Podium Session I A - Curriculum Development
Introduction Firearm injuries are a major public health crisis; however, providers are not routinely educated on how to address this topic with their patients. To address this gap, we developed a firearm safety curriculum for medical students during their surgery clerkship and evaluated perceptions, knowledge, and preparedness for counseling patients before and after dissemination.
Methods: All second-year medical students enrolled in the surgery core clerkship from March to September 2023 were included. The curriculum consists of a 30-minute didactic presentation discussing gun violence with techniques to identify and counsel at-risk patients, followed by a 30-minute interactive case-based discussion where students simulate counseling strategies. Pre- and post-session surveys included a 5-point Likert scale to evaluate the efficacy of the curriculum. A paired student’s t-test was conducted to compare pre- and post-survey responses.
Results: Of the 149 students participating from March to September 2023, 61.2% were female, and the mean age was 25±2 years. While 93.6% of students responded that they had never owned a gun, 34.0% had lived in a home where a gun was present, and 41.3% had fired a gun before. Twenty-one percent had previously taken a gun safety course, while only 13.0% had ever received training on how to counsel patients on firearm safety. 92 students completed both pre- and post-session surveys for analysis. After the course, students had higher agreement on the importance of physician’s roles and responsibilities in patient education on firearm safety and felt more prepared to counsel patients (Table 1). Knowledge of patient risk factors for firearm injury increased significantly from students being able to identify 1.3±1.2 risk factors correctly on pre-test to identifying 3.1±1.8 risk factors correctly on post-test (t(38)=-5.77, p<0.01).
Conclusion: The firearm safety curriculum is a simple and effective tool that augments students’ knowledge and understanding of gun violence, as well as prepares them to counsel patients on firearm safety. This curriculum can be widely implemented as an important intervention to equip future physicians with the necessary tools to help address the firearm crisis in the United States.
Objective: Service learning and community engagement have contributed to the education of medical students. Interest in incorporating service opportunities have increased in recent years especially in light of an LCME standard requiring such education. The purpose of this study was to determine the experience and learning of third year surgery clerkship students following a volunteering opportunity.
Methods: Third year students (n=86) on the surgery clerkship were required to attend a 2.5 hour shift at an organization for people who experience homelessness. Students were given protected time to attend this session and shift times were reserved for the students by the organization. Following the session, students were required to submit a reflective essay about their experience and learning. Essays were de-identified and then evaluated using a qualitative thematic analysis. The essays were initially analyzed, coded for themes, and then organized using NVivo qualitative software.
Results: Analysis of the reflective essays revealed a number of positive themes – 1) personal growth and connection to their medical calling and feelings of empathy, compassion, gratitude, humility, connectedness; 2) learning skills and attitudes that they can apply to clinical work and patient care; 3) increased sense of social responsibility, advocacy, and citizenship; 4) reduced stereotyping and improved understanding of others, 5) desire to continue volunteering, engaging with other organizations, or initiating their own community-based projects.
Conclusions: This service learning experience was feasible within an eight week surgical clerkship and can begin to meet an LCME standard. From an educational perspective, third year medical students were open to reflecting on their experiential learning. Their reflections demonstrated their feelings about themselves, their vocation, and development as clinicians and patient advocates. Students also expressed the recognition of bias against the people who availed themselves of the services of the organization. Surgery clerkship students had overall positive experiences and students appeared to have learning, social, and personal outcomes which added to their medical school experience.
Introduction
The emphasis on research experience in the general surgery application process has been a topic of interest in recent application cycles. More than 80% of general surgery residency programs consider research experience in their selection process, impacting an applicant’s competitiveness for an academic residency. Despite the potential benefit for a medical student’s residency application and career, there remain barriers to participation in research including lack of formal programs/curricula, mentorship, dedicated time or resources. Our project describes the purposeful development of a student-led surgery research initiative that prioritizes formal mentorship and a structured research curriculum to increase research productivity.
Methods
In January 2023, five third-year medical students with two attending surgeons as advisors organized the Research Initiative in Surgical Education (RISE). A formal curriculum involving introduction to research, methodology & technical skills workshops, and mentoring sessions was developed and implemented. New members were recruited on an on-going basis. The research productivity was recorded, and a survey was administered to assess impact of the initiative. Official group recognition was obtained from the Department of Surgery and affiliated medical school.
Results
Enrollment has increased 300% within a year since the group’s inception, with representation from all medical school class years. Expansion of mentor involvement includes attendings from more than 4 specialties/sub-specialties (trauma, bariatrics, ENT, urology, etc.) as well as general surgery residents. Members have produced a total of 6 presentations (4 podium presentations) at national and regional conferences, 15 posters, and 2 manuscripts that have been accepted since its establishment, with 6 on-going projects. Fourth-year RISE members entered the 2024 residency application cycle with an average of 1 presentation and 3 posters additionally produced since joining RISE. Preliminary data from student surveys showed that RISE positively influenced perceived access, involvement, and familiarity to research in addition to research mentorship and related activities.
Conclusion
Establishment of a research initiative with a dynamic mentorship component positively impacts medical students’ perception, preparation, and productivity towards research in addition to supporting potential career choices. These results will ultimately contribute towards students’ preparedness for residency applications and further career development overall.
Background: Our institution has previously published a validated surgical disparities curriculum (Figure 1 ) administered at the midpoint of a third-year medical student clerkship and based on the Surgical Disparity Framework published by the American College of Surgeons. A post-test immediately following the curriculum demonstrated positive feedback from the students, who found it useful and resulted in helping them feel more comfortable in identifying social determinants of peri-operative health and knowledge gain. We followed up with medical students at the end of their clerkship to determine if our curriculum resulted in behavioral changes and longer-term knowledge retention.
Methods: Curriculum evaluation was performed using Kirkpatrick’s Model of Training Evaluation. Post-participation surveys were conducted at the end of the surgical clerkship to assess knowledge retention using the same questions as the pre-test and included Likert-style questions on behavioral changes in the clinical setting. Results were pooled and an independent t- test was used for relevant analysis with p<0.05 considered significant.
Results: Ninety-nine students participated in the curriculum and post-session survey response rate was 57%. At the completion of their clerkship, 86% reported increased awareness of healthcare disparities, and 85% felt more comfortable identifying social determinants of health in their peri-operative patients. Additionally, over half of respondents reported changes in behavior including 48% reporting an increase in self-directed rounding and follow up on their patients, 55% reporting that they were more likely to discuss elements of healthcare disparities with their patients, and 61% reporting being more likely to discuss or intervene on encountered disparities in their patients. Participation in the curriculum also led to knowledge retention, as students scored significantly better on post-clerkship assessment compared to original pre-test scores (44% v 62%; p<0.0001).
Conclusions: Follow-up study on our published Novel Surgical Disparities Curriculum for Medical Education demonstrates successful knowledge retention and positive behavior change by the end of the clerkship. Future work will focus on assessing the translatability of our curriculum to other institutions with the aim of training clerkship students nationwide to recognize and act on surgical disparities.
Introduction
Structural competency (SC) is the trained ability for health professionals to recognize and respond to health and illness as the downstream effects of social, political, and economic structures. SC is critical to developing a workforce that can address structural determinants of health to reduce health disparities. However, SC in surgical education is limited. We aimed to address this gap via development, implementation, and evaluation of a longitudinal Structural Disadvantages Curriculum (SDC) at an academic surgical training program in the US.
Methods
We developed a curriculum based on 11 topics (Figure). Each topic included a resident lecture, guest lecture, and topic-specific book. A baseline survey was administered to residents prior to program implementation. Follow up surveys were administered at the end of year one and two. Using Likert scales, survey’s measured respondents’ comfort with components of SC using Likert scales and their ability to identify structural factors as determinants of health and disparities. Statistical analysis was performed using Chi-squared tests comparing pre and post surveys.
Results
We analyzed 68 baseline surveys and 37 follow up surveys (67% and 57% response rate, respectively). Compared to baseline, at follow up there was improved comfort engaging in meaningful conversations with marginalized patients about structural disadvantages (89% vs. 66%, p=0.01), recognizing evidence-based structural factors that influence health disparities (89% vs. 66%, p=0.01), and knowledge of resources available to address structural challenges (41% vs. 22%, p=0.045). Participants overwhelmingly agreed the curriculum increased their empathy for patients facing structural disadvantages (95%), were more aware of the language they use with patients experiencing structural disadvantages (92%), and were more likely to consider structural factors when caring for patients (92%). Residents more often chose structural factors as the source of existing health disparities after the curriculum, but this did not reach statistical significance.
Conclusions
Implementation of a longitudinal SC curriculum at a large general surgery program demonstrated benefit in perceived knowledge and skills and a trend toward improved identification of structural determinants of health as contributor to health disparities. Future work is needed to translate this knowledge into skills and improved patient outcomes.
Background: International Medical Graduates (IMGs) occupy most non-designated preliminary general surgery positions. Unfortunately, less than half complete surgical training. We aimed to compare the perceived essential competencies required by IMGs between evaluators and trainees.
Methods: Cross-sectional electronic survey distributed to IMGs and faculty. Participants categorized competencies as 1) Mandatory, 2) Desirable, not mandatory; or 3) Not required. Fisher's exact test and Pearson's Chi-squared test were used to compare categorical variables between both groups.
Results: 73 faculty and 126 IMGs were included. Both groups ranked “Knowledge Application/Critical Thinking Skills” as the most essential competency for preliminary IMG residents to do well in training. “Research Skills” followed by “Technical Skills” were rated as the least essential. The highest concordance (>80%) between groups for mandatory competencies was found for “Interpersonal and Communication Skills”, “Professionalism” and “Learning, Teaching, and Teamwork”. Significant differences were found in the perception of clinical, research, and technical skills between the groups (p<0.01, Table).
Conclusions: The value of non-technical skills in surgical training transcends cultural and educational backgrounds. IMGs place greater importance on clinical and technical skills. Future educational initiatives need to bridge the gap between perceptions and expectations to enhance training outcomes for IMGs.
Objective: Formal primary surgical palliative care education in the United States is lacking. We aimed to assess curricula and surgical program directors’ (PDs) attitudes toward instituting formal educational programs. Results will guide the Surgical Palliative Care Society (SPCS) Education Committee in future efforts to create and standardize educational materials to meet the needs of surgical training programs.
Design: An anonymized 15-item survey was developed by the SPCS Education Committee and electronically distributed to PDs through the Association of Program Directors in Surgery (APDS) in June 2023. It focused on content areas such as serious illness communication, pain management, other symptoms in the seriously ill, and aspects of end-of-life care.
Setting: The survey was shared with all active PDs of accredited general surgery residency programs across the United States through the APDS.
Participants: Invitations to participate were sent to PDs from 282 general surgery residency programs.
Results: Forty-three PDs completed the questionnaire (15% response rate). Sixty-seven percent reported providing dedicated instruction time for communication skills with seriously ill patients. Most (76%) reported using didactics format, while 48% utilized simulation-based instruction, and 35% vs 14% dedicated time to clinical instruction in the ICU and floor respectively. Use of materials created by educators within the institution was most common (69%), followed by SCORE materials (45%) and other established communication tools (7%). There was an overall positive attitude towards instituting standardized education materials with 37 respondents reporting definite or probable use of materials if made available, 3 who remain unsure, and only 3 who would probably not utilize such materials. Most state they do not provide formal education but would utilize resources if made available regarding end-of-life care (65%), decision-making capacity and the care and role of surrogate decision-makers (56%), code status documentation (49%), and ethics of medicalized death (65%).
Conclusions: Surgical residencies provide variable levels of formal education and utilize different tools and resources regarding primary palliative care and advanced communication skills necessary for caring for seriously ill patients. While a standardized formal curriculum does not currently exist, many surgical PDs display positive attitudes towards adopting such materials if made available.
Introduction
Surgeons are often faced with stressful situations in the OR that can affect performance and potentially compromise patient safety. Mental skills training can help manage stressful situations; however, little data exists on how mental skills affect stress management in the OR. We hypothesized that participants who use mental skills more frequently would experience less stress during simulated stressful operative scenarios.
Methods
Faculty surgeons and senior residents (PGY 3-5) were enrolled from May through October 2023. After providing consent, participants completed up to two simulated intraoperative scenarios (tension pneumothorax, intraabdominal hemorrhage). Scenarios were designed to elicit a stress response from participants using stressful surgical events reported in the literature. At baseline, participants completed the Test of Performance Strategy (TOPS) measuring frequency of mental skills used in practice and performance (e.g., emotional control, self-talk, automaticity, etc.). Participants wore monitors for collection of heart rate variability (HRV) data during the scenario, with participant baseline HRV measured for 3 minutes prior to initiating the simulation. HRV metrics included mean HR (bpm), mean R-R interval (the average distance in time (ms) between peaks of successive R waves), and RMSSD (the root mean square of successive differences between normal heartbeats), with lower HR and higher RR & RMSSD indicating a more relaxed state. After concluding the simulation, participants completed the Surgical Task Load Index (SurgTLX), a surgery-specific workload perception measure. We evaluated correlations between variables using Spearman’s Rho. A p-value <0.05 was considered significant.
Results
Nine scenarios with 4 faculty and 5 residents were analyzed. Several significant correlations were identified between mental skills use, SurgTLX scenario perception measures, and HRV (table 1).
Discussion
Our findings indicate that automaticity and emotional control are associated with decreased stress based on HRV and multiple perception metrics, which may be facilitated by unconscious processes. Conversely, self-talk and attention control are associated with higher stress, which may reflect the conscious use of mental skills to overcome an ongoing incidence of stress. In the future, educators should explore how mental skills training can impact the habituation of self-talk and attention control in response to stressful intraoperative situations.
Introduction
Surgical interns have limited protected educational time for technical skills acquisition outside of the operating room. To optimize this time, we must better understand what skills surgical interns find most challenging. We aimed to identify the most challenging tasks and common technical errors for surgical interns in our simulation lab through analysis of performance scores and written feedback on video-recorded homework assignments.
Methods
Each intern submits videos of four Suturing and nine Knot Tying tasks for our simulation lab. Several of these tasks are repeated later in the year. Faculty and resident instructors provide rubric-based numeric grades (reported as percent correct out of 100%) and written feedback. We categorized written feedback as positive or negative, and grouped feedback into larger technical skill categories (Figure 1). We analyzed grades, changes in performance, and feedback as a numeric ratio of positive to negative feedback (positive feedback ratio) from the past two years (2022-2023).
Results
97 interns from five different specialties completed assignments. Within Suturing, scores were highest on instrument tying (95%), and lowest on vertical mattress (79%). Within Knot Tying, scores were highest on tying under tension (93%) and lowest on two-hand square knots (78%). For tasks repeated later in the year, average resident score improved the most in vertical mattress (79% to 94%), and the least in interrupted subcuticular (84% to 88%). For Suturing tasks, residents had the highest positive feedback ratio in tissue handling (2.1), and the lowest in instrument handling (0.5). The positive feedback ratio improved the least for efficiency when comparing earlier to later assignments. For Knot Tying tasks, residents had the highest positive feedback ratio in efficiency (6.3), and the lowest in suture management (0.7). The positive feedback ratio improved the least in knot tying technique over time.
Conclusions
This analysis provides guidance on which tasks, such as interrupted subcuticular, may be most important to emphasize in simulation curricula. Additionally, we reveal that different technical skills should be highlighted when teaching knot tying versus suturing tasks. Future directions will be to assess the impact of targeted educational tools in these areas on intern performance.
Objective: Emphasize the importance of specialty directed EMR efficiency training as a mechanism to increase clinical experience for surgical residents.
Introduction: Surgical resident productivity is an understudied area of surgical education. A recent survey found 70% of surgical residents will report at least one duty hour violation, many of whom were likely completing daily progress notes, orders, or other patient-care tasks prior to handoff. Surgical EMR efficiency training may promote resident wellness, increase clinical opportunities, and minimize EMR-related duty hour violations.
Methods: In June 2022, the incoming PGY1 General Surgery resident class personalized their EMR workflow to match a standard Surgical Resident EMR template during a 4-hour workshop one week prior to matriculation. Notes written by the pre-intervention PGY1 class from July 2021 to November 2021 were compared to a post-intervention group from July 2022 to November 2022. Rate of progress note completion prior to 0700 was compared between groups with a p<0.05 considered significant.
Results: A total of 4,047 notes written by sixteen PGY1 surgical residents were reviewed. The pre-intervention PGY1 class of eight wrote 1,964 notes during the study period whereas the post-intervention PGY1 class wrote 2,083 notes. During the month of July, the post-intervention class completed 22.9% more notes before 0700 compared to the pre-intervention class (59.5% vs. 36.6%, p<0.001). The greatest difference between groups was found during the month of October, with a 28.9% increase in note completion post-intervention (58.7% vs. 29.8%, p<0.001). Overall, the post-intervention PGY1 class completed at least 23% more notes before 0700 compared to their pre-intervention cohorts, excluding September (30.6 vs. 46.2, p<0.001).
Conclusions: Specialty directed EMR efficiency training increased PGY1 note completion before 0700 by 29% compared to the pre-intervention cohort.
