Nicole Woll

The Predictive Value of Application Variables on the Global Rating of Applicants to a General Surgery Residency Program

OBJECTIVE Selection of applicants to residency programs can involve a great deal of variability. The purpose of this study was to determine the relationship between different subjective and objective application variables and the global rating score (GRS) of applicants to a general surgery residency program. DESIGN This was a retrospective analysis of data collected from the Electronic Residency Application Service on 188 applicants to a general surgery residency program from 2010 to 2013. Subjective variables including letters of recommendation (LORs), personal statements (PSs), and volunteer work were blindly assessed by raters using a literature-based method of evaluation. Objective data included several variables, such as United States Medical Licensing Examination (USMLE) scores. Each applicant received a GRS, which was a faculty-given numerical value reflecting both interview performance and overall application strength. The effect of subjective and objective variables on the GRS was determined. SETTING The Geisinger Medical Center, a rural moderate-sized general surgery residency program. RESULTS Of all the application variables examined, bivariate analysis indicated that having no prior residency (p = 0.0023), prior medical work (p = 0.0329), higher USMLE Step II Clinical Knowledge scores (p = 0.0021), higher overall PS score (p = 0.0125) and PS Written Expression score (p = 0.0007), and LORs from surgeons in leadership positions (p = 0.0029) have a significant (p < 0.05) effect on the GRS. Of these factors, USMLE Step II Clinical Knowledge score, PS Written Expression score, no prior residency, prior medical work, and LORs from surgeon in lead position had a significant effect on GRS based on multivariate stepwise regression analysis. CONCLUSIONS Our analysis identifies specific surgical resident applicant variables that are predictive of the GRS. Interestingly, most of these factors were objective. This may allow for the development of a more quantitative tool for selection of applicants.

Mo1500 Clinical Pathway for Pancreaticoduodenectomy Improves Short Term Outcomes at a Rural Tertiary Care Center

II and IIIa complications requiring either prolonged overall lengths of stay(>2 standard deviations beyond the mean for patients undergoing ODP without complication) including readmissions or more than one interventional procedure were also classified as SAPOs. All others were considered minor adverse outcomes(MAPO). RESULTS 127 patients underwent DP. 63 (49%) had a complication. 91% of DP patients had a complication of low/moderate Clavien-Dindo grade(I, II, IIIa) or no complication. Using our re-classification, however, 24.8% had what was considered to be a poor quality outcome(SAPO) while 75.2% had a high quality outcome(MAPO or no complication). Of the patients undergoing DP, 77 underwent ODP and 50 underwent LDP. Compared to patients undergoing ODP, patients undergoing LDP were statistically less likely to have ductal adenocarcinoma(4% vs. 26%, p<0.01) and tended to have smaller tumors(3.1+0.36 cm vs. 3.9+0.26 cm, p=0.05). Those undergoing LDP did also demonstrate, however, lower volumes of intraoperative blood loss (234+30.1 mLs vs 752+152.7 mLs, p<0.01), lower rates of postoperative transfusion (2% vs 20%, p<0.01), lower rates of postoperative morbidity (35% vs 58%, p<0.01), shorter initial postoperative lengths of stay (4.1+0.23 vs 8.3+0.7 days, p<0.01), shorter overall lengths of stay including 90-day readmissions (6.1+0.9 days vs. 10.51+0.9 days, p<0.01), and were less likely to have a poor quality(SAPO) outcome(15% vs 31%, p=0.02)than those undergoing ODP. There were no statistical differences between the two groups in regard to age, presenting symptoms, incidence of diabetes, chronic pancreatitis or comorbid cardiopulmonary disease, preoperative albumin, operative time, the rate of readmission or of pancreatic fistula. CONCLUSIONSGeneric grading systems underestimate the severity of some complications following distal pancreatectomy. Using a procedure specific metric for quality following distal pancreatectomy, LDP affords a higher quality postoperative outcome than ODP resulting in shorter initial and overall lengths of stay, a lower incidence of postoperative transfusion and a lower incidence of severe adverse postoperative outcomes.