Browsing by Subject "General Surgery"
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Item An Exanimation of GME Funding: A Critical Look at Non-ACGME Surgical Fellowships(2020-05-01T05:00:00.000Z) Lee, Joo Hyun; Scott, Daniel; Sendelbach, Dorothy; Pearson, Mary JaneBACKGROUND: Since 1997, the Fellowship Council (FC) has evolved into a robust organization that is responsible for the advanced training of nearly half of the U.S. residency graduates entering general surgery practice. While FC fellowships are competitive (55% match rate) and offer outstanding educational experiences, funding is arguably vulnerable as external support has diminished. OBJECTIVE: The aim of this study was to investigate the current funding models of FC fellowships. METHODS: Under an IRB-approved protocol, an electronic survey was administered to 167 FC programs with subsequent phone interview follow-ups to collect data on total cost and sources of funding. De-identified data were also obtained via 2020-2021 Foundation for Surgical Fellowships (FSF) grant applications. Means and ranges are reported. RESULTS: Data were obtained from 59 programs (35% response rate) via the FC survey and 116 programs via FSF applications. The results from the FC and FSF data sets indicated that the average cost to train one fellow per year was USD 107,957 and USD 110,816, respectively. Similar averages were reported for the four components of cost. Programs received an average funding of USD 109,118 and USD 110,816, respectively. Most programs utilized departmental and grants funds. Additionally, 36% (FC data) to 39% (FSF data) of programs indicated that they billed for their fellow, generating USD 74,824 (range USD 15,000-USD 200,000) and USD 33,281 on average (range USD 11,500 - 66,259), respectively. 14% of programs via FC survey reported generating net positive revenue whereas 100% of programs from FSF application declared budget neutral. CONCLUSIONS: Our results indicated similar findings in support of the overall accuracy of these data. Most programs seemed to rely heavily on subsidies from both internal and external sources, although some programs were able to generate a positive revenue stream. The most notable difference was the revenue amount generated from billing. Programs that generated a positive revenue often billed for fellows. Given the value of these fellowships and the inherent vulnerabilities associated with graduate medical education funding, new alternative grant funding models are encouraged. In addition, standardization of annual cost and funding reports would provide greater insights into funding models.Item Medical and surgical care during the American Civil War 1861-1865(2014-05-30) Reilly, Robert F., Jr.Item [News](1970-03-19) Fenley, Bob; Weeks, JohnItem Personality Styles among Surgical Faculty: Implications for Surgical Education(2017-01-17) Wu, Eva M.; North, Carol S.; Napier, Rebecca H.; Williams, Brian H.; Scott, Daniel J.; Choti, Michael A.INTRODUCTION: Faculty development efforts must acknowledge learners' perspectives to be effective in improving teaching and learning. An improved understanding of an individuals' own personality traits can allow one to gain insight and adapt to the learner and learning environment. Current literature has proposed a relationship between personality profiles and teaching performance in nonclinical settings, but this correlation has not been fully defined in clinical settings1-4. This study was designed to determine the association between attending surgeons' personality profile and residents' and students' teacher ratings. METHODS: 64 faculty members from UTSW Dept. of Surgery completed a voluntary standardized personality profile as part of a faculty development program: DISC Workplace assessment. DISC includes 4 dimensions: Dominance (D), Influence (I), Steadiness (S), and Conscientiousness (C)5. As part of the standard trainee evaluation process, residents and medical students complete an anonymous questionnaire, rating and commenting on teaching performance of surgical faculty while on surgical rotations. There was a total of 7,753 evaluations, 6,478 evaluations included comments. Three categories of comments were established: very positive, positive, and not positive. Resident and medical student evaluation of faculty were analyzed and compared with the faculty DISC profiles. A p value of <0.05 was defined as significant. RESULTS: Overall, residents ranked faculty with strongest dimensions of S or C in the highest quartile, while D or I were ranked in the lowest quartile. In contrast, faculty rankings among medical students were not associated with D, I, S or C. Analysis was also performed on a question specifically related to overall teaching effectiveness. Here, both residents and medical students considered faculty high in S to be more effective teachers. Faculty with D or I personality were perceived to be less effective by residents whereas medical students considered C to be less effective. When considering comments, faculty with S were again given the highest comment scores by both groups of trainees. Faculty with D or C were given lowest comments by residents and medical students, respectively. CONCLUSION: Faculty who have higher teaching evaluation scores tended to have a DISC profile that is high in S for both groups of trainees but lower in D or I for residents and C for medical students. Based on these findings, implementation of programs to promote emotional intelligence may allow for increased effectiveness of student and resident education.Item Safety of Essential Surgery Performed by Non-Physicians in Low and Middle Income Countries(2016-04-04) Sliz, Emily; Mihalic, Angela; Gibson, John; Ramanathan, AparnaBACKGROUND: A lack of surgically trained providers in low and middle income countries (LMICs) is a major contributor to high morbidity and mortality from surgical conditions in these settings. Some countries train non-physician clinicians (NPCs) in surgery to help solve this problem. The World Health Organization recommends this practice in some cases, although data on its safety is limited. HYPOTHESIS: Complication rates of NPCs and physicians practicing essential surgery in LMICs are similar. METHODS: A literature search using PubMed and OvidMEDLINE identified studies reporting complication rates of NPCs when performing essential surgery in LMICs. RESULTS: I identified 28 articles and 2 abstracts reporting the complication rates of 57,578 procedures performed by NPC and MD surgeons in LMICs, as well as 4 systematic reviews and/or meta-analyses on the safety of NPC surgery. Studies came from 4 world regions and the majority were from sub-Saharan Africa. Studies addressed 5 areas: major general surgery (13,253 procedures), medical male circumcision (14,248 procedures, 70% in adults), emergency obstetric surgery (18,853 procedures), tubal ligation (7,179 procedures) and first-trimester abortion (4,045 procedures). Complication and mortality rates for NPC and MD surgeons were similar when performing a variety of general surgery procedures, tubal ligation, and abortion. One out of 7 studies on circumcision found increased complications when NPCs performed the procedure. One out of seven studies found increased maternal and perinatal mortality when NPCs performed emergency obstetric surgery, although these differences were not found in meta-analysis. Meta-analysis did find increased rates of wound healing problems and wound infection in patients of NPCs after obstetric surgery. The majority of studies in this review are limited by factors related to study design. CONCLUSION: NPC surgeons contribute significantly to surgical practice in at least 7 LMICs, all in sub-Saharan Africa. In the majority of cases, NPC and MD surgeons had similar complication rates when performing essential surgery. In areas with large unmet need for surgical care, NPC providers offer a significant mortality and morbidity benefit by increasing access. More research is needed to define the scope of NPC surgical practice that will maximize this benefit and to develop the proper supervision and support mechanisms that MDs must provide to these clinicians.Item [UT Southwestern Medical Center News](2006-03-26) Rian, Russell