Objective Describe the early impact of the COVID-19 pandemic on general surgery residency training nationwide. Design A 31-question electronic survey was distributed to general surgery program directors. Qualitative data underwent iterative coding analysis. Quantitative data were evaluated with summary statistics and bivariate analyses. Participants Eighty-four residency programs (33.6% response rate) with representation across US geographic regions, program affiliations, and sizes. Results Widespread changes were observed in the surgical training environment. One hundred percent of programs reduced the number of residents on rounds and 95.2% reduced the size of their in-hospital resident workforce; on average, daytime staffing decreased by nearly half. With telehealth clinics (90.5%) and remote inpatient consults (26.2%), both clinical care and resident didactics (86.9%) were increasingly virtual, with similar impact across all program demographics. Conversely, availability of some wellness initiatives was significantly higher among university programs than independent programs, including childcare (51.2% vs 6.7%), housing (41.9% vs 13.3%), and virtual mental health services (83.7% vs 53.3%). Conclusions Changes in clinical care delivery dramatically reduced in face-to-face learning opportunities for surgical trainees during the COVID-19 pandemic. While this effect had equal impact across all program types, sizes, and geographies, the same cannot be said for wellness initiatives. Though all programs initiated some strategies to protect resident health, the disparity between university programs and independent programs may be cause for action.
nequities affecting underserved racial and ethnic groups continue to be identified across the spectrum of medical research. [1][2][3][4] From the disproportionate number of Black and Hispanic persons who have been hospitalized or died because of COVID-19 in 2020 [5][6][7][8] to discrimination against Asian American persons 9 and the comparatively poor perioperative outcomes even among low-risk racial and ethnic minority patients, 10,11 attentiveness to race and ethnicity has illuminated inequities and disparities throughout our health care systems. Recognition of health disparities through research has led to recent significant victories, such as the Henrietta Lacks Enhancing Cancer Research Act of 2019, 12 which became public law in January 2021, requiring officials to examine barriers to government-funded clinical trials for traditionally underrepresented groups. Unfortunately, race and ethnicity continue to be infrequently reported in the medical literature to describe study participants, and when race is described, the quality of the reporting is variable. [1][2][3][4][13][14][15][16] In 1978 (updated in 2019), the International Committee of Medical Journal Editors (ICMJE) developed recommendations for uniformity in manuscript submissions and promoting increased frequency and quality reporting of race. Current recommendations are that "[a]uthors should define how they determined race or ethnicity and justify their relevance," 17 and that a study "should aim for inclusion of representative populations into all study types and at a minimum provide descriptive data for these and other relevant demographic variables." [17][18][19] Despite these recommendations, studies examining the reporting of race continue to show infrequent use of race to desc ribe study partic ipants in sc ientific publications. [13][14][15][16] A 2020 article by Moore 14 revealed that in the ophthalmology literature, most articles (88%) reported baseline demographic information on study participants; however, only 43% of articles included data on race and ethnicity, and an even smaller fraction described how the information was determined. IMPORTANCEThe reporting of race provides transparency to the representativeness of data and helps inform health care disparities. The International Committee of Medical Journal Editors (ICMJE) developed recommendations to promote quality reporting of race; however, the frequency of reporting continues to be low among most medical journals.OBJECTIVE To assess the frequency as well as quality of race reporting among publications from high-ranking broad-focused surgical research journals. DESIGN, SETTING, AND PARTICIPANTSA literature review and bibliometric analysis was performed examining all human-based primary research articles
The incidence of pediatric (i.e., 0-17 y of age) cancers in North Carolina was studied for the years 1990-1993 in counties and ZIP-code areas that contained a National Priorities List hazardous-waste site. We analyzed the areas to determine if there was an excess incidence of cancer among the pediatric population. We used geographic information systems technology to address-match and map the cancer cases, along with county and National Priorities List hazardous waste-site location. No significantly elevated cancer incidence rates were found at the county level. Two ZIP-code areas had statistically significant elevations in cancer incidence (p < .05). Only 3 of the cancer cases we mapped resided within a 1.6-km (1 mi) buffer zone of a National Priorities List hazardous-waste site. These 3 cases were not in the ZIP-code areas that had increased incidence rates. The small numerators throughout the study led us to question the accuracy of the assessment of underlying rates. The general capabilities of the geographic information systems, as well as advantages and limitations of the system, are discussed. As an exploratory study, this study serves as a springboard into more in-depth environmental-health hypotheses and more-specific investigations of point sources of hazardous exposures.
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