Arghavan Salles

All Publications

• Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures. JAMA surgery Wallis, C. J., Jerath, A., Aminoltejari, K., Kaneshwaran, K., Salles, A., Buntin, M. B., Coburn, N. G., Wright, F. C., Gotlib Conn, L., Heybati, K., Luckenbaugh, A. N., Ranganathan, S., Riveros, C., McCartney, C., Armstrong, K. A., Bass, B. L., Detsky, A. S., Satkunasivam, R. 2023

  Abstract

  Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon's sex.To examine the association between surgeon sex and health care costs among patients undergoing surgery.This population-based, retrospective cohort study included adult patients undergoing 1 of 25 common elective or emergent surgical procedures between January 1, 2007, and December 31, 2019, in Ontario, Canada. Analysis was performed from October 2022 to March 2023.Surgeon sex.The primary outcome was total health care costs assessed 1 year following surgery. Secondarily, total health care costs at 30 and 90 days, as well as specific cost categories, were assessed. Generalized estimating equations were used with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female and male surgeons, with further adjustment for patient-, surgeon-, anesthesiologist-, hospital-, and procedure-level covariates.Among 1 165 711 included patients, 151 054 were treated by a female surgeon and 1 014 657 were treated by a male surgeon. Analyzed at the procedure-specific level and accounting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates, 1-year total health care costs were higher for patients treated by male surgeons ($24 882; 95% CI, $20 780-$29 794) than female surgeons ($18 517; 95% CI, $16 080-$21 324) (adjusted absolute difference, $6365; 95% CI, $3491-9238; adjusted relative risk, 1.10; 95% CI, 1.05-1.14). Similar patterns were observed at 30 days (adjusted absolute difference, $3115; 95% CI, $1682-$4548) and 90 days (adjusted absolute difference, $4228; 95% CI, $2255-$6202).This analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce.

  View details for DOI 10.1001/jamasurg.2023.6031

  View details for PubMedID 38019486

• Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study. BMJ (Clinical research ed.) Wallis, C. J., Jerath, A., Ikesu, R., Satkunasivam, R., Dimick, J. B., Orav, E. J., Maggard-Gibbons, M., Li, R., Salles, A., Klaassen, Z., Coburn, N., Bass, B. L., Detsky, A. S., Tsugawa, Y. 2023; 383: e075484

  Abstract

  OBJECTIVE: To determine whether patient-surgeon gender concordance is associated with mortality of patients after surgery in the United States.DESIGN: Retrospective observational study.SETTING: Acute care hospitals in the US.PARTICIPANTS: 100% of Medicare fee-for-service beneficiaries aged 65-99 years who had one of 14 major elective or non-elective (emergent or urgent) surgeries in 2016-19.MAIN OUTCOME MEASURES: Mortality after surgery, defined as death within 30 days of the operation. Adjustments were made for patient and surgeon characteristics and hospital fixed effects (effectively comparing patients within the same hospital).RESULTS: Among 2902756 patients who had surgery, 1287845 (44.4%) had operations done by surgeons of the same gender (1201712 (41.4%) male patient and male surgeon, 86133 (3.0%) female patient and female surgeon) and 1614911 (55.6%) were by surgeons of different gender (52944 (1.8%) male patient and female surgeon, 1561967 (53.8%) female patient and male surgeon). Adjusted 30 day mortality after surgery was 2.0% for male patient-male surgeon dyads, 1.7% for male patient-female surgeon dyads, 1.5% for female patient-male surgeon dyads, and 1.3% for female patient-female surgeon dyads. Patient-surgeon gender concordance was associated with a slightly lower mortality for female patients (adjusted risk difference -0.2 percentage point (95% confidence interval -0.3 to -0.1); P<0.001), but a higher mortality for male patients (0.3 (0.2 to 0.5); P<0.001) for elective procedures, although the difference was small and not clinically meaningful. No evidence suggests that operative mortality differed by patient-surgeon gender concordance for non-elective procedures.CONCLUSIONS: Post-operative mortality rates were similar (ie, the difference was small and not clinically meaningful) among the four types of patient-surgeon gender dyads.

  View details for DOI 10.1136/bmj-2023-075484

  View details for PubMedID 37993130

• Psychosocial Burdens Associated With Family Building Among Physicians and Medical Students. JAMA internal medicine Levy, M. S., Kelly, A. G., Mueller, C., Brown, A. D., Caban-Martinez, A. J., Arora, V. M., Salles, A. 2023

  View details for DOI 10.1001/jamainternmed.2023.2570

  View details for PubMedID 37486671

• Stigma Associated With Requesting Accommodations-the High Cost of Ableism in Medicine. JAMA network open Roy-O'Reilly, M., Salles, A. 2023; 6 (5): e2312131

  View details for DOI 10.1001/jamanetworkopen.2023.12131

  View details for PubMedID 37166805

• When Do Medical Societies Take a Stand on Abortion? Journal of general internal medicine Levy, M. S., Fishbach, S., Salles, A., Arora, V. M. 2022

  View details for DOI 10.1007/s11606-022-07867-w

  View details for PubMedID 36323828

• Debunking Four Common Gender Equity Myths EUROPEAN UROLOGY Malik, R. D., Salles, A. 2022; 81 (6): 552-554

  View details for DOI 10.1016/j.eururo.2022.02.0190302-2838

  View details for Web of Science ID 000807833300003

• Abortion Among Physicians. Obstetrics and gynecology Levy, M. S., Arora, V. M., Talib, H., Jeelani, R., Duke, C. M., Salles, A. 2022; 139 (5): 910-912

  View details for DOI 10.1097/AOG.0000000000004724

  View details for PubMedID 35576350

• Debunking Four Common Gender Equity Myths. European urology Malik, R. D., Salles, A. 2022

  Abstract

  To improve the quality of urologic care delivered to our patients, it is imperative to address and reduce existing gender disparities. This begins by debunking myths that perpetuate these disparities and working together to create meaningful systemic change, including how we hire, retain, promote, and support women.

  View details for DOI 10.1016/j.eururo.2022.02.019

  View details for PubMedID 35277290

• Institutional imperatives for the advancement of women in medicine and science through the COVID-19 pandemic. Lancet (London, England) Salles, A., Jagsi, R. 2021

  View details for DOI 10.1016/S0140-6736(21)01912-7

  View details for PubMedID 34450081

• Unpacking the Status-Leveling Burden for Women in Male-Dominated Occupations ADMINISTRATIVE SCIENCE QUARTERLY Cardador, M., Hill, P. L., Salles, A. 2021

  View details for DOI 10.1177/00018392211038505

  View details for Web of Science ID 000686975600001

• Everyone Must Address Anti-Black Racism in Health Care: Steps for Non-Black Health Care Professionals to Take. JAMA Salles, A., Arora, V. M., Mitchell, K. 2021; 326 (7): 601-602

  View details for DOI 10.1001/jama.2021.11650

  View details for PubMedID 34402822

• Everyone Must Address Anti-Black Racism in Health Care Steps for Non-Black Health Care Professionals to Take JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Salles, A., Arora, V. M., Mitchell, K. 2021; 326 (7): 601-602

  View details for Web of Science ID 000691480300009

• Queen Bee phenomenon: a consequence of the hive. Lancet (London, England) Salles, A., Choo, E. K. 2020; 395 (10228): 940

  View details for DOI 10.1016/S0140-6736(20)30597-3

  View details for PubMedID 32199482

• Queen Bee phenomenon: a consequence of the hive LANCET Salles, A., Choo, E. K. 2020; 395 (10228): 940

  View details for Web of Science ID 000521744600015

• Physician Fertility: A Call to Action. Academic medicine : journal of the Association of American Medical Colleges Marshall, A. L., Arora, V. M., Salles, A. 2019

  Abstract

  Infertility is more prevalent in female physicians than in the U.S. general population. While pregnancy and its potential medical and career development consequences among physicians have been explored in the literature, infertility and its consequences remain understudied and unaddressed. Fertility issues are important for all physicians hoping to start families, including male physicians, transgender physicians, single physicians, and physicians with same-sex partners.Infertility has numerous physical, emotional, and financial consequences and may have a negative impact on physician well-being. Options to preserve fertility (such as egg, embryo, and sperm cryopreservation) are available, yet physicians may not be aware of or have the financial ability to make use of such resources. Physician reproductive health, including the ability to build a family if and when a physician chooses, is a vital aspect of well-being. The risks and consequences of infertility and the management of fertility should be studied and addressed from policy and advocacy standpoints.The authors, who have experienced and sought treatment for infertility, bring attention to the challenges around both physician infertility and preservation of fertility. They propose three strategies to address physician infertility: increasing fertility education and awareness starting at the undergraduate medical education level and continuing throughout training and practice; providing insurance coverage for and access to fertility assessment and management; and offering support for those undergoing fertility treatments. The authors believe that implementing these suggestions would make a significant positive impact on trainees and practicing physicians and help build a health care workforce that is healthy and well physically, emotionally, and financially.

  View details for DOI 10.1097/ACM.0000000000003079

  View details for PubMedID 31738214

• Representation of women in speaking roles at surgical conferences. American journal of surgery Gerull, K. M., Wahba, B. M., Goldin, L. M., McAllister, J., Wright, A., Cochran, A., Salles, A. 2019

  Abstract

  BACKGROUND: There are a number of factors that may hinder women's surgical careers. Here, we focus on one possible factor: the representation of women at surgical conferences.METHODS: Using a purposive sample of 16 national surgical societies, we assessed the proportion of women speakers at each society's annual meeting in plenary speaker and session speaker (panelist and moderator) roles in 2011 and 2016.RESULTS: Overall, 23.8% (28,591/120,351) of all society members were women. Of the 129 plenary speakers, 19.4% (n = 25) were women. Twelve conferences (42.9%) had zero women as plenary speakers. Of the 5,161 session speakers, 1,120 (21.7%) were women. Three-hundred fifty-three (39.5%) of the 893 panels included only male speakers. The proportion of women on conference organizing committees was positively correlated with having women session speakers (r = 0.71, p=<0.001) CONCLUSIONS: There is underrepresentation of women as conference speakers, particularly in plenary roles. There was wide variability in the representation of women across conferences.

  View details for DOI 10.1016/j.amjsurg.2019.09.004

  View details for PubMedID 31530377

• Recognizing and Reacting to Microaggressions in Medicine and Surgery. JAMA surgery Torres, M. B., Salles, A., Cochran, A. 2019

  Abstract

  Diversity and inclusion in medicine, and in surgery in particular, still merit substantial attention in 2019. With each increase in academic rank there are fewer women, with only 24% of full professors in medicine being women. Underrepresented minorities face similar challenges, with only 3% of medical faculty being black and 4% of medical faculty being Hispanic or Latino; only 2% of full professors are Hispanic or Latino and only another 2% are black. Explicit discrimination unfortunately still does exist, but in many environments, more subtle forms of bias are more prevalent. Microaggressions, which are categorized as microassaults, microinsults, microinvalidations, and environmental microaggressions, are indirect expressions of prejudice that contribute to the maintenance of existing power structures and may limit the hiring, promotion, and retention of women and underrepresented minorities. The primary goal of this communication is to help readers understand microaggressions and their effect. We also provide suggestions for how recipients or bystanders may respond to microaggressions.

  View details for DOI 10.1001/jamasurg.2019.1648

  View details for PubMedID 31290954

• Estimating Implicit and Explicit Gender Bias Among Health Care Professionals and Surgeons. JAMA network open Salles, A., Awad, M., Goldin, L., Krus, K., Lee, J. V., Schwabe, M. T., Lai, C. K. 2019; 2 (7): e196545

  Abstract

  The Implicit Association Test (IAT) is a validated tool used to measure implicit biases, which are mental associations shaped by one's environment that influence interactions with others. Direct evidence of implicit gender biases about women in medicine has yet not been reported, but existing evidence is suggestive of subtle or hidden biases that affect women in medicine.To use data from IATs to assess (1) how health care professionals associate men and women with career and family and (2) how surgeons associate men and women with surgery and family medicine.This data review and cross-sectional study collected data from January 1, 2006, through December 31, 2017, from self-identified health care professionals taking the Gender-Career IAT hosted by Project Implicit to explore bias among self-identified health care professionals. A novel Gender-Specialty IAT was also tested at a national surgical meeting in October 2017. All health care professionals who completed the Gender-Career IAT were eligible for the first analysis. Surgeons of any age, gender, title, and country of origin at the meeting were eligible to participate in the second analysis. Data were analyzed from January 1, 2018, through March 31, 2019.Measure of implicit bias derived from reaction times on the IATs and a measure of explicit bias asked directly to participants.Almost 1 million IAT records from Project Implicit were reviewed, and 131 surgeons (64.9% men; mean [SD] age, 42.3 [11.5] years) were recruited to complete the Gender-Specialty IAT. Healthcare professionals (n = 42 991; 82.0% women; mean [SD] age, 32.7 [11.8] years) held implicit (mean [SD] D score, 0.41 [0.36]; Cohen d = 1.14) and explicit (mean [SD], 1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family. Similarly, surgeons implicitly (mean [SD] D score, 0.28 [0.37]; Cohen d = 0.76) and explicitly (men: mean [SD], 1.27 [0.39]; Cohen d = 0.93; women: mean [SD], 0.73 [0.35]; Cohen d = 0.53) associated men with surgery and women with family medicine. There was broad evidence of consensus across social groups in implicit and explicit biases with one exception. Women in healthcare (mean [SD], 1.43 [1.86]; Cohen d = 0.77) and surgery (mean [SD], 0.73 [0.35]; Cohen d = 0.53) were less likely than men to explicitly associate men with career (B coefficient, -0.10; 95% CI, -0.15 to -0.04; P < .001) and surgery (B coefficient, -0.67; 95% CI, -1.21 to -0.13; P = .001) and women with family and family medicine.The main contribution of this work is an estimate of the extent of implicit gender bias within surgery. On both the Gender-Career IAT and the novel Gender-Specialty IAT, respondents had a tendency to associate men with career and surgery and women with family and family medicine. Awareness of the existence of implicit biases is an important first step toward minimizing their potential effect.

  View details for DOI 10.1001/jamanetworkopen.2019.6545

  View details for PubMedID 31276177

• Assessing gender bias in qualitative evaluations of surgical residents AMERICAN JOURNAL OF SURGERY Gerull, K. M., Loe, M., Seiler, K., McAllister, J., Salles, A. 2019; 217 (2): 306–13

  View details for DOI 10.1016/j.amjsurg.2018.09.029

  View details for Web of Science ID 000454787500020

  View details for PubMedID 30343879

• Stereotype threat and working memory among surgical residents AMERICAN JOURNAL OF SURGERY Milam, L. A., Cohen, G. L., Mueller, C., Salles, A. 2018; 216 (4): 824–29

  Abstract

  Stereotype threat is a situational threat in which a member of a stereotyped group fears conforming to a negative stereotype. In this study, we examined the impact of stereotype threat on surgical performance and working memory among surgical residents.Residents at one institution were randomized to either the threat condition or the no-threat condition. We administered the Vandenberg Mental Rotation Test and the reading span task to assess residents' mental rotation and working memory, respectively.102 residents participated in this study (response rate 61%). In multivariable analysis, we found significant gender differences. Men outperformed women in mental rotation, and women outperformed men in working memory. There was no effect of condition on performance on the mental rotation or working memory test.No effect of condition on either test suggests that high-achieving women may be less susceptible to stereotype threat. This could be due to self-selection or adapted resilience, or women in this context may be more qualified to reach the same level of achievement as their male colleagues.

  View details for PubMedID 30249337

• Social Belonging as a Predictor of Surgical Resident Well-being and Attrition. Journal of surgical education Salles, A., Wright, R. C., Milam, L., Panni, R. Z., Liebert, C. A., Lau, J. N., Lin, D. T., Mueller, C. M. 2018

  Abstract

  OBJECTIVE: In light of the predicted shortage of surgeons, attrition from surgical residency is a significant problem. Prior data have shown that those who are happier are more productive, and those who are less well have higher rates of absenteeism. This study sought to identify the role of social belonging and its relationship to well-being and risk of attrition.DESIGN: Surgical residents were invited to participate in an online survey containing measures of social belonging (a 10-item scale adapted from previous studies), well-being (the Dupuy Psychological General Well-Being Scale, Beck Depression Inventory Short Form, and Maslach Burnout Inventory), and risk of attrition (indicated by frequency of thoughts of leaving the program).SETTING: We surveyed residents at 2 tertiary care centers, Stanford Health Care (2010, 2011, and 2015) and Washington University in St. Louis (2017).PARTICIPANTS: Categorical general surgery residents, designated preliminary residents going into 7 surgical subspecialties, and nondesignated preliminary residents were included.RESULTS: One hundred sixty-nine residents responded to the survey for a response rate of 66%. Belonging was positively correlated with general psychological well-being (r = 0.56, p < 0.0001) and negatively correlated with depression (r = -0.57, p < 0.0001), emotional exhaustion (r = -0.58, p < 0.0001), and depersonalization (r = -0.36, p < 0.0001). Further, belonging was negatively correlated with frequency of thoughts of leaving residency (r = -0.45, p < 0.0001). In regression analysis controlling for demographic variables, belonging was a significant positive predictor of psychological well-being (B = 0.95, t = 8.18, p < 0.0001) and a significant negative predictor of thoughts of leaving (B = -1.04, t = -5.44, p < 0.0001).CONCLUSIONS: Social belonging has a significant positive correlation with well-being and negative correlation with thoughts of leaving surgical training. Lack of social belonging appears to be a significant predictor of risk of attrition in surgical residency. Efforts to enhance social belonging may protect against resident attrition.ACGME COMPETENCY: Interpersonal and Communication Skills.

  View details for DOI 10.1016/j.jsurg.2018.08.022

  View details for PubMedID 30243929

• The relationship between perceived gender judgment and well-being among surgical residents AMERICAN JOURNAL OF SURGERY Salles, A., Milam, L., Cohen, G., Mueller, C. 2018; 215 (2): 233–37

  Abstract

  Physician well-being is a significant problem. Here we explore whether one factor, a resident's concern for being judged by one's gender, influences well-being.Over two years at one institution, we surveyed surgical residents on validated measures of well-being as well as the extent to which they felt they were judged because of their gender (gender judgment). We used correlations and linear regression to investigate the relationships between gender judgment and well-being.There were 193 unique respondents (87% response rate). Women had significantly more concerns about gender judgment than men (M = 2.39, SD = 0.73 vs. M = 1.46, SD = 0.62, t = -9.47, p < 0.00001). In regression analyses, gender judgment concerns were significantly associated with all three well-being outcomes (Bs -0.34, 0.50, and 0.39, respectively for well-being, emotional exhaustion, and depersonalization, all p < 0.013).The degree to which residents, both male and female, are concerned about being judged for their gender is significantly associated with worse well-being.

  View details for PubMedID 29223304

• Perceived Value of a Program to Promote Surgical Resident Well-being. Journal of surgical education Salles, A., Liebert, C. A., Esquivel, M., Greco, R. S., Henry, R., Mueller, C. 2017

  Abstract

  The demands of surgical residency are intense and threaten not only trainees' physical wellness, but also risk depression, burnout, and suicide. Our residency program implemented a multifaceted Balance in Life program that is designed to improve residents' well-being. The purpose of this study was to evaluate the program utilization and perceived value by residents.Residents (n = 56, 76% response rate) were invited to participate in a voluntary survey from December 2013 to February 2014 regarding utilization, barriers to use, and perceived value of 6 program components (refrigerator, After Hours Guide, psychological counseling sessions, Resident Mentorship Program, Class Representative System, and social events). They were also asked questions about psychological well-being, burnout, grit, and sleep and exercise habits before and after implementation of the program.The most valued components of the program were the refrigerator (mean = 4.61) and the psychological counseling sessions (mean = 3.58), followed by social events (mean = 3.48), the Resident Mentorship Program (mean = 2.79), the Class Representative System (mean = 2.62), and the After Hours Guide (mean = 2.10). When residents were asked how they would allocate $100 among the different programs, the majority was allocated to the refrigerator ($54.31), social events ($26.43), and counseling sessions ($24.06). There was no change in psychological well-being or burnout after the program. Residents had higher levels of grit (β = 0.26, p < 0.01) and exercised (β = 1.02, p < 0.001) and slept (β = 1.17, p < 0.0001) more after the program was implemented.This study demonstrated that a multifaceted program to improve the well-being of trainees is feasible, highly valued, and positively perceived by the residents. Further research is needed to quantify the effectiveness and longitudinal impact such a program has on resident depression, burnout, and other psychological factors.

  View details for DOI 10.1016/j.jsurg.2017.04.006

  View details for PubMedID 28457875

• Exploring the Relationship Between Stereotype Perception and Residents' Well-Being JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Salles, A., Mueller, C. M., Cohen, G. L. 2016; 222 (1): 52-58

  Abstract

  Medicine has historically been a male-dominated field, and there remains a stereotype that men are better physicians than women. For female residents, and in particular female surgical residents, chronically contending with this stereotype can exact a toll on their psychological health. The objective of this study was to determine the relationship between women surgeons' psychological health and their perception of other people's endorsement of the stereotype (stereotype perception).This is a correlational study based on survey data collected from 14 residency programs at one medical center from September 2010 to March 2011. The participants were 384 residents (representing an 80% response rate). The main survey measures were the Dupuy Psychological General Well-Being Scale and the Maslach Burnout Inventory.Among female surgical residents, we found that those with higher degrees of stereotype perception had poorer psychological health than those with lower degrees of stereotype perception (β = -0.44, p = 0.002). For men, there was no relationship between stereotype perception and psychological health (β = 0.015; p = 0.92). Among nonsurgeons, there was no relationship between stereotype perception and psychological health for either women or men (β = -0.016; p = 0.78; β = -0.0050; p = 0.97, respectively).The data suggest that women in surgical training, but not men, can face a stressor--stereotype perception--that is negatively associated with their psychological health. This same relationship does not seem to exist for women in nonsurgical training programs. Efforts should be made to further understand this relationship and investigate possible interventions to level the playing field for male and female surgical trainees.

  View details for DOI 10.1016/j.jamcollsurg.2015.10.004

  View details for Web of Science ID 000367097300006

  View details for PubMedID 26616033

  View details for PubMedCentralID PMC4862580

• "Women's work": Gender and the physician workforce. Social science & medicine (1982) Temkin, S. M., Salles, A., Barr, E., Leggett, C. B., Reznick, J. S., Wong, M. S. 2024; 351 Suppl 1: 116556

  Abstract

  Historically, the physician professional identity and the organizational structure of Western medicine have been defined by masculine norms such as authority and assertiveness. The past five decades have seen a rapid shift in the demographics of attendees as medical schools, with equal numbers of women and men matriculants for nearly twenty years. Gender as a social, cultural, and structural variable continues to influence the physician workforce. The entry of women into medicine, has had far reaching effects on the expectations of patients, the interactions of physicians with other members of the healthcare team, and the delivery of care. Redefining the culture of medicine to accommodate the diversity of the modern workforce may benefit all physician and improve the delivery of healthcare.

  View details for DOI 10.1016/j.socscimed.2023.116556

  View details for PubMedID 38825379

• Barriers to Family Building Among Physicians and Medical Students. JAMA network open King, Z., Zhang, Q., Liang, J. W., Levy, M. S., Plowden, T. C., Jeelani, R., Marshall, A. L., Barnett, R., Caban-Martinez, A. J., Brown, A., Mueller, C. M., Brown-Johnson, C., Salles, A. 2023; 6 (12): e2349937

  Abstract

  Physicians and medical students who desire to build families face significant barriers due to the structure and culture of medicine.To understand the barriers and facilitators to family building for all people in medicine-not only individuals who can become pregnant-through an open-ended, qualitative analysis of survey responses.This qualitative study used a survey conducted in April and May 2021 with a broad sample of physicians and medical students. Participants were recruited through social media, targeting physician and medical student communities. Physicians (residents, fellows, and physicians in independent practice) and medical students of all gender identities and sexual orientations were included. Informed by a postpositivist approach, coding reliability thematic analysis was performed on 3 open-ended survey questions on family-building experiences (what they would do differently, what advice they have for others, and anything else they wished to share).Identified themes were mapped to the social-ecological model, a model used in public health to examine how a spectrum of factors is associated with health outcomes.A total of 2025 people (1860 [92%] women; 299 [15%] Asian, 151 [8%] Black, and 1303 [64%] White; 1730 [85%] heterosexual; and 1200 [59%] physicians who had completed training) responded to at least 1 of 3 open-ended questions. Themes mapped to social-ecological model levels included: (1) cultural, eg, medical training being at odds with family building; (2) organizational, eg, lack of institutional support for the range of family-building routes; (3) interpersonal, eg, impact of social support on family building; and (4) individual, eg, socioeconomic status and other individual factors that facilitate or inhibit family building. Recommendations to improve family-building experiences include implementing family-building curricula at medical schools, providing adequate parental leave for all physicians and medical students who become parents, and providing insurance coverage for all family-building routes.In this qualitative study of physicians and medical students, self-reported barriers to family building were identified at each level of the social-ecological model. Addressing these barriers is critical to creating a more equitable family-building environment for physicians and medical students.

  View details for DOI 10.1001/jamanetworkopen.2023.49937

  View details for PubMedID 38153730

• PUTTING NUMBERS BEHIND THE ANECDOTES: INFERTILITY AND PREGNANCY COMPLICATIONS AMONG PHYSICIANS AND MEDICAL STUDENTS. Rasouli, M. A., Brown, A. D., Zoroufy, A., Levy, M. S., Arora, V., Salles, A., Sinclair, T. J., Plowden, T. C. ELSEVIER SCIENCE INC. 2023: E127

  View details for Web of Science ID 001084670200295

• Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA surgery Wallis, C. J., Jerath, A., Aminoltejari, K., Kaneshwaran, K., Salles, A., Coburn, N., Wright, F. C., Gotlib Conn, L., Klaassen, Z., Luckenbaugh, A. N., Ranganathan, S., Riveros, C., McCartney, C., Armstrong, K., Bass, B., Detsky, A. S., Satkunasivam, R. 2023

  Abstract

  Importance: Sex- and gender-based differences in a surgeon's medical practice and communication may be factors in patients' perioperative outcomes. Patients treated by female surgeons have improved 30-day outcomes. However, whether these outcomes persist over longer follow-up has not been assessed.Objective: To examine whether surgeon sex is associated with 90-day and 1-year outcomes among patients undergoing common surgeries.Design, Setting, and Participants: A population-based retrospective cohort study was conducted in adults in Ontario, Canada, undergoing 1 of 25 common elective or emergent surgeries between January 1, 2007, and December 31, 2019. Analysis was performed between July 15 and October 20, 2022.Exposure: Surgeon sex.Main Outcomes and Measures: An adverse postoperative event, defined as the composite of death, readmission, or complication, was assessed at 90 days and 1 year following surgery. Secondarily, each of these outcomes was assessed individually. Outcomes were compared between patients treated by female and male surgeons using generalized estimating equations with clustering at the level of the surgical procedure, accounting for patient-, procedure-, surgeon-, anesthesiologist-, and facility-level covariates.Results: Among 1 165 711 included patients, 151 054 were treated by a female and 1 014 657 by a male surgeon. Overall, 14.3% of the patients had 1 or more adverse postoperative outcomes at 90 days and 25.0% had 1 or more adverse postoperative outcomes 1 year following surgery. Among these, 2.0% of patients died within 90 days and 4.3% died within 1 year. Multivariable-adjusted rates of the composite end point were higher among patients treated by male than female surgeons at both 90 days (13.9% vs 12.5%; adjusted odds ratio [AOR], 1.08; 95% CI, 1.03-1.13) and 1 year (25.0% vs 20.7%; AOR, 1.06; 95% CI, 1.01-1.12). Similar patterns were observed for mortality at 90 days (0.8% vs 0.5%; AOR 1.25; 95% CI, 1.12-1.39) and 1 year (2.4% vs 1.6%; AOR, 1.24; 95% CI, 1.13-1.36).Conclusions and Relevance: After accounting for patient, procedure, surgeon, anesthesiologist, and hospital characteristics, the findings of this cohort study suggest that patients treated by female surgeons have lower rates of adverse postoperative outcomes including death at 90 days and 1 year after surgery compared with those treated by male surgeons. These findings further support differences in patient outcomes based on physician sex that warrant deeper study regarding underlying causes and potential solutions.

  View details for DOI 10.1001/jamasurg.2023.3744

  View details for PubMedID 37647075

• Perceptions of Gender Stereotypes among Women Residents in Surgical and Nonsurgical Specialties. Southern medical journal Soares, A., Fink, A., Salles, A., Lee, K., Zhong, L., Bhayani, R. K. 2023; 116 (6): 496-501

  Abstract

  OBJECTIVE: The objective of this study was to determine whether and to what degree residents experience stereotype perception by gender and specialty type (surgical vs nonsurgical).METHODS: A cross-sectional survey was sent to resident physicians across all specialties at a single academic institution in February 2021. The survey items asked whether participants believe residents, faculty, and the public expect men or women to be better physicians on a numerical scale from 1 to 7. A chi2 test compared the calculated mean and standard error for each survey item. This study took place at Washington University School of Medicine in St. Louis, Missouri, a large academic tertiary care center.RESULTS: A total of 411 (46% of total) residents participated; 13 were excluded because of nonbinary gender or missing demographic information, for a final sample of 398. Participants perceived all three groups to expect men to be better physicians than women. Regression analysis showed a significant effect of gender on stereotype perception, with women reporting stronger stereotype perceptions than men. There were no significant differences in stereotype perceptions by specialty type.CONCLUSIONS: Women resident physicians in both surgical and nonsurgical fields reported higher levels of gender stereotype perception compared with men, making it imperative that graduate medical education leadership support changes to the current learning environment.

  View details for DOI 10.14423/SMJ.0000000000001563

  View details for PubMedID 37263613

• Wondering If I'd Get There Quicker If I Was a Man: Factors Contributing to Delayed Academic Advancement of Women in Infectious Diseases. Open forum infectious diseases Stead, W., Manne-Goehler, J., Blackshear, L., Marcelin, J. R., Salles, A., Del Rio, C., Krakower, D. 2023; 10 (1): ofac660

  Abstract

  Background: Gender inequities in academic advancement persist in many specialties, including Infectious Diseases (ID). Prior studies of advancement disparities have been predominantly quantitative, utilizing large physician databases or surveys. We used qualitative methods to explore ID physicians' experiences and beliefs about causes and ways to mitigate gender inequities in advancement.Methods: We conducted semistructured focus group discussions with academic ID physicians in the United States at IDWeek 2019 to explore perceived barriers and facilitators to academic advancement. Participants were assigned to focus groups based on their academic rank and gender. We analyzed focus group transcripts using content analysis to summarize emergent themes.Results: We convened 3 women-only focus groups (1 for instructors/assistant professors, 1 for associate professors, and 1 for full professors) and 1 men-only focus group of full professors (total N = 50). Our analyses identified several major themes on barriers to equitable academic advancement, including (1) interpersonal and institutional gender bias, (2) difficulty balancing the demands of family life with work life, and (3) gender differences in negotiation strategies.Conclusions: Barriers to gender equity in academic advancement are myriad and enduring and span the professional and personal lives of ID physicians. In addition to swift enactment of policy changes directed at critical issues such as ending workplace harassment and ensuring adequate parental leaves for birth and nonbirth parents, leaders in academic medicine must shine a bright light on biases within the system at large and within themselves to correct these disparities with the urgency required.

  View details for DOI 10.1093/ofid/ofac660

  View details for PubMedID 36686641

• PROCEDURAL SPECIALISTS FAMILY BUILDING PATTERNS AND USE OF ASSISTED REPRODUCTIVE TECHNOLOGY Sundaram, P., Kelly, A. G., Levy, M. S., Salles, A., Arora, V. ELSEVIER SCIENCE INC. 2022: E31

  View details for Web of Science ID 000891804600076

• Supporting Physicians Along the Entire Journey of Fertility and Family Building. JAMA network open Marshall, A. L., Salles, A. 2022; 5 (5): e2213342

  View details for DOI 10.1001/jamanetworkopen.2022.13342

  View details for PubMedID 35583873

• The Impact of COVID-19 on Family Building Among Physicians and Trainees. Journal of general internal medicine Levy, M. S., Kelly, A. G., Brown, A. D., Caban-Martinez, A., Arora, V. M., Salles, A. 2022

  View details for DOI 10.1007/s11606-022-07442-3

  View details for PubMedID 35199263

• Barriers for Medical Students with Underrepresented Identities Considering Orthopaedic Surgery Careers: A Qualitative Investigation Gerull, K. M., Parameswaran, P., Cogsil, T., Jeffe, D., Salles, A., Cipriano, C. A. ELSEVIER SCIENCE INC. 2021: E169

  View details for Web of Science ID 000718306700411

• Strategies for Recruiting and Retaining Women and Minorities in Orthopaedics: AOA Critical Issues Symposium. The Journal of bone and joint surgery. American volume Gerull, K. M., Salles, A., Porter, S. E., Braman, J. P. 2021

  Abstract

  ABSTRACT: Despite considerable attention being paid to the lack of diversity in orthopaedic surgery over the last decade, there has been very little actual change in the racial and gender demographics. This article discusses mechanisms for improving the diversity of interested programs, including reviewing potential barriers to racial and gender-based diversity programs.

  View details for DOI 10.2106/JBJS.21.00016

  View details for PubMedID 34153011

• Does Medical Students' Sense of Belonging Affect Their Interest in Orthopaedic Surgery Careers? A Qualitative Investigation. Clinical orthopaedics and related research Gerull, K. M., Parameswaran, P., Jeffe, D. B., Salles, A., Cipriano, C. A. 2021

  Abstract

  BACKGROUND: The concept of social belonging has been shown to be important for retention and student success in collegiate environments and general surgery training. However, this concept has never been explored in relation to medical students' impressions of orthopaedic surgery careers.QUESTION/PURPOSE: To investigate medical students' sense of belonging in orthopaedic surgery and how it affects their interest in pursuing orthopaedic surgery careers.METHODS: Medical students from four medical schools were invited to participate in telephone interviews aimed to investigate medical students' reasons for considering (or not considering) orthopaedic surgery as a future career. Students were selected using random sampling and theoretical sampling methods (selecting participants based on specific characteristics) to obtain a diversity of student perspectives across medical school year, gender, race, age, and interest in orthopaedics. Semistructured interviews with open-ended questions and face validity were used to minimize bias in the interview process. Analysis was performed using grounded theory methodology, a rigorous and well-established method for creating conceptual models based on qualitative data. The result seeks to be a data-driven (as opposed to hypothesis-driven) theory that provides perspective on human behavior. Interviews were conducted until the point of thematic saturation, defined as the point when no new ideas occur in subsequent interviews; this was achieved at 23 students (16 self-identified as women, 12 self-identified as underrepresented minorities).RESULTS: Medical students articulated stereotypes about orthopaedic surgeons, in particular, that they were white, male, and athletic. Students derived their sense of belonging in orthopaedic surgery from how closely their identities aligned with these stereotypes about the field. Students who felt a sense of belonging described themselves as being part of a cultural "in-group," and students who did not feel a sense of belonging felt that they were in a cultural "out-group." Members of the in-group often reported that orthopaedic experiences further reinforced their positive identity alignment, which typically led to increased interest and continued engagement with the field. Conversely, students in the out-group reported that their exposures to orthopaedics further reinforced their lack of identity alignment, and this typically led to decreased interest and engagement. Many students in the out-group reported pursuing other specialties due to a lack of belonging within orthopaedics.CONCLUSION: Students derive their sense of belonging in orthopaedics based on how closely their identity aligns with stereotypes about the field. Importantly, there were gender and racial factors associated with orthopaedic stereotypes, and thus with belonging (self-identifying as the in-group). Moreover, out-group students tended not to choose orthopaedic surgery careers because of a lack of belonging in the specialty.CLINICAL RELEVANCE: With knowledge of the factors that influence students' sense of belonging, academic orthopaedic departments can focus on interventions that may lead to a more diverse pool of medical students interested in orthopaedic surgery. These might include explicitly addressing stereotypes about orthopaedics and cultivating positive identity alignment for students from diverse backgrounds through targeted mentorship fostering partnerships with affinity organizations, and creating space to talk about barriers. Targeted interventions such as these are needed to interrupt the cycle of in-group and out-group formation that, in this small multicenter study, appeared to deter students with underrepresented identities from pursuing orthopaedic surgery careers.

  View details for DOI 10.1097/CORR.0000000000001751

  View details for PubMedID 34081658

• How to Review a Surgical Scientific Paper: A Guide for Critical Appraisal. Annals of surgery open : perspectives of surgical history, education, and clinical approaches Greco, S. H., Davis, C. H., Hicks, C. W., Kaye, A. E., Maxwell, J. E., Salles, A., Henry, M. C. 2021; 2 (1): e027

  Abstract

  It is important for surgeons to participate in the peer-review process of scientific literature. As the number of published manuscripts continues to increase, there is a great need for volunteerism in this arena. However, there is little formal or informal training, which can help surgeons provide unbiased and meaningful reviews. Therefore, it is critical to provide more resources and guidelines to aid surgeons during the review process. The purpose of this paper is to provide a structured guide for a quality review of a surgical paper. This review represents the work of the Association of Women Surgeons Publications Committee.

  View details for DOI 10.1097/AS9.0000000000000027

  View details for PubMedID 37638253

  View details for PubMedCentralID PMC10455126

• Physician Athletes Promoting Physical Fitness Through Social Media During the COVID-19 Pandemic. Health promotion practice Stanford, F. C., Salles, A. n. 2021: 1524839920988261

  Abstract

  The COVID-19 pandemic has had an unprecedented impact on our daily lives and functioning. To reduce the potential transmission, countries throughout the world practiced social distancing. Unfortunately, this social distancing often contributed to a sense of social isolation and physical inactivity. Two physician athletes on opposite coasts of the United States sought to change this narrative by promoting physical activity among the general population with the #SocialDistancingFitnessChallenge. During the height of the COVID-19 pandemic in March and April 2020, these physicians would post exercises during the 5-day workweek-one would post yoga/flexibility exercises, while the other would post high-intensity cardio and strength exercises on two social media platforms. Some posts would amass over 100,000 views. They received daily feedback on how this challenge not only encouraged others to be engaged in physical activity during the most challenging pandemic of our lifetimes, but it also improved their mental health and outlook on the future amid great uncertainty.

  View details for DOI 10.1177/1524839920988261

  View details for PubMedID 33467929

• Order of Discontinuation of Glucose-lowering Medications following Bariatric Surgery. Diabetes research and clinical practice Martin Vouri, S., Chen, J., Sparkman, J., Salles, A., Micek, S. T. 2020: 108580

  Abstract

  AIMS: To assess the order of glucose-lowering medication (GLM) discontinuation following bariatric surgery among patients taking ≥2 GLMs.METHODS: Patients with diabetes mellitus taking ≥2 GLM classes who underwent bariatric surgery were identified using health claims data from the United States. The order of discontinuation was assessed in patients taking ≥2 GLM classes by comparing each GLM class to the other classes in aggregate. Descriptive statistics and Poisson regression were used to assess the order of discontinuation and changes in trends in the order of discontinuation.RESULTS: Overall, 12,244 of 26,651 patients with type 2 diabetes who underwent bariatric surgery were taking ≥2 GLM classes. When each GLM class was assessed separately, fewer than 50% of patients had metformin, sulfonylurea, thiazolidinedione, DPP-4 inhibitor, SGLT2 inhibitor, glucosidase inhibitor, or insulin discontinued first when compared to the other classes in aggregate. Between 2008 and 2014, thiazolidinediones were increasingly more likely to be the first GLM discontinued (p=0.0432). Slightly more than 50% of patients whose GLM regimen included a sulfonylurea discontinued the sulfonylurea first despite clinical recommendations.CONCLUSIONS: From a population level, there was no consistent approach in the order of discontinuation of GLM classes in patients following bariatric surgery.

  View details for DOI 10.1016/j.diabres.2020.108580

  View details for PubMedID 33316313

• Lack of insulin secretagogue deprescribing and risk of severe hypoglycemia following bariatric surgery Vouri, S. M., Chen, J., Sparkman, J., Brown, J. D., Shao, H., Salles, A., Micek, S. T. WILEY. 2020: 592

  View details for Web of Science ID 000577640502046

• Peering Through the Glass Ceiling: A Mixed Methods Study of Faculty Perceptions of Gender Barriers to Academic Advancement in Infectious Diseases. The Journal of infectious diseases Manne-Goehler, J., Krakower, D., Marcelin, J., Salles, A., Del Rio, C., Stead, W. 2020; 222 (Supplement_6): S528–S534

  Abstract

  BACKGROUND: The drivers of the gap in advancement between men and women faculty in academic Infectious Diseases (ID) remain poorly understood. This study sought to identify key barriers to academic advancement among faculty in ID and offer policy suggestions to narrow this gap.METHODS: During the 2019 IDWeek, we conducted focus groups with women faculty members at all ranks and men Full Professors, then we administered a brief survey regarding work-related barriers to advancement to the Infectious Disease Society of America (IDSA) membership. We report themes from the 4 focus group discussions that are most closely linked to policy changes and descriptive analyses of the complementary survey domains.RESULTS: Policy change suggestions fell into 3 major categories: (1) Policy changes for IDSA to implement; (2) Future IDWeek Program Recommendations; and (3) Policy Changes for IDSA to Endorse as Best Practices for ID Divisions. Among 790 faculty respondents, fewer women reported that their institutional promotion process was transparent and women Full Professors were significantly more likely to have been sponsored.CONCLUSIONS: Sponsorship and informed advising about institutional promotions tracks may help to narrow the advancement gap. The Infectious Disease Society of America should consider ambitious policy changes within the society and setting expectations for best practices among ID divisions across the United States.

  View details for DOI 10.1093/infdis/jiaa166

  View details for PubMedID 32926743

• Maternity Leave: Not Just a Challenge for Trainees. Academic medicine : journal of the Association of American Medical Colleges Pendleton, K. M., Salles, A. 2020; 95 (4): 489

  View details for DOI 10.1097/ACM.0000000000003164

  View details for PubMedID 32209845

• Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion. Pediatrics Spector, N. D., Asante, P. A., Marcelin, J. R., Poorman, J. A., Larson, A. R., Salles, A., Oxentenko, A. S., Silver, J. K. 2019

  Abstract

  Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.

  View details for DOI 10.1542/peds.2019-2149

  View details for PubMedID 31548337

• Stereotype threat and working memory among surgical residents (vol 216, pg 824, 2018) AMERICAN JOURNAL OF SURGERY Milam, L. A., Cohen, G. L., Mueller, C., Salles, A. 2019; 218 (3): 668

  View details for DOI 10.1016/j.amjsurg.2018.10.029

  View details for Web of Science ID 000484395500040

• Multi-institutional Surgical Education Interventions: A Scoping Review. Annals of surgery Salles, A., Milam, L., Sevdalis, N., Alseidi, A., Mellinger, J., Stefanidis, D., Nahmias, J., Kulaylat, A. N., Kim, R. H., Falcone, J. L., Arora, T. K., Phitayakorn, R., Cochran, A. 2019; 270 (2): 257-269

  Abstract

  The aim of the study was to identify and evaluate scholarship in multi-institutional interventional surgical education trials.Most research on interventions in surgical education occurs at individual institutions. These studies typically involve a small number of learners in a unique environment, thereby limiting their generalizability. The status of multi-institutional studies in surgical education remains unknown.We searched the Pubmed, ERIC, PsycINFO, SCOPUS, and CINAHL databases for all English language articles published from January 1, 2000 to December 31, 2015 using the keywords "medical education," "surgical education," "multi-institutional," "multi-center," and related terms. Articles published in an English language peer-reviewed journal that described an educational intervention conducted at more than one institution and involving surgeons were included.Of 3511 identified articles, 53 met criteria for full-text review and inclusion in this review. The median number of institutional sites was 4, with a range of 2 to 54. The 2 most common areas of focus were technical skills (43% of studies) and clinical knowledge (32% of studies). These were also the 2 most commonly measured outcomes (technical skills 32% of studies, clinical knowledge 21% of studies). Thirteen percentage of studies measured only learner attitudes and perceptions rather than learning outcomes.Multi-institutional surgical education studies do not uniformly incorporate characteristics of high quality research, particularly related to study design, measurable outcomes, and assessment tools used. Coordinated support, including grant funding, that addresses the challenging nature of multi-institutional surgical education research may improve the quality of these studies.

  View details for DOI 10.1097/SLA.0000000000003203

  View details for PubMedID 31306156

• The Relationship Between Self-Efficacy and Well-Being Among Surgical Residents JOURNAL OF SURGICAL EDUCATION Milam, L. A., Cohen, G. L., Mueller, C., Salles, A. 2019; 76 (2): 321–28

  View details for DOI 10.1016/j.jsurg.2018.07.028

  View details for Web of Science ID 000462264800004

• Corrigendum to 'Stereotype threat and working memory among surgical residents' [Am J Orthop Surg 216 (2018) 824-829]. American journal of surgery Milam, L. A., Cohen, G. L., Mueller, C., Salles, A. 2018

  View details for PubMedID 30390935

• Psychologist-Facilitated Group Sessions for Residents: A Worthwhile Investment? Lin, D. T., Qiu, W., Lai, C., Post, L. I., Merrell, S., Lau, J. N., Salles, A., Mueller, C. M. ELSEVIER SCIENCE INC. 2018: E53–E54

  View details for DOI 10.1016/j.jamcollsurg.2018.08.138

  View details for Web of Science ID 000447772500120

• Emotional Intelligence as a Possible Safeguard to Surgeon Wellness Lee, E. W., Hasty, B. N., Lau, J. N., Merrell, S., Hawn, M. T., Shanafelt, T., Salles, A., Lin, D. T. ELSEVIER SCIENCE INC. 2018: S145

  View details for DOI 10.1016/j.jamcollsurg.2018.07.307

  View details for Web of Science ID 000447760600278

• Surgeon Emotional Intelligence Is Strongly Correlated with Patient Satisfaction Lee, E. W., Hasty, B. N., Lau, J. N., Merrell, S., Hawn, M. T., Shanafelt, T., Salles, A., Lin, D. T. ELSEVIER SCIENCE INC. 2018: S164–S165

  View details for DOI 10.1016/j.jamcollsurg.2018.07.350

  View details for Web of Science ID 000447760600321

• The Relationship Between Self-Efficacy and Well-Being Among Surgical Residents. Journal of surgical education Milam, L. A., Cohen, G. L., Mueller, C., Salles, A. 2018

  Abstract

  OBJECTIVE: Residency is a challenging time in the lives of physicians. In this study, we examined the relationship between general self-efficacy, defined as the belief in one's own capabilities in a variety of situations, and burnout and psychological well-being in a sample of surgical residents.DESIGN: In the context of a larger study, a cross-sectional survey was administered to residents. The survey included measures of general self-efficacy, the emotional exhaustion and personal accomplishment domains of burnout, and general psychological well-being. We examined correlations between self-efficacy and these well-being outcomes and used multivariable linear regression models that controlled for age, gender, postgraduate year, ethnicity, and the interaction between gender and self-efficacy.SETTING: We surveyed residents at Stanford Health Care, a tertiary care center, between the fall of 2010 and the spring of 2013.PARTICIPANTS: One hundred and seventy nine residents from 9 surgical subspecialties responded to the survey for a response rate of 76%.RESULTS: Residents reported high levels of self-efficacy, and over a third reported high emotional exhaustion. Eighty-nine percent of residents had average or high personal accomplishment. In adjusted regression analyses, general self-efficacy was negatively predictive of emotional exhaustion (B = -0.43, p = 0.0127) and positively predictive of personal accomplishment (B = 0.33, p = 0.0185) and general psychological well-being (B = 0.34, p = 0.0010). There was no interaction between gender and general self-efficacy in regression analyses (ps ≥ 0.6776).CONCLUSIONS: Among other factors, self-efficacy appears to be significantly predictive of resident well-being. High self-efficacy suggests that residents feel prepared and capable. Interventions to improve residents' general self-efficacy should be explored as a possible mechanism to improve well-being.

  View details for PubMedID 30245061

• Physician Wellness in Surgical Residency CURRENT SURGERY REPORTS Alobuia, W., Salles, A., Gibson, M., Mueller, C. M. 2018; 6 (1)

  View details for DOI 10.1007/s40137-018-0200-2

  View details for Web of Science ID 000426474500002

• Self-Efficacy, Sex, and Resident Performance Milam, L., Mueller, C., Cohen, G., Salles, A. ELSEVIER SCIENCE INC. 2017: E159–E160

  View details for DOI 10.1016/j.jamcollsurg.2017.07.959

  View details for Web of Science ID 000413319300394

• Self-Efficacy and Well-Being among Surgical Residents Salles, A., Milam, L., Mueller, C., Cohen, G. ELSEVIER SCIENCE INC. 2017: E44

  View details for DOI 10.1016/j.jamcollsurg.2017.07.636

  View details for Web of Science ID 000413319300097

• Fundamentals of Laparoscopic Surgery: Not Only for Senior Residents. Journal of surgical education Cullinan, D. R., Schill, M. R., DeClue, A., Salles, A., Wise, P. E., Awad, M. M. 2017; 74 (6): e51-e54

  Abstract

  Fundamentals of laparoscopic surgery (FLS) was developed by the Society of American Gastrointestinal and Endoscopic Surgeons to teach the physiology, fundamental knowledge, and technical skills required for basic laparoscopic surgery. We hypothesize that residents are doing more laparoscopic surgery earlier in residency, and therefore would benefit from an earlier assessment of basic laparoscopic skills. Here, we examine FLS test results and ACGME case logs to determine whether it is practical to administer FLS earlier in residency.FLS test results were reviewed for the 42 residents completing FLS between July 2011 and July 2016. ACGME case logs for current and former residents were reviewed for laparoscopic cases logged by each postgraduate year. Basic and complex laparoscopic cases were determined by ACGME General Surgery Defined Category and Minimums Report. Descriptive statistics were used for analysis.Academic general surgery residency, Washington University in St. Louis School of Medicine.Current and former general surgery residents.A total of 42 residents took and passed FLS between July 2011 and July 2016. All residents successfully passed the FLS knowledge and skills examinations on the first attempt regardless of their postgraduate year (PGY 3n = 13, PGY 4n = 15, and PGY 5n = 14). Total laparoscopic case volume has increased over time. Residents who graduated in 2012 or 2013 completed 229 laparoscopic cases compared to 267 laparoscopic cases for those who graduated from 2014 to 2016 (p = 0.02). Additionally, current residents completed more laparoscopic cases in the first 2 years of residency than residents who graduated from 2012 to 2016 (median current = 38; former = 22; p < 0.001). Examining laparoscopic case numbers for current residents by PGY demonstrated that the number of total and complex laparoscopic cases increased in each of the first 3 years of residency with the largest increase occurring between the PGY 2 and PGY 3 years. In the PGY 4 and PGY 5 years, most laparoscopic cases were complex.Increased use of laparoscopic surgery has led to a corresponding increase in laparoscopic case volume among general surgery residents. We would advocate for FLS testing to serve as an early assessment of laparoscopic knowledge and skill and should be performed before a significant increase in complex laparoscopic surgery during training.

  View details for DOI 10.1016/j.jsurg.2017.07.017

  View details for PubMedID 28756968

  View details for PubMedCentralID PMC5732857

• Prevalence and predictors of depression among general surgery residents. American journal of surgery Lin, D. T., Liebert, C. A., Esquivel, M. M., Tran, J., Lau, J. N., Greco, R. S., Mueller, C. M., Salles, A. 2017; 213 (2): 313-317

  Abstract

  Recent resident suicides have highlighted the need to address depression among medical trainees. This study sought to identify the prevalence and predictors of depression among surgical residents.Surgical residents at a single institution were surveyed. Depression and personal traits were assessed using validated measures; participant demographics were also obtained.73 residents completed the survey (response rate 63%). 36% met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. In multivariate linear regression analyses controlling for demographic factors, trait emotional intelligence alone was a significant inverse predictor of depression (β = -0.60, p < 0.001).Depression is prevalent among general surgery residents. Identifying protective factors and at-risk populations may allow for effective initiatives to be developed to address depression, and optimize the mental health of trainees.The aim of this study is to identify the prevalence and predictors of depression among surgical trainees. Over one third of respondents met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. Among demographic and personal trait variables, emotional intelligence emerged as a significant inverse predictor of depression.

  View details for DOI 10.1016/j.amjsurg.2016.10.017

  View details for PubMedID 28017297

• Grit as a predictor of risk of attrition in surgical residency. American journal of surgery Salles, A., Lin, D., Liebert, C., Esquivel, M., Lau, J. N., Greco, R. S., Mueller, C. 2017; 213 (2): 288-291

  Abstract

  Grit, a measure of perseverance, has been shown to predict resident well-being. In this study we assess the relationship between grit and attrition.We collected survey data from residents in a single institution over two consecutive years. All residents in general surgery were invited to participate (N = 115). Grit and psychological well-being were assessed using validated measures. Risk of attrition was measured using survey items.73 residents participated (63% response rate). Grit was positively correlated with general psychological well-being (r = 0.30, p < 0.05) and inversely correlated with depression (r = -0.25, p < 0.05) and risk of attrition (r = -0.37, p < 0.01). In regression analyses, grit was positively predictive of well-being (B = 0.77, t = 2.96, p < 0.01) and negatively predictive of depression (B = -0.28 t = -2.74, p < 0.01) and attrition (B = -0.99, t = -2.53, p < 0.05).Attrition is a costly and disruptive problem in residency. Grit is a quick, reliable measure which appears to be predictive of attrition risk in this single-institution study.

  View details for DOI 10.1016/j.amjsurg.2016.10.012

  View details for PubMedID 27932088

• Belonging, Well-being, and Attrition in General Surgery Salles, A., Lin, D. T., Liebert, C. A., Esquivel, M., Mueller, C. ELSEVIER SCIENCE INC. 2016: E40–E41

  View details for DOI 10.1016/j.jamcollsurg.2016.08.106

  View details for Web of Science ID 000395825100087

• Emotional Intelligence as a Predictor of Resident Well-Being. Journal of the American College of Surgeons Lin, D. T., Liebert, C. A., Tran, J., Lau, J. N., Salles, A. 2016; 223 (2): 352-358

  Abstract

  There is increasing recognition that physician wellness is critical; it not only benefits the provider, but also influences quality and patient care outcomes. Despite this, resident physicians suffer from a high rate of burnout and personal distress. Individuals with higher emotional intelligence (EI) are thought to perceive, process, and regulate emotions more effectively, which can lead to enhanced well-being and less emotional disturbance. This study sought to understand the relationship between EI and wellness among surgical residents.Residents in a single general surgery residency program were surveyed on a voluntary basis. Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire-Short Form. Resident wellness was assessed with the Dupuy Psychological General Well-Being Index, Maslach Burnout Inventory, and Beck Depression Inventory-Short Form. Emotional intelligence and wellness parameters were correlated using Pearson coefficients. Multivariate analysis was performed to identify factors predictive of well-being.Seventy-three residents participated in the survey (response rate 63%). Emotional intelligence scores correlated positively with psychological well-being (r = 0.74; p < 0.001) and inversely with depression (r = -0.69, p < 0.001) and 2 burnout parameters, emotional exhaustion (r = -0.69; p < 0.001) and depersonalization (r = -0.59; p < 0.001). In regression analyses controlling for demographic factors such as sex, age, and relationship status, EI was strongly predictive of well-being (β = 0.76; p < 0.001), emotional exhaustion (β = -0.63; p < 0.001), depersonalization (β = -0.48; p = 0.002), and depression (β = -0.60; p < 0.001).Emotional intelligence is a strong predictor of resident well-being. Prospectively measuring EI can identify those who are most likely to thrive in surgical residency. Interventions to increase EI can be effective at optimizing the wellness of residents.

  View details for DOI 10.1016/j.jamcollsurg.2016.04.044

  View details for PubMedID 27182037

• Biliary Cystadenoma: A Suggested "Cystamatic" Approach? DIGESTIVE DISEASES AND SCIENCES Dua, M. M., Gerry, J., Salles, A., Tran, T. B., Triadafilopoulos, G., Visser, B. C. 2016; 61 (7): 1835-1838

  View details for DOI 10.1007/s10620-015-3943-y

  View details for PubMedID 26514678

• Minimally invasive approaches to resection of benign/low-grade gastric tumors SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Salles, A., Dua, M., Friedland, S., Visser, B. 2016; 30 (6): 2624–25

  Abstract

  Tumors in the stomach have traditionally been treated with either subtotal gastrectomy or total gastrectomy, depending on the location. However, many of these lesions are benign spindle cell tumors or adenomas and could be resected with margins. Here, we explore multiple minimally invasive methods for the resection of these tumors. We highlight a wedge resection, a circumferential resection with transverse closure, a transgastric resection, and an endoscopic/laparoscopic submucosal resection. The wedge resection was performed in a 71-year-old man found to have a mass in the stomach on screening upper endoscopy. The biopsy was not definitive, but on CT scan there was a 4.5-cm submucosal mass consistent with a gastrointestinal stromal tumor. The circumferential resection was performed for an 83-year-old woman who had abdominal discomfort which led to an upper endoscopy. She was found to have a mass in the lesser curve of her stomach. Biopsy revealed this to be a gastrointestinal stromal tumor. Ultimately, it was removed when serial CT scans showed that it was growing. The transgastric approach was used for a 75-year-old man who had upper endoscopy for reflux symptoms and was found to have a mass in the stomach. Biopsy showed that it was a gastrointestinal stromal tumor. Due to patient preference, it was initially observed but was eventually removed when it was found to be growing on serial CT scans. The endoscopic/laparoscopic approach was for a 65-year-old man who had an upper endoscopy performed for work-up of melena and was found to have a 5-cm mass at the gastroesophageal junction. The biopsy showed this to be an adenoma, and he went on to have it removed.We identified representative videos from patients treated with each of the above techniques. Small exophytic lesions can be completely excised with a wedge resection using a stapler to fire across the base of the lesion. By contrast, if the lesion is in an awkward location or is too large to remove in this way, a vessel-sealing device can divide the mass from the stomach circumferentially (intragastric resection). The resultant defect in the gastric wall must be repaired transversely to avoid narrowing the lumen. Endophytic lesions can be treated with transgastric resection. Ports are placed directly into the stomach allowing excision from within the stomach. Finally, submucosal resection is ideal for lesions close to the GE junction. This combined endoscopic and laparoscopic approach allows the tumor to be lifted off the muscle fibers and to be resected without transmural injury to the stomach or esophagus.All four patients tolerated the procedure well and were discharged home by postoperative day 2. There were no complications. One patient, the one who underwent the endoscopic/laparoscopic approach and was preoperatively found to have an adenoma on biopsy, was ultimately found to have an invasive component and later underwent total gastrectomy. The other three patients all had gastrointestinal stromal tumors.Minimally invasive techniques should be considered more frequently for the management of benign gastric tumors. The four methods illustrated here can be used safely and result in faster recovery as well as shorter hospital stays compared to traditional approaches.

  View details for PubMedID 26423418

• Emotional Intelligence as a Predictor of Resident Wellness Lin, D. T., Liebert, C. A., Lau, J. N., Salles, A. ELSEVIER SCIENCE INC. 2015: S52

  View details for DOI 10.1016/j.jamcollsurg.2015.07.110

  View details for Web of Science ID 000361119700091

• Belonging as a Measure of Risk of Attrition Salles, A., Liebert, C. A., Lin, D. T. ELSEVIER SCIENCE INC. 2015: S49

  View details for DOI 10.1016/j.jamcollsurg.2015.07.103

  View details for Web of Science ID 000361119700084

• Promoting Balance in the Lives of Resident Physicians: A Call to Action. JAMA surgery Salles, A., Liebert, C. A., Greco, R. S. 2015; 150 (7): 607-608

  View details for DOI 10.1001/jamasurg.2015.0257

  View details for PubMedID 25992632

• Prediction of neurosurgical intervention after mild traumatic brain injury using the national trauma data bank. World journal of emergency surgery Sweeney, T. E., Salles, A., Harris, O. A., Spain, D. A., Staudenmayer, K. L. 2015; 10: 23-?

  Abstract

  Patients with mild traumatic brain injury (TBI) as defined by an admission Glasgow Coma Score (GCS) of 14-15 often do not require neurosurgical interventions, but which patients will go on to require neurosurgical care has been difficult to predict. We hypothesized that injury patterns would be associated with need for eventual neurosurgical intervention in mild TBI.The National Trauma Databank (2007-2012) was queried for patients with blunt injury and a diagnosis of TBI with an emergency department GCS of 14-15. Patients were stratified by age and injury type. Multiple logistic regression for neurosurgical intervention was run with patient demographics, physiologic variables, and injury diagnoses as dependent variables.The study included 50,496 patients, with an overall 8.8 % rate of neurosurgical intervention. Neurosurgical intervention rates varied markedly according to injury type, and were only correlated with age for patients with epidural and subdural hemorrhage. In multiple logistic regression, TBI diagnoses were predictive of need for neurosurgical interventions; moreover, after controlling for injury type and severity score, age was not significantly associated with requiring neurosurgical intervention.We found that in mild TBI, injury pattern is associated with eventual need for neurosurgical intervention. Patients with cerebral contusion or subarachnoid hemorrhage are much less likely to require neurosurgical intervention, and the effects of age are not significant after controlling for other patient factors. Prospective studies should validate this finding so that treatment guidelines can be updated to better allocate ICU resources.

  View details for DOI 10.1186/s13017-015-0017-6

  View details for PubMedID 26060506

  View details for PubMedCentralID PMC4460849

• Prediction of neurosurgical intervention after mild traumatic brain injury using the national trauma data bank. World journal of emergency surgery Sweeney, T. E., Salles, A., Harris, O. A., Spain, D. A., Staudenmayer, K. L. 2015; 10: 23-?

  Abstract

  Patients with mild traumatic brain injury (TBI) as defined by an admission Glasgow Coma Score (GCS) of 14-15 often do not require neurosurgical interventions, but which patients will go on to require neurosurgical care has been difficult to predict. We hypothesized that injury patterns would be associated with need for eventual neurosurgical intervention in mild TBI.The National Trauma Databank (2007-2012) was queried for patients with blunt injury and a diagnosis of TBI with an emergency department GCS of 14-15. Patients were stratified by age and injury type. Multiple logistic regression for neurosurgical intervention was run with patient demographics, physiologic variables, and injury diagnoses as dependent variables.The study included 50,496 patients, with an overall 8.8 % rate of neurosurgical intervention. Neurosurgical intervention rates varied markedly according to injury type, and were only correlated with age for patients with epidural and subdural hemorrhage. In multiple logistic regression, TBI diagnoses were predictive of need for neurosurgical interventions; moreover, after controlling for injury type and severity score, age was not significantly associated with requiring neurosurgical intervention.We found that in mild TBI, injury pattern is associated with eventual need for neurosurgical intervention. Patients with cerebral contusion or subarachnoid hemorrhage are much less likely to require neurosurgical intervention, and the effects of age are not significant after controlling for other patient factors. Prospective studies should validate this finding so that treatment guidelines can be updated to better allocate ICU resources.

  View details for DOI 10.1186/s13017-015-0017-6

  View details for PubMedID 26060506

  View details for PubMedCentralID PMC4460849

• Predicting outcomes of mild traumatic brain injuries in the National Trauma Database Sweeney, T. E., Salles, A., Spain, D. A., Staudenmayer, K. ELSEVIER SCIENCE INC. 2014: E190

  View details for DOI 10.1016/j.jamcollsurg.2014.07.898

  View details for Web of Science ID 000361111400467

• The relationship between grit and resident well-being. American journal of surgery Salles, A., Cohen, G. L., Mueller, C. M. 2014; 207 (2): 251-254

  Abstract

  The well-being of residents in general surgery is an important factor in their success within training programs. Consequently, it is important to identify individuals at risk for burnout and low levels of well-being as early as possible. The aim of this study was to test the hypothesis that resident well-being may be related to grit, a psychological factor defined as perseverance and passion for long-term goals.One hundred forty-one residents across 9 surgical specialties at 1 academic medical center were surveyed; the response rate was 84%. Perseverance was measured using the Short Grit Scale. Resident well-being was measured with (1) burnout using the Maslach Burnout Inventory and (2) psychological well-being using the Dupuy Psychological General Well-Being Scale.Grit was predictive of later psychological well-being both as measured by the Maslach Burnout Inventory (B = -.20, P = .05) and as measured by the Psychological General Well-Being Scale (B = .27, P < .01).Measuring grit may identify those who are at greatest risk for poor psychological well-being in the future. These residents may benefit from counseling to provide support and improve coping skills.

  View details for DOI 10.1016/j.amjsurg.2013.09.006

  View details for PubMedID 24238604

• Belonging: a simple, brief intervention decreases burnout Salles, A., Nandagopal, K., Walton, G. ELSEVIER SCIENCE INC. 2013: S116

  View details for DOI 10.1016/j.jamcollsurg.2013.07.267

  View details for Web of Science ID 000325577900234

• Complete resection of a rare intrahepatic variant of a choledochal cyst JOURNAL OF PEDIATRIC SURGERY Salles, A., Kastenberg, Z. J., Wall, J. K., Visser, B. C., Bruzoni, M. 2013; 48 (3): 652-654

  Abstract

  The vast majority of choledochal cysts occur as either saccular or diffuse fusiform dilatation of the extrahepatic bile duct. We describe the complete resection of a rare single intrahepatic choledochal cyst communicating with the extrahepatic biliary tree. While previous reports describe partial resection with enteral drainage, we performed a complete resection of this rare choledochal cyst.

  View details for DOI 10.1016/j.jpedsurg.2012.12.016

  View details for Web of Science ID 000316470100037

  View details for PubMedID 23480926

• CT of pancreas: minimum intensity projections ABDOMINAL IMAGING Salles, A., Nino-Murcia, M., Jeffrey, R. B. 2008; 33 (2): 207-213

  Abstract

  The purpose of this pictorial essay is to showcase the use of minimum intensity projection in the imaging of low attenuation structures such as the pancreatic duct.Minimum intensity projection is a valuable adjunct to other processing techniques for the diagnosis and staging of pancreatic adenocarcinoma and cystic tumors of the pancreas.

  View details for DOI 10.1007/s00261-007-9212-6

  View details for Web of Science ID 000254847000014

  View details for PubMedID 17387537