Variability in Exposure to Subspecialty Rotations During Orthopaedic Residency: A Website-based Review of Orthopaedic Residency Programs.

IntroductionThe variability in exposure to various subspecialty rotations during orthopaedic residency across the United States has not been well studied.MethodsData regarding program size, resident's sex, department leadership, university-based status of the program, outsourcing of subspecialty rotation, and geographic location were collected from websites of 151 US allopathic orthopaedic residency programs. The relationship of these factors with the time allotted for various clinical rotations was analyzed.ResultsThe number of residents in a program correlated positively with time allocated for elective rotations (r = 0.57, P = 0.0003). Residents in programs where the program director was a general orthopaedic surgeon spent more time on general orthopaedic rotations (22 versus 9.9 months, P = 0.001). Programs where the program director or chairman was an orthopaedic oncologist spent more time on oncology rotations ([3.8 versus 3 months, P = 0.01] and [3.5 versus 2.7 months, P = 0.01], respectively). Residents in community programs spent more time on adult reconstruction than university-based programs (6.6 versus 5.5 months, P = 0.014). Based on multiple linear regression analysis, time allotted for adult reconstruction (t = 2.29, P = 0.02) and elective rotations (t = 2.43, P = 0.017) was positively associated with the number of residents in the program.ConclusionsSubstantial variability exists in the time allocated to various clinical rotations during orthopaedic residency. The effect of this variability on clinical competence, trainees' career choices, and quality of patient care needs further study

Stochastic master surgery scheduling

The aim of the Master Surgery Scheduling Problem (MSSP) is to schedule the medical specialties to the different operating rooms available, such that surgeries may be performed efficiently. We consider a MSSP where elective and emergency patients can be treated in the same operating rooms. In addition to elective-dedicated operating room slots, flexible operating room slots are introduced to handle the fluctuating demand of emergency patients. To solve the MSSP, we propose a simulation-optimization approach consisting of a two-stage stochastic optimization model and a discrete-event simulation model. For the two-stage stochastic optimization model, uncertain arrivals of emergency patients are represented by discrete scenarios. The discrete-event simulation model is developed to address uncertainty related to the surgery duration and the length of stay at the hospital, and to test the Master Surgery Schedule (MSS) developed by the optimization model in a stochastic operational-level environment. In addition, the simulation model is used to generate scenarios for the optimization model. We present some general advice for surgery scheduling based on testing the optimization model in a numerical study. The simulation-optimization approach is applied to a case study from a hospital department that treats both elective and emergency patients. The optimized MSS outperforms the manually generated MSS, both in terms of emergency waiting time for surgery, and emergency interruptions to the flow of electives.acceptedVersio

Surveying the Current State of International Outreach in Radiology Training Programs

Purpose: Over the past decade, there has been an increased level of attention focused on improving radiology’s contributions to global health programs in resource-restricted areas of the world. This has led to the formation of new organizations and international imaging partnerships. As a result, there have been related publications and guidelines, which has increased awareness and interest amongst current and prospective radiology trainees. Methods and Materials: With this survey of residency program directors, we set out to: 1) examine current opinions of and experience with integrating international and outreach opportunities into their training curriculum; and 2) to analyze these data to inform strategies for growing opportunities within training programs nationwide. Results: The majority (51%) of programs participating in the survey have interest in participating in international projects and 64% feel they add value to resident education. Only about a quarter (27%) of programs, however, have had residents participate in radiology-related international projects over the last five years, and even fewer (18.8%) have established international elective opportunities. However, the majority of programs (58.3%) have some faculty who are involved in international radiology. Conclusion: The reported interest in international educational and service opportunities among residency training programs is much greater than current levels of participation. A much larger percentage of responding programs have faculty involved in international work than residents, despite the acknowledged benefits and interes

The Impact of Previous Cardiology Electives on Canadian Medical Student Interest and Understanding of Cardiology

Background: Most Canadian medical schools do not have mandatory cardiology rotations. Early exposure to clinical cardiology aids career navigation, but clerkship selectives are chosen during pre-clerkship. This study investigates whether prior elective experiences affect medical student interest as well as understanding of cardiology before clerkship selections. Methods: A literature search was conducted using Google Scholar, Embase and PubMed to create an evidence-based cross-sectional survey. The anonymous questionnaire was administered to 53 second-year medical students at a Canadian medical school via Opinio, an online survey platform. Students were assessed on their interest and understanding of cardiology practice using a 5-point Likert Scale. Descriptive statistics and Chi-Square analysis were applied to assess the relationship between previous elective experience, medical student interest, and understanding of career-related factors pertaining to cardiology. Results: Overall, 26 (49.1%) students reported cardiology interest, while it was a preferred specialty for 9 (17.0%). Medical students reported low understanding of community practice (n=20, 37.7%), duration of patient relationships (n=14, 26.4%), spectrum of disorders (n=13, 24.5%), and in-patient care (n=11, 20.8%) associated with cardiology practice. Students with prior cardiology electives had increased understanding of in-patient care (?2 = 4.688, Cramer’s V = 0.297, p = 0.030 and were more likely to select cardiology as a top specialty choice (?2 = 7.983, Cramer’s V = 0.388, p = 0.005). Conclusions: Pre-clerkship medical students have a low understanding of cardiology practice. Increasing pre-clerkship exposure to cardiology may help students determine their interest in the specialty before clerkship selectives are chosen

Women’s Health educational opportunities at the University of Iowa’s Department of Obstetrics and Gynecology

The Department of Obstetrics and Gynecology’s educational programs span a continuum of learners from undergraduate premedical students to continuing education for practicing providers in Iowa and nearby states. The Department of Obstetrics and Gynecology is committed to teaching women-centered, compassionate, evidence-based care and fostering life-long learning. The Department of Obstetrics and Gynecology is a part of the Roy J. and Lucille A. Carver College of Medicine and the University of Iowa Health Care at the University of Iowa

Trauma electives in South Africa provide valuable training for international surgeons

Background. Trauma electives in South Africa (SA) are common and many foreign-based surgeons have undertaken such electives over the past 3 decades. Despite this, little academic attention has been paid to these electives, which remain largely informal and unstructured. This project aims to redress this deficit.Objectives. To investigate and document the extent of trauma clinical electives and to assess their impact on the careers of foreign surgeons who have undertaken such electives.Methods. A mixed methods-style questionnaire was compiled, which sought to document the demographics of surgeons undertaking an SA trauma clinical elective, the trauma clinical experience they had prior to the elective, as well as the volume of experience they acquired during the elective.Results. Sixty questionnaires were sent out and 21 were completed. There were 16 male and 5 female respondents. Only 17 had undertaken a formal trauma rotation before their elective in SA. The mean number of major resuscitations managed prior to rotating through surgery departments in SA was 15, and the mean number managed during a 12-month rotation in SA was 204. It would take each respondent 14 years in their country of origin to acquire an equivalent level of exposure to major resuscitation. During the year before their elective, each surgeon had been exposed to a mean number of the following: 0.5 gunshot wounds (GSWs), 2 stab wounds (SWs), 0.1 blast injuries and 19 road traffic accidents (RTAs). The equivalent mean number for their year in SA was 106 GSWs, 153 SWs, 4 blast injuries and 123 RTAs. The time necessary to achieve a similar level of exposure to their SA experience if they had remained in their country of origin was 213 years for GSWs, 73 years for SWs, 41 years for blast injuries and 7 years for RTAs. Compared with their SA elective, it would take each respondent 3 years to insert as many central venous lines, 9 years to perform the same number of tube thoracostomies, 9 years to manage as many surgical airways, 18 years to explore as many SWs of the neck and 93 years to explore as many GSWs of the neck. Furthermore, it would take 33 years to see and perform as many laparotomies for SWs to the abdomen, 374 years to perform an equivalent number of GSWs to the abdomen and 34 years of experience to perform as many damage-control laparotomies in their countries of origin. In terms of vascular trauma, it would take 23 years to see as many vascular injuries secondary to SWs and 77 years to see an equivalent number of vascular injuries secondary to GSWs.Conclusions. A trauma clinical elective in SA provides an unparalleled exposure to almost all forms of trauma in conjunction with a welldeveloped academic support programme. Formalising these trauma electives might allow for the development of exchange programmes for SA trainees who wish to acquire international exposure to advanced general surgical training

Facteurs influençant le choix du futur lieu d’exercice chez les résidents en rhumatologie

Background: There are regional disparities in the distribution of Canadian rheumatologists. The objective of this study was to identify factors impacting rheumatology residents’ postgraduate practice decisions to inform Canadian Rheumatology Association workforce recommendations. Methods: An online survey was developed, and invitations were sent to all current Canadian rheumatology residents in 2019 (n = 67). Differences between subgroups of respondents were examined using the Pearson χ2 test. Results: A total of 34 of 67 residents completed the survey. Seventy-three percent of residents planned to practice in the same province as their rheumatology training. The majority of residents (80%) ranked proximity to friends and family as the most important factor in planning. Half of participants had exposure to alternative modes of care delivery (e.g. telehealth) during their rheumatology training with fifteen completing a community rheumatology elective (44%). Conclusions: The majority of rheumatology residents report plans to practice in the same province as they trained, and close to home. Gaps in training include limited exposure to community electives in smaller centers, and training in telehealth and travelling clinics for underserviced populations. Our findings highlight the need for strategies to increase exposure of rheumatology trainees to underserved areas to help address the maldistribution of rheumatologists. Contexte : Au Canada, il existe des disparités régionales dans la répartition des rhumatologues. La présente étude recense les facteurs qui influencent les choix des résidents en rhumatologie concernant leur lieu d’exercice futur afin de guider les recommandations de Société canadienne de rhumatologie relatives aux effectifs. Méthodes : Après l’élaboration d’un sondage en ligne, une invitation a été envoyée à tous les résidents en rhumatologie au Canada en 2019 (n = 67). Les différences entre les groupes ont été examinées à l’aide du test Pearson χ2. Résultats : Trente-quatre des 67 résidents contactés ont répondu au sondage. Soixante-treize pour cent des répondants prévoyaient d’exercer dans la province où ils avaient fait leur formation en rhumatologie. La majorité des résidents (80 %) ont classé la proximité des amis et de la famille comme le facteur le plus important dans leur choix de lieu d’exercice. La moitié des participants s’étaient familiarisés avec d’autres modes de prestation de soins (par exemple, la télésanté) pendant leur formation en rhumatologie et 15 d’entre eux (44 %) avaient fait un stage en rhumatologie communautaire. Conclusions : La majorité des résidents en rhumatologie déclarent avoir l’intention d’exercer près de chez eux, dans la province où ils ont fait leurs études. Les lacunes dans la formation comportent l’exposition limitée à des stages dans les petits centres en milieu communautaire, en télésanté et dans les cliniques mobiles ciblant les populations mal desservies. Nos conclusions soulignent le besoin de stratégies visant à augmenter l’exposition des résidents en rhumatologie à des zones mal desservies afin de remédier à la mauvaise répartition géographique des rhumatologues

Surgery

This departmental history was written on the occasion of the UND Centennial in 1983.https://commons.und.edu/departmental-histories/1057/thumbnail.jp

Radiology and Global Health: The Case for a New Subspecialty

In high- and medium-income countries, the use of radiology has grown substantially in the last several decades. But in the developing world, access to medical imaging remains a critical problem. Unlike more structured efforts in the field of global health, interventions in global radiology have been largely unplanned, fragmented and sometimes irrelevant to the needs of the recipient society, and have not resulted in any significant progress. Access to medical imaging around the world remains dismal. There is a therefore a clear and urgent need for the radiology community to develop a vision for global radiology, beginning with defining the scope of the subject and establishing measurable goals. Agreement must be reached to declare global radiology as a bona fide subspecialty of radiology. This should soon be followed by the establishment of divisions of Global Radiology in academic radiology departments. Resident and medical students should be taught how physicians in low -income countries practice medicine without access to adequate radiology. As part of training and electives, residents and medical students should accompany global health teams to countries where the need for radiology services is great. Global scholar exchange and sabbatical opportunities should be offered to staff radiologists. Successful implementation of a unified vision of global radiology has the potential to improve access to medical imaging on a large scale. Radiology journals dedicated to the promotion of global radiology can play an important role in providing forums of discussion, analyses and sharing of field experiences. In this discussion we have attempted to make a case for assigning global radiology a subspecialty status