Surgical residency programs have long sought objective measures of determining applicants' long-term success, given the limited training positions and significant time and money expended in their training. Current data to evaluate and rank applicants focus on academic and standardized test performance, letters of recommendation, honor society membership, and research experience. Spatial and manual skills currently are not assessed as part of the application process.We hypothesized that dexterity and visual spatial testing of applicants for general surgery and otolaryngology residency provides information that is not assessed through the current process, and that these assessments would not correlate with the variables traditionally used to rank applicants. Additionally, we wanted to assess whether these tests could be completed during a single scheduled interview day without significant disruption to the interview structure. MethodsMedical student applicants to our institution's general surgery and otolaryngology residency programs were included in the study. Applicants interviewed were given the option to participate in the study or to decline but still undergo testing to blind faculty to an individual's participation status. AbstractBackground Manual dexterity and visual spatial ability are not routinely used to evaluate candidates for surgical residency training as part of the application interview.

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in evaluation of the biliary tree for choledocholithiasis. Formal indications for magnetic resonance cholangiopancreatography (MRCP) in suspected choledocholithiasis are lacking. Our objective was to determine if MRCP affects management of patients who otherwise would undergo ERCP. A review was conducted of all MRCPs and ERCPs at our institution from 2008 to 2012 with suspected choledocholithiasis. Patients who underwent MRCP and ERCP were compared with those who underwent ERCP alone. Demographic data were collected and notation of whether a post-MRCP ERCP occurred was the primary variable. MRCP was performed in 107 patients for choledocholithiasis. Eighty-eight patients were negative for choledocholithiasis (82%) and 76 were discharged without ERCP (71%). Thirty-one patients received a diagnosis of choledocholithiasis and were referred for ERCP. Of the 19 patients with MRCP-diagnosed common bile duct stones, 95 per cent were confirmed by ERCP (odds ratio 18.0, P > 0.05; agreement 77%, sensitivity 0.76, specificity 0.86, positive predictive value 0.95, negative predictive value 0.50). Length of stay was similar for all groups. A total of 131 patients underwent ERCP without a preprocedural MRCP. Choledocholithiasis was found in 116 patients (92%), whereas 12 patients (9%) had no common bile duct stones and three had an alternate diagnosis. In conclusion, MRCP significantly affected the management of patients who would have undergone ERCP. MRCP did not increase length of stay and contributed to the 95 per cent positivity rate of subsequent ERCPs. These data illustrate the utility of MRCP in suspected choledocholithiasis patients at a low cost with regard to risk and time.

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No modern studies have addressed the impact of cardiac surgery on military duty status, which is associated with constraints not applicable to the general population. A review of all active duty patients undergoing coronary artery bypass grafting (CABG), mitral valve repair (MVrep), bioprosthetic valve replacement (BIOVALVE), mechanical valve replacement (MECHVALVE), and septal defect closure (ASD/VSD) at Naval Medical Center Portsmouth between January 1, 2004 and December 31, 2011 was used to determine final duty status: Return to Full Duty (RTFD), Medical Board Separation or Planned Retirement/Separation. Complete data on final disposition was available for 99% (75/76) of patients. There were 9 Planned Retirement/Separation patients. There was a 100% rate of RTFD for all MVrep, BIOVALVE, and ASD/VSD patients. Patients undergoing CABG had an 83% (20/23) rate of RTFD. MECHVALVE patients had RTFD in only 23% (5/21) of cases. Patients undergoing MECHVALVE are unlikely to be suitable for continued service after surgery, but most if not all military patients undergoing MVrep, ASD/VSD, or BIOVALVE and the vast majority of CABG patients can expect to return to unrestricted active duty after surgery.

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