Charity C. Glass

American College of Surgeons/Association for Surgical Education medical student simulation-based surgical skills curriculum needs assessment.

BACKGROUND Simulation can enhance learning effectiveness, efficiency, and patient safety and is engaging for learners. METHODS A survey was conducted of surgical clerkship directors nationally and medical students at 5 medical schools to rank and stratify simulation-based educational topics. Students applying to surgery were compared with others using Wilcoxons rank-sum tests. RESULTS Seventy-three of 163 clerkship directors (45%) and 231 of 872 students (26.5%) completed the survey. Of students, 28.6% were applying for surgical residency training. Clerkship directors and students generally agreed on the importance and timing of specific educational topics. Clerkship directors tended to rank basic skills, such as examination skills, higher than medical students. Students ranked procedural skills, such as lumbar puncture, more highly than clerkship directors. CONCLUSIONS Surgery clerkship directors and 4th-year medical students agree substantially about the content of a simulation-based curriculum, although 4th-year medical students recommended that some topics be taught earlier than the clerkship directors recommended. Students planning to apply to surgical residencies did not differ significantly in their scoring from students pursuing nonsurgical specialties.

Quantifying the Burden of Interhospital Cost Variation in Pediatric Surgery: Implications for the Prioritization of Comparative Effectiveness Research

Importance Practice variation is believed to be a driver of excess health care spending, although few objective data exist to guide the prioritization of comparative effectiveness research (CER) in pediatric surgery. Objective To identify high-priority general pediatric surgical procedures for CER on the basis of the following 2 complementary measures: the magnitude of interhospital cost variation as a surrogate for the need for and potential effect of CER at the patient level and the cumulative fiscal burden of this cost variation when considering the case volume from all hospitals as a surrogate for public health relevance. Design, Setting, and Participants This was a cohort study of patients undergoing 1 of the 30 most costly pediatric surgical operations at 45 children’s hospitals between January 1, 2014, and September 30, 2015. Cost data were extracted from the Pediatric Health Information System database and adjusted for differences in unit-based costing at the hospital level and for differences in case mix and disease severity at the patient level. Main Outcomes and Measures First, the width of the interquartile range (WIQR) of the adjusted procedure-specific median cost across hospitals. Second, the procedure-specific cost variation burden, which was calculated as the aggregate sum of absolute cost differences between the overall adjusted median cost derived from all patients treated at all hospitals and the adjusted cost of each individual patient treated at all hospitals. Results A total of 92 535 encounters were analyzed. The median number of encounters per hospital was 2011 (interquartile range [IQR], 1224-2619), and the median number of encounters per procedure was 610 (IQR, 442-2610). In the final cohort, 66.9% (n = 61 933) of the patients were male, and the median age was 7 years (IQR, 1.9-12.3 years). Cost variation at the hospital level was greatest for gastroschisis (WIQR,

Overview and diagnosis of acute appendicitis in children

48 471; median,

Readmission following pancreatectomy: what can be improved?

111 566 [IQR,

Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children

91 195-

Diagnostic imaging practices for children with suspected appendicitis evaluated at definitive care hospitals and their associated referral centers

139 936]), congenital diaphragmatic hernia (WIQR,

Contemporary practice among pediatric surgeons in the use of bowel preparation for elective colorectal surgery: A survey of the American Pediatric Surgical Association

43 948; median,

Rates and burden of surgical site infections associated with pediatric colorectal surgery: insight from the National Surgery Quality Improvement Program

154 730 [IQR,

Endometriosis within a left-sided inguinal hernia sac

129 764-

Do all-cause revisit rates reflect the quality of pediatric surgical care provided during index encounters?

173 712]), tracheoesophageal fistula/esophageal atresia (WIQR,