Virtual Interactions and the 2020-2021 Residency Application Cycle in General Surgery: A Look Ahead.

INTRODUCTION: General surgery residency training programs adapted to the COVID-19 pandemic by going online instead of in-person, through virtual interviews, social media engagement, and virtual open houses. The impact of these virtual interactions is unknown. We sought to understand their effectiveness as per residency program directors and assistant program directors. MATERIALS AND METHODS: An institutional review board approval was obtained to conduct this anonymous survey. A Qualtrics XM survey containing multiple-choice and short-answer questions was distributed to 590 residency program and assistant program directors through the Association of Program Directors in Surgery (APDS) listserv on July 6, July 13, and July 20. RESULTS: We observed a response rate of approximately 11% across the 590 surgeons contacted. Nearly all (90%) respondents offered virtual preinterview interactions, primarily virtual open houses, virtual facility tours, and virtual question and answer (Q&A) sessions with residents and faculty; 48% of respondents were unsure of the utility of virtual interactions and the majority (54%) felt that virtual interaction limits a program's ability to evaluate applicants. Virtual Q&As were ranked to be the most effective interaction (7.6/10); 80% of respondents felt that visiting rotations were "somewhat important" to "very important," the two highest options available. In addition, 74% felt that applicants missed out on fully experiencing the program by forgoing these rotations. Most respondents (78%) noted that evaluation of applicants' preinterview did not change as a result of virtual interactions. Nearly half (48%) of the respondents offered more interview days due to the virtual format. A fifth (21%) of respondents stated that virtual interactions resulted in a change in the rank position of an applicant. Respondents ranked Twitter and Instagram higher in applicant engagement than Facebook. Factors that impacted interview or rank order list the most were late/absent step two CK scores (33%) and a lack of away rotations (31%), both being limitations largely due to the pandemic. With respect to future application cycles, most (71%) raised concerns regarding disparities between applicants applying in-person and virtually if both or either are offered. CONCLUSIONS: Our study suggests that program directors and associate program directors have reservations about the use of virtual interactions with applicants. Interestingly, these data suggest that visiting subinternships are useful for programs in evaluating applicants. This may encourage students to pursue rotations at other institutions at the expense of already-limited resources. It remains unclear whether virtual interactions will be used in the future, but respondents largely agreed that the virtual means of interacting with and disseminating information to the applicants of the 2020-2021 general surgery Match were a success.

Same day barium esophagography and high-resolution manometry during the COVID-19 pandemic.

PURPOSE: Double contrast barium esophagography (BAS) and high-resolution manometry (HRM) are traditionally performed on separate days to allow for pre-procedural fasting. In an effort to minimize COVID-19 exposure and improve appointment efficiency with required pre-procedure testing, we permitted same day HRM prior to BAS. Our study aimed to evaluate the adequacy of barium mucosal coating with same day HRM prior to BAS compared to BAS alone. METHODS: We performed a retrospective pilot cohort study including 14 patients undergoing same day HRM prior to BAS and 20 patients undergoing BAS alone over an 8-month interval during the COVID-19 pandemic. Three abdominal imaging subspecialty-trained radiologists blindly reviewed the images and graded adequacy of esophageal coating on a 4-point scale with a score of 1 representing inadequate coating and 4 representing optimal coating. RESULTS: For the cohort studied thus far, the mean grade of the HRM and BAS group was 3.17 with a standard deviation of 0.66. The mean grade of the BAS alone group was 3.13 with a standard deviation of 0.79. There was no statistical difference in the adequacy of esophageal coating between the two groups (p-value 0.97). CONCLUSION: Same day HRM prior to BAS has no detrimental effect on barium mucosal coating compared to BAS alone. Though created to limit patient exposures during the COVID pandemic, same day BAS and HRM may prevent delays in care and improve convenience towards improved patient-centered care beyond the pandemic.

Cross-Sectional Analysis of Global Surgery Opportunities Among General Surgery Residency Programs.

BACKGROUND: Global surgery is a rising field within academic surgery. With the publication of recent landmark papers highlighting the need for increased global efforts to combat surgical disease, many general surgery residents seek opportunities to gain clinical, research, and educational experience related to global surgery during residency. This study aims to quantify the global surgery opportunities that are publicly available to residents training in Accreditation Council for Graduate Medical Education (ACGME)-accredited general surgery programs. METHODS: The websites of all ACGME-accredited general surgery residency programs were surveyed for mention of global surgery training opportunities. Each opportunity was recorded in a database and categorized based on type. Recorded categories include international clinical rotations, international surgical research opportunities, and formal tracks or training pathways for global surgery. RESULTS: Of the 299 ACGME-accredited general surgery training programs, 52 (17%) mention some form of international surgical opportunity on their website. Among these programs, 11 (21%) note both clinical and research opportunities, 28 (54%) mention only clinical opportunities, and 13 (25%) list only research opportunities. The large majority of global surgery opportunities were based in training programs at academic medical centers (n = 50, 96%). There was no significant difference in the percentage of global surgery programs when evaluated by program region (p = 0.154) CONCLUSIONS: Few general surgery residency programs mention international training opportunities on their program websites. For those programs that do offer global surgery opportunities, these are typically international rotations offered as electives for upper-level residents. Expanding access to global surgery opportunities may be beneficial to meet the desires of residents wishing to pursue academic global surgery.

Examining the Correlation Between Altmetric Score and Citations in the General Surgery Literature.

BACKGROUND: With the emergence of social media platforms, new bibliometric profiles measuring impact and exposure of scientific research online have been introduced as an alternative to traditional bibliometric outcomes. The objective of this article is to evaluate relationships between Altmetric scores, journal impact factor, and citation counts among the surgical literature. METHODS: We analyzed the top 10 highest cited articles for the 10 general surgery journals with the highest impact factors for 2013 and 2016 by noting citation counts and Altmetric scores for each article. We also identified the journal impact factor and age of journal associated Twitter accounts. Variables were assessed for correlation using Pearson's correlation testing via Microsoft Excel. RESULTS: A total of 240 articles were analyzed. For 2013, Altmetrics score analysis demonstrated a significant, positive correlation with citation number (r = 0.462, P < 0.0001) and journal impact factor (r = 0.439, P < 0.0001). The 2016 cohort also demonstrated significant, positive correlations between Altmetric scores and citation count after the removal of one outlier (r = 0.182, P = 0.047) and journal impact factor when considering all articles (r = 0.425, P < 0.0001). From 2013 to 2016, the total number of citations for all articles decreased from 11,027 to 7661, but cumulative Altmetric scores increased from 1078 to 4782. Age of creation for a journal's Twitter account did not significantly affect Altmetric score or traditional bibliometric measures in either 2013 (r = 0.370, P = 0.293) or 2016 (r = 0.441, P = 0.202). CONCLUSIONS: Altmetric scores, while significantly associated with citation count in the surgical literature, should not necessarily be used as a surrogate marker for evaluating research performance, impact, or exposure. It is possible, however, that as the use of social media for distributing and sharing scientific research continues to expand, that exposure on such platforms could impact future interest or studies.

Analysis of Open Payments Receipts Among Surgical Faculty at a Large Academic Institution.

BACKGROUND: Section 6002 of the Affordable Care Act, commonly referred to as "The Sunshine Act," is legislation designed to provide transparency to the relationship between physicians and industry. Since 2013, medical product and pharmaceutical manufacturers were required to report any payments made to physicians to the Centers for Medicare and Medicaid Services (CMS). We predicted that most clinical faculty at our institution would be found on the Open Payments website. We elected to investigate payments in relationship to divisions within the department of surgery and the level of professorship. METHODS: All clinical faculty (n = 86) within the department of surgery at our institution were searched within the database: https://openpaymentsdata.cms.gov/. The total amount of payments, number of payments, and the nature of payments (food and beverage, travel and lodging, consulting, education, speaking, entertainment, gifts and honoraria) were recorded for 2017. Comparison by unpaired t-test (or ANOVA) where applicable, significance defined as P < 0.05. RESULTS: Of the 86 faculty studied, 75% were found within the CMS Open Payments database in 2017. The mean amount of payment was $4024 (range $13-152,215). Median amount of payment was $434.90 (range $12.75-152,214.70). Faculty receiving outside compensation varied significantly by division and academic rank (P < 0.05). Plastic surgery had the highest percentage of people receiving any form of payment ($143-$1912) and GI surgery had the largest payments associated with device management ($0-$152,215). The variation seen by rank was driven by a small number of faculty with receipt of large payments at the associate professor level. The median amount of payment was $428.53 (range $13.97-2306.05) for assistant professors, $5328.03 (range $28.30-152,214.70) for Associate Professors, and $753.82 (range $12.75-17,708.65) for full professors. CONCLUSIONS: Reporting of open payments to CMS provides transparency between physicians and industry. The significant relationship of division and rank with open payments database is driven by relatively few faculty. The majority (94%) received either no payments or less than $10,000.

Bariatric surgery is associated with renal function improvement.

INTRODUCTION: Weight loss after bariatric surgery improves both blood pressure and glycemic control following surgery. The effect of bariatric surgery on renal function is not well characterized. In this study, we sought to quantify the change in renal function over time following surgery. METHODS: We retrospectively reviewed all patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2012 and 2014 at our institution. The glomerular filtration rate (GFR, mL/min) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Body mass index (BMI, kg/m2) and percent weight loss (%WL) were calculated following the surgery. RESULTS: A total of 149 patients who underwent bariatric surgery were included in this study: LRYGB (n = 86 and LSG (n = 63). In LRYGB group, baseline BMI (kg/m2, ±SD) and GFR (mL/min, ±SD) were 48.5 ± 6.8 and 94.7 ± 23.8, respectively. In comparison, BMI and GFR were 49.1 ± 11.9 kg/m2 and 93.1 ± 28.0 mL/min in the LSG group, respectively. Over the follow-up period (19.89 ± 10.93 months), the patients who underwent LRGYB lost a larger percentage of weight as compared to those in the LSG group (29.9 ± 11.7% vs 22.3 ± 10.7%; p = <0.0001). Overall, GFR improved in both LRYGB (101.0 ± 25.8 mL/min) and LSG groups (97.9 ± 25.8 mL/min) and was not significantly different between the two groups. Of patients with a GFR < 90 mL/min prior to weight loss surgery (n = 62), 42% had improvement of their GFR to > 90 mL/min postoperatively (p < 0.001). There was no relationship between weight loss percentage and GFR improvement (p = 0.8703). CONCLUSIONS: Bariatric surgery was associated with improvement in postoperative renal function at almost two years following surgery but was not different for LRYGB versus LSG. The gain in GFR was independent of percentage of weight lost suggesting an alternate mechanism in the improvement of renal function other than weight loss alone.