Podium 1D - Simulation / Education Technology
(S040) FIRST-COHORT MICRO-CREDENTIALING IN THORACENTESIS AND PARACENTESIS: FEASIBILITY, UPTAKE, AND EARLY BARRIERS
Matías Aguilera, MD, Mateo Ferrer, MD, Vlada Vasilyeva, BS, Felipe Araya, BS, María Inés Gaete, MD, MSc, Julián Varas, MD, MSc; Pontificia Universidad Católica de Chile
Introduction
Traditional assessment in procedural training prioritizes knowledge and checklists over observed performance, creating a gap between grades and actual skill. Micro-credentials provide portable, evidence-linked recognition aligned with competency-based education and enable transparent documentation of progression from simulation to clinical practice. Our center is implementing this model, we explored student acquisition of this credential and possible barriers for future implementation.
Methods
We conducted a prospective implementation over one academic cycle for thoracentesis and paracentesis using a four-tier framework: Level-1 (simulation minimum competency), Level-2 (6-month retention), Level-3 (peer-teaching/assessor certification), and Level-4 (supervised clinical performance). Learners uploaded simulator attempts for asynchronous video review with OSATS-style global ratings, checklists, and written feedback. Meeting predefined thresholds triggered Level-1 issuance; Level-2 required ≥70% retention at ~6 months without critical errors. Level-3 involved rater calibration (target κ≥0.7). Level-4 required supervised clinical performance with tutor attestation and consent workflows. Primary outcomes were badge counts by status (issued, accepted/claimed, pending, publicly shared). Secondary outcomes were acceptance rate (accepted ÷ issued) and qualitative barriers to adoption.
Results
The platform recorded 387 badges issued. Overall acceptance among issued badges was 51.4% (199/387); among accepted badges, 48.2% were publicly shared (96/199). At ~6 months, 152 learners reached the Level-2(retention) review window; verification and release follow the academic schedule and are not yet reflected as issued in this report. Overall, the acceptance pattern is more consistent with assessment-value signaling and curricular timing(limited linkage to progression decisions, variable faculty signaling at the claiming step) than with platform usability alone.
Conclusion
Micro-credentialing of thoracentesis and paracentesis is feasible at scale with asynchronous video assessment; nevertheless, activation remains modest (~51%), and fewer than half of accepted badges are publicly shared. Uptake appears limited by misaligned incentives, visibility and claim-step friction. If interested in promoting microcredentials, programs should embed badges in progression decisions, synchronize claiming with graded milestones and faculty endorsement, streamline claiming, expand assessor capacity with protected time, and formalize clinic logistics. Next semester, by adding high-frequency skills, we expect to increase issuance and create realistic opportunities to award Level-4 micro-credentials.
(S041) REAL-TIME WEARABLE EEG-BASED KANSEI BIOMARKERS REVEAL SURGEONS’ COGNITIVE–EMOTIONAL STATES DURING SURGERY
Yusuke Watanabe1, Susumu Shibasaki2, Yasue Mitsukura3, Shutaro Hori3, Masaya Nakauchi2, Tsuyoshi Tanaka2, Ichiro Uyama2, Tetsuya Toma3, Koichi Suda2; 1Hokkaido University, 2Fujita Health University, 3Keio University
Background:
Understanding surgeons’ cognitive load and mental workload during surgery is recognized as critical for advancing surgical education, simulation-based training, and competency assessment. Recent advances in wearable electroencephalography (EEG) have enabled real-time and noninvasive monitoring of neurophysiological states. Our Kansei estimation model has been developed by analyzing EEG signals in relation to neuroendocrine responses associated with oxytocin, serotonin, dopamine, adrenaline, and cortisol. Based on this mapping, five affective states, Stress, Like, Interest, Concentration, and Calmness, can be algorithmically estimated as quantitative indicators of cognitive load and mental workload.We assessed the feasibility of using wearable EEG for real-time measurement and explored how these Kansei-based biomarkers reflect cognitive–emotional states during standardized simulation tasks.
Methods:
Participants included senior faculty, junior faculty, and trainees who performed two validated simulation tasks: the ATLAS needle handling task and the FLS intracorporeal suturing task using a robotic surgery platform. A wearable EEG-based Kansei analyzer was used to continuously estimate five affective parameters during task execution: Stress, Like, Interest, Concentration, and Calmness, each expressed on a 0–100 scale and measured every second.
Results:
A total of 12 participants completed all tasks (senior faculty n=4, junior faculty n=4, trainees n=4). All participants successfully completed both simulation tasks without technical issues related to EEG acquisition. Across all experience levels, Like, Interest, and Stress demonstrated higher values compared with Concentration and Calmness during task performance. These trends were observed consistently across both simulation tasks. In addition, Stress showed abrupt increases at moments when participants struggled with specific steps, suggesting differential cognitive–emotional activation depending on task demands.
Conclusion:
The feasibility of acquiring stable EEG data during simulation tasks was demonstrated. Preliminary findings indicate that specific Kansei-derived parameters: particularly Like, Interest, and Stress, show measurable variation and may serve as informative biomarkers of cognitive load and mental workload during surgery. These parameters also have potential for use in neurofeedback-based surgical training. Further studies in live operative settings are required to provide additional validity evidence, including the interpretability and educational utility of these digital biomarkers.
(S042) OBJECTIVE VIDEO-BASED ASSESSMENT OF RESIDENTS’ SKILL IN IDENTIFYING THE CRITICAL VIEW OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY
Eliza B Littleton, PhD, Bestoun H Ahmed, MD, Anthony R Cyr, MD, PhD, Carl H Snyderman, MD, MBA; University of Pittsburgh School of Medicine
Background: Correct identification of the Critical View of Safety (CVS) is fundamental to preventing bile duct injury during laparoscopic cholecystectomy (LC). Despite its widespread adoption, consistent recognition of CVS can be challenging, particularly for junior residents who must interpret dynamic intraoperative cues under varying visualization and anatomy. We applied theories of pattern recognition and visual cognition for surgery to construct an assessment and training approach. This IRB-approved study evaluated junior surgical residents’ ability to recognize CVS from short operative videos of the hepatocystic triangle. It examined residents’ accuracy when given structured feedback and deliberate practice in recognizing CVS.
Methods: Ten junior residents each completed a 91-item quiz based in video clips from 150 patient cases of LC. For every video clip, participants had to indicate whether it was safe to apply the first clip (Yes/No). Immediately after each response, the platform displayed the correct answer, a written explanation, and a screenshot of the video highlighting the visual cues of CVS. Content was developed by two General surgery faculty. Study execution and psychometric analytics were supported by a new AI-powered technology platform.
Results: Participants took between one and two hours to complete the quiz. Mean accuracy was 74.62% (SD 6.07%; 95% CI 70.27%–78.96%). By the end of the quiz participants had significantly improved their accuracy, F(2, 18) = 10.283, p = .001. Participants’ average scores increased by 50 percent from the first set of questions to the last set. Responses indicated a balanced mix of challenging and introductory items. The distribution of “Yes” responses compared to that of correct “Yes”s suggests participants were cautious or uncertain in their decision-making. Participants indicated in a post-quiz survey that they appreciated the exposure to a wide variety and number of examples of CVS.
Conclusions: Substantive exposures to small video clips from patient cases can be used for assessment and training of CVS knowledge. Supported by AI-enabled analytics and structured visual feedback, the pattern recognition approach offers a scalable, objective method for strengthening cognitive safety skills in laparoscopic cholecystectomy. The pattern-recognition approach is also procedure-neutral and applicable to teaching and assessing safe operating.
(S043) RAISING THE BAR IN SIMULATION-BASED TRAINING: FEASIBILITY, PERCEPTIONS AND EARLY OUTCOMES OF THE ADVANCED TRAINING IN LAPAROSCOPIC SUTURING (ATLAS) CURRICULUM FOR SURGICAL TRAINEES
Sofia Garces Palacios1, Angela Guzzetta, MD1, Kaustubh Gopal1, Dmitry Nepomnayshy, MD2, Ganesh Sankaranarayanan, PhD1, Daniel J Scott, MD1; 1University of Texas Southwestern Medical Center (SSO), 2Lahey Hospital and Medical Center
Introduction
Although Fundamentals of Laparoscopic Surgery (FLS) certification is mandatory for general surgery trainees, gaps in advanced laparoscopic suturing skills remain. The Advanced Training in Laparoscopic Suturing (ATLAS) program was developed to address this need; however, its feasibility as a structured curriculum within residency training has not been evaluated. This study reports the experience and outcomes of a two-year pilot implementation of the ATLAS curriculum in an academic program.
Methods
Beginning in early 2024, the ATLAS proficiency-based simulation curriculum was offered to FLS-certified residents (optional) and MIS fellows (required). Participants completed a proctored baseline assessment (pre-test), followed by self-directed training until national “basic” proficiency benchmarks were achieved, and a post-test. Feasibility measures included total time, number of sessions, attrition rate, and faculty/proctor time. Pre and post curriculum surveys assessed participant perceptions. Learning outcomes were analyzed using Wilcoxon Signed-Rank Test
Results
Eighteen trainees enrolled (2 PGY-2, 4 PGY-3, 7 PGY-4, 3 PGY-5, 2 MIS fellows); five (2 PGY-4, 1 PGY-5, and 2 MIS fellows) completed the curriculum, yielding a 75% attrition rate. Among completers, the average total training time was 2 hours 39 minutes (SD ± 31 min, range 2:04 – 3:20) with an average of 5.4 trials per task. Average proctoring time for testing was 54 minutes per trainee, and a single expert faculty member conducted four one-hour live tutoring sessions. Performance analysis revealed statistically significant improvements for all tasks, with all participants surpassing the basic proficiency level (Figure 1). Surveys revealed notable training gaps: 80% of trainees reported low confidence in laparoscopic suturing at baseline, and none had prior simulation experience beyond FLS. All respondents agreed that additional simulation opportunities should be available during residency, and 100% of those who completed training rated the curriculum as very effective, reporting increased comfort and improved OR performance, and stated they would recommend the curriculum to their peers.
Conclusion
These data suggest there is a need for the ATLAS curriculum and that completion results in significant skill improvement. Alternative implementation strategies, including scheduling flexibility or mandatory requirements, may address the high attrition rate observed. Integration into residency training should be further explored.
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(S044) POSTURE IN PRACTICE: SURGICAL RESIDENT ERGONOMICS IN A SIMULATED TRAINING EXERCISE
Heather Grubbs, Rachel Davis Bouvette, Christopher Luschen, Katherine White, Blaine Van Hoosier, Marianne Kimmell, Jimmy Le, Arthur Grimes, Jason Lees, Morgan Bonds, Chance Nichols, Alessandra Landmann, Jeremy Johnson, Alexander Raines, Dee Wu, Kristina Booth, Frank Wood; University of Oklahoma
Background
Resident education in procedural specialties relies on hands-on learning for technical skill development in both clinical and simulated environments. Ergonomics is an often-overlooked component of operative education, and early intervention can protect trainees from physical stress and long-term musculoskeletal injury. Our aim is to evaluate trainees during a simulated suturing exercise and assess the impact of self-evaluation on ergonomics.
Methods
Following informed consent, surgical residents performed a filmed simulated complex wound closure, blinded to the study’s focus. Standardized instructions included an offer to adjust operating table height. Following initial closure, residents reviewed their videos with an ergonomic self-assessment guide, repeated the exercise with increased ergonomic awareness, and finished with a post-survey. Representative video clips were analyzed to measure elbow, spine, and neck angles before and after self-evaluation. Standard angles were defined as 90-120° for elbow, <10° for spine, and <25° for neck.
Results
Twenty residents participated across four post-graduate years (PGY): five PGY-4, four PGY-3, four PGY-2, and seven PGY-1. Across all participants, we found significant reduction in spine angle (16.6° vs 5.1°, p=0.016) and neck angle (58.5° vs 46.4° (p=0.004) during the second exercise, but no difference in elbow angle (102.7° vs 101.1°, p=0.743). We also observed a significant increase in the proportion of participants with proper spine angles (40% vs 95%, p=0.003), but no difference in proper elbow angle (55% s 75%, p=0.134) or neck angle (5% vs 5%, p=0.480). To evaluate the impact of level of training, we compared PGY-3/4 to PGY-1/2 with no significant difference in proper initial angles. The post-survey revealed most residents think about their ergonomics in the operating room weekly or daily (60%) and feel physical strain monthly or weekly (75%). All residents reported improved awareness of ergonomics and perceived transferability to the clinical setting.
Discussion
Our study demonstrated a trainee self-assessment of ergonomics led to significant improvement in spinal and neck angles in a simulated exercise with increased awareness of operative ergonomics and perceived transferability to the clinical setting. These findings support the integration of ergonomic education early in surgical training to help reduce physical strain and promote operative longevity.
(S045) LESS PING, MORE PURPOSE: REDUCING MESSAGE FATIGUE AND BOOSTING COLLABORATION THROUGH SECURE CHAT OPTIMIZATION
Jackson Fos, MD1, Hayden Mezick, MD1, Jared Jones, MD1, Meredith G Rippy1, Kay B Buerster, MD1, Alexandra F Zeringue, MD1, Laura Holder, MD1, Nicole Nunez, MD1, MacKenzie Pairitz, MD1, Alexander Urevick, MD1, Jessica Holladay, MSN, RN, TCRN, CEN2, Stephanie Spain, RN, CCRN, TCRN2, W. Heath Giles, MD1, S. Dave Bhattacharya, MD1; 1Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, 2Trauma Services, Erlanger Health System, Chattanooga, TN
INTRODUCTION
The integration of secure messaging within Epic has become standard in healthcare, enabling immediate and continuous coordination among multidisciplinary care teams. Although intended to streamline communication, on-demand Epic messaging has contributed to message fatigue, disruption of learning in the operating room, and decreased satisfaction of resident surgeons and nurses. At our level I academic trauma center, high “chat” volumes and fragmented communication were identified as barriers to efficiency, resident intraoperative education, and interprofessional collaboration.
OBJECTIVE
To reduce Epic message burden of surgical residents on the trauma surgery service by 25% within 12 weeks while improving communication efficiency, continuity of care, and team collaboration.
METHODS
A multidisciplinary QI team consisting of resident surgeons, APPs, and nursing leadership identified secure chat workflow inefficiencies as a source of communication fatigue. Baseline data was extracted from EMR secure chat logs over two 72-hour periods. Trauma service residents, APPs, and nursing completed a pre-intervention survey assessing message burden, clarity of communication, and satisfaction.
Interventions included daytime workflow modifications, structured handoffs among APPs, surgical residents, and charge nurses, and education sessions for all team members on communication expectations. During daytime hours (06:00-16:00), nursing communications were routed to APPs rather than residents. APPs addressed messages within their scope and escalated unresolved concerns to appropriate providers. At shift-change, APPs provided structured hand-off to the on-call surgical resident summarizing key issues, pending orders, and unresolved tasks. Multidisciplinary rounds involving the APP, resident, and charge nurse were implemented to align priorities and mitigate care delays.
RESULTS
Residents demonstrated a 21.5% reduction in average number of messages received per 24-hour period and a 34.9% reduction in nursing-related communications. During daytime hours (06:00 – 16:00), the total number of messages received by residents decreased by 41.5%, and nursing communications received by residents decreased by 43.7%, reflecting APP management of these requests, enhanced communication on rounds, and improved utilization of secure messaging by team members.
CONCLUSION
Implementation of a structured secure chat workflow with APP involvement significantly reduced resident message burden and improved communication efficiency. This data has encouraged hospital administration and nurse leadership to acknowledge message fatigue and its impact on learners.
(S046) FEASIBILITY OF A BLENDED E-LEARNING AND VIRTUAL REALITY REFRESHER FOR POSTGRADUATE PROCEDURAL TRAINING
Jenna Gregory, Junko Tokuno, Teya Finan, Isabelle Lebeca-Gordon, Daniel Negreanu, Eleena Pearson, Noémi Sawaki-Desjardins, Sarah Aboushawareb, Gerald Fried, Jeffrey Wiseman, Tamara Carver; McGill University
Background: Repeated, deliberate practice is essential for procedures such as chest tube insertion and central venous catheterization, yet logistics limit repetition in traditional simulation. Blended designs that pair e-learning with virtual reality (VR) simulation may extend access to targeted refreshers.
Objective: Evaluate the feasibility and acceptability of a blended e-learning and virtual reality refresher within existing institutional infrastructure, and explore changes in knowledge and self-efficacy.
Methods: Exploratory mixed-methods study at a university simulation center (September 2024 to March 2025). E-learning modules (chest tube insertion and central venous catheterization) preceded an on-site VR session scheduled via a learning management system (LMS). Feasibility was assessed across four Bowen domains selected a priori for implementation relevance: demand, implementation, practicality, and integration. Acceptability was examined using the Theoretical Framework of Acceptability. Knowledge and self-efficacy were measured pre and post; qualitative comments were thematically analyzed.
Results: Thirteen residents enrolled for this refresher activity; 11 accessed the LMS modules and attended the VR sessions. Two did not meet the inclusion criteria of having prior training. Nine post-intervention surveys were completed across seven unique participants, including two who completed both procedures. Demand thresholds were met for module completion and VR attendance among completers. Overall satisfaction was high (median 5, IQR 4.5 to 5 on a 5-point scale), and 8 of 9 respondents would recommend the VR session to colleagues. Participants reported low burden for module, onboarding, and session time; intervention coherence ratings were high. Booking compatibility revealed logistical friction consistent with practicality constraints. Knowledge scores increased from pre to post with an exploratory effect that approached but did not reach statistical significance in this pilot; self-efficacy improved across several readiness items. Qualitative themes highlighted the value of targeted repetition, immediate feedback, and the need for expanded access points or hours.
Conclusion: A blended e-learning and VR simulation refresher for high-stakes procedures was feasible to deliver and acceptable to trainees in a real-world setting, with positive signals in knowledge and self-efficacy. Future work should include measurements of objective procedural skills outcomes, longer-term retention, and implementation strategies to reduce scheduling and location barriers.
(S047) 3D PRINTABLE, CUSTOMIZABLE, AND LOW-COST VASCULATURE MODEL FOR RESIDENT SUTURE TRAINING
Kent K Yamamoto, BS1, Kerry Gao, BA2, Shannon Barter, BS, MD2, Steven Thornton, BS, MD2, Cameron Reid, BS1, Brian Gilmore, BS, MD2, Sabino Zani, BS, MD2, Katharine L Jackson, BS, MB, MD2; 1Duke University, 2Duke University School of Medicine
Background:
Vascular suturing practice is essential yet limited by scarce practice opportunities for surgical residents. Simulation-based training (SBT) is a mainstay of surgical education, with current vascular models including vinyl tubes, animal or cadaveric tissue, and virtual reality. However, these are costly and require manual marking of suture placement locations. To address this, we developed a low-cost, 3D-printable, flexible vascular model with embedded suture placement markers to guide needle entry and promote muscle memory during training (Fig. 1(a-b)). These models can be batch-printed with minimal post-processing, enabling accessible and reproducible vascular skills training.
Methods:
A validity study was conducted to evaluate the model for teaching vessel suturing in general surgery junior residents (Fig. 1(c)). Thirteen residents and nine attending surgeons sutured the model (Fig. 1(d)) and completed a survey assessing validity evidence and threats to validity for its use in this context. Messick’s framework for validity evidence guided study design and analysis.
Results:
Validity evidence included content, response process, and consequences. Content evidence for validity showed 89% of attending surgeons and 70% of residents agree that the model appropriately replicated arterial bites. Response process evidence supported that all participants successfully passed sutures through the designated guide-points, and 89% of attendings and 60% of residents agreed that it developed muscle memory for proper vascular anastomotic technique. Consequence evidence for validity included affordability, ease of 3-D printing, ease of dissemination, and 100% of attendings and 70% of residents found the model useful for assessing technical skills. The primary threats to validity included construct-irrelevant variance related to vessel brittleness and inconsistencies in securing the model during use, leading to performance independent of participants’ technical abilities.
Conclusion:
This reproducible, low-cost, 3-D printed vascular model demonstrates strong preliminary validity for early vascular suturing training. It provides an accessible platform for repeated independent practice to build muscle memory, while also addressing the cost and tactile limitations of existing models. Future work includes tuning vessel stiffness, varying vessel sizes and shapes, and incorporating hemodynamic flow to enhance realism and training fidelity.
(S048) EVALUATION OF TOOLS FOR ASSESSMENT OF TECHNICAL SKILLS IN ROBOTIC SURGERY: A VALIDITY- FOCUSED SYSTEMATIC REVIEW
Naimisha Badri, BS1, Amber Chen-Goodspeed, MD2, Forlain Adeyemi, MD1, Iman Ghaderi, MD, MSc, MHPE3; 1Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, 2Department of Surgery, New York-Presbyterian Queens, New York, USA., 3Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
Introduction: Objective assessment of operative performance has become essential in competency-based surgical education. While there are well established for open and laparoscopic training, equivalent assessment tools for robotic surgery remain fragmented and sparse. This study reviews current tools for assessment of performance in robotic surgery, identifying areas of strength and existing gaps.
Methods: A PubMed search of current robotic assessment tools was conducted. Each study identified was mapped to 22 robotic equivalents of the American College of Surgeons (ACS) and the Association of Program Directors in Surgery (APDS) skills modules. An established rating scale was used to evaluate available evidence supporting the unitary framework of validity, including the five “sources of validity:” content, response process, internal structure, relationships to other variables, and consequences. Two independent reviewers scored each study, then came to a consensus score for each. Interrater reliability (IRR) was calculated using intraclass correlation coefficient (ICC) and weighted Cohen’s κ.
Results: Only 13 of the 22 robotic equivalents of the ACS/APDS skill modules had corresponding studies, totaling 17 papers, indicating that a significant portion of the robotic skill domains remain unstudied. Most available studies used established tools such as Global Evaluative Assessment of Robotic Skills (GEARS) and Objective Structured Assessment of Technical Skills (OSATS). Content had the highest level of evidence, followed by internal structure and relationships to other variables, while response process and consequences had the lowest. These findings highlight significant gaps in the literature, as most studies applied existing robotic-focused assessment tools rather than developing new ones, assessed only limited aspects of performance, and provided limited evaluation of validity.
Conclusion: The findings highlight a significant lack of robust assessment tools for robotic surgery, with some skill modules having no studies that provide supporting validity evidence. Future research should focus on development and evaluation of assessment tools based on contemporary framework of validity to support competency-based training as robotic surgery continues to expand in surgical practice.
