Quick Shot IV -DEI/GSE/Wellness
FROM SUNSET TO SUNRISE: RE-IMAGINING IDENTITY IN AGING AND RETIRING SURGEONS
Stephanie Jiang, MD, Melanie Hammond, Carol-Anne Moulton, MD, PhD; University of Toronto
Background/Purpose: Surgical education significantly invests in the formation of the surgical identity. Yet, as surgeons approach retirement, their individual identities may require negotiation in a powerful and rigid culture. Despite the inevitability of this transition, most surgeons remain unprepared, leading to implications for surgeon well-being.
Methods: This qualitative study used constructivist grounded theory to explore how surgeons experienced the process of retiring from clinical practice. Semi-structured interviews were conducted with 17 surgeons who were 1) in the process of retirement and changing their clinical practice, or 2) fully retired from clinical practice. Data collection and analysis were iterative and guided by Identity Process Theory.
Results: Approaching retirement was universally seen as “passing through a threshold [with] no turning back” (P5). Surgeons described a culture that demanded sacrifice and infallibility. Their careers “[were] all-consuming” (P7) and in some cases, “defined [them] as a person” (P1). Individuals experienced the negotiation of their identity in retirement along a continuum:
- “sunset”: the end of the professional identity that had defined much of their lives; a period of loss and uncertainty.
- “sunrise”: the beginning of something new; an opportunity for renewal and re-imagination of the self.
In the absence of formal supports, surgeons’ experiences were largely shaped by internal resources such as faith and active meaning-making. “Sunrise” retirees retained their surgical identity but redefined it through new roles and sources of fulfillment (i.e. grandparent, teaching at church, birdwatcher, etc.). Renewals often stemmed from life events that reoriented life priorities (i.e. family member death, personal health issues, etc.), a recognition that surgery would not last forever (i.e. early planning, “a young man’s game”, etc.) or a longstanding desire to pursue parallel identities.
Discussion: Retirement for surgeons is a profound experience, requiring negotiation on personal, social, and political levels. While often destabilizing, it can also be a space for reinvention. “Sunrise” retirees found meaning beyond surgery through reflection, family, faith, or other pursuits. By integrating identity diversification and the cultivation of values independent of surgery into education, faculty development, and institutional culture, we can help surgeons in retirement move from a sunset to a sunrise.
EXAMINEE PERCEPTIONS ON ENTRUST IMPLEMENTATION IN HIGH STAKES CREDENTIALING EXAMINATIONS
Alexa A Engel, MD1, Anam N Ehsan, MBBS2, Daniel Logan2, Kate Arnow2, Ivan Saruni, MBBS, MD3, Hanna Getachew Woldeselassie, MD, FCS4, Michael Mwachiro, MBChb, MPH, FCS, FACS4, Jason Tsai2, Abebe Bekele5, Dana Lin, MD2, Cara Liebert, MD2, Edward Melcer, PhD6; 1Riley Children's Hospital, Indiana University School of Medicine, 2Stanford University, 3Aga Khan University, 4College of Surgeons of Eastern, Central and Southern Africa (COSECSA), 5University of Global Health Equity, 6Carleton University
ENTRUST is an online, virtual case-based simulation tool developed to assess trainee decision-making skills. Through bidirectional collaboration with the College of Surgeons of East, Central, and Southern Africa (COSECSA), ENTRUST has been integrated as an official testing modality for Membership of College of Surgeons (MCS) examination. This high-stakes examination administered after the second year of surgical training is comprised of 8 online faculty-administered oral Objective Structured Clinical Examination (OCSE) stations and 8 ENTRUST case scenarios. With previously reported strong validity evidence and highly rated perceptions of usability, objectivity, and fairness, we seek to further evaluate trainees’ preferences regarding expansion and future use of ENTRUST in their surgical training.
The 2024 MCS examinees were invited to complete a voluntary electronic questionnaire. Examinees were provided access to ENTRUST learning cases and an ENTRUST practice exam prior to the examination date. The survey queried demographics and preferences regarding the Fellowship of the College of Surgeons (FCS) examination; this post residency high-stakes examination is required for certification and currently administered via an in-person OSCE format.
Examinee questionnaire response rate was 47%. The average age was 34 years (StDev 3.8). Majority of respondents were general surgery (42%), orthopedic surgery (16%), neurosurgery (13%), and plastic surgery (10%) residents. 90% of respondents had native or full professional proficiency in English. When asked which exam format best evaluated their clinical decision-making skills, examinees favored ENTRUST (74%) over OSCE (26%). On inquiry about the FCS exam at the end of their training, 97% of the respondents believed ENTRUST would be a useful learning tool and reported interest in using ENTRUST to help prepare for the FCS exam. Trainees' preferred test format for the FCS examination was a combination of OSCE oral exam cases and ENTRUST cases (74%) over ENTRUST alone (17%) or OSCE alone (9%).
COSECSA trainees expressed significant preference for ENTRUST to be implemented both as a preparatory learning tool as well as a testing modality for the FCS examination. These perceptions, taken with the strong validity evidence for the MCS examination, support the future expansion and application of ENTRUST to other high-stakes examination contexts.
DARK HUMOR MAY CORRELATE WITH RESIDENT BURNOUT DURING TRAINING
Meagan Rosenberg, MD, Anam J Furrukh, Aixa Perez Coulter, MS, MPH, Michael V Tirabassi, MD, FACS, FAAP; UMass Chan Medical School - Baystate
Background: Humor can be an effective strategy for coping with stress, but little is known about its impact on burnout during residency training. The goal of this study is to observe the prevalence of four humor styles, two positive (affiliative, self-enhancing) and two negative (aggressive, self-defeating), among residents and their correlation with burnout.
Methods: This study surveyed all residents at a single institution. In the first month of the academic year, residents completed surveys using the Short Work-related Humor Styles Questionnaire (Sw-HSQ) and Burnout Assessment Tool (BAT). Demographic data, specialty, and training level were collected. Descriptive analysis, Student’s t-test, and Pearson’s correlation were used to assess humor style prevalence and burnout associations.
Results: In total, 107 residents completed the survey. No significant differences in humor styles or burnout scores were found by specialty, training year, preliminary status, or prior career experience (Fig1). There was no correlation between age and humor style (p=0.24). Male residents had higher positive humor scores compared to female residents with an average (SD) of 32.3 (5.12) versus 29.1 (5.7) (p=0.0021). Female residents had higher burnout scores with an average (SD) of 2.5 (0.5) versus 2.25 (0.5) (p=0.016). Residents with clinical training interruptions adopted more positive humor (p=0.01). Psychiatry and OBGYN had the highest average positive humor scores (32.5), EM the highest average negative humor score (23.1), and pathology the highest burnout score (2.77). Overall, there was a significant correlation between greater positive humor style use and lower burnout scores (r=-0.22, p=0.026).
Conclusion: We observed a significant correlation between negative humor and burnout. We also observed a sex-based disparity in both humor style and burnout scores. Further research is needed to better understand the relationship between humor and burnout, but encouraging an environment with positive humor styles may help reduce job burnout among resident trainees.
Figure 1: Trends in Humor Style and Burnout Score by Training Specialty
LOCALLY LED, GLOBALLY IMPACTFUL: SIMULATION-BASED LAPAROSCOPIC TRAINING IN ETHIOPIA
Nathnael Abera Woldehana, MD, MPH1, Hilkiah Suga, MD, MPH2, Jochebed Suga, MD2, Zachary Enumah, MD, PhD3, Filagot Bizuneh Mikru, MD2, Ebenezer Fanta, MD2, Philimon Getu Bekele, MD2, Efeson Thomas Malore, MD2, Daniel Rhee, MD, MPH3; 1Department of Surgery, Southwest Healthcare MEC, 2MIS Africa, 3Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Background: Laparoscopic surgery training opportunities are limited in low-resource settings like Ethiopia, contributing to disparities in surgical care. This project implemented a locally led laparoscopic training program for surgical trainees with no prior formal laparoscopic instruction, aiming to build capacity in minimally invasive surgery using local trainers and resources.
Methods: A blended learning curriculum was delivered to 30 surgical trainees (14 general/pediatric surgeons, 16 residents) over 6 weeks of online modules (The Fundamentals of Laparoscopic SurgeryTM (FLS)) followed by a 5-day in-person workshop. The hands-on training utilized both locally fabricated and imported validated box trainers to practice core laparoscopic tasks (peg transfer, circle cutting, intracorporeal suturing). Pre- and post-training assessments included a multiple-choice knowledge test and standardized evaluations on the three tasks and a Global Rating Scale (GRS) for technical skills. Statistical analysis was performed using paired-samples t-tests, McNemar’s tests for categorical improvements, and effect size estimation (Cohen’s d or Hedges’ g) to quantify training impact.
Results: Twenty-eight participants completed pre- and post-training assessments. Significant improvements were observed across all measured skills. Mean peg transfer time decreased from 5.51±2.78 to 2.47±0.82 minutes (–3.04 min, p<0.0001, d=1.24); circle cutting from 5.74±2.84 to 3.17±1.35 minutes (–2.57 min, p<0.001, g=0.94); and suturing from 10.95±5.54 to 3.71±1.23 minutes (–7.14 min, p<0.001, d=1.26). GRS scores increased from 17.8±8.8 to 30.1±8.9 (+12.3 points, p<0.001, d=1.49), with 96% of participants improving. Knowledge scores rose from 13.5±2.8 to 15.6±2.5 (+2.1, p=0.003, d=0.58). Compared by role, surgeons showed significant improvement in both knowledge (p=0.002) and skill performance (GRS, p=0.001), whereas residents achieved significant skill gains (p<0.001) but no significant knowledge change (p=0.27). Notably, baseline knowledge correlated with pre-training skill (r=0.49, p<0.01) but not with post-training skill, indicating hands-on training mitigated initial knowledge disparities.
Conclusion: A short, intensive blended training program leveraging local expertise and resources can rapidly and substantially improve laparoscopic skills in a low-resource setting. Hands-on practice effectively bridged initial knowledge gaps, supporting the value of locally empowered surgical education initiatives to expand laparoscopic capacity in the Global South.
SURGICAL RESEARCH PIPELINE PROGRAM FOSTERS RESEARCH PRODUCTIVITY AND MENTORSHIP IN HIGH SCHOOL STUDENTS FROM BACKGROUNDS UNDERREPRESENTED IN BIOMEDICAL RESEARCH
Erin V Feeney, MD, MS, Laura Washburn, MD, David Boone, PhD, Emilia Diego, MD, Steven Evans, MD, Christine Leeper, MD; University of Pittsburgh Medical Center
Introduction: Participation in a surgical research pipeline program offers an opportunity for high school students to gain exposure to academic surgery and develop valuable research skills. Our program pairs students with backgrounds underrepresented in biomedical research with a Department of Surgery faculty mentor for completion of a research project and clinical shadowing experiences. The objective of this study is to assess the impact of this pipeline program in terms of academic productivity.
Methods: We conducted a cross-sectional survey of all Department of Surgery faculty mentors who have participated over the five years since program inception, with the aim of assessing objective metrics of research productivity. Data regarding mentees was provided by the pipeline program. Descriptive statistics were used to characterize cohort demographics and outcomes.
Results: In total,13/14 faculty mentors completed the survey for a response rate of 93%. Faculty reported diverse research disciplines including clinical research (7, 54%), basic/bench research (6, 46%), and translational research (4, 31%). The median (IQR) length of participation in the program was 2 years (1-3) and median (IQR) total number of student mentees was 2 (1-3). In total, 8 manuscripts, 16 oral presentations, 18 applications for scholarships/awards/academic programs, and 7 funded grants/awards/scholarships were attributed to participation in the program. Further, 5 mentors (38%) reported continuation of mentorship relationship following the conclusion of the program. The cohort of student mentees included 21 subjects, 9 current high school students and 12 high school graduates who are current college attendees (12, 100%). Of this group, 63% (10/16) for whom data were available self-identified as NIH identified underrepresented groups in biomedical research.
Conclusion: A high school pipeline program that includes exposure to academic surgery results in research productivity for both mentors and mentees, and ongoing mentorship for students from backgrounds underrepresented in biomedical research. Further longitudinal investigation is needed to assess the impact of this program on matriculation to biomedical research and surgical careers.