship (12.5; P productivity compared with their colleagues. Craniofacial-trained physicians also demonstrated a higher marker for academic productivity than multiple other specialties. In this study, we show that the type and number of fellowships influence the h-index and further identification of such variables may help improve academic mentorship and productivity within academic plastic surgery.
Darisi, Tanya; Thorne, Sarah; Iacobelli, Carolyn
Research was conducted to gain insight into potential clients' decisions to undergo plastic surgery, their perception of benefits and risks, their judgment of outcomes, and their selection of a plastic surgeon. Semistructured, open-ended interviews were conducted with 60 people who expressed interest in plastic surgery. Qualitative analysis revealed their "mental models" regarding influences on their decision to undergo plastic surgery and their choice of a surgeon. Interview results were used to design a Web-based survey in which 644 individuals considering plastic surgery responded. The desire for change was the most direct motivator to undergo plastic surgery. Improvements to physical well-being were related to emotional and social benefits. When prompted about risks, participants mentioned physical, emotional, and social risks. Surgeon selection was a critical influence on decisions to undergo plastic surgery. Participants gave considerable weight to personal consultation and believed that finding the "right" plastic surgeon would minimize potential risks. Findings from the Web-based survey were similar to the mental models interviews in terms of benefit ratings but differed in risk ratings and surgeon selection criteria. The mental models interviews revealed that interview participants were thoughtful about their decision to undergo plastic surgery and focused on finding the right plastic surgeon.
Rouch, Joshua D; Wagner, Justin P; Scott, Andrew; Sullins, Veronica F; Chen, David C; DeUgarte, Daniel A; Shew, Stephen B; Tillou, Areti; Dunn, James C Y; Lee, Steven L
General surgery residents lack a standardized educational experience in pediatric surgery. We hypothesized that the development of a mobile educational interface would provide general surgery residents broader access to pediatric surgical education materials. We created an educational mobile website for general surgery residents rotating on pediatric surgery, which included a curriculum, multimedia resources, the Operative Performance Rating Scale (OPRS), and Twitter functionality. Residents were instructed to consult the curriculum. Residents and faculty posted media using the Twitter hashtag, #UCLAPedSurg, and following each surgical procedure reviewed performance via the OPRS. Site visits, Twitter posts, and OPRS submissions were quantified from September 2013 to July 2014. The pediatric surgery mobile website received 257 hits; 108 to the homepage, 107 to multimedia, 28 to the syllabus, and 19 to the OPRS. All eligible residents accessed the content. The Twitter hashtag, #UCLAPedSurg, was assigned to 20 posts; the overall audience reach was 85 individuals. Participants in the mobile OPRS included 11 general surgery residents and 4 pediatric surgery faculty. Pediatric surgical education resources and operative performance evaluations are effectively administered to general surgery residents via a structured mobile platform. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Kordahi, Anthony M; Hoppe, Ian C; Lee, Edward S
Reduction mammoplasty is an often-performed procedure by plastic surgeons and increasingly by general surgeons. The question has been posed in both general surgical literature and plastic surgical literature as to whether this procedure should remain the domain of surgical specialists. Some general surgeons are trained in breast reductions, whereas all plastic surgeons receive training in this procedure. The National Surgical Quality Improvement Project provides a unique opportunity to compare the 2 surgical specialties in an unbiased manner in terms of preoperative comorbidities and 30-day postoperative complications. The National Surgical Quality Improvement Project database was queried for the years 2005-2012. Patients were identified as having undergone a reduction mammoplasty by Current Procedural Terminology codes. RESULTS were refined to include only females with an International Classification of Diseases, Ninth Revision, code of 611.1 (hypertrophy of breasts). Information was collected regarding age, surgical specialty performing procedure, body mass index, and other preoperative variables. The outcomes utilized were presence of superficial surgical site infection, presence of deep surgical site infection, presence of wound dehiscence, postoperative respiratory compromise, pulmonary embolism, deep vein thrombosis, perioperative transfusion, operative time, reintubation, reoperation, and length of hospital stay. During this time period, there were 6239 reduction mammaplasties performed within the National Surgical Quality Improvement Project database: 339 by general surgery and 5900 by plastic surgery. No statistical differences were detected between the 2 groups with regard to superficial wound infections, deep wound infections, organ space infections, or wound dehiscence. There were no significant differences noted between within groups with regard to systemic postoperative complications. Patients undergoing a procedure by general surgery were more likely
Müller, Karin; Becker, Frederic; Pfau, Matthias; Werdin, Frank
Pressure sores in geriatric patients represent a challenge for all disciplines involved in the treatment process; however, the prerequisite for successful treatment is the elaboration of an interdisciplinary treatment concept. The treatment goals should be adapted to the individual needs of the patients including the life situation, general condition and local findings. In addition to general basic operative techniques, such as wound cleansing and conditioning, plastic and reconstructive surgery provides a wide range of highly specialized operative techniques for the treatment of these patients by which a definitive defect coverage can be achieved. The aim of this article is to raise awareness for these complex and highly specialized procedures for all disciplines participating in the treatment in order to improve the interdisciplinary cooperation and ultimately the quality of treatment.
Full Text Available Sentiment analysis is a growing research these days. Many companies perform this analysis on public opinions to get a general idea about any product or service. This paper presents a novel approach to get views or comments of Twitter users about plastic surgery treatments. The proposed approach uses machine-learning technique embedded with the naïve Bayesian classifier to assign polarities (i.e. positive, negative or neutral to the tweets, collected from ?Twitter micro-blogging website?. The accuracy of the obtained results has been validated using precision, recall and F-score measures. It has been observed from 25000 tweets dataset that people tend to have positive as well as substantial negative opinions regarding particular treatments. The experimental results show the effectiveness of the proposed approach
Jokhio, M.; Mahoto, N.A.
Sentiment analysis is a growing research these days. Many companies perform this analysis on public opinions to get a general idea about any product or service. This paper presents a novel approach to get views or comments of Twitter users about plastic surgery treatments. The proposed approach uses machine-learning technique embedded with the naive Bayesian classifier to assign polarities (i.e. positive, negative or neutral) to the tweets, collected from Twitter micro-blogging website. The accuracy of the obtained results has been validated using precision, recall and F-score measures. It has been observed from 25000 tweets dataset that people tend to have positive as well as substantial negative opinions regarding particular treatments. The experimental results show the effectiveness of the proposed approach. (author)
Lea C. George
Full Text Available Objective. Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training. Methods. An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used. Results. 20 program directors were surveyed, a majority being from medium-sized programs (4–7 graduating residents per year. Most respondents (73.68% had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%, with simulation training prior to console use (84.21%. About two-thirds of the respondents (63.16% believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%. Conclusion. A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.
George, Lea C; O'Neill, Rebecca; Merchant, Aziz M
Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training. An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used. 20 program directors were surveyed, a majority being from medium-sized programs (4-7 graduating residents per year). Most respondents (73.68%) had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%), with simulation training prior to console use (84.21%). About two-thirds of the respondents (63.16%) believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%). A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.
Hsieh, Tsung-Yen; Dedhia, Raj; Cervenka, Brian; Tollefson, Travis T
To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery. Studies reviewed demonstrated 3D printing applications in surgical planning including accurate anatomic biomodels, surgical cutting guides in reconstruction, and patient-specific implants fabrication. 3D printing technology also offers access to well tolerated, reproducible, and high-fidelity/patient-specific models for surgical training. Emerging research in 3D biomaterial printing have led to the development of biocompatible scaffolds with potential for tissue regeneration in reconstruction cases involving significant tissue absence or loss. Major limitations of utilizing 3D printing technology include time and cost, which may be offset by decreased operating times and collaboration between departments to diffuse in-house printing costs SUMMARY: The current state of the literature shows promising results, but has not yet been validated by large studies or randomized controlled trials. Ultimately, further research and advancements in 3D printing technology should be supported as there is potential to improve resident training, patient care, and surgical outcomes.
Dorfman, Robert G; Vaca, Elbert E; Mahmood, Eitezaz; Fine, Neil A; Schierle, Clark F
Recent data suggest patients are seeking aesthetic surgery to improve their appearance on Instagram and other social media. Despite the rising influence of Instagram in plastic surgery, few academic publications address Instagram, let alone evaluate its utilization in plastic surgery. We set out to answer the following three questions: 1) what plastic surgery-related content is being posted to Instagram; 2) who is posting this content; and 3) what specific hashtags are they using? Our study queried 21 Instagram plastic surgery-related hashtags. Content analysis was used to qualitatively evaluate each of the nine "top" posts associated with each hashtag (189 posts). Duplicate posts and those not relevant to plastic surgery were excluded. A total of 1,789,270 posts utilized the 21 hashtags sampled in this study. Of the top 189 posts for these 21 queried hashtags, 163 posts met inclusion criteria. Plastic surgeons eligible for membership in American Society for Aesthetic Plastic Surgery (ASAPS) accounted for only 17.8% of top posts, whereas noneligible physicians accounted for 26.4%. All nonplastic surgery trained physicians marketed themselves as "cosmetic surgeons." Nine top posts (5.5%) were by nonphysicians, including dentists, spas with no associated physician, and a hair salon. The majority of these posts were self-promotional (67.1%) as opposed to educational (32.9%). Board-certified plastic surgeons were significantly more likely to post educational content to Instagram as compared to nonplastic surgeons (62.1% vs 38.1%, P = 0.02). ASAPS eligible board-certified plastic surgeons are underrepresented amongst physicians posting top plastic surgery-related content to Instagram. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: email@example.com
Full Text Available Preoperative evaluation of the patients scheduled for ambulatory surgery is of great importance in regards of both surgery and anesthesia considerations. Malignant Hyperthermia (MH is a pharmacogenetic clinical syndrome which mostly arises from volatile anesthesia with halothane and the depolarizing muscle relaxant succinylcholine. Clinical manifestations of MH are acidosis and rhabdomyolysis which occur following uncontrolled increases in skeletal muscle metabolism and rapidly increasing body temperature (by as much as 1°C/5 min (1. Primary cases of MH were reported to be of a 70% mortality rate; however, thanks to the emergence of diagnostic tools such as end-expired carbon dioxide and the administration of dantrolene, this rate has decreased to less than 5%. MH might occur even in those with no previous or familial history. Even a safe history of the previous surgery under the administration of MH triggering agents cannot guarantee a next safe surgery. A noteworthy point in the preoperative evaluation is the probable association of MH with certain musculoskeletal disorders including Duchenne, Becker, and myotonic muscular dystrophies, strabismus, osteogenesis imperfecta, ptosis, myelomeningocele, kyphoscoliosis, King-Denborough syndrome, periodic paralysis, hernias, marfanoid syndrome, and central core disease (1. These diseases are frequently encountered by dental and facial plastic surgeons and having the knowledge of the probable association between MH and these conditions could aware the dental and facial plastic surgeons and the anesthesiologists to be more vigilant. Although MH workup leads to the definite diagnosis, no convincing intraoperative diagnostic tool has been introduced so far. Masseter spasm is a condition which might follow administration of depolarizing neuromuscular blocking agents due to the slow tonic fibers of masseter and lateral pterygoid muscles (2-4. The severer forms of masseter spasm would
Luan, Anna; Momeni, Arash; Lee, Gordon K; Galvez, Michael G
Cloud-based applications including Box, Dropbox, Google Drive, Evernote, Notability, and Zotero are available for smartphones, tablets, and laptops and have revolutionized the manner in which medical students and surgeons read and utilize plastic surgery literature. Here we provide an overview of the use of Cloud computing in practice and propose an algorithm for organizing the vast amount of plastic surgery literature. Given the incredible amount of data being produced in plastic surgery and other surgical subspecialties, it is prudent for plastic surgeons to lead the process of providing solutions for the efficient organization and effective integration of the ever-increasing data into clinical practice.
E. De la Poza
Full Text Available Plastic surgery practice grows continuously among the women in Western countries due to their body image dissatisfaction, aging anxiety, and an ideal body image propagated by the media. The consumption growth is so important that plastic surgery is becoming a normal practice among women, like any other cosmetic product, with the risk of suffering psychopathology disorders in the sense that plastic surgery could be employed as an instrument to recover personal self-esteem or even happiness. Plastic surgery practice depends on economic, demographic, and social contagion factors. In this paper, a mathematical epidemiological model to forecast female plastic surgery consumption in Spain is fully constructed. Overconsumer subpopulation is predicted and simulated. Robustness of the model versus uncertain parameters is studied throughout a sensitivity analysis.
Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M
The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise
Chandawarkar, Akash A; Gould, Daniel J; Grant Stevens, W
Recent studies demonstrate that board-certified plastic surgeons are underrepresented amongst individuals posting public-directed marketing plastic surgery-related content on Instagram. However, peer-to-peer and education-based social media influence has not been studied. Twitter is a social media platform has been suggested to be useful for educating the masses and connecting with colleagues. The purpose of this study is to identify the top influencers in plastic surgery on Twitter, characterize who they are, and relate their social media influence to academic influence. Twitter influence scores for the topic search "plastic surgery" were collected in July 2017 using Right Relevance software. The accounts associated with the highest influencer scores were linked to individual names, status as a plastic surgeon, board certification, location, and academic h-index. The top 100 Twitter influencers in plastic surgery are presented. Seventy-seven percent of the top influencers are trained as plastic surgeons or facial plastic surgeons. Sixty-one percent of influencers are board-certified plastic surgeons or board-eligible/future eligible trainees. International plastic surgeons made up 16% of influencers. Other medical doctors made up another 10%. The other 13% of influencers were nonphysicians. Three-quarters of social media influencers were physically located in the United States. Academic h-index of social media influencers ranged from 0 to 62 (mean, 8.6). This study shows that the top plastic surgery social media influencers on Twitter are predominantly board-certified or eligible plastic surgeons and physically based in the United States. This study also provides the influencer network for other plastic surgeons to engage with to improve their own influence within the plastic surgery social media sphere.
Zuhr, Otto; Rebele, Stephan F; Cheung, Stefani L; Hürzeler, Markus B
Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.
Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601
...] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Amendment of Notice... announcing an amendment to the notice of meeting of the General and Plastic Surgery Devices Panel of the..., FDA announced that a meeting of the General and Plastic Surgery Devices Panel of the Medical Devices...
Chávez, A E; Dagum, P; Koch, R J; Newman, J P
Although plastic surgeons are increasingly incorporating computer imaging techniques into their practices, many fear the possibility of legally binding themselves to achieve surgical results identical to those reflected in computer images. Computer imaging allows surgeons to manipulate digital photographs of patients to project possible surgical outcomes. Some of the many benefits imaging techniques pose include improving doctor-patient communication, facilitating the education and training of residents, and reducing administrative and storage costs. Despite the many advantages computer imaging systems offer, however, surgeons understandably worry that imaging systems expose them to immense legal liability. The possible exploitation of computer imaging by novice surgeons as a marketing tool, coupled with the lack of consensus regarding the treatment of computer images, adds to the concern of surgeons. A careful analysis of the law, however, reveals that surgeons who use computer imaging carefully and conservatively, and adopt a few simple precautions, substantially reduce their vulnerability to legal claims. In particular, surgeons face possible claims of implied contract, failure to instruct, and malpractice from their use or failure to use computer imaging. Nevertheless, legal and practical obstacles frustrate each of those causes of actions. Moreover, surgeons who incorporate a few simple safeguards into their practice may further reduce their legal susceptibility.
Stacey, Andrew W; Czyz, Craig N; Kondapalli, Srinivas Sai A; Hill, Robert H; Everman, Kelly R; Cahill, Kenneth V; Foster, Jill A
To assess intraoperative blood splatter to the ocular surface and adnexa during oculofacial surgery. Four surgeons and multiple assistants at three separate locations wore a total of 331 protective eye shields during 131 surgeries. Postoperatively, a luminol blood detection system was used to identify blood splatter on the shields. In the event of positive blood splatter, the total number of blood spots was counted. Controls were used to verify the blood detection protocol. A postoperative questionnaire was given to all surgeons and assistants after each case, and they were asked whether intraoperative blood splatter was noticed. Blood was detected on 61% of eye shields and in a total of 80% of surgical cases. However, only 2% of blood splatters were recognized intraoperatively by the surgical participants. There was no significant difference in the splatter rate between surgeons (64%), assistants (60%), and surgical technicians (58%) (p = 0.69). Shields worn during full-thickness eyelid procedures, direct brow lifting, orbitotomy with bony window, and orbital fracture repairs were more likely to be splattered (p = 0.03), and there was a significant difference between splatter rates among different surgeons (range, 29-90%; p = 0.0004), suggesting that blood splatter rate may be both procedure dependent and surgeon dependent. Mucocutaneous and transconjunctival transmission of human immunodeficiency virus and viral hepatitis has been documented. These results suggest that oculofacial plastic surgeons should consider eye protection for patients with known blood-borne diseases and in cases where blood splatter is expected. This precautionary practice is supported by the high incidence (98%) of undetected, intraoperative blood splatter.
Wojcik, Brandon M; Fong, Zhi Ven; Patel, Madhukar S; Chang, David C; Petrusa, Emil; Mullen, John T; Phitayakorn, Roy
General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Ten third-year general surgery residents. Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing
Haddock, Nicholas T; McCarthy, Joseph G
A number of historical texts published during the first half of the twentieth century played a pivotal role in shaping and defining modern plastic surgery in the United States. Blair's Surgery and Diseases of the Mouth and Jaws (1912), John Staige Davis's Plastic Surgery: Its Principles and Practice (1919), Gillies's Plastic Surgery of the Face (1920), Fomon's Surgery of Injury and Plastic Repair (1939), Ivy's Manual of Standard Practice of Plastic and Maxillofacial Surgery, Military Surgery Manuals (1943), Padgett and Stephenson's Plastic and Reconstructive Surgery (1948), and Kazanjian and Converse's The Surgical Treatment of Facial Injuries (1949) were reviewed. These texts were published at a time when plastic surgery was developing as a distinct specialty. Each work represents a different point in this evolution. All were not inclusive of all of plastic surgery, but all had a lasting impact. Four texts were based on clinical experience from World War I; one included experience from World War II; and two included experience from both. One text became a military surgical handbook in World Wars I and II, playing an important role in care for the wounded. History has demonstrated that times of war spark medical/surgical advancements, and these wars had a dramatic impact on the development of reconstructive plastic surgery. Each of these texts documented surgical advancements and provided an intellectual platform that helped shape and create the independent discipline of plastic surgery during peacetime. For many future leaders of plastic surgery, these books served as their introduction to this new field.
Ibrahim, Abdulrasheed; Asuku, Malachy E
Background: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. Materials and Methods: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. Conclusion: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students. PMID:27013852
Full Text Available Background: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. Materials and Methods: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important. Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. Conclusion: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students.
Stausmire, Julie M; Cashen, Constance P; Myerholtz, Linda; Buderer, Nancy
The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients. The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient. The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program. Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up. Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%. The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive
Depoortère, C; François, C; Belkhou, A; Duquennoy-Martinot, V; Guerreschi, P
Skin graft is a skin tissue fragment transferred from a donor site to a receiving site with a spontaneous revascularization. Basic process of plastic surgery, skin graft known in children, specific, warnings and refinements. It finds its indication in many pediatric cases: integumental diseases (neavus, hamartoma), acute burns and scars, traumatic loss of substance or surgically induced, congenital malformations of the hands and feet, etc. Specific skin graft techniques in children are developed: donor sites, sampling technique and procedure, early postoperative care. Especially in children, the scalp is a perfect site for split skin graft and technique is actively developed. Refinements and special cases are discussed: use of dermal matrices, allografts, xenografts, negative pressure therapy, prior skin expansion of the donor site. Results of skin graft in children are exposed: taking of graft, growth and shrinkage, pigmentation. Skin graft sometimes allows to stay the complex movement and get the best final benefit, permanent or at least temporary, in a growing being. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Full Text Available This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.
O'Heron, Colette T; Jarman, Benjamin T
To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.
Rajaram, Ravi; Chung, Jeanette W; Jones, Andrew T; Cohen, Mark E; Dahlke, Allison R; Ko, Clifford Y; Tarpley, John L; Lewis, Frank R; Hoyt, David B; Bilimoria, Karl Y
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident duty hour requirements beyond those established in 2003, leading to concerns about the effects on patient care and resident training. To determine if the 2011 ACGME duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance. Quasi-experimental study of general surgery patient outcomes 2 years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform. Teaching and nonteaching hospitals were compared using a difference-in-differences approach adjusted for procedural mix, patient comorbidities, and time trends. Teaching hospitals were defined based on the proportion of cases at which residents were present intraoperatively. Patients were those undergoing surgery at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). General surgery resident performance on the annual in-training, written board, and oral board examinations was assessed for this same period. National implementation of revised resident duty hour requirements on July 1, 2011, in all ACGME accredited residency programs. Primary outcome was a composite of death or serious morbidity; secondary outcomes were other postoperative complications and resident examination performance. In the main analysis, 204,641 patients were identified from 23 teaching (n = 102,525) and 31 nonteaching (n = 102,116) hospitals. The unadjusted rate of death or serious morbidity improved during the study period in both teaching (11.6% [95% CI, 11.3%-12.0%] to 9.4% [95% CI, 9.1%-9.8%], P adverse outcome. Mean (SD) in-training examination scores did not significantly change from 2010 to 2013 for first-year residents (499.7 [ 85.2] to 500.5 [84.2], P = .99), for residents from other postgraduate years, or for first-time examinees taking the written or oral board
Watson, Shawna L; Hollis, Robert H; Oladeji, Lasun; Xu, Shin; Porterfield, John R; Ponce, Brent A
This study evaluated the effect of the fellowship interview process in a cohort of general surgery residents. We hypothesized that the interview process would be associated with significant clinical time lost, monetary expenses, and increased need for shift coverage. An online anonymous survey link was sent via e-mail to general surgery program directors in June 2014. Program directors distributed an additional survey link to current residents in their program who had completed the fellowship interview process. United States allopathic general surgery programs. Overall, 50 general surgery program directors; 72 general surgery residents. Program directors reported a fellowship application rate of 74.4%. Residents most frequently attended 8 to 12 interviews (35.2%). Most (57.7%) of residents reported missing 7 or more days of clinical training to attend interviews; these shifts were largely covered by other residents. Most residents (62.3%) spent over $4000 on the interview process. Program directors rated fellowship burden as an average of 6.7 on a 1 to 10 scale of disruption, with 10 being a significant disruption. Most of the residents (57.3%) were in favor of change in the interview process. We identified potential areas for improvement including options for coordinated interviews and improved content on program websites. The surgical fellowship match is relatively burdensome to residents and programs alike, and merits critical assessment for potential improvement. Published by Elsevier Inc.
Iorio, Matthew L; Verma, Kapil; Ashktorab, Samaneh; Davison, Steven P
The goal of this review was to identify the safety and medical care issues that surround the management of patients who had previously undergone medical care through tourism medicine. Medical tourism in plastic surgery occurs via three main referral patterns: macrotourism, in which a patient receives treatments abroad; microtourism, in which a patient undergoes a procedure by a distant plastic surgeon but requires postoperative and/or long-term management by a local plastic surgeon; and specialty tourism, in which a patient receives plastic surgery from a non-plastic surgeon. The ethical practice guidelines of the American Medical Association, International Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and American Board of Plastic Surgeons were reviewed with respect to patient care and the practice of medical tourism. Safe and responsible care should start prior to surgery, with communication and postoperative planning between the treating physician and the accepting physician. Complications can arise at any time; however, it is the duty and ethical responsibility of plastic surgeons to prevent unnecessary complications following tourism medicine by adequately counseling patients, defining perioperative treatment protocols, and reporting complications to regional and specialty-specific governing bodies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Krieger, Lloyd M; Lee, Gordon K
Anecdotally, plastic surgeons have complained of working harder for the same or less income in recent years. They also complain of falling fees for reconstructive surgery and increasing competition for cosmetic surgery. This study examined these notions using the best available data. To gain a better understanding of the current plastic surgery market, plastic surgeon incomes, fees, volume, and relative mix of cosmetic and reconstructive surgery were analyzed between the years 1992 and 2002. To gain a broader perspective, plastic surgeon income trends were then compared with those of other medical specialties and of nonmedical professions. The data show that in real dollars, plastic surgeon incomes have remained essentially steady in recent years, despite plastic surgeons increasing their surgery load by an average of 41 percent over the past 10 years. The overall income trend is similar to that of members of other medical specialties and other nonmedical professionals. The average practice percentage of cosmetic surgery was calculated and found to have increased from 27 percent in 1992 to 58 percent in 2002. This most likely can be explained by the findings that real dollar fees collected for cosmetic surgery have decreased very slightly, whereas those for reconstructive procedures have experienced sharp declines. This study demonstrates that plastic surgeons have adjusted their practice profiles in recent years. They have increased their case loads and shifted their practices toward cosmetic surgery, most likely with the goal of maintaining their incomes. The strategy appears to have been successful in the short term. However, with increasing competition and falling prices for cosmetic surgery, it may represent a temporary bulwark for plastic surgeon incomes unless other steps are taken.
Full Text Available Young A Kim,1 Hyang-In Cho Chung2 1Department of Nursing, Jeju National University College of Nursing, Jeju-si, Republic of Korea; 2Department of Nursing, Chonnam National University College of Nursing, Gwangju, Republic of Korea Background: Rates of plastic surgery procedures have increased dramatically over the past several decades, especially for the women in South Korea.Purpose: The purpose of this study was to explore the subjective experience of South Korean women in their twenties and thirties with facial plastic surgery (FPS side effects.Participants and methods: Seven women who have suffered from FPS side effects participated in this study. Data were collected from July to September 2015 through individual in-depth interviews using open-ended questions and analyzed using Colaizzi’s method, which is a Husserlian phenomenological approach.Results: Six themes, and 25 subthemes, were found. Major themes were “choosing FPS to gain a new self”, “facing an unintended self”, “trying to accept a changed self”, “making efforts to overcome the situation”, “coming to know a new world”, and “pursuing a new lifestyle”.Conclusion: This study raises social awareness on the risk of plastic surgery side effects, which could prevent unnecessary plastic surgery. It also suggests the need for a deeper understanding of women’s biopsychosocial suffering from plastic surgery side effects. Keywords: cosmetic surgery, aesthetic plastic surgery, qualitative research, interview
Farivar, Behzad S; Flannagan, Molly; Leitman, I Michael
With the continued expansion of robotically assisted procedures, general surgery residents continue to receive more exposure to this new technology as part of their training. There are currently no guidelines or standardized training requirements for robot-assisted procedures during general surgical residency. The aim of this study was to assess the effect of this new technology on general surgery training from the residents' perspective. An anonymous, national, web-based survey was conducted on residents enrolled in general surgery training in 2013. The survey was sent to 240 Accreditation Council for Graduate Medical Education-approved general surgery training programs. Overall, 64% of the responding residents were men and had an average age of 29 years. Half of the responses were from postgraduate year 1 (PGY1) and PGY2 residents, and the remainder was from the PGY3 level and above. Overall, 50% of the responses were from university training programs, 32% from university-affiliated programs, and 18% from community-based programs. More than 96% of residents noted the availability of the surgical robot system at their training institution. Overall, 63% of residents indicated that they had participated in robotic surgical cases. Most responded that they had assisted in 10 or fewer robotic cases with the most frequent activities being assisting with robotic trocar placement and docking and undocking the robot. Only 18% reported experience with operating the robotic console. More senior residents (PGY3 and above) were involved in robotic cases compared with junior residents (78% vs 48%, p robotic case. Approximately 64% of residents reported that formal training in robotic surgery was important in residency training and 46% of residents indicated that robotic-assisted cases interfered with resident learning. Only 11% felt that robotic-assisted cases would replace conventional laparoscopic surgery in the future. This study illustrates that although the most residents
Cormac W. Joyce, MB BCh
Conclusions: This study has identified the most influential articles on breast in the plastic surgery literature over the past 68 years and highlighted many important scientific breakthroughs and landmarks that have occurred during this time.
This study has highlighted the gap between a medical student's perception and reality of the scope of Plastic and Reconstructive Surgery. It has emphasised the need for greater exposure and education in this surgical subspeciality if future medical practitioners are to better match the requirements of their patients to the skills of the specialist. If plastic surgeons wish to continue to be recognised as specialists in hand, craniofacial and reconstructive surgery, this gap between perception and reality needs to be addressed.
Conclusions: Robot-assisted plastic and reconstructive surgery provides clinical outcomes comparable to conventional techniques. Advantages include reported improved cosmesis, functional outcomes and greater surgeon comfort. Disadvantages included longer operating and set-up times, a learning curve, breaking of microneedles, high monetary costs and authors consistently recommended improved end-effectors. All authors were optimistic about the use of robotics in plastic and reconstructive surgery.
Kazan, Roy; Viezel-Mathieu, Alex; Cyr, Shantale; Hemmerling, Thomas M; Lin, Samuel J; Gilardino, Mirko S
To identify new tools capable of predicting surgical performance of novices on an augmentation mammoplasty simulator. The pace of technical skills acquisition varies between residents and may necessitate more time than that allotted by residency training before reaching competence. Identifying applicants with superior innate technical abilities might shorten learning curves and the time to reach competence. The objective of this study is to identify new tools that could predict surgical performance of novices on a mammoplasty simulator. We recruited 14 medical students and recorded their performance in 2 skill-games: Mikado and Perplexus Epic, and in 2 video games: Star War Racer (Sony Playstation 3) and Super Monkey Ball 2 (Nintendo Wii). Then, each participant performed an augmentation mammoplasty procedure on a Mammoplasty Part-task Trainer, which allows the simulation of the essential steps of the procedure. The average age of participants was 25.4 years. Correlation studies showed significant association between Perplexus Epic, Star Wars Racer, Super Monkey Ball scores and the modified OSATS score with r s = 0.8491 (p 41 (p = 0.005), and r s = 0.7309 (p < 0.003), but not with the Mikado score r s = -0.0255 (p = 0.9). Linear regressions were strongest for Perplexus Epic and Super Monkey Ball scores with coefficients of determination of 0.59 and 0.55, respectively. A combined score (Perplexus/Super-Monkey-Ball) was computed and showed a significant correlation with the modified OSATS score having an r s = 0.8107 (p < 0.001) and R 2 = 0.75, respectively. This study identified a combination of skill games that correlated to better performance of novices on a surgical simulator. With refinement, such tools could serve to help screen plastic surgery applicants and identify those with higher surgical performance predictors. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
de Runz, Antoine; Boccara, David; Chaouat, Marc; Locatelli, Katia; Bertheuil, Nicolas; Claudot, Frédérique; Bekara, Farid; Mimoun, Maurice
The use of a patient's image in plastic surgery is common today. Thus, plastic surgeons should master the use of the image and be aware of the implications of the patients' perception of themselves. The mere-exposure effect is a psychological phenomenon in which a person tends to rate things more positively merely because (s)he is familiar with them. Faces are asymmetric, so faces in photos are different from those observed in mirrors. The main objective of this study was to assess whether patients within a plastic surgery population, particularly those undergoing facial aesthetic surgery, preferred standard photographs or mirror-reversed photographs of themselves. A prospective study was conducted in a plastic surgery department, which included women who were admitted to the hospital the day before their procedures. The patients were separated into the following two groups: Group 1 was composed of patients who were undergoing facial aesthetic surgeries, and Group 2 consisted of other patients who presented to the plastic surgery department for surgery. The patients were required to rate their appreciation of their own faces and to choose between standard and mirror-reversed photos of themselves. A total of 214 patients participated. The median age was 47.9 years (interquartile range (IQR): 36.4-60.6), and the median face appreciation was 5 (IQR: 5-7). The preference for the mirror-reversed photograph was significantly different from chance (p < 0.001, binomial (214, 156, 0.5)); 73% of the patients preferred the mirror-reversed photographs. The proportions of patients who preferred the mirror-reversed photograph differed significantly (p = 0.047) between Groups 1 (84%) and 2 (70%). Plastic surgery patients have a significant preference for mirror-reversed photographs of themselves over standard photographs. This preference is even more pronounced among patients who are undergoing facial aesthetic surgery. III. Copyright © 2015 British Association of Plastic
Ibrahim, Abdulrasheed; Asuku, Malachy E
Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P work-life balance in selecting plastic surgery compared to male medical students.
Ahmad, Rima; Mullen, John T
There remains a debate as to whether nondesignated preliminary (NDP) positions in surgery ultimately translate into successful surgical careers for those who pursue them. We sought to identify the success with which our NDP residents were able to transition to their desired career and what, if any, factors contributed to their success. The records of all NDP residents accepted into the Massachusetts General Hospital General Surgery Residency Program from 1995 to 2010 were examined and long-term follow-up was completed. Thirty-four NDP residents were identified, including 26.5% US graduates and 73.5% international medical graduates. At the end of the initial preliminary year, 30 (88%) got placed in a postgraduate residency program, whereas 4 (12%) pursued other career paths. Of those who got placed, 25 (83%) attained surgical residency positions, including 17 (57%) who continued as preliminary residents at our institution and 8 (27%) who got placed in categorical surgical positions at other programs. After multiple preliminary years, 15 of 17 achieved a categorical position, of which, 93% were in surgical fields. Overall, 64.7% of all entering NDP residents eventually went on to have careers in general surgery (50%) or surgical subspecialties (14.7%), and 24 of 34 (71%) fulfilled their desired career goals. No factor predicted success. From 1995 to 2012 there have been 15 midlevel (11 postgraduate year 4) vacancies in our program, 4 of which were filled by preliminary residents, 2 from our program and 2 from elsewhere. All have gone on to board certifications and careers in surgery. More than 70% of NDP residents in our program successfully transitioned to their desired career paths, many achieving categorical surgical positions and academic surgical careers, thus demonstrating the benefit of this track to both residency programs and trainees. © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Objective: This paper aimed to characterize the resident exposure to acute general surgical conditions during a three-months rotation in a general surgical unit. Setting: The Department of Surgery, University of Nairobi and Kenyatta National Referral and Teaching Hospital in Nairobi. MethodS: Four residents (in their first to ...
Finlayson, Emily; Zhao, Shoujun; Boscardin, W. John; Fries, Brant E.; Landefeld, C. Seth; Dudley, R. Adams
Objectives To determine functional status and mortality rates after colon cancer surgery in older nursing home residents. Design Retrospective cohort study. Setting and Participants 6822 nursing home residents age 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005. Measurements Changes in functional status were assessed before and after surgery using the Minimum Data Set-Activities of Daily Living (MDS-ADL) summary scale, a 28-point scale in which score increases as functional dependence increases. Methods Using the Medicare Inpatient File and the Minimum Data Set for Nursing Homes, we identified the 6822 nursing home residents age 65 and older who underwent surgery for colon cancer. We used regression techniques to identify patient characteristics associated with mortality and functional decline at 1 year after surgery. Results On average, residents who underwent colectomy experienced a 3.9 point worsening in MDS-ADL score at one year. One year after surgery, the rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (age 80+ v. age 65–69, adjusted relative risk (ARR 1.53), 95%CI 1.15–2.04, pppp<0.0001) were associated with functional decline at one year. Conclusion Mortality and sustained functional decline are very common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population. PMID:22428583
...] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Amendment of Notice... announcing an amendment to the notice of meeting of the General and Plastic Surgery Devices Panel of the... INFORMATION: In the Federal Register of July 7, 2011, FDA announced that a meeting of the General and Plastic...
B. Haeseker (Barend)
textabstractJan F.S. Esser (1877-1946) was a remarkable and gifled Dutch surgeon whose contributions to plastic and reconstructive surgery, made long befare this specialty was recognised as a branch of surgery, are part of our surgical heritage. His interest in the bloodsupply of skin flaps was the
Loh, Charles Yuen Yung; Wang, Aline Yen Ling; Tiong, Vincent Tze Yang; Athanassopoulos, Thanassi; Loh, Meiling; Lim, Philip; Kao, Huang-Kai
The use of live and cadaveric animal models in surgical training is well established as a means of teaching and improving surgical skill in a controlled setting. We aim to review, evaluate, and summarize the models published in the literature that are applicable to Plastic Surgery training. A PubMed search for keywords relating to animal models in Plastic Surgery and the associated procedures was conducted. Animal models that had cross over between specialties such as microsurgery with Neurosurgery and pinnaplasty with ear, nose, and throat surgery were included as they were deemed to be relevant to our training curriculum. A level of evidence and recommendation assessment was then given to each surgical model. Our review found animal models applicable to plastic surgery training in four major categories namely-microsurgery training, flap raising, facial surgery, and hand surgery. Twenty-four separate articles described various methods of practicing microsurgical techniques on different types of animals. Fourteen different articles each described various methods of conducting flap-based procedures which consisted of either local or perforator flap dissection. Eight articles described different models for practicing hand surgery techniques. Finally, eight articles described animal models that were used for head and neck procedures. A comprehensive summary of animal models related to plastic surgery training has been compiled. Cadaveric animal models provide a readily available introduction to many procedures and ought to be used instead of live models when feasible. Copyright © 2017 Elsevier Inc. All rights reserved.
Wani, Shabeer Ahmad; Rabah, Sari M; Alfadil, Sara; Dewanjee, Nancy; Najmi, Yahya
The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility. From January 2012 onwards, the authors used smartphones and its WhatsApp application as a communication method amongst their team for various aspects of patient management and as a tool for academic endorsements. During the period of this study, there were 116 episodes regarding patient management, which were handled, in a timely fashion by using this application. In addition opinion of rotating residents in the section was sought regarding the efficacy of this method of communication. Overall majority of residents were satisfied with this mode of communication. This new method of communication is an effective method for clinical and academic endorsements. The method is cheap and quick and easy to operate.
Shabeer Ahmad Wani
Full Text Available Objective: The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility. Materials and Methods: From January 2012 onwards, the authors used smartphones and its WhatsApp application as a communication method amongst their team for various aspects of patient management and as a tool for academic endorsements. Results: During the period of this study, there were 116 episodes regarding patient management, which were handled, in a timely fashion by using this application. In addition opinion of rotating residents in the section was sought regarding the efficacy of this method of communication. Overall majority of residents were satisfied with this mode of communication. Conclusions: This new method of communication is an effective method for clinical and academic endorsements. The method is cheap and quick and easy to operate.
Engels, Paul T; de Gara, Chris
Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.
Stain, Steven C; Biester, Thomas W; Hanks, John B; Ashley, Stanley W; Valentine, R James; Bass, Barbara L; Buyske, Jo
High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.
Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L
Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity
Wheeler, Chad K; Said, Hakim; Prucz, Roni; Rodrich, Rod J; Mathes, David W
Social media is a common term for web-based applications that offer a way to disseminate information to a targeted audience in real time. In the current market, many businesses are utilizing it to communicate with clients. Although the field of plastic surgery is constantly changing in response to innovative technologies introduced into the specialty, the utilization of social media in plastic surgery practices is currently unclear. The authors evaluate the current attitudes and practices of aesthetic surgeons to emerging social media technology and compare these to attitudes about more traditional modes of communication. A 19-question web-based survey was disseminated by e-mail to all board-certified or board-eligible American plastic surgeons (n = 4817). Respondents were asked to answer questions on three topics: (1) their use of social media in their personal and professional lives, (2) their various forms of practice marketing, and (3) their demographic information. There were 1000 responses (20.8%). Results showed that 28.2% of respondents used social media in their practice, while 46.7% used it in their personal life. Most plastic surgeons managed their social media themselves or through a staff member. The majority of respondents who used social media in their practice claimed that their efforts were directed toward patient referrals. The typical plastic surgery practice that used social media was a solo practice in a large city with a focus on cosmetic surgery. Local competition of plastic surgeons did not correlate with social media use. Most plastic surgeons (88%) advertised, but the form of marketing varied. The most common forms included websites, print, and search engine optimization, but other modalities, such as television, radio, and billboards, were still utilized. Social media represents a new avenue that many plastic surgeons are utilizing, although with trepidation. As social media becomes commonplace in society, its role in plastic surgery
Stevens, Roger J G; Hamilton, Neil M
Some authors have claimed that those plastic surgeons born between 1965 and 1979 (generation X, or Gen-X) are more technologically able than those born between 1946 and 1964 (Baby Boomers, or BB). Those born after 1980, which comprise generation Y (Gen-Y), might be the most technologically able and most demanding for electronic learning (e-learning) to support their education and training in plastic surgery. These differences might represent a "digital generation gap" and would have practical and financial implications for the development of e-learning. The aim of this study was to survey plastic surgeons on their experience and preferences in e-learning in plastic surgery and to establish whether there was a difference between different generations. Online survey (e-survey) of plastic surgeons within the UK and Ireland was used for this study. In all, 624 plastic surgeons were invited by e-mail to complete an e-survey anonymously for their experience of e-learning in plastic surgery, whether they would like access to e-learning and, if so, whether this should this be provided nationally, locally, or not at all. By stratifying plastic surgeons into three generations (BB, Gen-X, and Gen-Y), the responses between generations were compared using the χ(2)-test for linear trend. A p value learning. These findings refute the claim that there are differences in the experience of e-learning of plastic surgeons by generation. Furthermore, there is no evidence that there are differences in whether there should be access to e-learning and how e-learning should be provided for different generations of plastic surgeons. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Tanious, Adam; Wooster, Mathew; Jung, Andrew; Nelson, Peter R; Armstrong, Paul A; Shames, Murray L
As the integrated vascular residency program reaches almost a decade of maturity, a common area of concern among trainees is the adequacy of open abdominal surgical training. It is our belief that although their overall exposure to open abdominal procedures has decreased, integrated vascular residents have an adequate and focused exposure to open aortic surgery during training. National operative case log data supplied by the Accreditation Council for Graduate Medical Education were compiled for both graduating integrated vascular surgery residents (IVSRs) and graduating categorical general surgery residents (GSRs) for the years 2012 to 2014. Mean total and open abdominal case numbers were compared between the IVSRs and GSRs, with more in-depth exploration into open abdominal procedures by organ system. Overall, the mean total 5-year case volume of IVSRs was 1168 compared with 980 for GSRs during the same time frame (P surgery, representing 57% of all open abdominal cases. GSRs completed an average of 116 open alimentary tract surgeries during their training. Open abdominal surgery represented an average of 7.1% of the total vascular case volume for the vascular residents, whereas open abdominal surgery represented 21% of a GSR's total surgical experience. IVSRs reported almost double the number of total cases during their training, with double chief-level cases. Sixty-five percent of open abdominal surgeries performed by IVSRs involved the aorta or its renovisceral branches. Whereas open abdominal surgery represented 7.1% of an IVSR's surgical training, GSRs had a far broader scope of open abdominal procedures, completing nearly double those of IVSRs. The differences in open abdominal procedures pertain to the differing diseases treated by GSRs and IVSRs. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Merchant, Shaila J; Hameed, S Morad; Melck, Adrienne L
Medical student interest in general surgery has declined, and the lack of adequate accommodation for pregnancy and parenting during residency training may be a deterrent. We explored resident and program director experiences with these issues in general surgery programs across Canada. Using a web-based tool, residents and program directors from 16 Canadian general surgery programs were surveyed regarding their attitudes toward and experiences with pregnancy during residency. One hundred seventy-six of 600 residents and 8 of 16 program directors completed the survey (30% and 50% response rate, respectively). Multiple issues pertaining to pregnancy during surgical residency were reported including the lack of adequate policies for maternity/parenting, the major obstacles to breast-feeding, and the increased workload for fellow resident colleagues. All program directors reported the lack of a program-specific maternity/parenting policy. General surgery programs lack program-specific maternity/parenting policies. Several issues have been highlighted in this study emphasizing the importance of creating and implementing such a policy. Copyright © 2013 Elsevier Inc. All rights reserved.
Santos, Elizabeth G; Salles, Gil F
Phenomenon: Recent studies have shown that up to 40% of the General Surgery (GS) residents are not confident with their surgical skills. There is concern that residents are at risk of receiving inadequate training due to the low number of operations they perform. In Brazil, although all GS residents receive by law the Board Certification at the end of their programs, the assessment of their technical skills is not mandatory in Medical Residency programs' training. Consequently, our concern was that current GS medical residency format might be insufficient to create competent and autonomous general surgery residents after 2 years of regular training. Hence, the aim was to assess GS residents' surgical skills in their final months of training to evaluate the present format of GS residency programs in Brazil. Trained surgical faculty members directly observed 11 operations of varying difficulty performed by 2nd-year regular GS residents and by 4th-year residents in the optional Advanced Program in General Surgery. Participants were located at 3 university and 3 nonuniversity hospitals in Rio de Janeiro and Sao Paulo (Brazil's largest cities). Surgical skills were assessed using an internally developed observation checklist reviewed by subject matter experts. Sixty residents (46 regular 2nd-year trainees and 14 advanced 4th-year trainees) were assessed on performing 499 operations. Only 10 residents (17%), all advanced 4th-year residents, satisfactorily performed all operations and were considered eligible for the Board Certification. Even after excluding the 2 operations of greatest difficulty, only 24 regular 2nd-year residents (52%) satisfactorily performed the other 9 operations. Residents from hospitals with open Emergency Departments performed better than those from hospitals without Emergency Departments. Insights: The results of this pilot study suggest that residents with 2 years of training are not prepared for independent high-level surgical practice. The
White, Ian; Buchberg, Brian; Tsikitis, V Liana; Herzig, Daniel O; Vetto, John T; Lu, Kim C
Colorectal cancer is the second most common cause of death in the USA. The need for screening colonoscopies, and thus adequately trained endoscopists, particularly in rural areas, is on the rise. Recent increases in required endoscopic cases for surgical resident graduation by the Surgery Residency Review Committee (RRC) further emphasize the need for more effective endoscopic training during residency to determine if a virtual reality colonoscopy simulator enhances surgical resident endoscopic education by detecting improvement in colonoscopy skills before and after 6 weeks of formal clinical endoscopic training. We conducted a retrospective review of prospectively collected surgery resident data on an endoscopy simulator. Residents performed four different clinical scenarios on the endoscopic simulator before and after a 6-week endoscopic training course. Data were collected over a 5-year period from 94 different residents performing a total of 795 colonoscopic simulation scenarios. Main outcome measures included time to cecal intubation, "red out" time, and severity of simulated patient discomfort (mild, moderate, severe, extreme) during colonoscopy scenarios. Average time to intubation of the cecum was 6.8 min for those residents who had not undergone endoscopic training versus 4.4 min for those who had undergone endoscopic training (p Virtual reality endoscopic simulation is an effective tool for both augmenting surgical resident endoscopy cancer education and measuring improvement in resident performance after formal clinical endoscopic training.
von Websky, Martin W; Oberkofler, Christian E; Rufibach, Kaspar; Raptis, Dimitri A; Lehmann, Kuno; Hahnloser, Dieter; Clavien, Pierre-Alain
To assess trainee satisfaction in their surgery residency with a validated instrument and identify the contributing factors. Currently, surgery is deemed unattractive by medical students and ignored by many candidates planning to enter an academic career. New insights on the rational for such lack of interest are needed. Job satisfaction is a central concept in organizational and behavioral research that is well understood by large companies such as Google, IBM, and Toyota. Similar assessment can likewise be used to improve trainee satisfaction in surgery residency. A survey among 2039 surgery residents was conducted in three European countries analyzing satisfaction at work using the Global Job Satisfaction Instrument (validated in Emergency Room physicians). Crucial factors covering different aspects of surgery residency where identified using the GJS instrument combined with multiple logistic regression analysis. With an overall response rate of 23%, we identified trainee dissatisfaction in one third of residents. Factors affecting satisfaction related almost exclusively to training issues, such as assignment of surgery procedures according to skills (OR 4.2), training courses (OR 2.7), availability of a structured training curriculum (OR 2.4), bedside teaching, and availability of morbidity-mortality conferences (OR 2.3). A good working climate among residents (OR 3.7) and the option for part time work (OR 2.1) were also significant factors for trainee satisfaction. Increased working hours had a modest (OR 0.98)-though cumulative- negative effect. The sex of the trainee was not related to trainee satisfaction. Validated measurement of job satisfaction as used in the industry appears to be an efficient tool to assess trainee satisfaction in surgery residency and thereby identify the key contributing factors. Improvement of conceptual training structures and working conditions might facilitate recruitment, decrease drop-out, and attract motivated candidates with
Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M
To determine whether dedicated research time during surgical residency leads to funding following postgraduate training. Unlike other medical specialties, a significant number of general surgery residents spend 1 to 3 years in dedicated laboratory research during their training. The impact this has on obtaining peer reviewed research funding after residency is unknown. Survey of all graduates of an academic general surgery resident program from 1990 to 2005 (n = 105). Seventy-five (71%) of survey recipients responded, of which 66 performed protected research during residency. Fifty-one currently perform research (mean effort, 26%; range, 2%-75%). Twenty-three respondents who performed research during residency (35%) subsequently received independent faculty funding. Thirteen respondents (20%) obtained NIH grants following residency training. The number of papers authored during resident research was associated with obtaining subsequent faculty grant support (9.3 vs. 5.2, P = 0.02). Faculty funding was associated with obtaining independent research support during residency (42% vs. 17%, P = 0.04). NIH-funded respondents spent more combined years in research before and during residency (3.7 vs. 2.8, P = 0.02). Academic surgeons rated research fellowships more relevant to their current job than private practitioners (4.3 vs. 3.4 by Likert scale, P < 0.05). Both groups considered research a worthwhile use of their time during residency (4.5 vs. 4.1, P = not significant). A large number of surgical trainees who perform a research fellowship in the middle of residency subsequently become funded investigators in this single-center survey. The likelihood of obtaining funding after residency is related to productivity and obtaining grant support during residency as well as cumulative years of research prior to obtaining a faculty position.
Offner, Patrick J; Hawkes, Allison; Madayag, Robert; Seale, Fred; Maines, Charles
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. 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. 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. 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.
Reusche, Ryan; Buchanan, Patrick J; Kozlow, Jeffrey H; Vercler, Christian J
The growth and acceptance of smartphones among clinicians has been remarkable over the last decade. Over 87% of doctors use a smartphone or tablet capable of running third-party software known as applications (apps). In the field of plastic surgery, apps have been designed for personal practice development, education, clinical tools and guidelines, and entertainment. This study reviews the literature on apps related to plastic surgery and determines the number and types of apps available. A systematic review of the literature was performed to find articles written about plastic surgery applications. Queries were run in the Apple iPhone iOS App store and Google Play using the term "plastic surgery." Apps were reviewed for ratings, downloads, and cost. In addition, apps were categorized based on purpose. Categories include practice development, media/literature, clinical tool and guideline apps, or recreation. The literature search yielded 8 articles for review, 2 articles focused on categorizing apps and 6 articles focused on describing useful apps. Searching Apple's iTunes (iOS) store identified 273 and Google Play identified 250 apps related to plastic surgery; since 2013, a 62%, and 580% increase, respectively. The iOS store included practice development (46%), recreation (26%), media/literature (14%), and clinical tool and guideline (11%). Google Play store included recreation apps (44%), practice development (24%), clinical tools and guidelines (11%), and media and literature (9%). Apps related to the field of plastic surgery are increasing in prevalence. The content of these apps are variable, and the majority are intended for marketing and development of private practices. Apps linking to literature, texts, study materials, and clinical tools and guidelines are developed for both practicing plastic surgeons and surgical trainees. Finding "useful" apps takes time because searches are often complicated by a variety of apps.
Journal ranking based on the impact factor (IF) can be distorted by self-citation. The aim of this study is to investigate the present status of self-citation in the plastic surgery journals and its effect on the journals' IFs. IF, IF without self-citations (corrected IF), self-cited rate, and self-citing rate for 11 plastic surgery journals were investigated from 2009-2015, by reviewing the Journal Citation Report ® . The correlations of the IF with the self-cited rate and the self-citing rate were statistically assessed. In addition, Plastic and Reconstructive Surgery was compared with 15 top journals from other surgical specialties in 2015. IF was significantly correlated with the self-cited rate (R: 0.594, p = 0.001) and the self-citing rate (R: 0.824, p citation rate positively affects the IF in plastic surgery journals. A high concentration of self-citation of some journals could distort the ranking among plastic surgery journals in general.
Paik, Angie M; Mady, Leila J; Villanueva, Nathaniel L; Goljo, Erden; Svider, Peter F; Ciminello, Frank; Eloy, Jean Anderson
The h-index has utility in examining the contributions of faculty members by quantifying both the amount and the quality of research output and as such is a metric in approximating academic productivity. The objectives of this study were (1) to evaluate the relationship between h-index and academic rank in plastic surgery and (2) to describe the current gender representation in academic plastic surgery to assess whether there are any gender disparities in academic productivity. The h-index was used to evaluate the research contributions of plastic surgeons from academic departments in the United States. There were 426 (84%) men and 79 (16%) women in our sample. Those in higher academic ranks had higher h-index scores (p productivity between men and women in assistant and associate professor positions (6.4 vs 5.1, respectively; p = 0.04). The h-index is able to objectively and reliably quantify academic productivity in plastic surgery. We found that h-indices increased with higher academic rank, and men had overall higher scores than their female colleagues. Adoption of this metric as an adjunct to other objective and subjective measures by promotions committees may provide a more reliable measure of research relevance and academic productivity in academic plastic surgery. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Schubert, C D; Leitsch, S; Haertnagl, F; Haas, E M; Giunta, R E
Despite its recognition as an independent specialty, at German university hospitals the field of plastic surgery is still underrepresented in terms of independent departments with a dedicated research focus. The aim of this study was to analyse the publication performance within the German academic plastic surgery environment and to compare independent departments and dependent, subordinate organisational structures regarding their publication performance. Organisational structures and number of attending doctors in German university hospitals were examined via a website analysis. A pubmed analysis was applied to assess the publication performance (number of publications, cumulative impact factor, impact factor/publication, number of publications/MD, number of publications/unit) between 2009 and 2013. In a journal analysis the distribution of the cumulative impact factor and number of publications in different journals as well as the development of the impact factor in the top journals were analysed. Out of all 35 university hospitals there exist 12 independent departments for plastic surgery and 8 subordinate organisational structures. In 15 university hospitals there were no designated plastic surgery units. The number of attending doctors differed considerably between independent departments (3.6 attending doctors/unit) and subordinate organisational structures (1.1 attending doctors/unit). The majority of publications (89.0%) and of the cumulative impact factor (91.2%) as well as most of the publications/MD (54 publications/year) and publications/unit (61 publications/year) were created within the independent departments. Only in departments top publications with an impact factor > 5 were published. In general a negative trend regarding the number of publications (- 13.4%) and cumulative impact factor (- 28.9%) was observed. 58.4% of all publications were distributed over the top 10 journals. Within the latter the majority of articles were published in
Dreher, Rodrigo; Blaya, Carolina; Tenório, Juliana L C; Saltz, Renato; Ely, Pedro B; Ferrão, Ygor A
Quality of life (QoL) is an important outcome in plastic surgery. However, authors use different scales to address this subject, making it difficult to compare the outcomes. To address this discrepancy, the aim of this study was to perform a systematic review and a random effect meta-analysis. The search was made in two electronic databases (LILACS and PUBMED) using Mesh and non-Mesh terms related to aesthetic plastic surgery and QoL. We performed qualitative and quantitative analyses of the gathered data. We calculated a random effect meta-analysis with Der Simonian and Laird as variance estimator to compare pre- and postoperative QoL standardized mean difference. To check if there is difference between aesthetic surgeries, we compared reduction mammoplasty to other aesthetic surgeries. Of 1,715 identified, 20 studies were included in the qualitative analysis and 16 went through quantitative analysis. The random effect of all aesthetic surgeries shows that QoL improved after surgery. Reduction mammoplasty has improved QoL more than other procedures in social functioning and physical functioning domains. Aesthetic plastic surgery increases QoL. Reduction mammoplasty seems to have better improvement compared with other aesthetic surgeries.
Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R
This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. Residents who considered academia were more likely to be women (29% vs 8%; P career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Mehaffey, J Hunter; Michaels, Alex D; Mullen, Matthew G; Yount, Kenan W; Meneveau, Max O; Smith, Philip W; Friel, Charles M; Schirmer, Bruce D
Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing robotics at an academic general surgery residency program. All patients who underwent laparoscopic or robotic cholecystectomy, ventral hernia repair (VHR), and inguinal hernia repair (IHR) at our institution from 2011-2015 were identified. The effect of robotic surgery on laparoscopic case volume was assessed with linear regression analysis. Resident participation, operative time, hospital costs, and patient charges were also evaluated. We identified 2260 laparoscopic and 139 robotic operations. As the volume of robotic cases increased, the number of laparoscopic cases steadily decreased. Residents participated in all laparoscopic cases and 70% of robotic cases but operated from the robot console in only 21% of cases. Mean operative time was increased for robotic cholecystectomy (+22%), IHR (+55%), and VHR (+61%). Financial analysis revealed higher median hospital costs per case for robotic cholecystectomy (+$411), IHR (+$887), and VHR (+$1124) as well as substantial associated fixed costs. Introduction of robotic surgery had considerable negative impact on laparoscopic case volume and significantly decreased resident participation. Increased operative time and hospital costs are substantial. An institution must be cognizant of these effects when considering implementing robotics in departments with a general surgery residency program. Copyright © 2017 Elsevier Inc. All rights reserved.
Stefanidis, Dimitrios; Ingram, Katherine M; Williams, Kristy H; Bencken, Crystal L; Swiderski, Dawn
Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students. Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared. A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience. Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather train with experienced nurses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Dilday, Joshua C; Miller, Elizabeth A; Schmitt, Kyle; Davis, Brian; Davis, Kurt G
Professionalism is 1 of the 6 core competencies of the Accreditation Council of Graduate Medical Education. Despite its obvious importance, it is poorly defined in the literature and an understanding of its meaning has not been evaluated on surgical trainees. The American College of Surgeons (ACS) has previously published tenets of surgical professionalism. However, surgery residents may not share similar views on professionalism as those of the ACS. Surgical residents of all levels at 2 surgery residencies located in the same city were interviewed regarding their personal definitions, thoughts, and experiences regarding professionalism during their training. They were then queried regarding 20 points of professionalism as outlined by the ACS tenets of professionalism. The study utilized the surgery residencies at William Beaumont Army Medical Center and Texas Tech University Health Science Center in El Paso, Texas. All general surgery residents at each program were invited to participate in the study. Eighteen residents volunteered to take the survey and be interviewed. The definitions of professionalism centered on clinical competence. Surgery residents conveyed experiences with both professional and unprofessional behavior. Seven of the 20 ACS tenets of professionalism were unanimously agreed upon. There were key differences between resident definitions and those as outlined by the ACS. The least agreed upon ACS tenets of professionalism include professionalism education, public education, and public health. Surgical trainees express personal experiences in both professional and unprofessional behavior. Their definitions of professionalism are not as expansive as those of the ACS and seem to focus on patient and colleague interaction. Due to the lack of congruency, a tailored curriculum for professionalism based upon ACS tenets appears warranted. Published by Elsevier Inc.
Kavic, Michael S; Mirza, Brian; Horne, Walter; Moskowitz, Jesse B
Natural orifice translumenal endoscopic surgery (NOTES) is a development of recent origin. In 2004, Kalloo et al first described NOTES investigation in an animal model. Since then, several investigators have pursued NOTES study in animal survival and nonsurvival models. Our objectives for this project included studying NOTES intervention in a laboratory environment using large animal (swine) models and learning to do so in a safe, controlled manner. Ultimately, we intend to introduce NOTES methodology into our surgical residency training program. The expertise of an experienced laparoscopic surgeon, fellowship-trained laparoendoscopic surgeon, and veterinarian along with a senior surgical resident was utilized to bring the input of several disciplines to this study. The Institutional Animal Care and Use Committee (IACUC) of Northeastern Ohio Universities College of Medicine and Pharmacy (NEOUCOM/COP) approved this study. A series of 5 laboratory sessions using mixed breed farm swine varying in weight from 37 kg to 43.1 kg was planned for the initial phase of NOTES introduction into our residency program. Animals were not kept alive in this investigation. All animals were anesthetized using a standard swine protocol and euthanized following guidelines issued by the American Veterinary Medical Association Panel on Euthanasia. Equipment included a Fujinon EVE endoscope 0.8 cm in diameter with a suction/irrigation channel and one working channel. Initially, a US Endoscopy gastric overtube, 19.5 mm OD and 50 cm in length, was used to facilitate passage of the endoscope. However, this device was found to have insufficient length. Subsequently, commercially available 5/8" diameter clear plastic tubing, 70 cm to 80 cm in length, was adapted for use as an overtube. Standard endoscopic instruments included Boston Scientific biopsy forceps, needle-knife, papillotome, endoscopic clip applier, and Valley Lab electrosurgical unit. A Karl Storz laparoscope and tower were used for
Zubair, Muhammad H; Hussain, Lala R; Williams, Kristen N; Grannan, Kevin J
The quality of working life of US surgical residents has not been studied, and given the complexity of interaction between work and personal life there is a need to assess this interaction. We utilized a validated Work Related Quality of Life (WRQoL) questionnaire to evaluate the perceived work-related quality of life of general surgery residents, using a large, nationally representative sample in the United States. Between January 2016 and March 2016, all US general surgery residents enrolled in an ACGME general surgery training program were invited to participate. The WRQoL scale measures perceived quality of life covering six domains: General Well-Being (GWB), Home-Work Interface (HWI), Job and Career Satisfaction (JCS), Control at Work (CAW), Working Conditions (WCS) and Stress at Work (SAW). After excluding for missing data, the final analysis included 738 residents. The average age was 30 (±3) years, of whom 287 (38.9%) were female, 272 (36.9%) were from a community hospital, and 477 (64.6%) were juniors (postgraduate year ≤ 3). Demographically, the respondents matched expected percentages. When male and female residents were compared, males had statistically better HWI (pseniors. There were no differences between university and community residents in any of the domains of WRQoL. Although residents were more stressed than other professions but the overall WRQoL was comparable. The nature of surgical residency and a surgical career may in fact be more "stressful" than other professions, yet may not translate into a worsened Quality of Life. Our findings suggest further study is needed to elucidate why female residents have or experience a lower perceived WRQoL than their male colleagues. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Raines, Alexander; Garwe, Tabitha; Adeseye, Ademola; Ruiz-Elizalde, Alejandro; Churchill, Warren; Tuggle, David; Mantor, Cameron; Lees, Jason
Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 (P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 (P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.
Molecular biology has become an essential component in many fields of modern medical research, including plastic surgery. Research into the molecular mechanisms underlying many disease processes offer increased understanding of the pathogenesis of disease and provide exciting therapeutic possibilities. Yet for many clinicians, the presentation of much research into molecular biological processes is couched in confusing terminology and based on scientific techniques, the basis of which are frequently difficult for the clinician to understand. The purpose of this review is to present an introduction to some of the molecular biological techniques currently in use, namely the polymerase chain reaction (PCR) and explore its applications to different aspects of plastic surgery. This review explores the role PCR now plays in all aspects of modern plastic surgery practise, with particular emphasis on normal and abnormal wound healing, the diagnosis of craniofacial anomalies, the diagnosis and treatment of cancer including melanoma and squamous cell carcinoma of the head and neck, and burns.
Oct 16, 2015 ... tertiary education students in Enugu, South‑East. Nigeria. CM Isiguzo ..... This finding should be a motivation for plastic surgeons who have private ... population of this country some of whom travel abroad to source for these ...
... reconstructive procedures, they were not necessarily identified as primary surgeons for procedures that they commonly perform. A significant number of respondents believed that plastic surgeons are seldom the first line of referral, and are more involved in cases with aesthetic rather than functional sequelae. Discussion.
Topic of this thesis is " Mitral Valvuloplasty". The thesis has been divided into theoretical and practical parts. The theoretical part begins with the classification of heart diseases. Main topic of this thesis is mitral insufficiency - its etiology and pathogenesis, clinical picture, therapy, the possibility of prosthetic valves and post surgery complications. Theoretical part also contains information about the preoperative and post-operative care at cardiac surgery department. The practic...
Dubern, Béatrice; Tounian, Patrice
The increased frequency of extreme forms of obesity in adolescents and the disappointing results of conventional treatments are now leading pediatricians to consider bariatric or cosmetic surgery as the only real long-term effective therapeutic alternative. The two main techniques currently used for bariatric surgery in adolescents are gastric bypass and adjustable gastric banding. Whatever the technique, weight loss is significant with improvement of comorbidities and quality of life. In addition, the complications are identical to those in adults and equally frequent. However, because of the particularities of this age, caution is still required. Adolescence is indeed characterized by specific nutritional needs, but also changes in body image in which surgery could have a negative effect. Currently, all obese teenagers making a request for bariatric surgery should have a comprehensive assessment with global care for at least 6 months. The indication is then discussed on a case-by-case basis by multidisciplinary teams and experts. To date, the type of surgery (gastric banding, gastric sleeve, or bypass) is still widely discussed. Based on experience with adults, we believe that gastric sleeve and bypass should be preferred. In addition, obesity in adolescents almost always involves psychosocial consequences, while somatic complications are rare. Thus, the care of adipo- or gynecomastia, abdominal fat excess, and concealed penis is essential and therefore justifies cosmetic surgery. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Lopez, Joseph; Juan, Ilona; Wu, Adela; Samaha, Georges; Cho, Brian; Luck, J D; Soni, Ashwin; Milton, Jacqueline; May, James W; Tufaro, Anthony P; Dorafshar, Amir H
Recently, several studies have demonstrated that articles that disclose conflicts of interests (COI) are associated with publication of positive results. The purpose of this study was to learn more about the different types of COI as they relate to the general topic of COI in plastic surgery. Specifically, we aimed to examine whether different types of COI are more likely than others to be associated with the presentation of positive findings. We reviewed all original articles in Annals of Plastic Surgery, Journal of Plastic, Reconstructive, and Aesthetic Surgery, and Plastic & Reconstructive Surgery from January 1, 2012, to December 31, 2013. All scientific articles were analyzed, and several article characteristics were extracted. Disclosed COI were categorized into the following categories: consultant/employee, royalties/stock options, and research support. The findings reported in each article abstract were blindly graded as reporting a positive, negative, neutral, or not applicable result. A multivariable analysis was performed to determine whether an association existed between certain types of COI and publication of positive conclusions. A total of 3124 articles were identified of which 1185 fulfilled the inclusion criteria. Financial COI were reported in 153 studies (12.9%). The most common type of COI was "research support" (7.3%), whereas the least common was "royalties/stock options" (1.2%). Rates of different types of COI varied significantly by plastic surgery subspecialty field (P reported COI are uncommon in plastic surgery research. Our results provide evidence that certain types of financial COI are more likely than others to be associated with the presentation of positive findings. This analysis suggests that certain investigators may be more biased, consciously or unconsciously, by the type of financial benefit offered by industry.
Avashia, Yash J; Thaller, Seth R
Regarded as "America's first plastic surgeon," Dr John Peter Mettauer's professional life displays 3 fundamental keystones of plastic surgery: education, innovation, and practice. To fully appreciate the history of our plastic surgery, one must look beyond a purely factual recount of noteworthy actions performed decades ago. Fundamental principles that governed achievements of our predecessors remain applicable even today. Dr Mettauer thrived as a medical student under the influence of distinguished professors in medicine at the University of Pennsylvania. Later, he continued to propagate their basic tenets when he established his medical institute in 1837. Throughout his life, Dr Mettauer combined ingenuity with scientific inquiry to devise numerous unprecedented surgical techniques and instruments. He was a prolific writer and exquisitely documented his work in medical journals for the benefit of both contemporary and future surgeons. One of Dr Mettauer's momentous achievements in plastic surgery that displays his remarkable capabilities was his contributions to management of both simple and complicated cases of cleft palate. He was the first to describe relaxing lateral incisions for treating complete cleft palates and, incidentally, was the first to successfully treat this in America. He invariably replicated similar success in establishing techniques for treating a wide range of anatomic deformities. Cumulatively, Dr Mettauer's lifelong commitment and diligence have truly laid a foundation for the eventual progress and success in the field of plastic surgery.
Maruscak, Adam A; VanderBeek, Laura; Ott, Michael C; Kelly, Stephen; Forbes, Thomas L
Work-hour restrictions have had a profound impact on surgical training. However, little is known of how work-hour restrictions may affect the future practice patterns of current surgical residents. The purpose of this study is to compare the anticipated career practice patterns of surgical residents who are training within an environment of work-hour restrictions with the current practice of faculty surgeons. An electronic survey was sent to all surgery residents and faculty at 2 Canadian university-affiliated medical centers. The survey consisted of questions regarding expected (residents) or current (faculty) practice patterns. A total of 149 residents and 125 faculty members completed the survey (50.3% and 52.3% response rates, respectively). A greater proportion of males were in the faculty cohort than in the resident group (77.6% vs 62.4%, p = 0.0003). More faculty than residents believed that work-hour restrictions have a negative impact on both residency education (40.8% vs 20.8%, p = 0.008) and preparation for a surgical career (56.8% vs 19.5%, p implications and might require larger surgical groups and reconsideration of resource allocation. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Marck, K W; Martin, D
The authors propose to define as main characterization of plastic reconstructive surgery the conceptual thinking that leads to a rational choice of an operative treatment. Conceptual thinking in plastic surgery started halfway the nineteenth century with the first schematic representations of the operative procedures available at that time, in which Von Ammon and Baumgarten, Szymanowski and Denucé played a prominent role. These four authors and their works are presented with special attention for the less known of them, Jean-Paul Denucé, surgeon in Bordeaux. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
The skill set of a plastic surgeon, which addresses a broad range of soft tissue conditions that are prevalent in sub-Saharan Africa, remains relevant in the unmet need for surgical care. Recently, there has being a major paradigm shift from discipline-based to disease-based care, resulting in an emerging component of patient-centered care; adequate access to subspecialty care in plastic and reconstructive surgery. Given the need for an evolution in sub-specialization, this article focuses on the benefits and future role of differentiation of plastic surgeons into sub-specialty training pathways in sub-Saharan Africa. PMID:25584125
Ross, Kimberly M; Moscoso, Andrea V; Bayer, Lauren R; Rosselli-Risal, Liliana; Orgill, Dennis P
Medical tourism is a growing, multi-billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors' center. A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied. The authors collected demographic information, types of surgery performed, destinations, insurance coverage, and complications. Seventy-eight patients were identified over 7 years. Most commonly, complications were seen following abdominoplasty (n = 35), breast augmentation (n = 25), and foreign body injections (n = 15). Eighteen patients underwent multiple procedures in one operative setting. The most common destination country was the Dominican Republic (n = 59). Complications included surgical-site infections (n = 14), pain (n = 14), and wound healing complications (n = 12). Eighty-six percent of patients (n = 67) relied on their medical insurance to pay for their follow-up care or manage their complications, with the most common type of health insurance coverage being Massachusetts Medicaid (n = 48). Cosmetic surgery performed in developing countries can carry substantial risks of complications that can be challenging to patients, primary care providers, insurers, and plastic surgical teams not associated with the original surgery. These complications pose significant burdens on our public health systems.
Shi, Yunyong; Lin, Li; Zhou, Chaozheng; Zhu, Ming; Xie, Le; Chai, Gang
Mandible plastic surgery plays an important role in conventional plastic surgery. However, its success depends on the experience of the surgeons. In order to improve the effectiveness of the surgery and release the burden of surgeons, a mandible plastic surgery assisting robot, based on an augmented reality technique, was developed. Augmented reality assists surgeons to realize positioning. Fuzzy control theory was used for the control of the motor. During the process of bone drilling, both the drill bit position and the force were measured by a force sensor which was used to estimate the position of the drilling procedure. An animal experiment was performed to verify the effectiveness of the robotic system. The position error was 1.07 ± 0.27 mm and the angle error was 5.59 ± 3.15°. The results show that the system provides a sufficient accuracy with which a precise drilling procedure can be performed. In addition, under the supervision's feedback of the sensor, an adequate safety level can be achieved for the robotic system. The system realizes accurate positioning and automatic drilling to solve the problems encountered in the drilling procedure, providing a method for future plastic surgery.
Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels
surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all...... of implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast...... symmetrisation procedures were performed by plastic surgeons. Breast surgeons had sought more specific education, both international observerships and specific courses. In both groups of surgeons, the majority expressed that both tumour removal and reconstruction should be performed by doctors of their own...
Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan
Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852
Gutiérrez-Baños, J L; Ballestero-Diego, R; Truan-Cacho, D; Aguilera-Tubet, C; Villanueva-Peña, A; Manuel-Palazuelos, J C
The training and learning of residents in laparoscopic surgery has legal, financial and technological limitations. Simulation is an essential tool in the training of residents as a supplement to their training in laparoscopic surgery. The training should be structured in an appropriate environment, with previously established and clear objectives, taught by professionals with clinical and teaching experience in simulation. The training should be conducted with realistic models using animals and ex-vivo tissue from animals. It is essential to incorporate mechanisms to assess the objectives during the residents' training progress. We present the training model for laparoscopic surgery for urology residents at the University Hospital Valdecilla. The training is conducted at the Virtual Hospital Valdecilla, which is associated with the Center for Medical Simulation in Boston and is accredited by the American College of Surgeons. The model is designed in 3 blocks, basic for R1, intermediate for R2-3 and advanced for R4-5, with 9 training modules. The training is conducted in 4-hour sessions for 4 afternoons, for 3 weeks per year of residence. Residents therefore perform 240 hours of simulated laparoscopic training by the end of the course. For each module, we use structured objective assessments to measure each resident's training progress. Since 2003, 9 urology residents have been trained, in addition to the 5 who are currently in training. The model has undergone changes according to the needs expressed in the student feedback. The acquisition of skills in a virtual reality model has enabled the safe transfer of those skills to actual practice. A laparoscopic surgery training program designed in structured blocks and with progressive complexity provides appropriate training for transferring the skills acquired using this model to an actual scenario while maintaining patient safety. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Chun, Maria B J; Deptula, Peter; Morihara, Sarah; Jackson, David S
Recent articles have documented the importance of cultural competency in surgery. Surgical residency programs have used the Objective Structured Clinical Examinations or cultural standardized patient examinations as a training tool. Past studies evaluating cultural competency have noted the importance of including an observational (control) arm, which would allow for a more objective assessment of a resident's competency in this area. The purpose of our article is to present the results of a follow-up study to a pilot cultural standardized patient examination for surgery residents. All first-year surgery residents were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were used to assess resident performance. On the day of the examination, the Cross-Cultural Care Survey was administered. The examination was assessed by the residents themselves, faculty observers, and standardized patients, using a written checklist that was developed to evaluate residents on all 6 Accreditation Council for Graduate Medical Education competencies. The current study includes 20 first-year surgery residents from academic years 2011 to 2012 and 2012 to 2013. The examination of pretest differences in groups found that students born outside of the United States had significantly higher scores on attitude (t = -2.68, df = 18, p = 0.02), but no statistically significant differences were found in skillfulness or knowledge or in the overall rating scale. For the overall rating scale, change from pretest to posttest was statistically significant (t = -2.25, df = 18, p = 0.04). Further analysis revealed that students who were born in the United States demonstrated a significant increase in ratings (t = -3.08, df = 10, p = 0.01) whereas students who were not born in the United States showed little change (t = -0.35, df = 7, p = 0.74). These results show that the means in attitude scales changed little for all
de Gara Chris
Full Text Available Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.
Tapia, Nicole M; Milewicz, Allen; Whitney, Stephen E; Liang, Michael K; Braxton, Carla C
Although the Accreditation Council for Graduate Medical Education has defined 6 core competencies required of resident education, no consensus exists on best practices for reaching resident proficiency. Surgery programs must develop resourceful methods to incorporate learning. While patient care and medical knowledge are approached with formal didactics and traditional Halstedian educational formats, other core competencies are presumed to be learned on the job or emphasized in conferences. To test the hypothesis that our residents lack a foundation in several of the nonclinical core competencies and to seek to develop a formal curriculum that can be integrated into our current didactic time, with minimal effect on resident work hours and rest hours. Anonymous Likert-type scale needs assessment survey requesting residents within a large single general surgery residency program to rate their understanding, working knowledge, or level of comfort on the following 10 topics: negotiation and conflict resolution; leadership styles; health care legislation; principles of quality delivery of care, patient safety, and performance improvement; business of medicine; clinical practice models; role of advocacy in health care policy and government; personal finance management; team building; and roles of innovation and technology in health care delivery. Proportions of resident responses scored as positive (agree or strongly agree) or negative (disagree or strongly disagree). In total, 48 surgery residents (70%) responded to the survey. Only 3 topics (leadership styles, team building, and roles of innovation and technology in health care delivery) had greater than 70% positive responses, while 2 topics (negotiation and conflict resolution and principles of quality delivery of care, patient safety, and performance improvement) had greater than 60% positive responses. The remaining topics had less than 40% positive responses, with the least positive responses on the topics
Sudarshan, Monisha; Hanna, Wael C; Jamal, Mohammed H; Nguyen, Lily H P; Fraser, Shannon A
The purpose of this study was to describe Canadian general surgery residents' perceptions regarding potential implementation of work-hour restrictions. An ethics review board-approved, Web-based survey was submitted to all Canadian general surgery residency programs between April and July 2009. Questions evaluated the perceived effects of an 80-hour work week on length of training, operative exposure, learning and lifestyle. We used the Fisher exact test to compare senior and junior residents' responses. Of 360 residents, 158 responded (70 seniors and 88 juniors). Among them, 79% reported working 75-100 hours per week. About 74% of seniors believed that limiting their work hours would decrease their operative exposure; 43% of juniors agreed (p seniors and juniors thought limiting their work hours would improve their lifestyle (86% v. 96%, p = 0.12). Overall, 60% of residents did not believe limiting work hours would extend the length of their training. Regarding 24-hour call, 60% of juniors thought it was hazardous to their health; 30% of seniors agreed (p = 0.001). Both senior and junior residents thought abolishing 24-hour call would decrease their operative exposure (84% v. 70%, p = 0.21). Overall, 31% of residents supported abolishing 24-hour call. About 47% of residents (41% seniors, 51%juniors, p = 0.26) agreed with the adoption of the 80-hour work week. There is a training-level based dichotomy of opinion among general surgery residents in Canada regarding the perceived effects of work hour restrictions. Both groups have voted against abolishing 24-hour call, and neither group strongly supports the implementation of the 80-hour work week.
Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M
To quantify the prevalence, outcomes, and cost of surgical resident research. General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice. Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.
Eberlin, Kyle R; Perdikis, Galen; Damitz, Lynn; Krochmal, Dan J; Kalliainen, Loree K; Bonawitz, Steven C
With the advancement of technology, electronic communication has become an important mode of communication within plastic and reconstructive surgery. This can take the form of e-mail, text messaging, video conferencing, and social media, among others. There are currently no defined American Society of Plastic Surgeons guidelines for appropriate professional use of these technologies. A search was performed on PubMed and the Cochrane database; terms included "telemedicine," "text messaging," "HIPAA," "metadata," "video conferencing," "photo sharing," "social media," "Facebook," "Twitter," and "Instagram." Initial screening of all identified articles was performed; the level of evidence, limitations, and recommendations were evaluated and articles were reviewed. A total of 654 articles were identified in the level I screening process; after more comprehensive review, 41 articles fit inclusion criteria: social networking, 12; telemedicine, 11; text messaging, 10; metadata, four; video conferencing, three; and Health Insurance Portability and Accountability Act, one. General themes were identified from these articles and guidelines proposed. Electronic communication can provide an efficient method of information exchange for professional purposes within plastic surgery but should be used thoughtfully and with all professional, legal, and ethical considerations.
Silvestre, Jason; Bilici, Nadir; Serletti, Joseph M; Chang, Benjamin
The Plastic Surgery In-Service Training Exam is written by the American Society of Plastic Surgeons. Examinees reasonably infer that tested material reflects the Society's vision for the core curriculum in plastic surgery. The purpose of this study was to determine the levels of evidence on which credited answers to the examination questions are based. Two recent Plastic Surgery In-Service Training Exams (2014 and 2015) were analyzed. Questions were categorized using a taxonomy model. Recommended journal article references for Level III (decision-making) questions were assigned a level of evidence. Exam sections were analyzed for differences in question taxonomy distribution and level of evidence. To look for studies with higher levels of evidence, a PubMed search was conducted for a random sample of 10 questions from each section. One hundred three Level I (25.8 percent), 138 Level II (34.5 percent), and 159 Level III (39.8 percent) questions were analyzed (p < 0.001). The hand and lower extremity section had the highest percentage of Level III questions (50.0 percent; p = 0.005). Journal articles had a mean level of evidence of 3.9 ± 0.7. The number of articles with a low level of evidence (IV and V) (p = 0.624) and the percentage of questions supported by articles with a high level of evidence (I and II) (p = 0.406) did not vary by section. The PubMed search revealed no instances of a higher level of evidence than the recommended reading list. A significant percentage of Plastic Surgery In-Service Training Exam questions test clinical management, but most are supported with a low level of evidence. Although that is consistent with low level of evidence of plastic surgery literature, educators should recognize the potential for biases of question writers.
In this paper, I take up the theme of the volume by analyzing the dynamic and sometimes conflicting relationship between ‘health’ and ‘beauty’ in the practice of cosmetic surgery. Approaching Brazil as a case study, I show how cosmetic and medical rationales are merged within a broader field of
Chao, Albert H; Gangopadhyay, Noopur
Limited data exist regarding industry financial relationships in plastic surgery. The Sunshine Act Open Payments Database currently represents the largest repository of these data, but is limited primarily to queries of individual providers. The purpose of this study was to analyze these data and present them in a manner that better delineates these relationships, and to compare plastic surgery with other surgical subspecialties. A review of the Open Payments Database was performed for the period from January 1, 2014, to December 31, 2014. These data were analyzed with respect to types of payments, characteristics of plastic surgeons and companies, and comparison with other surgical subspecialties. A total of 49,053 payments from 274 companies were identified that were made to 4812 plastic surgeons (475 academic and 4337 private practice). The total value of payments was $17,091,077. Food and beverage represented the most common type of payment (82.2 percent). Royalties and licensing represented the highest valued type of payment (35.7 percent), but were received by only a minority of plastic surgeons (0.5 percent). No significant differences were identified between academic and private practice plastic surgeons in the value or quantity of payments. Plastic surgery (54.5 percent) exhibited the lowest prevalence of industry financial relationships compared with otolaryngology (57.9 percent), orthopedics (62.4 percent), neurosurgery (87.8 percent), and urology (63.1 percent) (p < 0.001). Approximately half of all plastic surgeons have industry financial relationships. The prevalence of these relationships is comparatively less than in other surgical subspecialties.
Zavod, Matthew B; Adamson, Peter A
To compare referral sources to a facial plastic surgery practice and to develop models correlating the referral source with the decision for surgery. Retrospective descriptive study. Well-established, metropolitan, private facial plastic surgery practice with training fellowship affiliated with an academic centre. One-thousand eighty-nine new consecutive patients presenting between January 2001 and December 2005 recorded intake data including age, gender, and chief complaint. Final data input was their decision for or against surgery. Main outcome measures included differences in referral sources based on data collected and how those sources related to decision for surgery. A 50% conversion rate was found. Women and older patients were more likely to be referred from magazines, television, and newspapers and for facial rejuvenation. Men and younger patients were more likely to be referred from the website and for rhinoplasty. For facial rejuvenation, both the number of patients interested in and the probability that they agreed to the procedure increased with age. For rhinoplasty, the converse was true. The most likely patients to schedule surgery were those who were referred from other patients, friends, or family members in our practice. The data confirm that word-of-mouth referrals are the most important source for predicting which patients will elect to proceed with surgery in this established facial cosmetic surgery practice.
Balla, Fadi; Garwe, Tabitha; Motghare, Prasenjeet; Stamile, Tessa; Kim, Jennifer; Mahnken, Heidi; Lees, Jason
.0043). The survey response rate was 100%. Survey results indicated that inability to find the precise code within the ACGME search interface and unfamiliarity with available CPT codes were by far the most common perceived barriers to accuracy. Survey results also indicated that most residents (74%) believe that they code accurately most of the time and agree that their case log would accurately represent their operative experience (66.6%). This is the first study to evaluate correctness of residents' ACGME case logs in general surgery. The degree of inaccuracy found here necessitates further investigation into the etiology of these discrepancies. Instruction on coding practices should also benefit the residents after graduation. Optimizing communication among attendings and residents, improving ACGME coding search interface, and implementing consistent coding practices could improve accuracy giving a more realistic view of residents' operative experience. Published by Elsevier Inc.
Dolan, Roisin T; Zins, James E; Morrison, Colin M
The aesthetic surgery arena has become a competitive marketplace. Recognition as an authority in aesthetic surgery remains a powerful marketing tool for plastic surgeons, but have significant inroads been made by other specialties? The aims of this study were to analyze publication trends relating to the top five most commonly performed aesthetic surgical procedures, and to assess the origins (i.e., source specialty, authorship, institutions, and countries) of published aesthetic surgical research. Based on the seventeenth annual multispecialty data set provided by the American Society for Aesthetic Plastic Surgery, the top five most commonly performed aesthetic surgical procedures were selected. A temporal analysis of publication and citation rates, source institution and country, publishing journal, funding agency trends, and level of evidence was undertaken from 1970 to 2013. Using the search criteria, 7762 articles were identified. There was an 8.8-fold increase in publication volume when the first decade (n = 375) was compared with the last decade (n = 3326). Over the past four decades, 52.2 percent of publications (n = 4053 of 7762) originated from plastic surgery research institutions, with varying contributions from other specialties. Competition was greatest in relation to authorship of blepharoplasty- and rhinoplasty-related publications. Although plastic surgeons continue to maintain a center-stage presence in terms of authorship of aesthetic surgical literature, significant contributions are now made by other specialties. Plastic surgeons must continue to foster high-quality, peer-reviewed research and innovations to maintain their visibility as leaders in the aesthetic surgery literature and sustain a competitive advantage in aesthetic surgery practice.
Krafcik, Brianna M; Sachs, Teviah E; Farber, Alik; Eslami, Mohammad H; Kalish, Jeffrey A; Shah, Nishant K; Peacock, Matthew R; Siracuse, Jeffrey J
General surgeons have traditionally performed open vascular operations. However, endovascular interventions, vascular residencies, and work-hour limitations may have had an impact on open vascular surgery training among general surgery residents. We evaluated the temporal trend of open vascular operations performed by general surgery residents to assess any changes that have occurred. The Accreditation Council for Graduate Medical Education's database was used to evaluate graduating general surgery residents' cases from 1999 to 2013. Mean and median case volumes were analyzed for carotid endarterectomy, open aortoiliac aneurysm repair, and lower extremity bypass. Significance of temporal trends were identified using the R(2) test. The average number of carotid endarterectomies performed by general surgery residents decreased from 23.1 ± 14 (11.6 ± 9 chief, 11.4 + 10 junior) cases per resident in 1999 to 10.7 ± 9 (3.4 ± 5 chief, 7.3 ± 6 junior) in 2012 (R(2) = 0.98). Similarly, elective open aortoiliac aneurysm repairs decreased from 7.4 ± 5 (4 ± 4 chief, 3.4 ± 4 junior) in 1999 to 1.3 ± 2 (0.4 ± 1 chief, 0.8 ± 1 junior) in 2012 (R(2) = 0.98). The number of lower extremity bypasses decreased from 21 ± 12 (9.5 ± 7 chief, 11.8 ± 9 junior) in 1999 to 7.6 ± 2.6 (2.4 ± 1.3 chief, 5.2 + 1.8 junior) in 2012 (R(2) = 0.94). Infrapopliteal bypasses decreased from 8.1 ± 3.8 (3.5 ± 2.2 chief, 4.5 ± 2.9 junior) in 2001 to 3 ± 2.2 (1 ± 1.6 chief, 2 ± 1.6 junior) in 2012 (R(2) = 0.94). General surgery resident exposure to open vascular surgery has significantly decreased. Current and future graduates may not have adequate exposure to open vascular operations to be safely credentialed to perform these procedures in future practice without advanced vascular surgical training. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R
The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. Hawaii Medical Journal Copyright 2010.
Lu Yafen; Zhang Junmin; Huang Zhiqin
The management of anesthesia used in the plastic reconstruction of 18 cases of radiation injury of neck is reported. 17 cases were malignant tumor patients. After radiotherapy, their general condition was weak. The injury of neck skin and surrounding tissues was severe. Most operations were excision of the focus and repairing the wound using adjacent flap. The choice of anesthesia depended on the general condition, degree of injury and the procedure. Good pre-operative preparation, close monitoring and satisfactory airway control during operation are very important
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0001] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting... the public. Name of Committee: General and Plastic Surgery Devices Panel of the Medical Devices...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-N-0606] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Amendment of Notice...) is announcing an amendment to the notice of a meeting of the General and Plastic Surgery Devices...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-0001] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting... the public. Name of Committee: General and Plastic Surgery Devices Panel of the Medical Devices...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0001] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of... General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee scheduled for August...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0002] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting... the public. Name of Committee: General and Plastic Surgery Devices Panel of the Medical Devices...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0002] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee: Notice of... Administration (FDA) is postponing the meeting of the General and Plastic Surgery Devices Panel of the Medical...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0002] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting... the public. Name of Committee: General and Plastic Surgery Devices Panel of the Medical Devices...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2010-N-0001] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting... the public. Name of Committee: General and Plastic Surgery Devices Panel of the Medical Devices...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0001] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting... the public. Name of Committee: General and Plastic Surgery Devices Panel of the Medical Devices...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0478] General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting... the public. Name of Committee: General and Plastic Surgery Devices Panel of the Medical Devices...
Orkin, Bruce A; Poirier, Jennifer; Kowal-Vern, Areta; Chan, Edie; Ohara, Karen; Mendoza, Brian
Objective - To determine whether residents with one or more years of dedicated research time (Research Residents, RR) improved their ABSITE scores compared to those without (Non-Research Residents, N-RR). A retrospective review of general surgery residents' ABSITE scores from 1995 to 2016 was performed. RR were compared to N-RR. Additional analysis of At Risk (AR) v Not At Risk residents (NAR) (35th percentile as PGY1-2) was also performed. Cohort - 147 residents (34 RR and 113 N-RR). There were no differences in initial ABSITE scores (p = 0.47). By definition, the AR group had lower scores than NAR. Overall, post-research RR v PGY-4 N-RR scores did not differ (p = 0.84). Only the AR residents improved their scores (p = 0.0009 v NAR p = 0.42), regardless of research group (p = 0.70). Protected research time did not improve residents' ABSITE scores, regardless of initial scores. At Risk residents improved regardless of research group status. Copyright © 2017 Elsevier Inc. All rights reserved.
Z. A. Radjabova
Full Text Available Issues of tissue defects replacement after radical surgery for tumors of the head and neck do not lose their relevance. The article presents the results of plastics and replacement of the perforating combined defects of the floor of the mouth, portion of the upper and lower lips, the angle of the mouth, cheeks, neck lateral parts with simultaneous reduction of the configuration and function of the operated organs. Depending on the depth and nature of the existing tissue defect various methods of plastics were applied using arterialized flaps on the vascular pedicle in a free and non-free version. Satisfactory cosmetic and functional results were achieved in patients allowing to improve life quality and to adapt socially.
Steven Nicholas Graves, MA
Conclusions: The GoPro HERO 3+ Black Edition camera enables high-quality, cost-effective video recording of plastic and reconstructive surgery procedures. When set to a narrow field of view and automatic white balance, the camera is able to sufficiently compensate for the contrasting light environment of the operating room and capture high-resolution, detailed video.
Li, R B; Li, M X; Guo, G H; Zhang, H Y
Three-dimensional bioprinting is one of the latest and fastest growing technologies in the medical field. It has been implemented to print part of the transplantable tissues and organs, such as skin, ear, and bone. This paper introduces the application status, challenges, and application prospect of three-dimensional bioprinting in burn and plastic surgery field.
.... FDA-2010-N-0513] Medical Devices; General and Plastic Surgery Devices; Classification of Non-Powered... risks. Adverse tissue reaction Material degradation Improper function of suction apparatus (e.g., reflux.... Material degradation Section 8. Stability and Shelf Life. [[Page 70113
İğde, Murat; Kaplan, Ahmet
Terror attacks have been progressively increasing worldwide through the present era. The management of the consequences of terrorism events is under debate in almost every scientific area. The organization and advancement of health services constitute important components of the crisis management. Similar to other specialty areas in medicine, the medical management of terrorist attacks is becoming important in terms of plastic and reconstructive surgery.Ankara, the capital of Turkey, has been subject to 2 terrorist events in public places within a year. The total number of patients involved in both cases was 434. Ankara Numune Training and Research Hospital is a tertiary health care institution and one of the most important trauma centers in the region. A total of 178 Patients exposed to these events referred to our hospital. Of the total, 34 patients were completely or partially treated in the plastic and reconstructive surgery clinic. In this study, we tried to discuss the difficulties encountered in the classification of patients and plastic surgery during the treatment period of patients who experienced these attacks.Data were obtained from The National News Agency, hospital, and our own clinic registries. Patient classification was based on the injured parts of the body. Statistical analysis was performed for all data. In conclusion, the role and the importance of plastic surgery department especially in trauma management have been emphasized in the light of our findings.
.... FDA-2010-N-0512] Medical Devices; General and Plastic Surgery Devices; Classification of Tissue... running to unintended areas, etc. B. Wound dehiscence C. Adverse tissue reaction and chemical burns D..., Clinical Studies, Labeling. Adverse tissue reaction and chemical Biocompatibility Animal burns. Testing...
van Ramshorst, Gabrielle H; Kaijser, Mirjam A; Pierie, Jean-Pierre E N; van Wagensveld, Bart A
Surgical procedures for morbid obesity, including laparoscopic Roux-en-Y gastric bypass (LRYGB), are considered standardized laparoscopic procedures. Our goal was to determine how bariatric surgery is trained in the Netherlands. Questionnaires were sent to lead surgeons from all 19 bariatric centers in the Netherlands. At least two residents or fellows were surveyed for each center. Dutch residents are required to collect at least 20 electronic Objective Standard Assessment of Technical Skills (OSATS) observations per year, which include the level of supervision needed for specific procedures. Centers without resident accreditation were excluded. All 19 surgeons responded (100%). Answers from respondents who worked at teaching hospitals with residency accreditation (12/19, 63%) were analyzed. The average number of trained residents or fellows was 14 (range 3-33). Preferred procedures were LRYGB (n = 10), laparoscopic gastric sleeve (LGS) resection (n = 1), or no preference (n = 1). Three groups could be discerned for the order in which procedural steps were trained: unstructured, in order of increasing difficulty, or in order of chronology. Questionnaire response was 79% (19/24) for residents and 73% (8/11) for fellows. On average, residents started training in bariatric surgery in postgraduate year (PGY) 4 (range 0-5). The median number of bariatric procedures performed was 40 for residents (range 0-148) and 220 during fellowships (range 5-306). Training in bariatric surgery differs considerably among centers. A structured program incorporating background knowledge, step-wise technical skills training, and life-long learning should enhance efficient training in bariatric teaching centers without affecting quality or patient safety.
Broer, P Niclas; Levine, Steven M; Juran, Sabrina
The objective of this article was to evaluate past and current trends regarding aesthetic operations in the United States and to project future changes regarding such procedures. Cosmetic surgery statistics from the American Society for Aesthetic Plastic Surgery from 1997 to 2012 were analyzed by sex, age, and ethnic group. Then, using population projections from the U.S. Census Bureau based on the 2010 census, two projection scenarios of the expected number of aesthetic plastic surgery procedures were generated. The scenarios included the presumed occurrence and nonoccurrence of a recession like that which occurred in 2007. Aesthetic procedures are expected to grow from 1,688,694 in 2012 to 3,847,929 by 2030, representing an average annual growth rate of 7.1 percent. Should another recession of similar degree to the one in 2007 occur, procedures would increase to only 2,086,994, displaying an average annual growth percentage rate of 1.3 percent. Because the age distribution of the patient population will change, preferences for specific procedures according to age influence-and thus are reflected in-future demand for those procedures. Furthermore, the ethnic profile of patients will change significantly, with 32 percent of all procedures being performed on patients other than Caucasians by 2030. Demand for aesthetic plastic surgical procedures is expected to continue to grow, while depending on the economic performance at the macro level and changing demographic dynamics of the U.S. population. Considering all investigated factors and trends among all patients, the most commonly requested procedures by 2030 are likely to be (1) breast augmentations, (2) lipoplasties, and (3) blepharoplasties.
Cochran, Amalia; Elder, William B; Crandall, Marie; Brasel, Karen; Hauschild, Tricia; Neumayer, Leigh
A significant faculty attrition rate exists in academic surgery. The authors hypothesized that senior residents and early-career faculty members have different perceptions of advancement barriers in academic surgery. A modified version of the Career Barriers Inventory-Revised was administered electronically to surgical residents and early-career surgical faculty members at 8 academic medical centers. Residents identified a lack of mentorship as a career barrier about half as often as faculty members. Residents were twice as likely as faculty members to view childbearing as a career barrier. Many early-career faculty members cite a lack of mentors as a limitation to their career development in academic surgery. Childbearing remains a complex perceived influence for female faculty members in particular. Female faculty members commonly perceive differential treatment and barriers on the basis of their sex. Faculty development programs should address both systemic and sex-specific obstacles if academic surgery is to remain a vibrant field. Copyright © 2013 Elsevier Inc. All rights reserved.
Carroll, Michael; Drosdovech, Darren; Faber, Kenneth J.; Hildebrand, Kevin A.; King, Graham; Pollock, J.; Rouleau, Dominique M.; Sandman, Emilie
Introduction: The aim of this paper is to guide training program and review course curriculum planning in elbow disorders. To this end, a nationwide email survey was administered to residents' in orthopaedic surgery training programs. Material and Methods: The survey had 12 items that examined learning needs in several domains: assessment of acute…
Swain, JaBaris D; Matousek, Alexi C; Scott, John W; Cooper, Zara; Smink, Douglas S; Bolman, Ralph Morton; Finlayson, Samuel R G; Zinner, Michael J; Riviello, Robert
Academic global surgery is a nascent field focused on improving surgical care in resource-poor settings through a broad-based scholarship agenda. Although there is increasing momentum to expand training opportunities in low-resource settings among academic surgical programs, most focus solely on establishing short-term elective rotations rather than fostering research or career development. Given the complex nature of surgical care delivery and programmatic capacity building in the resource-poor settings, many challenges remain before global surgery is accepted as an academic discipline and an established career path. Brigham and Women's Hospital has established a specialized global surgery track within the general surgery residency program to develop academic leaders in this growing area of need and opportunity. Here we describe our experience with the design and development of the program followed by practical applications and lessons learned from our early experiences. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Hultman, Charles Scott; Halvorson, Eric G; Kaye, Donna; Helgans, Richard; Meyers, Michael O; Rowland, Pamela A; Meyer, Anthony A
Professionalism is now recognized as a core competency for graduate medical education and maintenance of certification. However, few models exist in plastic surgery that define, teach, and assess professionalism as a competency. The purpose of this project was to evaluate the effectiveness of a professionalism curriculum in an academic plastic surgery practice. We created and conducted a 6-wk, 12-h course for health care professionals in plastic surgery (faculty, residents, nurses, medical students). Teaching methods included didactic lectures, journal club, small group discussions, and book review. Topics included: (1) Professionalism in Our Culture, (2) Leadership Styles, (3) Modeling Professional Behavior, (4) Leading Your Team, (5) Managing Oneself, and (6) Leading While You Work. Using Kirkpatrick methodology to assess perception of the course (level 1 data), learning of the material (level 2 data), effect on behavior (level 3 data), and impact on the organization (level 4 data), we compiled participant questionnaires, scores from pre- and post-tests, and such metrics as incidence of sentinel events (defined as infractions requiring involvement by senior administrators), number of patient complaints reported to Patient Relations, and patient satisfaction (Press Ganey surveys), for the 6 mo before and after the course. Thirty health care professionals participated in a 6-wk course, designed to improve professionalism in plastic surgery. Level 1 data: Although only 56.5% of respondents felt that the course was a "good use of my time," 73.9% agreed that the course "will help me become a better professional" and 82.6% "would recommend the course to others." Level 2 data: Post-test scores increased from 48% to 70% (P teaching, and influencing professionalism in plastic surgery are very valuable and should be pursued by educators to help satisfy Graduate Medical Education/Maintenance of Certification requirements and to improve the performance of the organization
Ostapenko, Laura; Schonhardt-Bailey, Cheryl; Sublette, Jessica Walling; Smink, Douglas S; Osman, Nora Y
Applicants to US general surgery residency training programs submit standardized applications. Applicants use the personal statement to express their individual rationale for a career in surgery. Our research explores common topics and gender differences within the personal statements of general surgery applicants. We analyzed the electronic residency application service personal statements of 578 applicants (containing 3,82,405 words) from Liaison Committee on Medical Education-accredited medical schools to a single ACGME-accredited general surgery program using an automated textual analysis program to identify common topics and gender differences. Using a recursive algorithm, the program identified common words and clusters, grouping them into topic classes, which are internally validated. We identified and labeled 8 statistically significant topic classes through independent review: "my story," "the art of surgery," "clinical vignettes," "why I love surgery," "residency program characteristics," "working as a team," "academics and research," and "global health and policy." Although some classes were common to all applications, we also identified gender-specific differences. Notably, women were significantly more likely than men to be represented within the class of "working as a team." (p differences between the statements of men and women. Women were more likely to discuss surgery as a team endeavor while men were more likely to focus on the details of their surgical experiences. Our work mirrors what has been found in social psychology research on gender-based differences in how men and women communicate their career goals and aspirations in other competitive professional situations. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Gurunluoglu, R; Gurunluoglu, A
Paulus Aegineta (625-690 ad), born on the island of Aegina, practiced medicine at Alexandria. The last of the eclectic Greek compilers in the Byzantine period, he wrote an Epitome of medicine in seven books. The sixth book, which is considered the best section of his work, is devoted mainly to surgery. The first edition, "editio princeps," of his Epitome was published in Greek by the Aldine press in Venice in 1528 and later translated into English for the Sydenham Society by Francis Adams of Banchory (1844-1847). Paulus was not only a compiler but also a competent and skillful surgeon. In addition to his achievements in general surgical progress, Paulus Aegineta, especially in the book on surgery, made valuable contributions in the history of plastic surgery. He may be considered as one of the originators of plastic surgery as it is known today. He described procedures varying from the treatment of nasal and jaw fractures to operations for gynecomastia, ganglion, and hypospadias. This Grecian master influenced not only his own but also the subsequent ages. Rhazes, Haly Abbas, Albucasis, Avicenna, and Fabricius ab Aquapendente were the greatest physicians influenced by Paulus Aegineta. Because the work of Paulus Aegineta was the only source for many of the surgical treatises of Arabian authors, his Epitome bridged Western and Eastern medicine and conveyed surgical experience and knowledge, including several plastic surgery procedures, to the subsequent ages.
Ahmed, Hesham M; Gale, Stephen C; Tinti, Meredith S; Shiroff, Adam M; Macias, Aitor C; Rhodes, Stancie C; Defreese, Marissa A; Gracias, Vicente H
Emergency general surgery (EGS) is increasingly being provided by academic trauma surgeons in an acute care surgery model. Our tertiary care hospital recently changed from a model where all staff surgeons (private, subspecialty academic, and trauma academic) were assigned EGS call to one in which an emergency surgery service (ESS), staffed by academic trauma faculty, cares for all EGS patients. In the previous model, many surgeries were "not covered" by residents because of work-hour restrictions, conflicting needs, or private surgeon preference. The ESS was separate from the trauma service. We hypothesize that by creating a separate ESS, residents can accumulate needed and concentrated operative experience in a well-supervised academic environment. A prospectively accrued EGS database was retrospectively queried for the 18-month period: July 2010 to June 2011. The Accreditation Council for Graduate Medical Education (ACGME) databases were queried for operative numbers for our residency program and for national resident data for 2 years before and after creating the ESS. The ACGME operative requirements were tabulated from online sources. ACGME requirements were compared with surgical cases performed. During the 18-month period, 816 ESS operations were performed. Of these, 307 (38%) were laparoscopy. Laparoscopic cholecystectomy and appendectomy were most common (138 and 145, respectively) plus 24 additional laparoscopic surgeries. Each resident performed, on average, 34 basic laparoscopic cases during their 2-month rotation, which is 56% of their ACGME basic laparoscopic requirement. A diverse mixture of 70 other general surgical operations was recorded for the remaining 509 surgical cases, including reoperative surgery, complex laparoscopy, multispecialty procedures, and seldom-performed operations such as surgery for perforated ulcer disease. Before the ESS, the classes of 2008 and 2009 reported that only 48% and 50% of cases were performed at the main academic
Sommer, Doron D; Mendelsohn, Martyn
The authors tested the hypothesis that certain maneuvers (neck flexion/extension and head protrusion/retrusion) alter the appearance of the submental area, jawline, and melolabial groove. They used a questionnaire survey of 20 naïve judges who assessed a standardized photograph album of three subjects. The subjects' faces (frontal and lateral views) were photographed in neutral, neck flexion/extension, and head protrusion/retrusion positions. High Kendall coefficients of correlation were observed in 10 of 12 questions evaluating an improvement in jawline definition with neck extension or head protrusion, as well as in 11 of 12 questions assessing decreased submental soft tissue. All questions relating to the melolabial groove had a correlation coefficient of less than 0.70. Small changes in patient positioning during photodocumentation for facial plastic surgical procedures can cause dramatic changes in the appearance of certain parameters. Standardizing patient positioning for preoperative and postoperative photographs is imperative.
Dorfman, Robert G; Vaca, Elbert E; Fine, Neil A; Schierle, Clark F
Recent videos shared by plastic surgeons on social media applications such as Snapchat, Instagram, and YouTube, among others, have blurred the line between entertainment and patient care. This has left many in the plastic surgery community calling for the development of more structured oversight and guidance regarding video sharing on social media. To date, no official guidelines exist for plastic surgeons to follow. Little is known about the ethical implications of social media use by plastic surgeons, especially with regard to video sharing. A systematic review of the literature on social media use in plastic surgery was performed on October 31, 2016, with an emphasis on ethics and professionalism. An ethical analysis was conducted using the four principles of medical ethics. The initial search yielded 87 articles. Thirty-four articles were included for analyses that were found to be relevant to the use of social media in plastic surgery. No peer-reviewed articles were found that mentioned Snapchat or addressed the ethical implications of sharing live videos of plastic surgery on social media. Using the four principles of medical ethics, it was determined that significant ethical concerns exist with broadcasting these videos. This analysis fills an important gap in the plastic surgery literature by addressing the ethical issues concerning live surgery broadcasts on social media. Plastic surgeons may use the guidelines proposed here to avoid potential pitfalls.
Jeong Gi Hyeon
This book deals with plastic, which includes introduction for plastic, chemistry of high polymers, polymerization, speciality and structure of a high molecule property of plastic, molding, thermosetting plastic, such as polyethylene, polyether, polyamide and polyvinyl acetyl, thermal plastic like phenolic resins, xylene resins, melamine resin, epoxy resin, alkyd resin and poly urethan resin, new plastic like ionomer and PPS resin, synthetic laminated tape and synthetic wood, mixed materials in plastic, reprocessing of waste plastic, polymer blend, test method for plastic materials and auxiliary materials of plastic.
Full Text Available Background: A systematic review of the literature was performed to clarify the psychosocial characteristics of patients who have an interest in cosmetic plastic surgery. Methods: Medical literature was reviewed by two independent researchers, and a third reviewer evaluated their results. Results: Twelve studies addressing the predictors of interest in cosmetic surgery were finally identified and analysed. Interest in cosmetic surgery was associated with epidemiological factors, their social networks, their psychological characteristics, such as body image, self-esteem and other personality traits and for specific psychopathology and found that these may either positively or negatively predict their motivation to seek and undergo a cosmetic procedure. Conclusions: The review examined the psychosocial characteristics associated with an interest in cosmetic surgery. Understanding cosmetic patients' characteristics, motivation and expectation for surgery is an important aspect of their clinical care to identify those patients more likely to benefit most from the procedure.
Austoni, E; Mantovani, F; Colombo, F; Canclini, L; Mastromarino, G; Vecchio, D; Fenice, O
The radical surgical option we propose for Peyronie's disease consists in removing the sclero-hyalinotic focus of disease and replacing it by an autologous dermal graft taken from the upper outer thigh area. Between 1981 and 1991, we operated 335 patients with IPP, 152 of whom underwent plaque excision and dermal graft. All could be assessed at two-year follow-up. Two main complications were observed: mild penile flexure due to scar retraction of the graft (35% of cases), and partial erectile deficit with decreased corporal rigidity (17% of cases). The degree of the graft retraction is linked to the individual's histologic response. A mild deviation of the penis can occur some months after surgery and is not a relapse flexure due to disease progression (as it should have evolutive characteristics) but is mere scar retraction and will spontaneously regress. As the patient will date the onset of a postoperative erectile deficit from the time of the operation, it is advisable to assess preoperatively the erectile ability of all patients. Furthermore, an impaired erectile response could result from hypoaesthesia of the glans, post-surgical stress, and fibrosis of the erectile tissue. A retrospective assessment of radical surgery cases involving plaque excision and dermal graft lead us to propose this option where precise indications apply, providing the presence of other alterations of the erectile function are pre-operatively assessed.
Full Text Available The purpose of this paper is to describe the technique of making casts using alginate compound for negative and dental stone plaster for positive impressions. With certain modifications a cast could be made of any part of the body and one can make a museum of interesting cases. Casts serve as useful teaching material especially in cleft lip and palate patients to study the effect of surgery on growth and development of the cleft lip-palate-nose complex in relation to the remaining face. It also helps in planning reconstruction in cases of facial defects, recording serial changes in multistage surgery, pre-operative and post-operative comparison as in rhinoplasty, ear reconstruction, hand etc; for comparing results before and after treatment in keloid and hypertrophic scars, fabrication of implants and preparation of prosthesis. In spite of newer modalities like 3-D imaging and stereolithography, the usefulness of this old technique in certain interesting cases can not be denied.
Hopmans, Cornelis J; den Hoed, Pieter T; van der Laan, Lijckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; Timman, Reinier; Wijnhoven, Bas P L; IJzermans, Jan N M
In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.
Escobar, Mauricio A; Hartin, Charles W; McCullough, Laurence B
The authors examine the ethical implications of teaching general surgery residents laparoscopic pyloromyotomy. Using the authors' previously presented ethical framework, and examining survey data of pediatric surgeons in the United States and Canada, a rigorous ethical argument is constructed to examine the question: should general surgery residents be taught laparoscopic pyloromyotomies? A survey was constructed that contained 24 multiple-choice questions. The survey included questions pertaining to surgeon demographics, if pyloromyotomy was taught to general surgery and pediatric surgery residents, and management of complications encountered during pyloromyotomy. A total of 889 members of the American Pediatric Surgical Association and Canadian Association of Paediatric Surgeons were asked to participate. The response rate was 45% (401/889). The data were analyzed within the ethical model to address the question of whether general surgery residents should be taught laparoscopic pyloromyotomies. From an ethical perspective, appealing to the ethical model of a physician as a fiduciary, the answer is no. We previously proposed an ethical model based on 2 fundamental ethical principles: the ethical concept of the physician as a fiduciary and the contractarian model of ethics. The fiduciary physician practices medicine competently with the patient’s best interests in mind. The role of a fiduciary professional imposes ethical standards on all physicians, at the core of which is the virtue of integrity, which requires the physician to practice medicine to standards of intellectual and moral excellence. The American College of Surgeons recognizes the need for current and future surgeons to understand professionalism, which is one of the 6 core competencies specified by the Accreditation Council for Graduate Medical Education. Contracts are models of negotiation and ethically permissible compromise. Negotiated assent or consent is the core concept of contractarian
Mohan, Arvind; Lahiri, Anindya
Herbal medicine is a multibillion-pound industry, and surveys suggest that ~10% of the UK population uses herbal supplements concurrently with prescription medications. Patients and health care practitioners are often unaware of the adverse side effects of herbal medicines. In addition, because many of these herbal supplements are available over the counter, many patients do not disclose these when listing medications to health care providers. A 39-year-old nurse underwent an abdominoplasty with rectus sheath plication after weight loss surgery. Postoperatively, she experienced persistent drain output, and after discharge, a seroma developed requiring repeated drainage in the clinic. After scar revision 10 months later, the woman bled postoperatively, requiring suturing. Again, a seroma developed, requiring repeated drainage. It was discovered that the patient had been taking a herbal menopause supplement containing ingredients known to have anticoagulant effects. Complementary medicine is rarely taught in UK medical schools and generally not practiced in UK hospitals. Many supplements are known to have anticoagulant, cardiovascular, and sedative effects. Worryingly, questions about herbal medicines are not routinely asked in clinics, and patients do not often volunteer such information. With the number and awareness of complementary medications increasing, their usage among the population is likely to increase. The authors recommend specific questioning about the use of complementary medications and consideration of ceasing such medications before surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Li, Yanqi; Yang, Xin; Li, Dong
Three-dimensional (3D) surface imaging system has gained popularity worldwide in clinical application. Unlike computed tomography and magnetic resonance imaging, it has the ability to capture 3D images with both shape and texture information. This feature has made it quite useful for plastic surgeons. This review article is mainly focusing on demonstrating the current status and analyzing the future of the application of 3D surface imaging systems in plastic and reconstructive surgery.Currently, 3D surface imaging system is mainly used in plastic and reconstructive surgery to help improve the reliability of surgical planning and assessing surgical outcome objectively. There have already been reports of its using on plastic and reconstructive surgery from head to toe. Studies on facial aging process, online applications development, and so on, have also been done through the use of 3D surface imaging system.Because different types of 3D surface imaging devices have their own advantages and disadvantages, a basic knowledge of their features is required and careful thought should be taken to choose the one that best fits a surgeon's demand.In the future, by integrating with other imaging tools and the 3D printing technology, 3D surface imaging system will play an important role in individualized surgical planning, implants production, meticulous surgical simulation, operative techniques training, and patient education.
Luce, Edward A; Jackman, Carye A
Recent articles in the scientific literature have expressed concerns about financial conflicts of interest in the profession of medicine in general and the specialty of plastic surgery in particular. Disclosure of financial ties to industry has been regarded as an address of a possible bias. The policies of medical journals places responsibility on authors for self-reporting of financial conflicts of interest, yet underreporting of conflicts of interest has occurred. The investigative hypothesis was that authors in the plastic surgery literature, in particular, Plastic and Reconstructive Surgery, underreported financial conflicts of interest. A review of articles published in Plastic and Reconstructive Surgery from July of 2015 through April of 2016 for author disclosures was accomplished. The disclosure statements were compared to the information available in the Open Payments database for 2015. The lack of disclosure on the part of an author, when present, was individually examined for relevance of the corporate conflicts of interest to the subject matter of the involved article. A total of 302 articles authored by 1262 individuals were reviewed. One hundred thirty-nine (45.5 percent) had neither a disclosed nor an actual conflict of interest. In 61 articles (20.2 percent), one or more authors disclosed; 105 articles (34.8 percent) did not provide disclosure of a financial conflict of interest. In assessment of relevance, 10 undisclosed conflicts of interest (9.5 percent) were determined relevant, and one-third of that total were non-plastic surgeons. Nondisclosure of financial conflicts of interest is common, but only a small minority pose a potential for harm from bias.
Mullen, Matthew G; Salerno, Elise P; Michaels, Alex D; Hedrick, Traci L; Sohn, Min-Woong; Smith, Philip W; Schirmer, Bruce D; Friel, Charles M
Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p surgeries, with appendectomy decreasing by 9.4%/y (p surgery resident education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Lebares, Carter C; Guvva, Ekaterina V; Ascher, Nancy L; O'Sullivan, Patricia S; Harris, Hobart W; Epel, Elissa S
Burnout among physicians affects mental health, performance, and patient outcomes. Surgery residency is a high-risk time for burnout. We examined burnout and the psychological characteristics that can contribute to burnout vulnerability and resilience in a group of surgical trainees. An online survey was distributed in September 2016 to all ACGME-accredited general surgery programs. Burnout was assessed with an abbreviated Maslach Burnout Inventory. Stress, anxiety, depression, resilience, mindfulness, and alcohol use were assessed and analyzed for prevalence. Odds ratios (ORs) were used to determine the magnitude of presumed risk and resilience factors. Among 566 surgical residents who participated in the survey, prevalence of burnout was 69%, equally driven by emotional exhaustion and depersonalization. Perceived stress and distress symptoms (depression, suicidal ideation, and anxiety) were notably high across training levels, but improved during lab years. Higher burnout was associated with high stress (OR 7.8; p burnout (OR 0.24; p stress (OR 0.15; p burnout, severe stress, and distress symptoms are experienced throughout general surgery training, with some improvement during lab years. In this cross-sectional study, trainees with burnout and high stress were at increased risk for depression and suicidal ideation. Higher dispositional mindfulness was associated with lower risk of burnout, severe stress, and distress symptoms, supporting the potential of mindfulness training to promote resilience during surgery residency. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Dietl, Charles A; Russell, John C
The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Fleischer, Adam E.; Yorath, Martin C.; Joseph, Robert; Baron, Adam; Nordquist, Thomas; Moore, Braden; Robinson, Richmond; Reilly, Charles
Background Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction, and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences mid-term outcomes in hallux valgus surgery. Methods Consecutive adults who underwent isolated hallux valgus surgery via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using simple, multiple and logistic regression analyses. Results A total of 102 adult patients (n=102 feet) agreed to participate with a mean age of 46.8 (SD 13.1 years, range 18-71) and average length of follow-up 6.2 years (SD 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% CI 0.98-1.01], p = 0.827) or multivariate analyses (odds ratio 1.00 [95% CI 0.97-1.02], p = 0.907). Conclusions We conclude that podiatry resident level of experience in hallux valgus surgery does not contribute appreciably to postoperative clinical outcomes. PMID:24726058
Momeni, Arash; Kim, Rebecca Y.; Wan, Derrick C.; Izadpanah, Ali; Lee, Gordon K.
Background. Three educational models for plastic surgery training exist in the United States, the integrated, combined, and independent model. The present study is a comparative analysis of aesthetic surgery training, to assess whether one model is particularly suitable to provide for high-quality training in aesthetic surgery. Methods. An 18-item online survey was developed to assess residents’ perceptions regarding the quality of training in aesthetic surgery in the US. The survey had three...
Joseph, Andrew W; Ishii, Lisa; Joseph, Shannon S; Smith, Jane I; Su, Peiyi; Bater, Kristin; Byrne, Patrick; Boahene, Kofi; Papel, Ira; Kontis, Theda; Douglas, Raymond; Nelson, Christine C; Ishii, Masaru
Body dysmorphic disorder (BDD) is a relative contraindication for facial plastic surgery, but formal screening is not common in practice. The prevalence of BDD in patients seeking facial plastic surgery is not well documented. To establish the prevalence of BDD across facial plastic and oculoplastic surgery practice settings, and estimate the ability of surgeons to screen for BDD. This multicenter prospective study recruited a cohort of 597 patients who presented to academic and private facial plastic and oculoplastic surgery practices from March 2015 to February 2016. All patients were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ). After each clinical encounter, surgeons independently evaluated the likelihood that a participating patient had BDD. Validated instruments were used to assess satisfaction with facial appearance including the FACE-Q, Blepharoplasty Outcomes Evaluation (BOE), Facelift Outcomes Evaluation (FOE), Rhinoplasty Outcomes Evaluation (ROE), and Skin Rejuvenation Outcomes Evaluation (SROE). Across participating practices (9 surgeons, 3 sites), a total of 597 patients were screened for BDD: 342 patients from site 1 (mean [SD] age, 44.2 [16.5] years); 158 patients, site 2 (mean [SD] age, 46.0 [16.2] years), site 3, 97 patients (mean [SD] age, 56.3 [15.5] years). Overall, 58 patients [9.7%] screened positive for BDD by the BDDQ instrument, while only 16 of 402 patients [4.0%] were clinically suspected of BDD by surgeons. A higher percentage of patients presenting for cosmetic surgery (37 of 283 patients [13.1%]) compared with those presenting for reconstructive surgery (21 of 314 patients [6.7%]) screened positive on the BDDQ (odds ratio, 2.10; 95% CI, 1.20-3.68; P = .01). Surgeons were only able to correctly identify 2 of 43 patients (4.7%) who screened positive for BDD on the BDDQ, and the positive likelihood ratio was only 1.19 (95% CI, 0.28-5.07). Patients screening positive for BDD by the BDDQ had lower
Rahmani, G; Joyce, C W; Jones, D M; Kelly, J L; Hussey, A J; Regan, P J
The Republic of Ireland has always had an influence on medicine and has produced many renowned doctors who have helped shape its history. Furthermore, many clinical articles that have originated from Ireland have changed clinical practice throughout the world. The Irish have also had an impact on the plastic surgery literature yet it has never specifically been analyzed before. The purpose of this study was to identify and analyze all papers that have originated from the plastic surgery units in the Republic of Ireland in the medical literature over the past 21 years. Twenty-four well-known plastic surgery, hand surgery and burns journals were selected for this study. By utilizing Scopus, the largest abstract and citation database of peer-reviewed literature, we analyzed each of our chosen 24 journals looking for Irish publications. Each paper was examined for article type, authorship, year of publication, institution of origin and level of evidence. Papers from the Republic of Ireland were published in 20 of the 24 journals over the past 21 years. A total of 245 articles from Ireland were published in the plastic surgery, hand surgery and burns literature over the 21-year period. Of these, 111 were original articles and 73 were case reports. The institution that published the most papers over the past 21 years was University Hospital Galway (66 publications) followed by Cork University Hospital with 54 papers. The journal with the most Irish articles was the Journal of Plastic, Reconstructive and Aesthetic Surgery with 56 papers. 2014 was the year with the most publications (28 papers). Authorship numbers also increased over time as the average number of authors in 1994 was 3.5, whereas it was 5.54 in 2014. The number of publications per year continues to increase along with authorship numbers. This mirrors the trend in other specialties. Publications are now no longer required for selection on to a higher surgical training scheme. There is now a fear that the
Sieffert, Michelle R; Fox, Justin P; Abbott, Lindsay E; Johnson, R Michael
Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery. From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables. The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery. Risk, II.
Clarke, A; Lester, K J; Withey, S J; Butler, P E M
Appearance related distress in both clinical and general populations is associated with the increasing identification of surgery as a solution, leading to referrals for cosmetic surgery and pressure on NHS resources. Cosmetic surgery guidelines are designed to control this growing demand, but lack a sound evidence base. Where exceptions are provided on the basis of psychological need, this may recruit patients inappropriately into a surgical pathway, and creates a demand for psychological assessment which transfers the resource problem from one service to another. The model described below evaluates the impact of a designated psychology service to a plastic surgery unit. Developing an operational framework for delivering cosmetic guidelines, which assesses patients using clearly defined and measurable outcomes, has significantly reduced numbers of patients proceeding to the NHS waiting list and provided a systematic audit process. The associated cost savings have provided a way of funding a psychologist within the plastic surgery service so that psychological assessment becomes routine, alternative methods of treatment are easily available and all patients have access to psychological input as part of the routine standard of care.
Marinescu, S; Florescu, IP; Jecan, C
Pressure sores–a constant problem for plegic patients and a permanent challenge for plastic surgery Pressure sores can be defined as lesions caused by unrelieved pressure resulting in damage of the underlying tissue. They represent a common problem in the pathology of plegic patients and, plastic surgery has a significant role in their treatment. Pressure sores occur over bony prominences and so, they are most commonly seen at the sacrum and trochanters in paralyzed patients and at ischium for the patients who sit in a wheelchair for a long time. For these patients, surgical treatment is very important because on one hand, it stops the loss of nutrients and proteins at the site of the pressure sore, and on the other hand, it permits the initiation of neuromuscular recuperation treatment much faster. PMID:20968200
Almeland, Stian K; Lindford, Andrew; Berg, Jais Oliver
.00 on a 1-4 Likert scale. Final agreement in the third round resulted in a list of 68 competences with agreement above 80% (31 skills and 37 knowledge items). CONCLUSIONS: This study proposes the first scientifically developed undergraduate core curriculum in plastic surgery. It comprises of a consensus......, there appears to be a need to define the core competences that are to be taught. The aim of this study was to establish a Scandinavian core undergraduate curriculum of competences in plastic surgery, using scientific methods. METHODS: The Delphi technique for group consensus was employed. An expert panel...... of anonymous questionnaires; a final core curriculum competency list was agreed upon based on a consensus agreement level of 80%. RESULTS: Two hundred and ninety-five competences were suggested in the first round. In the second round, 76 competences (33 skills and 43 knowledge items) received a score ≥3...
Full Text Available Facial recognition system is fundamental a computer application for the automatic identification of a person through a digitized image or a video source. The major cause for the overall poor performance is related to the transformations in appearance of the user based on the aspects akin to ageing, beard growth, sun-tan etc. In order to overcome the above drawback, Self-update process has been developed in which, the system learns the biometric attributes of the user every time the user interacts with the system and the information gets updated automatically. The procedures of Plastic surgery yield a skilled and endurable means of enhancing the facial appearance by means of correcting the anomalies in the feature and then treating the facial skin with the aim of getting a youthful look. When plastic surgery is performed on an individual, the features of the face undergo reconstruction either locally or globally. But, the changes which are introduced new by plastic surgery remain hard to get modeled by the available face recognition systems and they deteriorate the performances of the face recognition algorithm. Hence the Facial plastic surgery produces changes in the facial features to larger extent and thereby creates a significant challenge to the face recognition system. This work introduces a fresh Multimodal Biometric approach making use of novel approaches to boost the rate of recognition and security. The proposed method consists of various processes like Face segmentation using Active Appearance Model (AAM, Face Normalization using Kernel Density Estimate/ Point Distribution Model (KDE-PDM, Feature extraction using Local Gabor XOR Patterns (LGXP and Classification using Independent Component Analysis (ICA. Efficient techniques have been used in each phase of the FRAS in order to obtain improved results.
Denadai, Rafael; Pinho, André Silveira; Samartine, Hugo; Denadai, Rodrigo; Raposo-Amaral, Cassio Eduardo
to assess the conversion rate of Plastic Surgery meeting abstract presentations to full manuscript publications and examine factors associated with this conversion. we assessed the abstracts presented at the 47th and 48th Brazilian Congresses of Plastic Surgery by cross-referencing with multiple databases. We analyzed the Abstracts' characteristics associated with full manuscript publications. of the 200 abstracts presented, 50 abstracts were subsequently published in full, giving the conference a conversion rate of 25%. The mean time to publish was 15.00±13.75 months. In total, there were 4.93±1.63 authors per abstract and 67.8±163 subjects per abstract; 43.5% of the abstracts were of retrospective studies; 69% comprised the plastic surgery topics head and neck, and chest and trunk, and 88.5% had no statistical analysis. Overall, 80% of the manuscripts were published in plastic surgery journals, 76% had no impact factor and 52% had no citations. Bivariate and multivariate analyses revealed the presence of statistical analysis to be the most significant (previstas de Cirurgia Plástica, 76% não exibiam fator de impacto e 52% não possuíam citações. As análises bivariada e multivariada revelaram que a presença de análise estatística foi o fator preditivo significativo (p<0,05) para a conversão de resumos em manuscritos completos. a taxa de conversão deste estudo bibliométrico foi inferior à tendência de conversão descrita em congressos internacionais de Cirurgia Plástica, e a presença de análise estatística foi um determinante para o sucesso de conversão.
Ly, Catherine L; Chun, Maria B J
Although cultural competency is not a new concept in healthcare, it has only recently been formally embraced as important in the field of surgery. All physicians, including and especially surgeons, must acknowledge the potential influence of culture in order to provide effective and equitable care for patients of all backgrounds. The Accreditation Council for Graduate Medical Education (ACGME) recognizes cultural competency as a component of "patient care," "professionalism," and "interpersonal and communication skills." A systematic literature search was conducted using the MEDLINE, EBSCOhost, Web of Science, and Google Scholar databases. All publications focusing on surgical residents and the assessment of patient care, professionalism, interpersonal and communication skills, or specifically cultural competency and/or were considered. This initial search resulted in 12 articles. To further refine the review, publications discussing curricula in residencies other than surgery, the assessment of technical, or clinical skills and/or without any explicit focus on cultural competency were excluded. Based on the specified inclusion and exclusion criteria, 5 articles were selected. These studies utilized various methods to improve surgical residents' cultural competency, including lectures, Objective Structural Clinical Examinations (OSCE), and written exercises and evaluations. A number of surgical residency programs have made promising strides in training culturally competent surgeons. Ultimately, in order to maximize our collective efforts to improve the quality of health care, the development of cultural competency curricula must be made a priority and such training should be a requirement for all trainees in surgical residency programs. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Fonseca, Annabelle L; Reddy, Vikram; Longo, Walter E; Gusberg, Richard J
General surgical training has changed significantly over the last decade with work hour restrictions, increasing subspecialization, the expanding use of minimally invasive techniques, and nonoperative management for solid organ trauma. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing open surgical operations and to determine factors associated with increased confidence. A survey was developed and sent to general surgery residents nationally. We queried them regarding demographics and program characteristics, asked them to rate their confidence (rated 1-5 on a Likert scale) in performing open surgical procedures and compared those who indicated confidence with those who did not. We received 653 responses from the fifth year (postgraduate year 5) surgical residents: 69% male, 68% from university programs, and 51% from programs affiliated with a Veterans Affairs hospital; 22% from small programs, 34% from medium programs, and 44% from large programs. Anticipated postresidency operative confidence was 72%. More than 25% of residents reported a lack of confidence in performing eight of the 13 operations they were queried about. Training at a university program, a large program, dedicated research years, future fellowship plans, and training at a program that performed a large percentage of operations laparoscopically was associated with decreased confidence in performing a number of open surgical procedures. Increased surgical volume was associated with increased operative confidence. Confidence in performing open surgery also varied regionally. Graduating surgical residents indicated a significant lack of confidence in performing a variety of open surgical procedures. This decreased confidence was associated with age, operative volume as well as type, and location of training program. Analyzing and addressing this confidence deficit merits further study. Copyright © 2014 Elsevier Inc. All
Burd, Andrew; Chiu, Tor; McNaught, Carmel
As the undergraduate medical curriculum becomes increasingly crowded the competition for time inevitably increases and surgical specialties have decreasing representation. Plastic surgery is regarded with some confusion in terms of its relevance to the generic doctor. Plastic surgeons have no doubt about the relevance of the specialty to undergraduates. Others see this as a very technical specialty dealing with complex reconstructions and surgical interventions or, as a rather indulgent specialty focusing mainly on glamour and cosmesis. This study focuses on students' perceptions of an undergraduate teaching program in plastic surgery. The reality is that highly pressured undergraduates do not have the luxury of time to consider the finer details of the specialties to which they are exposed. Their priority is to pass their examinations and, having addressed that concern, further information becomes an acceptable bonus. The conclusion is that if plastic surgeons are going to gain greater involvement in the undergraduate curriculum they must start with involvement in examinations and assessments. The students will then ensure that adequate and appropriate teaching time is allocated.
Summary: This report examines the meaning of validity and reliability and the role of psychometrics in plastic surgery. Study titles increasingly include the word “valid” to support the authors’ claims. Studies by other investigators may be labeled “not validated.” Validity simply refers to the ability of a device to measure what it intends to measure. Validity is not an intrinsic test property. It is a relative term most credibly assigned by the independent user. Similarly, the word “reliable” is subject to interpretation. In psychometrics, its meaning is synonymous with “reproducible.” The definitions of valid and reliable are analogous to accuracy and precision. Reliability (both the reliability of the data and the consistency of measurements) is a prerequisite for validity. Outcome measures in plastic surgery are intended to be surveys, not tests. The role of psychometric modeling in plastic surgery is unclear, and this discipline introduces difficult jargon that can discourage investigators. Standard statistical tests suffice. The unambiguous term “reproducible” is preferred when discussing data consistency. Study design and methodology are essential considerations when assessing a study’s validity. PMID:25289354
Eric Swanson, MD
Full Text Available Summary: This report examines the meaning of validity and reliability and the role of psychometrics in plastic surgery. Study titles increasingly include the word “valid” to support the authors’ claims. Studies by other investigators may be labeled “not validated.” Validity simply refers to the ability of a device to measure what it intends to measure. Validity is not an intrinsic test property. It is a relative term most credibly assigned by the independent user. Similarly, the word “reliable” is subject to interpretation. In psychometrics, its meaning is synonymous with “reproducible.” The definitions of valid and reliable are analogous to accuracy and precision. Reliability (both the reliability of the data and the consistency of measurements is a prerequisite for validity. Outcome measures in plastic surgery are intended to be surveys, not tests. The role of psychometric modeling in plastic surgery is unclear, and this discipline introduces difficult jargon that can discourage investigators. Standard statistical tests suffice. The unambiguous term “reproducible” is preferred when discussing data consistency. Study design and methodology are essential considerations when assessing a study’s validity.
Kanevsky, Jonathan; Corban, Jason; Gaster, Richard; Kanevsky, Ari; Lin, Samuel; Gilardino, Mirko
Medical decision-making is increasingly based on quantifiable data. From the moment patients come into contact with the health care system, their entire medical history is recorded electronically. Whether a patient is in the operating room or on the hospital ward, technological advancement has facilitated the expedient and reliable measurement of clinically relevant health metrics, all in an effort to guide care and ensure the best possible clinical outcomes. However, as the volume and complexity of biomedical data grow, it becomes challenging to effectively process "big data" using conventional techniques. Physicians and scientists must be prepared to look beyond classic methods of data processing to extract clinically relevant information. The purpose of this article is to introduce the modern plastic surgeon to machine learning and computational interpretation of large data sets. What is machine learning? Machine learning, a subfield of artificial intelligence, can address clinically relevant problems in several domains of plastic surgery, including burn surgery; microsurgery; and craniofacial, peripheral nerve, and aesthetic surgery. This article provides a brief introduction to current research and suggests future projects that will allow plastic surgeons to explore this new frontier of surgical science.
Green, Courtney A; Chern, Hueylan; O'Sullivan, Patricia S
Current robot surgery curricula developed by industry were designed for expert surgeons. We sought to identify the robotic curricula that currently exist in general surgery residencies and describe their components. We identified 12 residency programs with robotic curricula. Using a structured coding form to identify themes including sequence, duration, emphasis and assessment, we generated a descriptive summary. Curricula followed a similar sequence: learners started with online modules and simulation exercises, followed by bedside experience during R2-R3 training years, and then operative opportunities on the console in the final years of training. Consistent portions of the curricula reflect a device-dependent training paradigm; they defined the sequence of instruction. Most curricula lacked specifics on duration and content of training activities. None clearly described cognitive or psychomotor skills needed by residents and none required a proficiency assessment before graduation. Resident-specific robotic curricula remain grounded in initial industrial efforts to train experienced surgeons, are non-specific regarding the type and nature of hands on experience, and do not include discussion of operative technique and surgical concepts. Copyright © 2017 Elsevier Inc. All rights reserved.
Johnson, Joey P; Savage, Kevin; Gil, Joseph A; Eberson, Craig P; Mulcahey, Mary K
In 2003 and again in 2011, the Accreditation Council for Graduate Medical Education (ACGME) mandated increasingly stringent resident duty hour restrictions. With less time required at the hospital, residents theoretically have more time for other academic activities, such as research. Our study seeks to examine whether the number of research publications by orthopaedic residents increased following implementation of the 2011 ACGME duty hour restrictions. Pubmed was queried using publicly available alumni lists from programs across the United States. The years 2008 to 2011 were included to assess pre-2011 productivity. The years 2012 to 2015 were included in the post 2011 group. Paired t tests were used to assess differences between groups. Statistical significance was set to p care in any meaningful way. In our study, there was a statistically significant increase in publications after 2011; however, the number of publications between NIH funded and non-NIH funded programs did not differ. Our study is the first to demonstrate that with increasing duty hour restrictions, orthopaedic surgery residents may be using more of their free time to conduct research. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Smeds, Matthew R; Thrush, Carol R; McDaniel, Faith K; Gill, Roop; Kimbrough, Mary K; Shames, Brian D; Sussman, Jeffrey J; Galante, Joseph M; Wittgen, Catherine M; Ansari, Parswa; Allen, Steven R; Nussbaum, Michael S; Hess, Donald T; Knight, David C; Bentley, Frederick R
The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate the knowledge and readiness of trainees to sit for the general surgery qualifying examination. It is often used as a tool for resident promotion and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however, its presence and effects on surgical trainees' performance are not well studied. We sought to understand factors including burnout and study habits that may contribute to performance on the ABSITE examination. Anonymous electronic surveys were distributed to all residents at 10 surgical residency programs (n = 326). Questions included demographics as well as study habits, career interests, residency characteristics, and burnout scores using the Oldenburg Burnout Inventory, which assesses burnout because of both exhaustion and disengagement. These surveys were then linked to the individual's 2016 ABSITE and United States Medical Licensing Examination (USMLE) step 1 and 2 scores provided by the programs to determine factors associated with successful ABSITE performance. In total, 48% (n = 157) of the residents completed the survey. Of those completing the survey, 48 (31%) scored in the highest ABSITE quartile (≥75th percentile) and 109 (69%) scored less than the 75th percentile. In univariate analyses, those in the highest ABSITE quartile had significantly higher USMLE step 1 and step 2 scores (P shop compared with at home; P < 0.04), and used active rather than passive study strategies (P < 0.04). Gender, marital status, having children, and debt burden had no correlation with examination success. Backward stepwise multiple regression analysis identified the following independent predictors of ABSITE scores: study location (P < 0.0001), frequency of reading (P = 0.0001), Oldenburg Burnout Inventory exhaustion (P = 0.02), and USMLE step 1 and 2 scores (P = 0.007 and 0
Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J
Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All
Azer, Nader; Shi, Xinzhe; de Gara, Chris; Karmali, Shahzeer; Birch, Daniel W
The increased use of information technology supports a resident- centred educational approach that promotes autonomy, flexibility and time management and helps residents to assess their competence, promoting self-awareness. We established a web-based e-learning tool to introduce general surgery residents to bariatric surgery and evaluate them to determine the most appropriate implementation strategy for Internet-based interactive modules (iBIM) in surgical teaching. Usernames and passwords were assigned to general surgery residents at the University of Alberta. They were directed to the Obesity101 website and prompted to complete a multiple-choice precourse test. Afterwards, they were able to access the interactive modules. Residents could review the course material as often as they wanted before completing a multiple-choice postcourse test and exit survey. We used paired t tests to assess the difference between pre- and postcourse scores. Out of 34 residents who agreed to participate in the project, 12 completed the project (35.3%). For these 12 residents, the precourse mean score was 50 ± 17.3 and the postcourse mean score was 67 ± 14 (p = 0.020). Most residents who participated in this study recommended using the iBIMs as a study tool for bariatric surgery. Course evaluation scores suggest this novel approach was successful in transferring knowledge to surgical trainees. Further development of this tool and assessment of implementation strategies will determine how iBIM in bariatric surgery may be integrated into the curriculum.
Viola, Kate V; Bucholz, Emily; Yeo, Heather; Piper, Crystal L; Piper, Crystal; Bell, Richard H; Sosa, Julie Ann
To determine how marriage, children, and gender influence US categorical general surgery residents' perceptions of their profession and motivations for specialty training. Cross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination. Two hundred forty-eight US general surgery residency programs. All US categorical general surgery residents. We evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed. Perceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle. The survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.
Hauck, Randy M; Nogan, Stephen
The indications for prophylactic antibiotics in plastic surgery remain controversial. No recent survey has been reported on the use of prophylactic antibiotics by plastic surgeons in clinical practice. This survey was designed to assess the current use of prophylactic antibiotics by plastic surgeons and to compare trends with previous studies. All members of the American Society of Plastic Surgeons with an e-mail address on the Society's website were contacted via an e-mail and sent a link to a SurveyMonkey questionnaire. To survey only in those subspecialty areas that they practice in, surgeons were queried only on the procedures that they perform. Within each section, a list of common representative procedures was included, with questions about the use of antibiotic prophylaxis. A total of 3824 American Society of Plastic Surgeons members were contacted. Of the 3613, 910 with working e-mail addresses responded to the survey for a response rate of 25%. And 833 or 91.5% completed the survey. Survey data cover the percentage of surgeons reporting their use of antibiotics in procedures that they currently perform. The percentage of plastic surgeons who use prophylactic antibiotics in almost all procedures studied has increased significantly when compared with earlier studies. The use of prophylactic antibiotics by plastic surgeons has increased considerably since the prior studies by Krizek et al (Plast Reconstr Surg. 1975;55:21-32 and 1985;76:953-963). Some of these uses are appropriate because of the use in procedures involving implants and longer operations. The elevated rates for clean procedures are not part of the evidence-based practice.
Raper, Steven E; Gupta, Meera; Okusanya, Olugbenga; Morris, Jon B
To improve physician/patient communication and familiarize surgeons with contemporary skills for and metrics assessing communication, courses were developed to provide academic general surgery residents and faculty with a toolkit of information, behaviors, and specific techniques. If academic faculty are expected to mentor residents in communication and residents are expected to learn good communication skills, then both should have the necessary education to accomplish such a goal. Didactic lectures introduced current concepts of physician-patient communication including information on better patient care, fewer malpractice suits, and the move toward transparency of communication metrics. Next, course participants viewed and critiqued "Surgi-Drama" videos, with actors simulating "before" and "after" physician-patient communication scenarios. Finally, participants were provided with a "toolkit" of techniques for improving physician-patient communication including "2-3-4"-a semiscripted short communication tool residents and other physicians can use in patient encounters-and a number of other acronymic approaches. Each participant was asked to complete an anonymous evaluation to assess course content satisfaction. Overall, 86% of residents participated (68/79), with a 52% response rate (35/68) for the evaluation tool. Overall, 88% of faculty participated (84/96), with an 84% response rate (71/84). Residents voiced satisfaction with all domains. For faculty, satisfaction was quantitatively confirmed (Likert score 4 or 5) in 4 of 7 domains, with the highest satisfaction in "communication of goals" and "understanding of the HCAHPS metric." The percentage of "top box" Doctor Communication Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and national percentile ranking showed a sustained increase more than 1 and 2 years from the dates of the courses. The assessment of communication skills is increasing in importance in the practice of
Kihara, Tomohiko; Tanaka, Yuuko; Furuhata, Kentaro
The use of three-dimensional replicas created using laserlithography has recently become popular for surgical planning and intraoperative navigation in plastic surgery and oral maxillofacial surgery. In this study, we investigated many clinical applications that we have been involved in regarding the production of three-dimensional replicas. We have also analyzed the features, application classes, and advantages of this method. As a result, clinical applications are categorized into three classes, which are 'three-dimensional shape recognition', 'simulated surgery', and 'template'. The distinct features of three-dimensional replicas are 'direct recognition', 'fast manipulation', and 'free availability'. Meeting the requirements of surgical planning and intraoperative navigation, they have produced satisfactory results in clinical applications. (author)
Carla Fernanda Voese
Full Text Available Objective: to identify reasons which lead healthy subjects to search, for the first time, surgical methods for corporal modifications. Methods: it is a descriptive, exploratory and qualitative study. Data were collected through semi-structured interviews which were recorded. The interviews were made with eight women and resulted into four analytic categories. Results: the reasons which took healthy subjects to face surgical risks are regarding the improvement of the satisfaction with their own corporal image aiming at reaching a higher social insertion. It was observed that dissatisfaction concerning physical appearance was generated by inherited characteristics or by marks left after pregnancy. Financial cost, fear and family support, can make the decision to undergo the surgery difficult. Conclusion: the plastic surgery can promote the regain of self-esteem in the subject who makes the surgery.
Background Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. Methods During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. Results I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. Conclusion On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and “other,” which comprised mostly hand surgery. PMID:19503663
Fleischer, Adam E; Yorath, Martin C; Joseph, Robert M; Baron, Adam; Nordquist, Thomas; Moore, Braden J; Robinson, Richmond C O; Reilly, Charles H
Despite modern advancements in transosseous fixation and operative technique, hallux valgus (i.e., bunion) surgery is still associated with a higher than usual amount of patient dissatisfaction and is generally recognized as a complex and nuanced procedure requiring precise osseous and capsulotendon balancing. It stands to reason then that familiarity and skill level of trainee surgeons might impact surgical outcomes in this surgery. The aim of this study was to determine whether podiatry resident experience level influences midterm outcomes in hallux valgus surgery (HVS). Consecutive adults who underwent isolated HVS via distal metatarsal osteotomy at a single US metropolitan teaching hospital from January 2004 to January 2009 were contacted and asked to complete a validated outcome measure of foot health (Manchester-Oxford Foot Questionnaire) regarding their operated foot. Resident experience level was quantified using the surgical logs for the primary resident of record at the time of each case. Associations were assessed using linear and logistic regression analyses. A total of 102 adult patients (n = 102 feet) agreed to participate with a mean age of 46.8 years (standard deviation 13.1, range 18-71) and average length of follow-up 6.2 y (standard deviation 1.4, range 3.6-8.6). Level of trainee experience was not associated with postoperative outcomes in either the univariate (odds ratio 0.99 [95% confidence interval, 0.98-1.01], P = 0.827) or multivariate analyses (odds ratio 1.00 [95% confidence interval, 0.97-1.02], P = 0.907). We conclude that podiatry resident level of experience in HVS does not contribute appreciably to postoperative clinical outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.
Bucknor, Alexandra; Kamali, Parisa; Phillips, Nicole; Mathijssen, Irene; Rakhorst, Hinne; Lin, Samuel J; Furnas, Heather
Previous research has highlighted the gender-based disparities present throughout the field of surgery. This study aims to evaluate the breadth of the issues facing women in plastic surgery, worldwide. A systematic scoping review was undertaken from October of 2016 to January of 2017, with no restrictions on date or language. A narrative synthesis of the literature according to themed issues was developed, together with a summary of relevant numeric data. From the 2247 articles identified, 55 articles were included in the analysis. The majority of articles were published from the United States. Eight themes were identified, as follows: (1) workforce figures; (2) gender bias and discrimination; (3) leadership and academia; (4) mentorship and role models; (5) pregnancy, parenting, and childcare; (6) relationships, work-life balance, and professional satisfaction; (7) patient/public preference; and (8) retirement and financial planning. Despite improvement in numbers over time, women plastic surgeons continue to be underrepresented in the United States, Canada, and Europe, with prevalence ranging from 14 to 25.7 percent. Academic plastic surgeons are less frequently female than male, and women academic plastic surgeons score less favorably when outcomes of academic success are evaluated. Finally, there has been a shift away from overt discrimination toward a more ingrained, implicit bias, and most published cases of bias and discrimination are in association with pregnancy. The first step toward addressing the issues facing women plastic surgeons is recognition and articulation of the issues. Further research may focus on analyzing geographic variation in the issues and developing appropriate interventions.
Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K
To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Devitt, Katharine S.; Keshet, Itay; Spicer, Jonathan; Imrie, Kevin; Feldman, Liane; Cools-Lartigue, Jonathan; Kayssi, Ahmed; Lipsman, Nir; Elmi, Maryam; Kulkarni, Abhaya V.; Parshuram, Chris; Mainprize, Todd; Warren, Richard J.; Fata, Paola; Gorman, M. Sean; Feinberg, Stan; Rutka, James
Background: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated 80-hour resident duty limits. In 2011 the ACGME mandated 16-hour duty maximums for PGY1 (post graduate year) residents. The stated goals were to improve patient safety, resident well-being, and education. A systematic review and meta-analysis were performed to evaluate the impact of resident duty hours (RDH) on clinical and educational outcomes in surgery. Methods: A systematic review (1980–2013) was executed on CINAHL, Cochrane Database, Embase, Medline, and Scopus. Quality of articles was assessed using the GRADE guidelines. Sixteen-hour shifts and night float systems were analyzed separately. Articles that examined mortality data were combined in a random-effects meta-analysis to evaluate the impact of RDH on patient mortality. Results: A total of 135 articles met the inclusion criteria. Among these, 42% (N = 57) were considered moderate-high quality. There was no overall improvement in patient outcomes as a result of RDH; however, some studies suggest increased complication rates in high-acuity patients. There was no improvement in education related to RDH restrictions, and performance on certification examinations has declined in some specialties. Survey studies revealed a perception of worsened education and patient safety. There were improvements in resident wellness after the 80-hour workweek, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented. Conclusions: Recent RDH changes are not consistently associated with improvements in resident well-being, and have negative impacts on patient outcomes and performance on certification examinations. Greater flexibility to accommodate resident training needs is required. Further erosion of training time should be considered with great caution. PMID:24662409
mainly volumetric reduction to significant emphasis on both ... Surgical landmarks that ensured reproducible aesthetic outcomes were described by Penn (1955) and Wise (1956). ... gigantomastia in 1561 and later on Briton William Durston.
occurs in lower limb injuries, makes the risk of failure very high.3–5 Limb .... prolonged strike, which meant that most of the hospital staff ... limitation to the knee. He was .... of soft tissue defects of the heel with local fasciocutaneous flaps.
fixation of fractures, wound debridement and reconstruction of soft tissue ... Soft tissue coverage of lower limb wounds may include one or the ... The recovery is lengthy, and the outcome dependent on the initial injury, the surgical procedures.
The formal training of oral and maxillofacial surgeons in Colombia started in 1958 at Hospital Sanjos6, thanks to the titanic work of Waldemar Wilhelm, a German-born surgeon who settled in BogotA in 1950. Today there are seven institutions in Colombia that offer residency programs in oral and maxillofacial surgery. The aim of this article is to describe the history of the Oral and Maxillofacial Surgery Residency Program at Universidad El Bosque in Bogota.
Xin, Zhao; Tsuda, Toshihide; Doi, Hiroyuki
We evaluated how exposure to airborne volatile organic compounds emitted from a plastic recycling facility affected nearby residents, in a cross-sectional study. Individuals>10 years old were randomly sampled from 50 households at five sites and given questionnaires to complete. We categorized the subjects by distance from the recycling facility and used this as a proxy measure for pollutant exposure. We sought to improve on a preceding study by generating new findings, improving methods for questionnaire distribution and collection, and refining site selection. We calculated the odds of residents living 500 or 900 m away from the facility reporting mucocutaneous and respiratory symptoms using a reference group of residents 2,800 m away. Self-reported nasal congestion (odds ratio=3.0, 95% confidence interval=1.02-8.8), eczema (5.1, 1.1-22.9), and sore throat (3.9, 1.1-14.1) were significantly higher among residents 500 m from the facility. Those 900 m away were also considerably more likely to report experiencing eczema (4.6, 1.4-14.9). Air pollution was found responsible for significantly increased reports of mucocutaneous and respiratory symptoms among nearby residents. Our findings confirm the effects of pollutants emitted from recycling facilities on residents' health and clarify that study design differences did not affect the results.
Kim, Roger H; Kurtzman, Scott H; Collier, Ashley N; Shabahang, Mohsen M
Learning styles theory posits that learners have distinct preferences for how they assimilate new information. The VARK model categorizes learners based on combinations of 4 learning preferences: visual (V), aural (A), read/write (R), and kinesthetic (K). A previous single institution study demonstrated that the VARK preferences of applicants who interview for general surgery residency are different from that of the general population and that learning preferences were associated with performance on standardized tests. This multiinstitutional study was conducted to determine the distribution of VARK preferences among interviewees for general surgery residency and the effect of those preferences on United States Medical Licensing Examination (USMLE) scores. The VARK learning inventory was administered to applicants who interviewed at 3 general surgery programs during the 2014 to 2015 academic year. The distribution of VARK learning preferences among interviewees was compared with that of the general population of VARK respondents. Performance on USMLE Step 1 and Step 2 Clinical Knowledge was analyzed for associations with VARK learning preferences. Chi-square, analysis of variance, and Dunnett's test were used for statistical analysis, with p learning modality. The distribution of VARK preferences of interviewees was different than that of the general population (p = 0.02). By analysis of variance, there were no overall differences in USMLE Step 1 and Step 2 Clinical Knowledge scores by VARK preference (p = 0.06 and 0.21, respectively). However, multiple comparison analysis using Dunnett's test revealed that interviewees with R preferences had significantly higher scores than those with multimodal preferences on USMLE Step 1 (239 vs. 222, p = 0.02). Applicants who interview for general surgery residency have a different pattern of VARK preferences than that of the general population. Interviewees with preferences for read/write learning modalities have higher scores
Nemeth, Zoltan H; Lazar, Eric L; Paglinco, Samantha R; Hicks, Addison S; Lei, Jason; Barratt-Stopper, Patricia A; Rolandelli, Rolando H
With the introduction of stapling devices (SDs), the proportion of hand-sewn (HS) intestinal anastomoses (IAs) has declined. As more IAs are constructed with SDs, there are fewer opportunities for general surgery residents (GSRs) to acquire the skills for HS techniques during their training. Data for this study were extracted from an existing database of all IAs performed at the Department of Surgery of the Morristown Medical Center since 2003. For the purposes of this study, a 5.5-year timeframe was used between July 2006 and 2011, which contained 1659 IA operations on adult patients with resident involvement. GSRs of the 5-year general surgery residency program were grouped by postgraduate year (PGY) for further analysis. The number of all IAs created by each resident during the 5-year training was 67.2 on average. Most of these operations were done in the last 2 years of the training: 45.1% of all IAs in PGY5 and 37.3% of all IAs in PGY4. Of all, 1659 IAs performed in the study period, 711 (42.9% of total) were done laparoscopically and 948 (57.1% of all IAs) were done as open operations. Laparoscopic operations had a proportionally higher rate of SD use when compared to open cases (90.9% vs 82.4%). On average, each resident constructed 9.4 HS IAs (13.98% of all IAs) and 57.8 SD IAs (86.02% of total). Out of all anastomoses, ostomy reversals (30.7%) had the highest percentage of HS suturing followed by right colectomies (27.5%), ileal pouch-anal anastomoses and total colectomies and proctocolectomies (23.3%), small bowel resection (17.0%), and left colectomies (5.5%). Regardless of the location of the operation, stapled and sutured anastomoses had similar outcomes measured by the rate of anastomotic leaks. Residents used significantly more SDs in the creation of anastomoses than HS suturing in the PGY3, PGY4, and PGY5 years. We also documented that attending surgeons who are older more often used HS suturing than their younger colleagues when creating IAs. The
... plastic surgery and in dermatology. 878.4810 Section 878.4810 Food and Drugs FOOD AND DRUG ADMINISTRATION... dermatology. (a) Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a...) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by...
Maruthappu, Mahiben; Duclos, Antoine; Orgill, Dennis; Carty, Matthew J
The assessment of performance in surgery is expanding significantly. Application of relevant frameworks to plastic surgery, however, has been limited. In this article, the authors present two robust graphic tools commonly used in other industries that may serve to monitor individual surgeon operative time while factoring in patient- and surgeon-specific elements. The authors reviewed performance data from all bilateral reduction mammaplasties performed at their institution by eight surgeons between 1995 and 2010. Operative time was used as a proxy for performance. Cumulative sum charts and exponentially weighted moving average charts were generated using a train-test analytic approach, and used to monitor surgical performance. Charts mapped crude, patient case-mix-adjusted, and case-mix and surgical-experience-adjusted performance. Operative time was found to decline from 182 minutes to 118 minutes with surgical experience (p factors is essential for correct interpretation of performance in plastic surgery at the individual surgeon level. Cumulative sum and exponentially weighted moving average charts represent accurate methods of monitoring operative time to control and potentially improve surgeon performance over the course of a career.
Reich, Shani S; Null, Robert C; Timoney, Peter J; Sokol, Jason A
To assess current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) regarding preference in surgical techniques for orbital decompression in Graves' disease. A 10-question web-based, anonymous survey was distributed to oculoplastic surgeons utilizing the ASOPRS listserv. The questions addressed the number of years of experience performing orbital decompression surgery, preferred surgical techniques, and whether orbital decompression was performed in collaboration with an ENT surgeon. Ninety ASOPRS members participated in the study. Most that completed the survey have performed orbital decompression surgery for >15 years. The majority of responders preferred a combined approach of floor and medial wall decompression or balanced lateral and medial wall decompression; only a minority selected a technique limited to 1 wall. Those surgeons who perform fat decompression were more likely to operate in collaboration with ENT. Most surgeons rarely remove the orbital strut, citing risk of worsening diplopia or orbital dystopia except in cases of optic nerve compression or severe proptosis. The most common reason given for performing orbital decompression was exposure keratopathy. The majority of surgeons perform the surgery without ENT involvement, and number of years of experience did not correlate significantly with collaboration with ENT. The majority of surveyed ASOPRS surgeons prefer a combined wall approach over single wall approach to initial orbital decompression. Despite the technological advances made in the field of modern endoscopic surgery, no single approach has been adopted by the ASOPRS community as the gold standard.
Bernard, Johnathan A; Dattilo, Jonathan R; Srikumaran, Uma; Zikria, Bashir A; Jain, Amit; LaPorte, Dawn M
Traditional measures for evaluating resident surgical technical skills (e.g., case logs) assess operative volume but not level of surgical proficiency. Our goal was to compare the reliability and validity of 3 tools for measuring surgical skill among orthopedic residents when performing 3 open surgical approaches to the shoulder. A total of 23 residents at different stages of their surgical training were tested for technical skill pertaining to 3 shoulder surgical approaches using the following measures: Objective Structured Assessment of Technical Skills (OSATS) checklists, the Global Rating Scale (GRS), and a final pass/fail assessment determined by 3 upper extremity surgeons. Adverse events were recorded. The Cronbach α coefficient was used to assess reliability of the OSATS checklists and GRS scores. Interrater reliability was calculated with intraclass correlation coefficients. Correlations among OSATS checklist scores, GRS scores, and pass/fail assessment were calculated with Spearman ρ. Validity of OSATS checklists was determined using analysis of variance with postgraduate year (PGY) as a between-subjects factor. Significance was set at p shoulder approaches. Checklist scores showed superior interrater reliability compared with GRS and subjective pass/fail measurements. GRS scores were positively correlated across training years. The incidence of adverse events was significantly higher among PGY-1 and PGY-2 residents compared with more experienced residents. OSATS checklists are a valid and reliable assessment of technical skills across 3 surgical shoulder approaches. However, checklist scores do not measure quality of technique. Documenting adverse events is necessary to assess quality of technique and ultimate pass/fail status. Multiple methods of assessing surgical skill should be considered when evaluating orthopedic resident surgical performance. Copyright Â© 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights
Thawani, Jayesh P; Ramayya, Ashwin G; Abdullah, Kalil G; Hudgins, Eric; Vaughan, Kerry; Piazza, Matthew; Madsen, Peter J; Buch, Vivek; Sean Grady, M
Simulated practice may improve resident performance in endoscopic endonasal surgery. Using the NeuroTouch haptic simulation platform, we evaluated resident performance and assessed the effect of simulation training on performance in the operating room. First- (N=3) and second- (N=3) year residents were assessed using six measures of proficiency. Using a visual analog scale, the senior author scored subjects. After the first session, subjects with lower scores were provided with simulation training. A second simulation served as a task-learning control. Residents were evaluated in the operating room over six months by the senior author-who was blinded to the trained/untrained identities-using the same parameters. A nonparametric bootstrap testing method was used for the analysis (Matlab v. 2014a). Simulation training was associated with an increase in performance scores in the operating room averaged over all measures (p=0.0045). This is the first study to evaluate the training utility of an endoscopic endonasal surgical task using a virtual reality haptic simulator. The data suggest that haptic simulation training in endoscopic neurosurgery may contribute to improvements in operative performance. Limitations include a small number of subjects and adjudication bias-although the trained/untrained identity of subjects was blinded. Further study using the proposed methods may better describe the relationship between simulated training and operative performance in endoscopic Neurosurgery. Copyright © 2016 Elsevier Ltd. All rights reserved.
Esfahani, B Janghorban; Faron, A; Roth, K S; Schaller, H-E; Medved, F; Lüers, J-C
The Internet is becoming increasing-ly important as a source of information for patients in medical issues. However, many patients have problems to adequately understand texts, especially with medical content. A basic requirement to understand a written text is the read-ability of a text. The aim of the present study was to examine texts on the websites of German -plastic-surgical hospitals with patient information regarding their readability. In this study, the read-ability of texts of 27 major departments of plastic and Hand surgery in Germany was systematically analysed using 5 recognised readability indices. First, texts were searched based on 20 representative key words and themes. Thereafter, texts were assigned to one of 3 major themes in order to enable statistical analysis. In addition to the 5 readability indices, further objective text parameters were also recorded. Overall, 288 texts were found for analyzation. Most articles were found on the topic of "handsurgery" (n=124), less were found for "facial plastic surgery" (n=80) and "flaps, breast and reconstructive surgery" (n=84). Consistently, all readability indices showed a poor readability for the vast majority of analysed texts with the text appearing readable only for readers with a higher educational level. No significant differences in readability were found between the 3 major themes. Especially in the communication of medical information, it is important to consider the knowledge and education of the addressee. The texts studied consistently showed a readability that is understandable only for academics. Thus, a large part of the intended target group is probably not reached. In order to adequately deliver online information material, a revision of the analysed internet texts appears to be recommendable. © Georg Thieme Verlag KG Stuttgart · New York.
de Blacam, Catherine; Tierney, Sean; Shelley, Odhran
Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity. An electronic survey was distributed to plastic surgery registrars in a university teaching hospital. Registrars were asked to rate 31 items on a five-point Likert scale, including statements on patient care, clinical and operative duties, training, and quality-of-life. Interquartile deviations explored consensus among responses. Operative caseload was objectively evaluated using eLogbook data to compare activity at equal time points before and after implementation of the EWTD rota. Highest levels of consensus among respondents were found in positive statements addressing alertness and preparation for theatre, as well as time to read and study for exams. Registrars agreed that EWTD compliance improved their quality-of-life. However, it was felt that continuity of patient care was compromised by work hours restriction. Registrars were concerned about their operative experience. eLogbook data confirmed a fall-off in mean caseload of 31.8% compared to activity prior to EWTD rota implementation. While EWTD compliant rotas promote trainee quality-of-life and satisfaction with training, attention needs to be paid to optimising operative opportunities.
Full Text Available Objective. The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. Design and Setting. A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom, McGill University (Canada, and a control group (non-medical staff. The questions were about plastic surgery: (1 source of information and basic understanding; (2 undergraduate curriculum inclusion and preferred learning methods; (3 factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group. The data was analysed based on categorical outcomes (Chi-square χ2 and level of significance p≤0.05. Results. Questionnaire was analysed for 243 students (Birmingham, n=171/332, 52% (McGill n=72/132, 54%. Birmingham students (14% considered the word “plastic” synonymous with “cosmetic” more than McGill students (4%, p<0.025. Teaching was the main source of knowledge for McGill students (39%, p<0.001 while Birmingham students and control group chose the media (70%, p<0.001. McGill students (67% more than Birmingham (49%, p<0.010 considered curriculum inclusion. The preferred learning method was lectures for McGill students (61%, p<0.01 but an optional module for Birmingham (61%. A similar proportion (18% from both student groups considered a career in plastic surgery. Conclusions. Medical students recognised the need for plastic surgery inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in
Swanson, Edward W; Miller, Devin T; Susarla, Srinivas M; Lopez, Joseph; Lough, Denver M; May, James W; Redett, Richard J
Research productivity plays a significant role in academic promotions. Currently, various bibliometric measures utilizing citation counts are used to judge an author's work. With increasing numbers of journals, numbers of open access publications, ease of online submission, and expedited indexing of accepted manuscripts, it is plausible that an author could influence his/her own bibliometric measures through self-citation. The purpose of this study was to determine the impact of self-citation in academic plastic surgery. A cohort of full-time academic plastic surgeons was identified from 9 U.S. plastic surgery training programs. For all included faculty, academic rank was retrieved from department/division websites, and bibliometric measures were assessed using a subscription bibliographic citation database (Scopus, Reed Elsevier, London, UK). Bibliometric measures included the Hirsch index (h-index, the number of publications h which are cited ≥ h times), total number of publications, and total number of citations. The h-index and total number of citations were collected with and without self-citations. Percent changes in the h-index and total citations were calculated after removal of self-citations and compared across academic ranks and levels of research productivity (total publications, h-index, and total citations). The study cohort consisted of 169 full-time academic plastic surgeons. The h-index and total citations experienced decreases of 2.8 ± 5.0% (P citation. More than half of the cohort (n = 113, 67%) did not experience a change in the h-index after removal of self-citations. These decreases did not vary across academic rank. Surgeons who self-cited at rates greater than 5% were 9.8 times more likely (95% confidence interval, 4.5-21.9; P citation (after adjusting for academic rank). There were weak correlations between percent decreases in the h-index and total citations and various biblimoteric measures (total publications, h-index, total citations
Steven Nicholas Graves, MA; Deana Saleh Shenaq, MD; Alexander J. Langerman, MD; David H. Song, MD, MBA
Background: Significant improvements can be made in recoding surgical procedures, particularly in capturing high-quality video recordings from the surgeons? point of view. This study examined the utility of the GoPro HERO 3+ Black Edition camera for high-definition, point-of-view recordings of plastic and reconstructive surgery. Methods: The GoPro HERO 3+ Black Edition camera was head-mounted on the surgeon and oriented to the surgeon?s perspective using the GoPro App. The camera was used to ...
Choi, Jong Woo; Kim, Namkug
Three-dimensional (3D) printing has been particularly widely adopted in medical fields. Application of the 3D printing technique has even been extended to bio-cell printing for 3D tissue/organ development, the creation of scaffolds for tissue engineering, and actual clinical application for various medical parts. Of various medical fields, craniofacial plastic surgery is one of areas that pioneered the use of the 3D printing concept. Rapid prototype technology was introduced in the 1990s to m...
Jong Woo Choi
Full Text Available Three-dimensional (3D printing has been particularly widely adopted in medical fields. Application of the 3D printing technique has even been extended to bio-cell printing for 3D tissue/organ development, the creation of scaffolds for tissue engineering, and actual clinical application for various medical parts. Of various medical fields, craniofacial plastic surgery is one of areas that pioneered the use of the 3D printing concept. Rapid prototype technology was introduced in the 1990s to medicine via computer-aided design, computer-aided manufacturing. To investigate the current status of 3D printing technology and its clinical application, a systematic review of the literature was conducted. In addition, the benefits and possibilities of the clinical application of 3D printing in craniofacial surgery are reviewed, based on personal experiences with more than 500 craniofacial cases conducted using 3D printing tactile prototype models.
Three-dimensional (3D) printing has been particularly widely adopted in medical fields. Application of the 3D printing technique has even been extended to bio-cell printing for 3D tissue/organ development, the creation of scaffolds for tissue engineering, and actual clinical application for various medical parts. Of various medical fields, craniofacial plastic surgery is one of areas that pioneered the use of the 3D printing concept. Rapid prototype technology was introduced in the 1990s to medicine via computer-aided design, computer-aided manufacturing. To investigate the current status of 3D printing technology and its clinical application, a systematic review of the literature was conducted. In addition, the benefits and possibilities of the clinical application of 3D printing in craniofacial surgery are reviewed, based on personal experiences with more than 500 craniofacial cases conducted using 3D printing tactile prototype models. PMID:26015880
Abt, Nicholas B; Reh, Douglas D; Eisele, David W; Francis, Howard W; Gourin, Christine G
Patients may perceive resident procedural participation as detrimental to their outcome. Our objective is to investigate whether otolaryngology-head and neck surgery (OHNS) housestaff participation is associated with surgical morbidity and mortality. Case-control study. OHNS patients were analyzed from the American College of Surgeons National Surgical Quality Improvement Program 2006 to 2013 databases. We compared the incidence of 30-day postoperative morbidity, mortality, readmissions, and reoperations in patients operated on by resident surgeons with attending supervision (AR) with patients operated on by an attending surgeon alone (AO) using cross-tabulations and multivariable regression. There were 27,018 cases with primary surgeon data available, with 9,511 AR cases and 17,507 AO cases. Overall, 3.62% of patients experienced at least one postoperative complication. The AR cohort had a higher complication rate of 5.73% than the AO cohort at 2.48% (P < .001). After controlling for all other variables, there was no significant difference in morbidity (odds ratio [OR] = 1.05 [0.89 to 1.24]), mortality (OR = 0.91 [0.49 to 1.70]), readmission (OR = 1.29 [0.92 to 1.81]), or reoperation (OR = 1.28 [0.91 to 1.80]) for AR compared to AO cases. There was no difference between postgraduate year levels for adjusted 30-day morbidity or mortality. There is an increased incidence of morbidity, mortality, readmission, and reoperation in OHNS surgical cases with resident participation, which appears related to increased comorbidity with AR patients. After controlling for other variables, resident participation was not associated with an increase in 30-day morbidity, mortality, readmission, or reoperation odds. These data suggest that OHNS resident participation in surgical cases is not associated with poorer short-term outcomes. 3b Laryngoscope, 126:2263-2269, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Targarona Soler, Eduardo Ma; Jover Navalon, Jose Ma; Gutierrez Saiz, Javier; Turrado Rodríguez, Víctor; Parrilla Paricio, Pascual
Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. A data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analysed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. The survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P=.001) and breast surgery (P=.042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512±226 vs. 625±244; P<.01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures
Drake, Frederick Thurston; Horvath, Karen D; Goldin, Adam B; Gow, Kenneth W
The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. To evaluate changes in operative experience for general surgery CRs. Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. Total cases and defined categories were evaluated for changes over time. The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.
Joyce, Cormac Weekes; Carroll, Sean Michael
The number of citations that a published article has received reflects the importance of the paper in the particular area of practice. In microsurgery, thus far, which journal articles are cited most frequently is unknown. The purpose of this study was to identify and analyze the characteristics of the top 50 papers in the field of microsurgery in the plastic surgery literature. The 50 most cited papers published in high impact plastic surgery and microsurgery journals were identified. The articles were ranked in the order of the number of citations received. These 50 classic papers were analyzed for article type, journal distribution, and geographic and institutional origin. Six international journals contributed to the top 50 papers in microsurgery. The most cited paper reported on the early use of the vascularized bone graft and was cited 116 times. The top 50 papers originated from just 10 countries with the United States producing the most. The Preston and Northcote Community Hospital, Melbourne published 5 papers and this was the most productive institution in the top 50. These papers represent many important milestones in the relatively short history of microsurgery. Furthermore, our citation analysis provides useful information to budding authors as to what makes a paper attain a "classic" status.
Vyas, Krishna S; Hambrick, H Rhodes; Shakir, Afaaf; Morrison, Shane D; Tran, Duy C; Pearson, Keon; Vasconez, Henry C; Mardini, Samir; Gosman, Amanda A; Dobke, Marek; Granick, Mark S
Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field. A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice. A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise. Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use
Hou, Yang; Shi, Jiangang; Lin, Yanping; Chen, Huajiang; Yuan, Wen
The cervical screw placement is one of the most difficult procedures in spine surgery, which often needs a long period of repeated practices and could cause screw placement-related complications. We performed this cadaver study to investigate the effectiveness of virtual surgical training system (VSTS) on cervical pedicle screw instrumentation for residents. A total of ten novice residents were randomly assigned to two groups: the simulation training (ST) group (n = 5) and control group (n = 5). The ST group received a surgical training of cervical pedicle screw placement on VSTS and the control group was given an introductory teaching session before cadaver test. Ten fresh adult spine specimens including 6 males and 4 females were collected, and were randomly allocated to the two groups. The bilateral C3-C6 pedicle screw instrumentation was performed in the specimens of the two groups, respectively. After instrumentation, screw positions of the two groups were evaluated by image examinations. There was significantly statistical difference in screw penetration rates between the ST (10%) and control group (62.5%, P VSTS as an advanced training tool exhibited promising effects on improving performance of novice residents in cervical pedicle screw placement compared with the traditional teaching methods.
Drake, Frederick Thurston; Aarabi, Shahram; Garland, Brandon T; Huntington, Ciara R; McAteer, Jarod P; Richards, Morgan K; Zern, Nicole Kansier; Gow, Kenneth W
To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room. A dataset was generated from annual ACGME reports. Operative volume for total major cases (TMC), defined categories, and four index laparoscopic procedures was evaluated. TMC dropped after implementation of DHR but rebounded after a transition period (949 vs 946 cases, P = nonsignificance). Abdominal cases increased from 22% of overall cases to 31%. Alimentary cases increased from 21% to 26%. Trauma and vascular surgery substantially decreased. For trauma, this drop took place well before DHR. The decrease in vascular surgery also began before DHR but continued afterward as well: 148 cases/resident in the late 1990s to 107 currently. Although total operative volume rebounded after implementation of DHR, diversity of operative experienced narrowed. The combined increase in alimentary and abdominal cases is nearly 13%, over a half-year's worth of operating in 5-year training programs. Bedrock general surgery cases-trauma, vascular, pediatrics, and breast-decreased. Laparoscopic operations have steadily increased. If the competence of current graduates has, in fact, diminished. Our analysis suggests that operative volume is not the problem. Rather, changing disease processes, subspecialization, reductions in resident autonomy, and technical innovation challenge how today's general surgeons are trained.
Reismann, M; Ellerkamp, V; Dingemann, J
As in other surgical specialties, increasing concern has been expressed worldwide about the shortage of trainees in pediatric surgery training programs. We performed a nationwide survey to investigate the current situation in Germany. An internet-based nationwide survey comprising 36 questions on training conditions in pediatric surgery was linked to the homepage of the German Society of Pediatric Surgery from June to September 2008. Statements on the following aspects were evaluated by responding residents using a scale from 1 (I do not agree at all) to 5 (I fully agree): workplace, cooperation with colleagues, head of the department, cooperation with other specialties, training and research conditions. A median value of 3 indicated an unsatisfactory assessment, with at least 50% of respondents giving an indifferent or negative response. 70 questionnaires were completed. Some of the evaluations revealed problematic areas. In particular, statements regarding working hours revealed dissatisfaction among the responding doctors. The median value accorded the statement "I am satisfied with the current working time regulation" was 2.9. With regard to departmental heads, some criticisms were directed against a perceived lack of soft skills. According to the respondents, their involvement in decision-making processes was insufficient ("We are involved in decision-making processes affecting our working conditions" - median value 2.4). Residents were also dissatisfied with the feedback they received for their work ("I get enough feedback regarding my achievement" - median value 2.6). Another problem area was career development ("I will finish my specialist training in time" - median value 2.9). However, these points did not affect overall satisfaction. Trainee satisfaction with regulations on working hours is low. Despite a general satisfaction with all fields appraised, improvements in various individual areas, e. g., the attitude of departmental heads and strategies of
Siam, Baha; Al-Kurd, Abbas; Simanovsky, Natalia; Awesat, Haitham; Cohn, Yahav; Helou, Brigitte; Eid, Ahmed; Mazeh, Haggi
In some centers, the presence of a senior general surgeon (SGS) is obligatory in every procedure, including appendectomy, while in others it is not. There is a relative paucity in the literature of reports comparing the outcomes of appendectomies performed by unsupervised general surgery residents (GSRs) with those performed in the presence of an SGS. To compare the outcomes of appendectomies performed by SGSs with those performed by GSRs. A retrospective analysis was performed of all patients 16 years or older operated on for assumed acute appendicitis between January 1, 2008, and December 31, 2015. The cohort study compared appendectomies performed by SGSs and GSRs in the general surgical department of a teaching hospital. The primary outcome measured was the postoperative early and late complication rates. Secondary outcomes included time from emergency department to operating room, length of surgery, surgical technique (open or laparoscopic), use of laparoscopic staplers, and overall duration of postoperative antibiotic treatment. Among 1649 appendectomy procedures (mean [SD] patient age, 33.7 [13.3] years; 612 female [37.1%]), 1101 were performed by SGSs and 548 by GSRs. Analysis demonstrated no significant difference between the SGS group and the GSR group in overall postoperative early and late complication rates, the use of imaging techniques, time from emergency department to operating room, percentage of complicated appendicitis, postoperative length of hospital stay, and overall duration of postoperative antibiotic treatment. However, length of surgery was significantly shorter in the SGS group than in the GSR group (mean [SD], 39.9 [20.9] vs 48.6 [20.2] minutes; P < .001). This study demonstrates that unsupervised surgical residents may safely perform appendectomies, with no difference in postoperative early and late complication rates compared with those performed in the presence of an SGS.
Kahol, Kanav; Huston, Carrie; Hamann, Jessica; Ferrara, John J
Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers. Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors. We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation. By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas. Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.
Lozoya, J P; Teixeira de Mello, F; Carrizo, D; Weinstein, F; Olivera, Y; Cedrés, F; Pereira, M; Fossati, M
Beaches are social-ecological systems that provide several services improving human well-being. However, as one of the major coastal interfaces they are subject to plastic pollution, one of the most significant global environmental threats at present. For the first time for Uruguayan beaches, this study assessed and quantified the accumulation of plastic and microplastic debris on sandy beaches of the major touristic destination Punta del Este during the austral spring of 2013. Aiming to provide valuable information for decision-making, we performed a detailed analysis of plastic debris, their eventual transport pathways to the coast (from land and sea), and the associated persistent pollutants. The results indicated that the smallest size fractions (<20 mm) were the dominant size range, with fragments and resin pellets as types with the highest number of items. PAHs and PCBs were found in plastic debris, and their levels did not differ from baseline values reported for similar locations. The abundance of plastic debris was significantly and positively correlated with both the presence of possible land-based sources (e.g. storm-water drains, beach bars, beach access, car parking, and roads), and dissipative beach conditions. The analysis of coastal currents suggested some potential deposition areas along Punta del Este, and particularly for resin pellets, although modeling was not conclusive. From a local management point of view, the development and use of indices that allow predicting trends in the accumulation of plastic debris would be critically useful. The time dimension (e.g. seasonal) should also be considered for this threat, being crucial for locations such as Uruguay, where the use of beaches increases significantly during the summer. This first diagnosis aims to generate scientific baseline, necessary for improved management of plastic litter on beaches and their watersheds. Copyright © 2016 Elsevier Ltd. All rights reserved.
Kim, Roger H; Gilbert, Timothy; Ristig, Kyle
There is a growing body of literature that suggests that learners assimilate information differently, depending on their preferred learning style. The VARK model categorizes learners as visual (V), aural (A), read/write (R), kinesthetic (K), or multimodal (MM). We hypothesized that resident VARK learning style preferences and American Board of Surgery In-Training Examination (ABSITE) performance are associated. The Fleming VARK learning styles inventory was administered to all general surgery residents at a university hospital-based program each year to determine their preferred learning style. Resident scores from the 2012 and 2013 ABSITE were examined to identify any correlation with learning style preferences. Over a 2-year period, residents completed 53 VARK inventory assessments. Most (51%) had a multimodal preference. Dominant aural and read/write learners had the lowest and highest mean ABSITE scores, respectively (p = 0.03). Residents with dominant read/write learning preferences perform better on the ABSITE than their peers did, whereas residents with dominant aural learning preferences underperform on the ABSITE. This may reflect an inherent and inadvertent bias of the examination against residents who prefer to learn via aural modalities. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Lamb, Laura C; DiFiori, Monica M; Jayaraman, Vijay; Shames, Brian D; Feeney, James M
We sought to determine if a daily gamified microblogging project improves American Board of Surgery In-Service Training Examination (ABSITE) scores for participants. In July 2016, we instituted a gamified microblogging project using Twitter as the platform and modified questions from one of several available question banks. A question of the day was posted at 7-o׳clock each morning, Monday through Friday. Respondents were awarded points for speed, accuracy, and contribution to discussion topics. The moderator challenged respondents by asking additional questions and prompted them to find evidence for their claims to fuel further discussion. Since 4 months into the microblogging program, a survey was administered to all residents. Responses were collected and analyzed. After 6 months of tweeting, residents took the ABSITE examination. We compared participating residents׳ ABSITE percentile rank to those of their nonparticipating peers. We also compared residents׳ percentile rank from 2016 to those in 2017 after their participation in the microblogging project. The University of Connecticut general surgery residency is an integrated program that is decentralized across 5 hospitals in the central Connecticut region, including Saint Francis Hospital and Medical Center, located in Hartford. We advertised our account to the University of Connecticut general surgery residents. Out of 45 residents, 11 participated in Twitter microblogging (24.4%) and 17 responded to the questionnaire (37.8%). In all, 100% of the residents who were participating in Twitter reported that daily microblogging prompted them to engage in academic reading. Twitter participants significantly increased their ABSITE percentile rank from 2016 to 2017 by an average of 13.7% (±14.1%) while nonparticipants on average decreased their ABSITE percentile rank by 10.0% (±16.6) (p = 0.003). Microblogging via Twitter with gamification is a feasible strategy to facilitate improving performance on the ABSITE
Ray, Juliet J; Sznol, Joshua A; Teisch, Laura F; Meizoso, Jonathan P; Allen, Casey J; Namias, Nicholas; Pizano, Louis R; Sleeman, Danny; Spector, Seth A; Schulman, Carl I
The American Board of Surgery In-Training Examination (ABSITE) is designed to measure progress, applied medical knowledge, and clinical management; results may determine promotion and fellowship candidacy for general surgery residents. Evaluations are mandated by the Accreditation Council for Graduate Medical Education but are administered at the discretion of individual institutions and are not standardized. It is unclear whether the ABSITE and evaluations form a reasonable assessment of resident performance. To determine whether favorable evaluations are associated with ABSITE performance. Cross-sectional analysis of preliminary and categorical residents in postgraduate years (PGYs) 1 through 5 training in a single university-based general surgery program from July 1, 2011, through June 30, 2014, who took the ABSITE. Evaluation overall performance and subset evaluation performance in the following categories: patient care, technical skills, problem-based learning, interpersonal and communication skills, professionalism, systems-based practice, and medical knowledge. Passing the ABSITE (≥30th percentile) and ranking in the top 30% of scores at our institution. The study population comprised residents in PGY 1 (n = 44), PGY 2 (n = 31), PGY 3 (n = 26), PGY 4 (n = 25), and PGY 5 (n = 24) during the 4-year study period (N = 150). Evaluations had less variation than the ABSITE percentile (SD = 5.06 vs 28.82, respectively). Neither annual nor subset evaluation scores were significantly associated with passing the ABSITE (n = 102; for annual evaluation, odds ratio = 0.949; 95% CI, 0.884-1.019; P = .15) or receiving a top 30% score (n = 45; for annual evaluation, odds ratio = 1.036; 95% CI, 0.964-1.113; P = .33). There was no difference in mean evaluation score between those who passed vs failed the ABSITE (mean [SD] evaluation score, 91.77 [5.10] vs 93.04 [4.80], respectively; P = .14) or between those who
Santos, Felipe Rychuv; Kamarowski, Stephanie Felice; Lopez, Camilo Andres Villabona; Storrer, Carmen Lucia Mueller; Neto, Alexandre Teixeira; Deliberador, Tatiana Miranda
Periodontal surgery associated with prior waxing, mock-up, and the use of digital tools to design the smile is the current trend of reverse planning in periodontal plastic surgery. The objective of this study is to report a surgical resolution of the gummy smile using a prior esthetic design with the use of digital tools. A digital smile design and mock-up were used for performing gingival recontouring surgery. The relationship between the facial and dental measures and the incisal plane with the horizontal facial plane of reference were evaluated. The relative dental height x width was measured, and the dental contour drawing was inserted. Complementary lines are drawn such as the gingival zenith, joining lines of the gingival and incisal battlements. The periodontal esthetic was improved according to the established design digital smile pattern. These results demonstrate the importance of surgical techniques and are well accepted by patients and are easy to perform for the professional. When properly planned, they provide the desired expectations. Periodontal Surgical procedures associated with the design digital smile facilitate the communication between the patient and the professional. It is, therefore, essential to demonstrate the reverse planning of the smile and periodontal parameters with approval by the patient to solve the esthetic problem.
Korczak, Karol; Kasielska-Trojan, Anna; Niedźwiedziński, Marian; Antoszewski, Bogusław
Photographic documentation is very important for plastic, reconstructive, and especially aesthetic surgery procedures. It can be used to improve patient care as well as to carry out scientific research. The results of our previous studies confirmed a strong demand for Information Technology (IT) systems dedicated to plastic surgery. Unfortunately, most of the solutions of this type are not suited to the actual needs. For this reason we decided to develop a reliable system for photographic documentation storage. The Plastic Reconstructive Esthetic Surgery Photo System (PRESsPhoto) was developed and finally deployed in the Plastic, Reconstructive and Aesthetic Surgery Clinic of the Medical University in Łódź (Poland). Preliminary single-center performance tests proved that the PRESsPhoto system is easy to use and provides, inter alia, rapid data search and data entry as well as data security. In the future the PRESsPhoto system should be able to cooperate with Hospital Information Systems (HIS). The process of development and deployment of the PRESsPhoto system is an example of good cooperation between health care providers and the informatics, which resulted in a system that meets the expectations of plastic surgeons. Copyright © 2017 Elsevier Ltd. All rights reserved.
Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.
Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692
Nowacki, Maciej; Kloskowski, Tomasz; Pietkun, Katarzyna; Zegarski, Maciej; Pokrywczyńska, Marta; Habib, Samy L; Drewa, Tomasz; Zegarska, Barbara
The aim of this paper was to collect currently available data related to the use of stem cells in aesthetic dermatology and plastic surgery based on a systemic review of experimental and clinical applications. We found that the use of stem cells is very promising but the current state of art is still not effective. This situation is connected with not fully known mechanisms of cell interactions, possible risks and side effects. We think that there is a big need to create and conduct different studies which could resolve problems of stem cells use for implementation into aesthetic dermatology and plastic surgery.
Ward, Brittany; Ward, Max; Paskhover, Boris
Celebrities have long influenced the medical decisions of the general population. By analyzing Google search data using Google Trends, we measured the impact of highly publicized plastic surgery-related events on the interest level of the general population in specific search terms. Additionally, we investigated seasonal and geographic trends around interest in rhinoplasties, which is information that physicians and small surgical centers can use to optimize marketing decisions. Google Trends was used to access search data histories for three separate areas of interest: Kylie Jenner and lip fillers, Joan Rivers and plastic surgery, and rhinoplasty, which were then analyzed using two-tailed, two-sample equal variance t-tests. The average interest level in fillers increased by 30.31 points after Kylie Jenner announced that she received Juvéderm lip injections. The interest level in plastic surgery was decreased by 21.3% the month after Joan Rivers' death. Between January 2004 and May 2017, the average interest level for rhinoplasty was significantly different in January/December (67.91 ± 20.68) and June/July (70.12 ± 18.89) from the remaining calendar months (63.58 ± 19.67). Los Angeles, New York City, and Miami showed consistently high interest levels throughout the time period, while Tulsa, OK, showed a major interest increase between 2015 to 2016 of 65 points. A noticeable impact was observed in both celebrity cases on search term volume, and a seasonal effect is apparent for rhinoplasty searches. As many surgeons already employ aggressive Internet marketing strategies, understanding and utilizing these trends could help optimize their investments, increase social engagement, and increase practice awareness by potential patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www
Sui, Jinghu; Deng, Xiaoming; Liu, Xiaowen; Wang, Yuhui; Jin, Jinhua; Wei, Lingxin; Yang, Dong
To observe the effectiveness of conscious sedation with dexmedetomidine and sufentanil in patients for plastic surgery. Forty patients scheduled for elective plastic surgery under conscious sedation were infused 1 µg/kg intravenously within 15 minutes as loading dose followed by a continuous infusion of dexmedetomidine (0.5 µg·kg⁻¹·h⁻¹) and sufentanil (0.07 µg·kg⁻¹·h⁻¹) respectively. Sufentanil 0.05 µg/kg and midazolam 0.025 mg/kg were administrated intravenously 5 minutes before local infiltration, and then a bolus of sufentanil or midazolam was given as needed to maintain OAA/S score of 11 during the procedure. The drug infusion was discontinued at 5 to 10 min before the end of the surgical procedure. The complications (i.e. anoxemia, apnea, bradycardia, restlessness, nausea, vomiting, crying and excitation), if any, anesthesia duration and drug consumption were recorded. On the first postoperative day, patients were asked to rate their satisfaction with the anesthetic management and whether they would choose to receive the same sedative analgesic medications and should they require a similar surgical procedure in the future. The OAA/S score decreased from 20.0 ± 0 to 11.5 ± 2.5 after patients being infused the loading dose of dexmedetomidine, and was maintained 10.5-11.1 during the procedure. At the end of the procedure, the OAA/S score return to 16.1 ± 2.8. The induction of sedation produced a significant decrease in HR (P 0.05). There were 38 patients completed their procedures under conscious sedation, and there were incident of crying and bradycardia in 5 and 2 patients respectively. The anesthesia duration and consumption of dexmedetomidine, sufentanil and midazolam were (128 ± 47) min, (116 ± 43) µg, (10 ± 5) µg and (2 ± 1) mg respectively. In an interview on the first postoperative day, there were 13 patients complaining no memory, 17 patients complaining fuzzy memory and 8 patients complaining awake during the procedure
Wiener, Scott; Haddock, Peter; Shichman, Steven; Dorin, Ryan
To define the time needed by urology residents to attain proficiency in computer-aided robotic surgery to aid in the refinement of a robotic surgery simulation curriculum. We undertook a retrospective review of robotic skills training data acquired during January 2012 to December 2014 from junior (postgraduate year [PGY] 2-3) and senior (PGY4-5) urology residents using the da Vinci Skills Simulator. We determined the number of training sessions attended and the level of proficiency achieved by junior and senior residents in attempting 11 basic or 6 advanced tasks, respectively. Junior residents successfully completed 9.9 ± 1.8 tasks, with 62.5% completing all 11 basic tasks. The maximal cumulative success rate of junior residents completing basic tasks was 89.8%, which was achieved within 7.0 ± 1.5 hours of training. Of senior residents, 75% successfully completed all six advanced tasks. Senior residents attended 6.3 ± 3.5 hours of training during which 5.1 ± 1.6 tasks were completed. The maximal cumulative success rate of senior residents completing advanced tasks was 85.4%. When designing and implementing an effective robotic surgical training curriculum, an allocation of 10 hours of training may be optimal to allow junior and senior residents to achieve an acceptable level of surgical proficiency in basic and advanced robotic surgical skills, respectively. These data help guide the design and scheduling of a residents training curriculum within the time constraints of a resident's workload.
Giuglea, Carmen; Marinescu, Sllviu; Florescu, Ioan Petre; Jecan, Crenguta
Pressure sores can be defined as lesions caused by unrelieved pressure resulting in damage of the underlying tissue. They represent a common problem in the pathology of plegic patients and, plastic surgery has a significant role in their treatment. Pressure sores occur over bony prominences and so, they are most commonly seen at the sacrum and trochanters in paralyzed patients and at ischium for the patients who sit in a wheelchair for a long time. For these patients, surgical treatment is very important because on one hand, it stops the loss of nutrients and proteins at the site of the pressure sore, and on the other hand, it permits the initiation of neuromuscular recuperation treatment much faster.
Lopez, Joseph; Ameri, Afshin; Susarla, Srinivas M; Reddy, Sashank; Soni, Ashwin; Tong, J W; Amini, Neda; Ahmed, Rizwan; May, James W; Lee, W P Andrew; Dorafshar, Amir
It is currently unknown whether formal research training has an influence on academic advancement in plastic surgery. The purpose of this study was to determine whether formal research training was associated with higher research productivity, academic rank, and procurement of extramural National Institutes of Health (NIH) funding in plastic surgery, comparing academic surgeons who completed said research training with those without. This was a cross-sectional study of full-time academic plastic surgeons in the United States. The main predictor variable was formal research training, defined as completion of a postdoctoral research fellowship or attainment of a Doctor of Philosophy (PhD). The primary outcome was scientific productivity measured by the Hirsh-index (h-index, the number of publications, h that have at least h citations each). The secondary outcomes were academic rank and NIH funding. Descriptive, bivariate, and multiple regression statistics were computed. A total of 607 academic surgeons were identified from 94 Accreditation Council for Graduate Medical Education-accredited plastic surgery training programs. In all, 179 (29.5%) surgeons completed formal research training. The mean h-index was 11.7 ± 9.9. And, 58 (9.6%) surgeons successfully procured NIH funding. The distribution of academic rank was the following: endowed professor (5.4%), professor (23.9%), associate professor (23.4%), assistant professor (46.0%), and instructor (1.3%). In a multiple regression analysis, completion of formal research training was significantly predictive of a higher h-index and successful procurement of NIH funding. Current evidence demonstrates that formal research training is associated with higher scientific productivity and increased likelihood of future NIH funding. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Hatchell, Alexandra C; Farrokhyar, Forough; Choi, Matthew
Case-control study designs are commonly used. However, many published case-control studies are not true case-controls and are in fact mislabeled. The purpose of this study was to identify all case-control studies published in the top three plastic surgery journals over the past 10 years, assess which were truly case-control studies, clarify the actual design of the articles, and address common misconceptions. MEDLINE, Embase, and Web of Science databases were searched for case-control studies in the three highest-impact factor plastic surgery journals (2005 to 2015). Two independent reviewers screened the resulting titles, abstracts, and methods, if applicable, to identify articles labeled as case-control studies. These articles were appraised and classified as true case-control studies or non-case-control studies. The authors found 28 articles labeled as case-control studies. However, only six of these articles (21 percent) were truly case-control designs. Of the 22 incorrectly labeled studies, one (5 percent) was a randomized controlled trial, three (14 percent) were nonrandomized trials, two (9 percent) were prospective comparative cohort designs, 14 (64 percent) were retrospective comparative cohort designs, and two (9 percent) were cross-sectional designs. The mislabeling was worse in recent years, despite increases in evidence-based medicine awareness. The majority of published case-control studies are not in fact case-control studies. This misunderstanding is worsening with time. Most of these studies are actually comparative cohort designs. However, some studies are truly clinical trials and thus a higher level of evidence than originally proposed.
Graves, Steven Nicholas; Shenaq, Deana Saleh; Langerman, Alexander J; Song, David H
Significant improvements can be made in recoding surgical procedures, particularly in capturing high-quality video recordings from the surgeons' point of view. This study examined the utility of the GoPro HERO 3+ Black Edition camera for high-definition, point-of-view recordings of plastic and reconstructive surgery. The GoPro HERO 3+ Black Edition camera was head-mounted on the surgeon and oriented to the surgeon's perspective using the GoPro App. The camera was used to record 4 cases: 2 fat graft procedures and 2 breast reconstructions. During cases 1-3, an assistant remotely controlled the GoPro via the GoPro App. For case 4 the GoPro was linked to a WiFi remote, and controlled by the surgeon. Camera settings for case 1 were as follows: 1080p video resolution; 48 fps; Protune mode on; wide field of view; 16:9 aspect ratio. The lighting contrast due to the overhead lights resulted in limited washout of the video image. Camera settings were adjusted for cases 2-4 to a narrow field of view, which enabled the camera's automatic white balance to better compensate for bright lights focused on the surgical field. Cases 2-4 captured video sufficient for teaching or presentation purposes. The GoPro HERO 3+ Black Edition camera enables high-quality, cost-effective video recording of plastic and reconstructive surgery procedures. When set to a narrow field of view and automatic white balance, the camera is able to sufficiently compensate for the contrasting light environment of the operating room and capture high-resolution, detailed video.
Cervelli, Valerio; Gentile, Pietro; Scioli, Maria Giovanna; Grimaldi, Monica; Casciani, Carlo Umberto; Spagnoli, Luigi Giusto; Orlandi, Augusto
The clinical use of platelet-rich plasma (PRP) for a wide variety of application has been reportedly employed most prevalently in problematic wounds, maxillofacial and hemi-facial atrophy, Romberg Syndrome, and diabetic foot ulcers. To our knowledge, PRP has never been described in the enhancement of fat grafting during tissue-engineering application in vivo. The authors describe the preparation of PRP and its use in a series of 43 patients who underwent plastic, reconstructive, and maxillofacial surgery for chronic lower extremity ulcers (n = 18) and multiple facial applications (n = 25). PRP mixed with fat grafting was used in 76% patients affected by multiple facial diseases and in 88.9% patients affected by lower extremity ulcers. PRP injection alone was used in the remaining patients. The authors observed that after a 7.1-week and 9.7-week (average) course of twice-daily wound treatment with PRP suspended on a collagen base, 61.1% and 88.9% of chronic lower extremity ulcers underwent to 100% reepithelization compared with 40% and 60% of controls (n = 10) treated with hyaluronic acid and collagen medication. In patients treated with reconstructing three-dimensional projection of face by fat grafting and PRP, we observed a 70% maintenance of contour restoring and three-dimensional volume after 1 year compared to only 31% of controls (n = 10) treated with fat grafting alone. In vitro, PRP induced a significant increase in the number of adipose-tissue-derived stem cells compared to control cultures. These results documented that PRP accelerates chronic skin ulcer reepithelization and improves maintenance and function of fat graft in patients who underwent plastic reconstructive surgery, possibly by stimulating adipose-tissue-derived stem cell proliferation.
Rosique, Marina Junqueira Ferreira; Rosique, Rodrigo Gouvea; Costa, Ilson Rosique; Lara, Brunno Rosique; Figueiredo, Jozé Luiz Ferrari; Ribeiro, Davidson Gomes Barbosa
Acute swelling of the parotid glands after general anesthesia has become known as anesthesia mumps. Its cause is unknown. Only one case of postsurgical parotitis without general anesthesia is reported. This report describes three cases in this setting after plastic surgery. A 37-year-old women underwent breast surgery and abdominoplasty with a dual thoracic/lumbar epidural block (bupivacaine 0.5 %). The operative time totaled almost 6 h. Subsequently, 4 h after surgery, the patient experienced painless bilateral parotid swelling without palpable crepitus. The edema resolved completely within 12 h under clinical observation and parenteral hydration. A 45-year-old patient received subglandular breast implants and body contouring with liposuction, all with the patient under a dual thoracic/lumbar epidural block with 0.5 % marcaine. The total surgical time was 5 h. Subsequently, 3 h after surgery, the patient experienced a similar clinical presentation. The problem resolved completely in 36 h with clinical observation and parenteral hydration. CASE 3: A 30-year-old patient received a subglandular breast implant and underwent liposuction of the outer thighs using a dual thoracic/lumbar epidural block with lidocaine 1 %. The duration of surgery was 1 h. Subsequently, 5 h postoperatively, the patient experienced a similar clinical presentation. Dexamethasone and parenteral hydration were administered. The problem resolved completely in 48 h without sequelae. The occurrence of parotitis in patients undergoing surgery under epidural anesthesia is a novel situation, which increases the range of possible etiologies for this little known condition. Dehydration leading to transient parotid secretion obstruction may play a significant role. Further reports of parotitis occurring in the regional anesthesia setting are expected to help elucidate its pathophysiology. This journal requires that authors assign a level of evidence to each article. For a full description of
Chun, Maria B J; Young, Keane G M; Jackson, David S
In response to the growing diversity of the United States population and concerns with health disparities, formal training in cross-cultural care has become mandatory for all medical specialties, including surgery. The aim of this study was to assess the readiness of a general surgery residency program to incorporate cultural competency initiatives into its curriculum. Eighteen surgical teaching faculty (at a community-based hospital with a university affiliation) voluntarily participated in a qualitative study to share their views on cultural competency and to discuss ways that it could potentially be incorporated into the curriculum. Reflective of current definitions of cultural competency, faculty viewed the term culture broadly (i.e., beyond race and ethnicity). Suggested instructional methods varied, with some noting that exposure to different cultures was helpful. Others stated the importance of faculty serving as role models. Most faculty in this study appear open to cultural training, but desire a clear understanding of what that would entail and how it can be taught. They also acknowledged the lack of time to address cultural issues. Taking into consideration these and other concerns, planned curricular interventions are also presented.
Silvestre, Jason; Abbatematteo, Joseph M; Chang, Benjamin; Serletti, Joseph M; Taylor, Jesse A
The h-index is an objective measure of an investigator's scholarly impact. The purpose of this investigation was to determine the association between scholarly impact, as measured by the h-index, and the procurement of National Institutes of Health (NIH) grant funding among academic plastic surgeons. This was a case-control study of NIH-funded plastic surgery faculty identified on the RePORTER database. Non-NIH-funded faculty from the top 10 NIH-funded programs served as a control group. The mean h-index was calculated from Scopus (Elsevier, London, United Kingdom) and compared by funding status, academic rank, and terminal degree(s). The relationship between h-index and career NIH funding was elucidated via Spearman's correlation coefficient. NIH-funded faculty had higher h-indices than nonNIH-funded faculty (23.9 versus 9.9, p 0.05), but investigators with a master's degree exhibited a trend toward greater NIH funding. Higher h-indices correlated with greater NIH funding (r = 0.481, p < 0.001). A strong relationship exists between scholarly impact and the procurement of NIH funding. Faculty with greater funding had greater scholarly impact, as measured by the h-index, which suggests that this tool may have utility during the NIH grant application process.
Davis, Christopher R; Rosenfield, Lorne K
Google Glass has the potential to become a ubiquitous and translational technological tool within clinical plastic surgery. Google Glass allows clinicians to remotely view patient notes, laboratory results, and imaging; training can be augmented via streamed expert master classes; and patient safety can be improved by remote advice from a senior colleague. This systematic review identified and appraised every Google Glass publication relevant to plastic surgery and describes the first plastic surgical procedures recorded using Google Glass. A systematic review was performed using PubMed National Center for Biotechnology Information, Ovid MEDLINE, and the Cochrane Central Register of Controlled Trials, following modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key search terms "Google" and "Glass" identified mutually inclusive publications that were screened for inclusion. Eighty-two publications were identified, with 21 included for review. Google Glass publications were formal articles (n = 3), editorial/commentary articles (n = 7), conference proceedings (n = 1), news reports (n = 3), and online articles (n = 7). Data support Google Glass' positive impact on health care delivery, clinical training, medical documentation, and patient safety. Concerns exist regarding patient confidentiality, technical issues, and limited software. The first plastic surgical procedure performed using Google Glass was a blepharoplasty on October 29, 2013. Google Glass is an exciting translational technology with the potential to positively impact health care delivery, medical documentation, surgical training, and patient safety. Further high-quality scientific research is required to formally appraise Google Glass in the clinical setting.
Sullivan, Michael C; Yeo, Heather; Roman, Sanziana A; Bell, Richard H; Sosa, Julie A
To determine how marital status and having children impact US general surgical residents' attitudes toward training and personal life. There is a paucity of research describing how family and children affect the experience of general surgery residents. Cross-sectional survey involving all US categorical general surgery residents. Responses were evaluated by resident/program characteristics. Statistical analysis included the χ test and hierarchical logistic regression modeling. A total of 4402 residents were included (82.4% response rate) and categorized as married, single, or other (separated/divorced/widowed). Men were more likely to be married (57.8% vs 37.9%, P work (P work (P work hours caused strain on family life (P work (P = 0.001), were happy at work (P = 0.001), and reported a good program fit (P = 0.034), but had strain on family life (P work [odds ratio (OR): 1.22, P = 0.035], yet feeling that work caused family strain (OR: 1.66, P work (OR: 0.81, P = 0.007). Residents who were married or parents reported greater satisfaction and work-life conflict. The complex effects of family on surgical residents should inform programs to target support mechanisms for their trainees.
Silvestre, Jason; Lin, Ines C; Levin, L Scott; Chang, Benjamin
Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.
Silvestre, Jason; Lin, Ines C; Chang, Benjamin; Levin, L Scott
Orthopedic and plastic surgery residents receive unique training yet often compete for similar hand surgery fellowships. This study compared didactic hand surgery training during orthopedic and plastic surgery residency. The Plastic Surgery In-Service Training Exam and Orthopaedic In-Training Examination were analyzed for hand content for the years 2009 to 2013. Topics were categorized with the content outline for the Surgery of the Hand Examination. Differences were elucidated by means of Fisher's exact test. Relative to the Orthopaedic In-Training Examination, the Plastic Surgery In-Service Training Exam had greater hand representation (20.3 percent versus 8.1 percent; p < 0.001) with more annual hand questions (40 ± 3 versus 24 ± 2; p < 0.001). The Plastic Surgery Exam questions had more words, were less often level I-recall type, and were less often image-based. The questions focused more on finger and hand/palm anatomy, whereas the Orthopaedic examination was more wrist-focused. The Plastic Surgery Exam emphasized wound management and muscle/tendon injuries, but underemphasized fractures/dislocations. References differed, but Journal of Hand Surgery (American Volume) and Green's Operative Hand Surgery were common on both examinations. The Plastic Surgery Exam had a greater publication lag for journal references (10.7 ± 0.5 years versus 9.0 ± 0.6; p = 0.035). Differences in didactic hand surgery training are elucidated for plastic surgery and orthopedic residents. Deficiencies in the Plastic Surgery In-Service Training Exam hand curriculum relative to the Orthopaedic In-Training Examination may underprepare plastic surgeons for the Surgery of the Hand Examination. These data may assist future modifications to hand surgery training in the United States.
Elkabetz, R.; And Others
This study examined the impact of facial plastic surgery, labeling (mentally retarded, normal, Down's syndrome), and level of knowledge of Down's syndrome on 127 student teachers' evaluations of slides of persons with such characteristics. Although there was no overall significant main effect for the pre-post operation condition, there was a…
Horch, R E; Vogt, P M; Schaller, H E; Stark, G B; Lehnhardt, M; Kneser, U; Giunta, R E
Recruitment problems in surgical disciplines have become an increasingly debated topic. On the one hand current career prospects appear to be less attractive than those were seen for the previous generation. On the other hand the demands for a so-called "work-life balance" have changed and the proportion of female students and colleagues in medicine has risen and will continue to increase. Although Plastic Surgery currently seems to be less affected by these problems than other surgical disciplines, securing a qualified supply of young academics in Plastic Surgery is a prerequisite for the further development of this discipline. The traditional model of mentoring is discussed and the role of coaching in a sense of helping the mentorees examine what they are doing in the light of their intentions and goals is reflected. The present article tries to analyze the current status of academic Plastic Surgery from the viewpoint of German university senior surgeons in academic plastic surgery, and aims to highlight the specific prospects for young academics against the backdrop of an often one-sided and superficial perception of this profession. © Georg Thieme Verlag KG Stuttgart · New York.
In the early 1990s, it was reported that silicone breast implants were possibly responsible for serious damage to women's health. In January 1992, the Food and Drug Administration issued a voluntary breast implant moratorium and, in April, issued a ban on the use of silicone gel-filled implants for cosmetic breast augmentation. Since that time, silicone gel-filled breast implants have been available to women only for select cases: women seeking breast reconstruction or revision of an existing breast implant, women who have had breast cancer surgery, a severe injury to the breast, a birth defect that affects the breast, or a medical condition causing a severe breast deformity. Since the ban on the use of silicone gel-filled breast implants for cosmetic breast augmentation, numerous scientific studies have been conducted. To ensure patient safety, the American Board of Plastic Surgery believes that these scientific studies and the Food and Drug Administration's scrutiny of silicone gel-filled breast implants have been appropriate and necessary.
E. Cabrera Sánchez
Full Text Available La Telemedicina es aplicable a todos los campos médicos, incluyendo la Cirugía. Poca atención se ha prestado a sus aplicaciones diagnósticas, de las que sin embargo, nuestra especialidad, en la que es perfectamente aplicable el antiguo proverbio chino "una imagen vale mil palabras", podría salir muy beneficiada. Esto permitiría una mayor reducción de costes con contundentes mejoras en eficiencia y calidad. Presentamos un modelo de Telemedicina tipo envío y almacenaje (store and forward desarrollado y aplicado en un hospital británico del sureste de Inglaterra desde hace 7 años. Comentamos las ventajas e inconvenientes del sistema y sus posibles aplicaciones en nuestro medio. Es un hecho claro que estas tecnologías van a producir un gran cambio en la sociedad y en el quehacer diario del médico durante la próxima década. Lo que hoy conocemos como Telemedicina, en breve perderá el prefijo "tele" porque la población entenderá este tipo de Medicina y de aplicaciones telemáticas como algo habitual. Sin duda, nuestra especialidad será una de las grandes beneficiadas de la aplicación de estas tecnologías.Telemedicine is available in any medical fields, including Surgery. Poor attention has been showed to diagnosis application. Nevertheless, Plastic Surgery, is a practice in which the application of the old chinese proverb: "A picture is better than thousand words", would be very benefited, reducing costs and improving efficiency and quality. We present a Telemedicine store and forward model developed and worked in a Plastic Surgery Unit of southern England for 7 years. We show system advantages and disvantages and its potential applications in our country. It's clear that this technology will be able to produce a great change in our society and in our daily medical activity in the next years. What today we knows as Telemedicine, in a few time will lose "tele" prefix, because people will understand as usual this kind of Medicine and
Devitt, Katharine S; Kim, Michael J; Gotlib Conn, Lesley; Wright, Frances C; Moulton, Carol-Anne; Keshet, Itay; Ahmed, Najma
Individuals representing various surgical disciplines have expressed concerns with the impact of resident duty hours (RDH) restrictions on resident education and patient outcomes. This thematic review of published viewpoints aimed to describe the effects of these restrictions in surgery. The authors conducted a qualitative systematic review of non-research-based literature published between 2003 and 2015. Articles were included if they focused on the RDH restrictions in surgery and resident wellness, health promotion, resident safety, resident education and/or training, patient safety, medical errors, and/or heterogeneity regarding training or disciplines. A thematic analysis approach guided data extraction. Contextual data were abstracted from the included articles to aid in framing the identified themes. Of 1,482 identified articles, 214 were included in the review. Most were from authors in the United States (144; 67%) and focused on the 80-hour workweek (164; 77%). The emerging themes were organized into three overarching categories: (1) impact of the RDH restrictions, (2) surgery has its own unique culture, and (3) strategies going forward. Published opinions suggested that RDH restrictions alone are insufficient to achieve the desired outcomes and that careful consideration of the surgical training model is needed to maintain the integrity of educational outcomes. Opinions from the surgical community highlight the complexity of issues surrounding the RDH restrictions and suggest that recent changes are not achieving all the desired outcomes and have resulted in unintended outcomes. From the perceptions of the various stakeholders in surgical education studied, areas for new policies were identified.
Grignol, Valerie P; Gans, Alyssa; Booth, Branyan A; Markert, Ronald; Termuhlen, Paula M
A correlation exists between people who engage in academic dishonesty as students and unethical behaviors later as professionals. Academic dishonesty has been assessed among medical students, but not among general surgery residents. We sought to describe the attitudes of general surgery residents with regard to ethical practices in test taking. A survey with 4 scenarios describing activities related to examination taking that may or may not be considered unethical was administered. Participants were asked about participation in the activities-either personally or any knowledge of others-and whether the activities were unethical. Fifty-seven of 62 residents (92%) participated. For each scenario, >70% indicated that neither they nor anyone else they knew had participated in the activities. Behaviors deemed unethical included memorizing or using memorized questions to prepare for future tests (52%), selling questions for financial gain (90%), and purchasing previously used questions (57%). No difference in attitudes was seen among incoming interns, junior-level (postgraduate year [PGY]1-3), or senior-level (PGY4-6) residents. Overall, general surgery residents indicated that they had not participated in activities they felt to be unethical. Defining what is unethical was less clear. This represents an area for further education. Copyright 2010 Mosby, Inc. All rights reserved.
Wu, Cindy; Scott Hultman, C; Diegidio, Paul; Hermiz, Steven; Garimella, Roja; Crutchfield, Trisha M; Lee, Clara N
What do patients want when looking for an aesthetic surgeon? When faced with attributes like reputation, years in practice, testimonials, photos, and pricing, which is more valuable? Moreover, are attributes procedure-specific? Currently, inadequate evidence exists on which attributes are most important to patients, and to our knowledge, none on procedure-specific preferences. First, to determine the most important attributes to breast augmentation, combined breast/abdominal surgery, and facelift patients using conjoint analysis. Second, to test the conjoint using an internet crowdsourcing service (Amazon Mechanical Turk [MTurk]). Anonymous university members were asked, via mass electronic survey, to pick a surgeon for facelift surgery based on five attributes. Attribute importance and preference was calculated. Once pre-tested, the facelift, breast augmentation and combined breast/abdominal surgery surveys were administered worldwide to MTurk. The university facelift cohort valued testimonials (33.9%) as the most important, followed by photos (31.6%), reputation (18.2%), pricing (14.4%), and practice years (1.9%). MTurk breast augmentation participants valued photos (35.3%), then testimonials (33.9%), reputation (15.7%), pricing (12.2%), and practice years (3%). MTurk combined breast/abdominal surgery and facelift participants valued testimonials (38.3% and 38.1%, respectively), then photos (27.9%, 29.4%), reputation (17.5%, 15.8%), pricing (13.9%, 13.9%), practice years (2.4%, 2.8%). Breast augmentation patients placed higher importance on photos; combined breast/abdominal surgery and facelift patients valued testimonials. Conjoint analysis has had limited application in plastic surgery. To our knowledge, internet crowdsourcing is a novel participant recruitment method in plastic surgery. Its unique benefits include broad, diverse and anonymous participant pools, low-cost, rapid data collection, and high completion rate. © 2016 The American Society for
Pitak-Arnnop, Poramate; Bauer, Ute; Dhanuthai, Kittipong; Brückner, Martin; Herve, Christian; Meningaud, Jean-Paul; Hemprich, Alexander
Ethical standards of biomedical publications are associated with editorial leadership, such as contents of instructions to authors and journal's mechanisms for research and publication ethics. To compare ethical issues in the guidelines for authors in oral-craniomaxillofacial/facial plastic surgery (OCM-FPS) journals with those in plastic surgery and otorhinolaryngology/head and neck surgery (ORL-HNS) journals, and to evaluate the relationship between journal's impact factor (IF) and ethical issues in the instructions to authors. This study used a cross-sectional study design. The predictor variables were journal's specialty and IF. The outcome variable was the presence of seven ethical issues in the online versions of journal's instructions to authors in October 2009. We included only journals with identifiable IF for 2008, published in English, French, German and Thai. Appropriate descriptive and univariate statistics were computed for all study variables. The level of statistical significance was set at Pjournals: seven OCM-FPS (14.6%), 14 plastic surgery (29.2%) and 27 ORL-HNS (56.2%) journals. Only four journals (8.3%) mentioned all ethical issues in their guidelines for authors. Neither journal's specialty nor IF was linked to completeness of the ethical requirements. The results of this study suggest that ethical issues in the instructions to authors of most IF-indexed journals in OCM-FPS, plastic surgery and ORL-HNS are incomplete, regardless of specialty and IF. There is room for substantial improvement to uphold scientific integrity of these surgical specialties. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Sun, Beatrice J; Tijerina, Jonathan; Nazerali, Rahim S; Lee, Gordon K
In recent years, there has been a push to publish higher level of evidence studies in medicine, particularly in plastic surgery. Well-conducted systematic reviews are considered the strongest level of evidence in medicine, recently becoming the key process indicators for quality delivery. A varying quality of systematic reviews, however, has led to concerns of their validity in clinical decision-making. We perform a quality analysis of systematic reviews published in head and neck microsurgery by the surgical specialties of plastic surgery and otolaryngology. An evaluation of systematic reviews published on microsurgery in 13 high-impact surgical journals was conducted by searching PubMed and Scopus. Two authors independently performed searches, screened for eligibility, and extracted data from included articles. Discrepancies were resolved by discussion and consensus. Assessment of Multiple Systematic Reviews (AMSTAR) criteria were used to assess methodological quality. The initial database search retrieved 166 articles. After removing duplicates, screening titles and abstracts, 26 articles remained for full text review. Seven did not focus on head and neck microsurgery and were further excluded, leaving 19 systematic reviews for final analysis. Of those, 10 systematic reviews were published by otolaryngology, and 9 were published by plastic surgery. Median AMSTAR score was 8 for otolaryngology, 7 for plastic surgery, and 8 overall, reflecting "fair to good" quality. The number of systematic reviews on head and neck microsurgery markedly increased over time. Of note, both the AMSTAR score and the number of systematic reviews published by plastic surgery have steadily increased from 2014 to 2016, whereas those published by otolaryngology have remained relatively stable since 2010. Our review shows a trend toward publishing more systematic reviews. The increasing quantity and quality of systematic reviews published by plastic surgeons indicates recognition in the
Tseng, Warren H; Jin, Leah; Canter, Robert J; Martinez, Steve R; Khatri, Vijay P; Gauvin, Jeffrey; Bold, Richard J; Wisner, David; Taylor, Sandra; Chen, Steven L
Outcomes of surgical resident training are under scrutiny with the changing milieu of surgical education. Few have investigated the effect of surgical resident involvement (SRI) on operative parameters. Examining 7 common general surgery procedures, we evaluated the effect of SRI on perioperative morbidity and mortality and operative time (OpT). The American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2007) was used to identify 7 cases of nonemergent operations. Cases with simultaneous procedures were excluded. Logistic regression was performed across all procedures and within each procedure incorporating SRI, OpT, and risk-stratifying American College of Surgery National Surgical Quality Improvement Program morbidity and mortality probability scores, which incorporate multiple prognostic individual patient factors. Procedure-specific, SRI-stratified OpTs were compared using Wilcoxon rank-sum tests. A total of 71.3% of the 37,907 cases had SRI. Absolute 30-day morbidity for all cases with SRI and without SRI were 3.0% and 1.0%, respectively (p < 0.001); absolute 30-day mortality for all cases with SRI and without SRI were 0.1% and 0.08%, respectively (p < 0.001). After multivariate analysis by specific procedure, SRI was not associated with increased morbidity but was associated with decreased mortality during open right colectomy (odds ratio 0.32; p = 0.01). Across all procedures, SRI was associated with increased morbidity (odds ratio 1.14; p = 0.048) but decreased mortality (odds ratio 0.42; p < 0.001). Mean OpT for all procedures was consistently lower for cases without SRI. SRI has a measurable impact on both 30-day morbidity and mortality and OpT. These data have implications to the impact associated with surgical graduate medical education. Further studies to identify causes of patient morbidity and prevention strategies in surgical teaching environments are warranted. Copyright © 2011 American College of Surgeons
Full Text Available Sidharth Puri,1 Amanda E Kiely,2 Jiangxia Wang,3 Alonzo S Woodfield,4 Saras Ramanathan,5 Shameema Sikder21Johns Hopkins School of Medicine, Baltimore, MD, 2Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 4Kaiser Permanente South Sacramento Medical Center, Sacramento, 5San Francisco School of Medicine, University of California, San Francisco, CA, USAPurpose: To determine whether supervision by an attending new to surgical teaching or an experienced attending measurably influences intraoperative complications rates or outcomes in phacoemulsification performed by ophthalmology residents.Setting: Single tertiary hospital.Design: Retrospective cohort study. Methods: Resident-performed phacoemulsification cases supervised by one novice attending (N=189 and experienced attending (N=172 over 1 year were included. Data included: resident year, patient age, sex, preoperative risk factors (4+ dense/white/brunescent cataracts, Flomax, zonular dialysis, pseudoexfoliation, glaucoma risk, post-vitrectomy, intraoperative risk factors (Trypan blue, iris hooks, and intraoperative complications (capsule tears, vitreous loss, zonular dialysis, zonular dehiscence, burns, nuclear fragment loss, Descemet’s tear. Experienced attending data were compared against those of the novice attending.Results: Regarding preoperative risks, experienced attending cases more likely involved 4+ cataract (P=0.005, Flomax (P<0.001, or glaucoma risk (P=0.001. For intraoperative risks, novice attending cases more likely involved Trypan blue (P<0.001. Regarding complications, novice attending cases were associated with vitreous loss (P=0.002 and anterior capsule tears (P<0.001. When comparing total complications, the novice attending was more likely to have both increased number of cases with complications and total complications than the experienced attending. The novice
M. Erol Demirseren
Full Text Available Achieving a level of technical skill and confidence in surgical operations is the main goal of plastic surgical training. Operating rooms were accepted as the practical teaching venues of the traditional apprenticeship model. However, increased patient population, time, and ethical and legal considerations made preoperation room practical work a must for plastic surgical training. There are several plastic surgical teaching models and simulators which are very useful in preoperation room practical training and the evaluation of plastic surgery residents. The full thickness skin with its vascular network excised in abdominoplasty procedures is an easily obtainable real human tissue which could be used as a training model in plastic surgery.
Al-Himdani, Sarah; Jessop, Zita M; Al-Sabah, Ayesha; Combellack, Emman; Ibrahim, Amel; Doak, Shareen H; Hart, Andrew M; Archer, Charles W; Thornton, Catherine A; Whitaker, Iain S
Recent advances in microsurgery, imaging, and transplantation have led to significant refinements in autologous reconstructive options; however, the morbidity of donor sites remains. This would be eliminated by successful clinical translation of tissue-engineered solutions into surgical practice. Plastic surgeons are uniquely placed to be intrinsically involved in the research and development of laboratory engineered tissues and their subsequent use. In this article, we present an overview of the field of tissue engineering, with the practicing plastic surgeon in mind. The Medical Research Council states that regenerative medicine and tissue engineering "holds the promise of revolutionizing patient care in the twenty-first century." The UK government highlighted regenerative medicine as one of the key eight great technologies in their industrial strategy worthy of significant investment. The long-term aim of successful biomanufacture to repair composite defects depends on interdisciplinary collaboration between cell biologists, material scientists, engineers, and associated medical specialties; however currently, there is a current lack of coordination in the field as a whole. Barriers to translation are deep rooted at the basic science level, manifested by a lack of consensus on the ideal cell source, scaffold, molecular cues, and environment and manufacturing strategy. There is also insufficient understanding of the long-term safety and durability of tissue-engineered constructs. This review aims to highlight that individualized approaches to the field are not adequate, and research collaboratives will be essential to bring together differing areas of expertise to expedite future clinical translation. The use of tissue engineering in reconstructive surgery would result in a paradigm shift but it is important to maintain realistic expectations. It is generally accepted that it takes 20-30 years from the start of basic science research to clinical utility
Miranda, Benjamin H; Ali, Syed N; Jeffery, Steven L A; Thomas, Sunil S
This study was designed to identify wound microorganisms and the reasons for differing prevalence between the wards, burns unit and intensive care unit (ICU) in a regional centre for burns and plastic surgery. Antibiotic sensitivities of the 10 most prevalent microorganisms cultured from inpatient wound swabs were also investigated. Inpatient wound swab data were collected retrospectively using notes and departmental database information between January and June 2007. Data were analyzed using chi-squared tests and P-values. Eight hundred five positive wound swabs from 204 swab positive inpatients were analyzed. Stage 1 of this study demonstrated 917 positive swab episodes and 30 varieties of organism. The five most prevalent organisms cultured were Staphylococcus (23.9%), Acinetobacter (21.2%), Methicillin Resistant Staphylococcus aureus (MRSA) (20.8%), Pseudomonas (9.7%) and Enterococcus (5.2%). Stage 2 revealed that Acinetobacter baumanni (ABAU) was significantly more prevalent in military over civilian inpatients (P < .001) and that military inpatients had a significantly greater proportion of ABAU over civilian inpatients within the first 24 hours after admission (P < .001). ABAU episodes were significantly higher on the ICU over the burns unit and on the wards (P < .001). MRSA was significantly more prevalent in military inpatients (P < .001); however, no significant difference was observed within the first 24 hours after admission (P = .440). MRSA was more prevalent on the ICU over the burns unit (P = .023). Pseudomonas aeruginosa (PAER) was significantly more prevalent in military inpatients over civilian inpatients (P < .001), and on the ICU over the burns unit and wards (P = .018). Stage 1 generated a comprehensive, up to date cross section of bacterial flora, with corresponding percentage antibiotic sensitivities, in a regional burns and plastic surgery centre. This will give clinicians a snapshot of organisms affecting inpatient wounds in advance of
Colvard, Benjamin; Shames, Murray; Schanzer, Andres; Rectenwald, John; Chaer, Rabih; Lee, Jason T
The first 2 integrated vascular residents in the United States graduated in 2012, and in 2013, 11 more entered the job market. The purpose of this study was to compare the job search experiences of the first cohort of integrated 0 + 5 graduates to their counterparts completing traditional 5 + 2 fellowship programs. An anonymous, Web-based, 15-question survey was sent to all 11 graduating integrated residents in 2013 and to the 25 corresponding 5 + 2 graduating fellows within the same institution. Questions focused on the following domains: training experience, job search timelines and outcomes, and overall satisfaction with each training paradigm. Survey response was nearly 81% for the 0 + 5 graduates and 64% for the 5 + 2 graduates. Overall, there was no significant difference between residents and fellows in the operative experience obtained as measured by the number of open and endovascular cases logged. Dedicated research time during the entire training period was similar between residents and fellows. Nearly all graduates were extremely satisfied with their training and had positive experiences during their job searches with respect to starting salaries, numbers of offers, and desired practice type. More 0 + 5 residents chose academic and mixed practices over private practices compared with 5 + 2 fellowship graduates. Although longer term data are needed to understand the impact of the addition of 0 + 5 graduating residents to the vascular surgery work force, preliminary survey results suggest that both training paradigms (0 + 5 and 5 + 2) provide positive training experiences that result in excellent job search experiences. Based on the current and future need for vascular surgeons in the work force, the continued growth and expansion of integrated 0 + 5 vascular surgery residency positions as an alternative to traditional fellowship training is thus far justified. Copyright © 2015 Elsevier Inc. All rights reserved.
Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy
To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing
Ayyildiz, Erdem; Tan, Enes; Keklik, Hakan; Demirtag, Zulfikar; Celebi, Ahmet Arif; Pithon, Matheus Melo
Objective: The aim of the this study was to evaluate the perception of smile esthetics and alterations in cases of gingival plastic surgery for correction of a gummy smile, by means of alterations in smile photograph among dentistry degree students. Materials and Methods: A frontal smile photograph of a 40-year-old woman having normal occlusion was used with diverse compositions of gingival exposure level and crown length of maxillary teeth. The eight photographs were evaluated by 216 dentistry students in five class groups (1st, 2nd, 3rd, 4th and 5th classes). Results: The results revealed that almost all of the class’ students perceived differences between images, additionally, the highest percentage of students that answered “no difference” was 12% at 1st class’ students. 1st and 2nd class’ students most liked photograph which is 2.5 mm gingival display and 3rd class students liked two different photographs which are 2.5 mm gingival display and 2 mm gingival display whereas 4th class students preferred two different photographs which are 1.5 mm gingival display and 1 mm gingival display, 5th class students preferred photograph which is 1.5 mm gingival display as the most. Conclusion: Esthetic perception of smile improve as a student passes to higher study classes in terms of gingival exposure. The harmonious display of gingiva exhibits an important effect in the smile esthetics rather than reduced or excessive display. PMID:27403061
Abraham, Manoj T; Rousso, Joseph J; Hu, Shirley; Brown, Ryan F; Moscatello, Augustine L; Finn, J Charles; Patel, Neha A; Kadakia, Sameep P; Wood-Smith, Donald
The American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE database was created to gather and organize patient data primarily from international humanitarian surgical mission trips, as well as local humanitarian initiatives. Similar to cloud-based Electronic Medical Records, this web-based user-generated database allows for more accurate tracking of provider and patient information and outcomes, regardless of site, and is useful when coordinating follow-up care for patients. The database is particularly useful on international mission trips as there are often different surgeons who may provide care to patients on subsequent missions, and patients who may visit more than 1 mission site. Ultimately, by pooling data across multiples sites and over time, the database has the potential to be a useful resource for population-based studies and outcome data analysis. The objective of this paper is to delineate the process involved in creating the AAFPRS FACE TO FACE database, to assess its functional utility, to draw comparisons to electronic medical records systems that are now widely implemented, and to explain the specific benefits and disadvantages of the use of the database as it was implemented on recent international surgical mission trips.
Ryssel, H; Germann, G; Köllensperger, E; Riedel, K
Gynecomastia is a potential side effect of hormone therapy for prostate cancer. In large, randomized, placebo controlled studies approximately 50% or more of patients with prostate cancer experienced gynecomastia attributable to various mechanisms. Although it is mostly reported as mild to moderate, gynecomastia is one of the reasons most frequently cited for premature discontinuation of such treatment. Prophylactic radiotherapy and prophylactic tamoxifen have been shown to decrease the incidence of hormone-induced gynecomastia; nevertheless, there are still cases of refractory gynecomastia, and in these plastic surgery is needed for correction. Gynecomastia is a benign enlargement of the male breast, requiring no treatment unless it is a source of embarrassment and/or distress for the adolescent or man affected. The indications for surgical treatment of gynecomastia are founded on two main objectives: restoration of the male chest shape and diagnostic evaluation of suspected breast lesions. The authors believe that the complete circumareolar technique with no further scarring creates the best aesthetic results with fewer complications. When this is used in combination with liposuction very pleasing aesthetic results can be achieved.
Pluvy, I; Garrido, I; Pauchot, J; Saboye, J; Chavoin, J P; Tropet, Y; Grolleau, J L; Chaput, B
Smoking patients undergoing a plastic surgery intervention are exposed to increased risk of perioperative and postoperative complications. It seemed useful to us to establish an update about the negative impact of smoking, especially on wound healing, and also about the indisputable benefits of quitting. We wish to propose a minimum time lapse of withdrawal in the preoperative and postoperative period in order to reduce the risks and maximize the results of the intervention. A literature review of documents from 1972 to 2014 was carried out by searching five different databases (Medline, PubMed Central, Cochrane library, Pascal and Web of Science). Cigarette smoke has a diffuse and multifactorial impact in the body. Hypoxia, tissue ischemia and immune disorders induced by tobacco consumption cause alterations of the healing process. Some of these effects are reversible by quitting. Data from the literature recommend a preoperative smoking cessation period lasting between 3 and 8 weeks and up until 4 weeks postoperatively. Use of nicotine replacement therapies doubles the abstinence rate in the short term. When a patient is heavily dependent, the surgeon should be helped by a tobacco specialist. Total smoking cessation of 4 weeks preoperatively and lasting until primary healing of the operative site (2 weeks) appears to optimize surgical conditions without heightening anesthetic risk. Tobacco withdrawal assistance, both human and drug-based, is highly recommended. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Moore, Maureen D; Abelson, Jonathan S; O'Mahoney, Paul; Bagautdinov, Iskander; Yeo, Heather; Watkins, Anthony C
As an adjunct to simulation-based teaching, laparoscopic video-based surgical coaching has been an effective tool to augment surgical education. However, the wide use of video review in open surgery has been limited primarily due to technological and logistical challenges. The aims of our study were to (1) evaluate perceptions of general surgery (GS) residents on video-assisted operative instruction and (2) conduct a pilot study using a head-mounted GoPro in conjunction with the operative performance rating system to assess feasibility of providing video review to enhance operative feedback during open procedures. GS residents were anonymously surveyed to evaluate their perceptions of oral and written operative feedback and use of video-based operative resources. We then conducted a pilot study of 10 GS residents to assess the utility and feasibility of using a GoPro to record resident performance of an arteriovenous fistula creation with an attending surgeon. Categorical variables were analyzed using the chi-square test. Academic, tertiary medical center. GS residents and faculty. A total of 59 GS residents were anonymously surveyed (response rate = 65.5%). A total of 40% (n = 24) of residents reported that structured evaluations rarely or never provided meaningful feedback. When feedback was received, 55% (n = 32) residents reported that it was only rarely or sometimes in regard to their operative skills. There was no significant difference in surveyed responses among junior postgraduate year (PGY 1-2), senior (PGY 3-4), or chief residents (PGY-5). A total of 80% (n = 8) of residents found the use of GoPro video review very or extremely useful for education; they also deemed video review more useful for operative feedback than written or communicative feedback. An overwhelming majority (90%, n = 9) felt that video review would lead to improved technical skills, wanted to review the video with the attending surgeon for further feedback, and desired expansion of
Ahmed M. S. Ibrahim, MD
Conclusions: Plastic surgeons currently use ADM in breast reconstruction for both immediate and staged procedures. Of those responding, a majority of plastic surgeons will incorporate drains and use postoperative antibiotics for more than 48 hours.
Flynn-O'Brien, Katherine T; Mandell, Samuel P; Eaton, Erik Van; Schleyer, Anneliese M; McIntyre, Lisa K
Morbidity and mortality conferences (MMCs) are often used to fulfill the Accreditation Council for Graduate Medical Education practice-based learning and improvement (PBLI) competency, but there is variation among institutions and disciplines in their approach to MMCs. The objective of this study is to examine the trainees' perspective and experience with MMCs and adverse patient event (APE) reporting across disciplines to help guide the future implementation of an institution-wide, workflow-embedded, quality improvement (QI) program for PBLI. Between April 1, 2013, and May 8, 2013, surgical and medical residents were given a confidential survey about APE reporting practices and experience with and attitudes toward MMCs and other QI/patient safety initiatives. Descriptive statistics and univariate analyses using the chi-square test for independence were calculated for all variables. Logistic regression and ordered logistic regression were used for nominal and ordinal categorical dependent variables, respectively, to calculate odds of reporting APEs. Qualitative content analysis was used to code free-text responses. A large, multihospital, tertiary academic training program in the Pacific Northwest. Residents in all years of training from the Accreditation Council for Graduate Medical Education-accredited programs in surgery and internal medicine. Survey response rate was 46.2% (126/273). Although most respondents agreed or strongly agreed that knowledge of and involvement in QI/patient safety activities was important to their training (88.1%) and future career (91.3%), only 10.3% regularly or frequently reported APEs to the institution's established electronic incident reporting system. Senior-level residents in both surgery and medicine were more likely to report APEs than more junior-level residents were (odds ratio = 4.8, 95% CI: 3.1-7.5). Surgery residents had a 4.9 (95% CI: 2.3-10.5) times higher odds than medicine residents had to have reported an APE to
Al-Himdani, Sarah; Jessop, Zita M.; Al-Sabah, Ayesha; Combellack, Emman; Ibrahim, Amel; Doak, Shareen H.; Hart, Andrew M.; Archer, Charles W.; Thornton, Catherine A.; Whitaker, Iain S.
Recent advances in microsurgery, imaging, and transplantation have led to significant refinements in autologous reconstructive options; however, the morbidity of donor sites remains. This would be eliminated by successful clinical translation of tissue-engineered solutions into surgical practice. Plastic surgeons are uniquely placed to be intrinsically involved in the research and development of laboratory engineered tissues and their subsequent use. In this article, we present an overview of the field of tissue engineering, with the practicing plastic surgeon in mind. The Medical Research Council states that regenerative medicine and tissue engineering “holds the promise of revolutionizing patient care in the twenty-first century.” The UK government highlighted regenerative medicine as one of the key eight great technologies in their industrial strategy worthy of significant investment. The long-term aim of successful biomanufacture to repair composite defects depends on interdisciplinary collaboration between cell biologists, material scientists, engineers, and associated medical specialties; however currently, there is a current lack of coordination in the field as a whole. Barriers to translation are deep rooted at the basic science level, manifested by a lack of consensus on the ideal cell source, scaffold, molecular cues, and environment and manufacturing strategy. There is also insufficient understanding of the long-term safety and durability of tissue-engineered constructs. This review aims to highlight that individualized approaches to the field are not adequate, and research collaboratives will be essential to bring together differing areas of expertise to expedite future clinical translation. The use of tissue engineering in reconstructive surgery would result in a paradigm shift but it is important to maintain realistic expectations. It is generally accepted that it takes 20–30 years from the start of basic science research to clinical utility
Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L
A pilot study of two academic training programs revealed concerning levels of resident burnout and psychological dysfunction. The purpose of the present study was to determine the quality of life of orthopaedic residents and faculty on a national scale and to identify risk factors for decompensation. Three hundred and eighty-four orthopaedic residents and 264 full-time orthopaedic faculty members completed a voluntary, anonymous survey consisting of three validated instruments (the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale) and question sets assessing demographic information, relationship issues, stress reactions/management, and work/life balance. High levels of burnout were seen in 56% of the residents and 28% of the faculty members. Burnout risk was greatest among second-postgraduate-year residents and residents in training programs with six or more residents per postgraduate year. Sixteen percent of residents and 19% of faculty members reported symptoms of psychological distress. Sleep deprivation was common among the residents and correlated positively with every distress measure. Faculty reported greater levels of stress but greater satisfaction with work and work/life balance. A number of factors, such as making time for hobbies and limiting alcohol use, correlated with decreased dysfunction for both residents and faculty. Despite reporting high levels of job satisfaction, orthopaedic residents and faculty are at risk for burnout and distress. Identification of protective factors and risk factors may provide guidance to improve the quality of life of academic orthopaedic surgeons in training and beyond.
Huang, Bryant Y; Hicks, Taylor D; Haidar, Georges M; Pounds, Lori L; Davies, Mark G
Vascular surgery residency and fellowship applicants commonly seek information about programs from the Internet. Lack of an effective web presence curtails the ability of programs to attract applicants, and in turn applicants may be unable to ascertain which programs are the best fit for their career aspirations. This study was designed to evaluate the presence, accessibility, comprehensiveness, and quality of vascular surgery training websites (VSTW). A list of accredited vascular surgery training programs (integrated residencies and fellowships) was obtained from four databases for vascular surgery education: the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, Fellowship and Residency Electronic Interactive Database, and Society for Vascular Surgery. Programs participating in the 2016 National Resident Matching Program were eligible for study inclusion. Accessibility of VSTW was determined by surveying the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, and Fellowship and Residency Electronic Interactive Database for the total number of programs listed and for the presence or absence of website links. VSTW were analyzed for the availability of recruitment and education content items. The quality of VSTW was determined as a composite of four dimensions: content, design, organization, and user friendliness. Percent agreements and kappa statistics were calculated for inter-rater reliability. Eighty-nine of the 94 fellowship (95%) and 45 of the 48 integrated residencies (94%) programs participating in the 2016 Match had a VSTW. For program recruitment, evaluators found an average of 12 of 32 content items (35.0%) for fellowship programs and an average of 12 of 32 (37%) for integrated residencies. Only 47.1% of fellowship programs (53% integrated residencies) specified the number of positions available for the 2016 Match, 20% (13% integrated residencies) indicated alumni
Abdelsattar, Jad M; AlJamal, Yazan N; Ruparel, Raaj K; Rowse, Phillip G; Heller, Stephanie F; Farley, David R
Faculty evaluations, ABSITE scores, and operative case volumes often tell little about true resident performance. We developed an objective structured clinical examination called the Surgical X-Games (5 rooms, 15 minutes each, 12-15 tests total, different for each postgraduate [PGY] level). We hypothesized that performance in X-Games will prove more useful in identifying areas of strength or weakness among general surgery (GS) residents than faculty evaluations, ABSITE scores, or operative cases volumes. PGY 2 to 5 GS residents (n = 35) were tested in a semiannual X-Games assessment using multiple simulation tasks: laparoscopic skills, bowel anastomosis, CT/CXR analysis, chest tube placement, etc. over 1 academic year. Resident scores were compared to their ABSITE, in-training evaluation reports, and operating room case numbers. Academic medical center. PGY-2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN. Results varied greatly within each class except for staff evaluations: in-training evaluation reports medians for PGY-2s were 5.3 (range: 5.0-6.0), PGY-3s 5.9 (5.5-6.3), PGY-4s 5.6 (5.0-6.0), and PGY-5s were 6.1 (5.6-6.9). Although ABSITE and operating room case volumes fluctated greatly with each PGY class, only X-Games scores (median: PGY-2 = 82, PGY-3 = 61, PGY-4 = 76, and PGY-5 = 60) correlated positively (p < 0.05) with operative case volume and negatively (p < 0.05) with staff evaluations. X-Games assessment generated wide differentiation of resident performance quickly, inexpensively, and objectively. Although "Minnesota-nice" surgical staff may feel all GS trainees are "above average," objective assessment tells us otherwise. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Hultman, Charles Scott; Wagner, Ida Janelle
Professionalism is now recognized as a core competency of surgical education and is required for certification and licensure. However, best teaching methods remain elusive, because (1) ethical standards are not absolute, and (2) learning and teaching styles vary considerably-both of which are influenced by cultural and generational forces. We sought to compare attitudes, knowledge, and behaviors in fourth year medical students, compared to surgeons in training and practice, focusing on issues related to professionalism in plastic surgery. Fourth year medical students participating in a capstone course (n = 160), surgical residents (n = 219), and attending surgeons (n = 99) at a single institution were asked to complete a questionnaire regarding surgical professionalism. Participants (1) identified components of professionalism, (2) cited examples of unprofessional behavior, (3) ranked the egregiousness of 30 scenarios, and (4) indicated best educational practices. Cohorts were compared using t test and χ, with statistical significance assigned to P values less than 0.05. Compared to surgeons in training or practice, medical students were younger (27.8 vs 38.0 years, P ethics" as the defining component of professionalism. Respondents from both groups agreed that professionalism could be taught, learned, and assessed. Surgeons (94.3%) had observed unprofessional behavior, as did 88.0% of students; "poor anger management," "dishonesty," and "bullying" were the most common examples. Compared to students, however, surgeons were more likely to witness substance and physical abuse (P company whose product the surgeon uses" (33% vs 13%, P behavioral aspects of professionalism. The fact that some clearly egregious behaviors are not viewed as unethical by individual students, trainees, and surgeons, and that such behavior continues to be observed, indicates the need to improve our efforts in promoting professionalism in plastic surgery.
Han, Kyunghwa; Jung, Inkyung
This review article presents an assessment of trends in statistical methods and an evaluation of their appropriateness in articles published in the Archives of Plastic Surgery (APS) from 2012 to 2017. We reviewed 388 original articles published in APS between 2012 and 2017. We categorized the articles that used statistical methods according to the type of statistical method, the number of statistical methods, and the type of statistical software used. We checked whether there were errors in the description of statistical methods and results. A total of 230 articles (59.3%) published in APS between 2012 and 2017 used one or more statistical method. Within these articles, there were 261 applications of statistical methods with continuous or ordinal outcomes, and 139 applications of statistical methods with categorical outcome. The Pearson chi-square test (17.4%) and the Mann-Whitney U test (14.4%) were the most frequently used methods. Errors in describing statistical methods and results were found in 133 of the 230 articles (57.8%). Inadequate description of P-values was the most common error (39.1%). Among the 230 articles that used statistical methods, 71.7% provided details about the statistical software programs used for the analyses. SPSS was predominantly used in the articles that presented statistical analyses. We found that the use of statistical methods in APS has increased over the last 6 years. It seems that researchers have been paying more attention to the proper use of statistics in recent years. It is expected that these positive trends will continue in APS.
Oliker, Aaron; Napier, Zachary; Deluccia, Nicolette; Qualter, John; Sculli, Frank; Smith, Brandon; Stern, Carrie; Flores, Roberto; Hazen, Alexes; McCarthy, Joseph
BioDigital Systems, LLC in collaboration with New York University Langone Medical Center Department of Reconstructive Plastic Surgery has created a complex, real-time, step-based simulation platform for plastic surgery education. These simulators combine live surgical footage, interactive 3D visualization, text labels, and voiceover as well as a high-yield, expert-approved testing mode to create a comprehensive virtual educational environment for the plastic surgery resident or physician.