National survey of mentorship in Canadian general surgery residency programs: Where are we and what do we need?

Background: The benefits of mentorship on residents are well established. The current state of mentorship in General Surgery (GS) residency programs in Canada is unknown. The objectives of this study were to obtain GS residents’ and program directors’ (PD) perspectives on resident mentorship.Study Design: An electronic survey was developed and distributed to all 601 GS residents in Canada. All 17 PDs were invited for telephone interviews.Results: A total of 179 of the 601 residents responded. Ninety-seven percent (n=173) felt mentorship was important. Only 67% (n=116) identified a mentor and only 53% (n=62) reported a mentorship program. Most who identified a mentor (n=87/110, 79%) were satisfied with the mentorship received. Significant variations in mentorship existed between demographic subgroups and mentorship program types. Overall, residents (n=121, 74%) favoured having a required mentorship program.A total of 11 out of 17 PDs participated in the telephone interviews. The majority of PDs (n=9, 82%) were satisfied with current resident mentorship but most acknowledged that barriers exist (n=8, 73%).Conclusion: GS programs in Canada should ensure they are providing equal opportunities for mentorship across demographic subgroups. Programs are encouraged to examine both their program’s and their residents’ needs as well as local barriers to improve mentorship.

A comparative study of the adjuvant management of and survival from colon cancer in the two Canadian provinces of Newfoundland & Labrador and Ontario

INTRODUCTION: The crCIHRt collaboration between Newfoundland and Ontario (2000-present) is an interdisciplinary study of the determinants of and impact from colorectal cancer (CRC) between these two Canadian provinces. It includes an evaluation of the adjuvant treatment of CRC and overall survival from this common disease. Clinical Practice Guidelines (CPGs) for the adjuvant treatment of surgically curable (Stage I-III) colon cancer have not previously been evaluated in Canada. Canadian Cancer Statistics (CCS) have shown that overall survival from CRC is better in Ontario. The aims of this study were to evaluate whether adjuvant chemotherapy for Stage I-III colon cancer in the two provinces is concordant with accepted CPGs and to contrast overall survival from colon cancer in comparison with data from CCS. -- METHODS: In Newfoundland, all incident cases of colon cancer diagnosed between January 1, 1999 and December 31, 2000, ages 20-74 were included. In Ontario, all patients with a high- or intermediate-risk pedigree and a random sample of those with a low-risk pedigree for colon cancer, ages 18-74, diagnosed between January 1, 1999 and June 30, 2000 were offered participation in the study. Data was retrospectively retrieved using a standardized extraction form and quality assurance was undertaken through a random re-extraction by two physician researchers. The charts of all patients with stage II disease were qualitatively assessed to determine what factors were used to recommend chemotherapy to these patients. This was contrasted with CPGs recommending chemotherapy only in stage II patients with 'high-risk' features. An overall survival comparison between the two provinces was contrasted with age-standardized projections from CCS suggesting that Newfoundland experiences a worse overall survival than Ontario from CRC. -- RESULTS: 173/274 (63%) and 364/514 (71%) eligible patients consented in Newfoundland and Ontario, respectively. -- No one with stage I colon cancer in either province received adjuvant chemotherapy. 20/55 patients (36%) in Newfoundland and 44/116 evaluable patients (38%) in Ontario received adjuvant therapy for stage II disease. 18/41 patients (44%) in Newfoundland and 30/53 patients (57%) in Ontario with high-risk features received adjuvant treatment, significantly higher than patients without high-risk features. On multivariate analysis, age < 50 years was shown to be an independent predictor for the use of chemotherapy in stage II patients. 45/52 patients (87%) in Newfoundland and 108/115 patients (94%) in Ontario with stage III disease received adjuvant chemotherapy. -- Kaplan-Meier survival analysis revealed that overall 5-year survival from colon cancer was significantly better in Ontario. Exclusion of patients consented by proxy in Newfoundland negated this survival advantage. -- DISCUSSION: Concordance with CPGs for adjuvant chemotherapy in stage II colon cancer was not optimal. This may reflect selection bias of referring surgeons, a paucity of level I evidence and the belief that other factors such as age may play a role in predicting outcome. Ontario showed a significantly better overall survival, however, this advantage was lost when bias introduced through recruitment methods was controlled for. Methods to ensure consistency and appropriate resource allocation in the development, adaptation and implementation of CPGs and the importance of minimizing bias in survival analysis are discussed

Mucinous Cystadenoma of the Appendix in a Patient with Systemic Lupus Erthematosus

A 38-year-old female with systemic lupus erythematosus presented with abdominal pain, diarrhea and iron-deficient anemia. Computed tomogram showed a 2x4 cm inhomogeneous lesion of the right adnexa. An unusual mass was identified extending from the appendiceal orifice at colonoscopy, and an 8 cm tubular appendix, apparently prolapsed into the cecum, was identified at celiotomy. An appendectomy with cecectomy was performed. On cut section, mucin was extruded from the lumen of the appendix. A mucinous neoplasm of the appendix with mucinous dissection to the serosal surface was reported at the time of frozen section. No gross ovarian pathology or peritoneal implants were noted. Cystadenoma with associated mucocele formation was verified by permanent histology. Mucocele of the vermiform appendix is a rare condition associated with neoplastic transformation in approximately 75% of all cases. Benign mucinous cystadenoma of the appendix should be differentiated from cystadenocarcinoma by frozen section at the time of celiotomy to ensure appropriate treatment. While systemic lupus erythematosus can lead to cutaneous mucinosis, an association with mucinous cystadenoma of the appendix has not been previously reported. Surveillance for metachronous colonic neoplasms is warranted in patients diagnosed with a mucinous neoplasm of the appendix