Friday, March 31, 2017

Surgical fellowship match results for 2017

Two weeks ago, I reviewed the preliminary results of the 2017 main NRMP match. Data for the specialty match, also known as the fellowship match, recently became available. Here are the outcomes for the subspecialties of general surgery.

For abdominal transplant surgery, 36 of 58 programs filled, comprising 51 of 74 positions. There were 75 applicants with 24 going unmatched. The number of transplant programs has dropped from 69 in 2013 with a concomitant decrease in the number of available positions from 84 to 74. Applicants numbered 116 in 2013, and except for a slight upturn in 2016, interest has steadily declined. Consistent with the previous four years, US grads filled 31% of the positions in 2017.

Colon and rectal surgery filled all 56 programs and all 95 positions; 35 of the 130 applicants failed to match. Colorectal has filled 100% of positions available in three of the last five years. US grads filled 75% of the slots which is fairly consistent with previous years.

Pediatric surgery’s 44 programs filled all but one of the 45 available positions. This is the first time in the last five years that pediatric surgery did not fill 100% of its slots through the match. There were 96 applicants this year, and 52 of them did not secure a position. US grads filled 80% of the slots which is a slightly lower percentage than previous years.

Tuesday, March 28, 2017

An expert witness goes the extra mile

A Canadian dermatologist was found guilty of professional misconduct by a disciplinary committee of the Ontario College of Physicians and Surgeons. He had been accused of rubbing his penis against the legs of two patients he was examining.

In his defense, the doctor said it couldn't have happened because he was so obese that his penis was covered by abdominal fat.

After 38 days of testimony, the committee was in effect a “hung” jury regarding the penis allegation but found against the doctor for rubbing his abdomen against the patients without "any form of warning, apology or excuse." The committee found the conduct "disgraceful, dishonorable or unprofessional."

One of several fact witnesses, not a direct party in the case but having seen the doctor, was asked how she knew it was a penis rubbing against her. She said, “I’m a woman of almost 70 years; I know what a penis is and what it feels like. I have no doubt at all that it was a penis.”

The doctor was also found guilty on charges of touching a patient's breasts under her bra without a valid clinical reason for doing so and for not giving patients a warning or explanation before removing some of their clothes.

The most interesting part of the hearing was that both the defense and the college had retained expert urologists to examine the dermatologist to see if the patients' allegations would have been possible.

The defense expert examined the dermatologist with and without an erection and said it would not have been possible for him to have done what the patients alleged.

The urologist for the college pretended to be the patient on the examining table with the dermatologist reprising his role as the examiner. At three different table positions, the urologist said he was able to feel the dermatologist's chemically induced erection.

I tried to imagine the conversation between representatives of the college and their expert witness prior to his encounter with the defendant.

College: Are you willing to be our expert?
Urologist: Yes. What do I have to do?
College: You must determine if the accused's erect penis can be felt at various heights of the examining table.
Urologist: How should I do that?
College: Just give him a drug to produce an erection, lie on the table while the defendant presses up against you, and testify about what you feel.
Urologist: Say what?

I tweeted a link to one of the newspaper articles about this case, and @Laconic_doc said he knew all along “the evidence wouldn't stand up in court.”

References:
Globenews.ca
The star.com

Thursday, March 23, 2017

Evidence? We don’t need no stinkin’ evidence

One of my posts requires clarification. The post "A paper of mine was published. Did anyone read it?" went live in August 2014 and has been viewed 5133 times to date.

A reader had emailed me to ask if I might know why two papers he had written did not cause much of a stir in the orthopedic world. One reason might have been that the papers appeared in an obscure orthopedic journal.

I then wrote: "A paper in Physics World claims that that 90% of published papers are never cited and 50% are never read by anyone but the authors and the journals' peer reviewers." This is simply not true.

The link in the above paragraph originally went to a nebulous Indiana University web page and eventually became a "file not found." The source of the 2007 Physics World paper remained elusive. The subject came up again about a week ago on Twitter and a follower, @TirathPatelMD, sent me a link to the full text.

Friday, March 17, 2017

Brief summary of 2017 residency match data

Here are some snippets from the NRMP Advance Data Tables for the 2017 Main Residency Match.

The number of PGY-1 positions offered was the highest total ever. US allopathic medical school seniors in the match numbered 18,539, which is also a new high. Only 5.7% of US seniors failed to match. That was a slightly lower percentage compared to 2016 and 2015.

The numbers were not as good for previous graduates of US allopathic medical schools with only 46% of 1472 applicants matching. Osteopathic graduates fared better with 81.7% of 3590 applicants matching.

I have blogged about the prospects for international medical school graduates. Of the 5069 US citizen graduates of international medical schools, 54.8% matched—a rate consistent with the totals for the last four years.

Wednesday, March 15, 2017

Nonoperative treatment of appendicitis in children: Is it safe?

After writing my 21st post about appendicitis back in November, I swore I would not write about it again for the foreseeable future.

Well, the future is now because investigators from the United Kingdom and Canada just published a meta-analysis including 10 papers and 413 children about the efficacy and safety of nonoperative treatment for appendicitis in children.

They concluded that nonoperative management is effective in 96% of children with acute uncomplicated appendicitis during their initial hospitalizations with just 17 (4%) children requiring appendectomy before discharge. An additional 68 (16.4%) developed recurrent appendicitis later, and 19 of these patients were treated with the second course of antibiotics. The other 49 underwent appendectomy with histologic evidence of recurrent appendicitis.

Another 11 patients underwent appendectomy in the follow-up period for various reasons. In all, 77 (18.6%) patients initially treated with antibiotics eventually underwent appendectomy.

Although the initial hospital length of stay for appendectomy was shorter than that of patients treated with antibiotics, complication rates were similar.

These findings were met with headlines like "Antibiotics, not surgery, could treat appendicitis in children, study suggests" from The Guardian and "Is Surgery Always Needed for Kids' Appendicitis?" from US News.

What are the problems with this paper?