Transplant Surgery Pipeline: A Report from the American Society of Transplant Surgeons Pipeline Taskforce

BACKGROUND: Transplant surgery fellowship has evolved over the years and today there are 66 accredited training programs in the US and Canada. There is growing concern, however, about the number of US-trained general surgery residents pursuing transplant surgery. In this study, we examined the transplant surgery pipeline, comparing it with other surgical subspecialty fellowships, and characterized the resident transplantation experience. METHODS: Datasets were compiled and analyzed from surgical fellowship match data obtained from the National Resident Matching Program and ACGME reports and relative fellowship competitiveness was assessed. The surgical resident training experience in transplantation was evaluated. RESULTS: From 2006 to 2018, a total of 1,094 applicants have applied for 946 transplant surgery fellowship positions; 299 (27.3%) were US graduates. During this period, there was a 0.8% decrease per year in US-trained surgical residents matching into transplant surgery (p = 0.042). In addition, transplant surgery was one of the least competitive fellowships compared with other National Resident Matching Program surgical subspeciality fellowships, as measured by the number of US applicants per available fellowship position, average number of fellowship programs listed on each applicant\u27s rank list, and proportion of unfilled fellowship positions (each, p \u3c 0.05). Finally, from 2015 to 2017, there were 57 general surgery residency programs that produced 77 transplant surgery fellows, but nearly one-half of the fellows (n = 36 [46.8%]) came from 16 (28.1%) programs. CONCLUSIONS: Transplant surgery is one of the least competitive and sought after surgical fellowships for US-trained residents. These findings highlight the need for dedicated efforts to increase exposure, mentorship, and interest in transplantation to recruit strong US graduates

Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows

Burnout among surgeons has been attributed to increased workload and decreased autonomy. Although prior studies have examined burnout among transplant surgeons, no studies have evaluated burnout in abdominal transplant surgery fellows. The objective of our study was to identify predictors of burnout and understand its impact on personal and patient care during fellowship. A survey was sent to all abdominal transplant surgery fellows in an American Society of Transplant Surgeons-accredited fellowship. The response rate was 59.2% (n = 77) and 22.7% (n = 17) of fellows met criteria for burnout. Fellows with lower grit scores were more likely to exhibit burnout compared with fellows with higher scores (3.6 vs 4.0, P = .026). Those with burnout were more likely to work \u3e100 hours per week (58.8% vs 27.6%, P = .023), have severe work-related stress (58.8% vs 22.4%, P = .010), consider quitting fellowship (94.1% vs 20.7%, P \u3c .001), or make a medical error (35.3% vs 5.2%, P = .003). This national analysis of abdominal transplant fellows found that burnout rates are relatively low, but few fellows engage in self-care. Personal and program-related factors attribute to burnout and it has unacceptable effects on patient care. Transplant societies and fellowship programs should develop interventions to give fellows tools to prevent and combat burnout

Characterization of neutrophil-derived microparticles after hepatic ischemia-reperfusion injury.

<p>Neutrophil-derived microparticles present in plasma in varying times of reperfusion following hepatic ischemic injury. Microparticle levels are subdivided as total MP, Annexin negative, and Annexin positive MPs. Data presented are mean ± standard error of mean. N = 5–15 for all groups. *P<0.05 compared to sham.</p

Characterization of microparticles following hepatic ischemia-reperfusion.

<p>Microparticles were isolated and analyzed as described in the methods. (A) Sizing for the microparticles was based on latex beads ranging in size from 0.5 to 3.0 µm. (B) Representative flow cytometric analysis of the forward and side scatter of microparticle mixture. (C) Representative flow cytometric analysis using Anti-CD41 (platelet specific cell marker) and Annexin V (apoptosis marker). (D) Representative flow cytometric analysis using Anti-Ly-6G (neutrophil specific marker) and Annexin V. (E) Representative flow cytometric analysis using Anti-CD62E (endothelial specific marker) and Annexin V.</p

Characterization of platelet-derived microparticles after hepatic ischemia-reperfusion injury.

<p>Platelet-derived microparticles present in plasma in varying times of reperfusion following hepatic ischemic injury. Microparticle levels are subdivided as total MP, Annexin negative, and Annexin positive MPs. Data presented are mean ± standard error of mean. N = 5–20 for all groups. *P<0.05 compared to sham.</p

Characterization of endothelial cell-derived microparticles after hepatic ischemia-reperfusion injury.

<p>Endothelial cell-derived microparticles present in plasma in varying times of reperfusion following hepatic ischemic injury. Microparticle levels are subdivided as total MP, Annexin negative, and Annexin positive MPs. Data presented are mean ± standard error of mean. N = 6–20 for all groups. *P<0.05 compared to sham.</p

Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163973/1/ajt16075_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163973/2/ajt16075.pd