The purpose of this study was to analyze a nationwide database of malpractice lawsuits involving pediatric surgical patients to identify contributing factors in liability claims.
Using the CRICO ...(Controlled Risk Insurance Company Strategies’ Comparative Benchmarking System) database, malpractice claims involving patients ≤18 y old were reviewed from 2008 to 2017. Data were analyzed using descriptive statistics and logistic regression.
Of the 844 claims, 76% of the patients were older than age 5. While the average total indemnity paid was $544,325, cases with claimants <1-year-old accounted for 24% of the total indemnity paid, with an average of $1,135,240 per claimant. The most frequently named responsible services were Orthopedics (34%), General Surgery (15%), and Otolaryngology (11%). Fracture or dislocation, appendectomy, skin/breast surgery, arthroscopy, and tonsillectomy/adenoidectomy were among the frequently involved procedures for the cohort of cases. The most common contributing factors for the top procedures involve issues surrounding patient assessment, technical performance, and communication. Cases with a contributing factor of failure to appreciate and reconcile relevant sign/symptom/test results were associated with a higher likelihood of payment (OR 6.6, P < 0.05). Issues surrounding the selection of therapy also led to an increased likelihood of an indemnity payment (OR 2.8, P < 0.05).
Malpractice claims related to pediatric surgical procedures involve a wide range of specialties. Patient evaluations, technical performance, and communication are modifiable factors to improve surgical care in children. The contributing factors assigned to each procedure may represent an opportunity for focused improvement to improve patient outcomes.
Pediatric surgery remains the most competitive general surgery subspecialty. The authors suspected significant inflation in academic metrics since the last published paper. This study aimed to ...identify factors associated with applicant success in the match.
After IRB approval, all applications to a single accredited pediatric surgery fellowship program were reviewed for match years 2014–2018. Matched and unmatched applicants were compared in an unadjusted and adjusted analysis.
This training program received 414 of 425 total applications (97%). Match results were available for 388 (94%). Matched applicants were more likely to train in programs with pediatric surgery fellowships (64% vs. 28%) and to have dedicated research time (55% vs. 21%; all p < 0.01). Matched applicants had more total publications (median: 12 vs. 7, p < 0.01) and higher ABSITE scores (median: 64th vs. 59th percentile, p < 0.01). Training in multiple programs negatively impacted the chance to match (p < 0.01). The median number of publications per applicant increased over the study time period from 7 to 11 (p < 0.01).
The likelihood of matching into a pediatric surgery fellowship was related to the type of residency attended, dedicated research time, ABSITE scores, and number of publications. Overall, the total number of publications reported by all applicants increased.
Retrospective Comparative Study.
Level III.
Previous studies have examined characteristics critical to make a successful applicant in the pediatric surgery match. No previous study has focused on what applicants consider important as they ...interview pediatric surgery training programs.
Successfully matched applicants to our training program from 2018 to 2020 were identified and a 49-question survey sent electronically. In addition to a descriptive analysis of responses, comparisons between those who matched into one of their top three programs and those who matched outside of their top three programs were made. A Likert scale was used and data are reported as mean (95% confidence intervals).
One hundred and thirty individuals were surveyed. Sixty-three (48%) responded. The most important characteristics identified were total index case volume 1.94 (1.87, 2.00), interactions with faculty on the interview day 1.84 (1.74, 1.94), neonatal case volume 1.75 (1.61, 1.88) and degree of autonomy 1.63 (1.50, 1.77). Respondents also placed a high importance on the in-person interview experience 1.63 (1.49, 1.77). The least important training program characteristics were quantity of vacation time -0.24 (-0.52, 0.05), opportunity to participate in medical mission trips -0.25 (-0.54, 0.06), paid accommodation at the interview -0.29 (-0.57, 0.00), and access to a simulation laboratory -0.51 (-0.78, -0.24).
Clinical volume, neonatal volume, faulty interactions and the experience on the interview day are the most important characteristics to applicants. There were few, if any, characteristics applicants felt were truly unimportant as they weighed their rank lists. Applicants also placed a high level of importance on an in-person interview
Level IV
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