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Challenges remain in the study and execution of ERAS. Controlling for adherence to ERAS components and implementing uniform ERAS protocols across studies are burgeoning topics that have significant implications for study design. The practice of ERAS and its benefits to patients are expected to evolve. Assessing improvements in postdischarge quality of life, timing of return to work and independent living, and adherence to scheduled delivery of adjuvant treatments will strengthen future ERAS investigations.

Background: The coronavirus disease 2019 pandemic has negatively affected the training of general surgery chief residents during the last trimester of their residency. Our goal was to evaluate the educational concerns of graduating general surgery chief residents during the coronavirus disease 2019 pandemic. Methods: An anonymous web-based survey was distributed between March 31 and April 7, 2020 to all current general surgery chief residents from 6 academic medical centers in Boston, Massachusetts. Interviews were also conducted with attending surgeons from participating institutions. Results: A total of 24 of 39 general surgery chief residents participated in our survey (61.5% response rate). General surgery chief residents were most concerned about the potential delay in the date of board examinations, followed by not feeling adequately prepared for the board examinations and a possible delay in the graduation date. Whereas not having enough cases to feel ready for fellowship or job and not achieving a sufficient number of cases to meet the requirements for graduation were only moderately concerning to chief residents, attending surgeons stressed a greater importance on the loss of the operative experience as nearly all (93.3%) of them suggested a personalized approach for additional general surgery training during fellowship or job onboarding. Conclusion: In addition to the dramatic impact on public health, the coronavirus disease 2019 outbreak has also caused unprecedented changes to surgical education. Therefore, creative interventions are needed to help general surgery chief residents successfully transition into the next phase of their surgical career.

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The surprise question is a valuable tool for identifying older patients with higher risk of death, and it may be a useful screening criterion for older emergency general surgery patients who would benefit from palliative care evaluation.

Emergency department visits for electric scooter-related injuries after introduction of an urban rental program.

Background: With increased attention on the federal budget deficit, graduate medical education (GME) funding has in particular been targeted as a potential source of cost reduction. Reduced GME funding can further deteriorate the compensation of physicians during their residency training. Methods: In order to understand the GME funding mechanisms and current challenges, as well as the value of the work accomplished by residents, we searched peer-reviewed, English language studies published between 2000 and 2019.Results: Direct and indirect GME funding is intended to support resident reimbursement and the higher costs associated with supporting a teaching program. However, policy efforts have aimed to reduce federal funding for GME. Furthermore, evidence suggests that residents are inadequately compensated because their salaries do not reflect the number of hours worked and are not comparable to those of other medical staff. Conclusions: Our review suggests that creative solutions are needed to diversify GME funding and improve resident compensation.

Background: Retirement of surgeons has important workforce implications given the shortage of surgeons throughout the country. Our study was designed to evaluate factors that influence surgeon retirement decisions. Material and methods:A paper-based survey regarding retirement decisions was mailed nationwide from April to June of 2018 to retired General, Colorectal, Vascular, and Cardiothoracic surgeons that are members of the American College of Surgeons.Results: A total of 2295 of 5282 surveys were completed (43.4% response rate). The mean age of respondents was 79.0 ± 0.8 years, their mean age of retirement was 63.9 ± 0.1 years, and their mean interval since retirement was 15.2 ± 0.9 years. The five most common reasons for retirement were advancing age, personal health, increased outside interference, burnout, and worsening malpractice environment. The most common reported health problems leading to retirement were musculoskeletal disorders. The percentage of reported burnout was significantly lower in academic surgeons (5.8%) vs. surgeons in private practice (10.5%); academic/private practice combination (10.0%); those employed by community hospital or health system (11.4%); and Veteran Affairs institution, military hospital, and Indian Health Service (13.8%). Burnout was the only factor associated with an earlier retirement age (61.2 ± 0.4 years vs. 65.8 ± 0.2 years in the absence of burnout). Results were comparable when stratified by surgical specialty. Conclusion:Our survey brings awareness to potentially-modifiable factors influencing surgeon retirement, such as