82.03 Surgical Boot Camp for Senior Medical Students: Impact on Objective Skills and Subjective Confidence

Posted on January 31, 2019

J. Simon1, L. A. Bevilacqua1, D. Rutigliano1, S. Docimo1, J. Sorrento1, R. Verma1, A. Wackett2, L. Chandran3, M. Talamini1  1Stony Brook University Medical Center,Surgery,Stony Brook, NY, USA 2Stony Brook University Medical Center,Emergency Medicine,Stony Brook, NY, USA 3Stony Brook University Medical Center,Office Of The Dean,Stony Brook, NY, USA

Introduction: In recent years, boot camp courses for senior medical students have risen in popularity with the goal of improving preparation for residency. While studies have demonstrated increased student confidence after such boot camps, data is lacking on the impact of these courses on objective clinical skills. The American College of Surgeons (ACS) has developed a curriculum for use in such courses. This study aims to test the impact of a Surgical Boot Camp course using the ACS-based curriculum and objective, observer-based rating tools, on both subjective confidence and objective skills of fourth-year medical students.            

Methods: Fourth-year medical students who had matched into surgical subspecialties were invited to participate in a two-week Surgical Boot Camp. Informed consent was obtained on the first day of the course. Prior to any teaching, students performed five tasks (patient handoff, suturing, knot tying, central line placement, and chest tube placement) which were scored using objective rating tools provided by the ACS. Students also completed two subjective confidence measures, the New General Self-Efficacy scale (NSGE) and a Task-Specific Confidence Scale (i.e., "How confident are you placing a central line"). Both measures used a 5-point likert scale. After two weeks of dedicated lectures, simulation, and cadaver-based anatomy review, students were scored on the same five tasks and repeated the confidence measures. To help avoid potential bias, each scorer graded a different skill at pre- and post-course testing, so that they were unaware of scores given by the previous assessor.

Results: Twelve students participated in the Boot Camp. Average age was 26.7 years; 25% of subjects were female. Subspecialties represented included general surgery (N=5) orthopedics (N=3), integrated plastics (N=2), urology (N=1), and neurosurgery (N=1). Scores on objective skills improved significantly in all five tasks at post-course testing (Table 1). Mean NSGE scores did not improve over the study period (4.49 vs. 4.46; p=0.866), however mean scores on task-specific confidence improved significantly (2.77 vs. 3.64; p<0.0010). 

Conclusion: Implementation of a two-week, multimodal Surgical Boot Camp improved student performance on objectively-rated surgical skills and increased student confidence. Research is still lacking on whether, and for how long, these improvements persist into surgical residency. Future studies utilizing larger samples of students with matched controls are needed to confirm these findings and support the use of such boot camps in undergraduate medical education nationwide.

82.02 Implicit Biases in the Operating Room: A Simulation Based Study

Posted on January 31, 2019

S. Jones1, P. P. Parikh1, T. N. Crawford4, P. Hershberger3, A. Cochran2, L. Peterson1, G. Falls1  1Wright State University,Department Of Surgery,Dayton, OH, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA 3Wright State University,Department Of Family Medicine,Dayton, OH, USA 4Wright State University,Division Of Epidemiology And Biostatistics, Department Of Population And Public Health Sciences,Dayton, OH, USA

Introduction: Implicit biases are increasingly recognized as a wide-spread phenomenon in medicine, including surgery.  In surgery, physicians and other providers of different specialties and expertise work together in an operating room (OR) that impacts lives. Any implicit biases in such dynamic environments could lead to poor satisfaction and performance of providers, which in turn may result in poor patient outcomes. The primary objective of this study was to assess perception of the lead surgeon in OR.

Methods:
The simulated scenarios used 8 different actors as lead surgeon with the combination of age (<40 vs. >55), race (white vs. black), and gender (male vs. female). An IRB approved anonymous video-based survey was distributed nationwide to surgeons, residents, OR nurses and ancillary OR staff. It included demographic questions, 3 short videos and questions regarding the perception of the situation and surgeon. The perception towards the lead surgeon was divided into favorable, unfavorable, and neutral categories. Favorable perception included the surgeon’s behavior that was thought to be commendable, acceptable, or the surgeon should have received an apology. The unfavorable perception included responses such as “inform managers of surgeon’s behavior,” “surgeon should apologize to the OR staff,” or the “surgeon should receive probation.” The participants also rated overall performance of the surgeon using a 5-star rating system.

Results:
There were 419 respondents, 53.7% were females. A higher proportion of the respondents (53.5%) were attending surgeons. Our results suggest that both gender and age are significantly associated with the perception of a lead surgeon. Older surgeons were perceived more favorably than their younger counterparts; 50.5% versus 35.6%, respectively. Similarly, male surgeons were perceived more favorably than female surgeons; 47.2 vs. 37.7 (Figure 1). The overall rating of a surgeon suggests that older surgeons were rated higher than younger (3.27 vs 3.05). While assessing the group of older surgeons in details for race, our data showed that older white males were ranked significantly higher (3.53/5) than all other group of surgeons. 

Conclusion:
Widespread perception of gender bias in surgery may not be the only bias that exists in the OR. Our data shows that older surgeons, especially older white males, are perceived more favorably than any other lead surgeon. These results shed light on some of the challenges faced by young surgeons, particularly females, taking on a leadership role in OR.  These results can provide insight in developing inter-professional education curriculum or training for residents, attendings and OR staff to address implicit biases and to foster cohesiveness of the surgical team in order to provide optimal patient care.
 

79.03 Assessing Fatigue Recovery in Trauma Surgeons Utilizing Actigraphy Monitors

Posted on January 31, 2019

Z. C. Bernhard1,2, T. W. Wolff1,3, B. L. Lisjak1, I. Catanescu1, E. Baughman1,4, M. L. Moorman1,4, M. C. Spalding1,4  1OhioHealth Grant Medical Center,Division Of Trauma And Acute Care Surgery,Columbus, OHIO, USA 2West Virginia School of Osteopathic Medicine,Lewisburg, WEST VIRGINIA, USA 3OhioHealth Doctors Hospital,Department Of Surgery,Columbus, OHIO, USA 4Ohio University Heritage College of Osteopathic Medicine,Athens, OHIO, USA

Introduction: Mental fatigue is a psychobiological state caused by prolonged periods of demanding cognitive activity. For over 20 years, the relationship between mental fatigue and physical performance has been extensively researched by the US military, the transportation industry, and other high-risk occupations. This is a growing area of interest within the medical community, yet there remain relatively few investigations specifically pertaining to surgeons. This study sought to quantify and evaluate fatigue and recovery time following 24-hour call among trauma surgeons to serve as a starting point in optimizing staffing and scheduling. We expected more sleep both during and after call, prior to the next normal circadian sleep cycle, would lead to faster recovery times.

Methods:  This was a prospective analysis of trauma surgeons employed at an urban, Level 1 trauma center. Readiband actigraphy monitors (FatigueScience, Vancouver, BC) incorporating a validated Sleep, Activity, Fatigue, and Task Effectiveness Model, were used to track sleep/wake cycles over a 30-day period. Recovery time was measured as the time required during the post-call period for the surgeon to return to his/her pre-call 24-hour mean alertness level. Three groupings were identified based on recovery time: rapid (0-6 hours), intermediate (6-18 hours), and extended (>18 hours). Tri-linear regression analysis was performed to assess correlation between recovery time and on-call, post-call, and combined sleep quantities.

Results: Twenty-seven 24-hour call shifts among 8 trauma surgeons (6 males, 2 females) were identified and analyzed. Mean age was 41.0 ± 5.66. Mean work hours per week was 54.7 ± 13.5, mean caffeinated drinks per day was 3.19 ± 1.90, and mean hours of exercise per week was 4.0 ± 2.5. Six call shifts met rapid criteria, 11 shifts intermediate, and 10 shifts extended, with mean recovery times of 0.49 ± 0.68, 8.86 ± 2.32, and 24.93 ± 7.36 hours, respectively. Table 1 shows the mean alertness levels and sleep quantities for each group. Statistically significant and moderate positive correlations were found between recovery time and the amount of sleep achieved on-call (p=0.0001; R2=0.49), post-call (p=0.0013; R2=0.49) and combined (p<0.0001; R2=0.48).

Conclusion: This early analysis indicates that increased sleep quantities achieved on-call, post-call, and combined are partially indicative of quicker recovery time in surgeons following 24-hour call shifts, thus serving as a viable starting point to optimize trauma surgeon staffing and scheduling. Further studies to validate these findings and evaluate the impact of additional sleep components, such as number of awakenings, should be undertaken.

 

76.10 Molecular Profiling and Mitotic Rate in Cutaneous Melanoma

Posted on January 31, 2019

K. Liang1, G. Gauvin1, E. O’Halloran1, D. Mutabdzic1, C. Mayemura1, E. McGillivray1, K. Loo1, A. Olszanski2, S. Movva2, M. Lango1, H. Wu3, B. Luo4, J. D’Souza5, S. Reddy1, J. Farma1  1Fox Chase Cancer Center,Department Of Surgical Oncology,Philadelphia, PA, USA 2Fox Chase Cancer Center,Department Of Hematology/Oncology,Philadelphia, PA, USA 3Fox Chase Cancer Center,Department Of Pathology,Philadelphia, PA, USA 4Fox Chase Cancer Center,Molecular Diagnostics Laboratory,Philadelphia, PA, USA 5Fox Chase Cancer Center,Molecular Therapeutics Program,Philadelphia, PA, USA

Introduction:  Mitotic rate (MR) is a measure of tumor cellular proliferation in melanoma and has been associated with the tumor’s likelihood to metastasize. Although higher mitotic rate is associated with worse prognosis, specific genetic mutations associated with MR are less known. In this study, we examine the relationship between mitotic rate and genetic mutations in melanoma using next generation sequencing (NGS) technology.

Methods:  A retrospective chart review was conducted on all melanoma patients who received NGS and had pathology reports with documented mitotic rates at an NCI designated cancer center. We compared no mitosis versus ≥ 5 mitoses. Groups were compared using chi squared tables and linear regression models.

Results: Between 1997 and 2018, 239 melanoma patients had NGS performed and were included in this study. The median age of the study group was 64 and 62% were male. Primary tumor locations were trunk (n=70), lower extremity (n=59), upper extremity (n=50), head and neck (n=31), mucosal (n=10), genital (n=5), and other (n=14). Pathological staging included stage I (n=25), stage II (n=64), stage III (n=109), stage IV (n=20), and unknown (n=21). Only 5 patients had 0 mitoses/mm2, while 104 patients had ≥ 5 mitoses/mm2. Out of a total of 380 mutations, the most common gene mutations were any BRAF (18%, n=69) or NRAS (14%, n=53) mutation, but these were not associated with mitotic rate. Mutations in ERBB4, PIK3CA, and SMAD genes were protective against high mitotic rate, associated with 0 mitoses/mm2 (p=0.009, 0.002, 0.044, respectively). Higher mitotic rates, greater than 5/mm2, were associated with mutations in TP53 (p=0.015), KRAS (p=0.002), and FGFR3 (p=0.048). Only three patients had mutations in all three of these genes; these patients had 8, 9, and 20 mitoses/mm2 on final pathology. After controlling for mutations in KRAS and FGFR3, a mutation in TP53 is associated with 2.74-fold increased odds of having more than 5 mitoses/mm2 (95%CI 1.15-6.52, p=0.023).

Conclusion: Mitotic rate is an important prognostic indicator in melanoma. Our data demonstrate that certain genetic mutations such as TP53, FGFR3, and KRAS are associated with higher mitotic rate while other mutations, including ERBB4, PIK3CA, and SMAD4 are more frequently found in patients with no mitoses. Further studies are needed to determine whether next generation sequencing can be used to predict more aggressive tumors so that treatment and surveillance can be better tailored to these patients.

 

76.05 Features of Synchronous versus Metachronous Metastasectomy for Adrenal Cortical Carcinoma

Posted on January 31, 2019

K. M. Prendergast1, P. Marincola Smith2, C. M. Kiernan2, S. K. Maithel4, J. D. Prescott5, T. M. Pawlik5, T. S. Wang6, J. Glenn6, I. Hatzaras7, J. E. Phay8, L. A. Shirley8, R. C. Fields9, S. M. Weber10, J. K. Sicklick11, A. C. Yopp12, J. C. Mansour12, Q. Duh13, E. A. Levine14, G. A. Poultsides3, C. C. Solorzano2  1Vanderbilt University Medical Center,School Of Medicine,Nashville, TN, USA 2Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 3Stanford University School of Medicine,Department Of Surgery,Palo Alto, CA, USA 4Emory University School Of Medicine,Department Of Surgical Oncology,Atlanta, GA, USA 5Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 6Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA 7New York University School Of Medicine,Department Of Surgery,New York, NY, USA 8Ohio State University,Department of Surgery,Columbus, OH, USA 9Washington University School of Medicine,Department Of Surgery,St. Louis, MO, USA 10University Of Wisconsin School of Medicine and Public Health,Department Of Surgery,Madison, WI, USA 11University Of California – San Diego,Department Of Surgery,San Diego, CA, USA 12University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 13University Of California – San Francisco,Department Of Surgery,San Francisco, CA, USA 14Wake Forest University School Of Medicine,Department Of Surgery,Winston-Salem, NC, USA

Introduction:  Adrenocortical carcinoma (ACC) is a rare and aggressive cancer and many patients present with metastases. We describe the features of patients presenting with metastatic disease who underwent synchronous metastasectomy and contrast them with patients who underwent metastasectomy for recurrent ACC.

Methods:  Adult patients who underwent resection for metastatic ACC from 1993-2014 at 13 participating institutions of the US-ACC Group were analyzed retrospectively. Patients were categorized as “synchronous” if they underwent metastasectomy at the time of their index adrenalectomy or “metachronous” if they underwent resection for disease recurrence. Differences between groups were summarized using descriptive statistics. Factors associated with overall survival were assessed by univariate analysis.

Results: 84 patients with ACC underwent metastasectomy: 26 (31%) synchronous and 58 (69%) metachronous. Demographics were similar between groups. Patients in the synchronous group had more right-sided (54 vs. 40%) and glucocorticoid-secreting tumors (27 vs. 16%); however these differences were not significant (p=0.341 and  p=0.304, respectively). The synchronous group had a higher percentage of T4 tumors at index resection (42 vs. 3%, p<0.001); both groups had a similar proportion of N1 disease (11 vs. 7%, p=0.734). There were no significant differences between groups in the rate of treatment with neoadjuvant chemotherapy or adjuvant chemotherapy, mitotane, or radiation. The most common site of metastasectomy in the synchronous group was liver (58%), followed by lung (23%). The most common site of metastasectomy in the metachronous group was local (36%), followed by multiple sites (17%). The metachronous group had prolonged median survival following index resection (86.3 vs. 17.3 months, p<0.001) and following first metastasectomy (36.9 vs. 17.3 months, p=0.007). In the synchronous group, patients with R0 resection had improved survival over patients with R1 or R2 resection (p=0.008), while margin status at metastasectomy was not significantly associated with survival in the metachronous group (p=0.452).

Conclusion: Select patients with metastatic ACC may benefit from metastasectomy. Compared to patients with metachronous metastases, those with synchronous metastases have shortened survival following metastasectomy. This study highlights the need for future studies examining differences in tumor biology that might influence treatment decisions in these two distinct patient populations.
 
 

76.04 Trends in the Use of Adjuvant Chemotherapy for High-Grade Truncal and Extremity Soft Tissue Sarcoma

Posted on January 31, 2019

M. H. Squires1, L. Suarez-Kelly1, P. Y. Yu1, T. M. Hughes1, R. Shelby1, C. G. Ethun2, T. B. Tran3, G. Poultsides3, J. Charlson4, T. Gamblin4, J. Tseng5, K. K. Roggin5, K. Chouliaras6, K. Votanopoulos6, B. A. Krasnick7, R. C. Fields7, R. E. Pollock1, V. Grignol1, K. Cardona2, J. Howard1  1Ohio State University,Division Of Surgical Oncology,Columbus, OH, USA 2Emory University School Of Medicine,Division Of Surgical Oncology,Atlanta, GA, USA 3Stanford University,Department Of Surgery,Palo Alto, CA, USA 4Medical College Of Wisconsin,Division Of Surgical Oncology,Milwaukee, WI, USA 5University Of Chicago,Department Of Surgery,Chicago, IL, USA 6Wake Forest University School Of Medicine,Department Of Surgery,Winston-Salem, NC, USA 7Washington University,Department Of Surgery,St. Louis, MO, USA

Introduction:  In the randomized controlled trial (RCT) EORTC-62931, adjuvant chemotherapy failed to show improvement in relapse-free survival (RFS) or overall survival (OS) for patients with resected high-grade soft tissue sarcoma (STS). We sought to evaluate whether the negative results of this 2012 RCT have influenced multidisciplinary treatment patterns for patients with high-grade STS undergoing resection at 7 academic referral centers.

Methods: The US Sarcoma Collaborative (USSC) database was queried to identify patients who underwent curative-intent resection of primary high-grade truncal or extremity STS from 2000-2016. Patients with recurrent tumors, metastatic disease, and those receiving neoadjuvant chemotherapy were excluded.

 

Patients were divided by treatment era into early (2000-2011, pre-EORTC trial) and late (2012-2016, post-EORTC trial) cohorts for analysis. Rates of adjuvant chemotherapy delivery, standard demographics, and clinicopathologic variables were compared between the two cohorts. Univariate and multivariate regression analyses (MVA) were used to determine factors associated with OS and RFS. 

Results: 949 patients who met inclusion criteria were identified, with 730 patients in the early cohort and 219 in the late cohort. Adjuvant chemotherapy rates were similar between the early and late cohorts (15.6% vs 14.6%; p=0.73). Patients within the early and late cohorts demonstrated similar median OS (128 mos vs median not reached [MNR], p=0.84) and RFS (107 mos vs MNR, p=0.94).

 

Receipt of adjuvant chemotherapy was associated with larger tumor size (13.6 vs 8.9cm, p<0.001), younger age (53.3 vs 63.7 yrs, p<0.001), margin-positive resection (p=0.04), and receipt of adjuvant radiation (p<0.001).

 

On MVA, risk factors associated with decreased OS (Table 1) were increasing ASA class (p=0.02), increasing tumor size (p<0.001), and margin-positive resection (p=0.01). Adjuvant chemotherapy was not associated with OS (p=0.88). Risk factors associated with decreased RFS included increasing tumor size (p<0.001) and margin-positive resection (p=0.04); adjuvant chemotherapy was not associated with RFS (p=0.22). 

Conclusion: Rates of adjuvant chemotherapy for resected high-grade truncal or extremity STS have not decreased over time within the USSC, despite RCT data suggesting a lack of efficacy. In this retrospective multi-institutional analysis, adjuvant chemotherapy was not associated with RFS or OS on multivariate analysis, consistent with the results from EORTC-62931. Rates of adjuvant chemotherapy for high-grade STS were low in both cohorts, but may be influenced more by selection bias based on clinicopathologic variables such as tumor size, margin status, and patient age, than by prospective, randomized data.

75.08 Trends in Incidence, Treatment and Survival of Gallbladder Cancer; a Nation-Wide Cohort Study.

Posted on January 31, 2019

E. A. De Savornin Lohman1, T. De Bitter2, R. Verhoeven3, I. Nagtegaal2, C. Van Laarhoven1, R. Van Der Post2, P. De Reuver1  1Radboudumc,Surgery,Nijmegen, Netherlands 2Radboudumc,Pathology,Nijmegen, Netherlands 3Netherlands Comprehensive Cancer Organization,Eindhoven, Netherlands

Introduction:

Gallbladder cancer (GBC) is a rare but lethal malignancy, primarily diagnosed in an advanced stage unless detected incidentally after laparoscopic cholecystectomy for benign gallbladder disease. Scarce data is available on GBC treatment and survival outcomes in Western populations. Consequently, controversy exists regarding surgical and systemic treatment. Using data from the Netherlands Cancer Registry, trends in incidence, treatment and survival of GBC patients were evaluated.

Methods:
Data of 2427 GBC patients diagnosed between 2000 – 2015 were included in this nationwide population-based study. Incidence and demographics were assessed. Treatment strategies and associated survival were analysed using Kaplan-Meier methods and propensity score matching.

Results:
Age-standardised incidence of GBC varied from 0.6 to 0.9 per 100.000 person years and did not change significantly over time. Demographic characteristics are presented in Table 1. Most tumours (67.2%) were detected pre-operatively. The overall median survival was 5.2 months and primarily determined by tumour stage, ranging from 36.2 months in stage I patients to 3.0 months   in stage 4 patients. Between 2000 and 2015 median survival improved from 4.1 to 6.6 months (p < 0.01). After propensity score matching, median survival in surgically treated stage III + IV gallbladder cancer was 7.4 months, compared to 3.3 months for non-surgically treated patients (p < 0.001). Stage II GBC patients receiving additional liver bed resection showed superior median survival to those whom did not receive additional surgery (21.7 vs. 46.6 months, p < 0.001). Systemic therapy in advanced stage GBC improved median survival from 2.8 to 7.4 months.

Conclusion:

Although an increase of 2 months in overall survival was demonstrated over time, the clinical significance of this finding is debatable and outcome of GBC patients is still poor. A considerable, clinically relevant increase in survival was seen in two subgroups: patients with early GBC receiving additional resection and patients with advanced GBC treated with systemic therapy. More aggressive treatment strategies should be advocated, as they appear to improve the prospects of GBC patients.

75.04 Maximum Diameter is a Poor Surrogate Measure for Volume and Surface Area of Small Pancreatic Cysts

Posted on January 31, 2019

A. M. Awe1, V. Rendell3, M. Lubner2, E. Winslow3  1University Of Wisconsin,School Of Medicine & Public Health,Madison, WI, USA 2University Of Wisconsin,Department Of Radiology,Madison, WI, USA 3University Of Wisconsin,Department Of Surgery,Madison, WI, USA

Introduction: Determining an appropriate surveillance strategy for pancreatic cysts (PC) presents a challenge due to management guideline heterogeneity and a relatively poor ability to predict the malignant potential of PCs. Current management protocols use maximum axial diameter (MAD) to steer treatment; however, other measures may better capture the evolution of PCs. The aim of this study is to determine whether MAD is an appropriate surrogate measure for volume and surface area of PCs.

Methods: A single-institution retrospective analysis of patients with radiologically confirmed PCs was conducted. Patients with a PC >1cm and a contrast-enhanced CT or MR scan were included. Patients with pancreatic pseudocysts, underlying pancreatitis, genetic syndromes, or solid tumors were excluded. MAD, volume, and surface area data were collected using HealthMyne, a novel lesion detecting software. Pearson’s correlations were used to determine associations between volume and MAD, and surface area and MAD for total patients and size sub-groups from the Fukuoka guidelines for PC surveillance and treatment.

Results: In total, 202 patients were included in the analysis. The MADs of the cysts ranged from 1.0 cm to 7.5 cm. PC volume as a function of the MAD for all PC sizes had a strong correlation of r=0.94. When sub-grouped by size based on the Fukuoka guidelines, correlations with volume varied: 1-2 cm (n=87), 2-3 cm (n=61), and >3 cm (n=54) PCs had correlations of 0.78, 0.53, 0.90, respectively (Fig. 1A-C). Volumes ranged for 1-2 cm cysts from 0.3- 3.8 cm3, for 2-3 cm cysts from 1.1- 10.8 cm3, and for >3 cm cysts from 6.7- 104.3 cm3. Based on volume alone, 95 cysts (47%) overlapped in Fukuoka size groupings. PC surface area as a function of the MAD for all PC sizes had a strong correlation of r=0.96. When sub-grouped by Fukuoka guideline size, correlations varied: 1-2 cm (n=87), 2-3 cm (n=61), and >3 cm (n=54) had correlations of 0.80, 0.56, 0.92, respectively (Fig. 1D-F). Surface area ranged for 1-2 cm cysts from 0.2- 13.2 cm2, for 2-3 cm cysts from 7.3- 29.6 cm2, and for >3 cm cysts from 19.6- 126.2 cm2.  Based on surface area alone, 77 cysts (38%) overlapped between axial diameter size groupings in the Fukuoka guidelines.

Conclusion: Overall, there is strong correlation between PC volume, surface area and MAD, suggesting that unidimensional size is an appropriate surrogate measure. However, grouping PCs based on the Fukuoka guideline size criteria reveals poor volume and surface area correlation with MAD for small cysts. This suggests volume and surface area may be a useful adjunct measurements to guide surveillance and treatment decisions for smaller PCs.

 

74.07 Gender Bias in Surgical Publication: Improvement but Still Progress to be Made

Posted on January 31, 2019

L. T. Boitano1,2, K. L. Hart3, A. Tanious1,2, M. J. Eagleton1,2, K. D. Lillemoe2, R. H. Perlis3, S. D. Srivastava1,2  1Massachusetts General Hospital,Vascular And Endovascular Surgery, Surgery,Boston, MA, USA 2Massachusetts General Hospital,Surgery,Boston, MA, USA 3Massachusetts General Hospital,Center For Quantitative Health And Department Of Psychiatry,Boston, MA, USA

Introduction:  Despite an increase in the female graduates entering surgical residency, there remains a gender disparity in academic surgical leadership. Scholarly activity, as measured by scientific publications in high impact journals, is the foundation for academic promotion. Thus, this study seeks evaluate the distribution of authorship by gender over the last 10 years among the top 25 surgical journals.    

Methods:  Original research articles published in the 25 highest-impact general surgery and general surgery subspecialty journals between January 2008 and March 2018 were considered for inclusion. Excluded were journals for which at least 70% of author gender could not be identified. Articles were categorized by gender of first, last and overall authorship using the established genderize.io application programming interface (API) for R, which predicts gender and provides the probability of the associated gender. We examined changes in proportions of female first, last, and overall authorship over time, and analyzed the correlation between these measurements and journal impact factor.

Results: There were a total of 71,867 articles from 19 journals included for analysis. The general surgery and sub-specialty journals included in this analysis represent the following subspecialties: general surgery, cardiothoracic surgery, vascular surgery, transplantation, bariatric surgery, surgical oncology, colorectal surgery, plastic surgery, surgical pathology and trauma and acute care surgery. Gender was successfully predicted for 87.3% of authors (range: 79.1%-92.5%). There were significant increases in the overall percentage of female authors (β = 0.55, p = 1.01e-6), in the percentage of female first authors (β = 0.97, p = 1.69e-8), and in the percentage of female last authors (β = 0.53, p = 3.09e-5) over the 10-year study period. In regards to last author, one journal, Eur J Cardiothorac Surg (β= -0.5), had a significant decrease in the proportion of female last authors. Furthermore, all journals representing the cardiothoracic subspecialty failed to show a significant increase in the proportion of female last authors over the study period. There were, however, no significant correlations between the impact factor of the journal and the overall percentage of female authors (rs = 0.39, p = 0.09), percentage of female first authors (rs = 0.29, p = 0.22), or percentage of female last authors (rs = 0.35, p = 0.13).

Conclusion: The current study identifies continued but slow improvement in female authorship of high impact surgical journals during the contemporary era. However, the improvement was more apparent in the first author compared to senior author positions.

 

74.02 Operating Room Personnel Response to Surgeon Behavior: Predictors of Sex-Based Bias

Posted on January 31, 2019

E. M. Corsini1, J. G. Luc2, K. G. Mitchell1, N. S. Turner1, A. A. Vaporciyan1, M. B. Antonoff1  1University Of Texas MD Anderson Cancer Center,Thoracic And Cardiovascular Surgery,Houston, TX, USA 2University Of British Columbia,Cardiovascular Surgery,Vancouver, BRITISH COLUMBIA, Canada

Introduction:
While recent attention has been directed toward exploring differential treatment of male versus female health care professionals in the hospital setting, detailed understanding is lacking regarding those circumstances which may contribute to display of bias. The operating room (OR) provides a unique setting in which to examine these biases, which are of particular interest given the changing face of surgery in recent years. We sought to evaluate the presence of sex-based biases of OR staff in response to surgeon behaviors, as well as explore predictors of such bias.

Methods:
We performed a prospective, randomized study in which OR personnel, including registered nurses (RN), surgical technologists (ST), and surgical assistants (SA), were asked to assess questionable surgeon behaviors across a standardized set of 5 scenarios via online survey. Respondents were randomized to surveys that either described a female or male surgeon, with all other aspects of the survey identical. For each scenario, respondents were asked to identify the behavior as Acceptable; Unacceptable but would ignore; Unacceptable and would confront surgeon directly; or Unacceptable and would report to OR management. Detailed demographic information was also collected. Analyses compared respondents’ assessments of surgeon behaviors with the sex of the surgeon and respondent characteristics; χ2 was used to identify associations among these variables.

Results:
3,186 respondents completed the survey (response rate=4.5%), among whom 81% were female, 54% were RN, 21% were SA, and 15% were ST. Assessed across all scenarios, likelihood to write up the surgeon was predicted by job role: ST, RN, and SA reported surgeons with frequencies of 65.5%, 53.2%, and 48.8%, respectively (p=0.008). Moreover, ST were also more likely to specifically report female surgeons (p=0.006) than other OR staff, (Table). When scenarios were evaluated individually, there were participants who reported female surgeons more frequently than males, including staff at academic hospitals (p=0.031), staff with more than 15 years’ experience (p=0.005), and male RN (p=0.034). Similarly, certain groups found particular behaviors more appropriate when they were exhibited by a male, rather than female, surgeon, including millennial respondents (p=0.011).

Conclusion:
Role appears to be predictive of sex bias in the OR, with ST evaluating behaviors of female surgeons more critically than males.  More subtle implicit sex biases may exist between other OR staff and surgeons, yet such attitudes are complex and may not be uniformly present. Additional investigations are needed to determine the interpersonal and task-related circumstances which may accentuate these biases.
 

73.06 Characterization of Wound Misclassification in Common Surgical Procedures

Posted on January 31, 2019

A. P. Worden1, P. Kandagatla1, I. Rubinfeld1, A. Stefanou1  1Henry Ford Health System/Wayne State University,Surgery,Detroit, MICHIGAN, USA

Introduction:  Wound class helps predict wound related complications and is useful for stratifying surgical site infection (SSI) reporting.  Misclassification could be significant as report cards increasingly affect reimbursement and publicly reported data. We sought to evaluate misclassification among commonly performed surgeries that are defined to be clean-contaminated or higher. We hypothesized that rates of misclassification are increasing, and this increasing trend may be correlated with laparoscopic approaches.
 

Methods:  The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005-2016 by CPT codes identifying common surgeries that are by definition not clean: colectomy, cholecystectomy, hysterectomy, and appendectomy. Misclassification was defined as a procedure classified as clean.  Obtained information included year of surgery, pre-operative patient characteristics, intra-operative characteristics, laparoscopic vs open approach, wound complications, readmission, and mortality. Variables were compared between correctly and incorrectly classified patients. Multivariate logistic regression was performed to derive independent predictors of misclassification.

Results: We reviewed 789,221 cases, of which 17,696 (2.29%) were misclassified as clean. There were 75,684 colectomies (16,749 laparoscopic and 58,935 open), 374,564 cholecystectomies (347,894 laparoscopic and 26,670 open), 65,3940 hysterectomies (15,089 laparoscopic and 63,8851 open) and 25,6905 appendectomies (24,8491 laparoscopic and 8,414 open). Misclassification was associated with the type of procedure (p<0.01). Hysterectomy was the most commonly misclassified procedure (4.8%), and colectomy the most accurately classified (0.8%). Misclassification was lower in laparoscopic cases (2.1% vs 2.7%, p<0.01).

Misclassified cases increased from 2005 to 2016 (0.2% vs 3.7%, p<0.01). Misclassified patients were younger (46.7 vs 47.7 years, p<0.01) and had lower rates of HTN (27.7% vs 30.4%, p<0.01), COPD (2.0% vs 2.7%, p<0.01), smoking history (17.1% vs 18.8%, p<0.01), and steroid use (1.7% vs 3.0%, p<0.01).  Post-operatively, misclassified patients had lower rates of Clavien 4 complications (1.0% vs 2.7%, p<0.01), shorter length of stay (2.2 vs 3.2 days, p<0.01), and 30-day readmission (3.7% vs 5.0%, p<0.01). The rate of any SSI is decreased in misclassified patients (1.7% vs 3.4%, p<0.01). Open hysterectomy was the most significant positive predictor for misclassification (OR 3.34, p<0.01), while open appendectomy was the most significant negative predictor (OR 0.20, p<0.01).

 

Conclusion: Despite guidelines, there is an increasing trend of wound misclassification. Given that misclassified patients have better outcomes, misclassification may be affected by patient characteristics, operative approach, and type of procedure, rather than reflecting the true infectious burden. Further research is warranted to explore this phenomenon.
 
 

73.05 Predicting the Need for Operative Management of Small Bowel Obstruction with Machine Learning

Posted on January 31, 2019

J. D. Bozzay1,19, P. F. Walker1,19, V. Khatri1,17,19, M. Zielinski2, S. Wydo3, D. Cullinane4, J. Dunn5, T. Duane6, D. Turay7, K. Inaba8, R. Lesperance9, M. Rosenthal10, J. Watras11, A. Pakula12, K. A. Widom13, J. Cull14, E. Toschlog15, T. Z. Hayward16, S. Schobel-Mchugh1,17,19, E. A. Elster1,17,19, C. J. Rodriguez1,19, M. J. Bradley1,17,18,19  1Walter Reed National Military Medical Center,Department Of Surgery,Bethesda, MD, USA 2Mayo Clinic,Department Of Surgery,Rochester, MN, USA 3Cooper University Hospital,Department Of Surgery,Camden, NJ, USA 4Marshfield Clinic,Department Of Surgery,Marshfield, WI, USA 5UC Health Northern Colorado,Department Of Surgery,Loveland, CO, USA 6John Peter Smith,Department Of Surgery,Forth Worth, TX, USA 7Loma Linda University Health,Department Of Surgery,Loma LInda, CA, USA 8Keck School of Medicine of USC,Department Of Surgery,Los Angeles, CA, USA 9San Antonio Military Medical Center,Department Of Surgery,Fort Sam Houston, TX, USA 10Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 11Inova Fairfax Hospital,Department Of Surgery,Falls Church, VA, USA 12Kern Medical Center,Department Of Surgery,Bakersfield, CA, USA 13Geisinger Medical Center,Department Of Surgery,Danville, PA, USA 14Greenville Memorial Hospital,Department Of Surgery,Greenville, SC, USA 15East Carolina University,Department Of Surgery,Greenville, NC, USA 16Indiana University School Of Medicine,Department Of Surgery,Indianapolis, IN, USA 17Surgical Critical Care Initiative,Bethesda, MD, USA 18Naval Medical Research Center,Department Of Regenerative Medicine,Bethesda, MD, USA 19Uniformed Services University Of The Health Sciences,Bethesda, MD, USA

Introduction: Identifying candidates who will require therapeutic surgery (TS) for non-emergent small bowel obstruction (SBO) remains challenging.  Machine learning models can elicit complex dependencies and may perform better than traditional regression models. The objective of this study was to compare both strategies to best identify patients who would require TS for the management of SBO.

Methods: A prospectively maintained multi-institutional database from the Eastern Association for the Surgery of Trauma was reviewed. Presence of peritonitis, closed loop obstruction on imaging, virgin abdomen, or patients with data paucity were excluded, leaving 566 patients for analysis. Random Forest (RF) and logistic regression (LR) models were generated separately for both gastrografin challenge (GC) and non-GC patients.

Results: 156 (27.6%) patients underwent TS. The non-GC RF model produced an area under the curve (AUC) of 0.68, sensitivity of 0.64, and specificity of 0.70. The non-GC LR model produced an AUC of 0.62, sensitivity of 0.59, and specificity of 0.65. The GC RF model produced an AUC of 0.89, sensitivity of 0.86, and specificity of 0.89. The GC LR model produced an AUC of 0.89, sensitivity of 0.87, and specificity of 0.87. Predictive variables for therapeutic surgical intervention for the GC RF and LR models included GC test result,  systolic blood pressure, presence of intraperitoneal fluid, presence of CT transition point, and previous occurrence of at least of 1 of the following: Crohn’s disease, enterocutaneous fistula, gastric bypass, metastatic cancer, small bowel obstruction, or ventral hernia. In the GC RF and LR models, removal of the GC test result as a predictor, substantially lessened performance metrics for both the RF (AUC of 0.59, sensitivity of 0.57, specificity of 0.64) and LR models (AUC of 0.61, sensitivity of 0.62, specificity of 0.65). The GC test result alone had a sensitivity of 0.7 and specificity of 0.93.

Conclusion: An accurate model for predicting the need for SBO TS was developed using a combination of clinical and radiographic data. Furthermore, incorporation of the GC significantly improves model performance and is an important clinical test during the workup of non-emergent SBO. The improved performance for GC patients is critically dependent on the inclusion of GC result as a predictor. This type of predictive modeling may be a useful adjunct to support future clinical decision-making. Evaluation with an external validation dataset is required to assess the generalizability of model performance.

73.03 Differential Responses of Operating Room Personnel to Behaviors of Male and Female Surgeons

Posted on January 31, 2019

E. M. Corsini1, J. G. Luc2, K. G. Mitchell1, N. S. Turner1, A. A. Vaporciyan1, M. B. Antonoff1  1University Of Texas MD Anderson Cancer Center,Thoracic And Cardiovascular Surgery,Houston, TX, USA 2University of British Columbia,Cardiovascular Surgery,Vancouver, BRITISH COLUMBIA, Canada

Introduction:
To date, several qualitative studies have been conducted assessing the relationships between physicians and registered nurses (RN), with special attention paid to the dynamics between females working together. However, while surgeon demographics have shifted in recent decades to include more women, the female-to-female relationship in the operating room (OR) remains largely unstudied. Furthermore, stereotypical surgeon-specific behavior may stand at odds with societal expectations for appropriate behavior of women. Therefore, we sought to examine biases related to surgeon sex within the environment of the operating room, paying special attention to views of female allied health professionals.

Methods:
We performed a prospective, randomized study in which OR support staff, including RN, surgical technologists (ST), and surgical assistants (SA), were asked to assess questionable surgeon behaviors across a standardized set of five scenarios via online survey. Respondents were randomized to surveys that either described a female or male surgeon, with all other aspects of the survey identical. For each scenario, respondents were asked to identify the behavior as Acceptable; Unacceptable but would ignore; Unacceptable and would confront surgeon directly; or Unacceptable and would report to OR management. Analyses included comparisons of respondents’ assessments of surgeon behaviors with the sexes of both the surgeon and respondents; χ2 was used to identify associations among these variables.

Results:

There were 3,186 responses (response rate=4.5%). 81% of respondents were female, 54% were RN, 55% reported working in the OR for greater than 15 years, 41% were Baby Boomers, and 94% worked in the United States. When evaluating across all scenarios and both surgeon sexes, female respondents were more likely to find the surgeon’s behaviors inappropriate than male respondents (p=0.001), (Figure). Sex of the surgeon did not appear to play a role in the assessment of appropriateness of the surgeon’s behaviors when evaluated across all respondents (p=0.322), male respondents (p=0.980), or female respondents (p=0.265). Similarly, sex of the respondent did not impact the likelihood to report the surgeon, regardless of surgeon sex (p=0.499).

Conclusion:
Our results suggest that ancillary OR staff of either sex do not have an inherent bias towards male or female surgeons when assessing behaviors via survey. However, female OR support staff appear to be more critical in their evaluation of surgeons across both sexes. Future investigations should aim to capture more subtle differences in responses and behaviors in the OR, such as body language, tone of voice, and type of language used.

71.03 Predictive Value of Surgeon Performed Ultrasound In the Diagnosis of NIFTP

Posted on January 31, 2019

M. S. Sussman1, M. B. Mulder1, O. Picado1, J. I. Lew1, J. C. Farra1  1University Of Miami,DeWitt Daughtry Department Of Surgery: Division Of Endocrine Surgery,Miami, FL, USA

Introduction:  The reclassification of noninvasive encapsulated follicular variant papillary thyroid carcinoma (FVPTC) to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been shown to decrease the reported risk of malignancy (ROM) for all categories within the Bethesda System for Reporting Thyroid Cytology (BSRTC), with the greatest impact seen in atypia /follicular lesion of undetermined significance (AUS/FLUS) or Bethesda III thyroid nodules. There are currently no clinical factors to help predict malignancy vs. NIFTP in indeterminate thyroid nodules. This study evaluates the utility of gene expression classifier (GEC) testing and surgeon performed ultrasound (SUS) features as predictive factors for NIFTP in patients with thyroid nodules.

Methods:  A retrospective review of prospectively collected data of 847 patients who underwent thyroidectomy at a single institution from 2010 to 2016 was performed. Pathology slides with a diagnosis of FVPTC (n=146) were re-reviewed by endocrine pathologists for reclassification to NIFTP. Risk of malignancy (ROM) overall and within each BSRTC classification was determined before and after the reclassification of NIFTP. GEC testing and SUS characteristics were compared in FVPTC vs. NIFTP patients to evaluate for predictive value with significance defined as P<0.05.

Results: Of 146 patients who underwent thyroidectomy for FVPTC, 22% were reclassified as NIFTP (n=32). Of the NIFTP group, 35% (n=11) had AUS/FLUS thyroid nodules. GEC testing was performed in 25 patients, of which 22 had a suspicious result. Suspicious GEC results between FVPTC (12%) and NIFTP (12%) pathologies were identical. On multivariate regression, SUS characteristics of echogenicity and microcalcifications were independent predictors of NIFTP vs. FVPTC. Isoechogenicity was predictive of NIFTP, whereas hypoechogenicity was predictive of FVPTC (OR 3 95% CI 1.3 – 7, p<0.05). Additionally, microcalcifications was predictive of FVPTC compared to NIFTP (OR 4 95% CI .9-18, p<0.05).

Conclusion: A significant proportion of AUS/FLUS thyroid nodules are NIFTP on final pathology. Although GEC testing has limited utility, SUS features such as isoechogenicity and the absence of microcalcifications may favor a diagnosis of NIFTP in such thyroid nodules. This may help guide and determine extent of thyroidectomy in these select cases. 

 

70.03 Modifiable Risk Factors Associated with Poor Wellness and Suicidal Ideation in Surgical Residents

Posted on January 31, 2019

R. J. Ellis1,2, D. Hewitt3, Y. Hu1, A. D. Yang1, J. T. Moskowitz4, E. O. Cheung4, D. B. Hoyt2, J. Buyske5, T. J. Nasca6, J. R. Potts6, K. Y. Bilimoria1,2  1Northwestern University,Department Of Surgery, Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2American College of Surgeons,Chicago, IL, USA 3Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 4Northwestern University,Department Of Medical Social Sciences,Chicago, IL, USA 5American Board of Surgery,Philadelphia, PA, USA 6Accreditation Council for Graduate Medical Education,Chicago, IL, USA

Introduction:  Poor physician wellness often manifests as burnout and may lead to thoughts of attrition and suicidal ideation, with suicide a leading cause of physician mortality. Surgical residents may be particularly at risk for these issues. Objectives of this study were (1) to examine the frequency of burnout, thoughts of attrition, and suicidal ideation in general surgery residents and (2) to characterize individual and environmental factors associated with poor wellness outcomes.

Methods: Cross-sectional national study of clinically active general surgery residents administered in conjunction with the 2018 American Board of Surgery In-Training Examination. Outcomes of interest were burnout, thoughts of attrition, and suicidal ideation. Individual resident and environmental factors associated with resident wellness included resident grit, stress, duty hour violations, discrimination, abuse, and sexual harassment. Associations between exposures and outcomes were assessed using multivariable logistic regression models.

Results: Among 7,413 residents (99.3% response rate) from 262 general surgery programs, 12.9% of residents reported at least weekly symptoms on both burnout subscales (emotional exhaustion and depersonalization). Burnout was more likely in residents with low grit scores (OR 2.27 [95%CI 1.95-2.63]), frequent duty hour violations (OR 1.46 [95%CI 1.22-1.74]), and in those reporting discrimination (OR 1.23 [95%CI 1.02-1.49]), verbal/physical abuse (OR 1.78 [95%CI 1.47-2.15]), or sexual harassment (OR 1.28 [95%CI 1.00-1.63]). Thoughts of attrition were reported by 12.6% of residents and were more likely in female residents (OR 1.32 [95%CI 1.09-1.60]), those with lower grit scores (OR 1.26 [95%CI 1.06-1.50]), frequent duty hour violations (OR 1.68 [95%CI 1.38-2.04]), or in those reporting severe stress (OR 2.47 [95%CI 2.04-2.99]), frequent burnout symptoms (OR 2.35 [95%CI 1.92-2.87]), discrimination (OR 1.27 [95%CI 1.06-1.51]), or verbal/physical abuse (OR 2.16 [95%CI 1.81-2.57]). Suicidal ideation was reported by 4.5% of residents and was more likely in those with lower grit scores (OR 1.43 [95%CI 1.10-1.84]), or in those who reported severe stress (OR 2.61 [95%CI 1.99-3.42]), frequent burnout symptoms (OR 1.94 [95%CI 1.43-2.63]), verbal/physical abuse (OR 1.80 [95%CI 1.39-2.33]), or sexual harassment (OR 1.58 [95%CI 1.13-2.21]).

Conclusion: Burnout symptoms, thoughts of attrition, and suicidal ideation were reported at lower rates in this comprehensive national survey than in previous studies, but remain an important problem among general surgery residents. Resident grit and environmental factors such as duty hour violations, discrimination, abuse, and harassment are associated with burnout. Burnout and negative environmental factors are further associated with thoughts of attrition and suicidal ideation. Targeted interventions aimed at minimizing inappropriate behaviors and improving the learning environment may improve trainee wellness.

66.09 A chemotactic functional scaffold enhances BMP2-induced bone regeneration in a rodent model

Posted on January 31, 2019

D. Khalil1, R. Bakshi1, L. Wang1, S. Zhou1, K. Rezzadeh1, A. Hokugo1, R. Jarrahy1  1David Geffen School of Medicine at UCLA,Department Of Surgery,Los Angeles, CA, USA

Introduction:  Current commontechniques for repairing full thickness calvarial defects include autologous bone grafting and the use of alloplastic implants, both of which have significant limitations. In this study, we investigate a novel alternative approach to bone repair based on tissue engineering principles. Specifically, we examine the ability of nanoscale peptide amphiphile gels (PAs) engineered tocontrolrelease of VEGF to recruit circulating stem cells to a site of bone regeneration and to help facilitate large-scale bone healing by BMP-2. 

Methods:  Chemotactic functional scaffolds (CFS) were fabricated by combining collagen sponges with PAs to which VEGF was bound. The in vitro chemotactic activity of these constructs was evaluated by measuring human mesenchymal stem cell (hMSC) movement across a semipermeable membrane when exposed to the CFS. In vivo,CFS function was assessed by implantation of scaffolds into dorsal subcutaneous pockets in rodentsand analysis of migration of peripherally injected hMSCs to the CFS. Large-scale rodent cranial bone defectswas created. CFS and other control materials were implanted and bone regeneration was evaluated.

Results: Migration of hMSCs through semipermeable membranes was significantly greater in scaffolds exposed to CFS compared to control scaffolds (P<0.05). In vivo chemotaxis was evidenced by migration of circulating DiR-tagged hMSCs to the CFS. Successful bone regeneration was noted in the defects treated with CFS. 

Conclusion: Our observations suggest that this bioengineered construct successfully acts as a chemo-attractantfor circulating hMSCs, likely due to controlled release of VEGF from the CFS. The CFS may play a role in the future design of clinically relevant bone graft substitutes.?

 

63.17 How Many Clicks Does It Take to Get to the Center of a Department-wide Wellness Initiative

Posted on January 31, 2019

M. E. Hadley1, A. Coughlan1, J. G. Chipman1, C. J. Tignanelli1,2,3  1University Of Minnesota,Department Of Surgery,Minneapolis, MN, USA 2University Of Minnesota,Institute For Health Informatics,Minneapolis, MN, USA 3North Memorial Health Hospital,Department Of Surgery,Minneapolis, MN, USA

Introduction:
Burnout is a public health crisis that affects over 50% of healthcare providers and results in adverse patient outcomes, poor physician job satisfaction, depersonalization, and increased rates of depression, substance abuse, and physician suicide. Our institution developed a unique Department of Surgery wellness program to combat this issue, reduce stress, and promote wellbeing. The aim of this study was to evaluate user interaction with our program vis-à-vis a monthly newsletter as a dissemination tool.

Methods:
Our wellness program is sponsored by the Department of Surgery Wellness Committee and includes the following regular activities: chair yoga, wellness walks, photography club, craft lunch, visiting seasonal farmers market and music on the plaza, sitcom break, and themed potlucks. Additionally, it includes wellness insights from faculty and opportunities to participate in University of Minnesota fundraisers such as the annual Turtle Derby or Chainbreaker events. A regular wellness newsletter was developed to disseminate this program which is sent to Department of Surgery housestaff, faculty, and staff, with approximately 350 subscribers. Mailchimp® (marketing automation platform, Atlanta, GA) was used to evaluate subscriber interaction with the newsletter from April, 2017 – July, 2018. Interactions were defined as the number of subscribers opening each newsletter and the number of subscribers who clicked on linked content within the newsletter. The Mailchimp® industry average for health and fitness newsletters was used a reference standard.

Results:
The average number of subscribers who opened the newsletter each month was 178, or 51% compared to the industry average of 16% (Table 1). There was an average of 18 subscribers clicking content per newsletter. Thus, of the people who received the newsletter, 5% of subscribers opened and then clicked for further content. This is higher than the industry average of 2%. All employee types equally opened the newsletter; however, staff were most likely to click individual content within each newsletter.  

Conclusion:
A wellness newsletter is an effective tool to disseminate a wellness program within a Department of Surgery and is interacted with more than the industry average. Future directions should focus on identifying ways to further improve interaction with and better integrate surgical wellness programs for faculty and housestaff. A wellness newsletter may be an important way to reach healthcare workers who are at risk for burnout.
 

63.15 Trends in Medical Education Research: A Look at Abstracts from the Academic Surgical Congress

Posted on January 31, 2019

M. Mankarious1,2, E. Palmquist1, L. Chen1  1Tufts Medical Center,Department Of Surgery,Boston, MA, USA 2Tufts University School of Medicine,Boston, MA, USA

Introduction:

Medical education research is a quickly growing field of interest that has attracted many brilliant minds over the last decade that address this multifaceted landscape. With the surgical educational environment undergoing many significant changes, new topics emerged with increasing trends and interesting results. In this study, we utilize available abstracts from Academic Surgical Congress (ASC) over the past years to examine emerging topics and trends in medical education research.

Methods:

ASC abstracts over the past four years were obtained from the ASC website. University and state affiliation of the first author for each abstract was collected. Abstracts were categorized according to topic (Curriculum/Teaching, Innovations, Assessment, Program Evaluation, Wellbeing/Burnout, and Miscellaneous) and design (Descriptive, Test Assessment, Relational, and Qualitative) based on previously published categories. Miscellaneous topics were recategorized based on theme.

Results:

A total of 429 abstracts were obtained from previous four ASC meetings. 405 abstracts were from within the United States and 24 from other countries. 29.6% of abstracts within the USA came from Wisconsin, Illinois, California, and Texas.

Overall number of abstracts nearly doubled from 77 in 2015 to 140 in 2018. Descriptive studies were the most common research design (41%), followed by test assessment (20%), qualitative (18%), relationship (18%), and experimental (3%). Annual topic proportions were considerably stable with 21% curriculum and teaching, 26% technical and performance assessment, 6% wellbeing and burnout, and 5% program evaluations. 33% of the abstracts belonged to the miscellaneous category. Of the miscellaneous, most common topics addressed Global Health (19.15%) and Gender/Race (14.18%). Remainder of miscellaneous topics included personality traits of students, residents, and surgeons, experience and overall trends in practice, impact and utilization of social media, resident work-hour limits, and financial questions in surgical training.

Conclusion:
Research into medical education is a transforming and evolving field. Since 2000, there has been an increasing number of studies as well as new prominent topics that are more relevant to the current educational environment. Up to date knowledge of these current topic trends in medical education may inform future research. For instance, the increasing trend towards evaluating and restructuring global health programs points to the increasing prevalence of the topic to residency programs as it becomes an integrated aspect of many residency programs. Similarly, research regarding gender and racial inequalities in the surgical environment points to the changing landscape and the importance of creating a more inclusive environment. 

63.12 Acceptance of Xenotransplantation Among Nursing Students

Posted on January 31, 2019

W. Paris1, L. Padilla2, Z. Aburjania6, R. Bgainer3, K. Jang1, D. Cleveland6, Y. Lau4, S. Floyd6, D. Mauchley6, R. Dabal6, D. K. Cooper5  1Abilene Christian University,School Of Social Work,Abilene, TX, USA 2University Of Alabama at Birmingham,Department Of Epidemiology,Birmingham, Alabama, USA 3Texas Tech University Health Sciences Center,School Of Nursing,Lubbock, TX, USA 4University of Alabama at Birmingham,Division Of Pediatric Cardiology,Birmingham, AL, USA 5University Of Alabama at Birmingham,Department Of Surgery, Xenotransplant Program,Birmingham, AL, USA 6University Of Alabama at Birmingham,Department Of Surgery, Division Of Cardiothoracic Surgery,Birmingham, AL, USA

Introduction: Organ donation rates have not kept pace with the global incidence of end-stage organ failure. Given recent experimental progress, xenotransplantation (XTP; i.e., pig to human) has the potential to provide an unlimited supply of donor organs, but will present with many challenging public health issues for consideration. The objective of the study was to identify and report the most recent information relevant to XTP clinical trials; and report initial acceptance about the procedure.

Methods: A cross-sectional study among 70 nursing students from a large mid-western public university was conducted (July, 2017). An email was forwarded with a 35 item survey developed by the research team using a weblink after online consent.

Results: Regression analysis found that their willingness to consider receiving a XTP was being an organ donor themselves (p<0.01).  Only 7% were aware that pig donors must be genetically modified (to prevent rejection) before they could be used as sources of organs for transplantation into humans.  Wilcoxon Rank-Sum procedures found that anticipation of poorer medical outcomes with XTP (when compared to than human organ donation) was significantly associated with greater concern about potential psychosocial sequlae (p<0.01). 

Conclusion: The most commonly related factors towards acceptance of XTP among healthcare professionals were being an organ donor, and the expectation of positive medical results.  Findings suggest that even among healthcare professional’s knowledge of the process and immunology is limited.  The findings highlight the need to increase knowledge and awareness of XTP among healthcare professionals as an incremental step in public education and preparation for clinical trials.  

 

63.08 Gender Variance in NIH K-series Grant Funding in Surgery

Posted on January 31, 2019

J. M. Juprasert1, H. L. Yeo1  1NewYork-Presbyterian Hospital/Weill Cornell Medical Center,Department Of Surgery,New York, NY, USA

Introduction: Over the past 15 years, the number of women in academic surgery has increased dramatically, however, even as recently as 2015, women only accounted for 25% of assistant professors of surgery and <10% of full professors. Based on the current trajectory, women will not reach parity in academic surgery for over 100 yrs.  There is a concern that part of the disparity at the top levels may be attributed to gender discrimination, lack of visible role models, or lack of support and mentorship.  Because early funding is so important in an academic career, we sought to evaluate gender differences in NIH career development funding.

Methods:  Secondary analysis of prospectively collected data from fiscal year 2017 and 2018 from the NIH RePORTer database.  NIH K-series funding awards to principal investigators (PIs) were obtained and used to examine faculty from surgery departments for academic rank and gender.  Awardees with at least an M.D. were included in the study to focus our cohort on clinical academic surgeons.  K1, K07, K08, K22, K23 were included in the study to investigate early career awards; K24 recipients were excluded because they are for mid-career investigators.  The Scopus and Pubmed databases were used to ascertain publication statistics of these PIs.  Statistical trend tests were performed using t-test, ANOVA, and chi-squared test wherever appropriate with STATA v13.1.

Results: 63 surgical PIs (33% women vs 67% men) were identified who received a K-series grant from the NIH between 2017-18. The average number of first author publications for these awardees was 14.5 (+/-10) for women and 15.7 (+/-11) for men (p=0.67). The average number of senior author publications for these K awardees were 9.9 (+/-9) for women and 12.2 (+/-13) for men  (p=0.47).  The average number of total publications for K awardees was not significantly different for women (43.6+/-24) vs. men (53.2+/-32.2, p=0.23). The mean H-index for female faculty was 14.0 (+/-5) and 16.4 (+/-7) for men (p=0.15). Of the grants that were granted, 38 (60%) were basic science, 16 (25%) were translational, and 9 (14%) were health services related.  32 recipients were assistant professors (31% were women).  30 recipients were associate professors (37% were women).  The University of Michigan had the most recipients of any institution with 10 PIS (4 of whom are women) receiving grants; Northwestern University and University of Pennsylvania had the second highest with 5 PIS.  31 total institutions had at least one recipient.

Conclusion: The NIH K grant funding for early career women surgeons has not been previously described. There do not appear to be major gender related discrepancies in early career funding for surgeons.

 

« Previous Page
Next Page »