David C. Borgstrom

Are General Surgery Residency Programs Likely to Prepare Future Rural Surgeons

BACKGROUND Too few surgeons practice in small rural areas of the United States. Many newly graduating surgeons choose not to practice rurally because they feel unprepared for rural practice. Family medicine residencies have a track record of placing graduates in rural settings. Their experience shows that having a stated interest in training rural physicians, a rural-focused curriculum, and rural practice exposure opportunities are successful elements for graduating physicians who practice rurally. OBJECTIVE To describe the extent to which general surgery residency training is likely to prepare future rural surgeons using criteria cited in reviews of rural family medicine residency programs. METHODS Three criteria were used to assess whether general surgery residency programs are positioned to produce rural surgeons: rural location, rural-focused curriculum, and self-identified interest in rural training. Several search strategies were employed to identify residency programs that meet the criteria. Additionally, data extracted from the American Medical Associations Physician Masterfile was used to determine demographic characteristics of residency programs that have trained surgeons who currently practice rurally. RESULTS Overall, 25 general surgery residency programs meet at least 1 of the 3 criteria. This finding represents approximately 10% of all residency programs in the United States. Residency programs located in the Midwest and the South have generally been more successful in graduating surgeons who are practicing rurally than those situated in the Northeast and West. CONCLUSIONS Although a few general surgery residency programs have been successful in graduating surgeons who practice rurally, there has not been a coordinated effort among programs to accomplish this goal. Our findings suggest a need for organization and coordination among those programs committed to training surgeons for rural practice. The creation of a consortium of general surgical residency programs with an interest in training rural surgeons could be a useful first step in this process.

What Surgical Skills Rural Surgeons Need to Master

BACKGROUND As new technology is developed and scientific evidence demonstrates strategies to improve the quality of care, it is essential that surgeons keep current with their skills. Rural surgeons need efficient and targeted continuing medical education that matches their broader scope of practice. Developing such a program begins with an assessment of the learning needs of the rural surgeon. The aim of this study was to assess the learning needs considered most important to surgeons practicing in rural areas. STUDY DESIGN A needs assessment questionnaire was administered to surgeons practicing in rural areas. An additional gap analysis questionnaire was administered to registrants of a skills course for rural surgeons. RESULTS Seventy-one needs assessment questionnaires were completed. The self-reported procedures most commonly performed included laparoscopic cholecystectomy (n = 44), hernia repair (n = 42), endoscopy (n = 43), breast surgery (n = 23), appendectomy (n = 20), and colon resection (n = 18). Respondents indicated that they would most like to learn more skills related to laparoscopic colon resection (n = 16), laparoscopic antireflux procedures (n = 6), laparoscopic common bile duct exploration/ERCP (n = 5), colonoscopy/advanced techniques and esophagogastroscopy (n = 4), and breast surgery (n = 4). Ultrasound, hand surgery, and leadership and communication were additional topics rated as useful by the respondents. Skills course participants indicated varying levels of experience and confidence with breast ultrasound, ultrasound for central line insertion, hand injury, and facial soft tissue injury. CONCLUSIONS Our results demonstrated that surgeons practicing in rural areas have a strong interest in acquiring additional skills in a variety of general and subspecialty surgical procedures. The information obtained in this study may be used to guide curriculum development of further postgraduate skills courses targeted to rural surgeons.

Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies

Purpose Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism. Method Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews. Results A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient. Conclusions Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.

Reap What You Sow: Which Rural Surgery Training Programs Currently Exist and Do Medical Students Know of Their Existence?

BACKGROUND There exists an acute need to recruit and train general surgeons for rural communities. To assist medical students interested in rural surgery, the American College of Surgeons (ACS) website lists general surgery residencies, which are tailored to train the rural surgeon by providing exposure to endoscopy, gynecology, urology, orthopedics, and otolaryngology. Another available reference is the American Medical Association Fellowship and Residency Electronic Database (FREIDA). FREIDA allows programs to indicate availability of a rural training scheme. This is an effort to identify programs which demonstrate a commitment to training rural surgeons and evaluate accessibility of this information to medical students. METHODS Each ACGME general surgery residency program in the United States and Canada received an electronic survey. They were queried on commitment to training rural surgeons and their ability to provide 3 to 12 months of subspecialty training. RESULTS Of the 261 programs surveyed, 52 (19.9%) responses were obtained; 11 had established rural tracks and 15 were willing to customize a program. We identified 14 additional rural training programs not identified by either the ACS website or FREIDA. In total, 44 programs identified by ACS, FREIDA, and our survey indicate they can accommodate the rural surgical resident. CONCLUSIONS For a medical student interested in rural surgery, several obstacles must be overcome to find the appropriate residency program. A complete and updated list of established tracks or customizable training schemes does not exist. Review of the ACS website and FREIDA online in addition to our survey has identified 44 of 261 (16.9%) ACGME accredited programs either with an existing rural surgical track or willing to customize their program accommodate a resident. To facilitate the recruitment of medical students into rural surgery, we support the maintenance of a complete and routinely updated list that identifies available training programs.

Advanced Surgical Techniques for Rural Surgeons

Advanced surgical techniques for rural surgeons / , Advanced surgical techniques for rural surgeons / , کتابخانه دیجیتال جندی شاپور اهواز