Clinics in Colon and Rectal Surgery最新文献

The fight for gender equity in surgery extends well beyond the simplistic binary construct of man versus woman. Professor Kimberlé Crenshaw coined the term "intersectionality," which is used to describe the dynamic associations between the concepts of race, class, gender, and other individualized characteristics and their real-time interaction with one another in our society. Our review of intersectional identities among medical professionals attempts to examine the trends of difficulties at the intersections of an individual's identity within academic surgery, leadership in academic surgery, and the effects on patient outcomes in the United States. Specifically, we will focus on the interaction of race, ethnicity, religion, sexual orientation, family, disability, and international status. Much more research focused specifically on intersectional groups is required to statistically identify to what degree overlapping identities impact professional and patient care outcomes. Recognition of the problem and candid discussions will allow for vast improvements not only in surgical culture, but also in surgical care.

Traditionally employed in medical anthropologic and sociologic literature, qualitative methods are emerging as an essential component of clinical research as surgeons and researchers strive to optimize care informed by patient perspectives. Qualitative methods in health care-related research may be used to understand subjective experiences, beliefs, and concepts that are not captured using quantitative analyses and to gain in-depth knowledge of a specific context or culture. A qualitative approach may also be employed to explore under-researched problems and generate new ideas. Here, we provide an overview of aspects to consider when designing and conducting a qualitative research study.

With the rise in the availability of large health care datasets, database research has become an important tool for colorectal surgeon to assess health care quality and implement practice changes. In this chapter, we will discuss the benefits and drawbacks of database research for quality improvement, review common markers of quality for colorectal surgery, provide an overview of frequently used datasets (including Veterans Affairs Surgical Quality Improvement Program, National Surgical Quality Improvement Project, National Cancer Database, National Inpatient Sample, Medicare Data, and Surveillance, Epidemiology, and End Results), and look ahead to the future of database research for the improvement of quality.

Accreditation has played a major role in the evolution of health care quality as well as the structure and organization of American medicine. In its earliest iterations, accreditation aimed to set a minimum standard of care, and now more prominently sets standards for high quality, optimal patient care. There are several institutions that provide accreditations that are relevant to colorectal surgery including the American College of Surgeons (ACS) Commission on Cancer, National Cancer Institute Cancer Center Designation, National Accreditation Program for Rectal Cancer, and the ACS Geriatrics Verification Program. While each program has unique criteria, the aim of accreditation is to assure high-quality evidenced-based care. In addition to these benchmarks, these programs provide avenues for collaboration and research between centers and programs.

The use of social media platforms in a professional capacity has grown and presents unique opportunities for women surgeons. Women surgeons face unique obstacles and challenges compared with their male counterparts. Social media has helped women surgeons create an online community and has provided opportunities for mentorship and professional advancement. In addition, it has helped break down traditional constructs of what it means to be a surgeon and allowed the medical community and public to view images of a modern surgeon. Social media has played an important role in continually increasing efforts to diversify the field of surgery and break down traditional stereotypes associated with surgeons. However, there are some downsides of social media that women surgeons need to be aware of, particularly, the risk of harassment, criticism, and potentially harmful online reviews.

Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.

There are unique considerations to fertility and pregnancy for women surgeons. Women surgeons often decide to delay pregnancy and childbearing due to concerns of conflict with work and training. This is particularly true for surgical trainees who face many obstacles, including bias from peers and program directors, and work-life conflict. As such, rates of infertility are higher compared with the general population. Women surgeons require assisted reproductive technologies more often than the general population. During pregnancy, there are also additional occupational hazards that are unique to a surgical career. Overall, we must be aware of these issues to support surgeons who decide to become parents during a surgical career.

The paucity of gender diversity in the biotech and medical/surgical technology fields remains a persistent challenge. Over the course of history, advancements have been made; however, women remain underrepresented in these sectors from the entry level to the leadership and corporate positions. Similarly, there is a notable lack of women-led startup teams obtaining funding from venture capitalists and fewer women-led teams submitting and securing patents. We will discuss current data surrounding the lack of gender diversity in these fields, explore parallels specifically between the lack of women in surgical specialties and science, technology, engineering, and mathematics (STEM) pathways, and how this translates to the lack of women in the surgical and medical technology industry. We will also offer examples of the real-world ramifications of product development by teams not representative of the population. Lastly, we will offer recommendations and action items for companies, STEM educators, individuals, and allies that will continue to aid in improving gender diversity in the industry.

Women in surgery continue to face inequitable treatment from surgical leadership, their peers, hospital staff, and even from their patients. Despite this, women surgeons continue to produce equal, or improved, clinical outcomes for their patients, with their work being given less remuneration than that of their male peers. The cultural stereotypes and biases that drive these inequities are implicit and subtle; however, they have dramatic effects on the lives and careers of women surgeons.