Physician Workforce in Kansas: Where are the Orthopedic Surgeons?

Introduction: Rural patients have greater need but less access to orthopedic surgical care than their urban counterparts. Previous studies have investigated rural surgical care, but this is the first to assess the Kansas orthopedic surgery workforce to identify changes over time and rurality and inform thinking about future workforce composition.

Methods: The authors analyzed 2009 and 2019 AMA MasterFile and Area Health Resource File (AHRF) data.

The joy of surgery: how gender influences surgeons' experiences.

Introduction: Burnout in medicine is an epidemic, and surgeons are not immune. Studies often focus on negative factors leading to burnout, with less emphasis on optimizing joy. The purpose of this study, conducted by the SAGES Reimagining the Practice of Surgery Task Force, was to explore how gender may influence surgeon well-being to better inform organizational change.

The joy of surgery: how surgeons experience joy, time, and support.

Background: Burnout is a crisis in medicine, and especially in surgery it has serious implications not only for physician well-being but also for patient outcomes. This study builds on previous SAGES Reimagining the Practice of Surgery Task Force work to better understand how organizations might intervene to increase the "joy in surgery."

Methods: This was a cross-sectional, descriptive study utilizing a REDCap survey with closed-ended questions for data collection across 5 domains: facilitators of joy, support for best work, time for work tasks, barriers to joy, and what they would do with more time.

Genomic Answers for Kids: Toward more equitable access to genomic testing for rare diseases in rural populations.

Next-generation sequencing has revolutionized the speed of rare disease (RD) diagnoses. While clinical exome and genome sequencing represent an effective tool for many RD diagnoses, there is room to further improve the diagnostic odyssey of many RD patients. One recognizable intervention lies in increasing equitable access to genomic testing.

Moral Injury Among Transplant Providers: Evaluating the Effects of Training in End-of-Life Counseling.

Introduction: Ethical issues are pervasive in healthcare, but few specialties rival the moral complexity of transplant medicine. Transplant providers must regularly inform patients that they are no longer eligible to receive a potentially life-saving operation and the stress of these conversations poses a high risk of moral injury. Training in end-of-life counseling (EOLC) has proven to significantly reduce provider stress and burnout.

Use of Ultrasound-Guided Tendon Fenestration and Injection Procedures for Treatment of Tendinosis.

Introduction: Overuse injuries such as tendinosis are a common complaint at sports medicine clinics. When conservative management for tendinosis has failed, ultrasound-guided tendon fenestration and injection procedures, such as dry needling, needling tenotomy, autologous whole blood injections, and prolotherapy, can be utilized for treatment. This study examined the effectiveness of these procedures for pain improvement and ability to return to activity for patients with tendinosis.

Disparities in Referral Initiation and Completion at an Urban FQHC Look-alike (FQHC-LA) Clinic.

Introduction: The purpose of this study was to determine referral initiation and completion disparities across primary care encounters at the Hope Family Care Center (HFCC) in Kansas City, MO, by payor type (primary insurance): private insurance, Medicaid, Medicare, and self-pay.

Methods: Data were collected and analyzed for all encounters (N = 4,235) over a 15-month period, including payor type, referral initiation and completion, and demographics. Referral initiation and completion were calculated by payor type and differences analyzed using Chi-square tests and t-tests.

Factors influencing surgeon well-being: qualitatively exploring the joy of surgery.

Background: There has been considerable research into burnout but much less into how surgeons thrive and find joy. This study, conducted by the SAGES Reimagining the Practice of Surgery Task Force, explored factors influencing surgeon well-being, the eventual goal being translating findings into tangible changes to help restore the joy in surgery.

Methods: This was a qualitative, descriptive study.

Physician Dispositions Toward Noninvasive Non-Hormonal Contraception.

Introduction: Evidence-based, nonbiased, counseling on contraceptive options, followed by shared decision-making, is key in facilitating reproductive justice in a diverse population. An estimated 3% of contraceptive users in the United States use fertility awareness-based methods (FABMs) for contraception, and demand for these methods is increasing. FABMs can be a highly effective form of family planning when used in accordance with evidence-based protocols.

Infection and Recurrence Rates in Rural Inguinal Hernia Repair.

Introduction: Inguinal hernia repair (IHR) is a common procedure performed by general surgeons in rural community hospitals. Infection and recurrence rates for three types of IHR over two years at a rural Kansas hospital were analyzed. Previous research has shown outcomes regarding pain at six weeks were typically no different, and neither were long-term results, between open and laparoscopic techniques.

Correlations Between Department and Training Program Online Presence and Women in Orthopedic Surgery Training.

Background: Orthopedic residency programs increasingly use websites and social media to reach students. This accelerated during the COVID-19 pandemic, especially as away rotations became limited. Women remain a minority of orthopedic residents, and there are no data that indicate the correlation between department/program website content or social media presence on the gender diversity of residency classes.

AHPBA graduated fellows' assessments of strengths, weaknesses, opportunities and threats facing fellowship training in HPB surgery: "HPB training excellence means volume, knowledge, and mentorship".

Background: Many fellowship programs in North America prepare surgeons for a career in Hepato-Pancreato-Biliary (HPB) surgery. Recent fellowship graduates were surveyed as part of a strengths, weaknesses, opportunities, and threats (SWOT) analysis commissioned by Americas Hepato-Pancreato-Biliary Association (AHPBA).

Methods: This was a cross-sectional study surveying AHPBA-certified fellowship graduates conducted August-December 2021.

The job market for HPB surgeons: leadership perspectives on surgeon skillsets, training pathways, and hiring.

Background: Three tracks prepare Hepato-Pancreato-Biliary (HPB) surgeons: HPB, surgical oncology, and transplant fellowships. This study explored how surgical leaders thought about HPB surgery and evaluated potential candidates for HPB positions.

Methods: This descriptive qualitative study utilized interviews of healthcare leaders whose responsibilities included hiring HPB surgeons.

AHPBA senior leaders' assessments of strengths, weaknesses, opportunities, and threats facing fellowship training in HPB surgery: "We need to standardize our training experiences".

Background: Multiple fellowship programs in North America prepare surgeons for a career in Hepato-Pancreatico-Biliary (HPB) surgery. Inconsistent operative experiences and disease process exposures across programs and pathways produces variability in training product and therefore, lack of clarity around what trained HPB surgeons are prepared to do in early practice. Thus, a strengths, weaknesses, opportunities, and threats (SWOT) analysis of AHPBA fellowship training was conducted.

The Influence of the STORM Program and Other Elective Experiences During the Summer Between the First and Second Year on Medical Students' Career Interests.

Introduction: The purpose of this study was to investigate the influence of the Summer Training Option in Rural Medicine (STORM) program and other elective experiences during the summer between the first and second pre-clerkship years of medical school on medical students' career intentions.

Methods: A retrospective voluntary and anonymous cohort study was conducted by distributing an email survey to the 211 second-year medical students at the University of Kansas School of Medicine (KUSM). The survey consisted of a variety of questions regarding their recent summer break elective experiences.

Resident Perspectives on the Value of Rural General Surgery Rotations: It's Not Just About the Cases.

Purpose: Understand the scope of cases that residents participate in during rural general surgery rotations and the value residents and program directors find in such rotations. In turn, our goal is to add to the ongoing conversation the value exposure to rural surgery brings to surgery training.

Methods: Qualitative study analyzed reviews of residents' self-reported case lists and field notes from exit interviews with the site director.

Causes of Anemia in Patients Seen in a Rural Community Hematology Clinic.

Introduction: Anemia is a common medical disorder seen in consultation by hematologists. This study was performed to determine the incidence of the etiologies causing anemia in patients referred to the hematologists at Tammy Walker Cancer Center (TWCC) in the rural Kansas community of Salina. An additional goal of the study was to compare the frequencies of different etiologies for anemia in this cohort of patients with those previously reported by four academic medical centers.

Attitudes toward Rubella and Varicella Vaccination during Preconception Care.

Introduction: Studies of anti-vaccine attitudes in the perinatal time period previously have not paid special attention to the MMR and varicella vaccines. Because both contain live attenuated virus, a contraindication during pregnancy, it is important to assess barriers to vaccination clinically during preconception to avoid the known fetal morbidity associated with congenital rubella or varicella infection.

Methods: The primary outcome of this study was to determine prevalence of patients with nonimmune status for rubella and varicella in the setting of advanced reproductive care.

Non-coding region variants upstream of MEF2C cause severe developmental disorder through three distinct loss-of-function mechanisms.

Clinical genetic testing of protein-coding regions identifies a likely causative variant in only around half of developmental disorder (DD) cases. The contribution of regulatory variation in non-coding regions to rare disease, including DD, remains very poorly understood. We screened 9,858 probands from the Deciphering Developmental Disorders (DDD) study for de novo mutations in the 5' untranslated regions (5' UTRs) of genes within which variants have previously been shown to cause DD through a dominant haploinsufficient mechanism.

Is Rural Kansas Prepared? An Assessment of Resources Related to the COVID-19 Pandemic.

Introduction: This cross-sectional study investigated rural Kansas healthcare resources relevant to COVID-19 at the county level in the context of population characteristics.

Methods: The federal Area Health Resource File was used to assess system capacity and critical care-related resources and COVID-19-related risk factors at the county level. Data were described with summary statistics, cross-tabulations, and bivariate tests to discern differences across county rurality categories (2013 Rural-Urban Continuum Codes).

Recent Evolution in the Management of Lymph Node Metastases in Melanoma.

Introduction: Based upon two large randomized international clinical trials (German Dermatologic Cooperative Oncology Group (DeCOG-SLT) and Multicenter Selective Lymphadenectomy Trial II (MSLT-II)) published in 2016 and 2017, respectively, active surveillance has been demonstrated to have equivalent survival outcomes to completion lymphadenectomy (CLND) for a subset of patients who have microscopic lymph node disease. In this study, the changes in national practice patterns were examined regarding the utilization of CLND after positive sentinel lymph node biopsy (SLNB).

Methods: Using the National Cancer Database, CLND utilization was examined in SLN-positive patients diagnosed with melanoma between 2012 and 2016.