ePoster
CURRENT STATUS OF MULTISOURCE FEEDBACK IN VASCULAR SURGERY RESIDENCY
Robin Hu, BA1, Tiffany R Bellomo, MD2, Chase Marso, MD2, Camila M Muriel2, Erick H Castaneda2, Dandan Chen, PhD2, Nikolaos Zacharias, MD, MPH2, Sunita Srivastava, MD2, Sophia K McKinley, MD, MEd2; 1Harvard Medical School, 2Massachusetts General Hospital
Background: Multisource feedback (MSF) is an assessment method involving performance evaluations from multiple professional sources. Despite reported benefits of MSF and Accreditation Council for Graduate Medical Education (ACGME) mandates for the usage of MSF, limited data exist on MSF implementation, integration, and perceived value within vascular surgery training programs. This study aimed to examine existing MSF practices and barriers to inform strategies for enhancing surgical resident feedback.
Methods: A questionnaire regarding multisource feedback was distributed via email to all vascular surgery residency program directors in the United States. The questionnaire was adapted from a previously utilized questionnaire assessing attending physician feedback perceptions, reviewed by education experts, and pilot tested. Descriptive statistics were used to summarize current practices, perceptions, and barriers to MSF.
Results: The response rate was 30% (23/76). All participating programs were university-affiliated and graduated up to three residents per year (n=23, 100%). Participating programs were in the Northeastern, Midwestern, Southern, and Western regions of the United States. The majority of programs reported using MSF (19/23, 83%). The most common sources of feedback in MSF were surgical attendings (n=19, 100%), resident peers (n=13, 68%) and medical students (n=13, 68%). Only five programs (26%) obtain feedback from patients, and no programs reported soliciting feedback from social workers, physical therapists, or non-surgical resident peers (Figure 1). Feedback was most often collected by the residency program (n=17, 89%) and delivered to the resident by a third-party individual (n=13, 68%). The greatest perceived challenges to MSF implementation reported were resource limitations (n=7, 30%) and feedback consistency (n=6, 26%). Suggestions for improvement included protected time (n=13, 57%), increased administrative support (n=12, 52%), and standardized MSF templates (n=12, 52%).
Conclusions: While a majority of vascular surgery residency programs use MSF, it is not yet universally practiced. Important stakeholder groups in resident development, particularly patients, were infrequently represented. Programs identified frequent challenges related to feedback collection, implementation, and resources. Future work could focus on developing standardized templates and procedures for MSF collection to improve the implementation of MSF.
TRAINEE PARTICIPATION AND OPERATIVE EFFICIENCY: EVIDENCE FROM A ROBOTIC GENERAL SURGERY CURRICULUM
Ricardo E. Nunez-Rocha, MD1, Hye Rim Jang, MD1, Steven Lim, MD1, Ankur Choubey, MD1, Russell Pepe, MD1, Patricio M. Polanco, MD2, Victoria Needham, MD1, Joelle Getrajdman, MD1, Jenny Cai, MD1, Sammy Elsamra, MD1, Dylan Nieman, MD1, Nell Maloney Patel, MD1, Mayur Narayan, MD1, Advaith Bongu, MD1; 1Robert Wood Johnson Medical School, 2UTSouthwestern Medical Center
Background: Robotic adoption has outpaced standardized training. General surgery programs need proficiency-based simulation that advances resident autonomy while protecting the operating-room efficiency. We aimed to quantify efficiency across common robotic surgery procedures and identify targets where a proficiency-based simulation curriculum delivers value.
Methods: A retrospective review of all the robotic general surgery-related procedures was performed for 2025. We reviewed cases across the general surgery, emergency general surgery, surgical oncology, minimally invasive, and colorectal services via an OR scheduler dataset. Only limited data on demographics such as age and ASA were available. Outcomes assessed were case (hours) and room duration (minutes), summarized as medians, interquartile ranges, and compared by trainee participation and level (PGY1–3 vs PGY4–5/fellow).
Results: A total of 601 cases (inguinal hernia 163; simple ventral/umbilical 102; complex-ventral 104; cholecystectomy 141; right-hemicolectomy 91) were collected. inguinal hernia, cases with residents and those with senior residents/fellows had shorter case and room times compared to cases without residents or any trainees, respectively. (1.75h [1.67–1.92] vs 2.33h [2.08–2.50], p<0.001; 123 min [105–139] vs 132 min [117–162], p=0.003). In simple ventral/umbilical, there was a trend toward shorter case duration with resident involvement (2.92h vs 3.38h, p=0.06), and senior/fellow assistance reached borderline significance (2.92h vs 3.58h, p=0.05). In complex ventral hernia, junior-level assistance prolonged cases (3.83h [2.67–5.25] vs 2.92h [2.83–3.08]), p=0.04) without significant room-time penalty; the effect attenuated with senior/fellow assistance. In cholecystectomy, overall times were similar with or without trainees, but PGY1–3 teaching cases were faster than PGY4–5 (case 1.50h [1.42–2.08] vs 2.24 h [1.42–2.42], p=0.046; room 97 min [87–125] vs 138 min [109–151], p=0.046), underscoring the increased complexity and participation in senior cases. In hemicolectomies, no differences were observed by trainee participation or level.
Conclusions: Trainee participation did not worsen operative efficiency and was associated with shorter times for hernia repairs; only junior involvement in complex ventral hernia prolonged cases. These findings support adopting a structured robotic curriculum with proficiency benchmarks and graded autonomy for common cases, while prioritizing targeted preparation and enhanced supervision for complex abdominal procedures to sustain efficiency and safety.
DEVELOPMENT AND IMPLEMENTATION OF A TWO-PART CURRICULUM FOR CRICOTHYROIDOTOMY USING INDIVIDUAL CADAVERIC SIMULATION FOR SENIOR SURGICAL RESIDENTS
Joseph C L'Huillier, MD, MSHPEd, Dylan Tanzer, MD, Brianna Friend, BS, Jeremiah Chapman, BS, Joshua Aeh, BS, Asham Khan, MD, Stuart Inglis, PhD, Kenneth Snyder, MD, PhD, Kurt VonFricken, MD, Steven D Schwaitzberg, MD, FACS; University at Buffalo
Introduction
Cricothyroidotomy— emergent tube placement through an incision in the cricothyroid membrane—may be required for patients who are not oxygenating and cannot be ventilated. Emergency surgical airway management is a low-frequency, high-stakes procedure often performed by residents. The aim of this study was to develop and implement a mastery learning curriculum for residents to address the technical, cognitive, and emotional components of the procedure.
Methods
We developed a two-component emergency airway curriculum using Kern’s 6 step approach, which was delivered to PGY-4 and PGY-5 general surgery residents and neurosurgery residents in Spring 2024 (Cohort 1) and Spring 2025 (Cohort 2). The first component included a review of indications for cricothyroidotomy and a discussion of prior experiences with emergency airway situations facilitated by an attending surgeon. Participants then reviewed a procedural checklist and practiced on Advanced Trauma Life Support (ATLS) models. The second component was an individual cadaveric simulation with a clinical vignette for a patient who ultimately requires cricothyroidotomy as the scenario progresses. Confederates played the roles of the patient’s family member and the patient’s nurse in order to simulate additional challenges faced during these clinical scenarios. Participants completed pre-course demographics and confidence surveys. Performance in cadaveric simulation was assessed by faculty. Participants in Cohort 1 completed a one-year post-course survey to assess Kirkpatrick level four effectiveness.
Results
Forty residents participated (20 male (50%); 26 White (67%); 37 non-Hispanic (95%); 28 General Surgery (70%); 12 Neurosurgery (30%)). While 76% had practiced the procedure in simulation before the course, only 35% witnessed and 26% performed the procedure on a real patient. Half of participants felt confident in performing a simulated cricothyroidotomy before the course while only 20% felt confident performing the procedure on a real patient. All learners achieved mastery on the first attempt with an average cricothyroidotomy time of 1:28 (±0:48) and an average total simulation time of 3:54 (±1:17). One-year post-course survey results are in Table 1.
Conclusion
We instituted a successful, two-part emergency airway curriculum in which all learners achieved mastery. After implementation, nine successful emergency airways were performed one year afterwards, suggesting clinical effectiveness.
CONTRIBUTIONS OF QUALITATIVE RESEARCH IN SURGICAL EDUCATION RESEARCH: A SCOPING REVIEW
Chelsey Hewett1, Anjul Bhangu, BS1, Rija Awan, BS1, Mia Burns2, Angel Ozuna-Harrison1, Jamila Picart, MD, MS1, Marquise Singleterry, MD1, Alyssa Pradarelli, MD1, Lauren Szczygiel, PhD1, Gurjit Sandhu, PhD1; 1University of Michigan, 2Spelman College
Over the past two decades, surgical trainee education in clinical contexts has undergone substantial reform, most notably through competency-based medical education and Entrustable Professional Activities. Concurrently, qualitative research has gained prominence, offering valuable opportunities to explore complexities within surgical training environments. Such approaches deepen understanding of stakeholder experiences and multifaceted implications for teaching/learning. By assessing the breadth of qualitative research, we can better appreciate its contributions to advancing knowledge and informing surgical educational practice. Accordingly, this scoping review maps the scope, nature, and impact of qualitative research within clinical surgical training settings.
A scoping review was conducted following PRISMA-ScR to map qualitative research on surgical education in the US from 2005-2025. The search included MEDLINE, Embase, CINAHL, ERIC, and Scopus. Peer-reviewed English-language studies employing qualitative methods focused on postgraduate surgical education were included. Parameters encompassed structured learning experiences, training interventions, or programs developing surgical knowledge, skills, attitudes, or professional competencies in the clinical context. Two reviewers independently screened studies based on criteria, extracting data from study characteristics.
A total of 51 studies were included (Figure 1). Qualitative research was most common in general surgery (65%) and orthopaedics (12%). Grounded theory (35%), thematic analysis (29%), and content analysis (16%) were predominant methodologies. Interviews (53%) and focus groups (33%) were the primary data collection methods. An estimated 24 of 51 studies (47%) explicitly utilized a theoretical or conceptual framework, commonly grounded theory (35%), cognitive apprenticeship (10%), or self-directed learning (8%). The most commonly studied topics were assessment (27%) and autonomy (24%). Four themes were identified across the spectrum of studies: 1) gaps in intraoperative teaching and feedback, 2) resident perceptions of autonomy, 3) preparedness for independent practice, and 4) influence of faculty-resident relationships on learning environments.
This review is among the first to synthesize qualitative research conducted on US surgical education. Most studies concentrated on general surgery and emphasized grounded theory or thematic analysis. Examination of autonomy, preparedness, feedback, and faculty-resident dynamics underscores the role of qualitative research in advancing understanding of surgical education. Future opportunities for qualitative inquiry include recruitment, decision-making, and assessment design, advancing methodological rigor and the impact of research on surgical education practice.
DEVELOPMENT, IMPLEMENTATION AND OUTCOMES OF A PLASTIC AND RECONSTRUCTIVE SURGERY CASE-BASED LEARNING CURRICULUM FOR MEDICAL STUDENTS
Victoria Tucci, MSc1, Dave Gwun, HBSc1, Alexandra D’Souza, MD2, Thomas Milazzo, MD, MSc2, Sophocles Voineskos, MD, MSc2, David Wallace, MD, MSc2, Kyle Wanzel, MD, MEd2, Shaishav Datta, MD2; 1University of Toronto, Temerty Faculty of Medicine, 2Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
Background: Medical students across North America have limited exposure to Plastic and Reconstructive Surgery (PRS). To address this gap, we developed and implemented a longitudinal PRS case-based learning (CBL) initiative. CBL is a well-established format in medical education that utilizes small-group clinical case discussions to foster critical reasoning and the application of clinical knowledge. The goal of the PRS-CBL initiative was to introduce core concepts to first and second-year medical students, thereby improving PRS knowledge, increasing early exposure to the specialty, and creating opportunities for technical and clinical skill development.
Methods: Guided by the Medical Council of Canada learning objectives, a five-part PRS-CBL initiative was co-developed with PRS faculty and residents at our institution to complement the existing pre-clerkship curriculum. As such, only first- and second-year medical students at our institution (N=606) were eligible to participate. Topics covered included 1) PRS foundations, 2) Skin and soft tissue infections, 3) Benign and malignant skin lesions, 4) Hand traumas, and 5) Burns. Each session consisted of a didactic presentation, clinical case, and hands-on procedural workshop (e.g., suturing, incision and drainage, splinting, skin biopsies, and burn dressings). Pre- and post-session knowledge test results were compared using the Mann-Whitney U test. Feedback surveys were summarized descriptively, while written comments underwent thematic analysis.
Results: Between 2023-2025, 10 PRS-CBL sessions were delivered, with an average of 45 registrants per session (range: 11-82). Attendance grew from an average of 20 students in the first year of implementation to 70 in the second year. Across all sessions, 75% of registrants were first-year medical students, and 41% had no prior interest in plastic surgery. Pre- and post-session knowledge test scores significantly improved from 53% to 72% (p<0.001). 84% of students agreed that the sessions adequately addressed learning objectives, covered appropriate material, and were highly effective. Thematic analysis revealed medical students’ strong preference for hands-on, multimodal learning that combines practical skills with clinical relevance.
Conclusion: Our findings highlighted the initiative’s potential to improve PRS knowledge and increase exposure and interest in the specialty. This educational model can be adapted by other institutions and across underrepresented specialties, supporting early career exploration and skill development.
ADDRESSING THE GAP: IMPROVING RESIDENT KNOWLEDGE OF CONFLICT MANAGEMENT WITH A DISCUSSION-BASED CURRICULUM
Rosheem C Browne, MD, Angela A Guzzetta, MD; University of Texas Southwestern Medical Center
Introduction: From emergency visits to routine wellness checks, research has long demonstrated that the healthcare environment can be stressful for patients. This is particularly true with surgery, which proves to be anxiety-inducing. These psychological factors can lead to high-tension confrontations between patients, their families, and medical staff; however, there is a paucity of dedicated conflict management training in resident physician curricula. Therefore, the purpose of this “Angry Patient” session was to address this gap by introducing its audience to managing conflict in a low-stakes environment and providing them with the tools to navigate these situations.
Methods: Using Kern’s 6-step approach, we developed an interactive, discussion-based curriculum focused on simulated interactions with angry patients and/or their family members. The curriculum was completed in a single one-hour session by new first-year residents and included common triggers for a patient’s anger, as well as verbal and non-verbal signs of escalation. It also introduced the “SPIKES” protocol and verbal and non-verbal de-escalation techniques, then allowed residents to roleplay in pairs using scripted scenarios. Participants completed pre- and post-curriculum surveys to assess their knowledge, as well as a Likert scale to gauge enjoyment of the session. Statistical analysis was performed with the Wilcoxon signed-rank test; a p-value of <0.05 was considered significant.
Results: Forty-one residents completed the pre- and post-curriculum surveys and the Likert scale. Residents demonstrated a significant increase in their knowledge of anger triggers, early signs of aggression, and recognition of poor outcomes associated with angry patients (p<0.01). They also demonstrated a significant increase in their knowledge of verbal and non-verbal de-escalation techniques and communication frameworks for managing an angry patient (p<0.001). The Likert scale responses indicated that the residents enjoyed the session overall and felt it had improved their knowledge.
Conclusion: The curriculum significantly increased residents’ knowledge on the management of angry patients and was very well-received. Future directions include incorporating practice sessions with standardized patients and eventual evaluation of actual resident interactions with patients and their outcomes. Ultimately, we hope this curriculum will aid in improving physician-patient interactions.
THE REALITIES OF ENTERING SURGICAL EDUCATION ADMINISTRATION: INTERVIEWS WITH EDUCATION DIRECTORS
Faith Kehinde, Eliza B Littleton, PhD, Vaishali Schuchert, MD, Anthony R Cyr, MD, PhD; University of Pittsburgh School of Medicine
Research describes the qualifications, demographics, and career pathways of Program directors, Associate program directors, and Clerkship directors (Amersi et al. 2013; Fishman et al. 2018), but not what new faculty have to learn to take on these roles and how they achieve it. Our goal was to explore administrators’ knowledge so that future curricula can be designed to align with their expertise and experiences.
Method:
Semi-structured interviews were conducted to describe participants’ administration expertise. Questions were designed to address the following categories: participants’ “Journey and motivation”; “Day-to-day realities”; “Challenges and rewards”; “Leadership and skills”; “Advice to aspiring educators”; and required “Documentation.” Data was subjected to grounded theory and iterative, constant comparison until 100 percent agreement was achieved.
Participants: A convenience and purposeful sampling of education administrators from teaching hospitals and medical schools similar in profile yielded two APDs, two CDs, and three Residency/Fellowship directors in Vascular, Trauma/Critical Care, General, and Otolaryngology surgery. Three participants identified as female. Six identified as White and one as Caribbean Islander. Median age was 40.
Results:
Six participants said they fell into the job (“I didn’t plan to get involved in residency education”). Four mentioned that learning was on-the-job (“It was a steep learning curve”). All identified significant gaps in their knowledge (“[residents] have no idea what program coordinators actually do”). All mentioned that the realities of the job imposed higher burdens than expected (“There’s a whole lot more human resources than you could ever imagine”). All participants found learners’ successes rewarding (“helping preliminary residents navigate their careers”). Yet few discussed the education-specific knowledge they used in their roles.
Results revealed the difficult position that participants found themselves in. Not only were there many things to learn, but participants entered with minimal career guidance and preparation, and minimal education focus despite finding education outcomes the most rewarding.
Conclusion:
The transition to program administration involves acquiring knowledge for roles that residents may not have explored or prepared for. Local, formal curricula based in the insights and knowledge of expert administrators are needed.
THE GROWING MOMENTUM OF LEADERSHIP EDUCATION IN GENERAL SURGERY TRAINING: A SYSTEMATIC REVIEW
Baila Maqbool, MD, FACS1, Arshia Jahangir2, Murtuza Hassan, MD3, Muhammad Taha Nasim2, Shaikh Saif Ur Rehman2, Muhammad Uzair Qureshi, MD2; 1University of New Mexico, 2Aga Khan University, 3Northwell Health
Leadership is a core competency in surgery, critical for guiding interprofessional teams in high-stakes environments such as the operating room and trauma bay. While competency frameworks mandate leadership development during residency, training opportunities remain variable and inconsistently evaluated. This systematic review summarizes published curricula on leadership training for general surgery and subspecialty residents.
A systematic search identified studies describing leadership development interventions for surgical trainees. Data were extracted on study characteristics, intervention design, delivery methods, curriculum content, and evaluation strategies. Outcomes were synthesized narratively with emphasis on effectiveness and educational approaches.
Nineteen studies published between 1987 and 2024 were included. Most originated from the United States, with additional contributions from Australia and Canada. Interventions targeted a range of trainees from interns to fellows, with participant numbers ranging from 8 to 180. Curricula varied in duration, from single-day workshops to multi-year longitudinal programs. Delivery methods included lectures, case-based discussions, simulations, coaching, and hybrid models. Early curricula emphasized practice management and career preparation, whereas more recent initiatives focused on non-technical skills, resilience, diversity, and inclusivity. Curricular content was grouped into practice readiness, non-technical skills, professional and personal development, and career development. Most programs provided protected time, and about half mandated participation. Evaluation was predominantly via post-session surveys, though some incorporated validated tools such as the Internal Strength Scorecard, NOTSS, and structured video assessments. Participants consistently reported improved confidence, leadership behaviors, and team communication. Randomized studies demonstrated significant gains in leadership performance during simulated and real clinical settings.
Leadership training for surgical residents has evolved from management-focused lectures to interactive, competency-driven curricula. While evidence shows consistent learner benefit, the literature remains limited by reliance on self-reported outcomes and heterogeneity in evaluation methods. Future efforts should prioritize rigorous assessment, longitudinal follow-up, integration across surgical specialties and incorporation of artificial intelligence. Embedding structured, evidence-based leadership training into residency is essential for preparing surgeons to lead interprofessional teams effectively, improve patient outcomes and foster resellience in the next generation of surgeons.
BRIDGING THE GAP: IMPROVING SURGICAL RESIDENT PREPAREDNESS FOR PALLIATIVE AND END-OF-LIFE CONVERSATIONS
V Rozen, MD, O Llaguna, MD; Memorial Healthcare System
Background:
Surgical trainees frequently encounter serious illness conversations and end-of-life (EOL) discussions, yet most receive minimal formal training in these essential communication skills. Despite the increasing role of surgeons in managing terminal and complex patients, palliative care education remains underrepresented within general surgery curricula. Recognizing this gap, our study sought to assess residents’ comfort, awareness, and prior training related to palliative care and to use these insights to inform the development of a targeted educational curriculum.
Methods:
A mixed-methods needs assessment was conducted among general surgery residents (PGY 1–5) at a single academic institution. Qualitative data were collected through surveys exploring key domains such as comfort level in discussing poor prognosis or goals of care, awareness of palliative care services, and previous formal instruction in EOL communication. Thematic analysis identified common emotional, educational, and systemic barriers to engaging in these conversations. Based on these findings, a structured surgical palliative care curriculum will be developed. A post-curriculum survey is planned to evaluate changes in resident comfort, communication effectiveness, and perceived preparedness.
Results:
A total of 20 of 30 residents (66%) completed the pre-curriculum assessment. Most respondents (45%) reported feeling only somewhat comfortable discussing goals of care with terminal cancer patients. While 55% strongly agreed that they know when to involve palliative care for surgical oncology patients, only 55% somewhat agreed they had received adequate training in delivering bad news. Importantly, 50% strongly agreed that they would benefit from additional structured education in palliative and EOL communication.
Conclusion:
Despite routinely managing critically ill and terminal patients, most general surgery residents lack confidence in key domains of surgical palliative care and express a strong desire for formalized training. Our findings underscore the need for integrating structured palliative care education into surgical residency programs. Implementation of a dedicated curriculum has the potential to enhance communication skills, patient-centered care, and trainee preparedness for complex clinical discussions.
RESIDENT-DESIGNED AND LED TECHNICAL SKILLS CURRICULUM IMPROVES CLERKSHIP READINESS AND ENGAGEMENT FOR THIRD-YEAR MEDICAL STUDENTS
Jessica R Santos-Parker, MD, PhD1, Keli S Santos-Parker, MD, PhD1, Jessica Santhakumar2, Chelsie Anderson, MD1, Sabreea J Parnell, MD1, Hueylan Chern, MD1, Jessica Gosnell, MD1, Mathhew Lin1; 1Department of Surgery, University of California San Francisco, 2University of California San Francisco School of Medicine
Background: Resident teaching is an essential component of surgical education, yet residents are seldom the primary architects of clerkship curricula. We developed a surgery resident–designed and led technical skills session aligned with the skills expected of third-year medical students during their surgical clerkship.
Methods: Surgical resident simulation education fellows redesigned a two-hour technical skills session for third-year medical students starting their surgery clerkship. Developed in collaboration with clerkship and surgical simulation faculty leadership, the curriculum emphasized skills students are expected to perform on rotation. The revised session included three rotating stations: (1) knot tying, (2) deep dermal suturing, instrument ties, and running subcuticular closure, and (3) drain stitch placement and introduction to laparoscopic instruments and laparoscopic camera handling. All instruction was delivered by surgical residents assisted by fourth year medical students. Sessions were held every eight weeks for cohorts of 10–30 students. Clerkship medical students completed an anonymous post-session survey (Likert scale and open-ended questions) immediately after the course assessing overall experience, skill relevance, behavioral takeaways, and session improvement. Qualitative comments were analyzed using thematic analysis.
Results: Among 38 respondents, overall experience was rated highly (median = 5, scale 1–5; 1 = Very negative, 5 = Very positive), and all hands-on stations received top scores for helpfulness (median = 1). Interest in surgery increased moderately (median = 3, 1= not at all, 5 = extremely). Qualitative analysis revealed three dominant themes: (1) authentic skill relevance: appreciation for tasks mirroring clinical expectations; (2) safe, mentored learning environment emphasizing resident instruction and approachability; and (3) behavioral change, including improved knot tying technique, suture handling, and laparoscopic camera control. The most frequent suggestion was to allot more time or offer multiple sessions.
Conclusion: A resident-designed and led surgical skills session aligned with clinical responsibilities is valued by students, enhances perceived preparedness, and increases engagement in surgery. Empowering residents as curriculum leaders offers a scalable, learner-centered model complementing traditional faculty-led approaches and may strengthen early surgical education.
DO TRAINEES OR ATTENDINGS KNOW THE COST OF CARE? A MULTI-DISCIPLINARY ANALYSIS
Rachel Davis Bouvette, MD, Heather C Grubbs, MD, Arthur D Grimes, MD, Jason S Lees, MD, FACS, Sarah Grimes, MD, Brian W Cross, MD, Morgan M Bonds, MD, Chance A Nichols, MD, FACS, Alessandra Landmann, MD, Jeremy J Johnson, MD, FACS, Alexander R Raines, MD, FACS, Kristina K Booth, MD, FACS, Frank C Wood, MD; University of Oklahoma Health
Background: The cost of healthcare has become a prominent topic in national media, politics, and healthcare systems. Healthcare clinicians are impacted by systemic efforts to reduce costs with changes in supplies, billing practices, and pressure to expedite patient discharge. We hypothesize that physicians – both faculty and trainees– have limited knowledge of the cost of care they are providing.
Methods: Following informed consent, a survey was administered to faculty and trainees in the Departments of Surgery (GS), Obstetrics and Gynecology (OB), and Urology (URO) at a single academic tertiary care center. Participants estimated the cost of three laboratory studies (complete blood count, basic and complete metabolic panels), two imaging studies (one-view chest x-ray and computed tomography of the abdomen/pelvis with intravenous contrast), and two specialty-specific procedures. These estimates were compared against 2025 Medicare payment rates for all operations and FairHealth Cost Estimates for all inpatient laboratory and imaging tests and mean absolute error (MAE) calculated to assess accuracy.
Results: 117 participants completed the survey, with the majority being trainees (63.2%). All three departments were well-represented with trainee response rates of 89.7% (GS), 92.0% (OB), and 84.2% (URO). Overall, clinicians overestimated costs on average, with normalized mean absolute percentage error (MAPE) ranging from 92.7% (CBC) to 254.8% (Procedures). No difference in MAPE was seen between faculty and trainees when estimating cost of procedures (184.8% vs. 265.3%, p=0.267). Similar proportions of participants overestimated laboratory and imaging studies regardless of trainee level or specialty. However, significant differences were seen in both rates of overestimation and MAPE of procedures when stratified by specialty (Figure 1). OBGYN participants were most likely to overestimate cost of procedure (76.9%), followed by GS (45.7%) and URO (30.0%, p<0.001). OB participants also demonstrated the highest MAPE for procedures, demonstrating lowest accuracy among the specialties.
Conclusion: Clinicians across all training levels are expected to help reduce hospital system costs; however, they lack understanding of the cost of care they are directing. Our findings highlight a knowledge gap in both our trainees and their supervising physicians, identifying the opportunity for department-specific education on cost of care at academic centers.
