Oxford Handbook of Clinical Surgery

This new edition of the Oxford Handbook of Clinical Surgery is thoroughly revised with the latest guidelines, management algorithms, and guidance on decision-making. It features three new chapters, on day case surgery, remote and rural surgery, and emergency surgery. The book also offers surgically relevant anatomy and physiology, quick reference symbols, key diagrams, and a focus on evidence-based practice with key references throughout. It is thoroughly comprehensive, without sacrificing the clear, concise, and quick-reference style the Oxford Medical Handbooks are known for. Ultimately, the new edition provides an accessible pocket reference for surgical trainees, medical students, and all those involved in the care of the surgical patient.

Remote and rural surgery

This chapter describes remote and rural surgery. For many years, surgeons working in remote and isolated areas have failed to receive the recognition they deserve. Anyone living in a remote and rural area will know of lives saved and diseases cured by locally based surgeons. Delivery of surgical services to remote and rural areas remains an intractable problem in many countries. Recently, the Royal College of Surgeons of Edinburgh has published a report titled ‘Standards informing delivery of care in rural surgery’ (2016); it provides explanations of how surgical services can be provided to remote and rural communities in a safe and appropriate manner. The chapter then looks at rural surgical practice; rural general hospitals; care pathways; and the recruitment, retention, and training of rural surgeons.

Do Rural Longitudinal Integrated Clerkships Impact Choice of Residency Type and/or Permanent Community Practice in Surgery?

Purpose: Rural general surgery experiences during medical school appear to have influenced the decision of prospective general surgery applicants to pursue residency programs that provide rural surgery opportunities. This is an analysis of a single cohort, rural-focused, longitudinal integrated clerkship to determine if there is an association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Methods: An institutional database of de-identified, self-reported data was reviewed to identify rural-focused longitudinal integrated clerkship alumni who matched into a surgical residency program. Findings: Of the seventy-five alumni who chose a surgical residency program, 40 (53.3%) matched into a university-affiliated residency program, and 32 (42.6%) matched into an independent-academic program. There was no association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Conclusions: A rural-focused longitudinal integrated clerkship can help increase the rural physician workforce within both the state and region of the sponsoring institution. To facilitate heightened interest in rural general surgery, these types of programs should continue to be promoted.

Rural Surgical Training in the United States: Delineating Essential Components Within Existing Programs

Background Rural access to surgical care has reached crisis level. Practicing in rural America offers unique challenges with limited resources and specialists. Most training programs do not provide enough exposure to the endoscopic or the surgical subspecialty skills to prepare a resident for an isolated rural environment. As awareness has increased, many programs have modified curriculum to address this need. The Advisory Council on Rural Surgery (ACRS) of the American College of Surgeons set out to delineate important components of rural training programs and measure to what degree the existing heterogeneous programs contain these components. Study Design The ACRS identified 4 essential components of rural surgical training based on literature and expert opinion. These components included rotations in a rural setting, broad exposure to surgical specialties, endoscopy experience, and lack of competing specialty learners. A list of Accreditation Council for Graduate Medical Education programs from a prior publication was updated with the 2019 Fellowship and Residency Electronic Interactive Database self-identified “rural track” programs, reviewed, and categorized. Results We identified 39 programs that self-identified as having a rural emphasis. Depending on the extent of which 4 essential components were included, programs were categorized as either “Broad” (12 programs), “Basic” (20 programs), or “Indeterminate” (7 programs). Conclusion The ACRS described the optimal components of a rural surgical training program and identified which components are present in those surgical residencies which self-identified as having a rural focus. This information is valuable to students planning a future in rural surgery and benefits programs hoping to enhance their curriculum to meet this critical need.