Facebook and unprofessional behavior among surgical residents

Have you ever wondered about the behavior of surgical residents on Facebook? I have. A study from the Journal of Surgical Education posted online in June 2014 looked at the issue.

The paper, "An Assessment of Unprofessional Behavior among Surgical Residents on Facebook: A Warning of the Dangers of Social Media," identified 996 surgical residents from 57 surgical residency programs in the Midwest and found that 319 (32%) had Facebook profiles.

Most (73.7%) displayed no unprofessional content, but 45 (14.1%) exhibited possibly unprofessional material. Clearly unprofessional behaviors were noted in 39 (12.2%) resident profiles. The paper said, "binge drinking, sexually suggestive photos, and Health Insurance Portability and Accountability Act (HIPAA) violations were the most commonly found variables."

There were no differences in the rates of unprofessional behavior between male and female residents or by postgraduate year.

I have blogged previously about the ill-defined nature of professionalism, and the papers authors acknowledged that it can be subjective. Some of the behaviors they felt were potentially unprofessional such as photos of residents holding an alcoholic drink, holding a gun while hunting, or making political or religious comments are debatable.

They referenced another paper that found similar rates of unprofessional behavior (16%) on Facebook among applicants to an orthopedic surgery residency program.

A 2005 New England Journal of Medicine case-control study found that practicing physicians disciplined by state medical boards were significantly more likely to have had documentation of unprofessional behavior in medical school as well as lower Medical College Admission Test scores and poorer grades in the first two years of medical school.

Unprofessional behaviors listed in the New England Journal paper were irresponsibility, diminished capacity for self-improvement, immaturity, poor initiative, impaired relationships with students, residents, nurses, or faculty, impaired relationships with patients and families, and unprofessional behavior associated with anxiety, insecurity, or nervousness.

Some of those seem a bit vague. Are diminished capacity for self-improvement and poor initiative really unprofessional behaviors?

Facebook unprofessional behavior and the unprofessional behavior documented in the NEJM paper which pre-dated the widespread use of Facebook may not be comparable.

But I suppose one could say that some of the Facebook behaviors could be categorized as immature or irresponsible.

Until stories about residents being rejected for jobs after training start emerging, there probably wont be a change in the way they use Facebook or other social media.

Or maybe society will change.

In 1987, politician Gary Hart had to withdraw as a candidate for the Democratic Partys presidential nomination because he had an extramarital affair, and just a few years later, the president himself had a dalliance with an intern in the White House and survived.

Who thought marijuana use would ever be legalized?

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Cosplay should be encouraged not discouraged among peers

 Im often asked why I decided to dive into the wonderful world of cosplay and my answer is always the same: "Because it looked like fun". And it is! The imaginative world of costuming allows us to literally become our favorite characters. It is a creative process, a form of self expression and we have the freedom to decide which character to choose, what variant and add in any personal touches. The more, the merrier right? So why are some people getting their spandex in a bunch?
Apparently some individuals get offended when they see a fellow costumer dressed as the same character as they are. Their reasons are everything from admitting low self esteem to feeling that there should be only one character per convention or event. I was even told of an incident where someone asked a fellow cosplayer not to dress up as a certain character because it was something she wanted to do. Since when was it okay to behave like this among peers? Why are some people discouraging others instead of encouraging them? Unity has seemed to have gone out of the window and an attempt at dictatorship has taken its place.




This isnt taking place everywhere in the world of cosplay but among a small circle. Among some of the best cosplayers in the United States (also known as "Elite Cosplayers"), it is encouraged to cosplay any character you choose and some of them even act as mentors for aspiring cosplayers. The Superman portrait (seen above) taken at the 2011 DragonCon is a perfect example of unity among cosplayers who share the love of the same character. Each respective cosplayer is portraying a different version of the Man of Steel and the result is nothing short of stunning. Recently I was at a charity event and was one of two Wonder Woman cosplayers in attendance. We were two different variants; I was the traditional version and the other was the New 52 pants version. I learned a few months later (indirectly) that this was apparently a problem although I was told I could wear whatever I wanted. Now if four grown men can cosplay Earths Greatest Hero in glory, why cant the same be done between two grown women? I certainly didnt have a problem with it. I actually make it a point to approach a cosplayer who is dressed as the same character as I am because clearly we have something in common. I love taking pictures with these women and marveling at their version of the character, asking questions and telling them they did a great job. Some people however have become competitive about it. True, there are some cosplayers whom I feel are the best version of Supergirl or Wonder Woman that I have ever seen but I dont compare myself to them. I am satisfied with my version of those characters. I dont sit there thinking how can I "beat" someone like Margie Cox. Its not about beating someone, its about being the best Wonder Woman I can be.

Cosplayer Jonathan Carroll is one of the best in the country and acts as a mentor to people wanting to cosplay Superman, one of his signature characters. Says Jonathan:

"I think its very important to encourage any cosplayer, whether or not theyre portraying the same character. We can all learn something from one another. You go to a con, and see things on other costumes that you may not have thought about, like "oh! i like his boots, that guys cape is great! or i really like the way his symbol looks", and from that you grow, change, and evolve. Were all there to represent our favorite character, in our own way, the best way we can. And its up to the veteran costumers, whove been on the scene for a while, to help those that are just beginning. Be it in the actual costume, the work out and diet, or the product we use on our hair to give it the perfect quaff, I believe, we should help one another, so that this culture survives and grows into something even greater than it is today."


Jonathans brother and fellow cosplayer Danny Kelley concurs with Jonathans views and digs deeper on why we cosplay in the first place and all the hard work that goes into practicing our craft.

"I am very honored that people come to me with questions about fitness and costumes. It makes me feel like I am doing justice to this craft that I love. I think everyone no matter what size or shape, color or origin should be able to for a few times in their life, become those characters that they love. Most grownups have forgotten what it was like to be a kid and dream. We in the cosplay world never have and never will."  

 Iggy Cosplay (the Joker pictured on the left) is best known for his portrayal as the Clown Prince of Crime. I asked Iggy if he felt competitive towards other Joker cosplayers and he had this to say:

"I am far from competitive about it and I certainly encourage it. The only reason why Im still doing this is because another Joker cosplayer encouraged me to keep going. Ive become good friends with other Jokers through cons as well. You cant have one definitive version. Its fun to see where each cosplayer takes the character in their own imaginative way."  



I often read articles and say to myself  "Well, that was pointless!" I want to avoid that with this article and make my point clear. Cosplayers should be encouraging each other not discouraging one another. I am by no means saying that someone does not have the right to express their opinion if they are feeling hurt or insecure about their cosplay. However when you start making unrealistic demands and are becoming competitive amongst your friends, clearly you have crossed a line. You are not cosplaying for the right reasons. You are cosplaying for the wrong reasons. Cosplay is suppose to be fun. Personally I feel it boils down to a certain level of maturity and of course, insecurity. If you have issues with your image whither it be the quality of your costumes or your body, you need to address and take care of those issues but please dont rain on everyone elses parade. Learn to accept yourself, be proud of your accomplishments and count your blessings. There are times you will be the only Harley Quinn at an event, at others you may run into a dozen. Theres nothing wrong with that. Its a positive thing. Its love. A dark attitude will leave you trapped in a hobby you no longer enjoy and the possibility of loosing your friends in the process.

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Interview Artist Des Taylor

Des Taylors stunning superhero pin ups have become one of the hottest things to hit the web! Collectors are scrambling to own pieces of his original artwork which have received international recognition and praise. Combing the beauty of vintage photography with earths greatest heroes results in some of the most exquisite artwork I have ever seen.  Read on to learn more about this acclaimed British artist in my exclusive interview for the Confessions of A Cosplay Girl Blog.



Victoria: Tell me about your original creation, Vesha Valentine? What inspired you to create her? What is she about?

Des: The Vesha Valentine Story tells the story of this fictional bombshell who rockets to stardom on the strength of her beauty, charm and talents. Begun as an art book, The Vesha Valentine Story began to take shape in his mind when I was commissioned to use the character in a series of displays for Theo Fennell’s (the UK’s jeweler to the stars) Christmas Window display in 2009. It was from there that my thoughts began to veer towards a more story-driven project for the cartoon beauty. My love for the screen sirens like Rita Hayworth, Monroe, Garbo and Anne Margaret inspired me to put out a book that was different to what was out on the shelves.

Victoria: What projects are you working on right now?

Des: Oooooohh! The return of my first character Katie Rogers at the moment in the OGN THE INFAMOUS KATIE ROGERS. This will be taking up most of my time this year followed by Legend of The Blue Lotus which is sort of a retro-crime-fighting character.

Victoria:  Did you attend art school?

Des: Yep! Did a Foundation Course in Art Design and Graphics then went on to West Herts college to get a Diploma in Graphic Design and Image-Making. Word of advice to anyone wanting to pursue a career in design... forget sleep and ALWAYS hit your deadline!

Victoria What made you decide to merge pin-up and superheroes?

Des: It was a conscious decision looking at all of the DARK themed comics that are on the shelves at the moment. Too much! They are not the type of books I read growing up and not the type I shall be introducing to my little ones. Early last year I created a Pin Up Wonder Woman which sparked a frenzy on the web so I thought why not explore re-imagining some other characters too.

Victoria: What conventions will you be appearing at this year?

Des: Did a successful stint at KAPOW! London and I shall be at San Diego Comic Con and Thoughtbubble in Leeds this year.

Victoria: What are your thoughts on the New 52?

Des: Oboy! Gotta be honest...not a fan! Too dark, twisted and sexual (except the Batman/Owl story arc which is exceptional) and I cant get to like the characters like I did in the past. I understand you have to re-boot your characters every decade but this reboot was not thought out well. Superman... who I LOVE... I cant get to like the new high collared costume with the heavy boots. Wonder Woman... costume..not bad but the comic is not giving WW fans what they want and dont get me started on Detective Comics. Where is the detection? DC could have used this to show Batmans detective skills like a comic book CSI Gotham. In all, the whole line is aimed towards adults and there is nothing left for the kids, the next generation of consumers. I looked at the comic for Voodoo and half of it is of her stripping in a strip-club?????

Victoria:  Are you looking forward to the Man of Steel Superman reboot film?

Des: I am. Iif anything just to see the big-man up on the screen again. LOVE Superman films, even though the last one didnt really do well there were still a few things I liked about it. Im sorry though, the AVENGERS was the best super-hero film I have ever seen. The whole experience with the audience whooping and hollering just added to it. We all came out of that in tears of laughter at the Hulks antics. Brilliant, and cant wait for the sequel.

Victoria:  How long does it take you to create a work of art? Whats the creative process like?

Des: Well...I wake up at the crack of dawn ( have a 4 month old baby I use as an alarm clock LOL) and start to sketch, then go back to sleep for an hour or two, when I wake up and start inking, scanning the artwork, rendering and then coloring each character. I then work like an animator placing each element where I want them and then determine the environment, lighting and mood. Its a bit tedious on some occasions but I am happy I have developed a style people love and have gathered a loyal following .

Victoria: Where can people order prints and commissions of your art?

Des: People can go to my site http://www.despop.co.uk/ to purchase what is up there, for something unique or if they see an image they like on my blog or Facebook page...just ask! Drop me a mail! However, I only do short runs of designs, even 1 of 1. I like that very few people own a Des Taylor print or sketch.

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Dont jump to conclusions about that JAMA surgical readmissions paper

On February 3, JAMA published a paper online about readmission rates after surgery. The focus of most tweets was on the most common cause for readmission—surgical site infections (SSIs)—in 19.5% of readmitted patients.

At first glance, this suggests that infection rates after surgery were 19.5%, but that is not so. The paper said that 19.5% of the readmissions were caused by infections.

Of 498,875 total operations reviewed, only 30,270 (6.1%) were readmitted for any reason, and only 5576 (1%) of all patients were readmitted for SSIs.

According to the full text of the paper, the authors had two main points:

One, "because most readmissions were attributable to well-described postoperative complications, readmissions after surgery are mostly a proxy measure for postdischarge complications and in effect penalize hospitals twice [my emphasis] for postoperative complications (ie, other pay-for-performance programs include postoperative complications such as SSI)."

Two, "the majority of hospital readmissions were related to SSI and ileus [non-mechanical failure of bowel peristalsis]. Identifying clinical interventions to reduce the occurrence of these complications to below current levels has been challenging."

An article about the paper in US News quoted an editorial by Lucian Leape who said "system-wide changes need to be made." One such system change, the Surgical Care Improvement Project (SCIP), has been ongoing for more than 10 years.

The paper confirms what I wrote in 2010 about SCIP and other process measures and points out that "Most hospitals in the United States have high adherence rates for the SCIP SSI-prevention process measures; however, compliance with these process measures has not been shown to be strongly associated with reduced SSI rates."

And I am unaware of a conclusive study showing that the incidence of postoperative ileus can be lowered by any intervention.

I agree with the comments of the papers authors who say, "It is important to note that many readmissions may be unavoidable and are actually the correct course of action for surgical patients. [My emphasis] Many complications should be treated in the inpatient setting, and surgeons should not be deterred from readmitting patients because of concerns about quality measure performance and resulting penalties."

Every effort should be made to lower the infection rates of all procedures. But this papers results should be viewed not with alarm, but rather as reassurance that the problem is not out of control.

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