James E. Coverdill

Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study.

Purpose To examine whether duty-hour restrictions have been consequential for various aspects of the work of surgical faculty and if those consequences differ for faculty in academic and nonacademic general surgery residency programs. Method Questionnaires were distributed in 2004 to 233 faculty members in five academic and four nonacademic U.S. residency programs in general surgery. Participation was restricted to those who had been faculty for at least one year. Ten items on the questionnaire probed faculty work experiences. Results include means, percentages, and t-tests on mean differences. Of the 146 faculty members (63%) who completed the questionnaire, 101 volunteered to be interviewed. Of these, 28 were randomly chosen for follow-up interviews that probed experiences and rationales underlying items on the questionnaire. Interview transcripts (187 single-spaced pages) were analyzed for main themes. Results Questionnaire respondents and interviewees associated duty-hour restrictions with lowered faculty expectations and standards for residents, little change in the supervision of residents, a loss of time for teaching, increased work and stress, and less satisfaction. No significant differences in these perceptions (p ≪ .05) were found for faculty in academic and nonacademic programs. Main themes from the interviews included a shift of routine work from residents to faculty, a transfer of responsibility to faculty, more frequent skill gaps at night, a loss of time for research, and the challenges of controlling residents’ hours. Conclusions Duty-hour restrictions have been consequential for the work of surgical faculty. Faculty should not be overlooked in future studies of duty-hour restrictions.

Risk, Opportunism, and Structural Holes How Headhunters Manage Clients and Earn Fees

Headhunters find candidates for jobs. They are paid by their clients—employers—when the candidates they generate accept job offers. Headhunters, therefore, resemble other third-party agents or brokers whose fortunes rest on their ability to secure a match between their clients and other interested parties. In this analysis, we examine how headhunters manage the risks of being a broker in a highly competitive industry. They pursue two strategies: They attempt to develop close ties with clients, and they are willing to be opportunistic toward these clients. These strategies reflect their lack of power compared with that of clients, their belief that clients are disloyal, and the lack of embedded ties between clients and headhunters that could create a basis for enforceable trust.

Fit and Skill in Employee Selection: Insights from a Study of Headhunters

We draw upon evidence from a qualitative study of headhunters to provide insights into the character and importance of candidate “fit” and skill for the selection of a broad range of white-collar employees. Headhunters suggest that the “fit” of a job candidate is assessed at two levels, one corresponding with a general compatibility with organization-level norms, culture, and strategy, the other corresponding more closely with traits and characteristics of the person or persons with whom the job candidate actually interviews. Skill—a factor which is largely neglected by those who tout the importance of fit—also plays an important and independent role in employee selection. Stalls that influence the selection of employees from a pool of candidates tend to be highly specific if not idiosyncratic, and take the form of what headhunters call “hot buttons.” We conclude by discussing the conceptualization, causes, and implications of fit; we also consider how the importance of fit and hot buttons challenges the explanatory logic of standard accounts of labor-market success.

Do increased training requirements in gastrointestinal endoscopy and advanced laparoscopy necessitate a paradigm shift? A survey of program directors in surgery.

BACKGROUND Many modifications to the traditional residency model contribute to the ongoing paradigm shift in surgical education; yet, the frequency and manner by which such changes occur at various institutions is less clear. To address this issue, our study examined the variability in endoscopy and laparoscopy training, the potential impact of new requirements, and opinions of Program Directors in Surgery (PDs). METHODS A 22-item online survey was sent to 251 PDs in the United States. Appropriate parametric tests determined significance. RESULTS In all, 105 (42%) PDs responded. No difference existed in response rates among university (56.2%), university-affiliated/community (30.5%), or community (13.3%) program types (p = 0.970). Surgeons alone (46.7%) conducted most endoscopy training with a trend toward multidisciplinary teams (43.8%). A combination of fellowship-trained minimally invasive surgeons and other surgeon types (66.7%) commonly provided laparoscopy training. For adequate endoscopy experience in the future, most PDs (74.3%) plan to require a formal flexible endoscopy rotation (p < 0.001). For laparoscopy, PDs intend for more minimally invasive surgery (59%) as well as colon and rectal surgery (53.4%) rotations (both p < 0.001). Respondents feel residents will perform diagnostic endoscopy (86.7%) and basic laparoscopy (100%) safely on graduation. Fewer PDs confirm graduates will safely practice therapeutic endoscopy (12.4%) and advanced laparoscopy (52.4%). PDs believe increased requirements for endoscopy and laparoscopy will improve procedural competency (79% and 92.4%, respectively) and strengthen the fields of surgical endoscopy and minimally invasive surgery (55.2% and 68.6%, respectively). Less believe new requirements necessitate redesign of cognitive and technical skills curricula (33.3% endoscopy, 28.6% laparoscopy; p = 0.018). A national surgical education curriculum should be a required component of resident training, according to 79% of PDs. CONCLUSIONS PDs employ and may implement varied tools to meet the increased requirements in endoscopy and laparoscopy. With such variability in educational methodology, establishment of a national surgical education curriculum is very important to most PDs.

Understanding Mills via Mill-type methods: An application of qualitative comparative analysis to a study of labor management in southern textile manufacturing

A number of recent writers have advocated a computer-based approach to the analysis of qualitative data that leans on John Stuart Mills method of agreement and the indirect method of difference. Those discussions, however, remain fairly abstract and provide little insight into how analyses based on Mill-type methods unfold and their relative costs and benefits. In this paper we describe the logic and use of one prominent Mill-type software program called QCA (Qualitative Comparative Analysis) in the context of an analysis of evidence drawn from twenty-two interviews with managers in textile plants. Our substantive aim is to understand labor-management practices in Southern textile manufacturing plants; our methodological aim is to illustrate the strengths and weaknesses of the Mill-type logic in action.

Labor Management in the Southern Textile Industry Comparing Qualitative, Quantitative, and Qualitative Comparative Analyses

This article explores a method developed by Ragin called qualitative comparative analysis or QCA. QCA would appear to offer two attractive possibilities: (a) it combines a consideration of systematic and ideographic elements in a single analysis; and (b) it overcomes some notable limitations of traditional quantitative and qualitative methods. The aim of the authors is to contrast the logic and results of QCA with traditional qualitative and quantitative analyses through a consideration of labor management practices in the southern textile industry. The authors argue that QCA represents a bridge between traditional qualitative and quantitative approaches, because it draws on some aspects of each. It is not, however, without its own limitations, because it leaves out some very admirable aspects of these other methodologies. This analysis suggests that different methodological strategies should be used to complement one another, because each provides valuable insights that can be checked and augmented by the others.

Race, Ethnicity and the Quality of Life in America, 1972–2008

We extend research on black-white gaps in the subjective quality of life by exploring recent General Social Survey data, focusing attention on Latinos, and probing the value of partial proportional odds models for ordinal quality-of-life measures. Results indicate a declining but discernable black-white gap for four measures-marital happiness, overall happiness, health status and trust-and the persistence of a gap for another-satisfaction with finances. Although Latinos as a whole have a lower quality of life than non-Latinos, significant differences between Mexican-origin Latinos and those from other countries emerge for only two quality-of-life measures, overall happiness and financial satisfaction. The partial proportional odds models overcome technical problems common to the analysis of ordinal dependent variables and establish both the magnitude and location of inequalities.

Views of surgery program directors on the current ACGME and proposed IOM duty-hour standards.

PURPOSE The purpose of this study was to survey the experiences of surgery program directors with the current Accreditation Council for Graduate Medical Education (ACGME) duty-hour standards and views of the Institute of Medicine (IOM) proposed duty-hour recommendations. METHODS A total of 118 program directors (47.6% of all surgery programs in the US) responded to the survey. RESULTS Results showed that the current duty-hour standards have hindered clinical education opportunities by reducing or eliminating rotations on many services, didactic teaching conferences, and clinical bedside teaching opportunities. Additionally, patient safety has been compromised by frequent hand offs of care. Most IOM recommendations were perceived as extremely difficult or impossible to implement, with the exception of the moonlighting recommendation. The results indicated that adopting the IOM recommendations is not feasible given current workforce limitations, and most program directors supported maintaining the current duty-hour standards until such time as there is evidence-based outcomes research to direct change. CONCLUSIONS The conclusion was that the current ACGME duty-hour standards have reduced teaching opportunities and narrowed the scope of training.

Employment and the Use of Birth Control by Sexually Active Single Hispanic, Black, and White Women

Previous studies of the use of birth control by sexually active single women tend to emphasize family background and aspirations, and restrict their attention to teenagers. We elaborate this framework by considering how labor market experiences might shape the birth control practices of women in their late teens and twenties. Data from the National Longitudinal Survey of Labor Force Experiences — Youth Cohort provide evidence that employment histories and wages influence birth control practices, net of the effects of family background, aspirations, and educational attainment. Several pronounced racial and ethnic differences are found.

Fatigue as impairment or educational necessity? Insights into surgical culture.

Background The authors examine fatigue culture among surgical residents and faculty members and whether it squares with recent, fatigue-focused Accreditation Council for Graduate Medical Education (ACGME) policies and educational initiatives. Method Field observations of an academic general surgery program were supplemented with interviews (52 residents and 58 faculty members) conducted as part of a study of 15 general surgery programs. Field notes and interviews were analyzed for main themes. Results Most believe that fatigue surfaces after 24 hours of work and has minor consequences. Surgeons believe that residents can learn to manage fatigue and that surgical practice requires that capacity. Proper training implies that residents experience fatigue, learn to perform capably and confidently while fatigued, and recognize their limits. Conclusions Encountering and learning to manage fatigue are seen as educational necessities by surgeons, a view that runs counter to ACGME initiatives, requires reconsideration, and demands that attention be directed to professional and organizational practices that sustain fatigue culture.