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PubMed2003

Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons.

The utility of antibiotic and mechanical preparation for colorectal surgery is controversial, and numerous different regimens are used. The aim of this study was to detect trends in preparation for surgery among American colon and rectal surgeons. Members of the American Society of Colon and Rectal Surgeons practicing in the United States were surveyed with a postal questionnaire regarding their routine preparations for colon and rectal surgery. Five hundred fifteen (40%) of the 1295 questionnaires sent were returned. Eighty-one per cent of the respondents had completed an accredited colorectal training program, and the average experience in practice was 13.7 (+/- 8.7) years. Half of the surgeons felt that prophylactic oral antibiotic is essential, 41 per cent felt it was doubtful, and 10 per cent considered oral prophylaxis unnecessary. Despite these statements 75 per cent of the surgeons routinely utilized oral antibiotics (96% of them used a combination of two drugs), 11 per cent used them selectively, and only 13 per cent omitted oral prophylaxis from their practice. Similarly although the usefulness of intravenous antibiotics was questioned by 11 per cent of the surgeons 98 per cent routinely used them. The average number of postoperative doses was two (+/- 1.9). Although 10 per cent of the surgeons questioned the importance of mechanical preparation more than 99 per cent routinely used it. Forty-seven per cent of the surgeons used sodium phosphate, 32 per cent used polyethylene glycol, and 14 per cent alternated between these two options. We conclude that although the use of oral antibiotic prophylaxis for colorectal surgery is controversial among surgeons it is still routinely practiced by 75 per cent. Intravenous antibiotic prophylaxis and mechanical cleansing, however, are still a dogma and almost invariably used. There is a trend toward the use of a shorter course of postoperative intravenous antibiotics and the use of sodium phosphate for mechanical cleansing.

Administration, Oral↗

PubMed1992

Explaining the association between surgeon supply and utilization.

This study uses Medicare enrollment and physician claims data to examine the effect of surgeon supply on the demand for surgeons' services. The specialties studied were ophthalmology, general surgery, orthopedic surgery, and urology. The study found that higher surgeon supply increases the demand for initial contacts with surgeons (first-occurrences demand) but does not affect the demand for services among surgeons' patients (intensity-of-care demand). These findings suggest that a high supply of surgeons improves access or is associated with stronger preferences for referrals to surgeons. The findings offer little support for the hypothesis that a substantial component of the additional utilization that occurs when surgeons are plentiful is due to increases in physician-induced demand.

Aged↗

PubMedDate not supplied

[Trauma and emergency surgery. Organization and surgeons experience].

BACKGROUND: To evaluate if combining operative treatment of patients with trauma and general surgery emergencies offers a good operative experience and can be a model for a Trauma Center organization, we compare our surgical experience with that of our general surgeons. METHODS: We reviewed records to determine number of operation, need of intensive care unit care for patients treated, the after hours practice by the trauma and emergency surgeons and general surgeons over a 1-year period at Ospedale Maggiore of Bologna. RESULTS: Emergency and trauma surgeons performed more operations per surgeons (133.7 vs 102.6) and managed more patients in intensive care unit than general surgeons. 51.8% of emergency and trauma operations were after hours. CONCLUSION: The care of trauma and emergency patients resulted in a breadth and scope of practice for trauma and emergency surgeons compared well with that of general surgeons but in a worse lifestyle.

Emergencies↗

PubMed2005

The investigation of primary rectal cancer by surgeons: current pattern of practice.

OBJECTIVE: Selection of the optimal treatment strategy for patients with rectal cancer requires appropriate investigation, but published guidelines provide no clear consensus. We examined the current practice pattern for the investigation of primary rectal cancer by general surgeons in the province of Ontario, Canada. METHODS: A telephone interview was completed by 124 surgeons in Ontario who manage patients with rectal cancer, who indicated the investigations they routinely perform in assessment before treatment. An exploratory cluster analysis was used to identify surgeon-related variables that predicted the pattern of investigation; these were tested in univariate and multivariate analyses. RESULTS: Cluster analysis identified 3 distinct groups of surgeons based on patterns of test usage. Univariate analysis showed that the use of chest radiography, computed tomography of the abdomen and pelvis, and ultrasound of the abdomen varied significantly with the surgeon's subspecialty training, practice location and years in practice. Regression analysis confirmed that each of these 3 variables independently predicted the pattern of preoperative investigation. There were no significant predictors of the use of colonoscopy, sigmoidoscopy or carcinoembryonic antigen level. Over half of surgeons reported that they would have ordered additional imaging tests but did not because of lack of availability. The perceived desirability of additional tests, endorectal ultrasound in particular, varied with training. CONCLUSIONS: The current practice pattern for the preoperative investigation of primary rectal cancer by general surgeons varies significantly with specific surgeon-related variables, with potential impact on the management and outcome of patients with rectal cancer.

Adult↗

PubMedDate not supplied

Accuracy of surgeon-performed abdominal utrasound for gallstones.

BACKGROUND: Gallstone disease is common in Pakistan. It is primarily diagnosed by ultrasonography. which is traditionally done by radiologists. If surgeons could perform ultrasonography, it would enable early diagnosis in one-stop clinic. This study was done to evaluate the accuracy of surgeon-performed abdominal ultrasonography to detect gallstones. METHODS: This study was carried out at Surgical A and Surgical C units of Ayub Teaching Hospital, Abbottabad from July, 2000 to December, 2002. One hundred fourty two patients with signs and symptoms of gallstone disease who had ultrasonography performed by a surgeon. trained in ultrasonography were exclusively studied. These patients were referred for further scanning by the radiologists who were unaware of the surgeon's interpretation. The results of surgeon and radiologist performed ultrasonography were compared. RESULTS: The interpretation of surgeon-performed ultrasonography was correct in 100 patients and incorrect in 42 patients. There were 100 True Positive, 41 True Negative, One False Negative and Zero False Positive scans yielding 99%, Sensitivity, 100% Specificity and 99.3%, Accuracy. Sensitivity of surgeon-performed ultrasonography in detecting gallstones compared to operative findings was 100%. CONCLUSIONS: Abdominal ultrasonography performed by an ultrasonography trained surgeon can detect gallstones as accurately as by a radiologist.

Adult↗

PubMed2006

Agreement between surgeons and an independent panel with respect to surgical site fusion after single-level anterior cervical spine surgery: a prospective, multicenter study.

STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVE: To assess the: (1) agreement between surgeon and independent review of fusion after single-level anterior cervical decompression and fusion, and (2) influence of surgeon impression of patient status on agreement. SUMMARY OF BACKGROUND DATA: Failure to achieve fusion can lead to poor functional outcome. Visual inspection of plain radiographs is used to assess fusion, but this assessment's reliability is not well understood. METHODS: Of 668 participants in the Cervical Spine Research Society Outcomes Study, 181 underwent single-level procedures. Three independent reviewers and each surgeon assessed fusion (i.e., radiographic trabecular bridging of the graft-vertebral body gap and absence of spinous process motion) on plain radiographs at 3 and 6 months after surgery. Agreement was evaluated with an intraclass correlation coefficient (ICC). The influence of surgeon impression of patient status on agreement was assessed with logistic regression analysis. RESULTS: Agreement was high among reviewers (ICC 0.822 to 0.892) but poor between reviewers and surgeons (ICC 0.308 to 0.484); disagreement was higher when the surgeon reported medical (odds ratio [OR] = 0.19, 95%; confidence interval [CI] 0.12, 0.30; P < 0.001), neurologic (OR = 0.13, 95% CI: 0.09, 0.21, P < 0.001), or functional (OR = 0.19, 95% CI: 0.12, 0.29, P < 0.001) improvement than when the surgeon did not report this improvement. CONCLUSIONS: The finding that surgeons and independent reviewers disagreed on fusion assessment highlights the need for objective and reproducible measures of fusion.

Adult↗

PubMed1979

General surgeons and their surgical practices.

The work characteristics of general surgeons were studied as part of a national study of surgeon manpower. General surgeons were found to work long hours relative to other surgical specialists. Although general surgeons' operative workloads ranked fourth among the 10 surgical specialties, they were only modest in comparison with the surgeons with the highest operative loads (thoracic surgeons). The major conclusion is that the supply of general surgeons is more than adequate to meet the need for general surgeon consultants.

Certification↗

PubMed1995

Reduced frequency of percutaneous injuries in surgeons: 1993 versus 1988.

OBJECTIVE: To compare the frequency of occupational injuries reported by surgeons in 1993 with similar data obtained in 1988. DESIGN AND SETTING: Two point-prevalence studies of percutaneous injuries of surgeons practicing in tertiary and non-tertiary-care hospitals in the New York metropolitan area. PARTICIPANTS: A total of 202 surgeons and surgical residents surveyed in 1988 and 347 surveyed in 1993 (67 and 65% of the eligible groups, respectively), including 85 surgeons in 1993 (71% of the eligible group) who had participated in the 1988 survey. OUTCOME MEASURES: Yearly frequency of percutaneous injuries, and injury frequency per 1000 operative hours. RESULTS: There was a significant decrease in the frequency of reported percutaneous injuries over the 5-year period. For all surgeons, the mean number of yearly injuries decreased from 5.5 +/- 14.4 SD to 2.1 +/- 6.0 SD (P < or = 0.001). Paired analysis of the subgroup of 85 surgeons who participated in both surveys showed a nearly identical decrease (P = 0.001). Significant decreases were observed in general surgeons, specialists and residents. CONCLUSIONS: During the 5 years studied, surgeons practicing in the greater New York metropolitan area reported a significant reduction in the frequency of occupationally associated percutaneous injuries. The reduced risk of percutaneous injuries should substantially lower the rate of acquired infections from blood-borne pathogens.

Adult↗

PubMed1995

The community general surgeon: a time for renaissance.

The practice of general surgery in smaller Canadian communities requires a broad scope of training, and recently the Royal College of Physicians and Surgeons of Canada introduced training requirements to meet the needs of these communities. The traditional role of physicians and surgeons in relation to the hospital boards is changing, with the development of regional health boards. Surgeons must be adaptable to these changes while striving to preserve the standards of surgical care in the new environment. The 1990 Canadian Medical Association manpower studies indicated that there will soon be a major shortage of general surgeons in Canada. In 1990, 48% of general surgeons in Canada were over 55 years of age. In communities with a population of 10,000 or less, there were relatively more general surgeons than other specialists, but, again, they were proportionately older. Recruitment to general surgery is a concern. A survey of 205 residents obtaining the Royal College fellowship in surgery between 1991 and 1993 revealed that 107 took post-fellowship training; of these, 46 developed academic careers, 17 became community surgeons and 44 were lost to surgical practice (they went into cardiac surgery or emigrated). Ninety-eight did not take further training; of these, 5 developed academic careers, 87 chose community practice and 6 emigrated. The role of the general practitioner in providing surgical services in remote areas was the topic of discussion between the Canadian Association of General Surgeons (CAGS), the Royal College and the College of Family Physicians of Canada. Guidelines were developed and approved by the CAGS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Variation in orthopedic surgeons' perceptions of the indications for and outcomes of knee replacement.

OBJECTIVE: To determine the agreement among orthopedic surgeons' indications for knee replacement, their perceptions of the usefulness of various treatments for osteoarthritis of the knee and their expected outcomes of knee replacement, and to determine the relation between these opinions and the number of knee replacement procedures performed by individual surgeons. DESIGN: Survey. SETTING: Ontario. PARTICIPANTS: All 392 orthopedic surgeons in the province. Of the 325 practising traceable surgeons 234 (72.0%) responded. OUTCOME MEASURES: Indications for knee replacement, perceived usefulness of treatments for osteoarthritis, perceived outcomes of knee replacement and number of knee replacement procedures performed by individual surgeons. RESULTS: The respondents disagreed on how 20 of 34 patient characteristics affected their decision to perform knee replacement surgery. They also disagreed on the usefulness of seven of eight treatments for arthritis of the knee. The respondents demonstrated variation in their expected outcomes of knee replacement. The surgeons who performed more procedures judged, on average, the outcomes to be better and to have fewer complications than the surgeons who performed fewer procedures. CONCLUSIONS: Orthopedic surgeons demonstrated disagreement about some of the indications for knee replacement, the usefulness of treatments for arthritis of the knee and the perceived outcomes of knee replacement. The areas of greatest disagreement should be the focus of future research and the development of practice guidelines.

Adult↗

PubMed1993

Human immunodeficiency virus transmission between surgeons and patients in orthopaedic surgery.

Surgeons are at risk for contracting human immunodeficiency virus (HIV) from patients. The risk of HIV transmission between patient and surgeon and the potential strategies to reduce the risk of HIV transmission are important. Continuous occupational exposure makes the risk of HIV transmission greater for surgeons than patients. Although the risk of seroconversion after a single exposure is relatively low, the risk for surgeons is more appropriately expressed as a cumulative lifetime risk. The estimated cumulative risk of HIV seroconversion for surgeons may be as high as 1 to 4%. Currently available strategies to prevent HIV transmission require knowledge of the mechanisms of exposure. Adequate barriers, such as double-gloving, waterproof outerwear, and face protection, should be worn for most, if not all, orthopaedic procedures. Additional specific strategies, however, are required to minimize sharp injuries. Surgeons should report any significant exposure to the occupational health department of their institution. Hospitals should have appropriate guidelines and procedures for counseling exposed surgeons, HIV testing of source patients, consideration of zidovudine prophylaxis, and disability insurance policies for surgeons who are occupationally infected with HIV.

Gloves, Surgical↗

PubMed1996

Breast cancer evaluation and follow-up: a survey of The Ohio Chapter of The American College of Surgeons.

Preoperative evaluation and postoperative follow-up of breast cancer patients vary considerably. Recent literature suggests that routine surveillance studies for breast cancer patients can be reduced without compromising the outcome. The Ohio State Chapter of The American College of Surgeons Committee on Cancer sponsored a survey of its general surgeon fellows to determine their practice philosophies regarding these issues. The questions centered around breast cancer screening, evaluation and treatment, and follow-up. The fellows were also questioned as to their opinions regarding practice parameters and whether the State Chapter should take a role in this area. Of the 764 surveys sent out, 34.2% were appropriate for evaluation. For breast cancer screening, 96.1% believe yearly mammography is important. Newly diagnosed breast cancer patients are generally evaluated with history and physical exam, chest X-ray, complete blood cell count, and liver function tests. Bone scans are used by 38.6% of surgeons. Most patients with positive lymph nodes see a medical oncologist. About half of primary breast cancer treatment (44.7%) is by breast preservation. Essentially all surgeons follow their patients after treatment for breast cancer surveillance. Essentially all surgeons feel that physical exam and mammograms are important for post-treatment follow-up. Complete blood cell count, liver function studies, and chest X-rays are used less commonly but still by more than half of the surgeons. 44.4% of the surgeons have found difficulty with third-party payers covering the costs of surveillance studies. 87.7% of surgeons surveyed felt the State Chapter should become involved in establishing clinical guidelines or practice parameters.

Attitude of Health Personnel↗

PubMed1997

Surgeons' follow-up practice after resection of colorectal cancer.

Consultant surgeons in two United Kingdom Health Regions were invited to complete a questionnaire on details of their personal management of patients with colon and rectal cancer, with particular emphasis on follow-up. Replies from 140 (94%) were analysed by the surgeon's subspecialty of colorectal and gastrointestinal surgery (group 1) and all others (group 2). There was a wide variation in the duration of followup, but no difference between the two groups. More group 1 surgeons carried out investigations as a routine after colonic (P < 0.01) and rectal (P < 0.01) resection. Colonoscopy was used more frequently by group 1 (P < 0.0001) and barium enema by group 2 surgeons (P < 0.05). Investigations to detect asymptomatic metastases were used as a routine by 33.3% of surgeons, in whom there was no concordance over the choice or combination of tests and no difference between the two groups of surgeons. There is no consensus among surgeons as to the ideal duration, intensity and method of follow-up after resection for colorectal cancer and little difference between the practice of colorectal and gastrointestinal surgeons and that of other specialists, except in the use of colonoscopy and barium enema. These results reflect the continuing lack of evidence on which to base the follow-up of patients after surgery for colorectal cancer.

Colonic Neoplasms↗

PubMed1994

"Do not resuscitate" (DNR) orders in the perioperative period--a comparison of the perspectives of anesthesiologists, internists, and surgeons.

The purpose of this descriptive study is to compare and contrast the experience, perceptions, and opinions of practicing anesthesiologists, internists, and surgeons regarding "do not resuscitate" (DNR) orders in the perioperative period. A questionnaire was mailed to 600 internists and 600 surgeons. Responses from these two groups were analyzed and compared with the results of a previously reported survey of 420 anesthesiologists. One hundred ninety-two of 570 (34%) and 199/584 (34%) acknowledged responses were received from internists and surgeons, respectively. Anesthesiologists (114/190; 60%) were more likely than internists (61/182; 34%) or surgeons (71/194; 37%) to assume DNR suspension in the perioperative period and were less likely than their colleagues to discuss with the patient the implications of their DNR order during anesthesia and surgery. This assumption of DNR suspension by anesthesiologists was underestimated by both surgeons and internists. Anesthesiologists and surgeons were more similar than internists in their manner of utilization of resuscitative measures in the setting of a cardiopulmonary arrest. All groups were more likely to require DNR suspension for elective than for palliative cases. The majority of all groups concurred that physician responsibility for defining DNR status in the perioperative period should be shared by the anesthesiologist, surgeon, and primary care physician and not prescribed by hospital policy. The manner in which a DNR order is perceived in the perioperative period varies considerably among specialties and warrants further discussion among these groups.

Anesthesiology↗

PubMed2005

[Pehr af Bjerkén 1765-1818. Chief baber-surgeon at the Serafimer hospital. Physician to the king].

Pehr af Bjerkén had his descent from a parish named Bjärka in western Sweden. His father was a medical doctor and assessor in Stockholm. At the age of sixteen Bjerkén began his studies in Uppsala. Later on he became a "chirurgiae studiosus" in Stockholm at the Serafimer hospital as a pupil of professor Olof Acrel. He defended a doctor's dissertation on "Febris puerperalis" in 1793. Thereafter Bjerkén went to London, where he spent three years. He was taken care of by mr Henry Cline and he met also John Hunter. After some time mr Cline made him a "House surgeon" at S:t Thomasis and Guys hospitals. He got good practice especially regarding the surgery of stones in the urinary bladder and in the surgery of the eye. During the stay he was appointed a member of the Medical Society of London. Back in Sweden Bjerkén practised the surgery with great success.and became physician in ordinary to the king. When in Februar 1808 the Russian tzar Alexander invaded Finland Bjerkén was appointed chief army surgeon in nothern Finland. During this war Bjerkén showed his courage on the battle fields operating and taking care of the wounded soldiers, also the enemies. Most wellknowned for us he became through a sentense in the poem "Döbeln at Juutas". In February 1809, when the Russian tzar had conquered all of Finland. Bjerkén resigned from the Finnish army. The first of June 1809 af Bjerkén was appointed to be head barber-surgeon (head surgeon) of the Serafimer hospital in Stockholm. He was then the most qualified surgeon in Sweden and was looked upon as the most important authority in surgery. Bjerkén was the first one to describe an operation and ligation of an aneurysm of the carotide artery. In 1812 he also published a ligation and resektion of a huge tongue reaching below the chin on a girl eleven years of age. Together with the description there was an engraving. This became the first illustrated publication in the proceedings of the Swedish Society of Medicine. He was especially wanted för operations of stones in the urinary bladder but had also great success in most of his operations and clinical work. In spite of this or due to his great load of surgery he wrote few scientific works. In January 1818 Bjerkén was invited to Gothenburgh to operate upon a urinary bladder stone. During the journey from Stockholm he got a stroke. Bjerkén was token care of in Jönköping by his old friend Jacob Edgren, head army surgeon. When lying on his deathbed he was told that the king Karl XIII had died. Bjerkén then said: "Well, the king of Sweden is dead and the king of the surgeons goes soon after". Bjerkén died on the 24 th of February 1818, 53 years of age. Pehr af Bjerkén was buried in the churchyard at Dala in the parish where his brother Carl-Gustaf had been the dean. Some hundred years later in 1912 a monument to the memory of Pehr af Bjerkén was erected at Dala by the Swedish Society of Medicine in connection with a commemoration.

Barber Surgeons↗

PubMed2006

Differences in biopsy techniques of actinic keratoses by plastic surgeons and dermatologists: a histologically controlled pilot study.

OBJECTIVE: To compare differences in biopsy techniques of actinic keratoses between dermatologists and plastic surgeons. DESIGN: Blinded, comparative, retrospective study. SETTING: Dermatopathology laboratory at a major academic medical center with referral of outside cases. Intervention We reexamined the histopathologic slides of 405 actinic keratosis biopsy specimens obtained by plastic surgeons and dermatologists from January 1, 1992, through May 31, 2002. We were specifically interested in the type of biopsy technique (shave, punch, or excisional biopsy) used for the surgical management of actinic keratoses by both groups of physicians. We also recorded the clinical diagnoses rendered on the dermatopathology request form and compared them with the histopathologic diagnoses. RESULTS: Excisional biopsies were performed by plastic surgeons in 50.0% of the cases, compared with only 1.4% by dermatologists. In contrast, shave biopsies of actinic keratoses were performed by plastic surgeons in only 32.4% of the cases, compared with 89.4% by dermatologists. Only 1 (0.5%) of the 198 dermatopathology request forms submitted by the plastic surgeons mentioned actinic keratosis, compared with 82 (39.6%) of 207 histopathologic evaluation requests submitted by dermatologists. CONCLUSIONS: The predominance of excisional biopsies of actinic keratoses by plastic surgeons may be related to a different ability in the clinical recognition of actinic keratoses compared with that of dermatologists. The surgical approach of dermatologists to shave diagnostically uncertain cutaneous lesions is less invasive than that of plastic surgeons and is more likely to achieve a better cosmetic outcome.

Academic Medical Centers↗

PubMed1998

Surgeon-patient communication in the treatment of pancreatic cancer.

BACKGROUND: Effective physician-patient communication has been correlated with patient satisfaction and improved outcome. Pancreatic cancer (PC) is a disease with an overwhelmingly poor prognosis that requires a complex level of communication and emotional support. Since the treatment of PC is often surgical, surgeons play a central role in the care of these patients. OBJECTIVES: To assess the quality of long- and short-term surgeon-patient communication. To assess the role of the surgeon in the emotional support of patients with PC. DESIGN: Combined mail and telephone survey of a case series of patients who had undergone a pancreatic resection for PC. SETTING: Urban tertiary cancer referral center. PATIENTS: Forty-eight patients who underwent pancreatic resection for PC. INTERVENTION: Pancreatic resection. MAIN OUTCOME MEASURE: Patient satisfaction. RESULTS: Forty-eight patients completed surveys for a response rate of 70%. Patients were extremely satisfied with the information provided by their surgeon before surgery and while in the hospital. However, 21% of patients reported an unexpected outcome of their operation and 27% had questions about their disease at the time of the survey. Patients were largely satisfied with the emotional support they had received while in the hospital and after discharge. The attending surgeon was the most commonly desired source of additional emotional support. CONCLUSIONS: While surgeon-patient communication was extremely effective before surgery and during hospitalization, patients developed long-term questions and dissatisfaction after discharge from the hospital. Strategies to improve long-term support and communication would benefit a significant number of patients with operable PC. Surgeons play an important role in the emotional support of patients with operable PC.

Adult↗

PubMed2001

What are the primary concerns of recently graduated surgeons and how do they differ from those of the residency training years?

HYPOTHESIS: Graduated surgeons have differences in concerns when comparisons are made between fellows and practicing surgeons, practicing surgeons and residents, and male and female surgeons. DESIGN AND SETTING: A survey was distributed to surgeons who graduated from 17 New England residency programs from 1993 to 1996, consisting of 9 demographic questions and 33 items coded on a Likert-type scale (with scores from 1 [least concerning] to 5 [most concerning]). PARTICIPANTS: Surgical fellows and practicing surgeons recently graduated from general surgical residency programs in New England who had participated in a previous study as residents. INTERVENTION: Distribution and completion of the survey. MAIN OUTCOME MEASURE: Personal and career-oriented concerns of recently graduated surgical residents. RESULTS: Personal issues continue to rank high for graduated residents, but the areas of greatest concern became more financially and career oriented. The top concerns of fellows were personal finances (mean score, 3.2), child rearing (mean score, 3.1), salary (mean score, 3.1), postponing family plans (mean score, 3.0), availability of role models (mean score, 2.9), and number of work hours (mean score, 2.8). The top concerns of practicing surgeons were salary (mean score, 3.2), personal finances (mean score, 3.1), number of referrals (mean score, 3.0), support for research (mean score, 2.7), child rearing (mean score, 2.7), and availability of role models (mean score, 2.7). Differences existed between men and women for child rearing, initiating personal relationships, maintaining personal relationships, maternity leave, and promotional advancement. Women were more concerned than men. CONCLUSIONS: Assistance with career planning and job selection during the residency years should be enhanced to diminish the concerns about financial issues and the availability of role models after graduation. Many of the concerns among male and female graduates are still reflective of larger societal expectations, but some, such as promotional advancement, may be attenuated through guidance and mentoring of residents before job selection.

Adult↗