Frederic C. Chang

American Board of Surgery examinations: can we identify surgery residency applicants and residents who will pass the examinations on the first attempt?

BACKGROUNDnThe Residency Review Committee requires that 65% of general surgery residents pass the American Board of Surgery qualifying and certifying examinations on the first attempt. The aim of this study was to identify predictors of successful first-attempt completion of the examinations.nnnMETHODSnAge, sex, Alpha Omega Alpha Honor Medical Society status, class rank, honors in third-year surgery clerkship, interview score, rank list number, National Board of Medical Examiners/United States Medical Licensing Examination scores, American Board of Surgery In-Training Examination scores, resident awards, and faculty evaluations of senior residents were reviewed. Graduates who passed both examinations on the first attempt were compared with those who failed either examination on the first attempt.nnnRESULTSnNo subjective evaluations of performance predicted success other than resident awards. Significant objective predictors of successful first-attempt completion of the examinations were Alpha Omega Alpha status, ranking within the top one third of ones medical student class, National Board of Medical Examiners/United States Medical Licensing Examination Step 1 (>200, top 50%) and Step 2 (>186.5, top 3 quartiles) scores, and American Board of Surgery In-Training Examination scores >50th percentile (postgraduate years 1 and 3) and >33rd percentile (postgraduate years 4 and 5).nnnCONCLUSIONSnResidency programs can use this information in selecting residents and in identifying residents who may need remediation.

Debt and other influences on career choices among surgical and primary care residents in a community-based hospital system.

BACKGROUNDnTo evaluate debt and other factors that help formulate the career paths of future surgical and primary care physicians, a survey was undertaken.nnnMETHODSnSurgical specialty (SS) and primary care (PC) residents were surveyed regarding demographics, factors influencing choice of specialty, methods of financing education, debt characteristics, and outlooks regarding future earnings and practice characteristics.nnnRESULTSnThe clinical years of medical school and personalities of specialists and residents were important factors in career choices for both PC and SS. The length of residency, desirable lifestyle, and working hours were all more important to PC residents. Surgeons found intellectual challenge and procedure-based practice of greater importance. Although not highly regarded by either group, scholarship obligation and student loans had a significantly greater impact on specialty choice and practice plans for PC residents. At the completion of training, 55% of SS and 28% of PC residents anticipate owing more than

Pasg: Does It Help in the Management of Traumatic Shock?

100,000. Debt was especially significant in specialty choice and practice plans for PC residents with debt over

Delayed hemothorax resulting from stab wounds to the internal mammary artery.

100,000.nnnCONCLUSIONnSurgical residents are less concerned about personal sacrifices in their quest to become surgeons. It appears state funded scholarships are successful in attracting students to primary care. Both SS and PC residents have significant debt, although, SS residents have greater financial debt than primary care residents. However, the anticipation of indebtedness was a more significant factor in determination of career path for PC.

Kansas surgeons' attitudes toward immediate breast reconstruction: A statewide survey

A prospective, randomized study was designed to determine the efficacy of pneumatic antishock garment (PASG) in the treatment of traumatic shock in a medium-size urban community. A total of 291 traumatic shock patients were assigned to either the PASG or No-PASG treatment groups. Of these, data from 248 patients were analyzed in detail. Analysis of demographic factors--such as age, sex, and mechanism of injury--as well as prehospital evaluative tools--such as trauma and CRAMS scores, and injury severity scores--revealed that the two groups were well-matched. This study did not demonstrate significant differences in hospital stay or mortality between PASG and No-PASG patients. Similarly, in the subset of patients with blunt trauma, PASG was not found to be beneficial.

Spontaneous recanalization of the esophagus after exclusion using nonabsorbable staples

Massive delayed hemothorax as a result of stab wounds to the internal mammary artery have not recently been reported. A patient who died after such an injury prompted a 10-year retrospective review. During that time period, 88 patients with stab wounds to the chest were identified. Thirty-five of these involved injuries to the parasternal region. This region is described as being located below the clavicles, between the midclavicular lines, and above the costal margins. We identified 5 patients with internal mammary artery injuries: 4 had massive delayed bleeding and 2 died. Our current recommendations for managing stable patients with parasternal stab wounds include maintaining a high index of suspicion, intensive care monitoring, and placement of chest tubes for monitoring. Should delayed bleeding occur, a prompt thoracotomy is mandatory.

Massive upper gastrointestinal hemorrhage in the elderly.

BACKGROUNDnImmediate reconstruction following mastectomy provides patients the benefit of emerging from their operation with a reconstructed breast mound.nnnMETHODSnA survey was distributed to 197 Kansas surgeons to determine the frequency of breast reconstruction and to identify factors that may influence them to refer patients for immediate reconstruction.nnnRESULTSnA response of 78.2% was obtained. Ten percent of mastectomy patients had breast reconstruction. Significant findings were that younger surgeons were more likely to discuss reconstruction with all patients and were more likely to preoperatively refer their patients to a plastic surgeon; surgeons in larger communities had more patients who had undergone immediate reconstruction; surgeons who discussed reconstruction with all patients had more patients who underwent immediate reconstruction; and frequency of immediate reconstruction increased along with increased time spent discussing reconstruction preoperatively.nnnCONCLUSIONnOur survey indicated that immediate breast reconstruction was rarely performed; however, when it was, a number of factors were correlated. These included the surgeons age and practice location, attitude toward reconstruction, and time spent preoperatively with patients.

Gender differences in general surgical careers: results of a post-residency survey

Perforations of the thoracic esophagus can be fatal unless diagnosed promptly and treated effectively. Two patients in whom primary repair was not feasible were treated by esophageal exclusion and diversion using nonabsorbable stapling devices. Both patients had spontaneous recanalization of the esophagus without leakage or stricture formation. We conclude that nonabsorbable staples can be used safely to achieve effective esophageal exclusion, thereby allowing complete healing of the perforation. Furthermore, use of this technique may eliminate the necessity for another major procedure to reestablish esophageal continuity.

Intravenous cholangiography in the diagnosis of acute cholecystitis.

Sixty-six elderly patients with massive upper gastrointestinal bleeding were retrospectively analyzed. This study supports the concept of vigorous resuscitation, early diagnosis with fiberoptic endoscopy, and prompt surgical intervention in patients with continued bleeding. When this approach was utilized in a community hospital, operative mortality was reduced to 5 per cent.