A pilot trial of vaccination with Carcinoembryonic antigen and Her2/neu peptides in advanced colorectal cancer.

Checkpoint-blockade therapy (CBT) is approved for select colorectal cancer (CRC) patents, but additional immunotherapeutic options are needed. We hypothesized that vaccination with carcinoembryonic antigen (CEA) and Her2/neu (Her2) peptides would be immunogenic and well tolerated by participants with advanced CRC. A pilot clinical trial (NCT00091286) was conducted in HLA-A2 or -A3 Stage IIIC-IV CRC patients.

Examining the Impact of Using the SIMPL Application on Feedback in Surgical Education.

Objective: The System for Improving and Measuring Procedural Learning (SIMPL) smartphone application allows physicians to provide dictated feedback to surgical residents. The impact of this novel feedback medium on the quality of feedback is unknown. Our objective was to compare the delivery and quality of best-case operative performance feedback given via SIMPL to feedback given in-person.

Is the operative autonomy granted to a resident consistent with operative performance quality.

Background: We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality.

Methods: Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as "practice ready performance/meaningfully autonomous" or "not practice ready/not meaningfully autonomous.

Clinically Competent and Fiscally at Risk: Impact of Debt and Financial Parameters on the Surgical Resident.

Background: While the costs of medical training continue to increase, surgeon income and personal financial decisions may be challenged to manage this expanding debt burden. We sought to characterize the financial liability, assets, income, and debt of surgical residents, and evaluate the necessity for additional financial training.

Study Design: All surgical trainees at a single academic center completed a detailed survey.

What factors influence attending surgeon decisions about resident autonomy in the operating room?

Background: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents.

Methods: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs.

Readiness of US General Surgery Residents for Independent Practice.

Objective: This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy.

Background: The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate.

Integrating Postoperative Feedback Into Workflow: Perceived Practices and Barriers.

Objective: Previous studies have found that both resident and staff surgeons highly value postoperative feedback; and that such feedback has high educational value. However, little is known about how to consistently deliver this feedback. Our aim was to understand how often surgical residents should receive feedback and what barriers are preventing this from occurring.

The Feasibility of Real-Time Intraoperative Performance Assessment With SIMPL (System for Improving and Measuring Procedural Learning): Early Experience From a Multi-institutional Trial.

Purpose: Intraoperative performance assessment of residents is of growing interest to trainees, faculty, and accreditors. Current approaches to collect such assessments are limited by low participation rates and long delays between procedure and evaluation. We deployed an innovative, smartphone-based tool, SIMPL (System for Improving and Measuring Procedural Learning), to make real-time intraoperative performance assessment feasible for every case in which surgical trainees participate, and hypothesized that SIMPL could be feasibly integrated into surgical training programs.

Evaluating the effectiveness of a mock oral educational program.

Background: To obtain board certification, the American Board of Surgery requires graduates of general surgery training programs to pass both the written qualifying examination (QE) and the oral certifying examination (CE). In 2015, the pass rates for the QE and CE were 80% and 77%, respectively. In the 2011-2012 academic year, the University of Wisconsin instituted a mandatory, faculty-led, monthly CE preparation educational program (CE prep) as a supplement to their existing annual mock oral examination.

Short-term outcomes of minimally invasive versus open colectomy for colon cancer.

Background: Laparoscopic and open approaches to colon resection have equivalent long-term outcomes and oncologic integrity for the treatment of colon cancer. Differences in short-term outcomes should therefore help to guide surgeons in their choice of operation. We hypothesized that minimally invasive colectomy is associated with superior short-term outcomes compared to traditional open colectomy in the setting of colon cancer.

Resident training in a teaching hospital: How do attendings teach in the real operative environment?

Background: The study aim was to explore the nature of intraoperative education and its interaction with the environment where surgical education occurs.

Methods: Video and audio recording captured teaching interactions between colorectal surgeons and general surgery residents during laparoscopic segmental colectomies. Cases and collected data were analyzed for teaching behaviors and workflow disruptions.

Rural Surgery--A Crisis in Wisconsin.

Recruitment of general surgeons to practice in rural environments is challenging. We believe that innovative training programs focusing on the specific needs and experiences of rural surgical practice can play an important role in addressing this clinical workforce issue. For practical reasons, our program will start out small, but if 50 centers around the nation were to establish a similar rural track, we could see a substantial collective impact over time.

Does Anastomotic Leak Contribute to High Failure-to-rescue Rates?

Objective: Our aim was to evaluate failure-to-rescue (FTR) after anastomotic leak (AL) in colectomy patients.

Background: In the era of pay for performance, it is imperative that we understand the quality measures under which we are scrutinized. FTR has been proposed as a marker of surgical quality.

Postoperative Ileus--More than Just Prolonged Length of Stay?

Purpose: Given that postoperative ileus is common in colectomy patients, we sought to examine the association of ileus with adverse events in this patient population.

Methods: The ACS NSQIP puf file from 2012 to 2013 was queried for non-emergent colectomy cases. Predictors of other poor postoperative outcomes in patients who experienced postoperative ileus were assessed using chi-squared and multivariable regression analyses.

Characterizing readmission in ulcerative colitis patients undergoing restorative proctocolectomy.

Background: Postoperative readmissions increase costs and affect patient quality of life. Ulcerative colitis (UC) patients are at a high risk for hospital readmission following restorative proctocolectomy (RP).

Objective: The objective of this study is to characterize UC patients undergoing RP and identify causes and risk factors for readmission.

Utilizing a novel tool for the comprehensive assessment of resident operative performance.

Purpose: A mechanism for more effective and comprehensive assessment of surgical residents' performance in the operating room (OR) is needed, especially in light of the new requirements issued by the American Board of Surgery. Furthermore, there is an increased awareness that assessments need to be more meaningful by including not only procedure-specific and general technical skills, but also nontechnical skills (NOTECHS), such as teamwork and communication skills. Our aims were to develop a methodology and create a tool that comprehensively assesses residents' operative performance.

Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival.

Objective: The objective of this study was to identify the risk factors for delays in chemotherapy after rectal cancer surgery and evaluate the effects of delayed therapy on long-term outcomes. We also sought to clarify what time frame should be used to define delayed adjuvant chemotherapy.

Background: Postoperative complications have been found to influence the timing of chemotherapy in patients with colon cancer.

Predictors of mortality after emergent surgery for acute colonic diverticulitis: analysis of National Surgical Quality Improvement Project data.

Background: The surgical treatment of acute colonic diverticulitis is associated with significant morbidity and mortality. However, patient and operative characteristics associated with mortality in this patient population are unclear. We hypothesize that demographic and perioperative variables can be used to predict postoperative mortality.

Comparable postoperative morbidity and mortality after laparoscopic and open emergent restorative colectomy: outcomes from the ACS NSQIP.

Background: Laparoscopic surgery is safe and effective in the management of common abdominal emergencies. However, there is currently a lack of data about its use for emergency colorectal surgery. We hypothesized that laparoscopy can improve the postoperative outcomes of emergency restorative colon resection.

Educational value of morbidity and mortality (M&M) conferences: are minor complications important?

Background: Often, minor complications are not reported in morbidity and mortality (M&M) conference because they are considered insignificant to patient outcome. As part of an effort to improve the quality of the M&M conference, we sought to integrate a specific, focused intervention to improve the reporting of minor complications and to evaluate the perception of its educational value.

Materials And Methods: To provide evidence-based training in recognizing, treating, and preventing minor complications, a presentation strategy was created.

Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma.

Background And Objectives: General obesity, measured by the body mass index (BMI), increases the technical difficulty of total mesorectal excision (TME) but does not affect oncologic outcomes. The purpose of this study is to compare visceral and general obesity as predictors of outcomes of TME for rectal adenocarcinoma.

Methods: Adult patients undergoing TME for rectal adenocarcinoma were retrospectively identified.

Cyclical increase in diverticulitis during the summer months.

Objective: We hypothesized that the rate of nonelective hospital admissions for diverticulitis conforms to seasonal variation.

Design: Retrospective cohort analysis.

Setting: Patients admitted to hospitals in the Nationwide Inpatient Sample, a 20% sample of US community hospitals.

Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP.

Background: Although numerous studies have demonstrated improved short-term outcomes after laparoscopic resection of colon cancer, the benefits of laparoscopic-assisted proctectomy (LAP) for rectal cancer are less clear. The current report addresses the need for a large multi-institutional study on early outcomes after proctectomy for cancer.

Study Design: Patients who underwent elective LAP or open proctectomy for cancer during 2005 to 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Optimizing surgical care of colon cancer in the older adult population.

Objective: We have undertaken the current study to evaluate factors that correlate with postoperative complications in older patients undergoing surgery for colon cancer.

Patients And Methods: The database of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) from years 2005 to 2008 was accessed. Patients age 65 and older were included according to Current Procedural Terminology and International Classification of Disease-9 codes.