Questions Posed by Residents in the Operating Room: A Thematic Analysis.

OBJECTIVE: Questioning behavior is a type of intraoperative communication for which little information exists on the types of questions that residents ask. The purpose of this study is to describe and identify themes of questions asked by residents in the operating room. DESIGN: Trained observers documented questions asked by residents during operations. Thematic analysis was applied. SETTING: University of Utah Hospital (Salt Lake City, Utah) operating rooms; institutional. PARTICIPANTS: A total of 10 general surgical residents (postgraduate year 1 to 5) were observed along with 10 attending general surgeons. Cases were purposefully selected to be broadly representative of general surgery cases. RESULTS: Thematic saturation occurred following examination of 16 operative cases, which included 178 questions asked by residents. Two broad categories of questions emerged: case-related (71%) and noncase-related (29%), with multiple subcategories within the 2 groups. Case-related subcategories included operative techniques, logistics, patient care, and other. Questions unrelated to the case included subcategories of social, work-related but unrelated to case, other. Less than 1% of questions asked by residents during operations were reflective. CONCLUSIONS: Most questions related to the case were technical and most of those unrelated to the case were social; almost all questions were transactional in nature. Our identification of questioning themes by residents expands understanding of resident questioning behaviors, and therefore may enable residents and faculty to be more effective in establishing entrustment.

Trends in the match rate and composition of candidates matching into categorical general surgery residency positions in the United States.

BACKGROUND: The aim of this study was to analyze the trends in the proportion of students from various educational backgrounds who matched into categorical general surgery (GS) residency positions. METHODS: National Resident Matching Program reports (1994 to 2014) were analyzed, and regression was used to estimate the trends for each group. RESULTS: The match rate into GS-categorical residency has remained stable; however, since 1994, we witnessed a 13% decrease in US seniors matching into GS. This has corresponded to proportional increases in matches for US citizens from international medical schools (US IMG, 1350%) and a 62% increase for non-US citizen international medical graduates (non-US IMG) into GS. In comparison, US IMG matches into all first-year postgraduate positions increased by 468%, whereas non-US IMG matches decreased by 15%. CONCLUSIONS: The stable match rates into categorical GS residencies are not because of US seniors but rather because of a rise in the number of IMGs. In contrast to the decreased reliance on non-US IMGs in all other specialties, GS is accepting a larger proportion of non-US IMGs.

The Barcelona Technique for Ileostomy Reversal.

INTRODUCTION: The Barcelona technique for bowel anastomosis is not well described in the currently available literature, but it saves steps when compared to conventional stapled anastomoses. In short, the proximal and distal ends of a resection margin are approximated, small enterotomies made, a stapler is passed into both lumens creating a common channel, and lastly, this same stapler is used to create the anastomosis and amputate the specimen. We report on this technique with ileostomy reversal in terms of cost and complications. MATERIALS AND METHODS: Review of ileostomy reversals (2006-2014) by a single surgical oncologist. RESULTS: Thirty patients had surgery using the Barcelona technique. Median age was 58 years, and median postoperative surgical stay was 3 days. The majority of patients had rectal cancer initially treated with low anterior resection and diverting loop ileostomy (80 %). One patient had a wound infection (3 %), and there were no anastomotic leaks, intra-abdominal abscesses, or strictures. This technique required fewer stapler loads saving $510 in charges per case. CONCLUSIONS: The Barcelona technique is safe and effective for ileostomy reversal. There are reduced costs related to equipment as compared to the conventional technique and thus the use of this method can result in significant medical cost savings.

A multinational perspective on "lifestyle" and other perceptions of contemporary medical students about general surgery.

OBJECTIVE: The aim of this multinational study was to measure and describe the perceptions of medical students toward general surgery as a career choice with a particular emphasis on "lifestyle." BACKGROUND: Past studies from individual countries have considered the perceptions of medical students toward general surgery. No multinational study to compare the perceptions of medical students from different geographic and socioeconomic regions toward general surgery, has been broadly disseminated. METHODS: A survey about student perceptions of a general surgery career was distributed to 9 medical schools in 8 countries. Two-way analysis of variance was performed on the basis of country, level of economic development [Human Development Index (HDI)], and sex. RESULTS: A total of 841 respondents were included in the study with a response rate of 60%. The overall rate of interest toward general surgery as a career choice was 24%. We noted differences in the reasons behind why medical students choose general surgery between very high HDI countries and medium/high HDI countries. In contrast, the most important reason for not choosing general surgery was found to be due to perceptions of an unpleasant lifestyle. The negative influence of "lifestyle" persisted across all countries, both sexes, and all levels of socioeconomic development. CONCLUSIONS: The negative influence of lifestyle is the most important reason why contemporary medical students from different parts of the world choose not to pursue general surgery. Strategies to counteract the perceived unfriendly nature of the lifestyle are essential to increase the interest of contemporary medical students toward general surgery.