ASE 2024 Abstracts

Background: The use of robotic technology in colorectal surgery has grown rapidly. To keep pace with the growing use of robotic technology, it is imperative for general surgery residency programs to expose and train their residents in robotic techniques. The aim of this study was to compare the outcomes of robotic-assisted colorectal surgery cases with resident involvement to the outcomes of similarly resident-performed laparoscopic and/or hand-assisted colorectal procedures. Only procedures performed by fourth and fifth-year surgical residents were included in this comparison.  

Methods: A retrospective review of colorectal surgery patients who underwent laparoscopic procedures starting in 2012 and robotic-assisted procedures performed with resident involvement starting from the inception of the robot usage at our institution in 2017 was performed. Patient demographics and postoperative outcomes of robotic-assisted versus laparoscopic surgery were summarized. Postoperative outcomes were assessed by operative times, hospital length of stay, and complications. 

Results: A total of 438 laparoscopic and 43 robotic cases were included. Mean age across the entire study population was 60.9 (SD 14.5) and 241 (50.1%) patients were female. Resident-involved robotic cases had statistically significantly longer operative times compared to laparoscopic cases (p<0.0001), but significantly shorter length of stay (p<0.0001). Furthermore, the rate of any complication 30 days after the procedure was lower among patients who underwent resident-assisted robotic surgery. However, this difference was not statistically significant. 

Conclusions: Robotic-assisted colorectal surgery can be safely integrated into a rural general surgery training program without an increase in complication rates and with the benefit of shorter length of stay for patients. However, those benefits need to be weighed against the costs and risks associated with longer operative times. Further research including a larger sample of robotic-assisted cases is necessary to fully capture the risks and benefits to patient care of having residents assist in robotic colorectal cases. 

Introduction: Physical fitness is an important aspect of the overall wellness of surgical residents. Our study examined the perspectives of surgical residents on their physical fitness.

Methods:  From March to November of 2022, we conduced four voluntary 45-minute focus groups consisting of a total of 32 surgical residents of post-graduate years 1, 2, 4, and 5. De-identified discussions were recorded, coded, and thematically analyzed.

Results: There has been an increased focused on overall resident wellness from the residency programs, that are also providing access at off-site physical fitness facility. All participating residents reported suboptimal physical fitness. Many challenges to maintaining physical fitness were identified: time constraints given long working hours, hectic schedule, transitions between day and night shifts at work, lack of workplace fitness facilities lack of at-work fitness curriculum, feeling tired to engage in physical activities after work, prioritizing socialization, studying, and sleep over physical activity after work. Several fitness improvement interventions were recommended by the residents: regular assessment of physical fitness and activity of residents, creation of at-work individualized physical fitness curriculum with protected workout time away from work duties, virtual or in person physical fitness coaching, and establishment of regular fitness challenges.

Conclusions: Despite an increasing focus on trainee wellness, effective physical fitness programs that can be incorporated into the busy workday of our trainees are lacking. Support from ACGME and residency programs, input from residents, and practical applicability are crucial considerations for the implementation of an at-work personalized physical fitness curriculum for surgery residents.

Background: Mixed reality (MR) allows remote communication of audio and visual information in real time by allowing users to see and interact with virtual annotations overlaid on real-world physical surroundings. We evaluated the feasibility and acceptability of MR technology for remote teaching of surgical skills, using a chest tube insertion model for this proof of concept.

Methods: Six experts from general, trauma, and thoracic surgery, and critical care medicine, without any prior exposure to MR technology, participated in this feasability study. Participants were asked to perform chest tube insertion in a mannequin composed of 3D printed or affordable materials while receiving remote instructions in real-time in the form of virtual annotations and verbal guidance. Commercially available video conference software (Microsoft Teams) allowed communication between the participant’s headset (Microsoft HoloLens) and the instructor’s laptop. Participants then evaluated the experience using a 5-point Likert scale, ranging from 1 (negative) to 5 (positive). Data are reported as median and interquartile range.

Results: All participants reported that the MR system was easy to use (median 5; [IQR 5-5]), that remote instructions delivered through the MR system were clear in both virtual annotation (median 4.5, [IQR 4-5]) and audio guidance (median 5, [IQR 5-5]), and that instructions covered each of the necessary steps to execute the procedure (median 4-5 for each step). Experts reflected that this approach to technical skills teaching was very effective and could be extended to teaching other procedures (median 5 [IQR 5-5]), and they would strongly recommend this teaching approach to their colleagues (median 5 [IQR 5-5]).

Conclusions: This proof of principal study shows that remote teaching using mixed reality is easy to use, very acceptable to both learners and teachers, and can be applied to teach surgical skills. A study to examine its effectiveness and usability for remote teaching of less experienced professionals is underway.

Introduction: An essential element of surgical practice is the management of emotion. Surgeons must manage their own emotional expressions, along with those of patients, patient families, and surgical teams. This emotional labor is seldom recognized and can lead to emotional exhaustion, which is the leading contributor to burnout for surgeons. Surgeon emotion is not well documented in research literature. To better understand the emotions of surgical practitioners, a thematic analysis of surgeon-written Twitter posts was conducted.

Methods: A purposive sample of 1,150 Twitter accounts of self-identified surgeons were selected. Tweets posted during October 2022 and February 2023 were analyzed. A broad sentiment analysis and thematic analysis were performed. Plutchik’s Wheel of Emotions was used for emotion categorization. Thematic analysis was guided by the methods of Braun and Clark.

Results: A total of 659 accounts met the inclusion criteria, yielding 6,981 Tweets. Tweets with negative emotion represented only 11% of posts. Thematic analysis of negative emotion showed that rage and anger were mostly directed at public health concerns. Terror, fear, and apprehension were most often expressed concerning racism, sexism, and identity-based violence. Annoyance was mainly communicated with experiences of social inequity; gender and racial biases were included in this category. Loathing and disgust were contained in Tweets about surgery-specific educational and professional issues.

Conclusion: Although negative emotion was present only in a small portion of Tweets, these posts spotlight urgent factors that may negatively influence surgeon emotional health and well-being. This was particularly salient for surgeons with minoritized identities. Surgeons are using the Twitter platform to communicate negative feelings, utilizing it to create visibility and change. Attending to these negative cultural and educational factors may help combat emotional exhaustion and promote well-being among surgeons. These findings advance the understanding of surgeon emotion and may help inform educational programming in emotional labor, emotional intelligence, and emotion regulation in surgical work.

Introduction: The perceived benefits of residency mentorship programs have been well-studied, including increased productivity and academic success. Our mentorship program matches interns and junior residents with a faculty mentor to provide resources for academic and professional development, as well as goal setting. We used an annual evaluation process to improve our institutional program based on year-end resident and faculty feedback. 

Methods: The annual evaluation form for the mentorship program was electronically distributed to faculty and residents who participated in the program in the 2022-2023 academic year. The evaluations capture whether the mentor-mentee match was successful, what contributions the relationship has for both parties, and elicits feedback regarding helpful aspects and areas for improvement. Descriptive statistics were generated for categorical and Likert scale responses. Likert scale statements about the value and usefulness of having a mentor/mentee were ranked by both parties. Inductive thematic analysis was applied to the narrative portion of the evaluations. This work was declared exempt by the IRB.

Results: Resident and faculty response rates were 39% (11/28) and 65% (13/20), respectively. All residents identified their mentorship match as successful, as did 85% of the faculty. The median Likert scale response to the statement “having a mentor contributed positively to my wellbeing” was 2.6 (neutral), which was the lowest score of any statement. Key themes from resident narratives indicated that career planning advice was the main benefit of the program and that customized mentorship was important for residents. Both residents and faculty identified a lack of available wellness resources, and acknowledged that time was the greatest barrier to developing mentoring relationships. Therefore, we have added wellbeing as a topic to be discussed at every mentorship meeting and are providing protected time for residents to meet with faculty mentors. 

Conclusions: This study examined the effectiveness of our mentorship program utilizing resident and faculty feedback. Using this process, we identified actionable opportunities for improvement with the need for more wellness resources and protected time for mentorship meetings. Those changes have been implemented and will be reassessed in a continuous learning cycle.

Introduction: In the traditional surgical training environment, accommodation and accessibility for staff and learners with disabilities has often been limited. This has created a disparity in opportunities for aspiring medical professionals. As medical schools seek to diversify their classes, increased attention needs to be placed on how we make our learning environments–including surgical spaces– more welcoming and inclusive. This study aimed to evaluate how well the surgical clerkship is meeting the needs of students who require accommodations, and how accessible the clinical spaces are. Identifying any barriers of the surgical clerkship can allow us to suggest new interventions to address these limitations.

Methods: A literature review was conducted to identify relevant themes that were then used to generate a 12-item survey tool. This was distributed electronically to medical students at a single institution who had completed the surgery clerkship (i.e. second through fourth year). Survey data was assessed via descriptive analysis, comparing students with and without accommodations.

Results: We received a total of 110 survey responses. Of these, 65 surveys were fully completed and 62% (n=40) of these were from students who had completed the surgical clerkship. Analyzing only responses from students who completed the surgical clerkship, we identified five main barriers that students reported: physical barriers (20%), barriers to communication (18%), time limitations (30%), attitudes and approaches of faculty (28%), and grading methods (45%). Responses were similar from both students with and without accommodations for these barriers. 

Conclusion: Multiple barriers exist in the surgical clerkship that affect both students with and without accommodations. In recognizing these barriers, we hope to implement actionable interventions for students who require accommodations on the surgical clerkship.

Objective:  We aimed to restructure the application review process to create a standardized and holistic approach that would facilitate evaluation of the broader applicant pool while limiting potential bias and incorporating senior residents.

Methods:  In 2020, a new quantitative reviewer scoresheet was created for objective comparison of applicants based on the core values of our program. In addition to core faculty, senior residents were invited to review applications and conduct interviews. Quality and effectiveness of the selection process was assessed by analyzing scoring rubrics, reviewer feedback, and match results. Data from 2020 and 2021 were included in this study.

Results: Faculty and residents both found the scoresheet easy to use, was a fair approach for application review, and accurately reflected the qualities needed for a surgical resident to be successful in the program. Inter-rater variability was low (78% to 91%). All reviewers with prior experience in application review felt the new process was at least equivalent to the prior approach. Average faculty and resident scores were not significantly different (2020: faculty mean = 7.21, resident mean = 7.2; p = 0.78; 2021: faculty mean = 6.72, resident mean = 7.17; p = 0.11). In both years of implementing our approach, most (82% to 85%) of our objectively top scorers remained in the top tier of our final rank list. All matched residents were from the top tier of our final rank list, as in prior years.

Conclusion: We demonstrate a reproducible holistic process for reviewing residency applications that highlights core values of the program and is feasible to implement. Resident involvement in the review process maintains precision of the review, relieves the application volume for faculty, expands the diversity of perspective when considering how applicants may add to the program, and acknowledges the critical role of residents in the educational landscape of a program. Our approach can be a model for other residency programs to develop standardized processes for selecting residency applicants.

Box and Whisker Plot of Score Ranges Generated by Faculty and Residents in 2021. Resident and faculty scores are comparable.

Introduction: Many residents pursue fellowship following training in general surgery, especially at academic medical centers. However, there is no singular body that oversees surgical fellowships, and many aspects of fellowship remain speculative, including application and admissions. Our aim was to define the currently available statistics about surgical fellowships to create more transparency for applicants and program directors.

Methods: The major fellowships included in the current analysis were colorectal surgery, trauma/critical care, minimally invasive surgery, surgical oncology, pediatric surgery, plastic surgery, thoracic, transplant, and vascular surgery. We did not include burn fellowship, pediatric critical care surgery, or research fellowships.

We reviewed publicly available databases for information, namely the National Residency Match Program (NRMP) match data and analytics, the Fellowship Council, and the SF Match. We used the American Council on Graduate Medical Education Data Resource Book for additional information on the total number of surgical residents. All data were collated for the ten-year period from 2014-2023 and entered into an Excel database.

Results: Approximately 67% of US surgical residents pursue fellowship, which has been stable over the past decade. The largest fellowships are critical care, minimally invasive, vascular, and colorectal surgery. Statistically, US trainees are substantially more likely to match into specialty fellowship than non-US graduates (p<0.001). There is a very high match rate (>85%) among critical care, surgical oncology, vascular, and transplant surgery for US trainees. Pediatric surgery consistently has the lowest match rate, with an average rate of 59.8% for US trainees over the past 10 years.

Discussion/Conclusion: Our analysis provides the most comprehensive snapshot of surgical fellowship in the United States. Two-thirds of surgery residents pursue fellowship, and the likelihood of matching varies substantially between specialties. US graduates continue to have a strong advantage in matching. These results can help inform national workforce planning and may be valuable to current residents in their fellowship application process.

Introduction:

Simulation and operative coaching have been shown to improve resident skills. This study aims to assess the role of mentorship in confidence, proficiency, and time to acquisition of simulated laparoscopic tasks.

Methods:

A single-institution, randomized controlled trial was conducted assessing the acquisition of and proficiency in peg transfer (PT) and intracorporeal knot tying (IKT). Surgical interns were randomized to control (CP) vs mentored (MP) arms. All underwent a pretest, followed by three practice sessions (CP practiced independently and MP practiced with a faculty mentor). Skills exams were repeated following each practice session and scored with the Objective Structured Assessment of Technical Skills (OSATS) rubric. The analysis compared the overall improvement in skills, speed of improvement, and participant confidence level between groups using the Wilcoxon Rank Sum Test.

Results:

Eleven surgical residents participated with one withdrawal (5 CP, 6 MP). Demographics and prior simulation experience were similar between groups. There were no differences in pretest PT or IKT (390s CP vs 469s MP; p=0.748) times, or total pretest OSATS score (8.63CP vs 9.08MP, p=1). There were no differences in change between the pretest and final total OSATS score(p=0.33) or pre-to-final change of individual component scores (tissue handling (p=0.278), accuracy (p=0.513), efficiency (p=1), and proficiency(p=0.507). While there were no differences in final PT or IKT (249s CP vs 204s MP, p=0.831) times, MP trended toward greater final OSATS scores (11.75CP vs 14.12MP). At the end of the study, 75% CP and 100% MP reported increased confidence in skills performance (p=1).

Conclusion:

While this study showed no differences in pretest times and OSATS scores between CP and MP, there was a trend towards higher final OSATS scores among MP. There were no differences in improvement of total OSATS scores or scores of the individual OSATS components. However, the sample size was limited and a larger study is necessary to fully evaluate the role of mentorship in simulation.

Background:

Social determinants of health (SDH) significantly affect outcomes of vulnerable surgical patients; however, formal training on identification and mitigation of surgical health disparities is lacking in general surgery (GS) education. A 2022 national survey demonstrated that less than half of GS programs have a surgical disparities curriculum (SDC), and the few that exist exclusively focus on patient race. Therefore, we aim to develop and evaluate a standardized and comprehensive GS resident SDC to encompass a wider range of health disparities. 

Methods: 

A resident SDC was created using Kern’s Model of Curriculum Development (Figure 1). Residents took a pre-session survey to determine exposure, comfort, and knowledge on surgical SDH. Local and national experts were recruited to create modules on disparity topics extracted from patient cases in Morbidity and Mortality (M&M) Conferences such as “incarceration,” “obesity,” “socioeconomic status,” “women/pregnancy”, “social support”, etc. Each module includes a 1) clinical vignette adapted from M&M Conference, 2) recorded lecture created by the content area expert, and 3) guided discussion session. The effectiveness of our curriculum was evaluated using Kirkpatrick’s Model via surveys evaluating resident reaction and learning. Knowledge scores were pooled, and an independent samples t-test was performed to assess for differences.  

Results: 

Thirty GS residents participated in our first module and completed the pre-session survey with 66% completing the post-session survey. Although 93% endorsed prior clinical exposures to healthcare disparities, only 56% were confident in discussing SDH topics with their team and patients. However, after the session, 80% reported improved understanding and framing of surgical disparities, 85% had increased awareness of disparities encountered in their training, and 80% expressed increase in confidence in discussing DEI topics with multidisciplinary team members and patients. Knowledge scores improved significantly after the activity (p=0.004, pre-test 63%, SD 18%, post-test: 80%, SD 15%).  

Conclusion 

We created a SDC with the aid of content experts for GS residents and have shown improvement in knowledge and confidence. Future work includes increasing the repository of modules, evaluating resident behavioral change and knowledge retention at the conclusion of the academic year, and collaboration with outside institutions to make our SDC widely available.  

Background 

Perspectives of Muslim women who wear the Hijab are?unique and often overlooked. Specifically, there is little literature highlighting the experiences of Hijab wearing medical students while they choose a specialty. Exploring barriers unique to this population will ultimately identify?interventions to increase diversity across surgical subspecialties. We aimed to explore the sense of diversity and belonging in surgery perceived?among Muslim medical students who wear the Hijab and to investigate the factors that impact feelings of inclusion in?the operating room (OR). 

Methods 

This is an exploratory, qualitative study that used non-probability sampling. Narrative inquiry was used to explore the life and experiences of Muslim medical students who wear the Hijab and communicate common themes. Surveys were distributed online via forum, social media, or email listserv. Individuals were contacted to conduct an hour-long qualitative interview via ZoomÒ. Interviews were recorded, transcribed and coded to document themes.

Results 

Twenty-two Hijab wearing medical students and residents completed the survey; six participated in an interview. Fifty-nine percent of participants indicated interest in surgical specialties. The majority reported feeling anxious (64.7%) or considered wearing an alternative to the Hijab (41.2%) in the OR; 36.8% of participants avoided the OR because of concerns regarding the Hijab. Themes from the interviews included inadequate inclusive training prior to entering the OR, a sense of public embarrassment,D an additional mental burden to navigate the peri-operative space compared to non-Hijab wearing medical students and increased scrutiny compared to classmates. 

Discussion 

Using narrative inquiry, we found that a population of Hijab wearing medical students face prejudice and discrimination during their training, which impacts their sense of belonging in surgical specialties and leads to avoidance of the operating room. This may deter them from entering surgical subspecialties. Based on the themes identified, we recommend developing inclusive policies in the peri-operative space and training for OR staff to accommodate diverse learners. Additionally, many students commented on the need for culturally sensitive training aimed at preparing all students for surgical rotations. 

Background:

Resident core competencies include "professionalism" and "interpersonal and communication skills," yet resident curricula in these areas are widely varied if they exist at all.  There is a gap in understanding what general surgery residents believe is important for their professional development and implementing an effective curriculum.  The aim of this project was to determine which professionalism topics general surgery residents consider to be important and develop a curriculum to address those needs.

Materials/Methods:

A needs assessment survey was sent to all residents in an academic general surgery program. The survey inquired about prior professionalism training, exposure to unprofessional behaviors, the need for a professionalism curriculum during residency, and open ended questions about critical topics for a professionalism curriculum. A 1.5 hour professionalism curriculum was implemented incorporating themes from the assessment, including tools for dealing with challenging communication between co-workers and patients. Pre and post surveys were administered asking residents to rate their communication skills in a variety of scenarios and their level of confidence delivering difficult news to patients.

Results:

A total of 26 out of 44 residents (59%) responded to the needs assessment (69% junior and 31% senior). All residents reported encountering situations requiring professionalism at least 1-2 times per week. The most common unprofessional behaviors were encountered in nursing staff, followed by faculty, then fellow trainees. Most residents (88%) felt that professionalism in surgery should be emphasized during training. The most common professionalism needs identified included challenging interactions with co-residents, stressful conversations with patients/families, and delivering difficult news. Pre/post-surveys demonstrated a significant increase in resident confidence across all communication scenarios (p=0.04). The largest increase in confidence was in the ability to navigate conversations when the other person is upset or angry (51.7% pre-test to 82.6% post-test).

Conclusions:

Professionalism and communication techniques are skills that residents use daily, yet lack confidence using these skills in challenging scenarios. Most residents feel that professionalism in surgery should be emphasized. A professionalism curriculum based on a resident needs assessment demonstrated improvement in confidence in a variety of difficult communication scenarios. This can serve as a starting point for further professionalism development.

Introduction:

Increasing diversity in surgical workforce is vital for better healthcare outcomes for all. In this study, we examined how introducing students as early as high school from URM communities to the field of surgery influenced their perceptions of and interest in academic surgical careers.

Method:

We conducted a sequential mixed methods study of high school students involved in the Pre-College Research Internship for Students from Minority Backgrounds (PRISM) program at our institution from 2018 to 2022. PRISM connects academic surgeons with students from URM backgrounds interested in health care, involving them in research, lectures, and surgical clinical shadowing. We deployed questionnaires and focus group interviews to assess the program’s impact on the students' career goals. We analyzed questionnaire results in order to develop an interview guide. Inductive coding was utilized to explore emergent themes from the focus group.

Results:

14 out of 20 past program participants completed a self-administered survey (70% response rate), and 6 participated in a subsequent focus group interview. Of the participants, 78.5% were African American, 14.3% Hispanic, and 7.2% Native American. Students achieved a 100% college acceptance rate, with 81.0% selecting pre-medical courses in college and planning to pursue medical school. 78.6% students identified no family members working in healthcare and limited knowledge of healthcare professions. 90.0% reported that their involvement in the program improved their understanding of healthcare professions and inspired them to pursue a career in academic surgery. 86.6% found the program helpful for mentorship and career development. All students lacked prior research experience, but 67.0% were currently involved in active research post-program. During focus group interviews, participants emphasized four prominent themes as benefits of the program: the importance of appropriate mentorship, especially fellow URM faculty, improved understanding of surgical career pathways, enhanced research skills, and career development.

Conclusion:

Providing high school students from underrepresented minority (URM) backgrounds with early exposure to surgical practices, research, and mentorship can significantly alter their career trajectory. Investing in and understanding specific strengths of pipeline programs can serve as a solution to the current deficit in the lack of diversity in the surgical workforce.

Introduction

Pursuing a career in academic surgery can be challenging, often hindered by limited exposure and lack of mentorship. Surgical research pipeline programs can provide unique insight and preparation for academic careers. The objective of this study was to determine the impact of an academic summer research program on undergraduate students with interest in the fields of academic medicine and surgery.

Methods

We conducted a sequential mixed methods study of undergraduate students who participated in the Surgery Undergraduate Research Experience (SURE) program from 2017 to 2022. This program connects academic surgeons with students interested in medicine, involving them in research, lectures, and surgical clinical shadowing. Students completed questionnaires and participated in semi-structured focus group interviews to assess the program's impact on their career goals. We analyzed questionnaire results using this to develop an interview guide. Inductive coding was utilized to explore emergent themes from the focus group.

Results

Twenty-five past participants completed the self-administered survey with a response rate of 51.0% and five participated in the focus group interview. Among the participants, 12 ( 48.0%)  students were currently enrolled in medical school, 11 (44.0%) had taken their Medical College Admission Test (MCAT), and were in the process of applying to medical school. 88.0% believed that their involvement in the program significantly increased their interest in academic surgery and empowered them to pursue a career in medicine. 84.0% reported that the program helped them find the right mentorship and guidance, while 80.0% reported increased proficiency in research skills. 88.0% credited the program for enhancing leadership qualities including communication, teamwork and problem-solving skills. These quantitative findings were further substantiated through focus group interviews. Four noticeable themes emerged: the significance of “the right” mentorship, a deeper understanding of the path to an academic surgical career, increased research literacy, and career development skills.

Conclusion

Early exposure to surgical research and mentorship significantly enhanced the enthusiasm of undergraduate students toward an academic surgical career. Investing in and understanding the strengths of such programs can enhance the academic surgical and medical workforce.

Introduction:

The surgery clerkship serves as the primary introduction to surgical specialties for the majority of medical students. Given the variable daily structure of a surgical service, students and evaluators generally do not follow a standardized feedback format. Just as the Liaison Committee on Medical Education (LCME) emphasizes the importance of clinical clerkship feedback, prior qualitative reviews of medical students’ surgery clerkship evaluations have documented quality feedback as a consistently important feature of the clerkship. Prior studies have evaluated the efficacy of feedback models developed a priori; we sought to derive a clinical feedback model based on medical students’ qualitative clerkship feedback. 

Methods:

A retrospective qualitative review of de-identified post-clerkship third-year medical student evaluations across four clinical sites from June 2021-March 2023 (n=263) was performed. Open-ended responses to the questions “What were the greatest strengths of this clerkship?” “What changes would you make to the clerkship” and “Would you like to comment about the mid-clerkship feedback?” were grouped thematically a posteriori, and qualitative data abstraction was performed to code subcategories for these themes. 

Results:

Qualitative abstraction of 263 post-clerkship third-year medical student evaluations yielded three primary themes: Feedback, Mentoring/Developing Relationships with Team Members, and Curriculum Structure. Subcategories for the feedback theme were individualization, time course, and feedback style, with individualization and personalization (64%) most commonly highlighted. 17% of students who commented on the importance of feedback directly tied the feedback and mentorship themes together. 58% of students who commented on the mentorship/developing relationships theme highlighted a desire for a sense of purpose or defined roles on the team, and 43% conveyed eagerness for longitudinal relationships with residents and attendings on the surgical team. 

Conclusion:

Clinical feedback during the surgery clerkship is known to manifest in disparate forms, given students’ and evaluators’ variable perceptions regarding the definition and most effective form of feedback. An analysis of medical students’ surgery clerkship evaluations suggests that students prioritize personalization of feedback and longitudinal mentorship from their evaluator. This may inform the tenets of a potential standardized feedback modality for medical students completing the surgery clerkship.

Objectives

Communication is an innate skill one learns as a member of society. From a young age we develop verbal and non-verbal techniques to form relationships. Healthcare presents a unique environment where high stakes discussion requires the ability to build immediate rapport and trust with a patient and their family. Medical students often learn these skills through observation and apprenticeship, but many programs find it difficult to incorporate formal communication training while balancing all content requirements. International programs echo these sentiments. We implemented an adaptive and international communications course for a diverse cohort of medical students.

Design

We hosted a second annual, international, 5-week virtual communication skills course with each week dedicated to a unique communication skill. In partnership with the Eastern Association for the Surgery of Trauma, we recruited medical students and surgical faculty from the United States and Saudi Arabia (SA). Students watched a short, pre-recorded didactic lesson from a communications expert; then during the virtual class, a physician demonstrated the target skill and facilitated discussion. Students practiced target communication skills with simulated patients (SPs) in small groups; faculty facilitated reflections to allow students to receive immediate feedback and coaching. Students rated their confidence in target skills before and after each class; peers, SPs, and faculty rated simulation performances. At the end of the 5-week course, the students also had the opportunity to participate in a “graduation session” incorporating all the learned skills and techniques.

Results

From the past two international communication courses, 67 students from 13 institutions enrolled; physicians from 10 institutions joined as faculty, including 9 Saudi Arabian students and their faculty advisor. A total of 19 SPs participated, with enough available each class to ensure that both “patients” and “family members” were present in each practice room. In-class prompts generated word clouds for group discussion. Student confidence performing target skills statistically increased after each class. Post-class confidence scores matched faculty/observer simulation performance ratings, validating our skills confidence measures.

Conclusion

Collaborating across institutions and nations to provide simulation-based virtual communication training to medical students is feasible and fills a gap in medical school curricula.

Background: The traditional approach to teaching anatomy in preclinical medical education often faces challenges in engaging students, highlighting the strong interconnection with surgery, and facilitating the application of anatomical knowledge in clinical contexts. This study aimed to address these issues by introducing a novel infographics correlation book and assessing students' experiences with it.

Methods: We created a novel infographics correlation book that includes the core anatomical structures of the abdomen and their surgical clinical relevance. Elements such as links to surgical videos and practical assessment questions were also incorporated in the book. A survey was sent to preclinical second-year medical students (n = 175) to evaluate their experiences with this resource. The survey collected data on students' perception of the content, enjoyment, and effectiveness of the resource in applying anatomy in clinical contexts, among others.

Results: A total of 27 students completed the survey. The majority of students agreed or strongly agreed that the new book made their anatomy class more enjoyable (95%). 92% of students agreed or strongly agreed that the surgical videos were helpful in applying anatomy knowledge to clinical contexts. Furthermore, 74% of students expressed their intention to continue using this resource, for example, in their day-to-day clinical care as MS3s (27%) or to prepare for their surgery shelf exams (22%). Additionally, 77% of students would like similar materials to be available for other subjects in their curriculum.

Discussion: Redefining surgery and anatomy teaching in preclinical medical education is essential to keep up with the students’ and the profession’s needs. In this study, the positive feedback from students, including increased enjoyment and the practicality of applying anatomical knowledge to clinical scenarios, underscores the potential for reimagining educational resources to make preclinical education more relevant, focused, and effective. The students' desire for similar materials in other subjects suggests the scalability of this innovative approach across the curriculum. As educators, it is essential to consider student feedback and preferences to enhance the learning experience and better prepare future healthcare professionals. This study explores a potential way to bridge the gap between classroom learning and real-world surgical practice.

Background:

Musculoskeletal (MSK) pain and fatigue is common among surgeons and owes to the high physical demands of surgery. Over the course of a career, the effects of poor ergonomics and inadequate recovery can result in MSK pathology requiring surgical intervention and even early retirement. MSK pain among surgeons starts as early as residency with little insight into contributing factors. The goal of this study was to identify patterns in training that contribute to surgical resident MSK pain and are detrimental to wellness.

Methods:

An anonymous, voluntary electronic survey was sent out to all general surgery trainees at an academic medical center one month after the start of the academic year. The survey consisted of questions relating to MSK pain, including frequency, location, and contributing factors. Additional questions were asked regarding the use of pain medications.

Results:

31 out of 49 (63%) general surgery trainees completed the survey. 100% of the respondents reported pain related to operating with 61% reporting pain during or immediately following half or more of their operative cases. The back and neck were the most frequently identified sites of pain. 75% of interns reported MSK pain “most of the time” when operating.  “Duration of cases” was identified as the highest ranked contributing factor to MSK pain, followed by resident “positioning during case” and “total hours spent operating in day”. 55% of trainees reported that the pain they experience has increased and/or become more frequent as they progress in training. Only 13% of trainees reported formal training to reduce MSK pain related to surgery. 23% of trainees reported taking pain medications after work at some regular interval.

Conclusion:

General surgery trainees experience frequent MSK discomfort related to operating as early as the first month of internship. We have identified several factors that subjectively contribute to trainee pain. While many factors cannot be modified, such as the duration of an operation, future studies should focus on targeted efforts to educate trainees on the importance of surgical ergonomics, test the implementation of surgery-specific physical exercises, and explore the use of adaptive devices in the operating room.

Introduction: Co-management by medical and surgical teams is common in the care of complex surgical patients. This necessitates common understanding and collaboration between medical and surgical services in the perioperative setting. Therefore, we evaluated the comfort level of internal medicine (IM) residents in managing and engaging consultants on surgical patients.

Methods: We surveyed IM residents at a single institution using an anonymous online questionnaire regarding the frequency of consultations to vascular and general surgery over six months as well as resident comfort in managing or consulting on surgical patients (using a 5-point Likert scale). Specific surgical conditions and perioperative issues were also assessed on similar scales (i.e., gallstone disease, intraabdominal pathology, tubes/drains, hemostasis). Likert responses were analyzed dichotomously as comfortable or not comfortable (“neutral,” “somewhat uncomfortable,” and “very uncomfortable”).   

Results: Altogether, there were 29 survey responses (26% response rate), representing 12 junior (PGY-1&2) and 17 senior (PGY-3 & Chief) residents. While most expressed confidence in knowing when to consult general or vascular surgery teams (86% and 79%, respectively), about 50% were uncomfortable managing postoperative patients. Seventy-three percent of IM residents were comfortable requesting consultation on specific surgical problems while only 51% were comfortable managing patients with those problems. There were fewer reports of comfort when requesting consultation on vascular surgery than general surgery (62% vs 80%). Residents felt more comfortable managing surgical conditions than surgical issues (such as drains, wounds, bleeding, etc.; 53% vs 49%). IM residents were less comfortable managing acute-on-chronic surgical problems, such as carotid disease, aortic disease, surgical drains, and surgical wounds (Figure 1).

Conclusion: Our study highlights the need to optimize training on perioperative management and communication with surgery teams among our internal medicine colleagues. We identified targeted areas for educational efforts, such as experience troubleshooting perioperative equipment and education on the urgent and non-urgent management of acute-on-chronic issues. Further work is needed to elaborate and quantify their knowledge and experience in perioperative concepts, as well as develop a focused strategy to empower our medicine colleagues to contribute their expertise in the multidisciplinary management of surgery patients.

Background:Gender disparities have been identified in surgical resident teaching award (RTA) distribution. Qualitative analysis of RTA nominations has been performed previously; however, qualitative analysis of nominations of residents by gender has not yet been explored.

Methods: Nominations for RTAs over four years at a single institution were grouped by resident gender. Nominations were analyzed for thematic content via inductive coding methods using MAXQDA.

Results: All residents identified as male or female. 40 nominations (13 male, 17 female) were analyzed. The following themes emerged: 1)Inclusivity 2)Commitment to Teaching 3)Teaching Efficacy 4)Approval of Resident. (Subcategories described in Table 1.) Areas that differed by >5% of coded text included: female residents were more likely to be described as kind/approachable, and were more often noted for teaching a specific skill. Male residents were more likely to be described as incorporating the med student into the team and teaching in the OR. 

Conclusion: This analysis of nominations for RTAs shows areas of thematic difference between male and female residents and provides insight into how learners may value teaching skills differently by gender. Further study into how this may apply to faculty and impact the learning environment is warranted.

Introduction

The transition from undergraduate (UME) to graduate medical education (GME) has inadequacies related to non-standardized medical school assessments and lack of communication from UME to GME. Improving this process benefits students, schools, and programs. We created and gathered validity evidence for use of a Standardized Assessment Tool for Subinterns (SATS) to evaluate students in an objective and equitable manner to aid this transition.

Methods

SATS captures expected knowledge, skills, and attitudes of graduating medical students and is intended to populate an educational handover letter from UME to GME. The instrument was curated from prior literature and expert input. Item quality was evaluated using the Question Appraisal System (QAS). SATS and its application were evaluated with cognitive interviews based on a fictional student with 5 subinternship rotation directors from 3 academic institutions representing 3 general surgery residency programs. Interviews were recorded and transcribed. Behavioral coding was used for qualitative analysis. An updated SATS was created through consensus agreement to proposed changes. SATS was piloted by our participants with subinterns with whom they worked during July and August 2023.

Results

SATS was created with 20 items reflecting patient care, interpersonal and teamwork skills, professionalism and reflective practice. Use of the QAS resulted in changes for clarity in 3 items. Cognitive interviews resulted in major changes to the instrument introduction, modifications to Likert scale descriptors to improve applicability to all items, division of 1 item into 2 separate items, and 1 alteration of item order. Minor revisions included modifications to specific elements of content to be assessed as described in subheadings (14/21 items) and clarification of wording (4/21 items). Pilot of SATS revealed use of a range of scores and comments to contextualize student performance. SATS took an average 7 minutes to complete.

Conclusion

We created, gathered validity evidence for, and piloted SATS with relevant stakeholders who represent its target users. Next steps will include gathering additional validity evidence from a broader group of education leaders before using it to populate an education handover letter to aid in the transition from UME to GME.

Introduction: Though global surgery interest among trainees is high, global surgery education in general surgery training is limited and mainly offered as international electives.  We piloted a longitudinal global surgery curriculum integrated into the general surgery residency program in a large academic medical center over a single academic year.

Methods: We integrated a global surgery curriculum into the existing general surgery education and research curriculum. Weekly didactics were focused in 4-week organ system blocks. Each month a global surgery topic was focused on that organ system and included internal and external speakers in various educational formats. Dedicated topics in global surgery research were added to the resident research curriculum. A cross-sectional survey using a likert scale was distributed to all general surgery residents at the beginning and end of the academic year to assess their self-reported global surgery knowledge and interest. Responses to the questionnaire were anonymized and filtered based on the respondent's demographics. Descriptive statistics were conducted on the dataset using SPSS.

Results: A total of 25 residents completed the pre-survey (50% response rate), of which 62.5% were female, 64% were White, 12.5% were Black, and the median age was 29 (IQR 28-30.25). A total of 17 residents completed the post-survey, of which 70.59% were female, 76.47% were White, 11.76% were Black, and the median age was 29 (IQR 28-31). Median Global Surgery Knowledge was 2 (IQR 2-3) prior to curriculum and 2 (IQR 1-3) post curriculum (p=0.705). Median Global Surgery Interest was 4 (IQR 3-5) prior to curriculum and 4 (IQR 1.5-5) post curriculum (p=0.988). Median Global Surgery Importance was 3 (IQR 2-4) prior to curriculum and 2 (IQR 1-3) post curriculum (p=0.546). There was no significant difference in global surgery career interest, with 45.83% interested in the pre-survey and 50% interested in the post-survey (p=0.796).

Conclusion: Due to insufficient trainee interest in global surgery and competing educational priorities, the global surgery education program was restructured from this integrated curriculum for all residents to a dedicated longitudinal multi-dimensional global surgery track available to all residents committed to global surgery.

Introduction: 

VR rendering of CT scans enhances students' understanding of anatomical structures and associated pathology. We evaluated how VR offers pre-clerkship students a more precise visualization of spatial anatomic relationships for normal anatomy and clinical phase students a 360° view of normal and abnormal structures to enhance their understanding of complex surgical procedures.

Methods:

Pre-clerkship phase: the effectiveness of VR simulation in anatomy education was examined in early medical school students. The control group reviewed osteology videos employing cadaveric dissection, while the experimental group was taught with VR simulation. Student motivation to learn was measured on a LIKERT scale using a VR-specific version of the Instructional Materials Motivation Survey (IMMS). Outcomes were also measured using identical pre and post-instruction anatomy tests in the two groups. Statistical analysis was conducted using the Mann Whittney U test. 

Clinical phase: VR rendering produced 3D images derived from contrast-enhanced CT scans to demonstrate to students local vascular invasion in cases of pancreatic ductal adenocarcinoma (PDAC). 

Results:

Pre-clerkship phase: IMMS data highlighted the substantially positive impact of the VR intervention on student motivation (table 1). The study demonstrated a positive correlation between the VR intervention and student attention, relevance, confidence, and satisfaction. 

Both groups showed significant improvement between pre and post-instruction tests. There was a mean increase in score of 32.4% in the experimental group. 

Clinical phase: VR rendered high-resolution 3D images identifying vascular invasion in locally advanced PDAC in exquisite detail (fig.1). 

Discussion:

VR improves pre-clerkship student motivation and outcomes in anatomy learning. It produces detailed 3D renderings of locally invasive PDAC, enhancing the instruction of learners in assessing the resectability of pancreatic malignancies. 

Background:

While previous research has shown that increased practice on simulated models can improve Cricothyrotomy success rates, there are no studies that have examined the performace of General Surgery residents in relation to their trauma rotation. We hypothesize a significant improvement in Cricothyrotomy simulation model scores over a six-month period (summer to winter), with the winter scores influenced by the prior completion of a trauma rotation.

Methods:

This was a retrospective study and natural experiment that evaluated data from years 2020-2022, during which 69 residents (39 males and 30 females) were assessed on the simulated model developed at our institution (Figure 1). All residents completed the assessment on the model twice (summer and winter) and were scored out of 5 against a checklist. Residents naturally fell into one of two categories – those who completed a trauma rotation between simulation assessments, and those who did not. The data was analyzed on SPSS using ANOVA and T-Test.

Results:

The residents showed statistically significant improvement from summer (Mean score = 1.51 / SD =1.37) to winter (Mean score: 3.68 / SD=1.28) (p<0.05). While 48% of residents completed a trauma rotation between assessments, this rotation did not significantly impact winter simulation testing. In the summer assessments, 72% of the residents made the most common mistake of an inadequate incision size and inability to complete the steps of the station in the given time, however this reduced to 43% in the winter assessments.

Conclusion:

Our data suggests that residents improved over time in the cricothyrotomy station. Completing a trauma rotation didn't significantly affect their scores. Further investigation is required to understand performance factors, teaching, learning during trauma rotations, and the performance variance, which our model allows. Such results emphasize the complex relationship between surgical skill development, clinical rotations, and simulation assessment.

Figure 1: Cricothyrotomy Station at the Surgical Assessments

Introduction: Current methods for robotic surgery training outside of the operating room are video-based, however, they often lack specific instructional details for those that are robot-naïve. This study aims to test a potential new paradigm for teaching robotic skills to medical students. 

Methods: Twenty-eight first-year medical students were asked to complete three consecutive trials of a robotic knot-tying task. Students were randomized to control (standard video before each task) or intervention (switch to an enhanced video before task 2 and 3). The enhanced video included additional voiceover instructions and visual annotations. Each task was recorded and scored (blinded) using the Global Evaluative Assessment of Robotic Skills (GEARS) scale.  

Results: The study included 13 male and 15 female medical students, 64% of which were interested in surgery. 50% of the control group participants indicated that the task would have been easier with annotations. The change in GEARS score of the intervention group trended toward improvement by an average of 5.1 ± 5.9 compared to the 1.5 ± 4.4 in the control group (p =.08). When looking at the GEARS components independently, the intervention group improved in efficiency by an average of 1.3 ± 1.2 compared to .36 ± .84 in the control group (p=.03). Likewise, the force control component of the GEARS score improved by an average of .93 ± 1.1 in the intervention group compared to .04 ± .84 in the control (p = .02).  

Table 1. Change in total GEARS score and score components between control and intervention groups.  

Conclusions: Use of a novel annotated video-based approach to teaching robotic knot-tying improves both the efficiency and force control components of the GEARS score in novice surgeons. Providing more information in video-based instruction improves novice confidence and proper tissue handling.

Introduction

Surgical fellowship interviews shifted to virtual platforms in 2020 due to the COVID19 pandemic. While virtual interviews provide convenience, they also pose difficulties for programs and raise potential barriers for applicants. This study compares in-person to virtual interviews and characterizes the impact on programs and applicants.

Methods

In-person (2007-2019) and virtual (2020-2022) fellowship application data were extracted from publicly available NRMP Specialties Matching Service data. Fellowship programs included surgical critical care, surgical oncology, colorectal, pediatric, thoracic, and vascular surgery. Competitiveness was assessed using a validated normalized competitiveness index (NCI).

Results

Since 2020, rankings/applicant, a surrogate for program interview workload, increased for all fellowships except pediatric surgery (Table). The most competitive subspecialties now include colorectal, pediatric, and thoracic surgery (Figure). For non-US MDs in these subspecialties, applicants/position decreased (0.39±0.06 to 0.24±0.05, p=0.002, pediatric), match rate decreased (0.76±0.12 to 0.48±0.03, p=0.002, thoracic), and NCI increased (0.84±0.19 to 1.36±0.08, p=0.003, thoracic) under virtual interviewing. However, for the least competitive subspecialties, non-US MDs had increased rankings/applicant (5.98±2.14 to 13.30±1.49, p=0.0001, critical care and 10.75±1.41 to 13.50±1.20, p=0.011, vascular), increased match rate (0.83±0.05 to 0.92±0.04, p=0.038, critical care and 0.44±0.07 to 0.66±0.08, p=0.005, surgical oncology), and decreased NCI (1.57±0.20 to 0.96±0.17, p=0.003, surgical oncology) with virtual interviewing.

Conclusions

Since the virtual platform was implemented, applicants have interviewed at and ranked more programs subsequently increasing program workload. While this is positive for many applicants, a differential pattern of securing a fellowship emerged for non-US MD applicants. This finding is important for fellowship program directors to consider and ensure non-US MD applicants are not marginalized with the virtual platform.

Figure. In-Person versus Virtual Subspecialty Competitiveness.

Background:

Medicine, a long exclusive profession, has made inclusionary progress in recent years by matriculating more Assigned Female at Birth (AFAB) individuals into medical school versus males (AMAB). However, when assessing residency data, a disproportionate ratio of AMAB/AFAB individuals persists in competitive residencies, including surgical fields. While completely assessing this disparity would require multifactorial analysis, this study aims to tackle one aspect by asking two questions: what proportion of AFAB are interested in competitive specialties but not applying? And if offered, would fertility preservation increase application rates for AFAB persons?

Methods:

An IRB exempt anonymous REDCap survey study was sent via e-mail to medical students at 3 separate institutions and residents in Orthopedics, Urology, Otolaryngology, General/Plastic/Vascular/CT Surgery, and Obstetrics/Gynecology at a single institution.

Results:

Overall, 268 medical students and 25 residents completed the survey (response rate 20%). Most were AFAB, with 79% (212) medical students and 88% (22) residents identifying as women. The percentage of AFAB individuals who would go into a different field if having biological children weren’t a factor was 16% vs. 9%. Overall, 48 would pick another specialty, with 24 preferencing a surgery residency and 10 indicating OB/GYNE. Comparing AFAB medical students to AFAB residents, different attitudes regarding the importance of fertility preservation (20.3% v. 40.9% very important), having fertility preservation available if needed (45.3% v. 72.7% very important), and having biological children when considering one’s career (27.4% v. 54.5% very important) were identified. AFAB medical students and residents also differed in Egg retrieval and banking (ERB) attitudes, including opinions regarding the impact of ERB on finances.

Conclusion:

Nearly twice the percentage of AFAB individuals compared to AMAB would choose a different field if having biological children weren’t a consideration. In addition, the majority of AFAB medical students who reported they would pursue an alternate field picked those competitive surgical specialties currently overrepresented by AMAB individuals. Offering fertility preservation to young AFAB as they embark on 5 to 7 years of training during their most important reproductive years may provide peace of mind, preserve fertility, and offer a unique solution to plug the well-known leaky surgical pipeline.

Background and Hypothesis

In the current healthcare climate, burnout has become more prevalent with the increasing demands placed upon healthcare workers. When looking at residency specialties, surgery residents have the highest rates of stress and burnout which negatively affects learning and decision-making, surgical performance, and patient outcomes. While mindfulness-based interventions (MBIs) have been proven effective in reducing burnout in physicians, there is a paucity of research on MBIs in surgery. Limited resources, institutional investment, and time in surgery resident schedules are challenges to implementing MBIs. Utilizing mobile health technology for MBIs can be conducive to resident schedules while offering scalability and cost advantages. Our research group has developed and validated a mobile health MBI that has been shown to reduce stress and improve well-being in high-stress populations. We hypothesized that using our novel MBI in a prospective study of surgical residents would reduce stress and burnout.

Methods

A single institution, prospective study was performed by surveying surgical residents and providing a 4-week, mobile health MBI. We assessed variables associated with stress and burnout pre and post intervention. The variables included the Perceived Stress Scale and the Professional Fulfillment Index. Statistical analysis was then performed including Cohen’s d effect size and Student’s t-test.

Results

A total of 14 residents completed the intervention, consisting of surgical specialties in General Surgery (n=6), Obstetrics and Gynecology (n=4), Plastic Surgery (n=3), and Ophthalmology (n=1). At 2-week follow-up, there was a moderate decrease (effect size 0.35) in perceived stress and a significant reduction (p<0.01) in interpersonal disengagement on the Professional Fulfillment Index. Furthermore, feedback from residents found that being able to tailor the time lengths for the meditation practices and do active meditations during daily activities worked well with incorporating the MBI into their schedules.

Conclusion

Mobile health MBIs have the potential to improve well-being in surgical residents and can be easily scalable. We propose further research in assessing the feasibility and efficacy of mobile health MBIs nationally.

Introduction

With the advent of laparoscopic surgery, fellowships in Minimally Invasive Surgery (MIS) filled a training need that residency programs could not accommodate. However, as laparoscopic techniques have become commonplace, the role of fellowship may be in question. A previous survey of fellows suggested that twenty cases of a particular procedure were necessary for trainees to feel competent. We sought to review which cases met that threshold.

Methods

We reviewed the average national surgical resident experience with major cases of foregut, biliary, and gastrointestinal disease. Data was collected from the publicly available ACGME website over the 20 year period from 2002-2022.

Results

Over two decades, the single most common procedure reported by general surgery residents is the laparoscopic cholecystectomy. The six procedures with the largest growth were all laparoscopic. Residents exceed a twenty-case threshold for surgery of the small and large bowel, and inguinal hernias. Surgery on the stomach, including bariatric and anti-reflux surgery, approaches but does not yet exceed this number. Some procedures are rarely performed by general surgery residents, such as common bile duct exploration, esophagectomy and splenectomy, and seem to be declining. (Table 1)

Conclusion

The general surgery resident experience provides a solid base for gastrointestinal surgery and treatment of hernias. Residents are “most competent” at cholecystectomy, but receive little to no training on common duct exploration and inadequate exposure to open cholecystectomy. We conclude that MIS fellowship is necessary for those who plan to specialize in bariatrics and foregut procedures.

Introduction: Virtual reality (VR) is becoming widely available as commercial products enter the marketplace and prices fall. We have shown that VR simulation is effective in teaching medical students procedural skills and can provide remote, standardized, and reproducible independent training at a time and place convenient for the learner. Since this interface is novel in surgical education, our goals were to evaluate the user experience (usability and cognitive load) of VR simulation and examine the relationship between performance and user experience.

Methods: Novice medical students (n=20) were trained to perform chest tube insertion (CTI) by completing an online learning module (30 minutes) and two VR sessions of approximately 20 minutes. VR training was with a commercial chest tube simulation module (Vantari VR, NSW, Australia). Participants were evaluated performing CTI in a mannequin. Technical skill was assessed using OSATS (5-point, 11 items) by an experienced assessor. Usability was tested using the System Usability Scale (scores 0-100); higher scores indicate greater usability. Cognitive load was measured using Leppink’s scale (11-point, 10 items). Three types of cognitive load were evaluated: intrinsic (complexity of task), extraneous (complexity of instruction), and germane load (formation of schema). Scores (0-10) were calculated for each type of cognitive load; lower intrinsic and extraneous load and higher germane load are optimal.

Results: The median total time spent in VR simulation was 40 minutes (IQR 34-44), the OSATS score was 40.5 (IQR 35.5-49.3), and the SUS was 82.5 (IQR 73.8-88.8). A significant correlation between performance (OSATS) and usability was observed (r=0.51, p=0.02). The medians of intrinsic, extrinsic, and germane cognitive load were 3.7 (IQR 1.8-6.1), 0.15 (IQR 0-1.38), and 9.2 (IQR 6.0-10), respectively, reflecting the desired cognitive load. There was no correlation between cognitive load and performance.

Conclusion: VR simulation is an effective technology for procedural training, and the module tested had excellent usability and desired cognitive load when used by medical students, most of whom were unfamiliar with VR. There was a significant correlation between perceived usability and performance. Along with its effectiveness shown previously, VR simulation is feasible for technical skill training for naïve learners.

Introduction: We implemented a Surgical Culture and Etiquette Workshop into the preclinical (year MS2) medical school curriculum to promote early exposure to the operating room (OR) environment, personnel, procedures, and norms. This intervention aimed to improve medical students for the operating room regarding non-technical skills, communication, and team dynamics. Herein, we present the analyses performed to evaluate the efficacy of the workshop.

Methods: This workshop was implemented into the preclinical workshop at a single academic institution 2 months before students began clerkships.

To evaluate the immediate effectiveness of the workshop, student participants were asked to complete a Likert-scale survey assessing comfort with the OR environment, scrubbing, basic technical skills, and understanding of their role both before (pre-workshop) and after (post-workshop) the workshop. Descriptive and statistical analyses were conducted on pre- and post-workshop surveys.

To evaluate the global change in OR comfort, an anonymous, voluntary survey was distributed to third-year medical students before their surgery clerkship in the 2022-2023 (Year 1, pre-intervention) and 2023-2024 (Year 2, intervention) academic years. Descriptive and statistical analyses were conducted on the surveys between Year 1 and Year 2.

Results: One hundred sixty-two students attended the workshop. Pre- and postworkshop surveys received 123 and 61 responses, corresponding to 75.9% and 37.7% response rate, respectively.  We observed statistically significant increases in comfort levels across all questions (Figure 1).

Sixty-five students completed the pre-clerkship survey in Year 1, and 55 students completed it in Year 2. In the pre-clerkship surveys, fewer students in Year 2 indicated that they felt “extremely uncomfortable” in all Likert scale questions than in Year 1. There was a statistically significant increase in confidence in understanding the medical student role on the surgical team in the Year 2 cohort pre-clerkship survey (p=0.014).

Conclusion: A workshop focused on surgical behavioral norms, OR etiquette, and medical student roles and expectations on the surgical team improved students’ self-assessed comfort with the OR environment. Such attempts may lessen student anxiety and optimize the surgical learning environment. However, there is still more work to be done to break down the stigmas of the operating room and stereotypes of surgical culture.

INTRODUCTION: Mood and emotion have been identified as key factors shaping the tone of the operating room (OR), a dynamic construct that influences team performance. Natural language processing (NLP) can yield new insight into team processes by allowing the study of groups in their naturalistic environment. The purpose of this study was to apply NLP techniques to identify emotion in OR teams to better understand team processes and tone.

METHODS: 8 OR cases (2 cases per surgeon participant) were recorded in full. Transcripts for each recording were produced semiautomatically using automatic transcription followed by manual verification. For each utterance in each recording, a sentiment score (between -1 and +1) was calculated using modern natural language processing tools, reflecting the valence of the expressed emotion. We applied changepoint analysis with the PELTS method and the CROPS penalty (using the R package changepoints) to identify changes in mean expressed sentiment. Changepoints were then identified in the recording and transcript and qualitatively analysed for their precipitating context. Each changepoint was labelled and later analysis grouped labels into categories. Directionally positive changepoints were compared with directionally negative changepoints to understand their differences.

RESULTS: Changepoint analysis on audio recordings identified changes in expressed sentiment throughout an operation (mean number of changepoints 11.5, standard deviation 6.12) (Figure 1). The number of changepoints varied by operation (range 2-19). Expressed sentiment was generally neutral-to-positive though there were distinct instances of significantly increased positive and negative sentiment. Directionally positive changepoints occurred in the context of teaching, encouragement, social conversation, and completion of critical steps. Directionally negative changepoints occurred when beginning the operation or a critical step, identifying a potential issue, initiation of count, and when providing corrective feedback.

CONCLUSION: NLP and sentiment analysis are techniques which can be used to identify patterns in OR team mood and emotion. These techniques, when combined with qualitative interpretation, may yield new insights for understanding how emotions influence team interaction, tone, and the tone’s precipitating effects on team performance.

OBJECTIVE   

One-year surgical critical care fellows are required to spend 8 months of their training in the surgical intensive care unit, but must be able to perform all medical, diagnostic and surgical procedures considered essential for the area of practice. Limiting their operating room experience could lead to a lack of proficiency in essential trauma procedures and skill decay. This study aims to evaluate trends in trauma-specific operative case volume for general surgery residents over 10 years to determine if one-year surgical critical care fellows are at risk of being unprepared as they enter positions as trauma attendings.   

DESIGN   

Trauma surgeons were surveyed to determine the five trauma cases most essential for proficiency after training. Operative case data for graduating general surgery residents was extracted from the Accreditation Council for Graduate Medical Education database from 2013-2022. Linear regression models were used to analyze all essential trauma procedures performed during residency and for those performed as chief resident.   

RESULTS   

Thoracotomy, laparotomy, splenectomy, duodenal trauma and fasciotomy were deemed most essential. Over the study period, graduates reported increases in these trauma cases per year for all (28.9-31.6, p=0.00) and chief year (6.7-8.0, p=0.00). Average cases per year for thoracotomy increased for all (2.1-3.2, p=0.00) and chiefs (0.5-0.8, p=0.00). Average cases per year for open splenectomy decreased for all (2.4-2.0, p=0.05), but did not demonstrate linear trends (0.6-0.5, p=0.75) for chief residents. Laparotomy, duodenal trauma, and fasciotomy did not demonstrate linear trends. Average total cases per year remained low for all essential cases (8.1 laparotomy, 2.5 thoracotomy, 2.1 splenectomy, 0.75 fasciotomy, 0.07 duodenal trauma cases).  

CONCLUSIONS   

It is necessary for trauma surgeons to be able to competently perform the essential operations needed to potentially save a life. Observed decreases in splenectomy and overall low case numbers for the essential trauma operative cases suggest a need for further operative training following residency. Consideration should be given to allow increased operative experience during the 1-year surgical critical care fellowships.    

Introduction:

Simulation-based training enables practicing complex surgical skills repeatedly on a simulator to obtain proficiency. Such simulators should have sufficient fidelity and realism in replicating the surgical task.  We developed a novel inanimate rectal prolapse model for training and assessment of performance for the Altemeier procedure.  We hypothesize that the perceived workload of subjects performing the task on the simulator will be lesser for experts compared to novices if our model has sufficient realism and fidelity. We assessed the cognitive task load between experts and novice participants using the 10-point NASA-TLX survey.

Methods:

A realistic rectal prolapse model was created by artificially prolapsing the biotissue double-layered bowel (LifeLike Inc.)  through an artificially created anus on a custom silicone model developed using a mesh inlay to improve hardness to withstand considerable use. The dentate line indentation was made by using a hemostat (Figure 1a). Participants were separated into either novice (PGY1-3) or expert (PGY4-attending) groups based on experience, and given one hour to complete the procedure.  A 10-point NASA-TLX post-survey assessed participant perceived workload. Mann-Whitney U test was used to assess the difference between the groups.

Results:

In this IRB-approved study, a total of 22 participants (15 novice, 7 expert) participated in the study. Comparison of median scores shows that experts had significantly less workload compared to novice (NASA TLX total: 21 vs 29.07, p=0.01). In individual domains (Figure 1b), experts had significantly less physical demand (2 vs 4, p=0.01) and temporal demand (1 vs 5, p=0.002). There were no significant differences in mental demand (3 vs 6, p=0.07), performance (5 vs 5, p=0.72), effort (5 vs 5, p=0.47), and frustration (3 vs 5, p=0.25). 

Conclusion:

The perceived workload ratings show that our model demonstrated sufficient fidelity in replicating the task and its difficulty, expressed through lower workload experienced by experts for total NASA-TLX and the individual domain scores of physical and temporal demands. Though not statistically significant, experts also expressed less mental demand and frustration compared to novice. Compared to the live procedure, the task was less demanding and took equal effort for both groups.  

Introduction: Mattering is a psychosocial construct in which a person feels valued with domains including awareness, reliance, and importance. This study seeks to evaluate the implementation of a method to promote medical students’ sense of mattering in the third-year surgical clerkship. 

Methods: A General Surgery Grand Rounds presentation was given in November 2021 focusing on implementing “NAT: Name, Ask, Thank”. This intervention emphasized addressing students by name, asking one thing they wanted to learn, and thanking them for being part of the team. Student end-of-rotation evaluations were compared before (pre-NAT, January – November 2021) and after (post-NAT, December 2021 – August 2023) the presentation. Additionally, a four-question survey was sent to residents, fellows, and faculty to remind them about NAT four times between November 2021 and June 2022, and then a follow-up in September 2023. Evaluations and survey questions were analyzed with a logistic regression model and chi-square test. 

Results: In total, 332 medical students completed end-of-rotation evaluations pre-NAT and 785 post-NAT. There were no significant differences in mattering questions related to the operating room pre- and post-NAT. The implementation survey was completed by 47 residents, fellows, and faculty in 2021-2022 and 33 in 2023. Of the 35 (74.5%) residents, fellows, and faculty who implemented NAT in 2021-2022, 27 (57.4%) did so always or often. The most frequent barrier to implementing NAT for 21 (44.7%) respondents was forgetting about the process. In the 2023 follow-up survey, 25 (75.8%) residents, fellows, and faculty were still implementing NAT, with 24 (72.7%) citing the most frequent barriers were forgetting about the process and distractions in the operating room. There were no significant differences in any of the survey questions (p=0.896, 0.940, 0.962, 0.965). 

Conclusion: The NAT intervention did not significantly impact medical students’ perception of mattering in the third-year surgical clerkship. However, residents, fellows, and faculty continued to implement the method nearly two years after its initial introduction. Further interventions to increase its use and improve mattering could include visual reminders in the operating room as the most frequent barrier to implementation was forgetting about the process and being distracted. 

Introduction: It is unclear how attending surgeons define resident readiness for robotic surgery, while also setting expectations for resident preparation prior to operating at the robotic console. This study explores attendings’ perspectives on trainee preparedness for robotic surgery. In doing so, we aim to clarify expectations for both teacher and learner in the robotic operating room, while identifying potential opportunities for residents to meet attending expectations prior to operating with the robot.

Methods: Using the COREQ guidelines, individual interviews were conducted with experienced robotic surgeons (more than 30 cases per year, n=5) who operate with residents. Interviews identified factors used to assess readiness for residents, as well as early interventions undertaken by attending surgeons with novice trainees to increase their experience and autonomy. Transcribed interviews were assessed for recurrent patterns and organized into codes and then larger themes by FG and DP using Dedoose software.

Results: Participants spanned general surgery, thoracic surgery, urology, and gynecologic surgeons. Six themes surfaced: robot familiarity, technical proficiency, communication, educational approach and feedback, self-awareness, and learning resources. Notably, residents familiar with robotic consoles and proficient with specific skills such as camera movement were given more autonomy early in their operative experience. Technical expertise was marked by efficient tissue handling and skills transferrable from open and laparoscopic surgeries. Clear communication during the case with attendings and assistants was vital for increasing attending confidence in the trainee. Attendings often gave real-time feedback during surgery to allow novice trainees to improve, and surgeons frequently allocated specific portions of each case to trainees. Residents' safety and self-awareness on the robotic platform and their increasing comfort correlating with growing confidence were observed. Regarding learning resources to improve technical skills, importance of tissue labs and virtual simulations in training was also highlighted.

Conclusions: The criteria for deeming residents ready for robotic surgery, as perceived by attending surgeons, revolve around identifiable technical and non-technical skills. Pinpointing these factors that contribute to resident autonomy, patient safety, and maintaining attending trust is vital for trainee preparation prior to early opportunities to operate on the robotic console.

Objective: Medical students have limited exposure to procedures in their preclinical curriculum. In response, our institution’s core surgery clerkship includes a two-day skills orientation, teaching and simulating the skills students are expected to perform throughout the clerkship. We aimed to build on our prior work evaluating the concordance between skills introduced during the skills orientation, those performed by students during the clerkship, and students' self-reported experience and confidence.

Design: Upon completing an eight-week surgery clerkship at a large academic medical institution, students received a 29-question survey assessing their experience simulating and performing 36 common procedures, as well as confidence in performing these procedures. Using a 5-point Likert scale, the survey also assessed students' overall satisfaction with the skills orientation and the surgery clerkship. Surveys were administered to six clerkship cohorts (n=126) between September 2022 and August 2023. Statistical analysis included Chi-square, Fisher’s exact, and student t-tests.

Results: Thirty-nine students (31%) completed surveys. Thirteen skills showed a significant difference between the frequency of skill simulation versus performance during the clerkship (Figure). Notably, many students never attempted nasogastric tube placement/removal (20%), wound dressing change (28%), wound vac replacement (39%), or fluid collection incision and drainage (23%) during the surgery clerkship. Students’ confidence in surgical skills significantly increased (p <0.001) after the skills orientation, as well as after the clerkship itself. Additionally, 54% of students believed the skills orientation prepared them well, 61% found it enhanced their clerkship engagement, and 54% felt it increased their interest in pursuing surgery. However, less than half (48%) were satisfied with the procedures they were allowed to perform during the clerkship.

Conclusion: Our results underscore the need for enhanced exposure to surgical procedures in medical education, with a focus on aligning teaching with performance expectations. We report a significant discordance between the skills introduced during orientation and those practiced during the clerkship, particularly in tasks considered important for surgical interns. Although our skills orientation positively impacts students' confidence and interest in surgery, opportunity remains to better align student education and practical experience in surgical training, ideally by expanding procedural opportunities on the clerkship.

Introduction: Penetrating cardiac injuries have higher mortality due to occult injuries. While FAST scan is the initial diagnostic tool, it has limitations. The subxiphoid pericardial window, with almost 100% accuracy, is vital for timely management. To train our residents, we offer a low-cost, high-fidelity simulation model.

Methods: A low-cost model (Figure 1) was created using a cardboard box (depicting the chest), balloon (depicting the heart), saran and plastic wrap (depicting the pericardium layers), corrugated box and cotton (depicting the xiphoid and fibrinous tissue) and felt (skin and subcutaneous tissue). This model was initially introduced to the PGY4 residents and later to the PGY3 residents in the following year. Participants performed a simulated pericardial window procedure on this model during their bi-annual Surgical X-Games assessments. They were evaluated using a 22-point checklist (score out of 5) assessing both skill and knowledge.

Results: 45 residents completed simulated training on the model. Their mean overall scores (out of 5) improved from 2.02 in the fall to 2.39 in the spring X-Games, though statistical not significant (p>0.05). All residents correctly incised the xiphoid process in both assessments. In the fall, 48.9% residents retracted the lower sternum and dissected in the correct plane, increasing to 60% in the spring. Commonly missed steps included patient preparation and the cardiac bypass machine backup. Throughout the years, only 5 residents punctured the balloon, resulting in penalties. The residents performed better in the knowledge section compared to the skills section and their mean knowledge score did not show a statistically significant improvement from fall to spring (p>0.05). In the fall X-Games, 75.6% residents acknowledged the importance of a sternotomy in an unstable patient whereas in the spring X-Games, 97.8% residents mentioned this step.

Conclusion: We know that performing pericardial window on a model is not equivalent to presentation in the real clinical setting but knowing the surgical steps of safe and prompt trauma pericardial window formation can be lifesaving when the need to perform this procedure arises. Our low-cost and high-fidelity pericardial window model is reproducible, easily available, and a valid tool for teaching surgical skills to our residents.

Background: Cultural humility in surgery is an increasingly recognized and essential component of providing high-quality and equitable care to diverse patient populations. This study aimed to explore attitudes toward cultural humility in surgery and assess the impact of a cultural humility workshop on medical students and surgical professionals. As healthcare systems strive to prioritize diversity, equity, and inclusion (DEI) principles, it is imperative to integrate cultural humility into surgical education and practice.

Methods: To address these objectives, an interactive cultural humility workshop was offered to participants from medical schools and surgical practices. The workshop aimed to raise awareness of cultural humility, provide a platform for participants to share their experiences, and offer practical strategies for its implementation in surgical care. A survey was administered to assess participants' experiences and attitudes toward cultural humility before and after the workshop.

Results: Twenty-eight participants completed the survey. The majority of participants (89%) reported having experienced at least one instance of cultural insensitivity in their educational or professional environments. Importantly, 89% of participants recognized cultural humility as an essential element for providing high-quality surgical care. Moreover, the workshop highlighted a consensus among participants that surgical education should incorporate DEI principles into its curriculum, with the majority agreeing regarding the need for focused training in this area. Regarding their workshop experience, most participants expressed a commitment to promoting cultural humility in their surgical practice or roles. Most participants (82%) indicated they would "definitely" recommend the workshop to their colleagues.

Discussion: The surgical community is increasingly acknowledging the significance of cultural humility in delivering effective and equitable care. This study, which utilized an interactive workshop, aimed to explore its effects on initiating the process of cultural humility integration into surgical training curricula.

Introduction: Imposter Syndrome (IS) describes self-doubt of intellect, skills, or accomplishments among high-achieving individuals. Although certainly not a new concept, it has become exceedingly prevalent in healthcare and medicine. Given scant scholarly work investigating the prevalence and presentation of IS in healthcare trainees – and particularly amongst surgical trainees to date – our objective was to provide the first recorded description of IS in surgical residents.

Methods: This was a single survey sent by members of ASE Graduate Surgical Education Committee across multiple institutions to surgical residents. The survey is currently accruing data and preliminary results from N=24 respondents is reported. This survey asked participants to provide demographics and descriptive information, feelings of IS, impact on mental health, situations in which IS was most likely to occur, and any training or education received to date.

Respondents to date were 50% female, 63% Caucasian, and 75% General Surgery residents. 92% said they matched into their desired specialty (87% into a Top 3 rank list program). The most cited reasons for feelings of IS included: Starting residency (i.e. feelings prior to intern year), starting a new rotation, working with “that” attending, and having to take/study for national exams. Despite this, only 16% of trainees had received any previous training or education on IS. IS also impacted mental health: Residents reported ‘above average’ levels of Anxiety (Mean=3.5/5) and Burnout (Mean=3.2/5). Trainees also stated they had ‘become more callous toward people’ since starting this job (Mean=4.08/5). In the past month, only 46% of residents said they received positive reinforcement at least weekly (0% said daily).

Conclusion: Despite reportedly high rates of IS amongst surgical residents, little to no training has been given to mitigate these feelings, presenting a critical opportunity for education leadership (e.g. Program Directors) to provide this type of education to trainees. As there is currently no ‘gold standard’ for addressing IS, more work in surgical education is warranted.

Introduction: Mentorship is critical to the success of early-career academic surgeons, but finding a mentor can be challenging. Departmentally supported, structured, mixed-team approaches have been recently described in the literature, but their benefit to surgeons is unclear. This study reviewed our department’s mentorship program to better understand junior faculty career needs.  

Methods: A longitudinal early career surgeon mentorship program was created in 2021 at a single large academic institution. Mentees were paired with a team of mentors based on clinical/academic interests, which could include senior surgeons, research faculty, peer mentors, and mentors from other institutions. Each group met three times in the first year. After the program’s first year, mentees were invited to participate in focus groups which aimed to: 1) evaluate the perceived effectiveness of this mentorship program; 2) identify successful aspects of its implementation; 3) define the mentorship needs of early career academic surgical faculty in the context of this program. Focus groups (N=4) were conducted by the program faculty lead (a senior surgeon) and included two to four participants each. We used thematic analysis to inductively code transcripts (two coders, constant comparative method) and allow broad themes to emerge. 

Results: 13/18 (72%) of mentees volunteered for the focus groups (54% female, 69% first-year on faculty). 54% of participants had no prior mentor, and 92% were very satisfied with their experience. Participants reported many barriers to finding adequate mentorship outside of a structured program and thus appreciated the accessibility of senior mentors facilitated by this program. Other perceived program strengths included the diverse mentorship panel, incorporation of a wellness coach, and structured meetings encouraging accountability. Suggestions for improvement included diversity around group composition and more customizable meeting agendas. Broadly, mentorship needs included accessibility of mentorship/resources, obtaining specific skills, organization/prioritization, and achieving wellness (Figure 1). 

Conclusion: A longitudinal mentorship program for early career surgical faculty was well received by the participants, mitigated barriers to finding mentorship, and helped address the diverse needs of these surgeons. Next steps include further mentor training and programmatic improvement as well as broadening the program to mid-career and senior surgeons.

Background

Robotic surgery utilization has increased exponentially in the last decade across multiple surgical subspecialities, making it a routine tool in the contemporary surgeon’s repertoire. Surgical trainees now require curricula for advanced, not only foundational, skills in robotic surgery. Although specialty-specific and synchronous curricula have been published, we sought to develop a cross-disciplinary asynchronous advanced robotic surgery curriculum to meet institutional needs.

Methods

We utilized Kern's six-step method to frame curriculum development and implementation. Leaders in robotic surgery at a single academic institution responded to a free-text survey during their quarterly steering committee meeting, answering questions about protected educational time, current departmental curricula, robotic surgery case types essential for resident proficiency, faculty comfort level with teaching robotic surgery, and areas for improvement in robotic surgery education. A skeletonized curriculum was drafted based on these results, then refined through individual stakeholder interviews before implementation.

Results

Nine stakeholders representing gastrointestinal, colorectal, cardiac, thoracic, gynecologic, urologic, and hepatobiliary surgery participated in surveys and interviews. All stakeholders agreed, more than basic online modules and simulator training are required to build operative proficiency, with eight stating safe tissue handling as an essential skill. Each stakeholder listed specialty-specific procedures important for trainee proficiency, with common characteristics of suturing, tissue handling, and stapling across procedures. A core advanced curriculum, consisting of suturing and anastomosis drills on porcine bowel, was refined in individual interviews. Stakeholders agreed, asynchronous delivery would allow pressure-free practice for trainees. The curriculum was delivered via video instruction and individually proctored skills lab practice, to a pilot class of 13 senior / chief residents in general surgery, gynecology, colorectal surgery, and urology during academic year 2022-2023.

Conclusions

We developed and implemented an advanced robotic surgery curriculum for surgical residents, targeting common advanced and composite skills (e.g., tissue handling, bowel anastomosis) across surgical specialties and outside the scope of basic simulations. Feedback from the pilot class and video evidence of their performance will be utilized to evaluate and improve future iterations. We anticipate similar curricula could be implemented at other institutions with trainees across multiple surgical specialties to improve the acquisition of advanced robotic surgical skill.

INTRODUCTION 

The relationship between professionalism and procedural skill acquisition in medical education remains unexplored. Despite various tools assessing global clinical professionalism, none specifically focus on procedures. This study aims to explore the correlation between professionalism and procedural skill acquisition in undergraduate medical students.

METHODS

We developed a novel five-item tool to assess professionalism in skill acquisition based on common professionalism errors found in online procedural education. The tool distinguishes high and low levels of professionalism through assessment of readiness, conduct, and timeliness. Undergraduate medical students underwent a simulated lumbar puncture course and were graded through three tools: the professionalism tool, a Specific Rating Scale (SRS), and a modified Objective Structured Assessment of Technical Skills (OSATS). A binary variable "professionalism level" identified maximum scores as "high-professionalism" and other scores as "low-professionalism". We generated descriptive and inferential statistics to compare both groups.

RESULTS 

To date, half of the students have completed their training (61); 100% were assessed with the professionalism tool, 48 (78.7%) obtained the maximum possible score and were placed in the high-professionalism group. Eleven (18.0%) students received four of five points while one student each (1.6%) received two and three points; these students were placed in the low-professionalism group. There were no significant differences in SRS or OSATS between low-professionalism and high-professionalism groups (p=0.73 and p=0.93, respectively). The median SRS scores for low-professionalism and high-professionalism groups were 112.5 and 115.5, with interquartile ranges (IQR) of 7.5 (110.5, 118) and 5.5 points (112.9, 118.5), respectively. OSATS scores had identical medians (17.5) for both groups, with IQR 2.5 (16.5, 19) and 1.5 (17, 18.5) respectively.

CONCLUSIONS

Although the high-professionalism group scored higher than the low-professionalism group with less variability, the difference was not significant. Further research with the complete sample post-training is expected to yield more robust results. Our novel professionalism assessment tool in procedural skill acquisition requires additional validation, offering potential insights into competency domain associations.

Background

Meaningful mentorship plays a crucial role in the development of surgical residents. Providing formal guidance increases work satisfaction and lowers rates of burnout in a known stressful environment and training. This is especially true for residents that are female and/or underrepresented minorities who report higher rates of burnout or program dissatisfaction. Our objective was to create a novel formal mentorship program, Surgery IMPACT, at our single institution to address these issues. 

Methods

Prior to the start of this formal mentorship program, informal mentorship between faculty and residents was already present. A needs assessment survey was completed at the beginning of the academic year prior to implementation of Surgery IMPACT.  The program relied upon WISE Domains (Work-Life Balance, Interpersonal and cultural proficiency, Scholarly and career advancement, Effective learning and study techniques) as the foundation for the paired meetings and individual assessment throughout the year. Once the program was completed an end of year survey was  disseminated to assess the difference in the satisfaction of the informal mentorship model and our formal mentorship program.  

Results

Resident satisfaction from the informal mentorship model previously in place compared to the structured Surgery IMPACT model rose from 64% (14/26) to 88% (22/25) respectively. The number of meetings  also increased from less than two meetings 76%(20/26) to greater than two meetings at 84% (21/25) . Also finding that 92% (23/25) of residents desired to continue their current mentor relationship. 

Conclusions

Our formal mentorship program, Surgery IMPACT, is a successful model for structured mentoring in a surgical residency. Using the WISE domains as the cornerstone, our results demonstrate that residents were not only satisfied with their mentors but that the quality of the meetings were meaningful. This was shown with an increase in the number of meetings but also a desire to continue with the same mentor for the following year. There will be continued evaluation and evolution for this sustainable model within our surgical residency. Currently this is a model that can be replicated within any residency.