ASE 2024 Abstracts

On-Demand Posters

(P041) THE RAT PACK: A SCOPING REVIEW OF ATTRIBUTES OF GOOD RESIDENTS-AS-TEACHERS ACCORDING TO MEDICAL STUDENTS
Kathryn Radulovacki, BA¹, Dana Rowe, BA¹, Keira Goodell, MD², Isa DeLaura, MD³, Moronke Ogundolie, MD⁴, Daphne Zhu, BS¹, Shannon Barter, MD³, Joseph Ladowski, MD, PhD³, Samantha Kaplan, PhD¹, Alisan Fathalizadeh, MD³; ¹Duke University School of Medicine, ²Maine Medical Center, ³Duke University, ⁴University of Chicago

Introduction: Residents significantly influence medical students’ learning. Multiple studies have explored medical students’ perspectives on the qualities that make residents effective educators, but a succinct review is needed. Our scoping review seeks to define these attributes, which can provide insight on areas of focus in the training of residents in education and teaching.

Methods: A scoping review of medical student evaluations of resident teachers was performed by searching PubMed, EMBASE, Scopus, and APA PsycINFO from 1946 to 2023. The research team involved a librarian, medical students, and faculty. Two independent investigators screened abstracts for relevance, with a third reviewer resolving any disagreements. Selected manuscripts underwent full-text review and data were extracted for a qualitative summary. Themes were iteratively reviewed by two independent researchers.

Results: 4,430 articles were identified and 586 were selected for full text review. Inclusion criteria were discussion of residents and evaluations that solicited medical students’ opinions on the relative importance of different attributes. Fifteen articles were selected, which included 9 qualitative studies, 4 mixed-methods, and 2 quantitative. Represented specialties included surgery (10), internal medicine (8), family medicine (6), pediatrics (6), anesthesia (5), obstetrics/gynecology (4), and psychiatry (4). The most frequently identified themes were commitment to teaching (12), being supportive or encouraging (10), valuing teamwork and inclusion (10), providing feedback and advice (9), and serving as a role model (7) (Figure 1).

Conclusion: We identified five recurring themes of the qualities of good resident teachers from the perspectives of medical students. These results suggest students value intentionality in teaching efforts and psychological safety in their learning environments. Future efforts should focus on integrating these qualities into resident training to enhance the medical student learning experience.

(P042) EVALUATION OF VALIDITY EVIDENCE FOR ADVANCED TRAINING IN LAPAROSCOPIC SUTURING (ATLAS) USING A RATING SCALE BASED ON THE UNITARY FRAMEWORK OF VALIDITY
Nicholas Jonas, MD¹, Mohammad Abudoush, MD¹, Dmitry Nepomnayshy, MD², Iman Ghaderi, MD, MSc, MHPE, FRCSC, FACS, FASMBS¹; ¹Banner University Medical Center Tucson, ²Lahey Hospital & Medical Center

Introduction:

The Advanced Training in Laparoscopic Suturing (ATLAS) curriculum was developed and endorsed by the Association for Surgical Education (ASE) to address the gap in advanced laparoscopic suturing skills for senior surgical residents and minimally invasive surgical fellows. The aim of this study was to examine the validity evidence in the literature for this curriculum using an established rating scale based on Messick’s unitary framework of validity.

Methods:

Published articles containing assessment data on the ATLAS curriculum were identified through PubMed search. Thirteen articles were identified. After rater training, two independent raters reviewed these studies using previously published rating scale (score 0-3) for validity evidence regarding the following sources: Content, Response Process, Internal Structure, Relation to Other Variables, Consequences. Intraclass correlation coefficients (ICC) were calculated using a two-way agreement model in Excel; a p-value<.05 and ICC>.75 were sought. Disagreements were discussed and final scores were agreed upon.

Results:

All thirteen articles were reviewed, and scores were assigned for each source of validity. (Table 1). The inter-rater reliability was good with an overall ICC score of 0.84 (range between 0.42-1 for each domain) The scores were highest for Content validity (2.38) and lowest for Consequences (1.46).  

Conclusions:

This study examined the validity evidence for the ATLAS curriculum through the lens of the contemporary unitary concept of validity. Content validity was the most discussed source in the literature. Future studies should explore additional sources of validity, including the consequences of assessment, to evaluate the potential applications of this training model and its role in competency-based curricula for advanced suturing.

(P043) DOLLARS AND SENSE: DO SURGICAL RESIDENTS UNDERSTAND THE COST OF CARE?
Brady A Campbell, MD, MPH, Colin Scott, BS, Amy VanderStoep, MD, MPH, Nicole Kus, MD, Stephen Kavic, MD; University of Maryland

Introduction:

Physicians, specifically surgeons, have been shown to be poor at estimating healthcare costs, even though healthcare expenditure accounts for over $4.5 trillion annually. We investigated residents understanding and perceptions about their healthcare cost knowledge.

Methods:

An explorative analysis was conducted regarding healthcare costs at a single academic institution. We surveyed general surgery residents with an IRB-approved questionnaire in June and July 2024, using a mixture of free response and Likert Scale (1-5) questions. Cost estimation questions included the price of a nasogastric tube (NGT), inguinal hernia mesh, complete blood count (CBC) without differential, computed tomography (CT) scan of the abdomen and pelvis with intravenous (IV) contrast, laparoscopic cholecystectomy, and chest x-ray. The true values were obtained from FairHealth.org, a cited patient education tool, and the hernia mesh price was obtained from our hospital. Responses are reported as the overall cohort and compared between PGY 1/2 and PGY 3-5. A p-value of <0.05 was considered significant.

Results:

The survey was completed by 41 of 71 residents (58%). Our cohort was predominately woman (58%), white (59%), and had a mean age of 30. Residents reported a majority poor or very poor understanding of cost (56%) and no formal training (73%), with no difference between PGY cohorts (p>0.05). However, residents did report higher levels of informal training (63%). Cost estimations are shown in Figure 1, demonstrating varying accuracy between the two cohorts. The cost estimation of a CT scan was the only item with a significant difference by PGY category, with PGY 1/2 versus PGY 3-5 estimates of $876 (±523) vs $553 (±440) (p=0.042), respectively. The actual cost was $596. Overwhelmingly, all residents endorsed the need for more emphasis on healthcare costs in training (98%) and believed that increased understanding would lead to improved patient care (80%) and patient outcomes (76%).

Conclusion:

Surgical residents at our institution demonstrated a poor understanding of healthcare costs, with minimal improvement during training, even though they felt it is important for patient care and outcomes. Programs and societies should work to identify potential solutions and ways to increase training.

(P044) LEVERAGING OBJECTIVE STRUCTURED TEACHING EXERCISES (OSTE) TO ENHANCE FEEDBACK DELIVERY SKILLS AND SCORING ACCURACY IN MEDICAL EDUCATION
Binh Le¹, Emily Ehsan¹, Lily Ehsan², Avery Kallman³, Mollie Urkoski⁴, Keely Buesing, MD, FACS¹, Valerie Shostrom, MS¹, Priscila Rodrigues Armijo, MD¹, Jeremy Lipman, MD, MHPE, FACS, FASCRS⁵, Olabisi Sheppard, MD, FACS¹; ¹University of Nebraska Medical Center, ²Cornell University, ³Wayne State College, Nebraska, ⁴Concordia University, Nebraska, ⁵Cleveland Clinic

Background: Effective feedback enhances learning but is often overlooked in medical training. Objective Structured Teaching Exercises (OSTE) enhance teaching and communication skills in simulated sessions yet are underutilized and have not been researched for procedural learning feedback delivery.

Purpose: We aimed to develop a training session for feedback delivery using the Pendleton Method and assess its impact on feedback skills of physicians during OSTEs.

Methods: In July 2024, six physicians performing central line placement (CLP) at a single institution participated in this study. Four standardized students (SS) were recorded performing CLP in a mannequin. Participants were randomized to watch 3 of 4 pre-recorded videos, grade the SS using a checklist, and provide them feedback in an OSTE. After the first video, participants completed a module on using the checklist and providing feedback using the Pendleton Method. OSTEs were recorded, and the SSs and a master assessor graded participants’ feedback skills using a rubric. Afterwards, participants were interviewed and completed a Likert-scale survey evaluating training effectiveness. Scores were compared post- versus pre-training; data was analyzed using PC SAS v.9.4. Thematic analysis was done for qualitative data.

Results: Checklist scores were significantly lower post-training (post: -4.5 (-7.5, -4), pre: -3 (-3, -3), p-value 0.031), while there were no significant differences in the feedback skills of participants post- vs pre-training. Most participants found the OSTE format and training module helpful in enhancing their feedback skills. However, they suggested more in-depth feedback in return from the SSs and the ability to grade SSs during live simulated CLP sessions rather than through video.

Conclusion: Although participants perceived the training module and OSTE to be helpful, data illustrated a tendency to underscore the SSs post-training with no discernible improvement in feedback skills. The Dunning-Kruger effect may explain this, as participants became more critical of themselves and the SSs after the training module, showing that they knew how to evaluate them at an elevated level despite the scores showing that the SSs underperformed. Additionally, participants may have under-appreciated the Pendleton Method approach, limiting their engagement in feedback, which could have affected feedback quality. 

(P045) BARRIERS TO FEEDBACK WITHIN THE SURGICAL CLERKSHIP: A FACULTY PERSPECTIVE
Charan Talwar, Justin Sarquiz, Leta Ashebo, Emily Crowley, Jamila Picart, MD, Hunter J Underwood, MD; University of Michigan

Introduction:

Effective feedback is a cornerstone of undergraduate medical education. Feedback allows learners to identify areas for improvement, reinforce aspects of skills performed well, and assess avenues for further learning. While substantial literature exists describing medical students’ experience with feedback practices, there is a paucity of research probing faculty surgeon’s perspective on administering feedback. This study aims to characterize perceptions of feedback quality and barriers to delivery from a faculty surgeon’s perspective.

Methods:

A novel 24 item questionnaire was developed and distributed to surgery clerkship directors at LCME-accredited medical schools. This questionnaire assessed the current feedback system at their institution, the quality of feedback delivered, and perceived barriers to delivery of honest feedback. The data were analyzed using descriptive statistics, contingency table analysis, and logistic regression.

Results:

Forty-eight (28%) of 170 clerkship directors completed the online survey. Of the respondents, 54% were female, 79% were practicing in urban settings, and 71% were at a program utilizing a tiered grading system. There was a large variation of years in practice and geographic region. Surgery clerkship directors reported agreement that feedback at their institution is clear (88%) and constructive (75%). In identifying barriers to honest feedback, directors most agreed with perceptions that students are not receptive to feedback (52%) and the administrative burden of dealing with grade disputes (46%). Contingency analysis suggested senior surgeons were more limited by lack of time and junior surgeons were more concerned about negative evaluations or academic consequences for the student. Open-ended questions revealed concerns for lack of exposure to a given student, retaliation against faculty by students who receive negative feedback, and students misinterpreting negative feedback as mistreatment. There were no significant correlations noted between respondent characteristics and survey responses.

Conclusion:

This study demonstrates that barriers to feedback on the surgery clerkship are multifactorial. Most directors affirm that feedback mechanisms at their school are clear and constructive. Simultaneously, directors also acknowledge significant barriers to providing negative feedback, including both administrative concerns as well as concern for student reception. Our results suggest interventions are necessary to support surgical faculty in providing critical, constructive feedback when necessary.

(P046) AUTOMATED SEGMENTATION OF SIMULATED ROBOTIC GASTROJEJUNOSTOMY VIDEOS FOR APPLICATIONS IN SURGICAL EDUCATION
Huu P Nguyen, PhD, Sofia Garces Palacios, MD, Medha Sundar Rajan, Pranav Kikkeri, Justin Kosley, MS, Arushi Nadar, MS, Bryanna Stukes, MD, Ricardo Nunez, MD, Samy Castillo, MD, Patricio M Polanco, MD, FACS, Herbert Zeh III, MD, FACS, Ganesh Sankaranarayanan, PhD; University of Texas Southwestern Medical Center

Introduction
Mastering robotic anastomosis skills requires extensive training.  Video-based review is the current standard for assessment and feedback for trainees but requires manual segmentation, which is time-consuming and prone to errors. Automated segmentation using Advanced AI tools provides a cost-effective and efficient way of performing such analysis in a high volume of cases. This study aims to develop and evaluate an AI model for automatically segment the videos of the simulated gastrojejunostomy (GJ) performed on a bio-tissue bowel model. 

Methods 
A total of 58 GJ Bio-tissue drills videos performed by general surgery residents as part of the robotic surgery training from a tertiary center were used. Further, each video was annotated by trained annotators to mark the beginning and end frames of eight distinct steps of the task. To automate the detection of the phases, an X3D deep convolutional neural network model, pretrained on millions of images, was utilized. A smooth averaging filter (SMA) was applied to the model prediction to further improve the performance of segmentation in post-processing step.

Results
Out of 58 videos, 47 videos (~80%) were utilized for training and 11 videos (~20%) were allocated for testing. In the step segmentation task, the baseline model initially demonstrated an average accuracy of 0.6206 (window size w of 64) with standard deviation of 0.03. Notably, the results for SMA varied based on the size of w. When the SMA technique was applied, the accuracy increased to 0.6425. The highest accuracy achieved was 0.6672. In addition, the phase with the highest accuracy of 0.76 was the Inner Running Suture 1, while the Enterotomy phase had the lowest accuracy of 0.33. Using F1-score as the measure, the Inner Running Suture phases was the highest at 0.79, and the Enterotomy phase was the lowest at 0.38 (Figure 1).

Conclusion  
We developed a deep learning model capable of automated segmentation of simulated gastrojejunostomy videos. Our next step is to apply the model in our robotics curriculum to segment and store clips for easy retrieval for surgical education applications.

(P047) UTILITY OF SURGICAL GESTURES IN ASSESSING ADVANCED TRAINING IN LAPAROSCOPIC SUTURING SKILLS (ATLAS) PERFORMANCE
Sofia Garces Palacios, MD¹, Sharanya Vunnava¹, Madhuri Nagaraj, MD², Bryanna Stukes, MD¹, Daniel J Scott, MD, FACS¹, Ganesh Sankaranarayanan, PhD¹; ¹University of Texas Southwestern Medical Center, ²University of Colorado Anschutz Medical Campus

Introduction

Laparoscopic suturing is a complex skill to master, requiring extensive training. ATLAS offers a structured curriculum designed to improve laparoscopic suturing skills through six tasks of increasing difficulty. Task 1 (needle handling) involves maneuvering a needle through six variable angled holes on a circular model. By analyzing surgical gestures, the fundamental and meaningful units of motion of a task, this study aims to assess their reliability in evaluating performance on ATLAS Task 1.

Methods

Retrospective analysis of data collected from our previous study on proficiency-based training and transfer of skills of ATLAS was used in this study. The pre and post data of the group who underwent training in the Needle Handling task of ATLAS were graded by two trained raters on a 3-point scale (low, average and excellent) using needle handing gestures that consisted of repositions, control, orientation, grasping, withdrawal, motion, force and trajectory. Individual needle handling scores for each of the six holes and a total score for all holes was computed. Using Messick’s unitary framework, the internal structure validity was assessed using the intraclass correlation coefficient (ICC) for inter-rater agreement and construct validity was assessed by comparing pre and post test scores using a Wilcoxon-signed Rank Test.

Results

A total of six subjects completed the training and took a median of 13.5 [11.5 -14.8] repetitions to achieve proficiency in Task 1. High inter rater agreement was achieved between the graders (ICC = 0.98, p < 0.001). Significant differences in performance were found between the pre and posttest for both total gestures score (111.5 vs 138.5, p = 0.031) and normalized task scores (0 vs 80.89, p = 0.031).  Individual task level analysis showed a significant difference for holes 1(17.5 vs 22.5, p = 0.035), 3 (17.5 vs 23.5, p = 0.031), 5 (16 vs 24, p= 0.031). Further determination couldn’t be made for holes 2, 4 and 6 since the significance was at p = 0.05.

Conclusion

Our study demonstrated the utility of surgical gestures for assessing laparoscopic suturing skills.  Surgical gestures may be further used for providing feedback to trainees.

(P048) EFFECT OF TRAINING ON PERCEIVED MENTAL WORKLOAD IN A VIRTUAL COLORECTAL SURGICAL TRAINER PERINEAL PROCTECTOMY (VCOST-RP) SIMULATOR
Sofia Garces Palacios, MD¹, Alexis Desir, MD¹, Kaustubh Gopal, MS¹, Doga Demirel, PhD², Javier Salgado, MD¹, James W Fleshman, MD³, Suvranu De, ScD⁴, Mark Ellis, BSc⁵, George Westergaard, MSc⁵, Ganesh Sankaranarayanan, PhD¹; ¹University of Texas Southwestern Medical Center, ²School of Computer Science, University of Oklahoma, ³Baylor Scott & White Health, Dallas, TX, ⁴Florida A&M University, ⁵Florida Polytechnic University

Introduction

Simulation-based training offers a safe platform for the development of skills in surgical education. Virtual reality (VR) simulators replicate environments of surgical procedures like the perineal proctectomy for rectal prolapse. Training on simulators has shown to improve performance and enable the transfer of skills but little is known on how the perceived mental workload changes with training, which is the aim of this study.

Methods

A randomized controlled trial was conducted with medical students from all academic years at our institution. Participants were randomly assigned to either a simulation or a control group. The simulation group underwent training on VCoST-RP over three weeks, whereas the control group continued with standard medical school curriculum. All participants completed a pre-test, post-test, and retention test. Mental workload was assessed using the NASA Task Load Index (NASA-TLX) questionnaire at pre, during each trial of the training sessions, post and at the retention tests. To characterize learning and the improvement in mental workload, a nonlinear regression analysis was performed with inverse curve fitting of the form (y = a – b/x), where the learning plateau is defined as the asymptote (a). A two-way mixed ANOVA with post-hoc comparisons applying Bonferroni correction was used to analyze improvement in mental workload.

Results

Ten medical students equally distributed in both groups participated in our study. Nonlinear regression analysis showed that the total score improved with training, plateauing at 34.024. The total workload decreased with training to a plateau of 13.9. ANOVA revealed a significant main effect on group (p = 0.007) and interaction between group and time (p = 0.04). Post hoc analysis showed that the simulation group had significantly lower mental workload at both post (p = 0.003) and retention tests (p = 0.01) when compared to the control group.  No differences between the groups were seen at the pretest (p = 0.52)

Conclusion

Our results show that training with VCOST-RP improved the skill performance and reduced the perceived mental workload in a simulated perineal proctectomy procedure. Our findings support the potential of VR simulators for surgical training.

(P049) TEMPORAL ANALYSIS OF SURGERY RESIDENT STUDY HABITS
Jasmine A Estrada, MD¹, Mala Sharma, MD¹, Timothy K Lee, MD², Nicole Petcka, MD², Emma Bradley, MD³, Savannah R Smith, MD², Julia Shelton, MD, MPH¹; ¹University of Iowa Hospitals and Clinics, ²Emory University School of Medicine, ³Vanderbilt University Medical Center

Background: Residents who study regularly and throughout the year perform better on the American Board of Surgery In-Training Examination (ABSITE). Prior literature supports frequent studying for intervals as short as 15 minutes per day can make a significant impact on a resident’s ABSITE percentile range. 

Objective: Perform a targeted needs assessment to understand the temporality of and perceptions toward surgery resident studying as well as barriers to maintaining a study schedule in residency training. 

Methods: Anonymous, electronic surveys were distributed to general surgery residents at 3 academic residency programs of varying size (n = 191). Surveys asked about respondents’ demographics, study habits (during dedicated ABSITE study vs non-dedicated ABSITE study), barriers to studying, perceptions toward studying, perceptions toward ABSITE, and motivation to change study practices. The results of the surveys were analyzed using descriptive statistics. 

Results: In total, 32% of residents responded to the survey (n = 61). Of those, 87% (n = 53) report resident work hours as a major barrier affecting their ability to adhere to a consistent study schedule. Over half of respondents (56%, n = 34) do not follow any type of study schedule outside of dedicated ABSITE preparation despite 47% (n = 16) of those respondents selecting their belief that “consistent, year-round study” is the most effective ABSITE preparation strategy. October through January were the most commonly reported months for consistent studying (65%), described as studying daily (37%) or greater than 3 days per week (25%) during this period. Most residents self-described as somewhat or not at all disciplined (64%) regarding their studying for the ABSITE examination. When asked how likely respondents would be to use a supplemental study tool organized by the residency program, 85% of residents designated they would be likely to utilize it. 

Conclusions: A temporal relationship exists between surgery resident studying habits and the months preceding the ABSITE. Barriers such as resident time constraints and low self-discipline should be considered when developing educational interventions to improve consistent, year-round studying, particularly in the months outside of traditional ABSITE preparation. 

(P050) ASSESSMENT OF COMPETENCY IN CT SCAN INTERPRETATION BY FOURTH YEAR MEDICAL STUDENTS DURING A CAPSTONE COURSE
Olivia Heutlinger, MD, Rachel Treat, MA, Alex Halpern, MD, Kathleen Brindle, MD, Nadia Khati, MD, Juliet Lee, MD; George Washington University

Objective:  Imaging is central to patient care in multiple specialties, but only 25% of schools require a radiology rotation.  During a capstone course, a dedicated radiology session was integrated into the curriculum.  The purpose of this study was to assess the competency of fourth year medical students in CT imaging of the abdomen and pelvis.

Methods:  Fourth year medical students pursuing a surgical specialty or a surgery preliminary year were enrolled in a capstone course and participated in a one hour radiology lecture on a strategy to review a CT scan of the abdomen and pelvis (2022-2024).  Then, students were assigned to be “on call” and received a page in which the case scenario included CT imaging interpretation of a patient with suspected small bowel obstruction (SBO).  A standardized rubric on anatomic identification and interpretation of the CT scan was used to evaluate competency in cross-sectional imaging. 

Results:  Three cohorts of fourth year medical students (n=102, 53 male, 49 female) answered a page by the attending surgeon to check the interpretation of a CT scan of the abdomen and pelvis.   The students’ specialties were: general surgery or integrated program (43%), orthopaedics (18.6%), otolaryngology (12.7%), neurosurgery (7.8%), urology (7.8%), ophthalmology (4.9%), radiology (2.9%), and other (2%).

Only a few students (12.7%) requested identifying information, patient data, and clinical presentation information.  Even fewer interpreted the scan in a systematic fashion, including all the components on the rubric (7.84%).  In both cases, the majority of these students matched in general, vascular, or plastic surgery.  Slightly over a third of students (38.2%) were able to make the diagnosis of an SBO by identifying a transition point.  The ability to diagnose SBO was identified by students across all specialties.  The remaining students misdiagnosed the patient with a LBO (2.9%), ileus (53.9%), or a non-abdominal organ pathology (5%). 

Conclusions:  Fourth year medical students at the pre-internship phase of training continue to struggle to systematically review a CT scan, interpret a CT scan correctly with specific findings, and arriving at a diagnosis.  This study demonstrates that medical students would benefit from more formal radiology training.

(P051) SURGICAL FACULTY PERCEPTIONS OF AN INSTITUTION-WIDE TRANSITION TO A LONGITUDINAL INTEGRATED CLERKSHIP (LIC): A MIXED METHODS STUDY
Katie Glasgow, MD, Colleen McDermott, MD, Kirstyn E Brownson, MD, Kshama R Jaiswal, MD, FACS, Laura A Lambert, MD, FACS; University of Utah

Background

An LIC model is an alternative to the traditional block clerkship (TBC) method, pairing a medical student with a 1:1 preceptor for an academic year. Despite its long existence, little data explores LIC's impact on surgical education. Published data shows concerns of program directors perceiving LIC graduates as less qualified and ranking them lower. Perceptions of LIC models from surgical faculty prior to an institution-wide transition to LIC, in the MS2 year, from a TBC curriculum, has not been examined. 

Design and methods

An electronic survey was developed in Qualtrics and approved by the local institutional review board. Items in the survey included multiple-choice, Likert-scale, and free-response questions. Surveys were distributed using faculty email listservs. 120 responses were obtained with a response rate of 30%. Basic analysis of Likert and multiple-choice responses was conducted using Qualtrics analytics. Thematic analysis of qualitative responses was conducted in Excel.  

Results

Thematic analysis of perceived benefits included mentorship and continuity of care. Concerns included educational quality, implementation, and faculty burden. Faculty felt 6 weeks was the minimum inpatient exposure needed for students not pursuing a surgical career, and 9 weeks for those interested in a surgical career. When comparing TBC to LIC, TBC was felt to be superior in terms of a foundational surgical education, exposure to surgical disease, preparation for residency and a surgical career. Comparing skill development, a learning objective for both TBC and LIC, faculty felt TBC and LIC were equal in developing interviewing, physical exam, clinical reasoning and testing, and patient presentations. TBC was perceived as superior for interprofessional teamwork skill development.     

Conclusions

Surgical faculty recognize benefits of LIC in mentorship and continuity. However, concerns remain about quality of surgical education and preparedness of those pursuing a surgical career. There are also significant concerns about faculty burden and implementation of this model in an academic surgical setting.  Implementation of LIC in the second year of medical school, may offer early clinical exposure and allow time in the third year for addressing perceived inequities. Having information prior to institutional implementation allows educational concerns and faculty perceptions to be addressed early.

(P052) UTILITY OF LARGE LANGUAGE MODELS TO SUMMARIZE LANDMARK SURGICAL PAPERS FOR RESIDENT EDUCATION
Morgan Pettigrew, MD, Lauren Tyler, MD, Vanessa Nomellini, MD, PhD, Sneha Bhat, MD, Caroline Park, MD, Joseph Murphy, MD, Sitaram Chilakamarry, MD, Lauren Gillory, MD, Audra Clark, MD, Kareem Abdelfattah, MD; UT Southwestern

Introduction:

Knowledge of landmark surgical papers and their impact on clinical practice is an integral component of resident education. However, the growing volume literature of can be difficult for residents to navigate. This study explores the ability of AI large language models (LLMs), specifically ChatGPT 4.0 and Perplexity AI Pro, to generate concise and accurate summaries of key surgical papers and to build an educational resource.

Methods: 

Experts in multiple surgical fields were solicited to select landmark surgical papers that they viewed as critical for to residents’ knowledge base. ChatGPT and Perplexity were employed to generate summaries, including impact of the studies on clinical practice. Surgical attendings scored how well the outputs accurately captured the background, methodology, core findings, and clinical relevance. The evaluations were blinded to the AI source to ensure impartiality. Accuracy measures of the two large language models’ output was compared using unpaired students t-test. 

Results: 

Both ChatGPT and Perplexity achieved 100% precision in all domains, meaning there were no hallucinations in any outputs. Mean recall was 0.96 for Chat GPT and 0.92 for Perplexity (P = 0.34), meaning both LLMs included >90% of key components in their summaries. Mean F1 score was 0.99 for ChatGPT and 0.97 (P = 0.33).

Chat GPT performed slightly better than Perplexity in Background, Methods and Inclusion and Exclusion Criteria domains (F1 score 0.98 versus 0.96 for Background, 1.00 versus 0.98 for Methods, and 0.93 versus 0.88 for Inclusion and Exclusion Criteria, respectively). However, there were no significant differences in the overall performance of the models. All summaries were deemed highly effective for resident education, with potential to improve learning efficiency.

Conclusion: 

Both AI LLMs produced high-quality summaries, with minimal differences in overall accuracy. AI-driven summarization of landmark surgical papers holds promise for enhancing resident education by streamlining access to essential literature. This approach could serve as a valuable tool in surgical curricula, offering a scalable and time-efficient means to distill complex research into digestible content for trainees.

(P054) RESIDENT PERCEPTIONS OF ENVIRONMENTAL SUSTAINABILITY IN SURGERY
Stephanie Trautmann, MD, MS¹, Sarah Beckwith, MD¹, Erin Sullivan, PhD², Jonathan Myers, MD¹, Ami Shah, MD¹; ¹Rush University Medical Center, ²Suffolk University

Background: 

Climate change poses a direct threat to both human health and the facilities and supply chains that comprise the healthcare industry. Simultaneously, the health sector contributes 8.5% of annual greenhouse gas emissions in the United States. There is growing literature on structural and process changes that can reduce a health organization’s environmental impact. However, the perspectives of individual clinicians on their role in climate change and adoption of sustainability initiatives are largely unstudied, despite being key stakeholders in product and system utilization. This study aims to address this gap in the literature in a cohort of surgical residents.  

Methods: 

This study was conducted using an anonymous, electronic survey of resident surgeons from an urban academic tertiary referral center between 05/2024-09/2024. Survey questions assessed respondent’s level of concern regarding climate change, healthcare’s contribution and current behaviors to reduce environmental impact.  

Results: 

The response rate was 45% amongst residents (74/165). Respondents were primarily comprised of general surgery (41%), urology (13%), obstetrics and gynecology (13%) and orthopedics (11%). The majority were female (57%), white (71%), between 18- and 30- years old (54%), within their first three post-graduate years (69%), did not have children (82%) and lived in the city (95%). Respondents largely believed that global warming was real (95%) and were either moderately or greatly worried about its impact on self and their patients (68% and 72%, respectively). Respondents were also concerned about healthcare’s contribution to climate change (80%), as well as from their individual clinical practices (60%). However, most residents rarely or never consider environmental impact when making decisions in the operating room (66%), and almost half rarely or never consider it outside of the operating room (46%). Only 50% of respondents agree or strongly agree that their individual clinical or operative decisions can reduce carbon footprint.  

Conclusion: 

While most trainees want to decrease personal and systemic contributions to climate change, more curriculum is needed to educate residents on how to effectively incorporate sustainability work into clinical practice, both in and out of the operating room.

(P055) DO MEDICAL GRADUATES FEEL PREPARED? A MULTILEVEL ANALYSIS OF PERCEIVED PROCEDURAL COMPETENCIES FOR CURRICULAR INTERVENTION.
Enrique Cruz, MD¹, Sofia Abedrapo, MD¹, Felipe Silva, MD², Matthew J Van Leeuwen, BS³, Cristián Jarry, MD, MSc¹, Christian Pérez, PhD⁴, Julián Varas, MD, MSc¹, Eduardo Abbott, MD¹; ¹Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, ²Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, ³NYU Grossman School of Medicine, ⁴Department of Medical Education, Faculty of Medicine, Universidad de Concepción

Purpose: Medical education must adapt to evolving healthcare needs. National organizations, such as the Association of Chilean Medical Schools (ASOFAMECH), have defined procedural skills expected of medical graduates. However, the awareness and understanding of these skills among faculty and students, as well as how closely the perceived and actual competency levels align with these standards, remain unknown. This study aims to evaluate the perceptions of medical skills across different members of a medical school integrated within a university hospital, compared to the standards set by ASOFAMECH.

Methods: A cross-sectional study was conducted at a Chilean medical school, surveying students, interns, graduates, and faculty. Respondents were asked to evaluate their perceived competency in 35 key medical skills, which were categorized into nursing skills (NS), emergency skills (ES), and gynecology/pediatrics skills (GPS). Competency levels were defined based on ASOFAMECH classification (not proficient, proficient in theory, proficient in simulated scenario, proficient in real scenario), and perceptions were compared against actual standards using non-parametric statistical methods.

Results: Out of 287 distributed surveys, 244 fully completed responses were included in the analysis, comprising 71 students (29.1%), 43 interns (17.6%), 54 graduates (22.1%), and 71 professors (29.1%). Confirmatory factor analysis strongly supported the predefined skill categories. Perceived competency expectations at graduation significantly exceeded national standards in 25 skills, were lower in 9 skills, and were equivalent in one skill. Graduates’ perceived achievement levels met or surpassed standards in 27 skills, but were significantly lower in 8 skills. The perception of competencies taught through standardized simulation training (SST) did not significantly differ from non-SST competencies.

Conclusions: This is the first study to assess perceptions of medical competencies in relation to national standards in Chile. Discrepancies between perceived and expected competencies, particularly in areas where perceived competency was lower than the standards, were found in our sample. The study suggests a need to increase awareness of national standards among students and faculty and to strengthen training in areas where perceived skills were lower. This validated approach provides a reproducible framework for future objective assessment of competency level.

(P056) NEAR PEER TEACHING IMPROVES CLERKSHIP STUDENT CONFIDENCE IN THE CORE SURGERY ROTATION ACROSS MULTIPLE DOMAINS
Austin T Gregg, BS¹, Talia G Meidan, BS², Matthew Q Parsons, MD³, Roy Phitayakorn, MHPE, MD³, Sophia K McKinley, MED, MD³; ¹Harvard Medical School, ²Texas A&M College of Medicine, ³Massachusetts General Hospital

Introduction: The core surgery clerkship challenges medical students to learn technical skills such as suturing and knot-tying as well as non-technical competencies such as situational awareness in an operating room (OR). These skills are often unaddressed in the pre-clerkship curriculum yet constitute a significant source of medical student anxiety when entering the surgery clerkship. Senior medical students may be well suited to help clerkship students develop surgical skills through an education framework known as Near Peer Teaching (NPT). We report outcomes for a pilot NPT program in the core surgical clerkship at an academic hospital.

Methods: Surgical clerkship students participated in three NPT-led didactics (OR Orientation, Suturing Workshop, and Shelf Review) across a 12-week surgery clerkship. Students were surveyed before and after each session via a 5-point Likert scale regarding their confidence in a variety of domains addressed by the specific didactic session. Pre- and post-session means and standard deviations of Likert scale data were calculated for each item in the didactic-specific survey. Paired, two-tailed, student’s t-tests were used to determine statistical significance (α < 0.05). 

Results: The survey response rates were 57.5% for OR orientation (n=23/40), 77.5% for Suturing (n=31/40), and 42.5% for Shelf Review (n=17/40). After the OR Orientation didactic, students reported a significantly improved confidence in 27 of 30 categories related to understanding surgical workflow, expectations, and rounding (p < 0.01). Similarly, students reported significantly improved confidence in 10 of 10 categories related to knot-tying, identifying instruments, and suturing after the Suturing Workshop (p < 0.01). Lastly, students reported improved confidence in 2 of 2 categories related to identifying surgery knowledge gaps (p < 0.05).

Conclusion: After implementing near peer tutoring, surgical clerkship student confidence increased across a variety of domains including surgical workflows, suturing, and identifying surgical knowledge gaps. These findings highlight the value of a near peer teaching program in the core surgical education of medical students. Planned future work includes expanding to other surgical clerkship sites and further understanding the impact of NPT on clerkship students and the near peer teachers themselves.

(P057) EVALUATING PREDICTORS OF ABSITE SCORES: INSIGHTS FOR ENHANCING RESIDENT EDUCATION AND PROGRESS
Molly E Casey, Ramsey Dallal, MD; Einstein Jefferson

Purpose/Background: The ABSITE is administered annually to all general surgery residents to assess their educational progress throughout their training. The study aimed to measure predictors of general surgery ABSITE performance.

Methods: Using a longitudinal study at a single institution, we analyzed ASBITE raw score using a mixed model incorporating the following independent variables: gender, international medical graduate (IMG) status, PGY year, underrepresented minority (URM) status, USMLE 1, USMLE 2, year, national average for PGY, and resident perceptions of the program’s educational program based on the annual ACGME survey.

Results: We analyzed all 266 scores from 63 categorical residents between 2007-2024. Predictors of a higher raw score included: Male gender (-23.4, [-51.2, 4.5], 0.101), USMLE 1 scores >246 (56.8, [2.8,110.8], 0.04). Not predictive was URM status (-29.2, [-71.8,13.5], 0.18), IMG status (10.6, -20.2, 41.4], 0.5), USMLE 2 (-40.0, [-104.8,24.8], 0.226). There was no statistical difference in scores between PGY4 and PGY5 years. Scores significantly improved after implementing weekly educational conferences in 2013 (12.5, 0.006). ACGME survey results had no association with ABSITE (0.271, [-20.7,73.7], 1.10). The intraclass correlation coefficient of the mixed model was 0.39.

Conclusion: While individual variation in performance exists based on factors not modeled, without USMLE I scores, residency programs may lose the ability to select candidates who might perform better on their ASBITE exams. The ACGME survey has questionable value as it does not correlate with ABSITE results. A significant gender discrepancy exists in scores that calls for an investigation of the sources of this bias.

(P058) ENHANCING NON-CLINICAL EDUCATION IN GENERAL SURGERY RESIDENCY: A STRATEGIC APPROACH TO DEVELOPING WELL-ROUNDED SURGEONS
Abigail J Hatcher, MD, MSc, Blake T Beneville, MD, Ariana Naaseh, MD, MPHS, Michael M Awad, MD, PhD, MHPE; Washington University in Saint Louis

Background

General surgery (GS) residency curricula cover extensive requirements with core competencies, milestones, and entrustable professional activities. Surgical Council On Resident Education (SCORE) provides an outline for clinical topics (CT). Non-clinical education rooted in interpersonal and professional development lacks a similar roadmap, yet are critical to developing well-rounded surgeons. Non-clinical topics (NCT) can include health equity, ethics, research, financial literacy, educator and leadership training, career guidance, and wellness. This study describes a methodologic approach to designing a comprehensive two-year GS residency curriculum balancing CT and NCT.

Methods

A diverse resident-led, faculty-mentored curriculum committee chaired by two Education Fellows convenes biweekly and holds annual strategic planning retreats aimed at enhancing NCT in the residency curriculum. Novel NCT sessions were introduced including case-based presentations, small groups, ethics-based M&M, and Fireside Chats with visiting faculty. To assess the intervention’s impact, the committee performed a semi-quantitative review of CT versus NCT sessions in the GS residency curriculum over the last 8 years. An ongoing mixed methods needs assessment is collecting additional data on this comprehensive curriculum.

Results

Between 2017 and 2024, NCT lectures increased from 10.2% to 24.5% of total annual protected education time (Table 1, Figure A). Initial analysis from the comprehensive curriculum needs assessment indicates that residents value these sessions, with no observed decline in milestone or ABSITE performance. 

Discussion

By using a structured curriculum committee, we describe the development of a balanced curriculum that adapts to contemporary shifts in surgical training culture, prioritizing training well-rounded surgeons who are leadership-trained, culturally and ethically informed, and prepared for diverse career paths. This curriculum is designed to be replicable across institutions. Barriers include limited consensus on essential topics, balancing education with clinical duties, and finding qualified educators. A multi-institutional needs assessment could identify stakeholders and establish the foundation for NCT curricula using adult learning theory. Future efforts include collaboration with other residency programs and partnership with SCORE to enhance the NCT curriculum. 

(P059) THE CURRENT STATUS OF SKILLS LABS IN PLASTIC SURGERY RESIDENCY: A NATIONAL SURVEY STUDY
Israel O Falade¹, Annie Chen-Carrington², Jacquelyn Knox¹, Daniel Rouhani¹, Chelsea C Yim¹, Esther A Kim¹; ¹University of California San Francisco (UCSF), Department of Surgery, Division of Plastic and Reconstructive Surgery, ²The Virginia Commonwealth University, School of Medicine

Introduction: 

Surgical skills labs (SSLs) offer plastic surgery residents hands-on experience in surgical techniques within a controlled environment. However, SSL integration across residency programs is limited. This study aims to assess SSL prevalence and structure in plastic surgery residency programs, identify implementation barriers, and highlight successful strategies to inform the development of more accessible and effective SSL programs.  

Methods: 

A cross-sectional survey was conducted in February 2024, targeting U.S. plastic surgery residency program. The survey distinguished between programs with and without SSLs, addressing curriculum structure, participants, costs, administrative support, and facilities for those with SSLs, and alternative methods and barriers to those without.  

Results: 

Of the 93 programs surveyed, 29 (31%) responded, with 19 reporting a dedicated SSL and 10 indicating they lacked one. Most programs with SSLs (79%) followed structured curricula developed through faculty and resident input via discussions, focus groups, and interviews. Thirteen programs utilized both cadaver and non-cadaver sessions, while six focused solely on non-cadaver methods. Cadaver sessions pose the highest financial burden, especially in specimen and lab space costs. Funding sources typically combined contributions from plastic surgery divisions (63%), industry (53%), general surgery departments (32%), hospitals (26%), and private donors or grants (16%). Among programs with SSL, 90% advocated SSLs as a standard element in residency education. Programs without SSLs relied on alternative educational strategies, including periodic hands-on sessions (80%) and industry-sponsored workshops (50%). Key barriers to establishing SSLs were funding limitations, insufficient faculty availability, and inadequate facilities. 

Conclusion: 

The study reveals substantial variability in SSL infrastructure and curricula across programs, indicating a disparity in educational resources and training opportunities for residents. While SSLs are broadly valued for their impact on skill acquisition and resident confidence, many programs face barriers related to funding, faculty support, and faculty access. These challenges point to the need for collaborative solutions, such as regional coordination, to facilitate resource-sharing and SSL access to programs without dedicated labs. Future work will focus on strategies to mitigate these logistical challenges identified and propose structured guidelines for SSL development to improve the consistency and accessibility of surgical skills training in U.S. residency programs.  

(P060) FROM CURIOSITY TO COMMITMENT: UNRAVELING THE JOURNEY OF MEDICAL STUDENTS’ PERSPECTIVES ON SURGICAL CAREERS
Perry J Diaz, BS¹, Sadia Ilyas, MD², Misaki Kiguchi, MD, FACS², Raghuveer Vallabhaneni, MD, FACS, FSVS², Jason Crowner, MD, FACS²; ¹Georgetown University School Of Medicine, ²MedStar Heart and Vascular Institute

Introduction: Despite a consistent increase in medical student enrollment, surgical trainee positions face a proportional stagnation in applicants as compared to other specialties. Evidence suggests that interest in surgical careers declines throughout medical school. The aim of this study was to explore the perception of surgical careers amongst medical students and identify factors affecting their career choice.

Methods: A 25 item, 7-point Likert scale survey was developed and administered electronically to medical students within a single institution.

Results: The survey’s response rate was 43.7% (343/785). Single-degree-seeking M.D. students comprised 95.3% of respondents (n = 327), with 66.7% (n = 229) being underclassmen and 33.2% (n = 114) upperclassmen. Work-life balance and passion for the field were the primary influencers of specialty choice. Upperclassmen medical students and surgical resident trainees were identified as significant sources of knowledge and influence for 58.0% of respondents. 60.1% of all students disagreed that family members impacted their knowledge of surgical careers. Social media and television had limited influence across all years. A majority (74.1%) of students did not believe that surgical careers offer acceptable hours of practice. Concerns about race and gender bias affected 66.2% of students’ decisions to pursue surgery. Underclassmen did not believe that exposure to clinical rotations would increase their interest in surgery; however, upperclassmen largely agreed that clinical rotations increased their interest in surgical careers. Most students believed that their medical school did not adequately support their interest in pursuing a surgical career. High income potential, novel surgical procedures, and the diversity of patient problems were identified as positive influences for pursuing a surgical career.

Conclusion: This study highlights key influences on students' perceptions of surgical careers. Initiatives focused on increasing awareness of surgery and its subspecialties amongst medical students, increasing early medical student exposure to surgical cases and mentors, and diversifying the surgical workforce may help ensure a robust future for surgical training.

(P061) SURGICAL RESIDENTS USE SKILLS LABS MORE WHEN CLINICAL ROTATIONS ARE PAIRED WITH FORMAL SKILLS CURRICULA
Ana M Reyes, MD, MPH, Talia R Arcieri, MD, Ray I Gonzalez, Nicholas H Carter, MD, Mehmet Akcin, PhD, Jose M Martinez, MD, Danny Sleeman, MD, Laurence R Sands, MD, M. Carolina Jimenez, MD, MSc; University of Miami

Introduction:

Surgical skills labs can help residents develop and maintain technical competencies but resident participation is variable. Our general surgery residency developed three clinical rotations with paired, formal skills curricula: surgical endoscopy (SE), vascular access (VA), and transplant surgery (TS). Lab participation is encouraged but not compulsory. The objective of this study was to understand how residents in our program utilized the surgical skills lab. We hypothesized that residents who used the lab during clinical rotations with paired, formal skills curricula would report greater overall use of the lab.

Methods:

We surveyed general surgery residents on their use of the surgical skills lab during the 2023-2024 academic year, excluding those who had completed a required one-month PGY-1 skills rotation and those who were on dedicated research that year. Residents were asked to report all clinical rotations in which they used the skills lab, and total hours spent at the lab over the past year. A dichotomous variable for lab use during SE, VA, or T rotations [yes; no] was derived. Chi-square tests were performed.

Results:

Twenty-one of 29 eligible residents (72%) responded to the survey. Three residents were preliminary PGY1s, 10 were PGY2s, 3 were PGY3s, and 5 were PGY4s during the 2023-2024 academic year. Overall, 52% of residents spent ≤10 hours at the skills lab, 33% 11-20 hours, 10% 21-30 hours, and 5% 31-40 hours. 67% of residents used the lab during the SE, VA, or T rotations. Level of training was not associated with hours spent at the lab (p=0.80) or lab use during the SE, VA, or T rotations (p=0.49). Residents who used the lab during the SE, VA, or T rotations were more likely to report spending >10 hours at the lab than residents who did not use the lab during those rotations (64% vs. 14%, p=0.03).

Conclusion:

In our program, resident use of the surgical skills lab during clinical rotations with paired, formal skills curricula was associated with greater overall skills lab use. Future curriculum development should focus on pairing technical skills exercises with clinical rotation objectives to promote resident participation in surgical skills labs.

(P062) DEVELOPMENT OF A MULTI-DISCIPLINARY, CONFERENCE-BASED, RURAL TRAUMA SIMULATION CURRICULUM
Gabrielle Moore, MD¹, Zachary Aldaher, DO², Katherine Dunn, BS², Cole Harp, DO², Cara Jones, RN², Matthew Lyon, MD², A.j. Kleinheksel, PhD², Erika Simmerman Mabes, DO²; ¹University of Utah, ²Medical College of Georgia

Introduction:

Trauma patients experience a higher relative risk of dying in rural emergency departments compared to trauma centers. Consequently, trauma patients have higher mortality rates in rural cities. As such, the literature identified a need for dedicated skills training and resource allocation to rural trauma programs given this health disparity. Nationally, rural providers report minimal exposure to severe trauma and identify a need for skills training to improve efficacy. Here, we report on development of a multi-disciplinary rural trauma simulation curriculum.

Methods:

A multi-institutional, mixed methods rural trauma needs assessment was performed from February 2024 to October 2024. This included a systematic literature review and quantitative and qualitative analyses of survey responses from providers both in rural Georgia and a level 1 trauma referral center. Survey participants included physicians, nurses, advanced practice providers, and respiratory therapists. A rural trauma simulation curriculum was created based on results of identified knowledge gaps.

Results:

31 rural and 49 trauma referral center providers completed surveys. Trauma referral center providers ranked securing airway, prior to transfer to referral centers, as most beneficial to implement rural training in followed by tube thoracostomy, and hemorrhage control. Less emphasis was felt to be needed on FAST exam, intravenous access, and spine immobilization. Thematic analysis of survey responses provided by rural and referral center trauma providers identified agreement on training needs for procedures (chest tube placement, surgical airway, sizing/placement/clearance of c-collar) and trauma management (hemorrhage control, transfusion guidelines). A multi-disciplinary trauma simulation curriculum was developed based on the targeted needs assessment findings (Figure 1). The conference-based curriculum consists of an interactive didactic session (lecture and videos presented by trauma referral center providers) and procedural skills training. Learners will be assessed on performance during case-based simulations and procedure completion.

Conclusion:

Here, we identified a need for improvement in 4 core trauma skills: airway management, chest tube placement, hemorrhage control, and cervical spine protection. This information was used to inform development of a conference-based, multi-disciplinary rural trauma simulation curriculum. Next steps include curriculum implementation and program evaluation.

(P063) NEEDS ASSESSMENT FOR OPEN SURGICAL SKILL SIMULATION FOR MID-LEVEL RESIDENTS ACROSS SPECIALTIES
Katelyn R Ward, MD, M Yassin, BS, Jenny Bui, MD, MPH, Deborah Lee, NP, PhD, Rishindra Reddy, MD, PhD; University of Michigan

Background: Simulation-based training has been an important part of modern surgical education, particularly for minimally invasive skills and basic suturing and knot tying. However, there is no standardized surgical simulation for complex open skills. We hypothesized that surgical faculty and residents would identify a consistent set of open surgical skills that should be simulated. 

Methods: Specialty-specific surveys were created, validated, and then distributed to faculty and residents across general, vascular, cardiothoracic, and plastic surgery at a single academic center. Respondents identified and ranked essential open surgical skills that would benefit from improved simulation experiences during training. We evaluated current use of simulation and perceived limitations of simulation experiences. 

Results: There were 41 total survey responses: 16 general surgery (8 faculty, 8 residents), 12 cardiothoracic surgery (5 faculty, 7 residents), 7 plastic surgery (5 faculty, 2 residents) and 5 vascular surgery (3 faculty, 2 residents). Response rate was 23%. The majority of participants (2, 68%) either rarely or occasionally used proctored surgical simulation. Participants had the most experience with low-fidelity simulation such as laparoscopic trainers (mean experience score 5.1/10). The most cited limitation of current simulation models was inability to find time (26, 63%) followed by need for faculty teaching/oversite (15, 37%) and lack of location access (13, 32%). Most respondents felt that having a portable training kit for at-home practice was moderately or very important (28, 68%). 

The Figure reflects the top four rated surgical skills in each specialty that would benefit from improved simulation experience with overall median rating (0-10). Small vessel anastomosis and suturing/knot-tying deep in a cavity were rated among the top four skills in three out of four specialties. Plastic surgery did not have any skills overlapping with other specialties. 

Conclusions: There is a critical need for improved simulation experiences focused on open, mid-level resident skills with some variation in specific skill needs across surgical specialties. Limitations for the use of simulation include time, limited faculty supervision, and physical access.

(P064) SEAMLESS TRANSITION FROM OFF- TO ON-THE-JOB NON-TECHNICAL SKILLS TRAINING: ACTION-ORIENTED, TASK-BASED PROGRAM
Mari Katsuno, MD, Takashi Eguchi, MD, PhD, FACS, FCCP, Yuichi Oguchi, MD, Shuji Mishima, MD, Daisuke Nakamura, Yukihiro Terada, MD, Hirotaka Kumeda, MD, Kazutoshi Hamanaka, MD, PhD, Kimihiro Shimizu, MD, PhD; Shinshu University Hospital

Objective:
While the Non-Technical Skills for Surgeons (NOTSS) system is widely regarded for its comprehensive approach to evaluating non-technical skills (NTS) during surgery, an off-the-job NTS training system remains unestablished. Additionally, the complexity and subjectivity of the NOTSS system pose challenges for trainees' preparation and instructors' evaluations. In response, we developed a simplified, task-based NTS training program, combined with technical skills training, that facilitates a seamless transition from off-the-job simulation to on-the-job surgical practice.

Methods:
The NTS program focuses on four essential categories: 1) situation awareness, 2) decision-making, 3) communication and teamwork, and 4) leadership. In each category, six to eight "specific tasks" were developed. These tasks are action-oriented and can be simply evaluated as either done or not done. 

Example 1) In the preemptive preparation element under situation awareness, trainees "request preparation of tools in anticipation of the next step." 

Example 2) In the evidence-based decision-making element, trainees "explain the sequential order of hilar dissection while sharing the rationale behind their decision-making process."

Trainees first undergo simulation training using an isolated swine heart-lung model. Before performing actual surgeries, trainees must achieve "done" in at least 70% of instances for each NTS task, along with meeting technical skill requirements. The same evaluation system applies during live surgeries. Program details and evaluation tools are accessible via QR code, with feedback provided immediately after each session (see Figure).

Results:
Since launching the program in June 2024, we have completed 12 simulated lung resections and ten live surgeries with two trainees. Both trainees met the criteria during simulation training, completing at least 70% of instances for each task. In actual surgeries, they successfully performed lung resections as primary surgeons without major issues. Post-training questionnaires from trainees and instructors indicated significant improvement in trainees' understanding of NTS during thoracic surgery.

Conclusions:
This task-based NTS program improves clarity for trainees and enhances objectivity for instructors. It enables a seamless transition from off-the-job training to real surgical settings, alongside technical skills training. This framework can be easily integrated into existing programs to target and measure essential skills effectively.

(P065) SURGPREP: SUCCESSFUL IMPLEMENTATION OF A LONGITUDINAL SURGICAL SKILLS CURRICULUM DURING THE FIRST YEAR OF MEDICAL SCHOOL
Christopher Rutter¹, Fielding Fischer², Justin Li¹, Grace Monroe¹, Galo Bustamante¹, Andrew Denney¹, Madeline Su¹, Matthew Marquardt¹, Carmen Quatman³; ¹The Ohio State University College of Medicine, ²Harvard Medical School, ³The Ohio State University Medical Center

Objective

Formal surgical skills development typically begins during residency or clinical rotations in medical school. However, the implementation of longitudinal surgical training throughout the preclinical years of medical school remains unprecedented. SurgPrep, a longitudinal surgical preparation curriculum for first-year (M1) medical students, was designed and implemented to meet this demand.

Methods

A total of 56 incoming M1 students at a large US medical school were recruited in August 2022 through an email application sent to all incoming first-year students. Students participated in 10 sessions over one year focusing on skills and knowledge development through hands-on and didactic sessions including suturing, OR basics, and other high-yield topics. Data collection included an application (including 2022-2024), retrospective pre-and post-session surveys, and a comprehensive knowledge / skills assessment at the culmination of the program. Analysis was performed using Microsoft Excel and STATA.

Results

For the 2022-2024 cohorts, 34.0% (71/209), 46.4% (97/209), and 50.7% (106/209) of the M1 class applied, respectively. Notably, 27.8% (58/209), 32.1% (67/209), and 45.5% (95/209) of students applied within 4 minutes of the application opening at 6:00 A.M. Surveys on perceived knowledge / skill demonstrated that in all 10 sessions assessed, applicants showed perceived improvements (p<0.001). For the objective surgical knowledge / skills assessment, M1 scores (n=36) did not differ by a statistically different amount compared to a randomly selected group of third-year students (n=7) halfway through their clinical rotations who did not take part in the program (M1 score: 90.9%, M3 score: 90.6%, p=0.96).

Discussion

Our study is important for two reasons: Firstly, our results show that the demand for formal surgical education in medical school prior to starting clinical rotations is extremely high, with over half M1s applying by the third year of the program and a majority of applicants willing to wake up early to apply. This reflects a shift away from the traditional paradigm that formal surgical training begins during the clinical years of medical school or residency. Secondly, our results serve as a proof of concept that a strong surgical knowledge and skills base can be developed effectively even during the preclinical years of medical school.

(P066) UNDERGRADUATE SURGICAL EDUCATION: WHAT DO PRACTICING PHYSICIANS REFLECT ON THEIR EXPERIENCE? ?
Brett Norling, MD¹, Nell Maloney Patel, MD², Randi Lassiter, MD¹; ¹University of Minnesota Medical School, Department of Surgery, ²Rutgers Robert Wood Johnson Medical School, Department of Surgery

Introduction: The structure of undergraduate surgical education has rapidly changed in recent years, most notably reduced length of average surgical clerkships. Recent research has shown concerning trends regarding non-surgical practitioners’ perceptions of the value and core aspects of the surgical clerkship. Identification of the most important aspects of undergraduate surgical education is imperative for the careers of medical trainees, including both the surgeon and non-surgeon. 

 
Methods: A validity tested anonymous survey was distributed via email to all practicing physicians and surgery faculty a large US medical school, as well as a subset of recent graduates from the medical school. The survey collected quantitative and qualitative data regarding clerkship structure, valuable experiences, Likert scales, and demographic data. Data was stored securely and analyzed using Microsoft Excel and STATA. 
 
Results:?400 survey responses were received. 283 physicians in independent practice participated. Median age was 45 years with 12 years of independent practice. 26.5% of respondents practice in surgical specialties. Nearly 80% of survey respondents self-reported to be White. A longer ideal surgical clerkship length was reported by surgeons (median 8 weeks; IQR 6,8 versus 6 weeks IQR 4,8; p<0.001). Taking night call during a surgical clerkship was more commonly done by surgeons (94.7% versus 84.0%; p=0.02) and was felt an important component of the surgical clerkship amongst this group (82.7% versus 53.9%; p<0.001). 71.9% of faculty rated their core clerkship experience as valuable to their current practice, though less valuable amongst non-surgeons (65.7% versus 89.2%; p<0.001). Non-surgeons endorsed the surgical clerkship having less influence on their specialty choice (45.7% versus 82.4%; p<0.001). Scrubbing cases (88.0%), resident work rounds (43.1%) and following personal surgical patients (40.3%) were the most important experiences selected by participants. Surgeons more frequently selected scrubbing cases (96.0% versus 85.1%; p=0.013) as an important experience. 

Conclusion: The perceived value of surgical clerkships remains high for faculty regardless of specialty choice. There remain divergent ideas regarding the optimal length of a surgical clerkship and value of night call amongst faculty surgeons and non-surgeons. Exposure to the operating room remains a prioritized activity amongst the majority of faculty.  

(P067) SURGICAL ETHICS WORKSHOPS: BRIDGING GAPS IN PRE-CLINICAL ETHICS CURRICULUM
Austin D Williams, BS, Samantha Lowe, Nicolas Restrepo, Bhavana Kunisetty, Prathik Kalva, Samuel Creden, MD, Andrew Childress, PhD, Savitri Fedson, MD, MA, Ernest R Camp, MD, FACS; Baylor College of Medicine

Background:

With the shift to hybrid online/in-person learning, condensed pre-clinical curricula, and pass/fail grading, medical students report insufficient exposure to medical ethics before starting clinical rotations. To address this need, content must be delivered effectively, efficiently, memorably, and inclusively for various learning styles. This study presents Surgical Ethics Workshops, integrating didactic lectures, simulation-based learning, interactive role-playing, and peer review to teach first-year medical students (MS1s) surgical ethics and improve confidence in managing challenging patient conversations.

Methods:

After IRB approval, MS1s were invited to participate in this extracurricular workshop. Participants completed a 16-question Likert-type pre-survey evaluating their knowledge of surgical futility and their perceived importance and confidence in having difficult patient conversations. The workshop included a 45-minute didactic lecture, a 15-minute live re-enactment by faculty and residents, a 30-minute session of case-based role-playing, and a conversational debrief. Students completed a similar 16-question post-survey. Median responses were compared using Wilcoxon signed-rank tests, with a significance threshold of p<0.05.

Results:

Thirty-one MS1s participated, with a student-to-facilitator ratio of 5.33. After the session, students reported significantly improved understanding of the topic (Pre: 4 [IQR 5–7] vs. Post: 6 [IQR 2.5–5.5], p<0.0001) and increased confidence in discussing surgical futility with patients (Pre: 2 [IQR 3–4] vs. Post: 4 [IQR 3.5–5.5], p<0.0001) as well as in handling other challenging patient conversations (Pre: 4 [IQR 3–5] vs. Post: 5 [IQR 5–6], p<0.0001). Understanding the importance of their role in these conversations was high pre- and post-workshop. After the workshop, students preferred learning surgical ethics through real-patient experiences (71.0%), didactic lectures (67.7%), live re-enactments (64.5%), and case-based role-playing (54.8%).

Conclusions:

The Surgical Ethics Workshop, combining didactic instruction, live re-enactment, role-playing, and peer review, enhances students' understanding and confidence in applying ethical principles to surgical futility discussions.

(P068) INVESTIGATING THE ROLE OF HUMANITIES AND ARTS IN NEUROSURGICAL MEDICAL EDUCATION: A SCOPING REVIEW
Alsadeg Bilal, BMedSci¹, Bianka Bezuidenhout, BS, MS², Emilia Parsi, BMedSci³, Ashish Kumar, MB, MS, MCh⁴; ¹Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh UK, ²The University of Toronto, Ontario, CA, ³The University of Edinburgh, Edinburgh, UK, ⁴The University of Toronto, Division of Neurosurgery, Ontario, CA

Background

Integrating humanities and arts into medical education is essential for developing empathetic, well-rounded clinicians, yet it remains underrepresented. Traditional curricula, particularly in neurosurgery, emphasise biomedical sciences, often neglecting the humanistic aspects. Given the complexity of neurological disorders and the ethical dilemmas inherent in neurosurgical practice, incorporating humanities and arts could foster a more holistic approach to patient care. This review aims to assess the extent, range, and impact of incorporating humanities and arts into the education of neurosurgery for medical students. 

Methods

We used the PRISMA-Scoping review protocol to conduct a comprehensive search across multiple databases and grey literature. Studies were included if they involved medical students in neurosurgical education and incorporated humanities or arts, such as literature, visual arts, music, history, or philosophy. All study designs were considered, provided they were published in English. A total of 2,411 records were screened, resulting in 15 studies that met the inclusion criteria for further analysis.

Results

Four key themes emerged: the importance of ethical frameworks and moral reasoning (n=4), the role of reflective practices and emotional intelligence in professional identity formation (n=9), humanising medical practice through arts and narrative medicine (n=7), and the use of visual arts to enhance three-dimensional thinking in surgical training (n=3). Studies highlighted that integrating humanities and arts into neurosurgery education enhances empathy, ethical decision-making, critical thinking, and spatial skills essential for surgical practice. While there are efforts to include humanities in medical student education in neurosurgery, the implementation remains inconsistent and lacks rigorous research to validate its impact.

Discussion/Conclusion

This review underscores the importance of a more holistic approach to neurosurgical education, where humanities and arts are employed not only to humanise medical practice but also to enhance cognitive skills such as spatial reasoning and decision-making. Teaching methods such as operative rehearsal sketches present a cheap sustainable method that can significantly increase the learning gains attained from cases on surgical approaches and anatomical structures. Advocating for a balanced curriculum that combines biomedical and humanistic education can cultivate generation of future neurosurgeons who are not only technically proficient but also ethically reflective, and emotionally intelligent.

(P069) EDUCATING (UN)ETHICALLY: AN ANALYSIS OF PATIENT-CARE CASES IDENTIFIED BY SURGERY CLERKSHIP STUDENTS AS ETHICALLY CONCERNING
Douglas Brown, PhD, Piroska Kopar, MD; Washington University in St. Louis School of Medicine

Introduction

Academic medical centers have a fiduciary duty to care for their patients to the best of their ability, while also promising to train the next generation of physicians. Due to the invasive nature of surgery, conflicts between these two priorities are especially common and potentially ethically problematic. To date, little academic research has addressed the existence of this tension or offered a robust approach to navigating this tension. 

Material and methods

We used the Delphi qualitative research method to build consensus from a group of academic surgeons with expertise in surgical ethics and ethics education representing a variety of surgical specialties. The core materials given to our Delphi group participants as a starting point for consensus-building were 61 case vignettes addressing the ethical conflict in question that had been submitted by surgery clerkship students at a large university hospital during a seven-year period (2014-21).

Results

Consensus was successfully built around the following themes: (1) a description of the professionalism/ethics concerns surgery clerkship students experience when their educational objectives are addressed while caring for surgical patients, (2) a critique of the adequacy of the core concepts/themes foundational for surgical ethics to illuminate the surgery clerkship students’ concerns, and (3) a set of five criteria by which to ethically ground and assess the methods surgery educators use in educating surgery clerkship students during the care of surgical patients.

Conclusions

The simultaneous responsibilities of academic medical schools to prioritize the care of surgical patients while educating future generations of physicians present a conflict that is not adequately addressed in current practice.  We propose a set of five criteria to aid the ethical navigation of this tension for trainees and faculty alike.

(P070) FLOURISHING IN SURGERY: EXAMINING THE IMPACT OF CAREER INTEREST, CLINICAL EXPOSURE, AND SIMULATION ON MEDICAL STUDENT FLOURISHING DURING SURGERY CLERKSHIP
Edwin P Savage, BS¹, Alexandria L Soto, BS², Kevin Ig-Izevbekhai, MD³, Thomas C Howell, MD, MSHS³, Hima Bindu Thota, MD⁴, Catherine B Beckhorn, BA², Ryan M Antiel, MD, MSME³; ¹University of North Carolina School of Medicine, ²Duke University School of Medicine, ³Department of Surgery, Duke University School of Medicine, ⁴Department of Surgery, Rutgers Health New Jersey Medical School

Introduction: Identifying the factors that improve student flourishing during the surgery clerkship is important for improving clerkship quality and student learning. Flourishing, measured by the Harvard Secure Flourishing Index (SFI), is an effective measure of holistic well-being for trainees. We sought to evaluate the impact of skill confidence, career interest, and clerkship environment on students’ self-reported burnout and flourishing.

Methods: An electronic survey was distributed to medical students at a single academic institution upon completion of their surgery clerkship (2023-2024). Participants answered a 12-question flourishing assessment (SFI) and two question assessment of burnout from the Maslach Burnout Inventory. Information on students’ intention to seek future surgical training, perceived level of belonging to their surgical team, self-reported confidence in performing surgical tasks, and the number of hours spent in the hospital while on clerkship was collected. The relationship between these factors and flourishing was assessed using multivariable linear regression.

Results: Of 116 eligible students, 63 completed the survey (RR=54.3%). The median SFI (scale 0-10), was 7.0 (IQR [6.0–7.9]) which is comparable to the national average of 7.1. Before the clerkship 41.2% of respondents intended to pursue surgery. The average reported sense of belonging on the surgical team (scale 0-5) was 2.8±1.4 and reported confidence performing surgical skills (scale 1-5) improved from 1.59±0.54 pre-clerkship to 3.41±0.76 post-clerkship (p<0.001). Most students (79%) reported spending between 50-70 hours in the hospital per week during their rotation. On multiple-variable regression, flourishing was associated with intention to seek a surgical specialty (F Coef.=0.81, R²=0.14, p=0.02).

Conclusion: Student interest in pursuing a surgical career significantly correlates with flourishing, even after controlling for hours spent in the hospital and confidence in performing procedures. This suggests that while service hour restrictions and improving confidence may be important for a medical student’s functioning, an interest in surgery itself is essential for their overall flourishing. Fostering interest and engagement on the rotation, regardless of intended career, may be critical to promoting well-being during the surgery clerkship.

(P072) EMPOWERING DIVERSITY IN SURGERY: A PEER AND FACULTY INITIATIVE IN SURGICAL AND MICROSURGICAL SKILLS TO INSPIRE EARLY SURGICAL INTEREST AMONG UNDERREPRESENTED MEDICAL STUDENTS
Michael Griego, Alan De Brito Carneiro, Amirali Monshizadeh, Adriana Ene, Abou Mrad, Fady Charbel, Pier Giulianotti, Enrico Benedetti, A Bartholomew; University of Illinois

Background: Minorities and women  are underrepresented in surgical specialties. While barriers exist  prior to, during, and after medical school, this initiative focused on expanding medical school-based opportunities through early exposure, early mentorship, and psychological safety with peer support using a 4 session extracurricular didactic comprised of early exposure to surgical and  microsurgical  skills, mentorship, and peer to peer teaching. 

Methods: Four Sessions taught included 1) introduction to surgical instruments and single 4-0 interrupted suture secured with 3 knots and strict adherence to technique (target time <2 minutes), 2) introduction to microsurgical instruments and 100-knot towers with 9-0 suture, 3) chicken femoral artery anastomosis with eight 9-0 interrupted sutures, 4)single 4-0 interrupted suture (target time <19 seconds). Faculty instructed sessions 1 and 4 targeting OSAT evaluative criteria, while sessions 2 and 3 were led by a medical student trained in microsurgical techniques. Faculty interaction offered new mentorship pathways for participants. Participant perceptions of manual difficulty, satisfaction with learning outcomes post-session, microsurgical suture quality (criteria: straightness, spacing), average suture time, and correlation with pre-medical school manual dexterity activities were assessed.

Results: A two hour zoom colloquia publicized the course prior to google sign up. Over 200 first year medical students completed the course from 2022-24. Review of the 2022-2023 participants showed  35.3% Asian, 26.5% Caucasian, 14.7% Black, 14.7% Hispanic, and 8.8% multi-racial;43.2% were women. There were significant gains in learning objectives (p<0.001) and 53.3% completed the suture in <19 seconds. Pre-medical school skillsets (collegiate athlete, collegiate musician, video game frequency, fabric sewing) demonstrated no significant correlation (r<0.2) to microsurgical suture quality or suture time. Post-didactic enthusiasm for a surgical career correlated moderately with suture quality (r=0.4).  In 2024, two years after program initiation, a tripling in the number of M4 students applying to general surgery residency (from 6 to 18) occurred. 

Conclusions: Combined faculty and peer instruction created a low pressure environment  which allowed exploration of demanding surgical skills and early acquired competency.  As an accessible entry point to surgical careers,  this initiative also facilitated meaningful mentorship opportunities which contributed to sustained interest in surgery among a diverse student population. 

(P073) DEXTEROUS ACROSS DISCIPLINES: FOSTERING CULTURAL DEXTERITY IN RESIDENCY PROGRAMS
Nadj L Pierre, MD, Baraah Mohamed, Nadeera Sidique, MD, Lidia M Castillo, MD, Claire Wilson, MD, Ayaa Ali, MD, Diane Shih-Della Penna, MD, Ebondo Mpinga, MD; Wellspan York Hospital

Background: To address the need for equitable care in increasingly diverse populations, the ACGME mandates cultural competence as part of three core competencies: patient care, professionalism, and interpersonal and communication skills. Still, structured training in cultural dexterity remains sparse across many residencies. Existing curricula rarely address residents’ comfort with complex sociocultural issues. This study implemented a structured cultural competency curriculum across multiple residencies at one institution, assessing its impact on residents’ understanding of cultural dexterity, comfort in addressing race, sexism, heterosexism, awareness of discrimination, and willingness to intervene.

Methods: This prospective cohort study involved residents from multiple specialties at a single institution who participated in a structured cultural competency curriculum. Components included Grand Rounds, discussions, workshops, and a designated residency champion for equity-focused activities such as journal clubs, and modules. Main outcomes—defining cultural dexterity, comfort with sensitive topics, awareness of discrimination, and willingness to intervene—were assessed with pre- and post-surveys conducted one month apart. Paired t-tests and chi-square tests evaluated statistical significance (p < 0.05).

Results:  The implementation of a cultural competency curriculum showed significant improvements in residents' defining cultural dexterity (30.56% to 64%, p = 0.01). Post-survey data indicated an increase in correctly identifying race as a social construct rather than a biological one (36.36% to 83.71%, p < 0.001). Comfort levels in engaging in conversations about racism, sexism, and heterosexism showed modest increases, with mean scores rising from 3.56 to 4 for racism, 3.61 to 3.84 for sexism, and 3.5 to 3.88 for heterosexism, although these trends were not statistically significant. Notable improvements were observed in residents’ willingness to intervene when facing discrimination (2.69 to 3.6, p = 0.003) and awareness of organizational resources (3.11 to 3.8, p = 0.026). 

Conclusion:  The cultural competency curriculum significantly enhanced residents' ability to understand concepts related to cultural dexterity, particularly in recognizing race as a social construct and defining cultural dexterity. While comfort in discussing sensitive topics such as racism, sexism, and heterosexism showed positive trends, marked improvements were seen in residents’ willingness to intervene in instances of discrimination and their awareness of institutional resources for anti-discrimination efforts. 

(P074) TWO-THIRDS OF OR STAFF STRUGGLE TO HEAR IN THE OR: UNVEILING CRITICAL COMMUNICATION BARRIERS AND TRAINING GAPS IN SURGICAL EDUCATION
Sarah E Hughes, BA¹, Clare E Jacobson, MD², Isabel J Hsu, BA¹, Andrew S Bolze, BA¹, Kyle H Sheetz, MD, MS², Candice Stegink, MS², Rishindra M Reddy, MD, MBA²; ¹University of Michigan Medical School, ²University of Michigan Department of Surgery

Introduction: Effective OR communication is crucial for patient safety and trainee education, yet auditory challenges such as background noise disproportionately impact trainees. Although population estimates suggest 10% of OR staff experience hearing difficulties, we hypothesized these challenges are underreported due to discrimination concerns. This study quantifies these barriers to inform accessibility solutions. 

Methods: OR personnel—including students, surgeons, anesthesiologists, residents, nurses, and techs—completed a survey on communication and hearing barriers. Quantitative and thematic analyses highlighted key trends. 

Results: Of 865 OR personnel, 225 responded (26% response rate): 62 medical students, 27 residents, 51 surgeons, 33 anesthesiologists, and 84 staff (CRNA, nurses, scrub techs). Baseline hearing loss (DHH) was reported by 11% (24/225), with 8% (15/188) under age 50 and 24% (9/37) over 50 (χ² = 8.67, p = 0.003). Excluding DHH respondents, hearing difficulties were noted by 57% (99/173) under 50 and 54% (15/28) over 50 (χ² = 0.131, p = 0.7). Medical students had fewer DHH cases (5%, 3/62) compared to other staff (13%, 21/163) (χ² = 3.05, p = 0.08), but 75% (44/59) of non-DHH students reported OR hearing difficulties versus 50% (71/142) of other personnel (χ² = 10.28, p = 0.0013), with students most likely to report difficulties (Odds Ratio: 6.58, p < 0.001). Overall, 87% (195/225) believed OR communication could improve, and thematic analysis underscored key concerns (Table).

Conclusions: OR staff across all roles, particularly medical students, face significant auditory challenges in the OR and experience discomfort requesting accommodations, underscoring the need for targeted interventions to improve communication for trainees and DHH individuals.

(P075) THE IMPACT OF A SURGICAL PATHWAY PROGRAM FOR HIGH SCHOOL STUDENTS
William Wong, MD¹, Sonnya Nieves, Academic, Program, Specialist², Amanda B Cooper¹; ¹Penn State Milton S. Hershey Medical Center, ²Penn State College of Medicine

Introduction/Background: With increasing focus on improving diversity in surgery, pathway programs have proliferated.  Little is known, however, about the short and intermediate-term outcomes of these efforts. 

Methods:  In 2021, our Department of Surgery and our Office of Diversity, Equity, and Belonging developed and implemented a week-long interactive summer day camp known as the Science of Surgery Camp.  Participating students have been invited to complete pre- and post-camp surveys assessing its impact. 

Results:  Since inception, the Science of Surgery Camp has been held annually with 76 high school students participating in total.  18 medical, one graduate, and 12 undergraduate students have volunteered, with two former campers returning as volunteers.

58/76 (76.3%) high school student participants completed a pre-Camp survey.  Of those, 14/58 (24.1%) have neither parent with a 4-year college degree (5/58 were unsure/preferred not to answer), 10/58 (17.2%) live in families receiving public assistance (4/58 were unsure/preferred not to answer), 23/58 (39.7%) had not met a healthcare provider from a background similar to theirs (9/58 were unsure), and 15/58 (25.9%) primarily speak a language other than English at home.

49/58 (84.5%) also completed a post-Camp survey.  For those not choosing the strongest level of agreement on the pre-survey, post-survey answers showed higher levels of agreement with these statements:  26/39 (66.7%) I understand the path to becoming a healthcare professional, 17/25 (68%) I feel empowered to pursue a healthcare career, 16/38 (42.1%) I am interested in pursuing a career in surgery.  All students indicated the highest or second highest level of agreement with the statements: The camp met my expectations and I would recommend this camp to a friend interested in medicine.  35/76 (47.4%) students have not yet graduated, but at least 5 former campers are undergraduate pre-medical majors and one is in a PA program. 

Discussion:  An interactive week-long camp for high school students helps them better understand the path to becoming a healthcare professional, empowers them to pursue a healthcare career, and fosters or sparks interest in a career in surgery. Although longer-term follow up is needed, such a program can inspire students to pursue undergraduate programs in healthcare.

(P076) GETTING THE OPINION THAT MATTERS: A QUANTITATIVE MEASURE OF PATIENT FEEDBACK ON SURGICAL TRAINEES’ COMMUNICATION SKILLS.
Katherine L Esser¹, Jennida Chan¹, Kaylee N Scarnati¹, Austin Lawrence¹, David Yatsonsky, MD¹, Kristin Toy, MD², Christopher Sanford, MD¹, David Sohn, MD¹; ¹University of Toledo College of Medicine & Life Sciences, ²Samaritan Health Services Orthopaedic Surgery, Oregon

Introduction: Effective communication is a fundamental component of medical practice, directly impacting patient outcomes, healthcare costs, and physician satisfaction. Despite its recognized importance, formal communication training in orthopaedic surgery remains insufficient. Patient and physician demographics and unconscious biases have been shown to influence communication quality in healthcare, potentially contributing to healthcare disparities. This study aims to evaluate communication skills among orthopaedic residents and investigate the factors influencing patient perceptions of communication quality.

Methods: Conducted at an orthopedic clinic within a large academic hospital, this IRB-approved study utilized patient evaluation surveys to assess resident communication skills by using the modified Communication Assessment Tool (CAT), and study-specific questionnaires. Patient demographics, including age, gender, race, and insurance status, were collected. Data were analyzed to evaluate communication effectiveness across these variables. Statistical analyses, including ANOVA and Mann-Whitney tests, were performed using IBM SPSS Version 27.

Results: A total of 78 patient surveys assessing 9 residents were collected over a 6-month period. Female patients rated male residents significantly higher in communication effectiveness compared to male patients (p=0.0213), indicating a gender-based difference in patient perceptions. Older patients also rated male residents more favorably than younger patients (p=0.0246), suggesting age-related differences in communication expectations. Although racial variations in communication ratings were observed, they did not reach statistical significance.

Conclusion: The findings suggest that patient demographics, particularly gender and age, significantly influence perceptions of resident communication. Implicit biases and generational differences may contribute to these discrepancies. Given the critical role of effective communication in patient care, especially in surgical settings, implementing structured communication training in residency programs, with direct patient feedback, is crucial. Such interventions may enhance communication skills, foster patient engagement, and mitigate healthcare disparities.

(P077) MULTITASKING OR DISTRACTED? SURGERY RESIDENT ENGAGEMENT WITH THE EHR DURING PROTECTED EDUCATION TIME
Catherine G Pratt, MD, MS, Allison N Moore, MD, Ellen R Becker, MD, Gregory C Wetmore, MD, Michael D Goodman, MD, Jeffrey J Sussman, MD, Robert M Van Haren, MD, MsPH, Ralph C Quillin III, MD; University of Cincinnati

Background: ACGME residency requirements stipulate that programs must define core didactic activities during which residents are protected from clinical responsibilities. This protected time must fall within the 80-hour average work week limitation.  It is not well understood if residents are able to disengage from clinical responsibilities in the era of mobile access to the electronic health record (EHR). This study aimed to evaluate residents’ engagement with the EHR during protected educational didactic time.

Methods: The EHR of a single academic institution was queried for all activities completed by general surgery residents from 11/2022-6/2023. All EHR interactions during the protected time for those months (~3 hours weekly) were included. Surgical residents were grouped by post-graduate year (PGY) and EHR activities were grouped by mobile app or desktop access for analysis.

Results: The EHR activities of 28 general surgery residents over 56.5 didactic hours were analyzed. All 28 residents spent some amount of protected time engaged with the EHR. Cumulatively, 5,721 interactions occurred via the mobile app, accounting for 36.6 hours (2.4%) of didactic time. A total of 39.9 hours (2.5%) was desktop-specific access outside of the didactic lecture hall. Residents spent an equivalent amount of time on the mobile app by PGY level, however PGY2 and PGY4 residents spent more time on desktop access (p=0.04). By individual resident, an equivalent proportion of didactic time was spent on mobile and desktop engagement (Figure). A higher proportion of mobile interactions among junior residents were spent on the “secure chat” feature (PGY1: 9.4%, PGY2: 5.7%, PGY3: 2.0%, PGY4: 2.1%, PGY5: 1.7%, p<0.0001). Overall, residents were more likely to use the mobile app for patient care communication (eg: secure chat) and to check the OR Status Board but use desktop access for orders and note writing.

Conclusion: While continual access to the EHR allows for quick response time to clinical concerns, surgery residents struggle to disengage during protected didactic time. In addition to repeated distractions from education, residents are at times pulled away completely for desktop access. Additional work is warranted to study all clinical interruptions during protected time and methods to mitigate these disturbances.

(P078) IDENTIFYING IMPROVEMENT OPPORTUNITIES FOR A COLORECTAL SURGERY WEBINAR SERIES USING VIRTUAL EDUCATION BEST PRACTICES
Connie Y Gan, MD¹, Lauren Weaver, MD², James R Korndorffer Jr., MD, MHPE¹, Mark K Soliman, MD, FACS³, Matthew C Bobel, MD⁴; ¹Stanford University, ²University of Minnesota, ³AdventHealth Digestive Health and Surgery Institute, ⁴Granger Medical Clinic

Introduction

There has been exponential growth in webinars as a surgical education method due to their convenience, possible interactivity, and ability to reach a wide audience with relatively low costs. The Colorectal Surgery Virtual Education Series (CRSVE) is an innovative teaching platform for colon and rectal surgery (CRS) fellows and has produced over 130 webinars since 2020. We hypothesized that most of the CRSVE webinars would not utilize the full extent of recommended best practices guiding webinar development.

Methods

A conceptual framework was developed with previously published webinar best practices literature (Figure 1) and applied to all available recorded sessions. Panel-led discussions and mock oral board preparation were excluded. Additional data included speaker demographics, alignment with the Accreditation Council for Graduate Medical Education (ACGME) CRS milestones, and view count.

Results

54 webinars were recorded (54/130, 41.5%), averaging 437 viewers (standard deviation=242). No webinar incorporated all the recommended best practices. However, each webinar utilized at least 1 best practice (Figure 1). The most used best practices were organized and prepared host (54/54, 100%), energetic host (54/54, 100%), host that makes time for audience questions (54/54, 100%), and clear engaging slides (48/54, 88.9%). Most speakers specialized in CRS (44/55, 81.8%) with an even gender distribution (28/55 male, 50.9%). All webinars mapped to at least one of the 27 ACGME milestones.

Conclusion

Applying a conceptual framework of best practices to CRSVE webinars demonstrated that while most webinars utilized at least 1 best practice, there are still significant opportunities for improvement. Designing future webinars based on best practices may improve the overall educational value of the CRSVE. Future application of this framework to other surgical education webinars could offer valuable insights into the broader adoption of best practices and foster improvements in digital surgical education.

(P079) ENHANCING EBUS-TBNA TRAINING: DEVELOPMENT AND EARLY VALIDATION OF A HIGH-FIDELITY SYNTHETIC SIMULATION TRAINING MODEL FOR LYMPH NODE LOCALIZATION, VISUALIZATION, AND BIOPSY
Kate Kazlovich, MSc¹, Hana Kosoy², Fumi Yokote, MD, PhD³, Yoshihisa Hiraishi, MD, PhD³, Nicholas Bernards, PhD³, Kazuhiro Yasufuku, MD, PhD³; ¹Institute of Biomedical Engineering, University of Toronto, ²Faculty of Health Sciences, Queen’s University, ³Division of Thoracic Surgery, Toronto General Hospital, University Health Network

Objective: To develop and validate a high-fidelity synthetic simulation model (Fig.1) for lymph node (LN) biopsy and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) handling.

Methods: Our team utilized rapid manufacturing techniques, combining 3D modeling, printing, and assembly to create a high-fidelity model aimed at training technical skills in trainees with limited EBUS-TBNA experience. The point-of-care manufacturing process allowed us to ensure that this model is affordable and customizable. The model emphasizes navigation and visualization of LNs and realistic haptic feedback during LN biopsies. Early validation occurred at the annual Interventional Thoracic Surgery Training Program (ITSTP), where we tested and evaluated our synthetic model against a commercially available virtual model. Thirteen trainees (PGY 6-11) participated, experiencing both models. After a didactic session and practical training, participants completed a User Experience (UX) questionnaire assessing structural, functional, contextual, and haptic fidelity.

Results: The synthetic simulator improved participants' overall knowledge, LN visualization, procedural understanding, and biopsy completion, with average ratings of 4.2/5 for the synthetic and 3.9/5 for the virtual model. Realism, including LN positioning, tracheobronchial anatomy, and ultrasound quality, scored 4.1/5 for the synthetic model and 3.7/5 for the virtual one. The educational value of both models was rated at 4.3/5. Trainees with some prior experience in EBUS-TBNA procedures, rated the synthetic simulation higher for training fidelity due to its superior haptic feedback, while trainees with no prior experience preferred the virtual model for its comprehensive anatomical representation and screen prompts that provide additional learning.

Conclusion: Simulation training is crucial for developing technical skills in thoracic surgery and interventional bronchoscopy. Our findings indicate that affordable simulation tools for EBUS-TBNA can effectively enhance proficiency and confidence before transitioning to apprenticeship training. Feedback indicates that these models can refine skills and maintain mastery, and different modalities are suitable for varying training stages, informing an improved educational curriculum for thoracic surgeons and interventional bronchoscopists.

(P080) ANALYSIS AND MONITORING OF A ROBOTICS CURRICULUM: ARE SIMNOW MODULES VALUABLE?
Jacob Applegarth, MD, Nathan Novotny, MD, Anthony Iacco, MD, Ibrahim Baida, MD, Bradley Perry, MD, Ngan Nguyen, PhD; Corewell Health East, William Beaumont University Hospital

Introduction: During the rapid adoption of robotic surgery within general surgery, formal education processes have struggled to keep pace. 

A needs assessment at our institution showed that insufficient robotic simulated practice represented a significant barrier to residents participating in operations. In response, we implemented a simulation-based robotic curriculum including fourteen modules on the daVinci SimNow system. The curriculum stipulates residents must score at least 90 twice, consecutively to pass. No public data exist evaluating the SimNow modules. This study aims to perform post-implementation analysis to evaluate each module’s ability to simulate a valid, realistic operative experience and to train and capture a resident’s robotic surgery skill.

Methods: All general surgery residents were asked to complete the fourteen modules during the 2022-2023 academic year (n=39). Performance data were analyzed for average number of attempts, score, and duration of time spent for each attempt. This data was stratified into junior (PGY1-2) and senior (PGY3-5) resident groups. Appropriate statistical analysis was performed to assess differences in performance. To further characterize performance, basic assumptions of a high value module were agreed upon, including average attempts greater than or equal to 3 and average score less than 90, given the basic prinicples of our curriculum.  Additionally, robotic surgeons with greater than 1000 career robotic operations evaluated each module and were queried for perceived face and construct validity. 

Results: 2,425 attempts and 490 completed modules were performed by 35 residents. Senior residents performed significantly better in at least one performance category on 4/14 modules (28.5%) (Table 1). Given the small population, effect size was analyzed with Cohen’s d test. This showed at least a medium effect size (d ≥ 0.5) of increased PGY level on performance for 12/14 modules (85.7%). When combined with our assumptions and expert review, these results demonstrate a spectrum of module value.

Table1: Comparison of SimNow modules

Discussion: Post-implementation analyses of robotic surgery curricula are vital to ensure adequate simulated education. We present one method for continued surveillance of a robotics curriculum using SimNow modules and expert review. Future works should focus on the impact of simulated experience on operative performance.

(P081) PERSPECTIVES FROM SURGEONS WHO MEDITATE: HOW TRAINING THE MIND INFLUENCES WELL-BEING AND PRACTICE
Sydney F Tan, MD, Vasu Rishi, BS, Bhabna Pati, BS, Esra Alagoz, PhD, Dawn M Elfenbein, MD, MPH; University of Wisconsin-Madison

Introduction

Training the mind by meditating can improve surgeon well-being, concentration, and non-technical skills. Current research on how meditation influences surgeon well-being focuses on interventions for novice meditators. Little is known about the effects of meditation on surgeons who already meditate. We conducted a qualitative study to describe how meditation influences surgeon well-being and surgical practice in established meditation practitioners.

Methods

Semi-structured interviews were conducted with practicing or retired surgeons nationwide who self-identified as meditators. Participants were recruited through word of mouth and surgery network email lists. The interview guide was developed using the established Awareness, Connection, Insight and Purpose (ACIP) well-being framework to explore well-being domains influenced by meditation. Four researchers iteratively developed the codebook based on ACIP domains and created new codes for constructs specific to surgery (e.g. operating room performance, surgeon identity) and meditation (e.g. challenges for meditation practice). We coded the data using thematic analysis, identifying influences of meditation on surgeon well-being and surgical practice.

Results

We interviewed 12 participants. Participants were 50% male and included three obstetrics-gynecologists, two acute care surgeons, two endocrine surgeons, two otolaryngologists, one general pediatric surgeon, one transplant surgeon, and one urologist.  Participants identified meditation influencing all four ACIP domains: Awareness, Connection, Insight, and Purpose. Surgeons found meditation developed awareness in the operating room through focus and concentration. Outside of the operating room, surgeons practiced awareness by being present in daily life and noticing negative self-talk or reactions. Furthermore, surgeons identified improved connection with patients, colleagues, and operating teams through emotion regulation and increased compassion. Connection intersected with Purpose in that fostering purpose was tied to helping others. We found Awareness and Insight overlapped with surgeons developing self-awareness of their vulnerabilities which created tension with their identity as a surgeon. Challenges to meditation practice included time and stigma in the surgical community.

Conclusion

Meditation plays a transformative role in the well-being and work of surgeons with established meditation practices. However, stigma and community perceptions of meditation were challenges to meditation practice even for experienced meditators. Addressing these barriers and integrating meditation training into surgeon development and surgical workflows can promote well-being.

(P082) EDUCATION AND MENTORSHIP OF THE STRUGGLING SURGICAL INTERN: PERSPECTIVES FROM SENIOR RESIDENTS AND PROGRAM DIRECTORS
Mala Sharma, MD¹, Kelsey E Koch, MD², Muneera R Kapadia, MD, MME³, Jennifer E Hrabe, MD¹, Abbey Fingeret, MD⁴; ¹University of Iowa, ²Yale School of Medicine, ³University of North Carolina, ⁴University of Nebraska Medical Center

Introduction: The attrition rate of general surgery residents has recently peaked near 18%. A struggling intern may not know they are struggling. This not only has negative effects on their training program but also on safe patient care. To better identify and intervene on behalf of these residents, we explored senior residents' and program directors’ perspectives on the role senior residents play in educating and mentoring struggling interns. 

Methods: Semi-structured interviews were conducted with senior residents and program directors. Qualitative analysis of interview transcripts was performed to develop common themes among attributes of a struggling intern, barriers against or reasons for reporting and intervening on a struggling intern. They were also asked about their preferred method of intervening.  

Results: Five general surgery senior residents (PGY 3-5) and five general surgery program directors completed interviews. From a senior resident's perspective, the top attributes of a struggling intern are emotional instability or lack of organizational skills. In contrast, program directors identify struggling interns as those who are inefficient. Both groups report the primary barrier to intervention is time constraints. If they did intervene, the senior resident’s motivation was to protect the struggling intern. Program directors cited the top reason senior residents do not report struggling interns is to protect the intern. When senior residents intervene, they prefer direct discussions with the intern, while program directors indirectly use senior residents as mentors and role models. 

Conclusion: Senior residents and program directors report vastly different interactions with interns and as a result, they identify struggling interns through different characteristics. Although lack of time is a key barrier to intervention, both senior residents and program directors use the same method to help improve the intern: the senior resident. Senior residents are a valuable resource who have more time with and access to interns that should be leveraged to educate and mentor those who are struggling. When armed with appropriate support and resources, senior residents may be able to help decrease the attrition rate and trainee malperformance. 

(P083) GENERAL SURGERY RESIDENT PERCEPTIONS ON LEADERSHIP ROLES AND ENGAGEMENT THROUGHOUT RESIDENCY: A MIXED-METHODS STUDY
Ariana Naaseh, MD, MPHS, Katharine E Caldwell, MD, MSCI, Bethany C Sacks, MD, MEd, Paul E Wise, MD, Jennifer Yu, MD, MPHS; Department of Surgery, Washington University in St. Louis School of Medicine

Introduction:

Resident participation in and ownership of program improvements are important components of resident satisfaction. While ACGME requirements mandate the accessibility of formal channels to address resident concerns, little is known regarding effective methods for resident participation in program-level change. We aimed to understand general surgery resident (GSR) perceptions of both program responsiveness and ability to influence change.

Methods:

All GSR at a large, academic institution were surveyed in July 2024. The survey contained binary, open-ended, and rating questions on a 5-point Likert scale. Thematic analysis was performed on open-ended responses from the anonymized survey. Themes were developed inductively and iteratively.  

Results:

40 of 72 (55.5%) residents completed the survey, including 16 (40.0%) junior residents (PGY1-2), 16 (40.0%) lab residents (PGY3-4), and 8 (20.0%) senior residents (PGY5-8). Residents across all years agreed they were able to provide feedback (mean [SD], 4.35 [0.61]) and interface with program leadership (4.40 [0.73]). They were neutral on ability to influence program-level changes (3.42 [0.95]) and on how feedback is incorporated (3.58 [0.89]). 27 (67.5%) GSR felt they had the cognitive bandwidth to influence change or be a leader within the residency, however only 19 (47.5%) felt they had sufficient time to do so. Barriers to participation included challenges juggling clinical and non-clinical duties, time spent on interests outside of leadership, and the need to focus on learning surgery instead of extracurricular activities. 38 (95.0%) were interested in engaging in opportunities for programmatic change. However, only 23 (57.5%) desired a formal leadership position. When asked about this discrepancy, GSR discussed a perceived higher level of commitment and concerns about their capability for a formal position. Residents also questioned the necessity of a formal leadership position to influence change. Figure 1 demonstrates representative quotes from GSR across all years.

Conclusions:

GSR experience a disconnect in their ability to provide feedback and to influence change. While many residents do not seek formalized leadership positions, they want opportunities to engage in program-level change. Further study should be aimed at interventions to broaden resident participation in decision making and understand how this affects resident well-being.

(P084) MATCHING THE FACTS: EVALUATION OF SELF-REPORTED GENERAL SURGERY RESIDENCY APPLICANT DATA ON SOCIAL MEDIA
A Paladugu, MD, B Shin, BS, E Yung, MD, J P Namm, MD, S Lum, MD, MBA, R Khorfan, MD; Loma Linda University Health

Introduction:  

General surgery residency applicants use various resources to help navigate the application process, including social media platforms such as Reddit. These online forums rely on self-reported data by individual applicants, and little is known about the content and validity of the data. Our objectives were to: (1) compare Reddit applicant data to published National Resident Matching Program (NRMP) data, and (2) use Reddit data to determine interview yield, a metric not reported by NRMP.

Methods:

Anonymous self-reported data were extracted from a publicly shared Reddit page titled, “2024 General Surgery Residency Application Spreadsheet.” Applicant metrics were summarized and compared to NRMP’s “Charting Outcomes in the Match 2024” document using t-test and chi-squared analysis. Interview yield was defined as number of interview invitations per number of applications.

Results:

For US MD applicants, the Reddit (N=194) vs NRMP (N=1,039) cohort reported similar step 2 scores (251 vs 250, p=0.41) and AOA status (18.5% vs 18.7% p=0.97). The Reddit cohort additionally reported 66.0% earned surgery rotation honors and 39.4% top class quartile, data not reported by the NRMP.

Compared to matched US MD applicants on Reddit (N=89), NRMP reported similar step 2 (255 vs 253, p=0.10), AOA (30.3% vs 22.0%, p=0.10), publications (11.1 vs 10.9, p=0.31), research experiences (4.3 vs 4.2, p=0.86), and programs ranked (14.6 vs 14.1, p=0.88).

On Reddit, the median number of applications was 77.5 [61-100] and interview invitations was 13 [8-19]. The median interview yield was 17.2% [9.6%-26.3%]. There was a decrease in interview yield after 60 applications (Figure 1).

Conclusion:

Self-reported applicant data on Reddit matches that published by the NRMP. Unlike other resources, the Reddit data includes all applicants, matched or unmatched. Self-reported data can provide novel insights, such as interview yield, to assist both applicants and programs in efficiently navigating the application process. Future work should evaluate applicant priorities and perspectives when applying to residency.

Figure 1. Interview Yield by Number of Applications Submitted as Self-Reported by General Surgery Applicants in 2024

(P085) PUBLISH OR PERISH: HOW LONG DOES IT TAKE FOR RESIDENTS TO GET A MANUSCRIPT ACCEPTED?
Joseph C L'Huillier, MD, MSHPEd¹, John M Woodward, MD¹, Jorge G Zarate Rodriguez, MD², Riley Brian, MD³, Rebecca Moreci, MD, MS⁴, Justine Broecker, MD³, Rajika Jindani, MD⁵, Connie Gan, MD⁶, Ariana Nasseh, MD², Michael Kochis, MD⁷, Joshua Roshal, MD⁸, Tejas Sathe, MD⁹, Colleen McDermott, MD¹⁰, Darian Hoagland, MD¹¹, Caitlin Silvestri, MD⁹, Sarah Lund, MD¹²; ¹University at Buffalo, ²Washington University in St. Louis, ³University of California San Francisco, ⁴Louisiana State University, ⁵Montefiore Medical Center, ⁶Oregon Health and Science University, ⁷Massachusetts General Hospital, ⁸University of Texas-- Medical Branch, ⁹Columbia University, ¹⁰University of Utah, ¹¹Beth Israel Deaconess Medical Center, ¹²Mayo Clinic

Background: Publications are a key metric of research productivity. Manuscripts often require multiple submissions prior to acceptance. However, the average trainee’s understanding of this process is unknown. Therefore, we aimed to analyze trends in submission timelines for ultimately accepted manuscripts and compare timelines between surgical education and non-surgical education publications.

Methods: Members of the Collaboration of Surgical Education Fellows (CoSEF), a multi-institutional group of surgical trainees with an academic interest in surgical education, submitted data regarding the timelines of their published manuscripts. Surgical education manuscripts were compared to non-surgical education manuscripts. Medians and IQRs were reported.

Results: We included 152 manuscripts from 16 researchers (median=7/researcher) from 13 residency programs. The most common study design was a retrospective cohort study (53%, n=65) and half were about surgical education (50%, n=76). Time from first submission to acceptance was 122 days (IQR 73-189), of which 19 days (IQR 5-52) were with the author undergoing revisions and 93 days (IQR 53-128) were with the journal undergoing review. Manuscripts were submitted 2 times (IQR 2-3) to 1 journal (IQR 1-2). There were no differences in time metrics between surgical education and non-surgical education projects (Table).

Conclusions: Our experience suggests that resident researchers can anticipate submitting a manuscript 2-3 times to 1-2 journals over 3-6 months to secure an acceptance, regardless of research topic. Articles spend twice as long undergoing review as they do revisions between reviews. The editorial review process for surgical education manuscripts is no longer than that for manuscripts on other topics. Shortening journal review times and incentivizing reviewers would speed the publication process.

(P086) UNDERSTANDING MEDICAL STUDENT PERSPECTIVES ON SURGICAL CLERKSHIPS
Katherine Bingmer, Lilah Morris-Wiseman, Alodia Gabre-Kidan; Johns Hopkins Hospital

Background:

Medical student clerkship experiences expose learners to new skills and help shape future specialty choices. Using expectancy-value theory - which differentiates task value into attainment value, intrinsic value, utility value, and cost - we sought to understand medical students’ expectations of the surgical rotation to help inform future curricular development.

Methods:

Anonymous, voluntary surveys were administered to all third-year medical students prior to their core surgery clerkship (2016-2020). Students were asked to provide short-answer responses to questions about their interest in a surgical career (intrinsic and utility value), what they anticipated (attainment value), and their concerns (cost). Responses were qualitatively analyzed.

Results:

A total of 412 responses were collected for an 85% response rate (n=480 total).  Pre-rotation interest in a career in surgery was strong (33%), moderate (29%), and weak (27%); 11% of students had no interest in a surgical career. Students’ goals for the clerkship included learning suturing skills (79%), when to refer patients for surgical evaluation (71%), diseases treated with surgical therapies (80%), basic management of surgical patients (74%), and determining whether to pursue a career in surgery (59%). 

In short-answer responses, students commonly looked forward to learning technical/procedural skills and participating in the operating room. Students also frequently looked forward to being part of a surgical team and understanding how surgical teams work to care for patients (Figure 1).

Students’ concerns about the clerkship included long hours, lack of sleep, poor work-life balance, and insufficient time to study for exams. While looking forward to working within surgical teams, they were concerned about belonging and if they would be a hinderance to the team. Concerns about mistreatment, culture, and environment were frequently mentioned, often in the context of the reputation of surgery as a discipline.

Conclusion:

Despite two-thirds of students lacking attainment value prior to starting surgery clerkship, a majority are enthusiastic about learning technical skills, understanding surgical diseases, and managing surgical patients (intrinsic and utility value). Students enter clerkship with concerns about time and the perceived negative culture of a surgical environment (cost). Designing curricula along expectancy-value theory may help align expectations and combat potential biases.   

(P087) ESTABLISHING A CAMPUS-WIDE SIMULATION CENTER: PROGRAM EVALUATION OF THE FIRST SIX YEARS
Emily C Hoffer, Krystle K Campbell, DHA, MSMS, CHSE, Daniel J Scott; UT Southwestern Medical Center

Background. In 2015 our institution began the process of creating a campus-wide multidisciplinary simulation center which opened in 2018.  The purpose of this study was to perform a program evaluation of outcomes for our center over its first six years. 

Methods.  Using the CDC’s Program Evaluation Framework, we performed a structured analysis of simulation center activities from Fiscal Year (FY) 2018 to 2024. This assessment included 1) examination of context (prior efforts, mission, vision, stakeholders, strategic priorities), 2) description of programs (organization, resources, processes, program and curriculum design), and 3) program evaluation (evaluation objectives, data analysis). Outcomes were analyzed according to established strategic priorities: curricula, faculty development, scholarship, and innovation.  

Results. Implemented programs included simulation curricula, faculty development courses, an annual research forum, a grants program, and various innovation activities. A total of 7,204 simulation events were hosted with 138,624 learner encounters; substantial growth (146% and 61%, respectively, p=0.416) occurred over years 1-5, but a decrease was seen in year 6 due to AV system installation downtime. Simulations used high-fidelity (83%), standardized patient (15%), and mixed (2%) modalities. Post-encounter surveys (1,635-5,756 responses per year, 7.5%- 23.0% response rate) indicated > 99% satisfaction for the last 3 years. The largest learner groups included undergraduate (31%) and graduate medical education (39%).? The center supported 87 publications during this period. 

Conclusions. Through this evaluation, we identified several key factors that were critical to implementing a wide-scale simulation program that aligned with our strategic priorities, as well as areas for improvement.? Obtaining institutional and stakeholder buy-in, along with establishing standardized processes for administration, curriculum, and data collection have allowed growth and quality improvement.? This study will inform our future efforts and may serve as a model for other institutions. 

(P088) EFFECT OF WARM-UP ON ROBOTIC SURGICAL PERFORMANCE TO IMPROVE TECHNICAL PERFORMANCE USING AN INTESTINAL ANASTOMOTIC DRILL: A COMPARATIVE STUDY
Samy Castillo-Flores, Ricardo Nunez-Rocha, Andres Abreu, Angela Guzzetta, Daniel Scott, Herbert Zeh III, Ganesh Sankaranarayanan, Patricio Polanco; University of Texas Southwestern Medical Center

Introduction:
Optimizing technical performance in robotic surgery training is essential. While long-term skill development is well-studied, the impact of consecutive drills within a single session on short-term performance is underexplored. This study evaluates the effect of a bioanastomotic drill as a warm-up and its impact on a second consecutive drill within the same session.

Methods:
Fourteen surgical trainees in the warm-up group performed two consecutive bioanastomotic drills on biotissue in a robotic simulation after achieving proficiency (OSATS score ≥ 28). The first drill was used as a warm-up to assess its effect on the second drill. A control group of nine trainees performed only one bioanastomotic drill after reaching proficiency. Performance metrics included OSATS scores, time to completion, and number of errors. Paired t-tests were used to compare performance between the two drills in the warm-up group, while independent t-tests and regression analyses were used to compare the warm-up and control groups.

Results:
In the warm-up group, paired t-tests showed significant improvements between the first (warm-up) and second bioanastomotic drills. OSATS scores increased significantly (p < 0.001), and the number of errors decreased (p = 0.047). However, completion time did not change significantly (p = 0.170).

When comparing the warm-up group with the control group, independent t-tests revealed that the warm-up group completed the bioanastomotic drill significantly faster (p = 0.009) and achieved higher OSATS scores (p = 0.011). There was no significant difference in errors between the two groups (p = 0.496). Regression analysis confirmed that performing a second bioanastomotic drill in the same session was associated with a significant reduction in completion time (-8.66 minutes, p = 0.003) and a 3.29-point improvement in OSATS scores (p = 0.011) compared to the control group.

Conclusions:
Trainees who performed a warm-up drill before a second bioanastomotic drill achieved significantly higher OSATS scores and faster completion times than those who performed only one drill. These findings highlight the value of warm-up drills in enhancing surgical performance and support their integration into robotic surgery training curricula.

(P090) A BREATHTAKING PANCREAS MODEL: A NOVEL PANCREATICOJEJUNOSTOMY MODEL USING EXPLANTED PORCINE LUNG TISSUE
Shannon M Barter, MD, Layla Triplett, Msc, Edu, Brittany Loomis, BS, CST, Sheila Peeler, BS, RN, Brittany Sullivan, MD, Sabino Zani, MD, Katharine L Jackson; Duke University

Introduction: Pancreas tissue and the construction of a pancreaticojejunostomy (PJ) merit dedicated attention in surgical training. The existing models are low-fidelity, expensive, or challenging to acquire. We present a PJ model created from procured porcine lung tissue with content validity data from practicing pancreatic surgeons.

Methods: A segment of porcine lung tissue was cut to create a simulated pancreas body. A 5mm bladed trocar was placed through the tissue. A carotid or splenic porcine artery was pulled through the trocar, positioned in the lung parenchyma, and secured with a 4-0 Monocryl™ in three quadrants. The vessel was visible on both sides of the pancreas model, allowing for the model to be used twice. Hepatobiliary surgeons were recruited to perform a PJ on the porcine model, with a LifeLike BioTissue model available for comparison. The surgeons then completed a survey regarding their experience.

Results: Five surgeons tested the model with a median of 6 years in practice and a median of 2 PJs per month. All but one surgeon agreed that the simulated pancreas parenchyma and pancreatic duct were anatomically realistic. Written responses reported that the lung simulated a soft pancreas gland that posed a realistic challenge to the anastomosis.  Some reported the duct was thicker than in a patient, yet tactile feedback received favorable ratings. All the surgeons strongly agreed that the model was educationally valuable in teaching the steps of a PJ, and 4 strongly agreed that it is appropriate for teaching tissue handling. Participants strongly agreed that the model was intuitive and transferable to the OR. Preference scores between the two models, with 100 representing a complete preference for the porcine model, the surgeons preferred the porcine model for parenchyma, suturing, and knot tying (average scores of 62.6, 68, 69.6, respectively), but preferred the BioTissue for the duct (average score of 48.6).

Conclusions: Expert surgeons endorsed this porcine tissue pancreas model as appropriate for learning a PJ, simulating a softer gland, and creating a technically realistic PJ. The next steps include evaluating the model’s performance in minimally invasive platforms and an intracorporeal setting.

(P091) SECOND TAKE WITH FEWER STAKES: RECREATING CADAVERIC SIMULATIONS BASED ON PROXIMATE REAL-LIFE TRAUMA CASES FOR AUGMENTING TRAUMA RESIDENT AUTONOMY
Andrew Keogan, MD¹, Han Grezenko, MD², Kayla Gray, MS², Tess Montminy, MD¹, Mikaela Mahrer², Angela Mankin², Kristina Kupanoff, PhD², David Mankin², James Mankin, MD², Jordan Weinberg, MD², Hahn Soe-Lin, MD², James Bogert, MD²; ¹Creighton University, ²St Joseph's Hospital and Medical Center

Introduction:

Resident education in live trauma surgery is challenged by patient safety, high acuity low occurrence volume, and in simulation challenged by low fidelity. This study utilized whole body cadaveric donors known as Knowledge Donors (KDs), which maintain tissue integrity and allow high fidelity active bleeding. This study describes recreating complex trauma injury patterns identical to those a resident participated in within close temporal proximity to a live operation.

Methods:

Two general surgery residents (PGY-4) on their trauma rotations were enrolled in this pilot study. Within 24hrs to 7 days after pragmatically participating in a real operative trauma, a simulated scenario was recreated mimicking the same injury pattern and the resident invited to participate in the simulation of their live operative case.  One case was a motor vehicle collision necessitating emergency nephrectomy and splenectomy, and the other a gunshot wound with a complex right common iliac vein injury and thoracotomy.

The simulation protocol employed a crossed design where each resident served as primary surgeon for one case with complete operative and decision making autonomy. Pre- and post-simulation surveys assessed learner perspective on the platform, technical fidelity, and clinical correlation. Attending led debriefs focused on operative decisions, technical performance, and translation of clinical experience to the simulation environment. 

Results:

Residents reported high correlation between simulated and live experiences and that the technical aspects of the KD models had similar levels of fidelity. Structured debriefs revealed three critical domains: enhanced team communication, development of emotional resilience strategies encountering technical operative impasses, and deepened appreciation for surgical anatomy through autonomous tactile experience. Both residents cited the value of independent operative decision making in a controlled environment, noting that this autonomy allowed them to develop both technical confidence and leadership skills.

Conclusion:

This innovative approach to surgical simulation, which recreates recent trauma cases using KDs, offers novel benefits to surgical resident education, enabling residents to act as primary surgeons in a risk-free environment. By providing a second opportunity to perform complex simulated trauma surgeries in clustered proximity to live cases, residents can solidify technical and cognitive skills specific to low volume emergency operative scenarios.

(P092) VIRTUAL TEAM-BASED LAPAROSCOPIC CHOLECYSTECTOMY TRAINING: A PILOT STUDY OF A HIGH-FIDELITY SIMULATED TEACHING CASE
Alexandra Z Agathis, MD, Sarah Cao, MD, Jeanne Wu, MPH, Lee Schmidt, MD, Celia M Divino, MD, FACS; Icahn School of Medicine at Mount Sinai

Introduction: As surgical residents' operative exposure has decreased over time, it is becoming increasingly important to optimize resident skills and boost operative responsibility. Prior literature has shown the benefits of using high-fidelity virtual simulators to improve operative performance, however there is limited research using this technology to simulate senior teaching cases. 

Methods: In this prospective observational study, junior-senior resident pairs performed a simulated laparoscopic cholecystectomy using a high-fidelity virtual laparoscopic simulator. Residents answered pre- and post-survey questions about operative and video game experience, laparoscopic surgery comfort, and biliary anatomy knowledge. Impression questions were scaled 1-5, with 1 being the least confident and 5 the most. Responses were compared using a paired t-test. Simulator performance metrics were analyzed with linear regression.

Results: A total n=18 residents have participated, including n=9 junior (PGY1=1, PGY2=6, PGY3=2) and n=9 senior residents (PGY4=3, PGY5= 6). Juniors had performed a baseline average of 8.6 (+SD13.9) pre-study cholecystectomies and seniors 79.6 (+26.8). Overall, junior pre- and post-simulation mean confidence scores were 3.44 (+0.88) and 4.33 (+0.50) for identifying the critical view (p<0.01), 2.44 (+0.88) and 3.67 (+0.71) for identifying the critical view with aberrant ductal/arterial anatomy (p<0.01), and 3.56 (+0.88) and 4.22 (+0.83) for locating one’s instrument in camera view (p=0.02). Junior residents’ knowledge of Rouviere’s sulcus improved from 1 to 5 correct responses (p=0.03). While video game experience did not correlate with PGY-level or perceived simulation benefit, it had a direct relationship with simulator instrument collision frequency (R²=0.36, beta=4.33) and path length in centimeters (R²=0.47, beta=373.86).

Conclusion: Early findings suggest junior residents’ overall technical comfort and knowledge improved after performing a simulated, coached laparoscopic cholecystectomy. Residents with more video game experience had more collisions and less economical instrument path lengths, suggesting video game experience may compromise the realness of virtual simulation. By implementing simulation early in residency, especially with senior resident coaches, junior residents will enter the operating room with enhanced technical expertise, knowledge of anatomy, and confidence to ultimately expand their skills.

(P093) “PUSH DOWN HARD, PUSH, PUSH, PUSH, COME ON”, “LIKE TO THE FLOOR”: REFLECTIVE PRACTICE TO GENERATE VERBAL TEACHING STRATEGIES IN ROBOTIC SURGERY
Daniel R Bacon, MD¹, Selina Vickery, MSc¹, Maryam Mohammed-Norgan¹, Brian Carter, MD¹, Laura Washburn, MD², Gary Sutkin, MD³, Emily Huang, MD, MEd¹; ¹The Ohio State University Department of Surgery, ²University of Pittsburgh Medical Center Department of Surgery, ³University of Missouri-Kansas City School of Medicine, Department of Obstetrics and Gynecology

Background: Surgical knowledge is often tacit: difficult to verbalize and contained within the act of performance. Examined linguistically, most operative discourse is ambiguous but resolved via co-manipulation of the surgical field, non-verbal cues, and haptic feedback. The isolated configuration in robotic surgery leaves educators heavily reliant upon verbal communication, making disambiguation difficult. We sought to characterize instructional language used during console handovers and disambiguate that language through reflection in the office setting.  

Methods: Semi-structured self-confrontation interviews were performed with surgeons and trainees utilizing video excerpts of console handovers from their own robotic operations (dual operating console view, surgical field, audio recording). Interviews were designed to ascertain reasons for handovers, discussing breakdowns in communication and alternative verbal strategies for instruction. Researchers iteratively coded transcripts and organized themes for a pilot thematic analysis.  

Results: Four surgeons and three trainees reflected on two inguinal hernia repairs, a lung wedge resection, and hemicolectomy. Reasons for handover included lack of progress, danger, educational benefit / risk ratio, efficiency, and educational demonstration opportunity. The most significant reason for handover was communication difficulty arising from ambiguous verbal instruction (e.g. direction, “up and away”; force, “push down hard”). Disambiguation required iterative attempts to verbally reveal tacit knowledge (“push down hard” means “it’s safe to reflect that peritoneum so far down that it’s almost touching the omentum”) and was challenging (“no amount of me saying push down harder ever gets them to push down enough”). Sometimes, residents correctly followed verbal instruction, but an unstated principle was later recognized during reflection (“… I didn’t articulate [intraoperatively] I feel very strongly about the difference between the tip of the scissors and the back of the scissors… as two different instruments”).  Verbal teaching strategies for disambiguation included definite description of anatomic landmarks, explicit verbalization of instrument orientation, hand movements, and anticipated wrong maneuvers.  

Conclusions: Instructional ambiguity is a major reason for console handover in robotic surgery. Prompted reflection on teaching outside the operating room may help surgeons create effective verbal teaching strategies. These strategies illuminate tacit knowledge and surgical principles for teaching robotic surgery and may improve resident intraoperative learning and autonomy.

(P094) DOES JUST IN TIME TRAINING (JITT) INCREASE SURGICAL COMPETENCIES?: A SCOPING REVIEW
Sergio M Navarro, MD, MBA, Matthew T Parrish, MD, Andrew Tom, Aidin Gharavi, Matthew Gish, Kelsey A Stewart, MD, Morgan R Briggs, MD, Isabel C Green, MD; Mayo Clinic

Introduction: Surgical procedures, tasks, and techniques are being increasingly coupled with Just-in-Time training (JITT) technique. Aiming to provide real time learning and clinical needs as they progress in training, JITT offers medical and graduate medical students learning experiences to improve their abilities and skill.  The purpose of this scoping review is to offer a comprehensive overview of the implementation of JITT training for surgical education in undergraduate and graduate medical education (UME, GME).  

Methods: Following the five-stage framework by Arksey and O’Malley to methodically collect and analyze studies on JITT in GME and UME, we conducted a literature search of five electronic databases with supplemental search for grey literature.   Studies exploring the integration of JITT principles into UME and GME clinical training for surgical training and procedures and their effectiveness were included.   

Results: The scoping review yielded 10 studies across 8 countries. Surgical procedures and education topics ranged from chest tube placement, intraosseous needle placement, bronchoscopy, and wrist splinting, to focused assessment of sonography for trauma and posture in the operating room. The studies were just as varied, including randomized control trials (5), prospective pilot studies (3), and cohort studies (3). Assessment definitions and use of JITT varied as well. The primary Accreditation Council for Graduate Medical Education competency centered on patient care and procedural skills (60%), however, all other competencies were represented. One-half of the studies were longitudinal, with the remaining either pre-procedural preparation (40%) or pre-rotation (10%). Efficacy and utility of JITT in improving immediate clinical skills and learner satisfaction in surgical education was demonstrated in 80% of the studies reviewed. 

Conclusion: The introduction of JITT in GME and UME for surgical education shows promise as an effective educational strategy to better meet the needs of learners and trainees. Current efforts focus on specific cohorts within surgical education, with a focus on development of patient care and procedural skills via acquisition of basic skills and procedural knowledge.  Further research is required to determine its impact on long-term learning retention, professional development, and other competencies.