During the recent Medical Student Grand Rounds at Dartmouth Hitchcock Medical Center (DHMC), three Geisel students shared their research projects ranging from, a comparative review of laparoscopic and robotic paraesophageal hernia repair, the long-term financial implications of pursuing fellowships after general surgery training, and challenges and innovation in rural heart failure care.
Here are summaries of their presentations:
David Abraham MED’27: Comparing surgical outcomes of laparoscopic and robotic paraesophageal hernia repair
“We performed a retrospective study comparing surgical outcomes of laparoscopic and robotic paraesophageal hernia repair at DHMC spanning eight years, from June 2016 - December 2024. Data, including OR times, readmission rates, morbidity, and mortality were recorded for 580 laparoscopic cases and 103 robotic cases.
“From this data, we performed a statistical analysis, which found robotic paraesophageal hernia repair at DHMC was associated with longer average setup time, longer operative time, higher blood loss, higher conversion rate, and higher 30-day readmission. Overall, we concluded that laparoscopic paraesophageal hernia repair has several advantages over robotic repair.”
Jack F. Donaghue MED’26 (MD-MBA): Financial implications of fellowships after general surgery residency
“This study evaluates the long-term financial return on investment (ROI) of pursuing fellowship training after general surgery residency compared to entering practice directly as a general surgeon. As increasing numbers of residents pursue fellowship and academic development time, the financial implications of these decisions remain under-discussed despite their long-term impact. Using recent national salary data from the Association of American Medical Colleges and Medical Group Management Association, we modeled career earnings over a 35-year span across ten surgical subspecialties in both academic and private practice settings. Our analysis incorporates adjustments for weekly work hours, training duration, and promotion trajectories. We applied net present value (NPV) and breakeven analysis to compare cumulative earnings across four training scenarios: five-year general surgery residency, five-year residency with fellowship, seven-year residency (with research), and seven-year residency with fellowship.
“The results demonstrate that only select specialties—namely Pediatric, Plastic, and Cardiothoracic surgery—consistently yield a positive financial ROI, even when accounting for additional training and research time. Vascular, Transplant, and Plastic surgery show positive ROI only when fellowship is pursued without additional research years. Conversely, fellowships in Breast, Colorectal, Surgical Oncology, and Trauma/Critical Care generally result in negative NPV compared to general surgery, in both practice settings.
“This work provides an objective, transparent financial analysis to support career decision-making for surgical trainees. By quantifying opportunity costs and long-term earnings trajectories, the study aims to reduce informational asymmetry and empower residents to align their career paths with their financial expectations, values, and professional goals.”
Alexander Walkon MED’27: Challenges and future innovation in caring for heart failure patients in rural communities
“Individuals with heart failure living in rural areas face unique challenges, including frequent hospitalizations, severe symptoms, and limited healthcare access. Their care partners also experience fatigue, isolation, and a lack of support in the numerous responsibilities of managing their loved one’s heart failure.
“We interviewed 22 stakeholders at a rural academic center, including patients, care partners, clinicians, and non-clinical staff. The following key issues emerged: symptom burden, poor care coordination, limitations of Medicare, an unclear role for palliative care, and the unique challenges associated with receiving heart failure care in a rural setting. Participants recommended expanding palliative care to non-palliative clinicians, improving communication through multidisciplinary meetings and EHR alerts, integrating personalized case management, expanding home healthcare services, and incorporating pre-visit questionnaires to elicit both patient and care partner concerns.
“We hope this work contributes to the development of heart failure care that accommodates mental health, rural communities, care partner needs, and navigating the complexities of the health system.”
