The Israeli Surgical Oral Board Examination: Improved Objectivity Increases Knowledge Authenticity.

The oral board examination in general surgery in Israel was recently revised aiming for improved objectivity and standardization. Herein, we describe the current exam model. Between 05/2018 and 11/2020, two exams per year were conducted with the current exam model. The examination consists of 12 stations, each focusing on a different field. Passing score is 80%. At the end of the examination, examiners and candidates complete a questionnaire regarding the examination's process and quality (scale 1-5). A total of 142 residents attended six oral board examinations. Mean pass rate was 76.6 ± 9.5%. Questions with overall highest pass rates were acute-care surgery (86.6 ± 4.8%), foregut surgery (84.6 ± 7.6%), and colorectal surgery (84 ± 8.1%). Questions with the highest fail rates were surgical oncology (31.7 ± 13.3%) and abdominal-wall surgery (28.8 ± 16.9%). Examiners' feedback scored highest the following: standardization of the exam (4.45 ± 0.63) and whether the presented cases reflect the daily work of an attending surgeon (4.35 ± 0.87). Candidates' feedback scored highest the following: did the examiners treat you in an appropriate manner (4.08 ± 1.17). In conclusion, oral exams are challenging and bear limitations, but properly constructed exams allow good evaluation of the trainees' thinking process and decision-making skills, without compromising exam's integrity and standardization.

Breast Cancer in Men: A Single Center Experience Over a Period of 22 years.

BACKGROUND: Male breast cancer (MBC) is a rare disease that is poorly understood. Treatment protocols are widely extrapolated from breast cancer in women. OBJECTIVES: To review the experience with MBC of a single center in Israel over a period of 22 years. METHODS: This single center retrospective study evaluated all patients diagnosed with MBC over a period of 22 years (1993-2015). Data were extracted from patient medical charts and included demographics, clinical, surgical, and oncological outcomes. RESULTS: The study comprised 49 patients. Mean age at diagnosis was 64.1 ± 13.5 years. The majority were diagnosed at early stages (1A-2A) (54.4%), 30.6% were stage 3B mostly due to direct skin and nipple involvement, and 59.2% of the patients had node negative disease. All of the patients were diagnosed with invasive ductal carcinoma and 30.6% had concomitant ductal carcinoma in situ. Estrogen receptor (ER) status was predominantly positive and luminal B (HER2-) was the most common subtype. Of the patients, 18.4% were BRCA carriers. The majority of patients underwent mastectomy. Radiotherapy was delivered to 46.9% and hormonal therapy to 89.8%. Chemotherapy was administered to 42.9%. Overall survival was 79.6% with a median survival of 60.1 (2-178) months; 5- and 10-year survival was 93.9% and 79.6%, respectively. Progesterone receptor (PR)-negative patients had a significantly improved overall survival. CONCLUSIONS: MBC has increasing incidence. PR-negative status was associated with better overall survival and disease-free interval. Indications to radiotherapy and hormonal therapy need standardization and will benefit from prospective randomized control trials.

WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting.

Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.