Faculty Bibliography

The association between procedure volume at institutions and outcomes of cancer surgeries has been widely published in the medical literature; discussed in the lay press; and, during the past 15 years, incorporated into quality improvement endeavors. In certain cases, institutional volume has become a proxy for quality. Despite the vast amount of retrospective data on this topic, physicians generally have been unsure how to approach the information and interpret it for their patients. Even more challenging to some physicians has been deciding whether the data oblige them to either direct patients with cancer to high-volume centers for care or discuss the data with these patients as part of informed consent. An additional challenge is that physicians must understand laws related to these issues and that these laws are unclear. This article reviews the ethical arguments for including disparities in hospital outcomes as part of informed consent and examines whether legal precedent can shed light on this debate.

BACKGROUND:Mentorship in academic surgery is reflected in part by senior surgeon support of younger individuals with their scholarly contributions to the literature. Scholarship is also reflected in the procurement of extramural funding. This study sought to quantify this process in recent years. STUDY DESIGN/METHODS:All active American Surgical Association and Society of University Surgeons members in the following 2 eras were defined as being mentors (N = 559): 1993 to 1999 (I) and 2000 to 2006 (II). Mentees (N = 7,037) were defined as a primary author associated with the mentor. MEDLINE-cited papers of mentors and mentees were abstracted. Randomly selected mentees from era I and II were examined for academic productivity. The National Institutes of Health (NIH) Computer Retrieval of Information on Scientific Projects database was queried for federal research funding for the mentors and mentees. Continuous categoric and logistical regression was used as appropriate. RESULTS:Combining both eras, mentors published a total of 23,558 articles, of which 3,854 were primary and 9,881 were senior authored. Mentor primary-authored papers were more common in era I than era II (mean = 8 vs 6 articles, P < .01), whereas the number of senior-authored papers was similar in both eras (mean = 18 vs 17 papers, P = .09). Fewer mentors had federal funding in era I compared with era II (42% vs 51%, P = .04). More mentees per mentor existed in era I compared with era II (15 ± 5 vs 9 ± 4, P < .001). Era I mentees examined in era II (n = 187) were primary and senior author of a mean of 2.5 and 5 articles, respectively. Of this group, 14 (7.5%) had federal funding. The number of primary- and senior-authored articles from the mentee but not their prior mentor correlated with federal funding (P < .05). CONCLUSIONS:The number of mentees per mentor has decreased in recent years as has primary-authored authors, whereas federal funding has increased for mentors. Overall NIH funding for mentees was low but is related to their productivity with the mentor.