ASE 2024 Abstracts

Background

Podcasts are increasingly utilized in medical education due to ease of use and ability for remote and asynchronous learning. Despite their uptake and learner satisfaction, the literature regarding their efficacy is limited, and no systematic review has evaluated educational outcomes or research quality in this area.

Methods

A systematic PRISMA search was conducted across Embase, Ovid, and Scopus databases by a medical librarian for studies regarding podcast use for medical education. COVIDENCE software was used for manuscript evaluation and data extraction. Abstract and text screening was performed by three authors with consensus required for inclusion. Included manuscripts evaluated a podcast-only intervention for a population of medical learners (medical students, residents, or physicians).  The Medical Education Research Study Quality Instrument (MERSQI) was used as a research quality assessment metric.

Results

After de-duplification, 900 studies underwent screening and 112 were included (Fig. 1), 65% were published between 2020-2023. We noted two themes present in the literature: i) description of podcast utilization and uptake and ii) evaluation of podcasts as an educational modality.

In aggregate, 50% of trainees were utilizing podcasts, with an increasing percentage (71%) seen in the post-2020 literature. Evaluation demonstrated between 95 and 4406 episodes available in each medical specialty. The largest number of manuscripts concerned podcasts focused on emergency medicine trainees or medical students with only 5% regarding surgery.

Assessment of included studies by Kirkpatrick level highlighted that few studies investigated higher-order educational outcomes with 64% evaluating only level 1 outcomes. Average MERSQI scores were consistent with low educational quality with a median score of 6.8 (range 5-13.5). Of 10 studies comparing podcasts to traditional educational modalities, 60% found them as efficacious as traditional modalities, while 40% found them superior.

Conclusions

Podcasts are increasingly utilized in medical educational spaces and the rate of publication has escalated in the post-COVID period. However, the efficacy of podcasts is unclear as the majority of published literature reports only Kirkpatrick 1 outcomes. Additional rigorous research is required to evaluate podcasts as an educational modality for medical trainees, especially in surgical disciplines that are underrepresented in the published literature.

Background: Lifelong learning and self-reflection are essential skills in medical education. These skills are part of a “growth mindset” on the intelligence-mindset spectrum. A growth mindset focuses on learning, effort, and development while a fixed mindset views intelligence as unmodifiable and feedback can be perceived as criticism. Within graduate medical education (GME), there is a paucity of evidence on the prevalence of these mindsets amongst residents. Therefore, we aimed to characterize the prevalence of growth and fixed mindsets amongst procedural and non-procedural residents within GME with the goal of better understanding where to target mindset education efforts.

Methods: In 2019, all ACGME-accredited residency programs at a tertiary-care academic medical center were invited to complete a survey utilizing the validated Theories of Intelligence (TIS) scale to assess mindset. The TIS consists of four statements answered on a Likert scale with six selections ranging from Strongly Disagree to Strongly Agree. Each response was scored according to the pre-determined rubric and classified as a fixed, indeterminate, or growth mindset. The primary outcome was the prevalence of fixed mindset amongst resident physicians. The secondary outcome was the prevalence of fixed mindset amongst procedural and non-procedural residents. 

Results: A total of 172 out of 878 eligible residents completed the survey (20% participation). Individual residency programs with the largest number of participants were internal medicine (38/164), general surgery (14/50), and anesthesiology (12/80). Amongst all residents, 38% (n=66/172) had a fixed mindset, 51% (n=88/172) had a growth mindset, and 11% (n=18/172) were indeterminate. Procedural and non-procedural residents had similar odds of having a fixed mindset, with 47% (n=20/42) of procedural and 35% (n=46/130) of non-procedural residents possessing a fixed mindset (OR 1.50, 95% CI: 0.73-3.10; p=0.27) 

Conclusions: This is the largest study of mindset amongst U.S. resident physicians described to date. We identified roughly one-third of residents possess a fixed mindset, with no significant difference in the distribution of fixed mindsets amongst procedural and non-procedural residents. Given that mindset can be fluid, and a growth mindset may result in improved academic and clinical performance, incorporating mindset interventions should be prioritized in future resident curricula.  

Background: Surgical residents receive the majority of their education in the operating room, yet only recently has the body of literature on intraoperative teaching started to develop. Broad teaching paradigms have been described, but there is sparse literature with more granular descriptions of specific teaching actions used by faculty intraoperatively, and even less data on resident endorsed intraoperative teaching strategies. The objective of this study was to identify specific intraoperative teaching techniques that residents perceive as effective in facilitating the development of technical skills.

Methods: General surgery residents at an urban, university-affiliated medical center were recruited via email to participate in focus groups (FGs), which were conducted using semi-structured interviews. Narrative comments were audio-recorded, transcribed, and then coded by three authors using an inductive approach with no a priori hypotheses. Codes were then reviewed and revised, and consensus themes generated.

Results: Postgraduate year 1-5 residents (n = 11) participated in 3 FGs (2-6 participants/group). Analysis of narrative comments generated five themes: instruction, communication, environment, negative events, and emotions. With respect to specific types of instruction, residents preferred clear, verbal instruction and physical demonstration, including hand-over-hand instruction. The majority of narrative comments, however, centered on factors that contribute to fostering an environment conducive to learning. Communication was heavily emphasized, in particular discussion and explanation of decision making. Feeling respected and included in such conversations were valued at all levels of training. Constructive reactions to negative events, such as including corrective instructions when feedback for mistakes is given and controlling emotions during such events were favored approaches. Emotional intelligence and the ability to acknowledge internal factors that can influence one’s ability to teach in a given moment was heavily emphasized.

Discussion: When reflecting on effective teaching experiences in the OR, residents emphasized elements that cultivate an environment conducive to learning over specific teaching actions. This may reflect that while individuals can utilize a range of learning strategies, being able to do so in a constructive and supportive environment is a common priority that takes precedence over any specific teaching technique.

Introduction

Video-based surgical coaching (VBC) utilizes operative video review and individualized feedback, which has been described to improve operative performance. Such methods are not yet widely utilized in surgical training in part due to barriers with video access. A new robotic digital platform enables automated video access and operative performance indicators (OPIs). The aim of this randomized control trial is to evaluate the effect of a structured robotic VBC program on technical skills of surgical trainees.

Methods

Four robotic attending surgeons received surgical coach training from the Academy for Surgical Coaching. From January-October 2023, 18 surgical residents (PGY3-5) on minimally invasive surgery rotations were recruited and randomized to control or coaching groups. Both groups obtained operative assessments (RO-SCORE) over the course of their rotations. Active control time (ACT)—an OPI that describes the percent of robotic case time controlled by trainees—was also analyzed. The coaching group received 1-hour VBC sessions with an assigned surgical coach between their case assessments (Figure 1). Wilcoxon, paired t-tests, and descriptive statistics were applied.

Results

Fourteen residents completed the study with 6 in control and 8 in coaching groups. Groups had equivalent average robotic case numbers in the 6 months prior to participation. Overall technical performance from attending-assessed RO-SCORES improved for coached residents (median 2.0 v 3.0, p=0.031) with greatest improvement in procedural efficiency and flow (median 3.0 v 4.0, p=0.0156). Overall technical performance did not change for the control group (median 3.0 v 3.0, p=0.50). Mean %ACT increased for the coaching group (44±9.0 v 49±20, p=0.42) and was unchanged for control (49±12 v 48±38, p=0.92), however this did not reach statistical significance. On exit survey, 100% of coached residents found VBC very or extremely valuable and were highly satisfied with operative coaching feedback when compared to standard mechanisms.

Conclusions

This study demonstrates that VBC applied within robotic surgery can accelerate resident technical skill development. Residents who received operative coaching reported high value and satisfaction when compared to traditional teaching and feedback approaches. With improved video access, training programs should consider implementing VBC as a resident education method to support competency development in minimally invasive technologies.

Background

Teamwork is a core competency of medical training that is often taught indirectly. The unpredictable variability of modeling teamwork skills by attendings and residents is often exacerbated in the operating room (OR), where students encounter a highly regulated hierarchical environment characterized by safety precautions and an often mysterious code of conduct. By offering a structured framework for interpreting team dynamics, students may gain a better understanding of OR cultural expectations and develop leadership skills.

Methods

The Team Dynamics Workshop was designed by a group of medical student educators, including surgery faculty, to familiarize students with the OR and build teamwork skills.  Students were introduced to a team dynamics framework, described by organizational psychologist David Berg, that allowed them to process tense interactions and conflicts they witnessed in the OR. The objectives of the workshop included helping students recognize and analyze a team conflict, refocus on their role as a learner in the OR, and brainstorm how to approach such difficult interactions and conflicts outside of the OR and as future leaders. The workshop was facilitated by a surgery faculty member at the beginning of the surgery clerkship for each new group of students. Students provided written reflections at the end of the session that were reviewed by the core group of instructors to identify themes.  

Results

87 responses were collected from 88 students between 10/2022 and 11/2023 and 226 codes were generated. Ten themes were sorted into three overarching domains including looking inward with self-reflection, looking outward with situational awareness, and looking forward with development of leadership qualities. The most common themes that emerged included using the framework to internally sort through conflict and compartmentalize, empowering the student as the learner, learning language for effective debriefing, and recognizing the importance of professionalism, respect, and communication.

Conclusions

Structured discussion with students on team dynamics as it relates to the OR may promote self-reflection, provide language to process team interactions and conflict internally and externally, and provide a skillset that may serve as a foundation for building and developing leadership skills.

Introduction: The pursuit of surgical specialization often requires a robust mental framework given the high stakes and demanding nature of surgical practice. The mindset of surgical residents, specifically the dichotomy of fixed versus growth mindset, may significantly influence their learning trajectory and eventual performance. This study seeks to explore the prevailing mindsets of surgical residents, with the goal of fostering a conducive learning environment that promotes continuous growth and excellence.

Methods: A modified cross-sectional survey based on Dr. Carol S. Dweck's mindset theory was administered to surgical residents at our center. The purpose of the survey was to classify the predominant mindset into 4 groups (strong growth mindset, growth mindset with some fixed ideas, fixed mindset with some growth ideas, and strong fixed mindset) and assess whether this influenced residents' perceptions of performance.

Methods: A survey was distributed to surgical residents at our center. A trend toward a growth or fixed mindset was observed among the 17 surgical residents surveyed. The majority, 58.8% of the participants, both male and female, predominantly exhibited a "growth mindset with some fixed ideas". Notably, none of the participants fell into the "strong fixed mindset" category, highlighting a collective tendency toward learning and adaptability among the sample. 17.6% of the participants had a strong growth mindset, representing a significant but minority portion of the group. Although this study did not directly examine the underlying factors influencing these mindsets, the results highlight an area of interest for future research.

Conclusion: This study highlights the prevalence of a growth mindset among surgical residents, indicating a willingness to adapt and learn continuously. The absence of a strong fixed mindset in the surveyed group reinforces the evolving nature of surgical education that emphasizes adaptability and resilience. This study lays the groundwork for more extensive research to understand the factors that foster these mindsets and to develop strategies to further promote a growth mindset in surgical education.