Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study.

Objective: The ongoing complexity of general surgery training has led to an increased focus on ensuring the competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, Accreditation Council for Graduate Medical Education (ACGME) Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country.

The surgical management of complicated peptic ulcer disease: An EAST video presentation.

Background: Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention.

The PASS Course: Practical Anatomy and Surgical Skills Course as a Pragmatic Primer for Senior Medical Students Pursuing Surgical Residency.

The senior year of undergraduate medical education has been scrutinized for lacking emphasis from educators and value for students. Surgical residency program directors and medical students have reported different sets of perceived weaknesses as surgical trainees enter residency. With this in mind, we developed a novel rotation for senior medical students pursuing surgical residency.

Mastering the Match: Recruiting a Successful Surgery Resident.

Purpose Of Review: The objective of general surgery residency is to produce competent surgeons. At a minimum this requires being procedurally and clinically capable and able to pass the board exams. Recruitment is designed to select those residents who can successfully do so.

Lacking Advanced Degrees are not a Barrier to Entry into Academic Surgery Leadership.

Background: Undergraduate and graduate medical education offerings continue to create opportunities for medical students to pursue MD+ degree education. These educational endeavors provide formal education in fields related to surgery, which gives trainees and surgeons diverse perspectives on surgical care. This study sought to assess current prevalence of additional advanced degrees among leaders in academic surgery to assess the relationship between dual degree attainment and holding various leadership positions within surgical departments.

Sex Disparities in the Presentation of Gallbladder Disease.

Introduction: Although gallbladder disease is more common in women, there is a trend toward more complicated cases in male patients.

Methods: All cholecystectomies captured by the National Surgical Quality Improvement Program database for the year 2016 were reviewed. This encompassed 38 736 records.

Rural Surgical Training in the United States: Delineating Essential Components Within Existing Programs.

Background: Rural access to surgical care has reached crisis level. Practicing in rural America offers unique challenges with limited resources and specialists. Most training programs do not provide enough exposure to the endoscopic or the surgical subspecialty skills to prepare a resident for an isolated rural environment.

Optimal Resources for Rural Surgery.

Background: Timely access to emergency general surgery services, including trauma, is a critical aspect of patient care. This study looks to identify resource availability at small rural hospitals in order to improve the quality of surgical care.

Methods: Forty-five nonteaching hospitals in West Virginia were divided into large community hospitals with multiple specialties (LCHs), small community hospitals with fewer specialties (SCHs), and critical access hospitals (CAHs).

Enhancing the Educational Value and Faculty Attendance of a Morbidity and Mortality Conference.

Objective: There exists significant variation in the approach to and execution of morbidity and mortality conference (M&MC). Faculty attendance remains a working challenge. We sought to change our department's M&MC and hypothesized improved educational value and attendance.

A review of general surgery resident experience in common bile duct exploration in the ERCP era.

Background: Use of minimally invasive techniques for management of common bile duct (CBD) stones has led to declining number of CBD explorations (CBDE) performed at teaching and non-teaching institutions. We evaluate the impact of this decline on surgery training in bile duct procedures.

Study Design: National operative data for general surgery residents (GSR) were examined from 2000 to 2018.

Initial report on the impact of a perfused fresh cadaver training program in general surgery resident trauma education.

Background: Operative trauma volume for general surgery residents (GSR) continues to decline. This pilot study examines the impact of utilizing perfused cadavers in trauma surgical skills training for GSR.

Methods: GSR (post graduate year (PGY) 1 through 4) participated in trauma surgical skills training utilizing perfused cadavers.

Gender Disparities in the Presentation of Gallbladder Disease.

Although gallbladder disease (GBD) is more common in females, we have noticed a trend toward more complicated cases in male patients. We reviewed all cholecystectomies performed at our institution over the last five years. After eliminating cases with confounding variables, we identified 1529 records.

Laparoscopic Removal of Angelchik Prosthesis Followed by Interval Sleeve Gastrectomy.

Introduction: The Angelchik prosthesis (AP) is a historic antireflux device which consists of a C-shaped silicone ring placed around the gastroesophageal junction (GEJ) and secured by Dacron tape. We present a rare experience with an AP and its impact on bariatric surgical outcomes.

Case: Our patient is a 66-year-old woman who had an open antireflux procedure with an AP in 1987.

The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty.

Background: Nurse Practitioners and Physician Assistants - called non-physician practitioners or NPPs - are common, but little is known about their educational promise and problems.

Methods: General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns.

Assessing the 16 hour intern shift limit: Results of a multi-center, mixed-methods study of residents and faculty in general surgery.

Background: The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts.

Methods: Questionnaire response rates were 76% for residents (N = 291) and 71% for faculty (N = 279) in 13 general surgery residency programs. Results include means, percentage in agreement, and statistical tests for 15 questionnaire items.

Reap What You Sow: Which Rural Surgery Training Programs Currently Exist and Do Medical Students Know of Their Existence?

Background: There exists an acute need to recruit and train general surgeons for rural communities. To assist medical students interested in rural surgery, the American College of Surgeons (ACS) website lists general surgery residencies, which are tailored to train the rural surgeon by providing exposure to endoscopy, gynecology, urology, orthopedics, and otolaryngology. Another available reference is the American Medical Association Fellowship and Residency Electronic Database (FREIDA).

Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies.

Purpose: Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism.

Method: Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015.

Management of acute appendicitis in a rural population.

Background: Our system uses a hub and spoke approach to provide surgical care for our rural population. Patients access care anywhere in the system but are transferred centrally for surgical care. We sought to determine if surgical outcome differed depending on where initial care occurred.

Diluting chlorhexidine gluconate: one scrub or two?

Background: Two percent chlorhexidine gluconate (CHG) is used in preparing the skin of surgical patients. In practice, it often is diluted with saline prior to use. Whether this affects efficacy is unknown, as the manufacturer does not address dilution but does recommend scrubbing twice.

Evaluation of a blended learning surgical skills course for rural surgeons.

Background: Rural surgeons have unique learning needs not easily met by traditional continuing medical education courses.

Methods: A multidisciplinary team developed and implemented a skills curriculum focused on leadership and communication, advanced endoscopy, emergency urology, emergency gynecology, facial plastic surgery, ultrasound, and management of fingertip amputations.

Results: Twenty-five of 30 (89%) rural surgeons who completed a follow-up course evaluation reported that the knowledge acquired during the course had improved their practice and/or the quality of patient care, particularly by refining commonly used skills and expanding the care options they could offer to their patients.