Journal of the American College of Surgeons
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Review
Emergency General Surgery Quality Improvement: A Review of Recommended Structure and Key Issues.
Emergency general surgery (EGS) accounts for 11% of hospital admissions, with more than 3 million admissions per year and more than 50% of operative mortality in the US. Recent research into EGS has ignited multiple quality improvement initiatives, and the process of developing national standards and verification in EGS has been initiated. Such programs for quality improvement in EGS include registry formation, protocol and standards creation, evidenced-based protocols, disease-specific protocol implementation, regional collaboratives, targeting of high-risk procedures such as exploratory laparotomy, focus on special populations like geriatrics, and targeting improvements in high opportunity outcomes such as failure to rescue. The authors present a collective narrative review of advances in quality improvement structure in EGS in recent years and summarize plans for a national EGS registry and American College of Surgeons verification for this under-resourced area of surgery.
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Review
Moving Beyond Diversity: A Scoping Review of Inclusion Initiatives in the Surgical Workforce.
Addressing racial disparities within the surgical workforce is vital to provide quality care to all patients; inclusion is critical to do so. Inclusion signifies a move beyond numerical representation; tangible goals include reducing attrition and maximizing career development. The aims of this review were to (1) test whether there are academically published interventions or frameworks addressing inclusion in the surgical workforce and (2) characterize these interventions or frameworks. ⋯ Common themes included systematic reform of recruitment policies and practices, increased access to targeted mentorship, gaining leadership support, and increased avenues for underrepresented faculty advancement. While limited, promising work has been undertaken through national collaboration and model institutional work. Future considerations may include incentivizing academic publication of inclusion work, increasing access to funding, and rewarding these efforts in career advancement.
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Review
Moving Beyond Diversity: A Scoping Review of Inclusion Initiatives in the Surgical Workforce.
Addressing racial disparities within the surgical workforce is vital to provide quality care to all patients; inclusion is critical to do so. Inclusion signifies a move beyond numerical representation; tangible goals include reducing attrition and maximizing career development. The aims of this review were to (1) test whether there are academically published interventions or frameworks addressing inclusion in the surgical workforce and (2) characterize these interventions or frameworks. ⋯ Common themes included systematic reform of recruitment policies and practices, increased access to targeted mentorship, gaining leadership support, and increased avenues for underrepresented faculty advancement. While limited, promising work has been undertaken through national collaboration and model institutional work. Future considerations may include incentivizing academic publication of inclusion work, increasing access to funding, and rewarding these efforts in career advancement.
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Many residency programs struggle to meet the ACGME requirement for resident participation in quality improvement initiatives. ⋯ We demonstrate a novel way to involve trainees in an institutional quality initiative that served to educate trainees in quality improvement, the systematic review process, Delphi methodology, and preoperative optimization. This study provides a framework that other residency programs can use to engage residents in institutional quality improvement efforts.
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Global surgery is a medical field dedicated to the facilitation of timely access to safe, affordable, and high-quality surgical healthcare worldwide, including support for necessary surgery and anesthesia infrastructure. Standard surgical training in the US does not provide necessary exposure to the range of surgical operations and nontechnical skills critical to practice in resource-limited contexts. ⋯ However, the presence of trainees pursuing education for careers in resource-variable settings presents an added layer of ethical complexity that must be carefully considered on the individual, programmatic, and institutional level. This article reviews the complexities relevant to global surgery trainees across these levels and offers potential mechanisms for addressing these ethical challenges.