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Fig. 1. Number of gun related incidents from 2018 to 2020 amongst New York, Baltimore, Chicago, and Los Angeles. It can be observed that Los Angeles has experienced the largest amount of gun incidents in 2020 (N = 567) while New York has experienced the least (N = 172). 2018 was not available for Baltimore.

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Background: Gender disparities still exist in the field of academic surgery. Women face additional obstacles obtaining high-ranking, surgical academia positions compared to men, and this may extend to the appointment of editorial board members. We aim to evaluate the gender distribution of editorial board members, associate editors, and editors-in-chief of top US surgical journals and to recommend interventions, which can promote equitable gender representation among editorial boards. Methods: The study is a cross-sectional analysis using publicly available data regarding the number and proportion of female editorial board members, associate editors, and editors-in-chief from 42 US surgical journals. Descriptive statistics and linear regression were performed with significance defined as P < .05. Results: Of 2,836 editorial board members from 42 US surgical journals, 420 (14.8%) were women. Of 881 associate editors, 118 (13.3%) were women. Only 2/42 (4.8%) of editors-in-chief were women. The mean proportions of female editorial board members and associate editors were 14.5% and 19.5%, respectively. No significant associations were found between the 2019 Scimago Journal & Country Rank indicator nor the 2019 impact factor and the proportion of female editorial board members and female associate editors after adjusting for author H-index. Conclusion: Gender disparities are evident in academic surgery, and women comprise a minority of US surgical editorial board members, associate editors, and editors-in-chief. The implementation of women mentorship from senior faculty on behalf of senior residents and junior faculty, as well as journalfacilitated pipeline programs, can diversify editorial board members by increasing women representation and reduce disparities in surgical journal editorial boards.

Introduction The literature remains unclear on the development, consequences, and interventions for burnout in resident populations. We aim to identify the prevalence and nuances of reported burnout in general surgery resident physicians to better understand which factors contribute the greatest risk. Methods A 42-question anonymous online survey was distributed by the Association of Program Directors in Surgery (APDS) to general surgery resident physicians. ANOVA, chi-square and multinomial regression analyses were performed with significance defined as p < 0.05. This survey was reported in line with the STOCSS criteria. Results 81 survey responses were received. Burnout was reported by 89.5% of university-hospital affiliated respondents and 95.2% of community teaching hospital affiliated respondents. After adjustment, community respondents showed a nearly fifteen times greater likelihood of burnout (aOR = 14.735, 95% CI: 0.791,274.482). Females were 2.7 times as likely as males to report burnout (aOR = 2.749, 95% CI: 0.189,39.960) and nearly twice as likely to report contemplating suicide (aOR = 1.819, 95% CI: 0.380,8.715). Burnout rates by hours worked/week revealed that 100% of those working ≥80 h/week report experiencing burnout. Conclusion Overall burnout rates reported by surgical residents respondents were high. Community teaching hospital setting, female gender, and increased number of hours worked per week may be associated with higher rates of burnout. Both female and community-affiliated residents were at increased risk of reporting suicidal ideation. Targeted interventions are needed to adequately address program-specific causes for resident burnout and reduce its prevalence in high-risk cohorts.

Background United States Medical Licensing Examination (USMLE) Step 1 will transition to pass/fail score by 2022. We aim to investigate US medical students’ perspectives on the potential implications this transition would have on their education and career opportunities. Methods A cross-sectional study investigating US medical students’ perspectives on the implications of transition of the USMLE Step 1 exam to pass/fail. Students were asked their preferences regarding various aspects of the USMLE Step 1 examination, including activities, educational opportunities, expenses regarding preparation for the examination, and future career opportunities. Results 215 medical students responded to the survey, 59.1% were women, 80.9% were allopathic vs. 19.1% osteopathic students. 34.0% preferred the USMLE Step 1 to be graded on a pass/fail score, whereas 53.5% preferred a numeric scale. Osteopathic vs. allopathic students were more likely to report that the pass/fail transition will negatively impact their residency match (aOR = 1.454, 95% CI: 0.515, 4.106) and specialty of choice (aOR = 3.187, 95% CI: 0.980, 10.359). 57.7% of respondents reported that the transition to a pass/fail grading system will change their study habits. Conclusions The transition of the USMLE Step 1 to a pass/fail system has massive implications on medical students and residency programs alike. Though the majority of medical students did not prefer the USMLE Step 1 to have a pass/fail score, they must adapt their strategies to remain competitive for residency applications. Residency programs should create a composite score based off all aspects of medical students’ applications in order to create a holistic and fair evaluation and ranking system.

Background and Objectives: With the rate of physician suicide increasing, more research is needed to implement adequate prevention interventions. This study aims to identify trends and patterns in physician/surgeon suicide and the key factors influencing physician suicide. We hope such information can highlight areas for targeted interventions to decrease physician suicide. Methods: Review of Centers for Disease Control and Preventions National Violent Death Reporting System (NVDRS) for 2003 to 2017 of physician and dentists dying by suicide. Twenty-eight medical, surgical, and dental specialties were included. Results: Nine hundred five reported suicides were reviewed. Physician suicides increased from 2003 to 2017. Majority surgeons' suicides were middle-aged, White males. Orthopedic surgeons had the highest prevalence of suicide among surgical fields (28.2%). Black/African American surgeons were 56% less likely [odds ratio (OR) = 0.44, 95% confidence interval (CI): 0.06-3.16] and Asian/Pacific Islander were 438% more likely (OR = 5.38, 95% CI: 2.13-13.56) to die by suicide. Surgeons were 362% more likely to have a history of a mental disorder (OR = 4.62, 95% CI: 2.71-7.85), were 139% more likely to use alcohol (OR = 2.39, 95% CI: 1.36-4.21), and were 289% more likely to have experienced civil/legal issues (OR = 3.89, 95% CI: 1.36-11.11). Conclusions: The prevalence of physician suicide increased over the 2003 to 2017 time-frame with over a third of deaths occurring from 2015 to 2017. Among surgeons, orthopedics has the highest prevalence of reported suicide. Risk factors for surgeon suicide include Asian/Pacific Islander race/ethnicity, older age, history of mental disorder, alcohol use, and civil/legal issues.

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