ASE 2024 Abstracts

ePoster

FACTORS ASSOCIATED WITH SELF-REPORTED SKILL COMFORT FOR MEDICAL STUDENTS IN A LONGITUDINAL INTEGRATED CLERKSHIP
Dalton Hegeholz, MD, Ting Sun, PhD, Gabrielle Moore, MD, M. Libby Weaver, MD, Kirstyn E Brownson, MD, Motaz Selim, MD, Kshama Jaiswal, MD; University of Utah

Background:
Early clinical exposure influences both perceived competence and career interest among medical students. Within surgical education, structured and repeated exposure to operative and procedural environments may enhance comfort in technical and cognitive skills. This study aims to examine the factors influencing students’ self-perceived comfort with surgical skills after participating in a longitudinal integrated clerkship (LIC) at a single institution.

Methods:
A cross-sectional survey was administered to 123 medical students who completed a LIC and were entering their third year of medical school. The instrument collected data on pre-LIC and post-LIC career interest, perceived comfort in eight core surgical skills (Figure 1) as well as the setting of exposure (e.g., clinical, didactic learning, independent study) to ten core disease processes. Descriptive statistics summarized exposure frequency and self-reported skill comfort. Correlation analyses explored the relationships between career interest, variety of clinical exposure, and perceived comfort in surgical skills. Logistic regression was performed to assess whether increased exposure predicted higher odds of comfort in individual skills.

Results:
Of 120 respondents (response rate 98%), 118 answered career interest questions and 119 answered skill confidence and disease exposure questions. Respondents reported the most comfort with gowning and gloving (98.3%), forceps handling (83.3%), needle driver handling (80.0%), instrument tying (83.3%) and simple interrupted suturing (75.0%). Fewer students reported comfort in one-handed tying (50.8%), two-handed tying (62.5%) and mattress suturing (37.5%). Logistic regression indicated a greater number of different disease exposures (i.e. direct patient care experiences) in the clinical environment was associated with higher odds of comfort in six of eight skills (Figure 1). Surgical interest increased odds of reporting comfort in simple interrupted suturing (p = 0.02), one-handed tying (p < 0.001) and two-handed tying (p = 0.02) compared to those interested in non-surgical fields.

Conclusions:
Increased variety of direct patient care experiences was positively correlated with reported surgical skill comfort among medical students. Those interested in surgical careers were more likely to express comfort in multiple skills. These findings underscore the importance of providing diverse surgical learning experiences to promote skill acquisition for medical students.

LEARNING TO DOCUMENT OPERATIVE REPORTS IN SURGICAL RESIDENCY: PARTICIPATION, PERCEPTIONS, AND PATHWAYS FORWARD
Catherine P Evans¹, Alexandra Theall¹, Jamila K Picart, MD, MSc², Benjamin D Ferguson, MD, PhD²; ¹University of Michigan Medical School, ²Department of Surgery, University of Michigan

Background: Operative reports are essential medical documents that ensure patient safety, provide medico-legal documentation, communicate important surgical information, and serve as valuable educational tools for surgical trainees. Despite the medical and educational significance of operative documentation, resident education and engagement with operative report documentation (ORD) varies widely across institutional contexts, leaving many trainees underprepared for this aspect of independent practice. This study evaluated general surgery resident educational exposure to, participation in, and attitudes toward ORD to identify opportunities to enhance teaching and learning around this critical component of surgical practice.

Methods: A web-based survey was distributed via email to 1,570 residents at 35 general surgery residency programs across the United States in October 2025 to assess residents’ clinical and educational involvement with ORD. Respondents’ participation trends and attitudes were assessed using 5-point Likert scales (1 = worst, 5 = best). Descriptive statistics were generated to identify trends and gaps in surgical resident education. 

Results: Among 299 respondents (19.0% response rate), 268 (89.6%) were categorical general surgery residents, and 165 (55.2%) were affiliated with University-based training programs. 94.3% of residents reported having documented at least one operative report during training, though only 35.8% received any formal education from their training program. The majority of residents reported that learning about ORD is important during training (97.0% “very important” or “somewhat important”) and for readiness for independent practice as an attending surgeon (96.0%; Figure 1a). Furthermore, respondents reported that participating in ORD enhances their familiarity with surgical procedures (95.0% “strongly enhances” or “somewhat enhances”), surgical recall (91.4%), and the quality of their surgical education overall (74.9%) without positively or negatively impacting clinical duties (51.8% “does not impact”), other educational experiences (66.0%), or resident burnout (55.5%; Figure 1b).

Conclusion: A significant gap exists between trainee participation and education in ORD within general surgery residencies. Resident perspectives suggest that developing targeted curricula to address this unmet need may enhance learning outcomes and promote trainee preparedness without detracting from the clinical experience. Future research is needed to identify effective, learner-centered curricular interventions to address this educational opportunity.

IMPROVING THE SURGICAL CLERKSHIP LEARNING ENVIRONMENT: RESULTS OF A SINGLE CENTER CURRICULUM REDESIGN
Ezra S Brooks, MD¹, Jillian K Wothe, MD¹, Douglas S Smink, MD, MPH², Reza Askari, MD¹, Mohamad A Hussain, MD, PhD¹, Nancy L Cho, MD¹; ¹Brigham and Women's Hospital, ²Brigham and Women's Faulkner Hospital

Introduction

The surgical clerkship learning environment (LE) is instrumental to medical student education and specialty recruitment. We sought to evaluate the impact of targeted changes on the clerkship LE in response to feedback from students and teaching faculty.

Methods

Between July and December 2022, the surgery clerkship at a single academic institution was redesigned with changes focused on recruiting core teaching faculty, improving their  engagement and professionalism, as well as updating the didactic curriculum content and standardizing student feedback. Standard medical student institutional summative evaluations of their surgery clerkship LE were de-identified and aggregated. Ten survey metrics were included for analysis. Survey items were grouped into the following categories: feedback, inclusivity, patient care, and professionalism. The evaluations were split into two periods, before (July 2020-June 2022) and after (January 2023-September 2024) the implemented changes. Evaluations were compared across time periods using the Chi-square test.

Results

We collected 202 student evaluations, including 109 before and 93 after the changes were implemented with a minimum item response rate of 93.1%. Following clerkship changes, students reported significant improvement in “constructive feedback” (59% vs 43%, p=0.04) and “respect for diversity” (90% vs 77%, p=0.01). Several items evaluating faculty delivery of patient care improved including “respecting patient dignity” (87% vs 75%, p=0.03) and “showing empathy” (81% vs 61%, p=0.002). Within professionalism, while ratings of “respect for other professions” (76% vs 62%, p=0.03) and “respect for other specialties” (72% vs 55%, p=0.02) improved, there was no significant improvement in other metrics including “respect for students” (75% vs 67%, p=0.18), “professional language” (74% vs 67%, p=0.26), and “resolving conflicts with dignity” (85% vs 78%, p=0.25).

Conclusions

In this single center clerkship redesign, we demonstrated significant improvements in the LE across multiple dimensios including feedback, inclusivity, patient care, and professionalism through targeted interventions. Further curriculum innovations should continue to focus on feedback to improve LE metrics and encourage ongoing engagement between students and teaching faculty.

PATHOLOGY FOR SURGEONS AND RADIOLOGISTS: A SIMULATION-BASED INTERDISCIPLINARY CURRICULUM BRIDGING COMMUNICATION AND KNOWLEDGE GAPS IN BREAST CANCER CARE
Sin Yee (Amelie) Lim, BS¹, Tara Krishnan, MD², Kareem Hosny, MD, MBBCh, MPH², Mark R Kilgore, MD², Diana L Lam, MD³, Farin Amersi, MD⁴, Areti Tillou, MD⁵, Estell J Williams, MD⁶, Emily Palmquist, MD⁶, Kenechukwu Ojukwu, MD, MPP, MS⁷; ¹David Geffen School of Medicine at UCLA, Los Angeles, CA, ²Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, ³Department of Radiology, University of Washington School of Medicine, Seattle, WA, ⁴Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, ⁵Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, ⁶Department of Surgery, University of Washington School of Medicine, Seattle, WA, ⁷Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA

Background

Surgical specimen errors compromise patient safety, occurring in up to 1% of specimens, primarily driven by communication breakdown, inadequate labeling, and knowledge gaps in pathology workflows. Despite the high-stakes nature of intraoperative decisions involving specimen handling, margin assessment, and frozen section requests, surgical trainees receive minimal formal education about the specimen management process. This forces surgeons to learn through trial and error, contributing to diagnostic delays, repeat procedures, and suboptimal patient outcomes. Current surgical training models lack structured curricula that bridge the divide between surgical practice and pathology interpretation.

Methods

Since 2023, a yearly simulation-based interdisciplinary curriculum, "Pathology for Surgeons," has been implemented at an academic medical center. A 2-hour specialty-focused edition used breast cancer care as its framework, bringing together surgery, pathology, and radiology trainees. In multidisciplinary groups, they attended four 30-minute sessions: specimen chain-of-custody tracking, managing diagnostic discordance, hands-on grossing of silicone mastectomy specimens for margin assessment, and utilizing intraoperative consultations. Sessions were co-designed and co-facilitated by surgical oncologists, pathologists, and radiologists, with senior residents as peer instructors. Pre- and post-curriculum knowledge was assessed using a 20-question examination that was validated during course design through review and feedback from surgical faculty and residents.

Results

In January 2025, among 47 participants, knowledge scores significantly improved from 14.38 to 16.28 out of 20 (p=0.002), with surgical trainees showing the greatest gains. 68% of participants demonstrated measurable improvement. Qualitative feedback revealed shifting collaborative attitudes; a trainee noted they would "not hesitate to reach out to pathology colleagues with questions." Participants valued the hands-on simulation and real-world scenarios, noting the curriculum taught practical information "that would be hard to learn without someone explicitly teaching it."

Conclusions

This scalable, low-cost interdisciplinary curriculum effectively addresses critical knowledge gaps in surgical training and fosters collaborative mindsets essential for patient safety. By teaching surgeons to understand pathology workflows and communicate proactively with pathologists and radiologists, we can reduce specimen-related errors and improve multidisciplinary cancer care from the trainee level forward.

EXPERIENCES OF VIGILANCE IN GRADUATE SURGICAL TRAINING
Jamila K Picart, MD, MSc, Lauren Szczygiel, PhD, Marquise D Singleterry, MD, Alyssa Pradarelli, MD, Dana A Telem, MD, Hope T Jackson, MD, Gurjit Sandhu, PhD; University of Michigan

Introduction

Due to prior experiences of discrimination, learners from minoritized groups begin to anticipate and ruminate on the potential for future discrimination. Although well-studied in higher education, the detrimental impact of discrimination-related vigilance on learner well-being and retention is understudied in graduate surgical education. While vigilance is a chronic state, heightened vigilance can be disruptive to learner well-being and self-efficacy. We conducted a qualitative study to characterize vigilance in the surgical training environment, aiming to understand how it is experienced.

METHODS

Surgery residents from United States residency programs were recruited via multiple methods, including email, social media, and in-person methods. Using a semi-structured interview guide, we explored residents’ perceptions and experiences of vigilance. One-on-one, in-depth interviews were conducted from May 2025 to October 2025. Data were coded using an iterative, consensus-based codebook developed by a multidisciplinary team. We analyzed coded data using matrix analysis, analytic memoing, and team discussion to identify recurring patterns and themes.

RESULTS

Twenty residents participated (9 cisgender men, 8 cisgender women, 2 gender nonbinary or agender); 14 identified as a race/ethnicity underrepresented in surgery. We identified four themes describing experiences of vigilance during training: (1) Identification: repeated microaggressions and/or overt bias singling out a specific aspect of a learner’s identity or appearance. (2) Recalibration: continuous adjustment of speech, demeanor, and self-presentation to prevent future bias or negative judgment. (3) Check: persistent hyper-monitoring of the environment generated by emotional exhaustion, stress, and diminished professional self-efficacy. Lastly, trainees expressed two interrupters of the process (4a) Burnout/Attrition: undue stress and exiting the cycle due to the impact of heightened vigilance, and (4b) Temporary relief: fostering community and/or belonging to temporarily alleviate the load of heightened vigilance.

CONCLUSION:

Overall, surgical trainees experience heightened vigilance with symptoms of increased cognitive load and decreased self-efficacy. The experience of vigilance without relief lends itself to decreased intention to persist in surgical training, similar to the studies in higher education. Development of interventions to reduce the load and diminished self-efficacy related to vigilance is urgently needed in graduate surgical education.

RECENT TRENDS IN U.S. GENERAL SURGERY RESIDENT WORKFORCE ALLOCATION BY REGION
Zeran Zhang, BS, Luke Phillips, BS, Elizabeth Dauer, MD; Lewis Katz School of Medicine, Temple University

Background

General surgery residency positions are disproportionally concentrated in urban centers, potentially limiting resident case exposure and operative preparedness. As the national per capita supply of general surgeons declines, rural regions have a disproportionately older workforce with insufficient replacement. Residency programs with rural training exposure improves rural retention yet recent trends in regional allocation of the general surgery resident workforce relative to population growth remains poorly defined. We hypothesized that regional differences in general surgery resident workforce allocation do not align with population changes across U.S. regions.

Methods

We performed a retrospective review of publicly available data from the National Resident Matching Program and the United States Census Bureau spanning 2013-2024. General surgery resident workforce is approximated by entering residency positions per capita. Regions are defined according to FREIDA AMA Residency & Fellowship Programs Database. The strength and direction of a linear relationship between percentage change in entering general surgery residency positions per capita and percentage change in population from 2013-2024 was assessed by Pearson Correlation Coefficient. Differences in these percentage changes were assessed by paired t-tests. 

Results 

The national mean percentage change in entering residency positions per capita and population from 2013-2024 is 1.35% (SE=0.674, 95% CI: 0.0263- 2.67) and 0.483% (SE = 0.0809, 95% CI: 0.325- 0.642), respectively. There is no statistically significant difference between workforce changes and population changes per region from 2013-2024 (p>0.05). New England shows significant linear decline in entering residency positions per capita (R²=0.751, p<0.001) over time whereas Mid Atlantic, East North Central, South Atlantic, and Mountain regions show significant linear growth (0.727<R²<0.910, p<0.001). 

General surgery resident workforce allocation relative to population changes varies by region with East North Central showing the strongest positive correlation (r= 0.629, p=0.0382) and East South Central showing the most negative correlation (r= -0.566, p=0.0697).

Conclusions

Recent U.S. general surgery resident workforce allocation varies by FREIDA region and does not systematically scale with population growth. Heterogeneity in allocation may highlight regional disparities in training environments and access to surgical care.

SURGICAL EDUCATION RESEARCH FELLOWSHIP (SERF JR.): A SUMMER PROGRAM FOR UNDERREPRESENTED UNDERGRADUATE STUDENTS TO PROMOTE MATRICULATION TO A CAREER IN SURGERY
Tasha Posid, MA, PhD, Lisa Cunningham, MD, Megan Leitnaker, Vivian Wong, MD, Emily Huang, MD; The Ohio State University Wexner Medical Center

Introduction: Despite increasing awareness of the need for diversity in medicine, surgical specialties like urology remain one of the least diverse surgical specialties (e.g., only 7.6% of urology resident identify as underrepresented in medicine (URiM)). URiM students often face systemic barriers (limited mentorship, exposure, and access to surgical experiences) that contribute to low representation in residency training and beyond. Few structured interventions exist to address this gap. This novel initiative aimed to implement and evaluate a novel immersive summer fellowship that provides URiM pre-medical students with early exposure to urology, surgical education, and research, with the goal of strengthening the pipeline into surgical specialties.

Methods: This 8-week immersive summer fellowship provided undergraduate students with early exposure to urology/surgery and surgical education research through three integrated components: (1) a weekly didactic series on (a) research fundamentals and (b) pathways to surgery/surgical specialties, (2) mentored research experiences, and (3) immersive clinical shadowing. Participants completed pre- and post-program surveys assessing changes in interest in pursuing surgical careers and self-reported knowledge of the research process.

Results: Twelve undergraduate medical students participated in this pilot program across Urology and General Surgery in Summer 2025. Following participation, students reported an increase interest in specializing in a surgical field (22%, p<0.001), felt more satisfied with their research training to date (18%, p<0.001), felt more satisfied with the amount of exposure to surgery they had received (18%, p<0.001), and felt more satisfied with their current surgical knowledge (16%, p<0.001), with additional gains reported across research topics (Figure 1). Largest gains in content knowledge were seen for writing an IRB protocol / regulatory submission, project feasibility and design, data collection and management, data sources, running statistical analysis, journal selection, and how to give an academic / research presentation (>20%, all ps<0.01).

Conclusion: Preliminary evaluation of this pilot program provides critical insights into the feasibility and impact of an immersive summer fellowship aimed at supporting students’ early engagement in urology and surgical careers. Findings demonstrate increased interest in surgery and improved understanding of the research process, supporting future scale-up of structured pipeline initiatives to enhance diversity in surgical training.

VARIATION IN LANGUAGE OF PERSONAL STATEMENTS AMONG GENERAL SURGERY APPLICANTS
Sabrina Scollar, BA, Gloria Zacharias, MPH, Zeran Zhang, BS, Luke Phillips, BS, Nicolas Trocha, BS, Daohai Yu, PhD, Xiaoning Lu, MS, Elizabeth Dauer, MD, FACS; Lewis Katz School of Medicine at Temple University

Introduction: General surgery applicants are selected for residency interviews based on objective data and subjective review of the components of their application. The personal statement (PS) provides insight into an applicant’s personality and values that may align with a particular program or institutional mission. Since PS review is subjective, it is important to understand how applicant traits may impact language in these narratives. We aim to investigate whether demographic characteristics influence linguistics in PS composition.  

Methods: We performed a retrospective review of PSs for categorical general surgery residency program applicants at a single urban academic program for the 2025 application cycle. Demographic data and licensing exam performance were extracted from the Electronic Residency Application Service database. PS language was evaluated for summary dimensions, language variables, and word categories using linguistic software. Data was analyzed using exploratory descriptive statistics and multivariable logistic regression.  

Results: A total of 1,145 categorical general surgery applicants were included in this study. Tone and clout differed according to age (p = 0.015, p = 0.047) and gender (p = 0.044, p = 0.001), with clout also influenced by passing Step 1 (p = 0.039). Authenticity varied by race (p = 0.002) and passing Step 1 (p = 0.048). Age (p = 0.004) and race (p < 0.0001) predicted use of analytical thinking. Summary dimensions and word categories demonstrated relationships with demographics and exam performances. Multivariable regression showed tone varied by gender, age, and gender–race interactions; analytic thinking by race and Step 2; and clout and authenticity by race, age, and Step 1 (all p < 0.05).

Conclusion: Age, gender, and race influence linguistic expression in general surgery PSs, reflecting patterns of self-presentation in the application process. Recognizing how demographic traits shape linguistic style can enhance systematic evaluation of applicant narratives and support diversity in surgical education.

“I FEEL LIKE I HAVE SOMEONE WHO’S GONNA STICK UP FOR ME”: A QUALITATIVE ASSESSMENT OF UPSTANDER INTERVENTION AMONGST SURGEONS
Amber M Sheth, MD, MPH¹, Lulieth Martinez Gonzalez¹, Natalia Iding, BS², Shannon Cannon, MD², Sarah Jung, PhD¹; ¹University of Wisconsin Department of Surgery, ²University of Wisconsin Department of Urology

Background: The field of surgery has a call to cultivate an inclusive workplace that promotes wellness for both healthcare staff and patients. Upstander intervention, defined as intervening upon witnessing discrimination, is an important technique for responding to mistreatment and fostering an inclusive workplace environment. Prior work by our group demonstrated a need for education around intervention when witnessing discrimination; however, little education is dedicated to helping attending surgeons support the needs of a diverse workforce, despite their being tasked as leaders and teachers in the clinical and operative environment.

Methods: To address this gap and develop an upstander training program for attending surgeons, semi-structured interviews of 20 attending surgeons at four institutions were conducted. We queried institutional climate toward intervening, experiences with prior upstander training, and suggestions for developing an upstander training program. An inductive coding methodology was utilized to determine key themes by four research team members through a constant comparative method.

Results: Participants varied in specialty, stage in career, and demographic characteristics. Only 20% of participants had completed prior upstander training. Participants described departmental climates favorable to upstander intervention and an interest in participating in training. In-person training with case-based learning and role play were preferred modalities. Participants reported various barriers to being an upstander: Personal challenges included uncertainty of the appropriate response and the ability to detect bias, while interpersonal barriers encompassed navigating team dynamics and relationships while responding to discrimination. Structural obstacles to engaging in upstander training included lack of protected time to participate and limited clear endorsement from leadership, highlighting the need for institutional support. Nuanced descriptions of hierarchy and attention to balancing patient care with the needs of minoritized colleagues characterized participant responses.

Conclusions: Our study advances the development of an upstander training program that is relevant to the needs of attending surgeons within diverse and multidisciplinary learning environments. The majority of participants did not have experience with prior upstander training and reported skills gaps and structural barriers to being an upstander. Through the development of an upstander training program, this investigation promotes positive leadership and supports an inclusive culture of surgery.

AUTHORSHIP INEQUITY IN GLOBAL SURGERY LITERATURE
Aiman P Afsar; Mayo Clinic, Rochester

Introduction

 Addressing the overwhelming disparities in access to safe surgical and anaesthesia care in low and middle-income countries (LMICs) remains an important global health challenge. Authorship inequity has been observed in global surgery literature, with overrepresentation of high income countries (HIC) authors and underrepresentation of LMIC authors. Our objective was to understand authorship dynamics and impact of publications from HICs and LMICs concerning unmet surgical needs in LMICs.

 Methods

 A review of papers collected as part of a scoping review addressing unmet surgical needs, barriers, and solutions in LMICs (World Bank Classification), published between 2012 and 2022, across online databases was performed. The country of publication was determined by the first author’s affiliation. Descriptive statistics were used to summarise data.

 Results 

 The final analysis included 1715 articles. The proportion of publications was notably higher from HICs compared to LMICs (53.3% vs 46.7%). The leading HICs contributors were US (28.8%), UK (9.3%), and Canada (4.1%), while South Africa (5.6%), India (5.3%), and Nigeria (4.1%) emerged as the top LMICs contributors. The median impact factor (IF) was higher for HIC publications as compared to LMICs (3.1 vs 2.7). Among the top 10 journals with the highest IF, HIC publications (80.7%) significantly outnumbered those from LMICs (19.7%). The three most commonly addressed specialties for both HICs and LMICs were Reproductive and Child health(RCH), General surgery and Trauma.

 Conclusion 

Increased efforts are required to increase high-quality, impactful research on unmet needs in global surgery from LMICs.

Figure 1- Country of Authors (Main)