Brand new month!
So what’s out there that is catching my eye?
We all spend quite a bit of time thinking about how to improve teaching of technical skills. What about using video-based coaching to supplement OR teaching?
What does the public know (and want to know) about overlapping surgery?
The 2016 State of the Science articles for burn care are out. These cover everything from burn resuscitation to community reintegration, and are all important comments on where we are in burn care (and how far we have to go).
And bringing out my inner policy geek, here’s a great overview from Politico on what the impact is for the GOP if/ when Obamacare repeal fails.
Catching my ear is the “Up First” podcast from NPR. I seldom have time to listen closely to the news throughout the day, so this is a great summary of what’s happening.
Happy reading (and listening).
I’ll start with an apology: I’ve not been on my A-game with keeping up with the blog lately. Lots of life distractions, many of which I’m hopeful will start to settle down soon. It’s not been easy.
So, it is April, and a number of things out there have caught my eye.
The March print edition of JAMASurgery included this systematic review and metaanalysis of causes of attrition in general surgery residency. While I’m reasonably certain we can’t get the rate to zero because there are factors we cannot control, we must do what we can.
While we are all becoming painfully aware that too many narcotics are being prescribed for our patients, we tend to not have a good understanding of what constitutes too many or too much. This study provides an important baseline for us as surgeons. I will also note that Annals of Surgery will have an ongoing series examining the opiod crisis from a surgical perspective.
We’re definitely talking more about delirium mitigation in our adult ICU patient population. What about the children? Apparently it’s a problem for them too (particularly with “inflammatory disorders,” which would definitely be my patient population!).
Going a bit outside of the medical journals, what’s next in hospital innovations to keep patients safe? I was thrilled to see my friend Amir Ghaferi‘s name as first author on this piece.
Pleasure reading? Our book group is spending the next two months with one of my all-time favorites: The Amazing Adventures of Kavalier and Clay by Michael Chabon. I am looking forward to re-experiencing it.
Ah, March. Here you are, and you didn’t even come in like a lion. Thanks for that.
First, more information confirming my own bias that communication with our patients and families matters, not just for the fundamental “it’s the right thing to do” reason, but because it also impacts risk of postoperative complications.
This terrific Perspectives piece discusses the role of trainees in the changing medical care landscape in the US.
As my own team works to identify risk factors for delirium in Burn patients, this article with risk factors following colorectal surgery may provide us with some guidance.
Were you there for my friend Mary Klingensmith’s fantastic ASE Presidential address last April? If you missed it (or if you were there and loved it), here it is in print.
Side reading: February’s book group book was Alexander Marra’s The Tsar of Love and Techno. VERY highly recommended.
As promised, here’s the February reading round-up. What’s caught my eye recently?
I was at SCCM two weeks ago, and would encourage anyone with an interest in critical care to read the Plenary Articles published in Critical Care Medicine. These presentations at the meeting were all nothing short of amazing.
And… the Sepsis Guidelines have been updated (note: it’s mostly tweaks, little that’s entirely new). If you’re not a critical care doctor, this is still important and relevant if you want to provide evidence-based best care when your patient has something go wrong.
In surgery we sometimes get to have conversations with patients and families when we don’t anticipate a completely smooth clinical course. I’ve been playing with this framework since Gretchen Schwarze came and talked to us about it last year, and I find it helpful. You might too.
Here’s some background work (with more great work coming) from my colleague Chris Pannucci on Anti-Xa level monitoring and perioperative use of enoxaparin.
Last year at the ASE meeting I was a little dismayed to find the frequency with which medical students use Wikipedia as a reference during the clerkship. This article provides some justification for simply embracing it and makes me question if we should have a Wikipedia “hackathon” during 2018 Surgery Education Week.
I’ve preached about the importance of allies for women in male-dominated fields before in this blog. Here’s another confirmatory article from HBR. Men, we really need your support, and if done right we can even benefit from your leadership.
Happy reading, all.
Brand new month! Brand new year! So, what’s out there that’s caught my eye?
***Not to be missed reading for the surgeons*** The American College of Surgeons and Surgical Infection Society have published updated guidelines on Surgical Site Infections. Did I mention this should be mandatory reading for the surgeons? Because it should.
If I remember correctly, this fantastic review manuscript on the crisis confidence in trainees was Dawn Elfenbein’s SERF project. It’s also worth your time and illustrates the complexity of understanding confidence and its impact on our residents and junior faculty.
This is an excellent review of “what’s current in burn care” from the group at U of Alberta. HT to one of our plastics residents who shared it with me (since PRS is not in my usual journal wheelhouse).
If you’re one of our former students who have been “tortured” by the mock pages during your bootcamp course, here’s evidence supporting why we did that. You’re welcome.
Residents are now required to participate in quality improvement; this report shows how that can be a truly meaningful experience for the residents and the patients.
Current non-medical professional reading, which I recommend highly: Appreciative Leadership by Whitney, Trosten-Bloom, and Rader. I was hooked after the Inquiry chapter, and it has already proven invaluable.
Current non-medical, non-professional reading: Sally Mann‘s Hold Still. I only intended to read for 20 minutes last night. That quickly turned into an hour between her amazing use of language and the photographs that are included in this memoir.
Happy 2017, y’all!
It’s the last one of the year. That’s a bit bittersweet (but not too much so!).
What’s caught my eye lately? A few things…
The New Yorker often provides some of the best lay press reporting on medicine. This article on hypothermia in trauma patients is no exception.
Maybe my bias comes from practicing a specialty that is already regionalized (at least here in the Mountain West). This thoughtful piece presents regionalization as a possible strategy for improving surgical care more broadly.
I make plenty of jokes about midcareer in academic surgery being a bit like being Jan Brady- we simply don’t get much attention in terms of people supporting our ongoing career development, and while we’ve figured out how to get to where we are, there’s not always a clear road map on what’s next. Janet Bickel does a nice job describing growth opportunities for those with the mid career blues.
I’ll confess that I’m thrilled to see Surgery publishing qualitative work. This piece is particularly interesting to me because of its examination of challenges and barriers for surgeon-scientists.
Pleasure reading: The Door by Magda Szabo was our book group reading for November. I missed book group (call broke my soul) but loved the story in a strange way. Of course, everything about November was strange, wasn’t it?
Brand new month! And therefore…it’s that time!
I’m finishing some revisions on a manuscript describing effective mentorship in academic surgery, so it’s intuitive that this article on mentorship programs in Departments of Surgery that appeared in the October JAMASurgery would be of interest to me right now.
To clip or not to clip (hair, that is, before surgery). Would you believe it doesn’t matter for SSI rates?
It’s interview season for senior medical students, and as someone who has been involved in resident selection for a number of years (and has read plenty of not-helpful letters of recommendations), I am SO ready for us to develop a Standardized Letter of Evaluation in surgery. Emergency Medicine has led out well on this.
Overly enthusiastic intubation for facial burns is a real thing. Now we need to figure out how to mitigate it since the “cost” of a miss is so very high.
While this piece obviously has a strong business focus, this idea of unlearning to learn applies almost more critically in medicine. We all have old habits in how we do things, and often the evidence to support them is lacking. We have to unlearn the behaviors we had in order to do our best for our patients, particularly when new evidence or techniques become available to us.
Fun reading: I’m currently polishing off the New Yorker‘s annual politics issue (and will openly admit that the election CANNOT be over soon enough!). Our October book for book group was, fittingly, Frankenstein. I had forgotten what a tragic and beautifully told tale it is.
Lots of great stuff out there, so let’s get started.
Interested in surgical culture and patient safety? This Viewpoint reports the content of a panel during the 2015 Surgical Outcomes Club meeting addressing innovative approaches for modifying surgical culture.
Also in the JAMA Network, an on-line piece from JAMA about fluid responsiveness in hemodynamically unstable patients. This is a high yield article with an accompanying author interview. Highly recommended!
How should we think about honors criteria for the surgical clerkship? Here are some ideas (which are the product of a SERF fellowship!)
I’ve been spending quite a bit of time over the last year working on workforce issues as they relate to surgical GME, so this Academic Medicine article piqued my interest as we consider new ways to train.
Shameless self-promotion moment!!! I am so excited to see this in print, and I got to hold a copy in my hands last week. Y’all, I’m a book editor! Thank you to everyone who contributed; you made what could have been an onerous project downright fun.
And for your reading pleasure, our September book group assignment was The Underground Girls of Kabul. It was a simply amazing snapshot of an Afghani subculture.
Happy Fall, y’all!
Sincere apologies for another blog gap. Time was an issue. An update that failed was a bigger issue- I had to figure out how to restore the back-up, which was a bit of a challenge. We appear to be live again, so here we go!
In JAMA this week, an interesting Viewpoint about developing a national trauma system that can achieve zero preventable deaths after injury. It’s a lofty goal, to be sure.
I had the privilege of meeting Dr. Elmore, the first author, when I visited Wash U last year. This study on trainee burnout in general surgery is important food for thought for all of us. She’s asking some important questions.
Small bowel obstruction is a bread-and-butter issue in general surgery. Apparently, outcomes are best for patients with adhesive SBO who are managed by a surgical team.
Cultures that are driven by shame are cultures in which connection cannot occur- and in which we all tend to think that bad things are only happening to us. My own experiences during the hard times of residency tell me that the authors of this study are right– that connection AT work is as important in mitigating burnout and improving resilience as our activities away from work. When times get hard now, it remains true. Many of you know of my love of Brené Brown’s work, and this quote applies here: “If we can share our story with someone who responds with empathy and understanding, shame can’t survive.” Yes. This.
Recent pleasure reading that was discussed at book group last week was Outline by Rachel Cusk. It’s written in an interesting style and without terribly likable characters, though I’ll admit that the writing is excellent. 3 stars.
Happy September! Happy Fall, y’all!
To quote the Talking Heads, “How did I get here?” Seriously, y’all, where is the year going?
Anyway, to the business at hand…this month’s reading round-up.
If you’re interested in the intersection of gender and academic medicine (which is something that’s just a bit of an interest for me…), check out August’s Academic Medicine. And yes, I do mean essentially the whole publication.
I was touched by this essay in JAMA Pediatrics. Much like the author, in my line of work it’s near impossible to not form an attachment to patients and their families because of how long we’re together and the difficulties of the work. I will also confess that, like the author, my ongoing personal ties to some of my patients and their families is precisely what prevents burnout and discouragement during the hard times. We are part of one anothers’ stories. Period.
Another piece on women, this one about women in surgery, and it is the Julie Freischlag’s Jonasson lecture she gave last year. Bouncing up is a great thing to remember to do in life, not just in academic surgery.
Concurrent surgery is a hot topic still; this Viewpoint provides an important perspective on informed consent. I’m proud that the U of Utah seems to be ahead of the curve in this area.
Pleasure reading? I’m just starting Rachel Cush’s Outline for our August book group. The discussion around last month’s read, The Secret Scripture, was phenomenal!