Are we meeting ACGME core competencies? A systematic review of literature on international surgical rotations.

BACKGROUND: In response to the growing interest in global surgery among trainees, international surgical rotation (ISR) was approved as a formal elective of resident curriculum. To define ISR's role, we aim to identify the six core competencies of Accreditation Council for Graduate Medical Education (ACGME) in individual institution's experience. DATA SOURCES: This is a systematic literature review studying general surgery resident experience in ISR as it pertains to the ACGME core competencies. Articles were searched using PubMed, Scopus, and Web of Science. Each abstract and article was reviewed, selected, and tabulated. CONCLUSION: Fourteen articles were selected for the review after inclusion and exclusion criteria were applied. We found that ISR provided a valuable educational experience for US surgical residents by meeting the ACGME core competencies in a different environment. ISR is an important addition to the general surgery curriculum. Future direction should focus on bidirectional ISR and educational consortium development.

Perceptions regarding helmet use: a cross-sectional survey of female pillions in Karachi, Pakistan.

BACKGROUND: In 2011, road traffic injury-associated fatalities among motorized two-wheeler (MTW) pillion riders (backseat two-wheeler passengers) rose 30% in Karachi. Despite mandatory helmet laws, helmet use fell 20% the same year. This study aims to identify opinions of female pillions on helmet usage and whether various forms of media influence their self-perception. METHODS: Trained surveyors, using a survey tool used in similar studies in South Asia, conducted random, man-on-the-street interviews of 400 women in four areas of Karachi. Data pertaining to demographics, opinions on helmet laws, media influences, and helmet usage were collected. Data were analyzed in SAS 9.3 using chi-squared or Fisher's exact tests. RESULTS: Of the 400 women, 98.8% (n = 394) reported never wearing a helmet while riding on a MTW as a pillion rider. Women with a postsecondary or higher (US ninth grade) education level were more likely to be aware of helmet laws (38.6%) than women with lower education levels (24.6%, P = 0.005). Most women (82.4%, n = 329) supported mandatory laws and 97% (n = 289) recognized that disability was the more likely to result than death in event of a traumatic brain injury. Nearly all (98.5%, n = 394) stated that they would use a helmet if they were men, regardless of age, education level, or employment status. Television news was the most influential media form (83.7%, n = 334), with most women finding it effective because of its informative nature (91.3%, n = 303). CONCLUSIONS: Most Pakistani women do not personally use helmets when riding MTWs, yet most believe helmet use should be legally required for MTW riders and drivers. These data show that media outlets such as television can be used as a platform to educate the public about helmet usage, which may lead to improved helmet compliance among female MTW pillions in Pakistan. Furthermore, investigations into improved helmet comfort and appearance by collaborating with helmet manufacturers may have a positive impact on helmet use in Pakistan.

Patterns of injury among motorized two-wheeler pillion riders in New Delhi, India.

BACKGROUND: Motorized two-wheelers (MTWs) such as scooters and motorcycles place drivers and passengers at significant risk of injury and death in the event of a road traffic accident. In India, where road traffic is poorly regulated and consists of vehicles ranging from semitrucks to animal carts, the MTW pillion rider (backseat passenger) is particularly vulnerable. Annually, approximately 140,000 Indians are injured or killed in MTW road traffic accidents. In 2011, the city of New Delhi renewed a mandatory helmet use exemption for its 8 million women. We sought to identify the patterns of injury among MTW pillion riders in the city of New Delhi, including differences between helmeted and unhelmeted male and female pillion riders. METHODS: All records of incoming trauma patients to the Jai Prakash Narayan Apex Trauma Center, New Delhi, were reviewed for the 23-mo period from April 1, 2009 until March 1, 2011. More than 3000 charts were reviewed selecting for patients who were MTW pillion riders involved in road traffic accidents. Data including Glasgow Coma Scale score, number of surgical procedures performed, length of stay, and demographic information were collected from charts that met the criteria. Fisher's exact test was used for categorical variables and Kruskal-Wallis test for continuous variables. RESULTS: A total of 466 charts of MTW pillions in road traffic accidents were identified with 108 helmeted males, 161 unhelmeted males, three helmeted females, and 194 unhelmeted females. Females, both unhelmeted and helmeted, were more likely to have head and neck injury than unhelmeted males or helmeted males (66.0% and 66.7% versus 53.4% and 27.8%, P < 0.001). Unhelmeted females were most likely to suffer inhospital mortality (17.6%, P = 0.008) and require intensive care unit admission (40.0%, P = 0.004). Unhelmeted pillions, both male and female, had significantly lower Glasgow Coma Scale scores than helmeted pillions (12.6 and 12.8 versus 13.8 and 15, P = 0.04). CONCLUSIONS: Female pillions are more likely to have head and neck injury than male pillions, and unhelmeted pillions are more likely to have injuries resulting in their death. This firmly establishes the protective benefit of helmet use for pillions. Encouraging helmet use among all pillions may prevent a significant number of injuries and deaths, and mandatory helmet laws may decrease morbidity and mortality of MTW road traffic accidents for the women of New Delhi and all of India.

The problem of the pillion rider: India's helmet law and New Delhi's exemption.

BACKGROUND: In India, motorized two-wheeler (MTW) road traffic accidents injure or kill 72,000 women annually. Before the Motor Vehicle Act of 1988, which required mandatory helmet use for MTW riders, a study found 0.6% of all MTW pillions (backseat passengers) were helmeted. Citing religious protests to the legislation, Delhi's high court exempted the city's 12 million women from the law. We hypothesize that currently male pillions use helmets more frequently than females, and that overall pillion helmet usage has increased over the last 20 y. METHODS: Continuous video was recorded in half-hour blocks at four locations in Delhi on separate days, totaling 8 hours of high- and low-volume traffic. Videos were reviewed with at least two reviewers extracting the number of MTW pillions, as well as their gender, approximate age, and helmet usage. RESULTS: Of 4010 pillions identified, 63.8% were male, 32.4% female, and 3.3% children. Among males, there were significantly more helmeted pillions (88.4%, P < 0.001); among females, there were significantly more unhelmeted pillions (99.4%, P < 0.001). Among unhelmeted pillions, significantly more were female (81.4%) than male (P < 0.001). Current overall pillion helmet use is significantly higher than historical rate (P < 0.001). CONCLUSIONS: The significantly higher male pillion helmet usage compared with females indicates Delhi's helmet law is associated with increased compliance among those who fall under its jurisdiction. This augments the growing body of evidence that mandatory helmet laws are efficacious, thus repealing the exemption of women is an important step in increasing female pillion helmet usage.

Survey of helmet influences of female pillions in New Delhi.

BACKGROUND: In India, female motorized two-wheeler users involved in road traffic accidents account for 70,000 injuries and fatalities annually. Despite federal helmet laws, New Delhi exempted female pillion riders (backseat passengers) from mandatory helmet usage in response to religious and cultural opposition. This study attempts to elucidate factors influencing female pillion riders' helmet usage, hypothesizing religious-based opposition and poor understanding of helmet efficacy. MATERIALS AND METHODS: A cross-section of female pillion riders in five areas of New Delhi were approached by trained surveyors. Surveys were self-completed (n = 52) or completed with assistance (n = 243). Demographics, helmet use habits, opinions, and media influence data were collected. Data were analyzed using χ(2), Fisher exact test, and multivariable logistic regression. RESULTS: Of 305 women surveyed, 69.8% were Hindus (n = 213), 10.8% Muslims (n = 33), and 10.4% Sikhs (n = 32). More Muslim (33.3%, P = 0.001) and Sikh (25%, P = 0.04) women opposed mandatory helmet use compared with Hindu women (10.6%). There were 66 women who self-reported helmet use, with one woman (Sikh) who abstained from helmets for religious practices (0.9%). The most common reason for helmet disuse was discomfort (n = 40, 36.7%). Most respondents reported media positively influenced helmet use (57.7%). CONCLUSIONS: Despite arguments of infringement on religious rights, women pillions ride without helmets for comfort and appearance purposes primarily. Furthermore, though significantly fewer Sikh and Muslim women support mandatory helmet laws, supporters remain a clear majority in both groups. Most women report media outlets as influential on helmet use, principally television, suggesting that mass media campaigns may improve helmet compliance.