Within a matter of 48 hours, the promotion of the article entitled "Prevalence of unprofessional social media content among young vascular surgeons," aptly demonstrated the power of social media and the dangers of unconscious bias as it spread across Twitter with the #MedBikini tag. In response, vascular surgeons from around the world have come together in a call to action to address the article and highlight the misogynistic, racist, and oppressive issues facing young surgeons today. We, as female vascular surgery trainees, would like to make our own call to action. The publication of this article (now appropriately retracted) has encouraged important dialogue among female vascular surgeons, male colleagues who support #HeforShe initiatives, other disadvantaged and marginalized groups in surgery, and the future generation of surgeons who will pave the path forward. We have converged to discuss the current climate of our specialty and have determined that now is an opportunity for change.It is essential that we pursue ethics, as well as excellence, in surgical practice and research. The inherent conscious and unconscious biases, poor study design, and unethical data collection methods within the article have demonstrated a critical flaw within the editorial process of the Journal of Vascular Surgery (JVS). We are disappointed to find ourselves represented by the article. The publication was both tone deaf toward, and discriminatory against, us as professionals, trainees, and women. As vascular surgeons, we must hold ourselves to a higher standard. Our call to action for the JVS includes the following:1. Re-examine the review process for publication of ethical abstracts from regional and national meetings and manuscripts, and provide training in ethical research for all editors and reviewers.

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Objective: We tested the association of systems factors with the surgeon’s likelihood of offering surgical intervention for older adults with life-limiting acute surgical conditions. Background: Use of surgical treatments in the last year of life is frequent. Improved risk prediction and clinician communication are solutions proposed to improve serious illness care, yet systems factors may also drive receipt of nonbeneficial treatment. Methods: We mailed a national survey to 5200 surgeons randomly selected from the American College of Surgeons database comprised of a clinical vignette describing a seriously ill older adult with an acute surgical condition, which utilized a 2×2 factorial design to assess patient and systems factors on receipt of surgical treatment to surgeons. Results: Two thousand one hundred sixty-one surgeons responded for a weighted response rate of 53%. For an 87-year-old patient with fulminant colitis and advanced dementia or stage IV lung cancer, 40% of surgeons were inclined to offer an operation to remove the patient’s colon while 60% were inclined to offer comfort-focused care only. Surgeons were more likely to offer surgery when an operating room was readily available (odds ratio: 4.05, P<0.001) and the family requests “do everything” (odds ratio: 2.18, P<0.001). Conclusions: Factors outside the surgeon’s control contribute to nonbeneficial surgery, consistent with our model of clinical momentum. Further characterization of the systems in which these decisions occur might expose novel strategies to improve serious illness care for older patients and their families.

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