"I Came up Short on the Academic Ladder": A Grounded Theory Study of Careerism in Academic Surgery.

Objective: This study aims to explore the definition of career success in academic surgery.

Background: Career success in academic surgery is frequently defined as the achievement of a specific title, from full professor to department chair. This type of definition is convenient and established but potentially incomplete.

"The Story I Will Never Forget": Critical Incident Narratives in Surgical Residency.

Objective: We sought to better understand what defines a critical incident experience for the surgical trainee.

Summary Background Data: Critical incidents are formative moments stamped indelibly on one's memory that shape professional identity. The critical incident technique-using participants' narratives to identify patterns and learn from their perceptions-has been explored in some healthcare settings, but there has been no inquiry within surgery.

What Is the Best Operation for Proximal Gastric Cancer and Distal Esophageal Cancer?

Cancer of the gastroesophageal junction (GEJ) is increasing in incidence, likely as a result of rising obesity and gastroesophageal reflux disease rates. The tumors that arise here share features of esophageal and gastric cancer, and are classified based on their location in relationship to the GEJ. The definition of the GEJ itself, as well as optimal resection strategy, extent of lymph node dissection, resection margin length, and reconstruction methods are still very much a subject of debate.

Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees.

Importance: Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care.

Objective: To document the published programmatic and curricular attempts to decrease the incidence of mistreatment.

Data Sources: PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched.

Evaluating Surgical Coaching: A Mixed Methods Approach Reveals More Than Surveys Alone.

Objective: Traditionally, surgical educators have relied upon participant survey data for the evaluation of educational interventions. However, the ability of such subjective data to completely evaluate an intervention is limited. Our objective was to compare resident and attending surgeons' self-assessments of coaching sessions from surveys with independent observations from analysis of intraoperative and postoperative coaching transcripts.

Pilot evaluation of the Computer-Based Assessment for Sampling Personal Characteristics test.

Background: High attrition rates hint at deficiencies in the resident selection process. The evaluation of personal characteristics representative of success is difficult. Here, we evaluate a novel tool for assessing personal characteristics.

Quality of Life After Bariatric Surgery.

Purpose Of Review: The purpose of this review is to provide an introduction to quality of life (QOL) outcomes after bariatric surgery and a summary of the current evidence.

Recent Findings: QOL has been emphasized in bariatric surgery since the NIH Consensus Conference statement in 1991. Initial studies were limited to 1- and 2-year follow-up.

A Mixed-Methods Analysis of a Novel Mistreatment Program for the Surgery Core Clerkship.

Purpose: To review mistreatment reports from before and after implementation of a mistreatment program, and student ratings of and qualitative responses to the program to evaluate the short-term impact on students.

Method: In January 2014, a video- and discussion-based mistreatment program was implemented for the surgery clerkship at the Stanford University School of Medicine. The program aims to help students establish expectations for the learning environment; create a shared and personal definition of mistreatment; and promote advocacy and empower ment to address mistreatment.

Who Orders a Head CT?: Perceptions of the Cirrhotic Bleeding Risk in an International, Multispecialty Survey Study.

Objective: Traditional coagulopathic indices, including elevated international normalized ratio, do not correlate with bleeding risk in patients with cirrhosis. For this reason, head computed tomography (CT) has a low yield in cirrhotic patients with altered mental status and no trauma history. The initial diagnostic evaluation, however, is often made by nongastroenterologists influenced by the so-called "coagulopathy of cirrhosis.

Complementing Operating Room Teaching With Video-Based Coaching.

Importance: Surgical expertise demands technical and nontechnical skills. Traditionally, surgical trainees acquired these skills in the operating room; however, operative time for residents has decreased with duty hour restrictions. As in other professions, video analysis may help maximize the learning experience.

A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication.

Background: Patient history-taking is an essential clinical skill, with effects on diagnostic reasoning, patient-physician relationships, and more. We evaluated the impact of using a structured, timeline-based format, the Chronology of Present Illness (CPI), to guide the initial patient interaction.

Objective: To determine the feasibility and impact of the CPI on the patient interview, written notes, and communication with other providers.

Effectiveness of the Surgery Core Clerkship Flipped Classroom: a prospective cohort trial.

Background: The flipped classroom has been proposed as an alternative curricular approach to traditional didactic lectures but has not been previously applied to a surgery clerkship.

Methods: A 1-year prospective cohort of students (n = 89) enrolled in the surgery clerkship was taught using a flipped classroom approach. A historical cohort of students (n = 92) taught with a traditional lecture curriculum was used for comparison.

Predictors of negative intraoperative findings at emergent laparotomy in patients with cirrhosis.

Background: Emergent surgery in the setting of decompensated cirrhosis is highly morbid. We sought to determine the clinical factors associated with negative intraoperative findings at emergent laparotomy.

Methods: We performed a retrospective cohort study of consecutive inpatients with a diagnosis of cirrhosis (ICD-9 571) admitted to the Beth Israel Deaconess Medical Center (Boston, MA) who underwent emergent, nonhepatic, abdominal surgery between May 6, 2005 and September 3, 2012.

Tumor characteristics and survival analysis of incidental versus suspected gallbladder carcinoma.

Introduction: Over half of all gallbladder carcinoma (GBC) is discovered incidentally after cholecystectomy for benign disease. There are scant data comparing presentation and outcome for patients with incidental versus suspected GBC. The goal of this study is to determine the clinical differences between these two entities.

Single versus multi-specialty operative teams: association with perioperative mortality after endovascular abdominal aortic aneurysm repair.

Endovascular abdominal aortic aneurysm repair (EVAR) requires both endovascular and open surgical skills. Although usually performed by a single operating specialist, EVAR may alternatively involve multiple teams from different specialties performing separate procedural components. We examined the relative frequencies of single versus multi-specialty EVAR in the 2005 to 2008 American College of Surgeons National Surgical Quality Improvement Participant Use Datafile and explored the influence of multi-specialty EVAR on 30-day mortality.

Non-operative management of right posterior sectoral duct injury following laparoscopic cholecystectomy.

Objective: The purpose of this study is to describe the outcomes of conservative management for patients with right posterior sectoral bile duct injury acquired during laparoscopic cholecystectomy.

Methods: This retrospective, consecutive case series reviews seven patients with an isolated injury to the right posterior or right hepatic duct occurring during laparoscopic cholecystectomy.

Results: Seven patients with an isolated right sectoral duct injury were studied, six women and one man aged 22 to 71 years (mean age, 43.

Docosahexaenoic acid status in females of reproductive age with maple syrup urine disease.

Individuals with maple syrup urine disease (MSUD) have impaired metabolism of branched-chain amino acids (BCAA) valine, isoleucine, and leucine. Life-long dietary therapy is recommended to restrict BCAA intake and thus prevent poor neurological outcomes and death. To maintain adequate nutritional status, the majority of protein and nutrients are derived from synthetic BCAA-free medical foods with variable fatty acid content.