L.D. Britt

Incidence and prophylaxis of deep vein thrombosis in a high risk trauma population

BACKGROUNDnPelvic fractures, lower extremity injuries, acute head or spinal injury, and extended bedrest place trauma patients at an increased risk for deep vein thrombosis (DVT) and pulmonary embolism (PE). We reviewed patients with traumatic brain injuries (TBI), spinal cord injuries (SCI), and lower extremity fractures (LEF) to examine our DVT and PE incidence and evaluate the success of our DVT and PE prophylaxis.nnnMETHODSnFrom January 1, 1994 to March 1, 1995, the records of trauma patients with TBI, SCI, and LEF who were admitted to the trauma service and transferred to an inpatient rehabilitation facility were reviewed.nnnRESULTSnTwenty-two patients had a TBI, 16 patients with SCI, and 12 patients with LEF. Forty-nine of the 50 patients received DVT prophylaxis, with 7 inferior vena cava (IVC) filters placed. The DVT incidence was 6% and the PE incidence was 2%.nnnCONCLUSIONnThe 6% incidence of DVT was lower than expected due to diligent DVT prophylaxis and appropriate screening of symptomatic patients for clinically significant DVT. The 2% incidence of PE was also lower than expected, most likely due to our lower DVT incidence and the use of IVC filters. The lower DVT and PE incidence verifies our success at DVT and PE prophylaxis.

A template for change and response to work hour restrictions

Surgical program directors are seeking how to best meet the work hour restrictions recently mandated by the American College of Graduate Medical Education. Implementation of an 80-hour work week forces major change to graduate medical education, especially surgical education. Creative restructuring of surgical training is necessary to ensure compliance. Developing an innovative solution to meet these requirements must consider programmatic needs, requiring commitment to a change process. The Department of Surgery at Eastern Virginia Medical School experienced a 5-month strategic planning process that generated the Mendoza plan. This plan uses an every third night call model and a night float model to meet site-specific needs. The specifics of the Mendoza plan protect the cornerstone of surgical education, which is continuity of patient care and resident education. The Mendoza plan, and the process leading to its development, may provide insightful information for other surgical residency programs planning to meet work hour guidelines.

Surgical Disparities: A Comprehensive Review and New Conceptual Framework

Received February 11, 2016; Revised April 8, 2016; Acc 2016. From the Center for Surgery and Public Health: Departm Brigham and Women’s Hospital, Harvard Medical Schoo TH Chan School of Public Health, Boston, MA (Torain Hisam, Lilley, Najjar, Changoor, Rose, Zogg, Haider); the tute on Minority Health and Health Disparities (Dankw tional Institutes of Health (Maddox), Bethesda, MD; Do Health Sciences Medical College, Karachi, Pakistan (Hisa ment of Surgery, Johns Hopkins University School of Medi MD (Kodadek); and the Department of Surgery, Eastern V School, Norfolk, VA (Britt). Correspondence address: Adil H Haider, MD, MPH, FA Surgery and Public Health, 1620 Tremont St, Suite MA 02120. email: ahhaider@partners.org

Integrating Cultural Competency and Humility Training into Clinical Clerkships: Surgery as a Model

BACKGROUNDnCultural competency is gaining recognition as an essential strategy by which to address health care disparities. A closer examination of medical school curriculums was undertaken to determine how the need for cultural competency and humility (CCH) training in medical education is being addressed.nnnMETHODSnA MEDLINE review of published literature regarding CCH training in medical education was performed. Additionally, key informant interviews with influential faculty members from prominent medical institutions were completed.nnnRESULTSnMany academic medical institutions recognize the need for CCH and have successfully integrated it into the first 2 years of their curriculums. However, there seems to be a uniform deficit in CCH training in the third and fourth years of their education.nnnCONCLUSIONSnRecognizing the need for CCH training during the third and fourth years of medical education, we explored the issues inherent to the integration of CCH training in clinical education. Using surgery as a model, we established a set of recommendations to assist clerkship directors and curriculum committees in their efforts to ensure CCH training in the last 2 years of medical education.

The Diverse Surgeons Initiative: An Effective Method for Increasing the Number of Under-represented Minorities in Academic Surgery

f a s r a S here is increasing concern that US medical institutions re devoid of a sufficient number of under-represented miority (URM) faculty members. There is so much concern hat in the last decade there have been numerous special opic articles published in the surgery, internal medicine, astroenterology, pediatrics, family medicine, and public ealth literature assiduously describing the paltry number f URMs within the ranks of their respective faculty. The ause of the shortage of URM faculty in academic medicine s assuredly multifactorial. The literature suggests that posible factors include an insufficient number of URM medcal school graduates, URM residents who are uninformed f or ill prepared for opportunities in academic medicine, a aucity of role models and mentors, and other environental factors including educational indebtedness and intitutionalized racism. Recent reports state profoundly hat the continued under-representation of minorities in he medical profession is having a deleterious effect on the ealth of our nation. It has been documented that URM physicians have a istory of more readily serving underserved communities han their majority colleagues and URM patients have een said to feel more comfortable when being cared for by RM physicians. Additionally, the literature reveals hat URM patients have a heightened willingness to paricipate in clinical research if a member of the research team

The Diverse Surgeons' Initiative: Longitudinal Assessment of a Successful National Program

BACKGROUNDnThe Diverse Surgeons Initiative (DSI) is a program that was created to provide underrepresented minority surgical residents with the clinical knowledge and minimally invasive surgical skills necessary to excel in surgical residency and successfully transition into surgical practice. The early success of the graduates of the program has been published; however, a more longitudinal assessment of the program was suggested and warranted. This study provides a 5-year follow-up of the 76 physicians that participated in the DSI from 2002 to 2009 to determine if the trend toward fellowship placement and academic appointments persisted. Additionally, this extended evaluation yields an opportunity to assess these young surgeons professional progress and contributions to the field.nnnSTUDY DESIGNnThe most current professional development and employment information was obtained for the 76 physicians that completed the DSI from 2002 to 2009. The percentage of DSI graduates completing surgical residency, obtaining subspecialty fellowships, attaining board certification, receiving fellowship in the American College of Surgeons, contributing to the peer-reviewed literature, acquiring academic faculty positions, and ascending to professional leadership roles were calculated and compared with the original assessment.nnnRESULTSnOf the 76 DSI graduates, 99% completed general surgery residency. Of those eligible, 87% completed subspecialty fellowships; 87% were board certified; 50% received fellowship in the American College of Surgeons; 76% had contributed to the peer-reviewed literature; 41% had obtained faculty positions; and 18% held local, regional, or national professional leadership positions.nnnCONCLUSIONSnThis longitudinal analysis has revealed sustained success of the DSI in preparing underrepresented minority residents to excel in their training and transition into practice, obtain postsurgical fellowships, acquire faculty appointments, and contribute to the advancement of the field of surgery.