Bio

Bio


Dr. Salles is a minimally invasive and bariatric surgeon. She completed medical school and residency in general surgery at Stanford prior to completing her fellowship in minimally invasive surgery at Washington University in St. Louis. She stayed on faculty at Washington University for three years prior to moving back to Stanford. Dr. Salles obtained a PhD in education from Stanford University during her residency training, and her research focuses on gender equity, implicit bias, diversity, inclusion, and physician well-being. She is a sought-after speaker and has given over 40 national and international invited talks related to gender equity, physician well-being, and weight bias.

Honors & Awards


  • Visiting Professor, Society of Asian American Surgeons (2019)
  • Exceptional Mentor Award, American Medical Women's Association (2019)
  • #IStandWithHer Award Honorable Mention, Women in Medicine Summit (2019)

Education & Certifications


  • Board Certified, American Board of Obesity Medicine, Obesity Medicine (2019)
  • Board Certified, American Board of Surgery, Surgery (2016)
  • PhD, Stanford University School of Education, Social Psychology (2014)
  • MD, Stanford University School of Medicine, Medicine (2006)
  • BS, University of Southern California, Biomedical Engineering (2002)
  • BA, University of Southern California, French (2002)

Professional

Professional Affiliations and Activities


  • Advisor, 500 Women in Medicine (2018 - Present)
  • Founding member, TIME'S UP Healthcare (2018 - Present)
  • Creative Director and Associate Editor, Surgery for Obesity and Related Diseases (2018 - Present)
  • Chair Surgical Education Research Group, Association for Surgical Education (2018 - Present)
  • Vice Chair Awards Committee, Association for Surgical Education (2019 - Present)
  • Co-Chair Communications Committee, American Society for Metabolic and Bariatric Surgery (2018 - Present)
  • Member, Publications Committee, Association for Academic Surgery (2017 - Present)
  • Member, WE R SAGES Task Force, SAGES (2017 - Present)
  • Member, Western Surgical Association (2019 - Present)
  • Member, American Educational Research Association (2011 - Present)
  • Fellow, American College of Surgeons (2018 - Present)

Publications

All Publications


  • 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

  • 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
  • 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?

    View details for DOI 10.1001/jamanetworkopen.2019.6545

    View details for PubMedID 31276177

  • 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 (? = 0.26, p < 0.01) and exercised (? = 1.02, p < 0.001) and slept (? = 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 (? = -0.44, p = 0.002). For men, there was no relationship between stereotype perception and psychological health (? = 0.015; p = 0.92). Among nonsurgeons, there was no relationship between stereotype perception and psychological health for either women or men (? = -0.016; p = 0.78; ? = -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

  • 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
  • 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
  • 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?69

    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

  • 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

  • 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
  • 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
  • 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
  • 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)
  • Self-Efficacy, Sex, and Resident Performance Milam, L., Mueller, C., Cohen, G., Salles, A. ELSEVIER SCIENCE INC. 2017: E159?E160
  • Self-Efficacy and Well-Being among Surgical Residents Salles, A., Milam, L., Mueller, C., Cohen, G. ELSEVIER SCIENCE INC. 2017: E44
  • 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 (? = -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

  • 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

  • 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
  • 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 (? = 0.76; p < 0.001), emotional exhaustion (? = -0.63; p < 0.001), depersonalization (? = -0.48; p = 0.002), and depression (? = -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

  • Belonging as a Measure of Risk of Attrition Salles, A., Liebert, C. A., Lin, D. T. ELSEVIER SCIENCE INC. 2015: S49
  • Emotional Intelligence as a Predictor of Resident Wellness Lin, D. T., Liebert, C. A., Lau, J. N., Salles, A. ELSEVIER SCIENCE INC. 2015: S52
  • 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
  • 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
  • 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

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