Poster Session V - Wellness & Other
Objective: Development of peer mentorship programs medical education is continuously evolving. Challenges including time constraints, resident availability, commitment to mentorship programs, and continued resident interest are emphasized in surgical residency programs. This study aims to develop, implement, and assess the effectiveness of a structured peer mentorship program for all incoming general surgery interns.
Methods: Prior to starting 2023 general surgery residency, interns completed a survey covering personal aspects including their hometown, medical school, fellowship interests, living location, extracurricular hobbies, family plans, and others. Two senior residents used these data to match intern mentees with a mentor. The mentees and mentors were provided written expectations to encourage consistent contact. Mentors were expected to meet with their mentees weekly for the first month, biweekly for the subsequent two months, and monthly thereafter. To gauge program effectiveness and collect feedback, a survey with both close- and open-ended questions was administered to all mentees three months later. An annual survey is scheduled for May 2024. Preliminary data were analyzed descriptively.
Results: All 12 interns participated in the survey; 50% (6/12) were female. The survey completion rate was 92% (11/12). Of these, 100% of mentees agreed or strongly agreed that the mentorship program had a significant positive impact on their transition into surgical internship. 64% mentees mentioned that they reach out to their mentors weekly and 27% do monthly outside of their regular meetings. The top 3 areas they sought help were work-life balance, medical knowledge, and patientcare. Additional areas included research, leadership, learning style, and interpersonal skills. All (100%) mentees found discussing these areas with their mentors helpful/very helpful. Regarding program improvement, one mentee suggested providing a packet of useful topics for mentors to initially review with their mentee. Another recommended coordinating a surgical skills session with their mentor.
Conclusion: Preliminary data from this peer mentorship program demonstrate its positive impact on intern transition and provides valuable support in multiple areas. The high-level engagement and exclusive positive feedback from mentees indicate the program's success. Further assessment through the annual survey will provide a more comprehensive understanding of the program's long-term effectiveness.
Introduction: Surgical subspecialties such as urology have a large applicant pool relative to the number of positions, resulting in many qualified applicants going unmatched. Traditional options for unmatched applicants include pursuing a research fellowship or completing a preliminary general surgery training year. Here, we present a novel urology-focused preliminary curriculum within a department of surgery that aims to facilitate reapplicants’ successful match.
Methods: The urology-focused preliminary curriculum was instituted in 2020 through a partnership between the general surgery residency program and the division of urology in a single department of surgery. The general surgery program commits three preliminary general surgery intern positions for urology-focused interns. The urology program evaluates unmatched candidates from the American Urological Association (AUA) Urology Match and submits recommendations for the program’s preliminary general surgery intern positions. Urology-focused preliminary interns complete six months of urology rotations and six months of general surgery rotations, with the urology rotations frontloaded prior to the next application cycle to form connections with urology faculty. Additionally, the urology-focused preliminary interns are paired with a urology faculty member to participate in a longitudinal coaching and mentorship program. They participate in specialty-specific didactics with the remainder of the urology program.
Results: Eight residents have completed the urology-focused preliminary program in three academic years. Six residents have obtained categorical urology positions. Four matched via the AUA Urology Match into a post-graduate year 1 (PGY1) position, and two matched outside of a formal matching process into a PGY2 position. The remaining two residents matched into anesthesiology and radiology, respectively.
Conclusions: This urology-focused preliminary program, the first program of its kind to our knowledge, presents a novel strategy to address the growing number of unmatched applicants in competitive surgical subspecialties such as urology. The success of the program can be attributed to dedicated specialty-specific clinical training that is not possible through a traditional preliminary general surgery training year as well as active investment in the program’s trainees through the coaching and mentorship program. The approach described here has the potential to be expanded to other surgical subspecialties in the future.
Introduction:
Residents are critically important educators to medical students; however, many residents have no formal instruction on teaching. The One-Minute Preceptor model was incorporated into surgical intern orientation. The study aimed to assess the impact of this session on medical student evaluations of resident teaching.
Methods:
A 1-hour, resident-led session on the One-Minute Preceptor model was designed and incorporated into the 2023 surgical intern orientation focusing on teaching in a busy clinical enviroment. Medical students evaluate resident teaching using 5-point Likert scales (Poor [1] to Excellent [5]), yes/no questions, and general comments. Evaluations of PGY-1 residents present at the session were collected for the beginning of the academic year (July through September 2023) and compared to those of the 2022 PGY-1 cohort without this session (July through September 2022). Fishers exact, X2 and thematic coding were used for data analysis.
Results:
A total of 15 PGY-1 Residents were included, 8 from 2022 and 7 from 2023 with a combined 53 medical student evaluations. The frequency of weekly study sessions increased (62% vs 94%, p = 0.022) between the 2022 and 2023 cohorts, however there was no difference in resident receptiveness to questions (p = 0.632), role model behavior (p = 0.456), knowledge of basic science (0.831) or clinical care (p = 0.504). Coding of student feedback yielded 3 themes: establishing a welcoming environment, enthusiasm for teaching, and ability to care for patients. In 2022, the major theme was establishing a welcoming enviroment: a resident “made a point to talk through … situations that provoked emotions in us to ensure that we were processing the rotation healthily, which had such a positive impact on my experience”. The major theme in all but one review for 2023 was enthusiasm for teaching: the resident “always brought up thought-provoking topics for us to discuss and work though”.
Conclusion:
Integrating the One Minute Preceptor model into resident orientation increased the frequency of teaching sessions and fostered a theme of teaching as reported by medical students. Providing targeted didactic curricula to incoming interns may better prepare them to teach medical students in a busy clinical setting.
Purpose
Our previous work revealed substantial nonverbal communication in the operating room (OR) between teaching and learning surgeons. Our objective was to study how intraoperative nonverbal communication expressed by resident and attending surgeons is associated with resident autonomy leading up to critical moments. We hypothesized that confident nonverbal communication was more likely to be associated with resident operative autonomy.
Methods
This was a cross-sectional study of surgeon/resident dyads in the OR. We video-recorded 9 surgical cases across various specialties. We used Laban Movement Analysis (LMA), a validated movement analysis tool, to rate kinesic (time, space, plane, and rotation) and vocal (volume, pitch, rate, and inflection) communication leading up to the critical moment. Attending surgeons chose this moment according to an increased risk of iatrogenic damage or steps essential to the outcome. Resident surgeons rated their autonomy using the Zwisch scale. A LMA expert trained a medical student on rating 7 kinesic and 4 vocal variables with 93% agreement. The medical student rated 378 kinesic and 216 vocal variables of residents and attendings across 9 cases. Correlation analysis was used to compare resident self-perceived surgical autonomy and each nonverbal communication variable.
Results
Resident kinesic and vocal variables were not significantly correlated with resident self-perception of autonomy (kinesic Pearson Correlation 0.565, p=0.11; vocal -0.109, p=0.78). Plane 3 (widening vs. narrowing movement) displayed the most positive correlation (0.580, p=0.101,) and rotation (fixed inward vs. outward movement) displayed the most negative (–0.642, p=0.062). Attending kinesic and vocal variables were also not significantly correlated with resident self-perception of autonomy (kinesic 0.070, p=0.858; vocal 0.108, p=0.782).
Conclusions
Although nonverbal communication was not associated with resident self-perception of autonomy, it is important to understand how nonverbal communication is perceived in the OR. Surgical residents should recognize that demonstrating confidence may afford them opportunities in the OR. Surgical attendings should identify residents who display confidence to support their growth. Similarly, recognizing lack of confidence in a resident may suggest the need for remediation. Further studies can analyze how confidence through nonverbal cues can be applied in other health education settings.
Introduction:
Burnout and thoughts of quitting residency are common among general surgery residents. Residency programs have utilized various methods to measure resident well being including surveys, structured interviews, and townhall-style meetings. We sought to implement a resident-initiated, resident-led exploration of burnout using a mixed-methods approach with an initial validated survey followed by structured interviews of each PGY class.
Methods:
All categorical general surgery residents were invited to complete the Maslach Burnout Inventory (MBI). Group interviews of each PGY class were then performed, facilitated by the PGY5 class who functioned in an observer-as-participant role. Interviews were recorded and transcribed. The transcripts were assessed using an inductive open coding approach. Themes were identified, and thematic analysis performed.
Results:
Eighteen of 19 (95%) categorical general surgery residents completed the MBI. Rates of burnout were higher than the general population as reported in the MBI score report, including in the areas of emotional exhaustion (once a week vs. once a month or less), and depersonalization (a few times a month vs. once a month or less). Rates of personal accomplishment were similar to the general population (once a week).
Themes identified from the group interviews included a perceived imbalance of service with residents’ personal goals including education, career, and day-to-day autonomy. This imbalance was exhibited most notably on two rotations. As a result of imbalance, residents experienced feelings of guilt as well as a phenomenon of “trickle-down” burnout, where burnout of more senior individuals, both faculty and residents, had a negative impact on their peers and junior colleagues. Factors contributing to imbalance included systems and faculty factors. Finally, protective factors and ideas for improvement were also explored by residents. All themes were represented in each class, however manifested differently by PGY level.
Conclusion:
A peer-led approach identified resident burnout as a result of imbalanced service over personal goals resulting in feelings of guilt and a trickle-down phenomenon, manifesting differently by class. These findings provide a basis for a program-specific, resident-vetted approach to implement systems and institutional changes.
Background: Teaching portfolios were designed to capture the time and effort devoted by educators more accurately than a curriculum vitae. However, we found previously that fewer than one-quarter of surgery departments with a general surgery residency program mention a teaching portfolio as a resource or provide templates. The goal of this study was to understand the utilization of teaching portfolios across programs, as well as to assess the impact of increased awareness at a single institution.
Methods: A five question survey was distributed via the national program director email list. At our institution, we assessed the impact of advertising educational endeavors which could be included on a teaching portfolio. In the faculty-wide recruitment emails for activities, such as residency interviews, a block of text was included about what a teaching portfolio is, how it can be used for academic promotion, and how to cite helping with the above educational endeavors in a teaching portfolio.
Results: Twenty-four general surgery programs completed the survey of the 318 program contacts who were emailed. Most programs (21/24, 88%) indicated that teaching is a noteworthy consideration for academic promotion at their institution. Despite this, only 12/24 (50%) programs indicated that their program/institution offered information about a teaching portfolio as a resource to trainees and/or faculty members. Even fewer programs (10/24, 41%) indicated that an example of a teaching portfolio is available as a resource to trainees and/or faculty members. On an institutional level, we assessed the impact of teaching portfolio awareness by including teaching portfolio information in the faculty-wide emails to recruit interviewers for residency. We found only 3 reminder emails were required to achieve the necessary number of faculty sign-ups for residency interviews for the 2023-2024 year compared to 10 reminder emails the previous academic year (P=0.0031).
Conclusion: Our national survey results demonstrate a lack of awareness and utilization of teaching portfolios. However, our institutional experience suggests that promoting the usage of teaching portfolios may help increase faculty participation in educational activities. More studies are needed to understand the role of teaching portfolios and inclusion of surgical education activities in the promotions process.
Background: Prevalence of left-handed surgeons is 10-15%. Despite this, studies show that handedness is rarely acknowledged early in surgical residencies and poses barriers to training. Notably, surgical procedures in otolaryngology (ENT) require a particular dexterity that can be difficult to teach. With various constraints on technical skills development, strategies to mitigate negative factors should be promoted. Currently, there are no studies examining the impact of handedness in ENT oncology. This study therefore seeks to identify the perceptions, experience, and barriers facing left-handed ENT residents and fellows in ENT oncology.
Methods: A twenty-six question, web-based survey was developed at a single institution. The survey was distributed to ENT residents and fellows in the United States via email to residency and fellowship program directors. Data collected include: gender; training; writing/operating handedness; handedness acknowledgement/mentorship; handedness-specific equipment; handedness impact on surgical procedures, career decision-making, perceptions of technical competency; and, strategies to address handedness-related difficulties in training. Summary statistics were calculated.
Results: Among 85 respondents, 25% are left-handed. While most right-handed trainees (righties) suture with their dominant hand, 43% of left-handed trainees (lefties) suture with their non-dominant hand. 67% of lefties considered changing their operating hand. 7% identified an impact of handedness on nerve dissection, two of whom found it related to a difference in attending handedness. Both righties and lefties acknowledged an ipsilateral neck dissection as easier. The most common attending strategy to adjust to trainee handedness was switching sides of the operating table. No respondents were directed to resources to address handedness-related challenges. One respondent reported hesitancy in pursuing surgical residency due to being left-handed. The most commonly endorsed strategies to optimize the training of lefties were availability of left-handed instruments, opportunity to try surgical techniques bilaterally, support for mentorship, and resources.
Conclusion: Left-handed trainees face overt and covert barriers to technical skill acquisition in ENT procedures. There is untapped value in addressing trainee handedness early in training. Mentorship, left-handed instruments, and communicating support for lefties should be incorporated into residency and fellowship training.