Canadian Journal of Surgery最新文献

Background: Gender diversity is lacking in the orthopedic workforce, and patient outcomes are known to be negatively affected when gender inequity exists. Following an unpublished needs assessment, we sought to evaluate participants' proposed solutions to gender inequity faced by female orthopedic surgeons in Canada and to translate the range of solutions into a medical education model.

Methods: Open-text responses from a gender-bias survey of Canadian orthopedic surgeons who identified as women were analyzed qualitatively by 2 experts. The questions covered the domain of changes required to improve the work environment. We used the latter 2 steps of Kern's educational framework as a lens to interpret the data and generate solutions.

Results: A total of 330 eligible surgeons were approached, and 220 (67.0%) completed the survey. Respondents provided more than 14 000 words of text for analysis. Using the themes of the unpublished needs assessment, we defined broad goals and specific objectives, including raising awareness, establishing an equitable playing field, drawing attention to male privilege, developing effective mentorship, eliminating harassment, and unburdening the second shift. We present solutions via educational strategies and evaluative methods based on Kern's framework.

Conclusion: We offer a road map for improving gender diversity in orthopedic surgery, based on survey results from Canadian women in orthopedic surgery, analyzed using a gender bias framework and an educational conceptual framework. We hope that this work will improve the surgical profession and patient care.

Background: High rates of hospital revisits after pediatric appendectomy are costly to the health care system, patients, and families. We sought to trial a bundle of interventions targeted at reducing the rate of unnecessary revisits to hospital in this population.

Methods: In February 2021, a working group of relevant stakeholders was created. In June 2021, the group developed and implemented interventions to reduce revisits in a staggered fashion. Interventions included increased education provided to patients and their families, as well as nursing staff, revised discharge pamphlets, and a post-discharge phone call from our nurse practitioner. We tracked revisit rates prospectively using run charts with comparison to historical controls.

Results: We tracked revisit rates from July 2018 to October 2022. A total of 793 appendectomies were performed. There was a downward trend in revisit rates, from 16.7% before interventions to 13.4% after intervention implementation, for a relative reduction of 20%. In the postintervention period, 193 appendectomies were performed, with 78.0% contacted by our nurse practitioner in the early postoperative period. Of those contacted, 74% received the discharge pamphlet and 98.7% of respondents expressed that the phone call was useful. Almost all respondents stated they would want the follow-up phone call if they were to have another child with appendicitis.

Conclusion: Simple, low-cost interventions aimed at improving education at time of discharge after pediatric appendectomy were associated with a reduction in unnecessary hospital revisits. Ongoing efforts are required to sustain results and assess efficacy of bundle elements to determine if additional initiatives may be beneficial in further reductions of revisits.

SummaryThe Canadian Undergraduate Surgical Education Committee (CUSEC) undertook a project to address variance in undergraduate surgical learning objectives among Canada's medical schools. Its aim was to compile a reasonable set of national undergraduate surgical learning objectives (NUSLOs) for all medical undergraduates and map them to the Medical Council of Canada (MCC) objectives. In phase 1, CUSEC invited Canada's 10 surgical specialty societies or associations to identify discipline-specific lists of undergraduate surgical learning objectives deemed essential for all Canada's medical students to achieve by the time of graduation. In phase 2, 8 medical students and 7 CUSEC faculty from 6 Canadian universities mapped each individual NUSLO to the corresponding MCC objectives, then to primary and secondary MCC objectives. By 2023, all 10 surgical specialty societies had derived, ratified, and submitted their discipline-specific NUSLOs, for a total of 72 major objectives, some of which had sub-objectives. All phase 1 NUSLOs were mapped to corresponding MCC objectives, with each NUSLO mapping to an average of 18 MCC objectives. Each NUSLO was then tiered to 1-2 primary MCC objectives. The NUSLOs and the NUSLO-MCC maps, now publicly posted on the CUSEC website, may serve as a foundational reference for students and teachers. They are a means by which Canada's medical schools can customize, standardize, and revise their undergraduate surgical curricula.

Background: Timing to surgery for acute cholecystitis remains variable, ranging from early (< 7 d) to delayed surgery (> 7 d). Accelerated surgery may result in better outcomes owing to reduced exposure to hypercoagulable and inflammatory states. We sought to determine the feasibility of a trial comparing accelerated surgery with standard care among patients with calculous acute cholecystitis.

Methods: We conducted a multicentre pilot randomized controlled trial. We randomly assigned adult patients with acute cholecystitis to receive accelerated surgery (i.e., goal of surgery within 6 hours of diagnosis) or standard care. The primary feasibility outcome included recruitment of 60 patients, randomly assigning the equivalent of 1 patient per site per month, and 95% follow-up at 90 days.

Results: Sixty patients (mean age 61.7, standard deviation [SD] 13.5, yr; 27 [45%] female) were randomly assigned to accelerated surgery (n = 31) or standard care (n = 29) from December 2019 to December 2021, with 2 recruitment pauses due to the COVID-19 pandemic. The median time from diagnosis to surgery was 5.8 (interquartile range [IQR] 4.4-11.1) hours in the accelerated care arm and 20.3 (IQR 6.8-26.8) hours in the standard care arm. Across 4 sites, 4.6 patients per month were randomly assigned. All patients completed the 90-day follow up.

Conclusion: In our pilot trial, we found that accelerated cholecystectomy was achievable. These results show the feasibility of a trial comparing accelerated and standard care among patients requiring surgery for acute cholecystitis and support a definitive trial.

Trial registration: ClinicalTrials.gov, no. NCT04033822.

Background: Trauma educational opportunities for general surgery residents in Canada are uncharacterized. We aimed to characterize these opportunities for and identify factors associated with such opportunities.

Methods: We performed a prospective cross-sectional study characterizing trauma educational opportunities within Canadian trauma programs. Data were collected during 1 summer week and 1 winter week. We summarized educational opportunities by trauma site and season and used multivariable modelling to evaluate factors associated with increased likelihood of procedure opportunities.

Results: Nine academic trauma centres participated. Most consults (93.9%) and trauma team activations (TTAs) (72.3%) were for blunt injuries, and most presentations were during the summer (67.2% TTAs + consults, 69.3% TTAs). Trauma services cared for a median of 14 (interquartile range [IQR] 10-20) inpatients, 4 (IQR 1-6) patients in the intensive care unit, and 0 (IQR 0-2) patients admitted to another service but subsequently followed by a trauma physician (i.e., consulting patients), which varied across hospitals (p < 0.001). Consult, TTA, nonoperative, and operative procedure volumes varied across sites. The most common operative procedures were laparotomies (36.4%), with 1.33 laparotomies per week per site. For nonlaparotomy operations, the maximum volume was 6 over 2 weeks. More operations occurred during summer (74.2%) than winter. Multivariable modelling determined that penetrating mechanisms (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.11-3.15) and TTAs with a trauma surgeon present (OR 2.37, 95% CI 1.59-3.54) were associated with increased likelihood of procedures.

Conclusion: Trauma educational opportunities remain heterogeneous across Canada. Higher volumes of patients with trauma were seen during the summer. Penetrating mechanism and TTAs with a trauma surgeon present appear to increase opportunities to perform procedures. Our results can inform general surgery training programs to optimize resident trauma training in Canada.

Background: Strategies to address inequities, bias, and discrimination that disadvantage Canadian physicians from marginalized groups are urgently needed. We describe a multilevel needs assessment of equity, diversity, and inclusion (EDI) in 2 departments of surgery that focused on identifying evidence-based interventions.

Methods: We invited members of the departments of surgery at the University of Calgary and the University of Saskatchewan to complete the Diversity Engagement Survey (DES), a 22-item instrument designed to understand workplace engagement and inclusion among physicians, with higher scores indicating greater engagement and inclusion. Leaders completed a Leadership EDI Readiness Assessment to understand their own barriers to EDI work and an Organizational EDI Readiness Assessment to understand structures for EDI in their division. Leaders were provided resources and interventions to address the identified gaps in these assessments.

Results: The most common organizational gaps in structures for EDI work in surgical divisions and training programs (n = 34, 37.4%) were in community outreach and measurement and reporting. Surgeons who identified as cisgender men (n = 101) felt more engaged and included than those who identified as cisgender women (n = 43; 3.81 [standard deviation (SD) 0.73] v. 3.51 [SD 0.78]; p = 0.04). White cisgender men (n = 66) had the highest feelings of engagement and inclusion (mean 3.95 [SD 0.62]). Participating surgical sections and training programs were directed to evidence-informed initiatives to improve community outreach and measurement and reporting to address EDI in their settings.

Conclusion: Our findings support that gender and racial or ethnic identities influence the workplace experiences of surgeons in Canada. A multilevel approach to EDI work in surgical departments can direct leaders to areas for intervention.

SummaryWithin the field of global surgery, partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs) are often used to improve surgical capacity and enhance surgical training. Similarly, medical rounds are common in postgraduate medical training, although joint rounds between LMICs and HICs have not been widely used. Over 1 year, 6 online joint education rounds were held for general surgery residents at the University of British Columbia and the University of Guyana. Rounds comprised resident-led case-based presentations on a surgical subspecialty topic. These rounds were evaluated by residents through an online survey and were found to be valuable and relevant to their training, with mutual and differential benefits to Canadian and Guyanese residents. This project demonstrated that joint rounds are a meaningful method to partner surgical residency programs and can provide another tool for implementation of global surgery.