Surgeons underestimate their influence on medical students entering surgery.

BACKGROUND: Positive surgical role models influence medical students to pursue a career in surgery. However, the perception by role models of their own effectiveness has yet to be examined. In this study, we evaluated the influence of surgical role models on medical student career choice, and how these role models perceive themselves. METHODS: We distributed a voluntary and anonymous survey to third-year medical students, general surgery resident applicants, general surgery residents, and attending surgery faculty during the 2010-2011 academic year. We performed statistical analysis using the chi-square and Cochran-Mantel-Haenszel tests (P < 0.05 was significant). RESULTS: Medical students and resident applicants agreed that faculty and residents are important in shaping the career paths of students. The applicants were more likely to agree than were students that clerkship role models (P = 0.0049) and mentors (P = 0.0035) affected their interest in surgery. The applicants were also more likely to agree than the students that attending surgeons (P = 0.0004), senior (P = 0.0019) and junior (P = 0.0028) surgery residents served as positive role models. Although the surgical faculty and residents agreed with the students that each level of the surgical team served as positive role models, they did not agree as strongly with the students that they have an important role in shaping students' career path (P < 0.0001). CONCLUSIONS: Surgical faculty and residents serve as positive role models for medical students. They have an essential role in shaping students' career paths and should be more cognizant of their influence, which may draw a student toward or lead them away from the field of surgery.

VEGF expression predicts survival in patients with peritoneal surface metastases from mucinous adenocarcinoma of the appendix and colon.

BACKGROUND: High levels of vascular endothelial growth factor (VEGF) in ovarian cancer metastases are associated with a worse prognosis in patients treated with chemotherapy. VEGF-directed therapy improves survival for those with metastatic colorectal cancer. Patients with mucinous adenocarcinomas metastatic to the peritoneal surfaces can be treated with cytoreductive surgery, and both tumor grade and cytoreduction status are prognostic. We hypothesized that angiogenic indices may be prognostic in patients undergoing cytoreductive surgery for mucinous adenocarcinoma of the appendix and colon. METHODS: Cytoreductive cases from a 5-year period from the University of Cincinnati peritoneal malignancy database were reviewed. CD 34 counts (blood vessels) and VEGF expression was evaluated by means of immunohistochemistry on specimens from patients undergoing cytoreductive surgery and intraperitoneal hyperthermic perfusion (IPHP) for mucinous adenocarcinoma. RESULTS: A total of 26 males and 9 females, with a mean age of 50 years, underwent cytoreductive surgery and IPHP for mucinous adenocarcinoma of appendiceal (n = 32) or colonic (n = 3) origin. With a mean follow-up of 18 months (range 1-63 months), 23 had disease recurrence and 12 were alive without recurrence. The mean survival was 19 months (range 1-63 months). CD34 counts did not correlate with recurrence or survival; however, average VEGF counts correlated with survival (P = 0.017), and, for patients with recurrence, this correlation was stronger (P = 0.002). CONCLUSIONS: These results suggest that markers of tumor angiogenesis may predict survival in patients with peritoneal surface metastases from mucinous adenocarcinoma. These findings provoke the hypothesis that antiangiogenic therapies may be effective in patients with this devastating disease.