谷河 篤

PURPOSE: This study aimed to clarify the timing and motivations behind decisions to pursue a surgical career and identify optimal recruitment strategies. METHODS: A nationwide questionnaire was administered to newly certified surgical trainees. Respondents were classified into two groups based on when they decided to pursue surgery: before junior residency (BJR) or during/after junior residency (DJR). The backgrounds and motivations were compared. RESULTS: Among the 758 respondents (53.8%), 25.6% were female. Male trainees were more likely to decide to pursue surgery before medical school (18.7% vs. 9.4%, p = 0.003), whereas female trainees more often decided during their PGY-2 (35.4% vs. 24.1%, p = 0.002). The DJR group included more women (30.3% vs. 21.7%, p = 0.014) and residents from urban areas (46.6% vs. 36.7%, p = 0.008). The BJR group was more influenced by the images of surgeons and family. Among female residents, those in the DJR group were more influenced by recruitment from the surgeons. CONCLUSIONS: This study demonstrated sex differences in the timing and motivation for pursuing a surgical career. Understanding the optimal timing and appealing factors for recruiting surgeons, particularly women, could inform more effective recruitment strategies.

OBJECTIVE: Selective non-operative management (SNOM) is increasingly used for hemodynamically stable patients with abdominal gunshot wounds (GSW). Although peritoneal signs traditionally mandate emergency laparotomy, the clinical value in the era of computed tomography (CT) remains unclear. This study evaluated the clinical value of peritoneal signs and the adjunctive use of CT for identifying patients requiring therapeutic laparotomy. METHODS: We conducted a retrospective cohort study of patients with abdominal GSW admitted to a Level I trauma center between 2016 and 2023. Patients with systolic blood pressure < 90 mmHg, Glasgow Coma Scale<9 or intubation in the emergency department were excluded. Patients were categorized by the presence of peritoneal signs upon arrival. Clinical data, CT, and operative findings were reviewed. The primary outcome was intra-abdominal injuries requiring therapeutic laparotomy. RESULTS: Among 308 patients, 57 (18.5%) had peritoneal signs. Of those, 50 (89.3%) had therapeutic laparotomy. Peritoneal signs alone demonstrated sensitivity of 36.8% and specificity of 95.9% (95% confidence interval [CI]: 28.7-45.4 and 91.7-98.3, respectively). Among 251 patients without peritoneal signs, 95 underwent laparotomy based on CT findings, with 85 (89.5%) having therapeutic laparotomy. Only two of 157 patients managed non-operatively after CT required laparotomy following clinical observation. Combining peritoneal signs with CT findings yielded sensitivity of 99.3% and specificity of 87.8% (95% CI: 96.0-100.0 and 81.8-92.4, respectively). CONCLUSIONS: Peritoneal signs alone had high specificity but limited sensitivity for detecting intra-abdominal injuries requiring therapeutic laparotomy. With selective CT use, our results supported the safety of SNOM in hemodynamically stable patients with abdominal GSW.