Attrition in surgical residency programmes: Causes and effects

Objective: To determine the rate and trend of attrition from a surgical residency programme and to identify the reasons for attrition.Methods: A questionnaire-based survey was conducted at a university hospital. Separate questionnaires were designed for residents and programme directors (PDs). The residents who left the training voluntarily from one of the five surgical residency programmes (i.e., general surgery, orthopaedics, neurosurgery, otorhinolaryngology and urology) during the academic years 2005-2011 were identified from a departmental database. The residents who did not respond after three attempts at contact, or those who refused to participate, were excluded.Results: During the last 6years, 106 residents were recruited; 84 (78%) were men, of whom 34.5% left the programme voluntarily. Of 22 women, half (54%) left the programme voluntarily (P=0.07). The overall 6-year attrition rate was 39%. The reasons identified for attrition, in descending order, were personal reasons, attitude of senior residents or faculty, and change of specialty. None of the residents cited an excess workload as a reason for their leaving the programme. About 40% rejoined the same specialty after leaving, while 35% chose a different specialty (80% chose a different surgical subspecialty and 20% chose medicine). There was a significant discrepancy in the perspective of residents and PDs about the reasons for attrition.Conclusion: Attrition among surgical residents, in particular woman residents, is high. Personal reasons and interpersonal relations were the most commonly cited reasons. Programme managers and residents have significantly different perspectives, again an indication of a communication gap

Role of early contrast enhanced CT scan in severity prediction of acute pancreatitis

Abstract Severe pancreatitis occurs in approximately 15-25% of patients with acute pancreatitis. The objective of our study was to compare the CTSeverity Index (CTSI) with a clinical score (BISAP score) to predict severity of acute pancreatitis. Forty-eight consecutive patients with acutepancreatitis who underwent contrast enhanced CT scan within 72 hours of presentation were included. Results of our study showed that both CTSI and BISAP score were reliable predictors of mortality (p value = 0.019 and \u3c0.001 respectively) and need for mechanical ventilation (p value = .002 and .006 respectively). Positive predictive value of CTSI to predict recovery without intervention was 91.4% as compared to 78% for that of BISAP score. Receiver Operating Characteristics (ROC) Curves showed CT scan was superior to BISAP Score in predicting need of percutaneous or surgical intervention. Early CT scan may be utilized for prediction of clinical course of patients with acute pancreatitis

Terrorist bombings: Medical response in a developing country

Objective: To evaluate the process of transport and immediate Emergency Department (ER) management of mass casualties following the recent bomb blasts in Karachi and review in detail the medical response and management of victims undertaken in these two incidents. Methods: Eyewitness accounts of the victims, medical personnel and newspaper clippings were used to understand and identify difficulties faced during the rescue process. Data regarding presenting injuries and their outcomes was also collected from all victims presenting to the emergency department at Aga Khan University Hospital. Results: Seventy nine individuals died and over 250 victims were injured in the two incidents. All victims and dead bodies were shifted to the nearest public sector hospital overwhelming the health care facility. Subsequently all victims were evacuated to private sector hospitals creating similar difficulties. Over half of the victims presenting at the emergency department had minor injuries and did not require admission. Most patients requiring admission needed orthopaedic intervention. Conclusion: A comprehensive disaster plan with a centralized command and control system is required for the city of Karachi, involving all stake holders including charity ambulance services, security agencies, and trauma management facilities. Training courses and exercises for health care personnel should also be made mandatory to achieve professional excellence

Localised fungal infection in a prosthetic mesh treated conservatively.

Infection remains one of the most challenging complications of mesh hernioplasty. The authors report a case of a 28-year-old male with no known comorbidities who underwent reversal of ileostomy and prolene mesh hernioplasty. His wound was left open for delayed primary closure, although daily dressing started from second postoperative day. He developed fungal infection of prolene mesh on fifth postoperative day which was successfully treated with irrigation and daily wound dressing with amphotericin B avoiding the complications associated with mesh excision. He made an uneventful recovery and on last follow-up his wound was granulating well with no signs of infection

Portal hypertensive biliopathy: review of pathophysiology and management

Portal hypertensive biliopathy is described as abnormalities of the walls of the biliary tree secondary to portal hypertension. In literature it has also been named as Cholangiopathy associated with portal hypertension , Portal biliopathy and Portal cavernoma associated cholangiopathy . It is usually asymptomatic and found incidentally, but rarely patients do present with symptoms of abdominal pain, jaundice, asthenia and fever. Treatment is warranted in symptomatic cases only, and is dictated by the clinical manifestations and complications of the disease process. Due to presence of underlying severe portal hypertension, endoscopic biliary intervention is usually the first line of management, and is relatively safe and often sufficient. When surgery is resorted to, a porto-systemic shunt prior to biliary bypass procedure provides early relief of obstructive biliary symptoms and often precludes the need for a biliary bypass surgery. This review describes the pathophysiology, presentation, progression and management approaches to portal biliopathy

Surgical Grand Rounds at a university hospital: creating researchers out of surgical training programs

Objective: To evaluate the outcome of Surgical Grand Round (SGR) presentation at a University Hospital; in terms of national, international presentations and publications. Introduction: Grand rounds are an important educational activity in all teaching hospitals however each institute has its own way of conducting them. At our institute, grand rounds in the Department of Surgery include an original research presentation by the residents with a faculty supervisor. The publication of the research work acts as a measure of its success. In this study we analyzed the outcome of this activity and review the factors affecting the publication. Methodology: It is a retrospective review of prospectively maintained data of all presentations made at the Surgical Grand Round at a University Hospital during January 2001 and December 2010. Presentations with incomplete follow up records were excluded from analysis. A Publication-Presentation Index (PPI) was used to evaluate outcomes of SGRs and to study factors influencing outcomes and differences in PPI in each category were calculated using the chi square test. Results: Total of 470 presentations were made. Majority presented retrospective studies (73%). Majority of the presentations were made by junior residents (year 1-3, 62%). Following presentation, 279 (59.4%) studies were presented at a national conference, 80 (17%) were presented at an international forum while only 99 (21.1%) studies were published. Mean presentation to publication time was 34.8 months. Study design, level of resident, section of surgery, sample size and national/international presentation were associated with conversion to a publication (all p \u3c0.05). Overall PPI was 0.32. Randomized controlled trials had the highest PPI (0.67). Conclusion: The PPI has a potential to be used as a tool to study the association of presentation to publication. This model of Surgical grand rounds can be used to enhance research among residents and to create a researcher’s mind from a surgical training program

Surgical grand rounds at a university hospital. Applying publication presentation index to evaluate outcomes

Background and objective: Surgical grand rounds (SGR) are an important educational activity in all teaching hospitals however each institute has its own way of conducting them. At our institute, grand rounds in the Department of Surgery include an original research presentation by residents. The publication of the research work acts as a measure of its success. In this study we analyzed the outcome of this activity and review factors affecting their progression to publication.Methodology: We conducted a retrospective review of a prospectively maintained database of all presentations made at the Surgical Grand Round at a University Hospital from January 2001 to December 2010. Presentations with incomplete follow up records were excluded from analysis. A Publication-Presentation Index (PPI) was used to evaluate outcomes of SGRs and to study factors influencing outcomes. Differences in PPI in each category were calculated using the chi square test.Results: Total of 470 presentations were made. Majority presented retrospective studies (73%). Majority of the presentations were made by junior residents (year 1-3, 62%). Following presentation, 279 (59.4%) studies were presented at a national conference, 80 (17%) were presented at an international forum while only 99 (21.1%) studies were published. Mean presentation to publication time was 34.8 months. Study design, level of resident, section of surgery, sample size and national/international presentation were associated with conversion to a publication (all p \u3c 0.05). Overall PPI was 0.32. Randomized controlled trials had the highest PPI (0.67).Conclusion: The proportion of SGR presentations converted into national/international presentations and/or publications was found to be low. The PPI has a potential to be used as a tool to study the association of presentation to publication