Lauren E. Franzblau

Mentorship in surgical training: a systematic review

ObjectiveThis review systematically examines the literature regarding mentor–mentee relationships in surgery.BackgroundThe usefulness of mentorship in surgical training has been expressed in many articles. However, to date, there has been no systematic review on mentoring surgical trainees. This surgical environment is different from other areas of medicine and requires young surgeons to learn skills not readily available from textbooks. Instead, mentors are a valuable mode of transferring this knowledge to the next generation of surgeons. Thus, mentorship is a worthy area of research and attention.MethodsWe identified all articles discussing mentorship in surgery between January 1985 and August 2010 using PubMed and ISI Web of Knowledge. Predetermined exclusion and inclusion criteria were used to screen articles by title, abstract, and full text in sequence. We extracted the relevant data, and then analyzed the prevalence of major surgical mentoring themes in the literature.ResultsOf the 1,091 unique articles found during our original literature search, 38 were selected for review. The majority (68%) were commentary/editorial articles. The most discussed themes include the desirable qualities of a surgical mentor, the structure of mentor–mentee relationships, and advice for overcoming barriers to mentoring. Much less discussed themes include the desirable traits in a mentee and the appreciation of generational and cultural differences in mentorship.ConclusionsSeveral barriers to effective surgical mentoring were identified, such as time constraints and a lack of female mentors. By focusing on the positive traits found in this review, for example, developing formal programs to alleviate time constraints, these barriers can be overcome and effective mentor–mentee relationships can be built. Many articles draw attention to the dying art of mentorship in surgical training programs, and currently, the literature on mentorship in surgery is somewhat scarce. These concerns should serve as motivation to revive mentorship in surgery education and to expand the literature regarding underexplored themes and overcoming the current barriers. Although mentorship may not always take on a structured form, it should not be treated casually because proper mentorship is the foundation for training quality surgeons.

Psychosocial outcomes and coping after complete avulsion traumatic brachial plexus injury

Abstract Purpose: To understand psychosocial outcomes, coping and adjustment after complete avulsion traumatic brachial plexus injury (BPI). Method: We conducted a grounded theory analysis of 12 semi-structured patient interviews exploring psychosocial outcomes, augmented by quantitative evaluation of self-reported mental health and social functioning, body image and coping strategies obtained via three questionnaires (SF-36, Brief COPE and modified SWAP). Results: Subjects’ main sources of psychological stress were chronic pain, unemployment, decreased self-efficacy and social-emotional consequences of poor body image. One third of participants reported depression, half experienced anger and frustration and two-thirds were dissatisfied with the appearance of their affected limbs. Acceptance, active coping, planning and emotional support were the most frequently used coping strategies. Conclusions: Patients encounter high levels of physical and psychological stress after complete avulsion BPI and must find ways to cope to adjust to their injuries. They face similar challenges to patients with spinal cord injuries, for whom many models describing coping and adjustment exist. Similar models could facilitate more complete adjustment and rehabilitation of BPI patients and help to reduce the prevalence of negative stress responses, including anger and depression. Future patients would benefit from a multidisciplinary treatment program, involving medical and mental health services. Implications for Rehabilitation Complete avulsion brachial plexus injury is not only physically disabling, but also creates multiple sources of psychosocial stress that patients must cope with and adjust to. Patients with brachial plexus injuries appear to experience an increased prevalence of psychiatric symptoms (e.g. depression) and follow a similar model of stress, appraisal and coping as those with spinal cord injuries. Providers caring for these patients should conduct regular screening for psychiatric symptoms and disorders, and refer patients for psychotherapeutic interventions (e.g. cognitive behavioral therapy) as needed to promote psychosocial adjustment.

Mentorship: Concepts and application to plastic surgery training programs

Background: Countless articles have demonstrated and emphasized the importance of mentoring in academic medicine. However, the upcoming role of mentors in the evolving medical field is poorly defined. As translational medicine, collaboration, and health care priorities change, so too must the goals and use of mentoring. The aims of this article are to demonstrate key aspects of effective mentoring in academic plastic surgery, show institutions how to cultivate mentoring relationships among their faculty and trainees, and provide direction for how to optimize the future use of mentoring to best prepare the next generation of plastic surgeons. Methods: The authors reviewed the current literature regarding mentorship and the evolution of academic plastic surgery. Results: Mentors not only facilitate their protégés’ entrance into the field and future success, but can also attract medical students and residents to careers in research and reduce the racial and gender discrepancies in plastic surgery and academia. Ideally, faculty should undergo some form of training before they enter mentoring relationships. This will ensure that they are aware of their specific duties as mentors, are able to communicate with mentees, and can avoid potential pitfalls. Conclusions: Mentorship is a tool. If used correctly, it can help recruit and retain talented physician-scientists to plastic surgery to satisfy the growing demand. This will require institutions to actively support mentorship, provide opportunities and resources for training mentors, and enable faculty to allocate time to this vital pursuit.

Impact of medical tourism on cosmetic surgery in the United States.

Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

Applying the Patient-Reported Outcomes Measurement Information System to Assess Upper Extremity Function among Children with Congenital Hand Differences.

Background: Few studies have evaluated self-assessment tools among children with congenital hand differences. The authors compared three upper extremity disability instruments with the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity Item Bank. Methods: Thirty-three children (aged 6 to 17 years) with congenital hand differences completed the Pediatric Outcomes Data Collection Instrument; the Michigan Hand Outcomes Questionnaire; the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the PROMIS Upper Extremity short form and computerized adaptive test. Hand function was also assessed, and construct validity and feasibility were examined. Results: PROMIS demonstrated good construct validity. Short form and computerized adaptive test were highly correlated with Disabilities of the Arm, Shoulder, and Hand questionnaire scores (r = 0.80, p < 0.001) and Pediatric Outcomes Data Collection Instrument domains (r = 0.70, p < 0.001). PROMIS was moderately correlated with the Michigan Hand Outcomes Questionnaire (r = 0.40, p < 0.05). PROMIS scores also correlated with grip (r = 0.60, p < 0.001) and pinch strength (r = 0.50, p < 0.001). Compared with the Pediatric Outcomes Data Collection Instrument and the Disabilities of the Arm, Shoulder, and Hand and Michigan Hand Outcomes questionnaires, PROMIS required the least time to complete with fewer children requiring assistance. Conclusion: The Patient-Reported Outcomes Measurement Information System is highly correlated with both functional assessment and self-reported function among children with congenital hand differences.

Coping with congenital hand differences.

Background: Although functional outcomes following reconstruction for congenital hand differences are frequently described, much less is known regarding children’s ability to cope with the psychosocial effects of these conditions. The authors qualitatively explored stress and coping mechanisms among children following reconstructive surgery for congenital hand differences. Methods: Forty patients and their parents participated in semistructured interviews examining children’s stress related to hand functioning and appearance, emotional responses to stress, and coping strategies. Interviews were audio-taped, transcribed, and analyzed thematically. A consensus taxonomy for classifying content evolved from comparisons of coding by two reviewers. Themes expressed by participants were studied for patterns of connection and grouped into broader categories. Results: In this sample, 58 percent of children and 40 percent of parents reported stress related to congenital hand differences, attributed to functional deficits (61 percent), hand appearance (27 percent), social interactions (58 percent), and emotional reactions (46 percent). Among the 18 children who reported stress, 43 percent of parents were not aware of the presence of stress. Eight coping strategies emerged, including humor (12 percent), self-acceptance (21 percent), avoidance (27 percent), seeking external support (30 percent), concealment (30 percent), educating others (9 percent), support programs (21 percent), and religion (24 percent). Conclusions: Although children with congenital hand differences often experience emotional stress related to functional limitations and aesthetic deformities, many apply positive coping mechanisms that enhance self-esteem. Clinicians caring for children with congenital hand differences should inform families about potential sources of stress to direct resources toward strengthening coping strategies and support systems.

Medical treatment decision making after total avulsion brachial plexus injury: a qualitative study

OBJECT Complete avulsion traumatic brachial plexus injuries (BPIs) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how patients make decisions regarding surgical treatment or what impediments they face during the decision-making process. Using qualitative methodology, the authors aimed to describe how and why patients elect to pursue or forego surgical reconstruction, identify the barriers precluding adequate information transfer, and determine whether these patients are satisfied with their treatment choices over time. METHODS Twelve patients with total avulsion BPIs were interviewed according to a semi-structured guide. The interview transcripts were qualitatively analyzed using the systematic inductive techniques of grounded theory to identify key themes related to the decision-making process and long-term satisfaction with decisions. RESULTS Four decision factors emerged from our analysis: desire to restore function, perceived value of functional gains, weighing the risks and costs of surgery, and having concomitant injuries. Lack of insurance coverage (4 patients), delayed diagnosis (3 patients), and insufficient information regarding treatment (4 patients) prevented patients from making informed decisions and accessing care. Three individuals, all of whom had decided against reconstruction, had regrets about their treatment choices. CONCLUSIONS Patients with panplexus avulsion injuries are missing opportunities for reconstruction and often not considering the long-term outcomes of surgery. As more Americans gain health insurance coverage, it is very likely that the number of patients able to pursue reconstruction will increase. The authors recommend implementing clinical pathways to help patients meet critical points in care within the ideal timeframe and using a patient- and family-centered care approach combined with patient decision aids to foster shared decision making, increase access to information, and improve patient satisfaction with decisions. These measures could greatly benefit patients with BPI while reducing costs, improving efficiency, and generating better outcomes.

Scientific writing for enjoyable reading: how to incorporate style into scientific manuscripts.

Communication and progress are at the core of medical and scientific writing. Since the inception of scientific journals, authors and reviewers have striven to produce original, informative articles, yet often overlook style. Over 25 years ago, Crichton aptly dubbed medical writing “awkward.”1 Unfortunately, not much has changed. A dry, formulaic tone and circumlocution take the place of style in this genre and conceal the important parts of the article, forcing reviewers to sift through verbal clutter to find the underlying message.2 Editors and reviewers continue to draw attention to the mediocre writing in the articles they receive and to stress the necessity for simple, unambiguous language.3 Despite their repeated complaints, the nature of medical and scientific writing has not changed, and its cold, lackluster style is now accepted as a fact of life.4,5 Many articles focus on overall format or on how to improve journal acceptance but skirt around writing style. Our aim is to expand on our previous guide for scientific writing6 and review the fundamental principles of composition and style while also showing what can be done to improve the quality of scientific writing.

Adult-onset hydroa vacciniforme-like lymphoma in a long-term resident of the United States

EBER: Epstein-Barr encoding region EBV: Epstein-Barr virus HV: hydroa vacciniforme HVLL: HV-like lymphoma HVLPD: HV-like lymphoproliferative disorders INTRODUCTION Hydroa vacciniforme-like lymphoproliferative disorders (HVLPDs) arise from chronic active Epstein-Barr virus (EBV) infection of T cells and natural killer cells. The term HVLPD was introduced in the 2016 World Health Organization classification of lymphoid neoplasms to reflect the spectrum of EBV-related cutaneous disorders from classic hydroa vacciniforme (HV) to severe HV and HV-like lymphoma (HVLL). Although classic HV has no geographic predilection, severe HVLPDs (severe HV and HVLL) are endemic among children and young adults in Asia and Latin America. Here we present an unusual case of severe HVLPD that arose in a Hispanic adult resident of the United States with no recent travel to endemic areas or childhood history of HV. With shifting patterns of global migration, it is important for American physicians to be familiar with this disease spectrum.

Barriers to Reconstructive Hand Surgery for Rheumatoid Arthritis in China: A Multicenter Survey of Patients and Physicians

Background: China has a similar rheumatoid arthritis (RA) disease burden compared with other countries, yet RA patients rarely receive surgical treatment for hand deformities that limit function and impact appearance. We investigated potential barriers to rheumatoid hand surgery in China. Methods: Patients with RA, rheumatologists, and hand surgeons at 3 large tertiary hospitals in Beijing completed questionnaires that assess knowledge and attitudes surrounding RA hand surgery. We calculated descriptive statistics and compared responses among groups using chi-square and Fisher exact tests as appropriate. Results: One hundred RA patients with hand deformities and 94 physicians completed the surveys. No patients had received hand surgery, and just 13% were aware of this treatment option. Patients and physicians most frequently cited uncertain effectiveness of surgery, high cost, and risk of surgical complications as potential barriers to hand reconstruction. Rheumatologists reported low rates of referral to hand surgeons (39% referred <5% of the time and 31% never referred). Most hand surgeons (69%) had not performed metacarpophalangeal arthroplasty, a common procedure for RA hand deformities, within the past year. Some had never performed this operation. Conclusions: This survey revealed multiple barriers that support previous observations of infrequent reconstruction of RA hand deformities in China. These obstacles can be addressed through patient education, coordination between specialists, and more robust hand surgeon training in common RA procedures through the application of international plastic surgery collaborations.