Abstract
Background
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has recently developed and announced its Masters Program that aims to address existing needs of practicing surgeons for lifelong learning and consists of eight clinical pathways each containing three anchoring procedures. The objective of this study was to select the seminal articles for each anchoring procedure of these pathways using a systematic methodology.
Methods
A systematic literature search of Web of Science was conducted for the most cited articles for each of the anchoring procedures of the SAGES Masters pathways. The most relevant identified articles were then reviewed by expert members of the relevant SAGES pathway committees and task forces and the seminal articles chosen for each anchoring procedure using expert consensus.
Results
578 highly cited articles were identified by the original search of the literature and the seminal articles were selected for each anchoring procedure after expert review and consensus. Articles address procedural outcomes, disease pathophysiology, and surgical technique and are presented in this paper.
Conclusions
We have identified seminal articles for each anchoring procedure of the SAGES Masters program pathways using a systematic methodology. These articles provide surgeon participants of this program with a great resource to improve their procedure-specific knowledge and may further benefit the larger surgical community by focusing its attention to must-read impactful work that may inform best practices.
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The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has recently developed and published its Masters Program [1] that aims to address existing needs of practicing surgeons for lifelong learning after training completion and serve as an optimal way for general surgeons to achieve continuous certification. The SAGES Masters Program organizes educational content across 8 clinical pathways relevant to its membership (Acute Care, Bariatric, Biliary, Colon, Foregut, Hernia and Robotic Surgery, and Flexible Endoscopy) and builds on the Dreyfus model of skill acquisition [2] by offering curricula addressing three levels of performance (competency, proficiency, and mastery). The content of each pathway and level has been determined based on expert consensus of the SAGES board and includes elements addressing knowledge, technical, and nontechnical surgical skills [1]. Each pathway level incorporates an anchoring procedure that is meant to be used for training and assessment of surgeons and coaching by more experienced members of the society. The steering group of the Masters program felt it was important that knowledge acquisition for each anchoring procedure of the 8 pathways should incorporate the best available evidence in the literature. The steering group therefore assigned experts to identify up to 10 seminal articles for each anchoring procedure using a systematic methodology.
The objective of this paper is to report the seminal articles for each anchoring procedure of the eight SAGES Masters pathways and the methodology used to determine them.
Materials and methods
To determine the seminal papers for each anchoring procedure of the 8 pathways, a systematic literature review was performed by the SAGES librarian in April 2018 for each anchoring procedure. For each identified paper, the year of publication was recorded and the Web of Science and Google Scholar were then searched to assess the number of citations received since publication. To assess the impact of each paper in the field also taking into account the duration since publication, a citation index (CI) was calculated using the equation: CI = number of citations/ years since publication. All articles were then ranked based on this CI and the top 30 papers with the highest CI were selected. These 30 articles were then reviewed by members of the SAGES committees or task forces relevant to each pathway. Reviewing members had expertise in the respective pathways and procedures; the leaders of each relevant SAGES committee/ task force were also encouraged to obtain input from other well-known experts in the field as necessary. To select the top papers, experts were encouraged to select articles that they felt should be read by every surgeon performing the relevant procedure and that had known impact in the field taking into consideration the results of the literature search and CI for each paper. The expert group was allowed to include manuscripts not identified by the literature search if they were deemed to be important by consensus. The final seminal papers for each procedure of each pathway were selected based on expert consensus and are reported here; up to 10 articles per procedure were requested. Of note, the robotic pathway is an adjunct pathway without specific anchoring procedures as the technique applies to multiple procedures; hence seminal articles relevant to the robotic technique are listed together rather than according to specific procedures.
This study was exempt from IRB approval.
Results
160 SAGES Committee/ Task Force members and other experts participated in the sentinel article selection process. 578 articles for all procedures were retrieved initially by our search of which up to 30 per procedure were subjected to the expert review and consensus process. The CI for the seminal articles across all pathways for Google Scholar ranged from 0.25 to 257.2 and for Web of Science 0.25–140.44. Articles addressed procedural outcomes, disease pathophysiology, and surgical technique. Selected articles were published in a variety of surgical journals and originated from several different countries. The seminal articles for each procedure are reported on Tables 1, 2, 3, 4, 5, 6, 7, 8.
Discussion
In this paper, using a systematic methodology and expert consensus, we identified and reported the seminal articles for each anchoring procedure of the eight SAGES Masters pathways. The goal of this project was to provide participants of the SAGES Masters pathways with the best available literature relevant for each procedure. The steering group of the Masters program felt that these papers would be invaluable for surgeon participants of the program to ensure best possible acquisition of knowledge relevant to each procedure. Identifying articles that have exerted the most influence on a particular procedure and field could help surgeons become familiar with landmark works, recognize optimal procedural outcomes, better understand the mechanisms of action, and identify aspects of each procedure and technique that deserve more attention. Further, by identifying the top published articles, insight is provided into knowledge generation processes that may be vital to surgical education and research; these articles may highlight the types of work that have the most impact in a field and become “classics”. This process also honors leaders in the field by identifying the impact of their work [3].
Other studies have identified the top-cited articles in urology, [4] orthopedic surgery [5], arthroscopy, [6] emergency medicine, [7] plastic surgery, [8] and medical education [3]. Nevertheless, we could not identify publications relevant to seminal papers in general surgery and the anchoring procedures of the SAGES Masters program, which is why we undertook this project.
Similar to our work, prior studies have used citation frequency to identify the top articles in their field [3,4,5,6,7,8]. A distinct difference of our study’s methodology, however, is that we subjected the initially identified articles based on citation frequency to expert review and feedback. The latter determined the final list of sentinel articles. Our rationale was that for the purposes of this project, identifying the seminal articles for each procedure was a more appropriate approach as our focus was on teaching rather than the research impact of the top articles. While we took into consideration the impact of each article based on number of citations, our ultimate goal was to provide surgeons with the most relevant articles to each procedure with regard to technical considerations, pathophysiology, effectiveness, and patient outcomes.
Unlike prior studies, we also used a citation index instead of solely the number of citations. Our justification was that articles published earlier have more time to accumulate citations compared to more recent literature. While our approach is based on a solid rationale, the impact of time on citation number has not been proven [7]. It should also be noted that we searched the Web of Science, while other relevant papers have used the Web of Knowledge, which is a more comprehensive database of the literature. Nevertheless, Web of Science includes all relevant surgical journals and the additional expert review we conducted should have minimized potentially missing articles. Unlike prior publications that have limited their search to specific surgical journals, [5, 9] our approach provided a broader search of the literature and included all journals indexed in Web of Science.
Known limitations of identifying “top” articles [5, 10, 11] based on citation analysis include not accounting for self-citations, citations in textbooks, article popularity, and electronic views of an article, and authors’ potential preference to cite articles in the journal in which they seek to publish their work [5, 12]. The expert review we conducted may have addressed some of these limitations. On the other hand, expert reviews introduce their own biases such as selecting only articles they are familiar with or only consider those that reflect own experiences and biases. We believe we have minimized these biases by including both large number of experts and relying on consensus as well as by combining citation numbers with expert opinion. Given that the literature continues to accumulate and evolve, it is also important to note, that the process we followed in this study will need to be repeated in due time in the future (3–5 years) in order to ensure surgeons learn using the most up-to-date references.
In summary, we have identified the seminal articles for all anchoring procedures of the SAGES Masters program pathways using a systematic methodology. We believe that these articles will add value to the Masters pathways by providing surgeon participants a great resource to improve their procedural knowledge. They may further benefit the larger surgical community by focusing its attention to must-read impactful work that may inform best practices.
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Acknowledgements
We want to thank the following SAGES members who helped select the top 10 papers for each masters pathway: Deborah Keller, MS, MD, Sami Chadi, MD, MSc, Lawrence Lee, MD, PhD, Tonia Young-Fadock, MD, MS, Brian R. Davis, MD, B. Fernando Santos, MD, Sunny Shah MD, Saniea Majid MD, Matt Kroh MD, Nabeel Obeid MD, Vamsi Alli, MD, Antonio Caycedo, MD, Ryan Juza, MD, David Urbach, MD, Mazen Al-Mansour, MD, Abdulrahim Al Awashez, MD, Salvatore Docimo, MD, Konstantinos Makris, MD, Jim Ellsemere, MD, Emmanuele Lo Menzo, MD, Patrick Reardon, MD, Ankit Patel, MD, Michael Truitt, MD, Samer Sbayi, MD, Jonathan Pearl, MD, Nawar Alkhamesi, MD, Josh Weis, MD, Ben Clark, MD, Matt Bloom, MD, Dan Bonville, MD, Jon Roth, MD, Melissa Hogg, MD, Seth Rosen, MD, Seth Felder, MD, JB Bittner, MD, Yusef Kudsi, MD, Conrad Ballecer, MD, Alberto Meyer, MD, Ambar Banerjee, MD, Andrea Pakula, MD, Archana Ramaswamy, MD, Caitlyn Lesh, MD, David Earle, MD, Fernando Garcia, MD, Gabriel Arevalo, MD, Hussna Wakily, MD, Jake Greenberg, MD, Jeff Blatnik, MD, Julietta Chang, MD, Rebecca Peterson, MD, Rich Pierce, MD, Stephen Haggerty, MD, and Stephen McNatt, MD.
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This project did not receive any funding.
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Dr. Patricia Sylla reports grants and personal fees from Karl Storz, grants and personal fees from Olympus, grants and personal fees from Ethicon, grants and personal fees from Medtronic, outside the submitted work. Dr. Eric M. Pauli reports personal fees from Boston Scientific, personal fees from Cook Biotech, grants and personal fees from CR Bard, outside the submitted work.kimca. Dr. Dmitry Oleynikov reports personal fees and other financial ties from Virtual Incision, grants and nonfinancial support from Gore, outside the submitted work. Dr. Marina Kurian reports personal fees from Gore, personal fees from Ethicon, personal fees from Allurion, personal fees from Medtronic, outside the submitted work. Dr. Leena Khaitan has no conflicts of interest or financial ties to disclose. Dr. Michael W. Cripps reports personal fees from Hemosonics, personal fees from Instrumentation Laboratory Worldwide, outside the submitted work. Dr. Sharon Bachman has no conflicts of interest or financial ties to disclose. Dr. Adnan Alseidi has no conflicts of interest or financnial ties to disclose. Dr. L. Michael Brunt reports grants from Gore Medical, personal fees from Intutive Surgical, outside the submitted work. Dr. Horacio Asbun reports other financial ties from Boston Scientific, other financial ties from Olympus, outside the submitted work. Dr. Daniel B. Jones reports other financial ties from Allurion, outside the submitted work. Dr. Dimitrios Stefanidis, Linda Schultz and Shauna Bostian have no conflict of interest or financial ties to disclose
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Stefanidis, D., Schultz, L., Bostian, S. et al. SAGES masters program: determining the seminal articles for each pathway. Surg Endosc 34, 1465–1481 (2020). https://doi.org/10.1007/s00464-020-07392-z
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DOI: https://doi.org/10.1007/s00464-020-07392-z