The Journal of the American College of Surgeons (JACS) had a strong year in 2021, anchored by high-quality manuscript submissions and keen reader interest. Following are summaries of the top five most-downloaded JACS articles in 2021. Access the related links to read some of the biggest articles of the year.
“US Medical Licensing Exam Performance and American Board of Surgery Qualifying and Certifying Examinations”
Background
Program directors use US Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022.
Conclusions
USMLE Step 1 and Step 2 CK (Clinical Knowledge) examination scores correlate with ABS QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS exam performance for ranking applicants.
“Imposter Syndrome in Surgical Trainees: Clance Imposter Phenomenon Scale Assessment in General Surgery Residents”
Background
Imposter syndrome occurs when high-achieving individuals have a pervasive sense of self doubt combined with fear of being exposed as a fraud, despite objective measures of success. This threatens mental health and well-being. The prevalence and severity of imposter syndrome has not been studied among general surgery residents on a large scale. The primary outcomes of this study were the prevalence and severity of imposter syndrome.
Conclusions
Imposter syndrome is prevalent among general surgery residents, with 76% of residents reporting either significant or severe imposter syndrome. There were no predictive characteristics based on demographics or academic achievement, suggesting that there is something either inherent to individuals who choose general surgery training or the general surgery training culture that leads to such substantive levels of imposter syndrome.
“Survey of American College of Surgeons Members on Firearm Injury Prevention”
Background
Firearm-related injuries and deaths continue to be a substantial public health burden in the US. The purpose of this study was to describe the results of a survey of US members of the American College of Surgeons (ACS) on their practices, attitudes, and beliefs about firearms and firearm policies. The survey was designed to gain a representative understanding of the views of all US ACS members to help inform ACS positions related to firearm injury prevention.
Conclusions
There is broad support among ACS members for many initiatives related to firearm injury prevention. The degree of support for these measures varies based on both the specific initiative and demographic characteristics. The results align with the ACS strategy of healthcare professionals working together to better understand and address the root causes of violence and simultaneously working together to make firearm ownership as safe as reasonably possible.
“Timing of Perioperative Pharmacologic Thromboprophylaxis Initiation and Its Effect on Venous Thromboembolism and Bleeding Outcomes: A Systematic Review and Meta-Analysis”
Background
Perioperative thromboprophylaxis guidelines offer conflicting recommendations on when to start thromboprophylaxis. As a result, there is considerable variation in clinical practice, which can lead to worse patient outcomes. The objective of this study was to evaluate the association between the start time of perioperative thromboprophylaxis with venous thromboembolism (VTE) and bleeding outcomes.
Conclusions
This meta-analysis found a nonstatistically significant decrease in the rate of VTE and an increase in the rate of bleeding when thromboprophylaxis was initiated preoperatively rather than postoperatively.
“Firearm Storage Practices of US Members of the American College of Surgeons”
Background
As a part of its firearm injury prevention action plan, the ACS surveyed the entire US ACS membership regarding individual members’ knowledge, experience, attitudes, degree of support for ACS Committee on Trauma (COT) firearm programs, and degree of support for a range of firearm injury prevention policies. This survey included questions regarding members’ prevalence of firearm ownership, type of firearm(s) owned, type of firearm(s) in the home, personal reasons for firearm ownership, and methods of firearm/ammunition storage.
Conclusions
A significant percentage of ACS members keep firearms in their home, and nearly one-third store firearms in an unlocked and loaded fashion. Safe storage is a basic tenet of responsible firearm ownership. These data present opportunities for engaging surgeons in efforts to improve safe firearm storage.
