Heather Yeo

Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents: A National Survey

CONTEXTnGeneral surgery residency programs are facing multiple pressures, including attracting and retaining residents. Despite the importance of resident perspectives in designing effective responses to these pressures, understanding of residents views is limited.nnnOBJECTIVEnTo profile US general surgery residents; characterize resident attitudes, experiences, and expectations regarding training; and examine differences by sex and training year.nnnDESIGN, SETTING, AND PARTICIPANTSnCross-sectional study of all general surgery residents completing a survey in January 2008 following administration of the American Board of Surgery In-Training Examination.nnnMAIN OUTCOME MEASURESnResident satisfaction; perceived supports, strains and concern; career motivations; and professional expectations.nnnRESULTSnOf 5345 categorical general surgery residents, 4402 (82.4%) responded, representing 248 of 249 surgical residency programs. Most respondents expressed satisfaction with training (3686 [85.2%]; 95% confidence interval [CI], 84.1%-86.3%) and supportive peer relationships (3433 [84.2%]; 95% CI, 83.1%-85.3%). However, residents also reported unmet needs and apprehensions about training and careers. Worry that they will not feel confident performing procedures independently was reported by 1185 (27.5%; 95% CI, 26.2%-28.8%), while 2681 (63.8%; 95% CI, 62.4%-65.3%) reported that they must complete specialty training to be competitive. Perceptions of program support differ, with men more likely than women to report that their program provides support (2188 [74.5%] vs 895 [65.6%]; P < .001), and that they can turn to faculty when having difficulties (2193 [74.5%] vs 901 [66.4%]; P < .001). Reports of having considered leaving training in the prior year differed significantly across years (P < .001), highest in postgraduate year 2 (19.2%) and lowest in postgraduate year 5 (7.2%).nnnCONCLUSIONSnGeneral surgery residents attitudes, experiences, and expectations regarding training reflect both high levels of satisfaction and sources of strain. These factors vary by sex and training year.

A national study of attrition in general surgery training: which residents leave and where do they go?

Objective(s):Implementation of the 80-hour mandate was expected to reduce attrition from general surgery (GS) residency. This is the first quantitative report from a national prospective study of resident/program characteristics associated with attrition. Methods:Analysis included all categorical GS residents entered on American Board of Surgery residency rosters in 2007 to 2008. Cases of attrition were identified by program report, individually confirmed, and linked to demographic data from the National Study of Expectations and Attitudes of Residents in Surgery administered January 2008. Results:All surgical categorical GS residents active on the 2007–2008 resident rosters (N = 6,303) were analyzed for attrition. Complete National Study of Expectations and Attitudes of Residents in Surgery demographic information was available for 3959; the total and survey groups were similar with regard to important characteristics. About 3% of US categorical residents resigned in 2007 to 2008, and 0.4% had contracts terminated. Across all years (including research), there was a 19.5% cumulative risk of resignation. Attrition was highest in PGY-1 (5.9%), PGY-2 (4.3%), and research year(s) (3.9%). Women were no more likely to leave programs than men (2.1% vs. 1.9%). Of several program/resident variables examined, postgraduate year-level was the only independent predictor of attrition in multivariate analysis. Residents who left GS whose plans were known most often pursued nonsurgical residencies (62%), particularly anesthesiology (21%) and radiology (11%). Only 13% left for surgical specialties. Conclusions:Attrition rates are high despite mandated work hour reductions; 1 in 5 GS categorical residents resigns, and most pursue nonsurgical careers. Demographic factors, aside from postgraduate year do not appear predictive. Residents are at risk for attrition early in training and during research, and this could afford educators a target for intervention.

Our Trainees' Confidence Results From a National Survey of 4136 US General Surgery Residents

OBJECTIVESnTo characterize factors shaping surgery resident confidence and determine whether confidence is associated with future specialty training.nnnDESIGNnCross-sectional study.nnnSETTINGnSurvey administered at the 2008 American Board of Surgery In-Service Training Examination.nnnPARTICIPANTSnAll categorical general surgery residents.nnnINTERVENTIONSnNational Study of Expectations and Attitudes of Residents in Surgery survey.nnnPARTICIPANTSnreported demographics and level of agreement for 46 items regarding confidence, training, and professional plans.nnnMAIN OUTCOMES MEASURESnSurvey items My operating skill level is appropriate and I may not feel confident enough to perform procedures independently before training completion. We compared demographics and responses among residents who did/not feel confident.nnnRESULTSnResponse rate was 77.4%. Residents who were female, single, or without children and at a lower postgraduate year had less confidence in their operating skill, as did residents at larger, university-based programs, in the northeastern United States. Residents worried about competence were more likely to believe specialty training was needed (71.2% vs 60.2%; P < .001). After adjustment, residents dissatisfied with training were less likely to believe their skills were level appropriate (odds ratio, 0.13; P < .001) as were residents not comfortable asking for help (odds ratio, 0.48; P < .001). After adjustment, women were twice more likely than men to worry about competence after training; single residents were 1.36 times more likely than married residents to believe their skills were not level appropriate. Program location, type, and size remained associated with confidence, as did satisfaction and comfort asking for help. Residents worried about skills were more likely to plan for fellowship.nnnCONCLUSIONSnSex, marital status, children, and postgraduate year are predictors of confidence, as are program location, type, and size. Residency programs may target modifiable factors contributing to low surgical confidence.

Pheochromocytoma and functional paraganglioma

Purpose of review Pheochromocytoma is a rare, but clinically important tumor of chromaffin cells. Advances in our understanding of the genetic alterations causing hereditary forms and the increasing sensitivity of biochemical assays allow for early identification of high risk individuals and families. Surgical intervention remains the treatment of choice for patients with pheochromocytoma. This article reviews recent developments in the diagnosis, treatment, and pathophysiology of pheochromocytoma, with the objective of developing new guidelines in the identification and management of the disease. It emphasizes current diagnostic and surgical approaches and discusses the potential for future developments in the field. Summary Advances in the molecular basis of pheochromocytoma have introduced new diagnostic modalities. Refinements in imaging techniques have improved the rate of detection of metastatic disease. Innovations in surgical techniques and trials of adrenal sparing surgery may find a niche in the surgical armamentarium.

Racial Disparities in Clinical and Economic Outcomes From Thyroidectomy

Context:Thyroid disease is common, and thyroidectomy is a mainstay of treatment for many benign and malignant thyroid conditions. Overall, thyroidectomy is associated with favorable outcomes, particularly if experienced surgeons perform it. Objective:To examine racial differences in clinical and economic outcomes of patients undergoing thyroidectomy in the United States. Design, Setting, Patients:The nationwide inpatient sample was used to identify thyroidectomy admissions from 1999 to 2004, using ICD-9 procedure codes. Race and other clinical and demographic characteristics of patients were collected along with surgeon volume and hospital characteristics to predict outcomes. Main Outcome Measures:Inpatient mortality, complication rates, length of stay (LOS), discharge status, and mean total costs by racial group. Results:In 2003–2004, 16,878 patients underwent thyroid procedures; 71% were white, 14% black, 9% Hispanic, and 6% other. Mean LOS was longer for blacks (2.5 days) than for whites (1.8 days, P < 0.001); Hispanics had an intermediate LOS (2.2 days). Although rare, in-hospital mortality was higher for blacks (0.4%) compared with that for other races (0.1%, P < 0.001). Blacks trended toward higher overall complication rates (4.9%) compared with whites (3.8%) and Hispanics (3.6%, P = 0.056). Mean total costs were significantly lower for whites (

Impact of family and gender on career goals: results of a national survey of 4586 surgery residents.

5447/patient) compared with those for blacks (

Surgical Residency and Attrition: Defining the Individual and Programmatic Factors Predictive of Trainee Losses

6587) and Hispanics (

Incidence of Minimally Invasive Colorectal Cancer Surgery at National Comprehensive Cancer Network Centers

6294). The majority of Hispanics (55%) and blacks (52%) had surgery by the lowest-volume surgeons (1–9 cases per year), compared with only 44% of whites. Highest-volume surgeons (>100 cases per year) performed 5% of thyroidectomies, but 90% of their patients were white (P < 0.001). Racial disparities in outcomes persist after adjustment for surgeon volume group. Conclusions:These findings suggest that, although thyroidectomy is considered safe, significant racial disparities exist in clinical and economic outcomes. In part, inequalities result from racial differences in access to experienced surgeons; more data are needed with regard to racial differences in thyroid biology and surveillance to explain the balance of observed disparities.

Comparison of Open, Laparoscopic, and Robotic Colectomies Using a Large National Database: Outcomes and Trends Related to Surgery Center Volume.

OBJECTIVEnTo determine how marriage, children, and gender influence US categorical general surgery residents perceptions of their profession and motivations for specialty training.nnnDESIGNnCross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination.nnnSETTINGnTwo hundred forty-eight US general surgery residency programs.nnnPARTICIPANTSnAll US categorical general surgery residents.nnnINTERVENTIONSnWe evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed.nnnMAIN OUTCOME MEASURESnPerceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle.nnnRESULTSnThe survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P < .001; 57.0% with no children vs 50.1% with children, P < .001). In our multivariate analyses, male gender was an independent predictor of worry that general surgery is becoming obsolete (P = .003). Female residents who were single or had no children tended to identify lifestyle rather than income as a motivator for specialty training.nnnCONCLUSIONnMarital status, children, and gender appear to have a powerful effect on general surgery residents career planning.

“Join the Club”: Effect of Resident and Attending Social Interactions on Overall Satisfaction Among 4390 General Surgery Residents

BACKGROUNDnVoluntary resident attrition remains problematic despite recent changes in postgraduate general surgery training, including reduction of work hours.nnnSTUDY DESIGNnWe conducted a prospective study of all postgraduate year (PGY)-1 and -2 trainees on the 2008 American Board of Surgery resident roster (ABS-RR) who completed the National Study of Expectations and Attitudes of Residents in Surgery (NEARS) survey after the American Board of Surgery In-Training Examination (ABSITE) in 2008 or 2009.nnnRESULTSnAmong 2,222 PGY-1 and -2 residents on the 2008 ABS-RR, 2,033 completed the NEARS survey in 2008 or 2009 (91.5%). The only demographic or programmatic variables associated with voluntary attrition on univariate analysis were PGY-1 status (9.4% risk vs 4.5% risk for PGY-2, p < 0.001) and program location (p = 0.03). Response differences (p < 0.01) were noted in 23 survey items. In multivariate modeling, PGY-2 status was protective against voluntary attrition (p < 0.001, hazard ratio [HR] 0.41), while programs located outside of the South (Northeast: p = 0.006, HR 2.39; Midwest: p = 0.01, HR 2.37; West: p = 0.10, HR 1.76) were associated with higher attrition. The attrition group more frequently reported that they had considered leaving training (p < 0.001, HR 2.59), that the personal cost of training was too great (p < 0.001, HR 2.89), that they were dissatisfied with their operative experience (p = 0.002, HR 1.89), and that they were not committed to completing their training (p < 0.001, HR 3.96). Using the estimated regression coefficient for each variable in the multivariate models, we calculated a risk score for individual residents; these scores were used to construct covariate-adjusted survivorship functions.nnnCONCLUSIONSnResident attitudes, PGY-1 status, and program location are most frequently associated with voluntary attrition. Our risk score calculation represents a novel potential tool for programs to quantify deficiencies in the training experience of residents, and develop targeted strategies to limit disaffection and improve resident retention.