ASE 2024 Abstracts

ePoster

STUDYING FOR THE TEST: AN OPTIMAL SOLUTION FOR THE FUNDAMENTALS OF LAPAROSCOPIC SURGERY PRECISION CUTTING TASK
John L Falcone, MD, MS; Owensboro Health; University of Louisville

Introduction:

The Fundamentals of Laparoscopic Surgery (FLS) assessment is a high-stakes examination that must be passed as a prerequisite to take the American Board of Surgery Qualifying Examination.  One of the psychomotor elements in the assessment is the precision cutting task.  The purpose of the task is to use scissors to cut a marked circle with speed and precision out of a suspended two-ply 4 x 4 gauze.  There is a five-minute time limit.  The purpose of this study is to critically evaluate this task and offer the most efficient strategy for task completion.

Methods:

This is a study of task optimization.  First, the precision cutting task was evaluated for all possible solutions. Next, specific domains were identified to help maximize efficiency.  From there, the domains were explored, looking for optimization using geometric concepts, trigonometric concepts, and force diagrams.  Finally, the domain strategies were reconciled to create the most efficient solution.

Results: 

Were it not for the five-minute time limit, there would be infinite solutions to this task.  There were six important domains identified for optimization and efficiency:  A.) Minimizing the distance of gauze cut, B.) Avoiding backward angle cuts, C.) Utilizing the natural curvature of the scissors, D.) Avoiding hand-switching, E.) Avoiding instrument-crossing, and F.) Using the second hand to maximize counter-traction.  In order to avoid backward angle cuts, the minimum distance of gauze cut required compromise in the reconciliation process.  The optimal solution involves six steps, while first forming a mental axis/trajectory from the scissor port through the center of the circle along line ABCD.  See Figure 1.

Conclusions:

In this study, an efficient solution is described for the precision cutting task on the FLS assessment that minimizes path length and backward angle cuts, and maximizes the curvature of the scissors and counter-traction, all while eliminating the need for changing hands and crossing instruments.  These results are important to every surgical resident trainee for psychomotor performance on the high-stakes FLS assessment, where passage is a prerequisite criterion to take the American Board of Surgery Qualifying Examination.

LEARNING UNDER PRESSURE: FACULTY AND TRAINEE EDUCATION DURING ROBOTIC IMPLEMENTATION IN ACUTE CARE SURGERY
Zeynep Bilgili, MD, Anupamaa Seshadri, MD, Stephen Odom, MD, Daniel Bent, MD, Alok Gupta, MD, Gabriel Brat, MD, Charles Cook, MD, Sofia Volpi, Alexander Chacon, MD, Timothy Borjas, Charles Parsons, MD; Beth Israel Deaconess Medical Center

Background: 

Robotic surgery is rapidly expanding, and its implementation in acute care surgery (ACS) poses unique educational opportunities. In contrast to subspecialties where patients are often followed by an individual surgeon, ACS operates as a shared service in which multiple attendings contribute to patient care. This structure enables frequent co-scrubbing, real-time intraoperative teaching by the console and bedside. The introduction of robotic platforms into this environment also created opportunities for attendings to learn alongside trainees, adding a novel dimension to surgical education. We aimed to characterize how robotic adoption in ACS influences learning and perceptions of training among faculty, fellows, and residents. 

Methods: 
This mixed-methods study combined institutional operative data (2023–2025) with a Technology Acceptance Model based survey with open ended questions. Operative data captured attending/resident participation and procedure details. Survey responses (Likert 1–5) were analyzed across three domains: Perceived Ease of Use, Perceived Usefulness, and Attitude/Behavioral Intention. 

Results: 
Among 340 robotic ACS cases, four attendings performed robotic procedures as primary operators. Multi-attending participation occurred in 23% of all robotic ACS cases, decreasing from 29% in early program quarters to 15% by the last quarter of the study period. Resident console participation was observed in 93% of cases, with a median active console time of 38.5 minutes (IQR 20–56). Across 69 different residents, the median number of robotic cases per resident was 4 (IQR 2–8; mean 6.5). Among their first console experiences, robotic cholecystectomy (n=36) and appendectomy (n=15) were the most common. Survey respondents (n = 32; 5 attendings, 22 residents, 4 fellows) reported strong Attitude/Behavioral Intention (M = 4.0 ± 0.8). Free-text responses emphasized that robotic ACS enhanced procedural exposure and faculty–trainee collaboration. 

Conclusions: 
Robotic implementation in emergency general surgery represents not only a technological transition but also an educational one. Co-scrubbing trends reveal a culture of faculty learning alongside trainees, while survey results underscore willingness to engage in robotic education despite emergent conditions. These findings can inform structured, team-based robotic education models in ACS. 

ADVISING THROUGH THE NOISE: MEDICAL STUDENT ADVISOR PERSPECTIVES ON HOW PREFERENCE SIGNALS HAVE INFLUENCED SURGICAL RESIDENCY RECRUITMENT
Nicole M Santucci, MD, MAEd¹, John M Woodward, MD², Ming-Li Wang, MD³, Connie Y Gan, MD⁴, Ariana Naaseh, MD, MPHS¹, Maya L Hunt, MD⁵, Kimberly Hendershot, MD⁶, Caitlin Silvestri, MD⁷, Jorge Zarate Rodriguez, MD⁸, Adnan Alseidi, MD, MBA, MED⁹, Surkhaba Khan, MD¹⁰, Rachel Hight, MD¹¹, Rajika Jindani, MD, MPH, MS¹², Jessica Hudson, MD¹³, Jed Calata, MD¹⁴, Xinyi Luo, MD¹⁵, Sophia Williams-Perez, MD, MEd¹⁶, Trenton Foster, MD¹⁷, Sarah Lund, MD¹⁵; ¹Washington University, ²University at Buffalo, ³University of New Mexico, ⁴Oregon Health and Science University, ⁵Indiana University School of Medicine, ⁶University of Alabama at Birmingham, ⁷Columbia University, ⁸Icahn School of Medicine at Mount Sinai, ⁹University of California, San Francisco, ¹⁰Saint James School of Medicine, ¹¹University of California, Davis, ¹²Montefiore Medical Center/Albert Einstein College of Medicine, ¹³University of California, San Diego, ¹⁴Medical College of Wisconsin, ¹⁵University of Michigan, ¹⁶Baylor College of Medicine, ¹⁷Mayo Clinic

Background: The implementation of preference signals in the general surgery match added another layer of complexity to an already intricate system, challenging medical student advisors in effectively guiding their students. While others have studied program director and applicant outcomes with respect to signaling, few have investigated medical student advisors perspectives. Therefore, we aimed to explore advisors’ experiences counseling applicants about signaling to inform improvements to the signaling process.

Methods: Formal medical student advisors (e.g., clerkship directors, medical school deans) to general surgery applicants in the 2024-2025 application cycle underwent semi-structured interviews about preference signaling. Purposive sampling was used to identify advisors in a variety of roles and regions of the United States. De-identified transcripts underwent inductive coding and interpretative phenomenological analysis.

Results: Eleven advisors (55% male) were interviewed, including deans (n=4), clerkship directors (n=4), and program directors (n=3) spread across the US (Northeast: 45%, n=5; West: 28%, n=3; South: 18%, n=2; Midwest: 9%, n=1). We identified 15 themes from five codes; select salient themes reported here. Overall, advisors perceived signaling positively, believing that signaling improved applicant equity by decreasing interview hoarding and prestige bias. Advisors recounted common applicant mistakes, including only signaling reach programs, signaling based on prestige instead of ‘fit,’ and misjudging their competitiveness for a program. Advisors felt that applicants should focus on signaling programs they are both interested in and competitive for, which requires an individualized strategy based on a balance of professional goals, geographic preferences, and program fit. Advisors noted several challenges they face, including a lack of transparency regarding how programs use signals, uncertainty in advising students without clear data, and difficulty judging an applicant’s competitiveness paired with issues effectively communicating this to applicants.

Conclusions: While advisors generally understand the positive influence of preference signals on residency recruitment, the lack of information about the purpose and use of preference signals limits their ability to provide actionable advice to their students. Advisors seek clear communication and evidence-based guidance from national organizations regarding how signals are supposed to be used by applicants and how signals are actually being used by programs to effectively guide their students.

EXPLORING THE DISTRIBUTION AND GAPS OF APPLICANT-RELEVANT INFORMATION BETWEEN PLATFORMS FOR PLASTIC SURGERY RESIDENCY PROGRAMS
Caroline E Baker, BSE¹, Lasya P Marla, BS², Annie Hoang-Pham, BS², Ronald D Ford, MD, FACS¹; ¹Corewell Health West Michigan Plastic Surgery, ²Michigan State University College of Human Medicine

BACKGROUND: As plastic surgery grows tremendously as a field, so does its applicant pool, sustaining the specialty’s highly competitive match. Historically, applicants have been able to virtually gauge fit for a residency program by exploring its website. Today, social media makes information even more accessible. We aimed to assess the distribution and remaining gaps in applicant-relevant information between plastic surgery residency program websites and social media to provide a holistic picture of program information transparency.

METHODS: This is a cross-sectional observational study examining plastic surgery residency program websites and social media (Instagram and Facebook) accounts across nine informational domains: program mission, educational resources, curriculum, resident identification, faculty identification, clinical workload (e.g. duty hours, case volume), wellness initiatives, away rotations, and interviews. Jaccard similarity coefficients were used to quantify the overlap in content between the two platforms, and McNemar’s tests were performed to assess the differences in content per domain.

RESULTS: A total of 130 plastic surgery residency programs were analyzed (91 integrated, 39 independent). A mean of 46.5% of information was available on program websites, 37.0% on social media, and 64.5% combined (median Jaccard: 0.29). Across domains, resident information was most accessible (94.0% combined) while clinical workload was least prevalent (18.0%). Whereas faculty information, mission statement, and interview details were more likely to appear on program websites, wellness content and program resources were significantly more common on social media (all p<0.001). No significant platform differences were found for resident information, clinical workload, or curriculum (all p>0.05).

CONCLUSION: Together, plastic surgery residency program websites and social media provide approximately two-thirds of applicant-relevant information and less than half alone. Social media was much more likely to emphasize wellness (e.g. team bonding, personal activities) and resources (e.g. simulation labs, educational facilities), which may serve to humanize programs and increase applicant interest. However, critical gaps remain in transparency particularly regarding clinical workload. Making program information accessible allows applicants to better align their priorities with programs and potentially increase their odds of matching. Future analyses of applicant forums (Reddit, Student Doctor Network, etc.) could provide recommendations for information better aligning with applicants’ priorities.

QUANTITY OVER QUALITY? CHANGING TRENDS IN SCHOLARLY OUTPUT AMONG PEDIATRIC SURGERY FELLOWS
Andrada Diaconescu, MD¹, Bryanna Stukes, MD², Rachel Huselid³, Sarah Lund⁴; ¹Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, ²Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, ³Department of Surgery, University of Massachusetts Medical School, Worcester, MA, ⁴Department of Surgery, University of Michigan, Ann Arbor, MI

Introduction

The pediatric surgery fellowship match is highly competitive among surgical subspecialties with a strong emphasis on research productivity in recruitment. However, whether this surge in scholarly activity reflects sustained scientific engagement or primarily functions as a metric of competitiveness remains unclear. We aimed to compare the research quantity and quality among pediatric surgery fellows over time and assess whether productivity is maintained after matriculation. 

Methods

We conducted a bibliometric analysis of American Pediatric Surgical Association (APSA) pediatric surgery fellows in the United States. Fellows who matriculated in 2020 and 2025 were identified through the APSA website, individual program websites, and by contacting program coordinators. SCOPUS was used to identify peer-reviewed, full-length indexed publication and citation data for the 5 years before and after matriculation for each cohort. We reviewed publication number, citation counts, and proportions of first and last author publications. Pre-fellowship data were compared between 2020 and 2025 cohorts, and pre- versus post-fellowship data were analyzed for the 2020 cohort.

Results

We identified the pediatric surgery fellows matriculating in 2020 and 2025 at 74.7% of all programs – including 37 fellows who matriculated in 2020 and 28 in 2025. Pre-matriculation publication counts were similar between 2020 and 2025 (median publications: 2020=16, IQR=[11,25]; 2025=16, IQR=[13.75,25.25]; p=0.298). However, the proportion of first author publications prior to matriculation (2020=0.46, IQR=[0.31,0.63]; 2025=0.33, IQR=[0.24,0.34]; p=0.004) was significantly lower in 2025 than in 2020. Among 2020 fellows, no fellows published more first author publications and only 5.4% (n=2) published more publications in the 5 years after fellowship compared to the 5 years before matriculation. Of those who did publish after fellowship, there were fewer first author publications (pre-fellowship=8, IQR=[5,10]; post-fellowship=0, IQR=[0,2]; p<0.0001) and fewer median citations (pre-fellowship=15, IQR=[10.5,23.5]; post-fellowship=2, IQR=[1,4]; p<0.0001) after fellowship compared to before matriculation.

Conclusion

While pediatric surgery fellows today publish at similar rates compared to 5 years ago, their work increasingly reflects reduced first authorship and scientific impact, suggesting a shift toward quantity-driven scholarship. Overall, this may indicate a focus on research scholarship for the purpose of being perceived as a competitive fellowship applicant instead of as preparation for a career as a surgeon scientist. 

WITHIN-EVENT DEBRIEFING ADDS VALUE TO TRADITIONAL DEBRIEFING IN EPA-BASED SIMULATION
Parker J Vaughan, Sangmin Kim, Aimee Martin, Thomas Howdieshell; AU/UGA Medical Partnership

Background:
Medical students often enter residency underprepared for acute care responsibilities, such as those outlined in the AAMC Entrustable Professional Activities (EPAs). Simulated patient cases during clerkship offer students the opportunity and a safe environment to practice these skills. While post-event debriefing is widely used in healthcare simulation , within-event debriefing (real-time coaching and huddling) may offer additional advantages for skill acquisition and decision-making.

Methods:
Third-year medical students on their Surgery clerkship participated in a high-fidelity trauma simulation targeting nine EPAs, including urgent care recognition, diagnostic interpretation, procedural performance (eFAST), and interprofessional collaboration. A faculty surgeon acted as an embedded “Chief resident,” providing within-event debriefing, followed by structured post-event debriefing. Student performance was assessed using a critical action checklist. Pre- and post-simulation surveys measured self-perceived competence across EPA-linked tasks using a 5-point Likert scale.

Results:
Fifty-two students participated; 47 (90%) completed both surveys. Post-simulation confidence increased significantly across all EPAs (p < 0.001), with large effect sizes (Cohen’s d = 1.17–1.69) for improvements in primary survey (EPA 1), diagnostic prioritization (EPA 2), imaging interpretation (EPA 4), evidence application (EPA 6), and handoff communication (EPA 7). Checklist analysis revealed deficits in primary and secondary surveys (means 0.57 [95% CI: 0.54–0.60]; 0.24 [95% CI: 0.17–0.31]), oxygen delivery (0.58 [95% CI: 0.52–0.64]), and bedside resource use (0.49 [95% CI: 0.44–0.54]). Students rated prebriefing and debriefing highly (means > 4.0 [4.19–4.81]), emphasizing within-event coaching (4.66 [4.51–4.81]) as most beneficial.

Conclusions:
An EPA-based trauma simulation incorporating both within-event and post-event debriefing improved student confidence and performance in critical clinical tasks. Within-event debriefing was particularly effective for exposing knowledge gaps and reinforcing decision making in real time. This dual-debriefing model may enhance preparedness for high-acuity patient management and support a smoother UME–GME transition.

TOWARD SUSTAINABLE SIMULATION: EVALUATING THE RECYCLABILITY OF POLYVINYL ALCOHOL MODELS
Dena Shehata, MD, Mika Lindsley, MD, MPH, Nicole Wise, MD, William Faust, MD; Lahey Hospital and Medical Center

Background: Many plastic-based simulation models are single-use, raising concerns about sustainability and waste in medical education. Polyvinyl alcohol (PVA), a water-soluble polymer that forms hydrogels through freeze-thaw processing, is increasingly used for its favorable biomechanical properties, low cost, and ease of use. This study explored the feasibility of recycling PVA used in surgical simulation models and assessed the reported quality of the recycled material. 

Methods: Each participant received three standardized PVA pucks: Sample A (unrecycled), Sample B (recycled twice), and Sample C (recycled four times). Practicing surgeons and trainees blindly assessed each sample through incision and suturing tasks, then completed a survey rating material quality. 

Results: Twenty participants (7 attending surgeons, 13 trainees) completed the survey; 70% used simulation three or more times per month. For suturing or knot-tying, 30% had no preference when asked which sample was the best performer, while 44% rated Sample C as the worst performer. For incision tasks, 42% reported Sample A as the best performer, while 37% had no preference when asked which sample was the worst performer (Figure 1). One-third (33%) correctly identified Sample A as unrecycled; 19% chose Samples B or C, and 29% could not tell. When asked which appeared most recycled, responses were split between Samples A and C (29% each) (Table 1). Sixty percent reported that all samples were acceptable for future use, with only a few noting minor concerns about specific recycled samples. 

Conclusion: Recycling PVA for surgical simulation models appears feasible, with surgeons and trainees rating recycled samples as comparable in quality to the original material. Although some participants noted minor differences between recycling cycles, overall willingness to reuse the material was high. These findings suggest that recycled PVA may offer a sustainable, cost-effective option for training models. Further work is needed to define the optimal number of recycling cycles that maintain quality. 

SPLITTING HAIRS - IMPROVING STERNOTOMY PERFORMANCE AND PREPAREDNESS AMONG TRAINEES USING A NOVEL SIMULATION PROGRAM
Kaitlin Pardue, MD, Rachel Davis, MD, Elizabeth Trimble, MD, Matthew Harter, BS, Frank Wood, MD, Rebecca Scott, PhD, Jason Lees, MD; University of Oklahoma

Background: Sternotomy remains a critical but increasingly rare procedure encountered by general surgery trainees, with many reporting low comfort levels with the procedure. Given the inherent risks associated with the procedure, practice using a novel sternotomy simulator offers an opportunity to improve preparedness for future operations. We hypothesize that the use of a novel sternotomy simulation model will improve trainee comfort, preparedness, and technical skills needed to perform this essential procedure.   

Methods: Following informed consent, participants performed a sternotomy to assess their baseline ability using our training model (Figure 1). A standardized instructional video was then shown, and participants repeated the procedure. Surveys were conducted before and after the initial sternotomy as well as at the completion of the simulation to assess preparedness for the procedure and effectiveness of the educational material using a 5-point Likert scale. For accuracy scoring, artificial sternums were marked with a colored grading scale (Figure 1, Panel A) on a 30-point scale. Participant videos were de-identified and technique scored by blinded faculty on a 4-point scale. Appropriate statistical tests were used to assess the difference in pre- and post-training scores. 

Results: 25 learners were assessed, the majority of whom were resident trainees (72%) and male (60%). None of the participants had performed a sternotomy prior to the stimulation, and the group reported low preparedness (Mean 1.2/5). 96% of participants reported improvement in preparedness following the simulation exercise, with an average 1.3-point score increase. Participants reported a significant decrease in anxiety score after completing the simulation exercise (2.76 vs. 3.72, p=0.001). Sternum accuracy score (22.36 vs. 15.64, p=0.006, max score 30) and video technique score (3.48 vs. 2.08, p<0.0001, max score 4) were significantly increased after completing the simulation.  

Conclusion: Due to the rare and high-risk nature of sternotomy procedures, simulation offers an excellent opportunity to build skills and confidence in surgical trainees. Furthermore, it provides a metric for assessing competence in trainees' ability to perform such procedures. In this study, use of a novel, reproducible sternotomy simulator in conjunction with directed teaching led to significant improvement in sternotomy performance, participant anxiety, and reported preparedness.  

SEEKING AUTONOMY: PHASE 1 OF A MULTIPHASE STUDY
Miguel Ortiz-Rivera, MD, Nicole K Roberts, PhD; Southern Illinois University School of Medicine

Background: Whether perceived or factual, the state of current surgical training limits the ability of surgical residents to achieve operative autonomy in the operating room. Most development of the surgical trainee occurs in the operating room. It is still poorly understood how the process of gaining operative autonomy and mastery of the ballet of surgery occurs within the operating room. 

As part of a project to gain insight into how learning and teaching occurs in the operating room, our institution is conducting a 3 tiered study: in-person, third party observations of intraoperative interactions; debriefings with attending physicians about these interactions, and post graduate level specific general surgery trainee focus groups. This abstract reviews some of the salient themes that were obtained from a focus group of the 2025 graduating class. 

Methods: A resident and a faculty member created a semi-structured focus group guide. The resident led the focus group of graduating residents. AI was used to transcribe the recorded focus group. Both the resident and the faculty member reviewed the recording and corrected the transcript. The faculty member analyzed the resulting transcript, in consultation with the resident, using Atlas.ti and following Braun and Clark’s 6 step thematic analysis approach.

Results: Senior residents achieved peak autonomy during when the attending was not directly involved in the procedure (either nearby or in the operating room), being assisted by a junior resident where they (chief) can perform the exposure and lead the junior resident through the case. Various barriers to this “peak autonomy” were identified: 1) the omnipresent/overinvolved attending, 2) a busy/understaffed surgical program, 3) inability to ineffectively communicate or explain minutia of the procedure with the junior resident. Preoperative briefing was regarded most beneficial when it came about a process of self-reflection once the learner had gained some familiarity with the procedure. Simulation was considered effective when done in a timely and relevant fashion to the learner’s needs. Cadavers less effective for learning than double scrubbing. 

Conclusion: The surveyed chief surgery residents reported that discomfort, minimizing attending intervention and intraoperative teaching of junior residents were key to their perceived development of autonomy.

EFFECTS OF SUPPORTIVE AND NEGATIVE VERBAL FEEDBACK ON SURGICAL PERFORMANCE: INFLUENCE OF OPERATIVE EXPERIENCE AND PERSONALITY
Sayaka Rikitake¹, Yu Sugiyama², Haruka Suzuki, PhD², Shutaro Hori, MD, PhD³, Taira Shiono, MD³, Yasue Mitsukura, PhD⁴, Tomohiro Kanazawa³, Takeru Yamakawa³, Akina Masuda¹, Tetsuya Toma, PhD¹; ¹Graduate School of System Design and Management, Keio University, ²SDM Research Institute, Keio University, ³School of Medicine, Keio University, ⁴Faculty of Science and Technology, Keio University

Background

With the declining number of surgeons becoming a social concern, there is a growing need for effective educational methods that enable trainees to efficiently acquire minimally invasive surgical techniques that reduce the burden on both patients and surgeons. In skill acquisition, both the instructor’s teaching style and the trainee’s personality play important roles. Previous research showed that supportive verbal feedback during laparoscopic training facilitates skill improvement and enhances task success. This study examined how negative verbal feedback affects performance and whether its impact differs between trainees with and without operative experience.

Methods

Twenty-four participants were recruited: 12 trainees without operative experience (medical students and junior residents) and 12 with operative experience (surgical residents). Each performed a one-minute laparoscopic peg transfer task on a simulator, placing rings onto 16 pins three times per session across two days. Half received supportive comments on Day 1 and negative comments on Day 2, while the other half received them in the reverse order. The success rate (number of rings correctly placed) was calculated. Participants also completed the Big Five personality inventory and the Emotional Skills & Competence Questionnaire (ESCQ) before the experiment.

Results

Task performance was significantly influenced by feedback type, interacting with both personality and operative experience. Under supportive feedback, higher neuroticism correlated positively with success among trainees without operative experience (R = 0.62) but negatively among those with experience (R = –0.53). Under negative feedback, higher ESCQ “emotional expression and labeling,” extraversion, and openness correlated negatively with success among trainees without experience (R = –0.77, –0.79, –0.66), whereas these relationships reversed among those with experience (R = 0.53, 0.31, 0.30).

Post-experiment interviews suggested that trainees without operative experience were more negatively affected by critical comments, whereas those with experience tended to interpret them as constructive advice.

Conclusions

These findings indicate that incorporating operative experience and personality traits into training design enables the development of more effective, individualized technical education methods.