The Blue Ribbon Committee II Report and Recommendations on Surgical Education and Training in the United States: 2024.

OBJECTIVE: An expert panel made recommendations to optimize surgical education and training based on the effects of contemporary challenges. BACKGROUND: The inaugural Blue Ribbon Committee (BRC I) proposed sweeping recommendations for surgical education and training in 2004. In light of those findings, a second BRC (BRC II) was convened to make recommendations to optimize surgical training considering the current landscape in medical education. METHODS: BRC II was a panel of 67 experts selected on the basis of experience and leadership in surgical education and training. It was organized into subcommittees which met virtually over the course of a year. They developed recommendations, along with the Steering Committee, based on areas of focus and then presented them to the entire BRC II. The Delphi method was chosen to obtain consensus, defined as ≥80% agreement among the panel. Cronbach α was computed to assess the internal consistency of 3 Delphi rounds. RESULTS: Of the 50 recommendations, 31 obtained consensus in the following aspects of surgical training (# of consensus recommendation/# of proposed): Workforce (1/5); Medical Student Education (3/8); Work Life Integration (4/6); Resident Education (5/7); Goals, Structure, and Financing of Training (5/8); Education Support and Faculty Development (5/6); Research Training (7/9); and Educational Technology and Assessment (1/1). The internal consistency was good in Rounds 1 and 2 and acceptable in Round 3. CONCLUSIONS: BRC II used the Delphi approach to identify and recommend 31 priorities for surgical education in 2024. We advise establishing a multidisciplinary surgical educational group to oversee, monitor, and facilitate implementation of these recommendations

Heritability estimates for psychotic disorders: The Maudsley Twin psychosis series

Background: Previous twin studies have supported a genetic contribution to the major categories of psychotic disorders, but few of these have employed operational diagnostic criteria, and no such study has been based on a sample that included the full range of functional psychotic disorders. Methods: A total of 224 twin probands (106 monozygotic, 118 dizygotic) with a same-sex co-twin and a lifetime history of psychosis was ascertained from the service-based Maudsley Twin Register in London, England. Research Diagnostic Criteria psychotic diagnoses were made on a lifetime-ever basis. Main- lifetime diagnoses of DSM-III-R and International Statistical Classification of Diseases, 10th Revision schizophrenia were also made. Probandwise concordance rates and correlations in liability were calculated, and biometrical model fitting applied. Results: A substantial genetic contribution to variance in liability was confirmed for the major diagnostic categories except Research Diagnostic Criteria depressive psychosis and unspecified functional psychosis, where familial transmission was confirmed but the relative contribution of genetic and common environmental factors was unclear. Heritability estimates for Research Diagnostic Criteria schizophrenia, schizoaffective disorder, mania, DSM-III-R schizophrenia, and International Statistical Classification of Diseases, loth Revision schizophrenia were all between 82% and 85%. None of the estimates differed significantly from any other. Conclusions: Heritability estimates for schizophrenia, schizoaffective disorder, and mania were substantial and similar. Population morbid risk estimates were inferred rather than directly measured, but the results were very similar to those from studies where morbid risks were directly estimated.link_to_subscribed_fulltex

Concordance rates and biometrical model fitting for operational diagnoses in the maudsley twin psychosis series

Background: Twin studies have supported a genetic contribution to the major categories of psychotic illness, but few of these have employed operational diagnostic criteria, and no study using such criteria has been based on a sample that includes the full range of functional psychotic illnesses. Objectives: To investigate concordance rates and perform biometrical model fitting for operationallydefined psychotic diagnoses in a sample of twins with any functional psychosis. Methods: 224 twin probands (106 MZ, 118 DZ) with a same-sex co-twin and a lifetime history of psychotic symptomatology were ascertained from the service-based Maudsley Twin Register, in London. RDC psychotic diagnoses were made on a lifetime-ever basis. Main-lifetime diagnoses of DSMIIIR and ICD10 schizophrenia were also made. Probandwise concordance rates and correlations in liability were calculated, and biometrical model fitting applied. Results: A genetic contribution to variance in liability was confirmed for the major diagnostic categories except RDC depressive psychosis and unspecified functional psychosis, where familial transmission was confirmed, but the relative contribution of genetic and common environmental factors was unclear. Heritability estimates were: 82% for RDC schizophrenia; 85% for RDC schizoaffective disorders; 83% for all RDC affective psychoses; 84% for RDC mania; 89% for all RDC psychotic diagnoses; 84% for DSMIIIR schizophrenia; and 83% for ICD10 schizophrenia. Conclusions: Heritability estimates for schizophrenia, schizoaffective disorders, mania, and all psychoses combined were substantial and similar. Population morbid risk estimates were inferred rather than directly measured, but the results were very similar to those from studies where morbid risks were directly estimated.link_to_subscribed_fulltex