IMPORTANCE Women in medicine have been underrepresented at medical conferences; however, contributing factors have not been well studied. OBJECTIVE To examine the distribution of invited conference speakers by gender and factors associated with representation of women as speakers. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used medical conference programs from March 2017 to November 2018 across 20 specialties in 5 regions (Australasia, Canada, Europe, the UK, and the US) that were obtained online or from conference conveners. EXPOSURES Gender of invited lecturers, panelists, and planning committee members for each conference based on name or picture and publicly available data on compositions of specialties by gender for included regions. MAIN OUTCOMES AND MEASURES Outcomes included the proportion of female speakers (invited lecturers and panelists), the number of single-gender panels, and the proportion of female speakers compared with the specialties' gender composition. Correlations between the gender composition of conference planning committees and the proportion of female speakers were assessed. Multivariable regression models were used to evaluate factors independently associated with the proportion of female speakers at conferences. RESULTS A total of 8535 sessions (panels and invited lectures) with 23 440 speakers across 98 conferences were identified. Women accounted for 7064 (30.1%) of speakers; 1981 of 5409 panels (36.6%) consisted of men only, and 363 (6.7%) consisted of women only. The proportion of women speakers varied by region and specialty from 5.8% to 74.5%. In general, specialties with low baseline proportions of women (<20%) had a ratio of female speakers to female specialists greater than 1, whereas specialties with high baseline proportions of women (>40%) had a ratio of female speakers to female specialists less that 1. There was a strong positive correlation between the proportion of women on planning committees and conference representation of female speakers (r = 0.67; P < .001). The association remained statistically significant after controlling for other variables, including the regional gender balance of the specialty (odds ratio, 1.10; 95% CI, 1.04-1.15; P < .001 for every 10% increase in the proportion of women on the planning committee). CONCLUSIONS AND RELEVANCE In this cross-sectional study, the proportion of female speakers at medical conferences was lower than that of male speakers, and more than one-third of panels were composed of men only. Increasing the number of women on planning committees may help address gender inequities.

Background and Aims Non‐technical skills (NTS), involving cognitive, social and interpersonal skills that complement technical skills, are important for the completion of safe and efficient procedures. We investigated the impact of a simulation‐based curriculum with dedicated NTS training on novice endoscopists’ performance of clinical colonoscopies. Methods A single‐blinded randomized controlled trial was conducted at a single center. Novice endoscopists were randomized to a control curriculum or a NTS curriculum. The control curriculum involved a didactic session, virtual reality (VR) simulator colonoscopy training, and integrated scenario practice using a VR simulator, a standardized patient, and endoscopy nurse. Feedback and training were provided by experienced endoscopists. The NTS curriculum group received similar training that included a small‐group session on NTS, feedback targeting NTS, and access to a self‐reflective NTS checklist. The primary outcome was performance during two clinical colonoscopies, assessed using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) tool. Results Thirty‐nine participants completed the study. The NTS group (n = 21) had superior clinical performance during their first (P < 0.001) and second clinical colonoscopies (P < .0.001), compared to the control group (n = 18). The NTS group performed significantly better on the VR simulator (P < 0.05) and in the integrated scenario (P < 0.05). Conclusion Our findings demonstrate that dedicated NTS training led to improved performance of clinical colonoscopies among novices.

he current epidemic of opioid-related mortality has shed light on poor opioid prescribing practices after abdominopelvic surgery. Research has demonstrated that substantial variations exist in the amount of opioid prescribed at discharge [1][2][3] and that opioid prescriptions are often in excess of actual patient requirements. 1,[3][4][5] These findings are particularly concerning given that more than 70% of patients store their excess opioids in unlocked locations and do not properly dispose of them. 6 Such easily accessible supplies of prescription opioids may lead to unintended harms, such as opioid misuse 7 and accidental overdoses. 8 Moreover, there is growing awareness that a substantial proportion of opioid-naive patients will become long-term users of opioids after initial exposure in the immediate postoperative period. 9-13 Because long-term opioid use may lead to physiological dependence and misuse, prevention in the early phases of perioperative care is important. However, abdominal surgeons may not be aware of the risk of long-term opioid use, and they infrequently perform a risk assessment in their patients. 14 A lack of guidance for surgeons has been cited as a major factor contributing to the suboptimal nature of current postsurgical opioid prescribing practices. 1,14,15 Guidelines published by the American Society of Anesthesiologists and the American Pain Society provide general recommendations on the use of opioids in managing pain during the inpatient postoperative period, but they failed to explicitly address how clinicians should prescribe opioids at discharge. 16,17 Guidelines for the treatment of acute pain from the Centers for Diseases IMPORTANCE The prescription of opioids at discharge after abdominopelvic surgery is variable and often excessive. A lack of guidance for abdominopelvic surgeons may explain the suboptimal nature of current prescribing practices.OBJECTIVE To systematically review existing recommendations on the prescription of opioids at discharge, the appropriate disposal of opioids, and the prevention of chronic postsurgical opioid use after abdominopelvic surgery.EVIDENCE REVIEW This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From January 2010 to December 2018, a search of MEDLINE, PsycINFO, HealthSTAR, Embase, and the difficult to locate and unpublished (ie, gray) literature was performed using a peer-reviewed strategy with variations of the terms opioid, surgery, and guideline to identify English-language documents that contained recommendations published by professional societies or health care institutions. The quality of clinical practice guidelines was assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. A descriptive synthesis of results was performed.FINDINGS Of 5530 citations screened, 41 full-text documents were included in the systematic review. Fifteen clinical practice guidelines were identified. AGREE II domain scores varied substantially. Identified...

Horseshoe kidney is a common congenital fusion anomaly of the kidneys. It poses a challenge to surgeon because of its very variable anatomy in terms of location and lie, fusion, pelvicalyceal system, and the renal vessels. Here we describe a case of laparoscopic nephrectomy in a horseshoe kidney complicated by incomplete removal because of not realizing the lower and medial extent of pelvicalyceal system across midline to the contralateral side leading to persistent urine leak. The relevant anatomy and the necessary precautions to prevent such complication have been discussed.

Scrub typhus has a wide range of clinical presentation varying from mild symptoms like fever, chills, headaches, myalgias, gastric ulcerations and hepatitis to more fatal conditions like pneumonia and encephalopathy caused by disseminated vasculitis with splenic infarct being a rare complication. We report a case of 50-years old male with scrub typhus who presented as multiple splenic infarcts.