Fake News and Post-Submission Blues

Plus: Quality Over Quantity for Surgical Self-Efficacy

Author

Kyan Lynch
September 22, 2024 • Estimated Reading Time: 8 minutes

👋Hey, it's Ky. I'm so glad to have you in the MedEdge community.

As always, this week’s Newsletter is in SOAP note format:

Subjective: Match Season is Upon Us

On September 13th, the US-based National Residency Matching Program (NRMP) issued an unusual statement.

It begins:

The NRMP has been made aware of a statement, purportedly released by the NRMP, regarding “integrity screening” and the use of AI-generated content in residency applications that has been circulated on social media. This statement is fake and was not issued by the NRMP.

The NRMP

Here’s an image of the referenced fake statement:

Fake Statement Circulated on Social Media

The origin of this fake is unknown, but its intent is fairly obvious.

The “statement” advises Program Directors to screen international medical graduate (IMG) applicants for the use of artificial intelligence in their applications. The forgery goes on to allege (without evidence) that IMG use of AI has led to a disproportionate “Do Not Rank” rate, supposedly due to applications being written with greater English proficiency than could be demonstrated during live video interviews.

Fortunately, the legitimacy of the letter was questioned quickly, and the NRMP’s official statement put the issue to rest.

But this episode reflects the high-stakes nature of the residency application process and the immense pressure applicants are under.

Here are a few (much more lighthearted) examples:

Comedian Patton Oswalt credits his late wife, Michelle McNamara, with originating this quote:

❝

It’s chaos. Be kind.

That advice is always good. It may be particularly applicable to Match season.

Objective: Quality Over Quantity for Surgical Self-Efficacy

How ready are new surgical graduates for independent practice?

That’s a question that’s gotten a lot of attention in recent years:

  • Mattar et al. (2013)

    • Survey of Surgical Fellowship Directors:

      • 30% of first-year fellows couldn’t perform basic procedures independently (e.g., laparoscopic cholecystectomy).

      • 38% lacked patient ownership.

      • 66% couldn’t operate unsupervised for 30 minutes during major procedures.

  • Wright el al. (2022)

    • Survey of Gynecological Surgery Fellowship Directors:

      • 20% of fellows could perform a vaginal hysterectomy independently.

      • 46% could perform an abdominal hysterectomy.

      • 34% could handle basic hysteroscopic procedures.

  • Howard et al. (2024)

    • New surgeons had a higher risk of complications and mortality than experienced surgeons. The relative risk (RR) of mortality in the first year of practice was 1.17, compared to 15-year veterans.

Yikes.

So, when data from the 2020 American Board of Surgery In-Training Examination (ABSITE) revealed that only 7.7% of graduating surgical residents were confident in their ability to perform 10 common general surgery operations without attending supervision, people started asking some questions.

Dr. Rachel Jensen and her colleagues went looking for some answers and recently published their results in the Journal of Graduate Medical Education (June 2024).

Article Title: Looking Beyond the Numbers: A Comparison of Operative Self-Efficacy, Supervision, and Case Volume in General Surgery Residency

Study Overview: The study compared residents' self-efficacy, their level of operative independence (as rated by both residents and supervisors in the SIMPL app), and case logs.

What is Self-Efficacy?
Self-efficacy, a concept introduced by cognitive psychologist Albert Bandura, is an individual’s belief in their ability to accomplish specific tasks or goals. In the context of surgery, it refers to a resident's confidence in their ability to perform procedures independently.

Key Findings:

  • Correlation with Independence: Higher levels of attending-reported operative independence were significantly associated with greater self-efficacy.

  • Case Volume: While logging more cases was helpful, the correlation did not reach statistical significance.

👉 Key Takeaways
🗝️ Self-efficacy is crucial for surgical residents' transition to independent practice.

🗝️ Improving the quality of operative experience is more effective than increasing the quantity of cases.

How do we increase autonomy for trainees? That’s the million-dollar question.

Assessment: Quick Quiz!

Note: The results are anonymous - no one will know if you get it right or not!

As of 2022, what percentage of US medical students use non-institution-created online videos and resources for daily or weekly study?

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⏪Last Week’s Question:

Even after accounting for factors such as specialty and experience, what is the current gender pay gap for physicians in the US, as noted by the AAMC?

Answer: 25%

Plan: Upcoming Dates & Events

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P.S - Have you ever thought about sharing your expertise more widely, and even earning extra income doing so? If so, you’ll love the freebies I have for you on my website, kyanlynch.com