Effects of In-House Calls on Medical Students' Perspectives of Surgical Education and Future Career Opportunities.

Background: It has been shown that surgical residents who took few or no in-house calls during medical school felt less prepared for the residency. In this study, our objective was to assess the impact of in-house calls carried out by medical students on their perceptions of medical training, including the influence on specialty choice. Methods: The students were asked to complete an anonymized questionnaire at the first and last day of their general surgery clerkship. Students were asked regarding importance for medical training and education, preparation for the internship, learning opportunities, skills acquisition; negative effects, including fatigue, negative effect over medical training, personal life, and physical and mental health derangements; and the student's perception of the residents' in-house calls and parameters affecting specialty selection: difficulty of the residency, prestige, and future career opportunities. Results: A total of 42 medical students responded to 84 questionnaires. There was a significant difference in the importance of calls among male students before the beginning of the clerkships compared with the end of the clerkship (4.53 versus 4.21, P = .034). At the end of general surgery clerkship, students indicated that the calls less impaired studying during the clerkship (2.5 versus 2.21, P < .05) compared with the beginning of the clerkship. Female students ranked the calls as less demanding at the end of the clerkship (2.53 versus 2.12, P < .05). The impact of the residency difficulty on the selection of their future specialty was rated higher by the students at the end of the clerkship compared with their expectations at the beginning (3.13 versus 2.85, P = .033). Conclusions: In conclusion, our study demonstrates that in-house calls performed by medical students during their general surgery clerkships have a significant influence on their perceptions of medical training and choice of specialty. The study also highlights the importance of gender differences in the students' perception of the importance and impact of calls on their well-being.

Tumor-to-Nipple Distance in Selecting Patients for Nipple-sparing Mastectomy.

Nipple-sparing mastectomy (NSM) is a valid option for carefully selected cases. Oncologic guidelines have not been established, but proximity of the tumor to the nipple, tumor size, lymph node involvement, and neoadjuvant chemotherapy have been suggested as contraindications to nipple preservation. This study describes our experience with NSM in relation to these factors, in particular distance of tumor from the nipple, to help establish evidence-based guidelines for NSM. METHOD: All NSM procedures performed at our institution between 2014 and 2018 were reviewed. The tumor-to-nipple distance was measured for each patient using mammography, ultrasound, or magnetic resonance imaging. All patients underwent a frozen section (FS) biopsy of the base of the nipple during surgery, and if cancer was detected, the procedure was converted to a skin-sparing mastectomy. Patients were followed for postoperative complications and cancer recurrence. RESULTS: Sixty-eight patients (98 breasts) underwent NSM with immediate reconstruction. Fifty-three patients (78%) underwent the procedure for breast cancer. Nipple involvement was detected on FS in 1 patient and on permanent pathology after a negative FS in 1 patient. Forty-three percent of our patients had a tumor-to-nipple distance of ≤2 cm. During a mean follow-up of 32.5 months (±19.4 months), no locoregional recurrences were observed; however, distant metastasis occurred in 3 patients. CONCLUSIONS: When histologic examination from the base of the nipple is negative (either by FS or permanent pathology), NSM can be considered oncologically safe. Lack of nipple involvement by preoperative clinical and imaging assessment and intraoperative FS is sufficient to classify patients as suitable for NSM.