BACKGROUND: The selection of residents for any program and their evaluation for success is an inexact science. Errors can prove costly, disruptive, and potentially damaging to training programs, and personal and professional setbacks can occur for resident applicants. A method was sought to determine the intangible characteristics of applicants to a general surgery residency program, particularly an assessment of behavior and motivation. The hypothesis was that such information could contribute to a more objective analysis of how well an applicant might fit into a program and its culture, and therefore improve the residents' chance for success and reduce the attrition rate.METHODS: Applications were screened by the Program Director and selection committee according to departmental standards. Those applicants who were offered the opportunity for interview were asked to complete an on-line survey that assessed behavioral style, intrinsic motivators, and dimensional balance. The assessment is known as the TriMetrix Personal Talent Report (TriMetrix; Target Training International, Ltd; TTI, Phoenix, AZ). An initial job. benchmark was constructed from data based on surveys of current residents and faculty, and from interviews held with Subject Matter Experts (SMEs) familiar with the demands of the position and the qualities necessary for success. Resident selection was carried out as has been done historically within the program. An independent contractor, who was blinded to the ranking by the program, presented an applicant list based on the candidate's Personal Talent Reports against the job benchmark. The ranking lists were then compared.RESULTS: Of the 535 applications received, interviews were offered to 112, and 77 interviews were conducted. Seventy-five online TriMetrix (TTI) assessments were completed by the applicants. Rank lists developed independently by the program and by the consultant were compared, with obvious discrepancies. Overall there was little concordance between the two lists, suggesting that the TriMetrix (TTI) assessment measures something different. The job benchmark identified different behavioral styles among the most successful of the current residents, suggesting that a diversity of natural behavior does not preclude success in the program.CONCLUSIONS: Objective data regarding an individual's personal style can be used to identify applicants who match with a training program's job benchmark. Factors predictive of success specific to our program include an independent desire for knowledge, a commitment to the service of others, and a view of the world with a sense of direction and purpose. The diversity of our current residents' styles as identified by this analysis indicates that many different individuals can be successful. While the instrument can provide important information regarding elements that contribute to successful performance, it is weighted as one essential component utilized in conjunction with other tools. (J Surg 68:534-541. (C) 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.

We performed a retrospective chart review of trauma patients admitted to Palmetto Richland Memorial Hospital and identified 63 cases of adrenal insufficiency along with 65 trauma patient controls. Two statistical models, a neural network and a multiple logistic regression, were developed to predict patients with increased risk of developing adrenal insufficiency. Each model had 11 selected independent variables, along with patient demographic data, to make a probabilistic prediction of patient outcome. The neural network model was trained with 102 patients to identify linear and nonlinear relationships that could yield a predictive capability. The neural network achieved an accuracy of 71 per cent. The logistic regression model achieved an accuracy of 82 per cent. With these models, we have shown the feasibility of a method to more accurately screen patients with an increased risk of adrenal insufficiency. This ability should allow earlier identification and treatment of patients with adrenal insufficiency. Further development with a larger database is needed to improve the accuracy of the present models.

Background: Syncope occasionally occurs in trauma patients. The most appropriate and cost-effective evaluation for such patients is unknown,Methods: Trauma patients admitted to a Level I trauma center with a diagnosis of syncope or possible syncope between 1988 and 1994 were reviewed. History, physical examination, and past medical history were noted, as were the results of tests done as part of the syncope evaluation.Results: Eighty-eight patients were reviewed; 45% had been injured in falls. Thirteen patients who remembered their entire injury and denied syncope as a cause had negative evaluations. History, physical examination, and admission laboratory values were helpful in diagnosis 59% of the time. Subsequent evaluation provided useful diagnostic information 30% of the time, No patients with normal admission electrocardiograms (EKGs) had cardiac causes for their syncope,Conclusions: (1) Patients with possible syncope without loss of consciousness require no further evaluation, (2) A cerebrovascular evaluation should be the initial diagnostic approach in patients with signs and symptoms suggestive of stroke or transient ischemic attack, (3) Possible syncope patients with normal admission EKGs should undergo computed tomography of the head and electroencephalography, Those with abnormal EKGs should undergo echocardiography.

Objective: To assess short-term and long-term complication rates after trauma laparotomy in a group of health maintenance organization (Kaiser Permanante) patients.Design: Retrospective cohort study of patients belonging to Kaiser Permanente.Materials and Methods: Eighty Kaiser patients who underwent a negative or nontherapeutic laparotomy for trauma at a Level I trauma center (University of California, Davis Medical Center (UCDMC)) between April 1989 and Mag 1994 were identified, Demographic data, past medical history, mechanism of injury, indications for surgery, findings at laparotomy, and short-term complications were abstracted from the UCDMC record. Long-term complications were taken from the Kaiser record.Measurements: Long-term complications, including small bowel obstruction, hernia, and cosmesis. Short-term complications, including pneumonia, cellulitis, wound infection, prolonged ileus, and urinary tract infection.Results: The single death in the early postoperative period was not related to the laparotomy. Mean follow-up was 36 +/- 2 months (median, 36 months); 86% had follow-up of at least 1 year. The incidence of short-term complications was 43% in patients with associated extra-abdominal injuries and 20% in patients without associated extra-abdominal injuries (p = 0.17). On long-term follow-up, there were no small bowel obstructions, incisional hernias, or cosmetic problems requiring correction. One patient developed a stitch abscess 6 weeks after the operation.Conclusions: The incidence of long-term complications after negative or nontherapeutic laparotomy for trauma is low.