Poster Session V - Faculty Development & Leadership
(P032) “ONE MISTAKE IS THE ONLY THING I HAVE TO SHOW FOR IT”: PERSONAL PERFORMANCE WORRY IN SURGICAL RESIDENCY
Jennifer H Chen1, Alyssa Pradarelli2, Julie Evans2, Niki Matusko2, Norah Naughton2, Roy Phitayakorn3, John T Mullen3, Lily Chang4, Melissa Johnson5, Thavam Thambi-Pillai6, Jon Ryckman6, Melissa Alvarez-Downing7, Nell Maloney Patel8, Sebastiano Cassaro9, Felicia Ivascu10, David T Hughes2, Gurjit Sandhu2; 1Baylor College of Medicine, 2University of Michigan, 3Massachusetts General Hospital, 4Virginia Mason Medical Center, 5Gundersen Health System, 6University of South Dakota Sanford School of Medicine, 7Rutgers New Jersey Medical School, 8Rutgers Robert Wood Johnson Medical School, 9Kaweah Health, 10Oakland University William Beaumont School of Medicine
Background: Surgical training is a rigorous and demanding journey often accompanied by feelings of inadequacy and self-doubt. Personal performance worry, defined as concerns over performing poorly in front of others, has not been well studied in surgery. We aimed to explore causes of personal performance worry and ways to mitigate it amongst surgical trainees.
Methods: This was a qualitative study of surgical trainees from nine institutions (4 University-based, 3 Community-based, and 2 Community-based/University-affiliated) from Oct 2023-May 2024. Purposive sampling was used to recruit participants for semi-structured interviews. Transcripts were coded inductively and themes identified using interpretive description methodology.
Results: Of 25 surgical trainees, 52% (13) were female, 52% (13) junior residents (PGY1-3), 28% (7) racial/ethnic minorities, and 48% (12) from non-academic institutions. Majority (23, 92%) reported presence of personal performance worry. Two major themes, sources and protective factors, were identified with four subthemes each. Trainees cited 1) perfectionism, 2) not meeting expectations, 3) judgment of mistakes, and 4) peer-to-peer comparison as major sources of personal performance worry. Learners attributed their tendency to ‘do everything right’ and fear of falling short of expectations as the basis for performance worry. Judgment from residents and faculty for mistakes made and the anticipation of judgment for future mistakes were key perpetrators of performance worry. Trainees overwhelmingly expressed worry over progress in training and whether they were on track compared to their peers. Despite high levels of worry, trainees described four protective factors against performance worry – 1) admitting failures, 2) growth mindset, 3) preparation and setting expectations, and 4) prioritizing patient care. Open sharing of mistakes and persistent desire for self-growth helped reduce performance worry. In stressful operative settings, practicing skillsets outside the operating room and establishing expectations with faculty beforehand were also protective against worry. Lastly, remaining grounded in prioritizing patient care above all else mitigated personal performance worry.
Conclusion: Personal performance worry is highly prevalent in surgical training and stems from multifactorial sources on an individual and interpersonal level. Despite its widespread presence, trainees cited four methods to reduce personal performance worry and subsequently optimize their learning experience in surgical residency.
(P034) PERCEPTIONS OF A GENERAL SURGERY RESIDENCY FAMILY LEAVE POLICY: A SINGLE INSTITUTION EXPERIENCE
Jaimie Chang, D, Melissa Rangel, Sarah Beckwith, Emily Hejna, Andrea Madrigrano; Rush University Medical Center
Background: Although an increasing number of surgical residents are having children during training, many programs lack a formal family leave policy (FLP). Even among programs with FLPs, studies suggest residents are unfamiliar with existing policies. Additionally, the impact FLPs have on non-pregnant peers and the staffing of surgical services has not been studied. We sought to understand the familiarity with and opinions regarding our FLP, as well as its impact on resident workflow.
Methods: The general surgery residency FLP at our institution was created in 2022. In October 2024, an anonymous electronic survey was widely distributed to residents and faculty within the program. The survey was internally validated. An image of our condensed FLP (Figure 1) was embedded in the survey and Likert scales were used to assess familiarity and perceptions. p<0.05 was considered significant.
Results: The response rate was 82.8% (n=48) and 70.2% (n=33) among residents and attendings, respectively. On a scale from 1-10 (least to most familiar), there was no difference between residents and faculty regarding mean familiarity with our FLP (4.3 ± 0.45 vs 4.2 ± 0.54). 43.9% of residents vs 19.4% of attendings (p<0.05) felt that pregnant residents should be removed from the call pool earlier. More residents than attendings felt that the allocated amount of time for parental leave was insufficient (77.3% vs 32.3% p<0.001). While 0% reported that they felt our FLP allows for too much parental leave, fewer than 40% of all respondents agreed that the current policy allows for adequate staffing. 70.8% of the surveyed residents had worked with a pregnant co-resident before, of which 60.4% reported increased duties and 39.4% reported increased work hours on these rotations compared to others.
Conclusions: Our findings suggest that many faculty and residents are unfamiliar with the details of our FLP. Though many residents experienced increased workloads when working with a pregnant co-resident, none felt too much leave was offered. This suggests that more institutional support is needed for affected residents. Finally, compared to attendings, residents favored more parental leave and less call for pregnant residents, highlighting a culture shift within surgery.
(P035) AN INNOVATIVE METHOD FOR A NOVEL TOPIC: MINI-INTERVIEWS TO INVESTIGATE SOURCES OF SURGEON TEACHING SELF-EFFICACY
Jonathan D D'Angelo, PhD, MAEd, Sara Aboelmaaty, MD, Umer Bhatti, MBBS, Mohamed Baloul, MBBS, MD, Ellen L Usher, PhD, Mariela Rivera, MD, Anne-Lise D D'Angelo, MD, MSEd; Mayo Clinic - Rochester
Purpose
Teaching self-efficacy is the belief educators have in their capability to carry out their teaching responsibilities effectively. Stronger teaching self-efficacy has been positively associated with improved teaching outcomes, yet surgical teaching self-efficacy has not been systematically investigated, in part because faculty surgeons often lack availability/time. The first aim of this pilot study was to examine sources of faculty surgeons’ teaching self-efficacy. The second aim was to assess the feasibility of ‘mini-interviews’ as a novel technique for gathering data about surgical education.
Methods
Three-minute ‘mini-interviews’ were conducted with teaching faculty via audio diaries following weekly simulation sessions. Faculty rated their teaching effectiveness and responded to prompts regarding possible antecedents (e.g., “What previous experiences, in training or practice, impacted your teaching today?”). We used thematic analysis and inductive coding to identify sources of self-efficacy noted by surgeons; individual codes were coalesced into broader themes.
Results
Mini-interviews were conducted with 11 teaching faculty (55% Female). Faculty rated their simulation session teaching performance highly (M=7.50/10, SD=.52) basing this evaluation most commonly on perception of learner engagement, along with self-criticism of teaching performance (identifying areas to improve).
We identified three overarching themes as sources of teaching self-efficacy. Most commonly, previous teaching experience with the topic at hand was noted. Second, surgeons based their teaching approaches on what they found most effective when they were learners: “having been a surgical trainee not all that long ago, this is how I enjoyed learning.” Finally, surgeons identified content expertise as a source of self-efficacy. Notably, only one surgeon identified previous training in conducting adult medical education as impactful on their current teaching.
These results additionally suggest that the novel ‘mini-interview’ methodology may be a valuable tool for surgical education research. Faculty were open to short interviews and responses provided nuanced information about how they evaluated their teaching activities.
Conclusion
Surgeons identified previous teaching experience, approaches they found valuable as learners, and content expertise as influential to their teaching capabilities. Notably, training in adult medical education was seldom mentioned. These findings, along with the novel mini-interview methodology, provide fertile ground for future surgical education research.
(P036) ENSURING THE FOCUS OF ATLS IS THE LEARNER: AN ASSESSMENT OF STUDENT AND INSTRUCTOR FACTORS THAT IMPACT THE ADVANCED TRAUMA LIFE SUPPORT WRITTEN EXAM PERFORMANCE
Jaclyn Gellings, MD, Taylor Jaraczweski, MD, Taylor Chen, Danielle Wilson, MD, David Milia, MD, Jacob Peschman, MD; Medical College of Wisconsin
Background: The Advanced Trauma Life Support (ATLS) course serves as a foundational educational experience for surgical residents. While attending physicians traditionally serve as primary instructors, resident physicians increasingly participate as course educators. We analyzed data from our institution to evaluate the effectiveness of resident teachers compared to other instructors.
Methods: We performed a retrospective analysis of all ATLS participants at a single high-volume center during a two-year period. After excluding hybrid/refresher courses and incomplete records, we analyzed exam performance data with a focus on comparing resident instructors to other educators. Primary outcomes included cumulative and topic-specific exam scores. Independent variables included instructor training level (attending vs. trainee), instructor specialty (academic surgeon, community surgeon, emergency medicine), and instructor teaching experience (number of courses taught). Statistical analysis included Mann-Whitney U, Kruskal-Wallis, and Dunn's tests for group comparisons, with linear regression for continuous variables (p < 0.05 significance).
Results: Of 191 students, 48.2% (N=92) were mid-level providers and 51.8% (N=99) were physicians. Emergency medicine (49.7%, N=95) and general surgery (16.2%, N=31) were the most common specialties. There was no difference in average cumulative scores based on student profession. Exam topic scores were significantly higher for the pediatric (95.7% vs 91.5%) and airway (90.1% vs 81.7%) topics when taught by an attending physicians vs trainee (resident or fellow). When looking at instructor profession, average exam scores for pediatrics were significantly higher when taught by community general surgeons (98.6%) compared to academic surgeons (93.6%) or trainees (91.5%, p < 0.001). Instructor experience was associated with higher scores for spine (coef = 0.2, p = 0.037) and airway (coef = 0.43, p < 0.001).
Conclusions: The ATLS course is the leading course available for learning management of complex trauma patients; thus, effective instructors are critical. While slight variations exist in specific topics, resident instructors maintained high educational standards comparable to experienced colleagues, which supports the expansion of resident teaching roles in medical education.
Table 1: Average score of each ATLS exam topic section by instructor profession. Dunn’s test was used to determine binary intra group differences, which are designated with letters. EM = Emergency medicine.
(P037) FOSTERING BELONGING IN SURGICAL CLERKSHIPS: DOES HANDS-ON EXPERIENCE ENHANCE MEDICAL STUDENTS' SENSE OF INCLUSION?
Ace St John, MD, MSCR1, Gifty Kwakye, MD, MPH2, Peter K Henke, MD2, Kirstyn E Brownson, MD3, Brigitte K Smith, MD, MHPE3, Dawn M Elfenbein, MD4, Sarah Jung, PhD4, Yinin Hu, MD1, Stephen M Kavic, MD1, Eric D Strauch, MD1, Gurjit Sandhu, PhD2, Rebecca F Brown, MD1; 1University of Maryland, 2University of Michigan, 3University of Utah, 4University of Wisconsin
INTRODUCTION:
A sense of belonging in clinical environments is essential for medical students’ engagement, learning, and well-being. In surgical clerkships, fostering a supportive atmosphere may enhance educational experiences and interest in surgical careers. This study evaluates medical students’ perceptions of belonging during a third-year general surgery clerkship across multiple institutions, examining the impact of demographics and educational experiences.
METHODS:
Electronic surveys assessing the surgical clerkship environment were distributed to third-year medical students at four academic institutions. The survey included demographic items and Likert-scale questions on teaching quality, team dynamics, and feedback. A composite Belonging Score was created by averaging responses to seven items related to inclusion and team integration. Descriptive statistics, ANOVA for demographic differences, and Pearson correlations with teaching satisfaction and procedural skill opportunities were analyzed in SAS® Studio (significance threshold p < 0.05).
RESULTS:
The composite Belonging Score, created from responses to questions on teaching quality, team dynamics, and feedback, averaged 3.83 (SD = 0.58) across 134 respondents, reflecting moderate-to-high levels of belonging. ANOVA results showed no statistically significant differences in belonging scores by sex (F(2,112)=0.18, p=0.83), race/ethnicity (F(8,112)=0.83, p=0.5802), or their interaction (F(6,112)=1.82, p=0.10).
Correlations revealed that the belonging score was positively associated with satisfaction regarding procedural skills opportunities (r=0.276, p=0.001) and marginally with the amount of teaching received (r=0.171, p=0.05). These findings suggest that practical engagement in procedural skills may enhance students' sense of belonging more effectively than teaching quantity alone.
CONCLUSION:
Our findings suggest that practical engagement in procedural skills may play a key role in enhancing medical students' sense of belonging within the surgical clerkship environment. While there were no significant differences in belonging based on sex or race/ethnicity, students who reported greater opportunities to practice procedural skills reported a stronger sense of belonging. These results highlight the importance of hands-on experiences in fostering an inclusive learning environment and suggest that surgical clerkship programs may benefit from emphasizing procedural practice to support students’ integration and belonging.
(P038) CHARACTERISTICS OF EFFECTIVE FACULTY SURGICAL EDUCATORS: INSIGHTS FROM RESIDENT EVALUATIONS
Connie Y Gan, MD, Stephanie Seale, MD, James R Korndorffer Jr., MD, MHPE; Stanford University
Introduction
Surgery faculty are essential in training residents to become skilled surgeons. However, formal feedback for teaching performance is limited due to an incomplete understanding of what defines exemplary surgical educators. We hypothesize that key qualities and behaviors can be identified that distinguish top- and low-performing surgery faculty based on resident feedback.
Methods
De-identified evaluations were collected for all general surgery faculty from a single residency program over five years (June 2019-September 2024). Each form included resident evaluations of teaching behaviors, an overall teaching score utilizing a 5-point Likert scale, and narrative comments on teaching strengths and weaknesses. Quantitative data was analyzed using SPSS and utilized to stratify faculty to the top and bottom 10%. Two researchers qualitatively analyzed comments using a grounded theory approach. The researchers developed a codebook inductively, coded a subset of evaluations, subsequently refined coding and themes, and coded the stratified data.
Results
114 faculty were included in the study and were evaluated by an average of 73.1 residents (SD 46, range 11-220). The overall teaching score was 4.54/5 (SD 0.3, range 3.56-5.00). The global score significantly correlated with the specific teaching scores (R=0.8-0.958, p<0.001) and was used as the main quantitative metric representing teaching effectiveness. In qualitative analysis, three major themes along with associated behaviors and characteristics (Figure 1) were identified. Behaviors were additionally coded positive or negative. When comparing highest and lowest performing faculty using independent t-test, there is a significant difference in percent of overall negative statements (0.9% vs 16.1%, p<0.001). For the top 10%, positive statements were most commonly centered on themes of personality traits (14.0%), making time for teaching (14.0%), and providing autonomy (11.3%). For the bottom 10%, negative statements were most commonly centered on themes of service management and leadership (15.9%), communicating clearly (15.9%), and providing autonomy (14.8%).
Conclusion
This study identifies key characteristics of high-performing faculty[JK1] educators and areas of improvement for low-performing faculty based on resident evaluations. Our study provides a framework as well as validity evidence for understanding elements of effective teaching, which can be applied to faculty development, ultimately enhancing teaching quality within surgical education.
(P039) PSYCHOLOGICAL SAFETY IN THE SURGICAL EDUCATIONAL ENVIRONMENT: A QUALITATIVE STUDY OF THE EDUCATOR PERSPECTIVE
Divya Ramakrishnan, MD, Melissa Martos, MD, Pedro Tomás-Domingo, BS, Christina Grabar, MD, Sara Kim, PhD, Caitlin Smith, MD; University of Washington
Background
Psychological safety (PS) is essential for promoting patient safety and learning. However, clinical environments often lack sufficient PS. The role of a surgeon educator requires balancing the needs of the system, patient, and learner. Therefore, higher stress environments such as the operating room (OR) are not always conducive to establishing PS for the learner. There is not a consistent application of best practices for PS in the surgical learning environment, and the perspectives of the surgical educator and leader in the OR environment remain unknown. Understanding these perspectives is essential to creating PS in surgical education.
Methods
We conducted a qualitative study to examine surgical educators’ perspectives of PS including the facilitators and barriers they balance while fostering a psychologically safe learning environment. A total of 13 semi-structured interviews were conducted at an academic center across 9 different surgical specialties and 5 diverse hospital settings, ensuring thematic saturation. Transcripts were inductively coded and thematic analysis was performed.
Results
Six key themes emerged: 1) Educators’ experience of historically unsafe surgical training shape both current and future surgical culture. 2) Educators have a desire for formal training in PS with mixed perceptions on effectiveness of training. Barriers to PS exist on a 3) cultural level (hierarchies, reputation, pressure to perform), 4) individual level (communication breakdown, tension between PS and rigor for learning, educator’s teaching experience), and 5) on an external level (personal pressures, time constraints, medical acuity and cognitive overload, lack of team bond). Finally, 6) Facilitators of PS included concrete educator behaviors such as accountability for behavior, setting expectations and being inclusive to input, emotional awareness and vulnerability, and debriefing.
Conclusion
Surgical education has a long history of challenges with PS; however, surgeon educators recognize PS’s impact and their role as leaders in facilitating PS in the learning environment. They also desire more training on how to promote PS within the educational environment. Although barriers to PS exist on multiple levels, concrete educator behaviors can create more psychologically safe environments. Translating these behaviors to the OR educational environment is crucial to improving PS.
(P040) THE CLINICAL LEARNING ENVIRONMENT AND LOSS OF EMPATHY AMONG SURGICAL RESIDENTS
Jakela Neal, MPH, Srinivas Kavuturu, MD, Randi Stanulis, PhD; Michigan State University (MSU) College of Human Medicine
BACKGROUND
There is little empirical data about how surgical residents experience their learning environment. It is essential to understand how burnout from the learning environment affects residents in the workplace. When residents are emotionally exhausted, empathy may be affected. Since a physician’s ability to create an empathic relationship can significantly increase patient satisfaction, compliance, and outcomes1, we examined whether there is a relationship between the learning environment and empathy loss. This research is part of a larger study of surgical residents’ perceptions of their learning environment.2
METHODS
73 general surgery residents from four different programs in the Midwest responded to a survey that measured peer community, faculty relationships, meaningful engagement, negative emotion, and empathy loss through Likert scale and open-ended questions. Based on a review of literature we identified a descriptive definition of empathy and its components3: perspective taking, affective empathy, empathic concern, and empathic distress. Responses were coded by category of empathic language.
RESULTS
In the larger study, ANOVA and post-hoc tests revealed a significant relationship between learning environment and empathy loss. Residents from Juniper reported the least empathy loss, and Birch the most severe loss. Juniper residents also displayed the highest rates of empathic language use. In Juniper, there were 13 perspective taking comments compared to 3 from Birch. For empathic concern, with language reflecting their "strong desire to care for others", Juniper had 62 positive and 4 negative instances compared to 23 positive and 1 negative in Birch. Considering factors that influence empathy, Juniper respondents used higher rates of positive language to describe their learning environment. Additionally, there were more references to positive patient interaction and appreciation from Juniper.
DISCUSSION
Empathy loss can affect patient care and increase physician burnout and is impacted by the learning environment. This study of empathic language can provide research-based ideas for programs to recognize words and behaviors that might signal physician empathy loss. In a move toward physician well-being, support is needed to create environments where residents describe their learning environment as supportive and their patient interactions as meaningful. We acknowledge the limits of self-report data.