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A Look at Pregnancy-Related Attrition in General Surgery

A Look at Pregnancy-Related Attrition in General Surgery

Studies show that attrition from general surgery programs is high, even with the introduction of work-hour limitations and new restrictions on hours for general surgery residents. Research has also shown that many factors play a role in residency attrition, most notably lifestyle considerations. Several studies have linked female sex to an increased risk of attrition, but not all research has corroborated this relationship. “Women still represent the minority among surgical residents throughout the United States,” says Erin G. Brown, MD. “There are many stereotypes regarding attrition among female residents, including pregnancy during residency being a risk factor for attrition.” Exploring the Issue A significant number of residents report being perceived negatively if they become pregnant during training, according to some investigations. “Since more women are entering medicine, it’s important to examine the potential links between sex, pregnancy, and attrition,” says Dr. Brown. To address this research gap, Dr. Brown and colleagues conducted a study to determine whether child rearing during training increased the risk of attrition from general surgery residency. The study, published in JAMA Surgery, was a retrospective review of general surgery residents at the University of California, Davis over a 10-year period. The study team analyzed voluntary and involuntary attrition rates as well as the incidence of child rearing among residents. “Our study found that neither sex nor child rearing was a risk factor for attrition in general surgery residencies,” Dr. Brown says. Overall, the attrition rate for women was not significantly different from the proportion of men who left the general surgery residency program. The attrition rate, which was 18.8%, was comparable with rates published in...
Hip Fracture in Older Adults

Hip Fracture in Older Adults

As life expectancy continues to increase in the United States, the number of elderly people and those with chronic health conditions like osteo­porosis is also rising. The number of people older than 65 is expected to increase from 37.1 million to 77.2 million by the year 2040. With this aging trend, the incidence of hip fractures is also expected to increase. “The care of patients with hip fracture is improving, but it’s still a significant healthcare challenge that dramatically affects patients and their caregivers,” says W. Timothy Brox, MD. “These individuals are at greater risk of death after their hip fracture. They also experience other problems, including being unable to return to prior living circumstances, the need for increased super­vision, and decreased quality of life and mobility. Furthermore, hip fracture patients are at increased risk for secondary fractures.” Welcome Guidelines In 2014, the American Academy of Orthopaedic Surgeons (AAOS) released a clinical practice guideline (CPG) on managing hip fractures in the elderly. The guideline included many evidence-based recommen­dations throughout the continuum of care, ranging from preoperative treatments to post-discharge management. Some of the recommendations in the guidelines are aimed at reducing delirium in hip fracture patients, according to Dr. Brox, who chaired the AAOS CPG writing group. “Delirium is common among hip fracture patients,” he says. “Patients with postoperative delirium are less likely to return to their pre-injury levels of function. They’re also at higher risk for postoperative complications and are more frequently placed in nursing homes. The lower the incidence of post-fracture delirium, the more completely and effectively patients will recover.” Beyond delirium, the AAOS writing group gave...
Handling Sin

Handling Sin

There’s an old adage in surgery that says: “It takes 2 years to teach a resident how to operate and another 3 to teach a resident when not to operate.” Surgery is an active profession. Above all, the surgeon is expected to take action, even when that involves the decision to NOT do surgery. Surgical sins are different from Medical sins. There are sins of commission—hubris, arrogance, pride, vanity—of which we are all guilty at one time or another during our careers. Some of them are also surgical strengths depending on the situation. There are also the sins of omission—carelessness, sloth, ignorance, and perhaps the most egregious, indecision. As a mentor once said, “A surgeon doesn’t have to be right, but he has to be certain.” It’s incumbent on us by the nature of what we do to people in surgery to be affirmative in making decisions. By that I mean, any decision should be made actively, through consideration of the action we are taking and its potential consequences. But wait, aren’t all decisions made that way? No, not always. Delay, procrastination ‘watchful waiting’ often lead to a decision of indecision where the patient’s condition changes in spite of our attention rather than because of it. If I, as a surgeon, chose not to operate on a patient, it should be because I have a valid reason for expecting that the situation will resolve without surgery, or perhaps because the patient’s condition is such that surgery presents an unacceptable risk. I recently decided not to operate on an elderly woman with free air in her abdomen. Free air means...
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