Poster Session II - Curriculum Development
Background
Robotic-assisted surgery has become an integral part of modern surgical practice and education, demanding comprehensive training and assessment for resident surgeons. This study aims to evaluate the enhancement of robotic skills in general surgery residents as they engage in a robotics curriculum during their Thoracic Surgery rotation. This curriculum places a strong emphasis on simulation, video-based learning, and hands-on experiences, incorporating the GEARS evaluation tool.
Methods
Ten general surgery residents participated in this study, representing various Post-Graduate Year (PGY) levels: two PGY-1, three PGY-2, three PGY-3, and two PGY-4. They actively participated in a structured training program during their thoracic rotation, which included monthly lab sessions focused specifically on the deconstruction of a hiatal hernia repair. The Global Evaluative Assessment of Robotic Skills (GEARS) evaluation tool was employed to assess their proficiency in robotic surgical skills. On average, there was an approximately three-month interval between these training sessions and evaluations. Data analysis was carried out using the Paired Sample T-test to assess the significance of skill improvement between two distinct sessions.
Results
A comparison of the mean skill scores from the first session to those of the second session revealed a statistically significant difference (p < 0.01). Notably, significant differences between the two lab sessions were observed in individual skill types, particularly in the areas of Force Control (p: 0.041) and Robot Control (p: 0.044).
Conclusion
This study highlights a substantial improvement in robotic surgical skills among general surgery residents during their thoracic surgery rotation, particularly in their ability to perform a robotic deconstruction of hiatal hernia repair. Notably, the analysis reveals significant enhancements in specific skill types, such as force control and robot control, following the second lab session, along with the mean GEARS scores per skill. These findings underscore the critical importance of structured, hands-on training and objective evaluation in the education of surgical residents. Combined with the cumulative effect of participating in the second session, this led to a significant overall enhancement in the residents' robotic surgical skills.
Background: A standardized robotic curriculum for colorectal surgery (CRS) fellows was implemented in 2011. General surgery (GS) resident robotic training has increased in recent years and the impact on adoption of robotic CRS during and after fellowship is currently unknown. The purpose of this study was to describe colorectal robotic training exposure during GS residency and the impact on adoption during and after CRS fellowship.
Methods: An anonymous, internet-based survey was sent via Qualtrics® to colorectal surgeons who graduated from ACGME-accredited CRS programs between 2014 and 2022. Respondents were asked to provide information on training curriculum, experience, and practice during GS residency. Study variables were summarized using frequencies and proportions.
Results: 129 eligible respondents were included. Almost twice as many 2021 CRS fellowship graduates had formal robotic training during GS residency (66.7% vs 35.0%) and almost 4-times as many received a Robotic Training Equivalency Certificate (38.1% vs 10.0%) when compared to those graduated prior to 2016. Desired areas for more exposure during GS residency were intracorporeal anastomotic techniques (60.5%), robotic CRS (59.7%), medical to lateral dissection approach (32.6%) and laparoscopic CRS (31.8%). For CRS fellowship graduates prior to 2016, 70.0% did not have robotic experience during their GS residency (compared to 8.0% of 2021 graduates) and only 20.0% had performed ≥10 robotic cases (compared to 57.1% of 2021 graduates). Of those with no robotic colorectal training during GS residency, 27% did ≥50 cases during fellowship and 36% did ≥25 cases 1-year after fellowship. Of those with ≥25 robotic colorectal procedures during GS residency, 60% did ≥50 cases during fellowship and 50% did ≥25 cases 1-year after fellowship. Open, laparoscopic, and hand-assist laparoscopic experience during GS residency remained stable over the study time period.
Conclusion: General surgery residents are increasingly more experienced with robotic colorectal surgery and are better prepared for the robotic CRS fellowship training curriculum. Further research to implement the desired areas for more exposure during GS residency and understand the impact that increased robotic training during GS residency has on the adoption of robotic surgery during and after CRS fellowship are warranted.
INTRODUCTION:
Concomitant laparoscopic common bile duct exploration (LCBDE) with cholecystectomy for choledocholithiasis reduces cost and length of stay but is seldom utilized in deference to endoscopic retrograde cholangiopancreatography. We aimed to identify current learning practices to guide development of educational programs to increase concomitant use of LCBDE. This process could be generalized for incorporating other new techniques by practicing surgeons.
METHODS:
A survey designed and piloted by content experts was distributed to the membership of Society of American Gastrointestinal and Endoscopic Surgeon (SAGES) members and the American Association for the Surgery of Trauma (AAST). Descriptive statistics and chi squared tests were used to analyze survey results.
RESULTS:
Of the 726 respondents, 543 US surgeons performed laparoscopic cholecystectomy (7.3% response rate of the total society US memberships). 47% of respondents performed LCBDE in residency and 27% participated in a course. Surgeons who attend LCBDE courses are significantly more likely to utilize LCBDE in their practice (50%) than those who did not complete a course (20%) (p-value = 0.0001). Of those who performed LCBDE in residency, only 27% currently utilize the technique, while 30% of those without residency exposure performed LCBDE in practice (p = 0.30). 50% of surgeons noted that they most frequently hear about new technologies/procedural techniques from conferences/courses but when introducing new techniques into practice, the most utilized resources were much more heterogeneous with conferences/in-person courses (38%), partners (22%), online media (19%), and device representatives (17%) being most common (Figure 1). A majority (57%) preferred multimodal learning experiences.
CONCLUSIONS:
Residency exposure to LCBDE and courses do not assure its utilization in clinical practice. To increase utilization of LCBDE, learners and educators must ensure that knowledge gained through these means can be successfully incorporated into practice by implementing multifaceted solutions such as longitudinal mentoring through experts, maximizing local resources such as device specific instructions and carts, and incorporating a more experienced surgical partner. Understanding this critical gap between exposure and implementation and building strategies to overcome it, can be generalized to other novel surgical techniques and technologies when they are being introduced into practice.
Introduction: The operating room can be a stressful learning environment for medical students as operating room (OR) teams focus on patient care needs. Prior studies suggest that medical students may feel disengaged in the robotic operating room, the degree to which is unknown in contrast to open and laparoscopic surgery. This study assessed students’ experiences across these modalities and identify opportunities for areas of improvement in the operating room learning environment.
Methods: A survey assessing medical students’ perceptions of the operating room learning environment within three operative modalities was distributed nationally at three medical schools based on convenience sampling. Items addressed student engagement, feeling part of the team, teaching, view of operative field, and overall educational value of open, laparoscopic, and robotic operative modalities. Responses were captured on a four-point scale. Responses for the three modalities were analyzed with a chi-square for related samples.
Results: Among the 97 respondents (27% response rate), significant differences were observed between multiple learning environment domains. The percentage of students that felt engaged in the case was significantly different between modalities (p<0.001), comparing open (92%), laparoscopic (77%), and robotic (26%) operating rooms. There was a significant difference in the proportion of students feeling part of the team; 94% in open, 68% during laparoscopic, and 26% in robotic (p<0.001). The percentage of students who felt visibility was acceptable was 79% for robotic, compared to 68% in laparoscopic, and 62% in open (p<0.03). The percentage of students reporting teaching by attendings, and trainees was significantly different across modalities, 92% for open, 86% for laparoscopic, and 36% for robotic. The percentage of students reporting high educational value was significantly different between open (85%), laparoscopic (68%) and robotic (35%) cases.
Conclusions: Medical student learners identified differences in their experiences across open, laparoscopic, and robotic surgical modalities. Robotic surgery offers improved visualization, however students consistently reported more limitations to their learning than the other two modalities. These findings underscore the need to develop novel educational strategies to enhance the robotic learning environment for students.
Intro
Surgeons experience both acute and chronic musculoskeletal pains over the course of their careers, which can result in decreased work performance, shortened career longevity, and increased burnout. While emerging evidence has investigated retrospective pain modulation, there is little evidence investigating proactive interventions implemented at the beginning of a surgical career, especially prophylactic interventions at the trainee level. Our aim is to investigate the impact of an early intervention educational program on general surgery residents in reducing surgery related pain.
Methods
A single independent academic institution, in collaboration with a licensed physical therapist., introduced an early-intervention ergonomics curriculum. The curriculum consisted of a 2-hour formalized lecture with emphasis on physiology and surgeon ergonomics. This was followed with an in-person demonstration of self-directed techniques with feedback. All participants completed validated MSK and pain surveys pre-intervention (time zero) and post-intervention (6 weeks). Descriptive statistical interpretation was performed.
Results
6 of 7 general surgery residents completed the curriculum and the validated instruments (85.7% response rate) over 6 weeks. All participants reported improvement and increased awareness in surgery-related pains. 66.7% of residents reported increased confidence in self-management of pain. Neck pain was the predominant pain (83.3%) followed by back pain (50%) then wrist pain (16.7%). Residents reported utilizing self-directed modalities on average 1-2 times per week (50%). Self-massage equipment was the most frequently reported modality, while ice and heat were the least utilized method.
Discussion
An early intervention ergonomics program improved awareness, confidence, and competence to mitigate career-induced MSK pain; similarly, this curriculum also improved multiple measures among surgery residents using validated instruments. This study demonstrates that education on ergonomics and self-directed care can affect surgical residents’ awareness, skills, confidence, and commitment to early intervention for primary prevention of surgery related pain based on their participation. Future direction will emphasize a hybrid approach by evaluating the efficacy of a hands-on therapeutic arm for personalized, targeted treatment.
Purpose:
Point of care ultrasound (POCUS) curricula is increasingly taught in medical school, leading to growing familiarity of matriculating general surgery residents with POCUS examinations. The prior experience and competency of incoming surgical interns on preoperative neck endocrine ultrasound (PNEU) is, however, unclear. Our objective was to perform a skills-based needs assessment of surgical interns to inform the development of an endocrine POCUS curriculum.
Methods:
Surgical interns were surveyed regarding prior exposure to POCUS curricula in medical school, including thyroid/parathyroid ultrasound content and specific exposure to preoperative neck endocrine ultrasound. Interns were then asked to perform PNEU examination on a standardized patient with a Butterfly iQ+ ultrasound probe. A PNEU competency checklist (PNEU-C) was used for performance evaluation. The Thyroid Ultrasound Proficiency Scale, an existing tool developed via a multidisciplinary Delphi approach, was used as the basis for the PNEU-C. The PNEU-C was then further modified through input of local PNEU surgeon experts. The PNEU-C assesses competency in four categories: patient positioning, probe handling and technique, visualization and evaluation of anatomy, and measurement, including thyroid lobe volume and isthmus thickness.
Results:
Twenty surgical interns participated in our needs assessment. 85% reported participation in a formal POCUS curriculum in medical school, with 17.6% reporting inclusion of thyroid/parathyroid ultrasound content. 40% of participants reported prior exposure to PNEU, either by observing or assisting in the clinical setting, but none had previously performed PNEU examination independently. The average participant score on the PNEU-C was 52.5% (range 22.7%-86.4%, median 52.2%). None of the participants demonstrated competency in visualization and identification of the vocal cords or in measuring thyroid lobe volume.
Conclusion:
Our findings demonstrate that surgical interns have limited prior exposure to and lack of competency on PNEU despite previous participation in dedicated POCUS curricula in medical school. Thus, a need exists for the development of a PNEU competency based POCUS skills curriculum. Our needs assessment also identified areas of focus for our curriculum, including identification of vocal cords and thyroid lobe volume measurement.
Background: Concerns exist about clinical and operative skill decay in surgery residents when they dedicate time away from clinical training to pursue research. However, it remains undetermined how to best prevent these negative impacts. Our study evaluated the perspectives of surgical research residents on interventions to improve their reentry into clinical training.
Methods: An anonymous web-based survey was distributed between 5/01/2023 and 6/01/2023 to 112 current and former general surgery research residents from four academic medical centers in Boston, MA.
Results: Survey response rate was 35.3% (36/102 residents). 22 of 36 residents (61.1%) felt that their clinical aptitude decreased during the research years, whereas 33 of 36 (91.7%) reported reduced surgical skills. Residents who did not feel that their clinical and surgical skills decreased were the ones that moonlighted 1-2 times/week or more and operated often during moonlighting.
When reflecting on their re-entry to residency, former research residents reported feeling anxious and less confident (3.84/5 on a 1-5 Likert scale) as well as being below the expected level of clinical performance (3.42/5). Most of them (12 of 17; 70.6%) reported that it took up to 6 months, whereas 5 of them (29.4%) up to 12 months to feel at the expected level. When compared to non-moonlighting residents, those who moonlighted every week, reported less anxiety, higher confidence, and a quicker return to the expected level of performance.
Respondents reported that their residency programs do not offer continued clinical training and assessment of their residents during the research years or any preparation for reentry to clinical residency.
When considering how to improve the clinical re-entry of research residents, interventions proposed included individualized development plans for 3 months before returning to clinical training (69.4%), established curriculum for clinical work throughout the research years (38.9%), clinical preceptorships throughout the research years (27.8%), and simulation curriculum throughout the research years (25.0%).
Conclusions: General surgery residents feel that their clinical and surgical skills decreased during the research years, leading to anxiety and lack of confidence when returning to residency. Therefore, comprehensive interventions are needed to improve the reentry of the research residents into clinical training.
Introduction: We have reported that cognitive bias (CB) is associated with an increase in surgical management errors, a decrease in the standard of care, and a 1.6-fold increase in the severity of harm sustained1. This study prospectively evaluated the relationship between complication identified cognitive biases and specific “debiasing” strategies that would have mitigated the error.
Methods: We used a validated relational database, the Morbidity and Mortality Adverse Event Reporting System (MARS), to prospectively track surgical complication data concurrent with patient care. Complications are evaluated across multiple domains, including error (diagnosis, technique, judgment), Clavien Dindo scores, standard of care, CB, and four types of “debiasing” strategies. Data was reviewed weekly by a panel of supervising attending surgeons.
Results: From 12/2020 to 10/2023, 17474 general surgery and vascular cases sustained 2129 complications (CR = 12.8%) and 51 deaths among 822 patients (MR = 6.2%). CB was attributed in 53% (437/822) of cases with complications, and 614 CBs were identified. The incidence of debiasing strategies chosen (consider alternative/differential dx, replace Type I with Type 2 thinking, promote linear reasoning, and workflow improvement) was 44.1%, 34.2%, 12% and 9.7% respectively.
Conclusion: These data suggest that routine assessment of CB and identification of potential “debiasing” strategies, such as, diagnosis review and replacing Type I thinking with Type II thinking may impact 78% of cases with surgical complications. Understanding the relationship between CB and specific “debiasing” strategies may prove useful in educating residents and providers on how to mitigate their potential negative impact.