The Association for Surgical Education

Impacting Surgical Education Globally

 

 

Thinking Out of the Box Presentations

 

THE GAMIFICATION OF A SURGICAL DEPARTMENT: A NOVEL WELLNESS INITIATIVE
Lindsey Jean Loss, MD, Oregon Health and Science University; Oregon Health and Science University

What problem in education is addressed by this work? We have all been struggling with being disconnected from one another and increasing rates of burnt out and work dissatisfaction since the pandemic. We know that burn out can be combated with engagement and finding purpose within the workplace. We aimed to increase social networking and connections at work to create a more positive and healthy environment within our surgical department. Describe the intervention: We developed a gamification of the surgical department by sorting all members into teams which now compete to earn points throughout the year in our initiative called "The Torch Tournament." Points are earned in an almost endless amount of ways, many centering around social gathering: from team dinners and research, to group fitness, practicing in the skills lab, recognizing acts of kindness in the hospital and so much more. The teams then earn prizes for being the point leader at regular check ins throughout the year. Describe the improvement/outcome of the intervention. Throughout the implementation of The Torch Tournament we have subjectively noted increased camaraderie and team mentalities throughout the hospital. We also noted statistically significant improvement in 8 questions of measures of burnout and loneliness in our pre and post intervention surveys, importantly with no noted decrease in any measures. Overall trends showed that participants felt less lonely, more connected to others, and felt they now had more places to turn to when having a hard time. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. This initiative could easily be adopted by other institutions to help build closer teams within their own departments by following the same guidelines to “gamify” our existing residency structures. The biggest barriers are obtaining institutional buy in as well as individual buy in from the program. These are easy to overcome when discussions about the cost of burn out in the workplace and the feeling of isolation are ubiquitous throughout medical education today and the desire for increased connectivity is so prevalent.

 

 

LEVERAGING TECHNOLOGY TO CREATE A TRAUMA SURGERY VIDEO ATLAS
Patrick Georgoff, MD, Duke University; Duke University

What problem in education is addressed by this work? Preparing for the surgical treatment of deadly traumatic injuries is challenging, and currently available resources are extremely limited. Video-based education is a potent medium for teaching the surgical approach to severely injured patients. However, high-quality footage of injured patients is difficult to obtain. Describe the intervention: The Behind the Knife Trauma Surgery Video atlas uses fresh, perfused cadavers and a variety of video techniques to recreate deadly injuries and record repairs. Video editing and post-production was performed by the surgical team using widely available software and newer AI-based media creation tools. The final product, which includes text and original illustrations in addition to video, was delivered using Behind the Knife's bespoke media builder for consumption on our website or app. Link to atlas: https://app.behindtheknife.org/premium/trauma-surgery-video-atlas Describe the improvement/outcome of the intervention. Thousands of students, trainees, and surgeons around the world now have access to a practical, engaging, and highly useful trauma surgery education tool. The resource is being used by residency programs and fellowships, to supplement human and animal trauma labs like ASSET and ATOM, and in high-need areas like Syria and Gaza. There are multiple ongoing projects assessing the effectiveness of this resource for trainee education. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. The Trauma Surgery Video Atlas is just one of many examples of innovative surgical education content being produced by the team at Behind the Knife using resources available to all surgeons. Any interested educator can create highly engaging and contemporary content by leveraging currently available technology. Specifically, video editors like Final Cut Pro, digital media creators like Canva, and social media like X and YouTube.

 

 

FROM CONCEPT TO REALITY: DEVELOPING AN IMMERSIVE VR 3D MODEL FOR COMPLEX LIVER SURGERY EDUCATION
Prachi Patel, MBBS, MSc, University of Toronto; University of Toronto

What problem in education is addressed by this work? In complex liver surgery, the intricacies of visualizing and understanding the relationship between transection lines and vital structures are critical. This requires not only a deep understanding of the underlying anatomy but also the ability to translate two-dimensional (2D) imaging, such as CT and MRI scans, into mental 3D representations—a task that is time-consuming, cognitively demanding, and heavily dependent on the surgeon’s experience. For surgical trainees it adds an extra layer of complexuty to their training. Traditional solutions, such as 3D-printed or Desktop models, are limited by cost and static nature, which does not adequately prepare trainees for real-time anatomical understanding and decision-making in surgical contexts. Describe the intervention: To address these challenges, we developed immersive virtual reality (VR) models of the liver using advanced 3D imaging techniques and integrated them into a VR platform designed for the Oculus Quest 2 headset. This interactive environment allows trainees to explore 3D anatomical structures dynamically, facilitating navigation and enhancing depth perception, while also enabling real-time collaboration between trainees and surgeons through a multi-user feature. (Please refer to the attached document) Describe the improvement/outcome of the intervention. Preliminary feedback from a diverse group of users, including medical students, surgical residents, and attending surgeons, has been overwhelmingly positive. Participants highlighted the ease of navigation, the system’s intuitive design, and the realistic correlation between 2D scans and the interactive 3D model. The multi-user functionality was particularly well-received, as it enabled collaborative discussions on anatomical features and surgical planning, which enhanced the overall learning experience. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. While our study centers on liver pathology, success with VR suggests applications across other complex surgical specialties. VR’s scalability and multi-user functionality enable institutions to implement it widely, supporting collaborative learning among geographically distant trainees and surgeons. Barriers, such as high initial costs and the learning curve, can be mitigated through inter-institutional collaboration and pilot programs. Additionally, previous studies demonstrate that VR is intuitive and engaging, even for users unfamiliar with the technology, which further supports its broad adoption potential.

 

 

UTILIZATION OF A HOSPITAL ADMINISTRATIVE FELLOWSHIP TO TEACH SURGICAL RESIDENTS LEADERSHIP
; University of Colorado School of Medicine

What problem in education is addressed by this work? Surgical residents traditionally acquire leadership skills through informal processes which can result in gaps in knowledge and limited self-awareness regarding leadership performance. Over time, these deficits may contribute to ineffective leadership behaviors. In the complex healthcare landscape, surgeons need to develop structured leadership skills, particularly in collaboration with healthcare executives, to achieve shared goals of improving healthcare quality, reducing patient harm, and enhancing patient outcomes. Describe the intervention: In partnership with the clinical learning environment health system, the Department of Surgery Vice Chair of Quality, and General Surgery residency program we have developed a one-year executive leadership and hospital operations fellowship as an option for residents during their research years. This immersive fellowship integrates the resident into hospital executive committees and working groups where they lead process improvement initiatives, learn health system operations, and contribute to high-level decision making while applying learned leadership concepts in real-time. Structured monthly 1:1 mentoring with executive leadership provides direct individualized feedback, ensuring deliberate leadership development, in addition to leadership specific training, such as Six-Sigma. This fellowship was designed in parallel with an administrative fellowship for Master of Health Administration graduates who collaborate on projects with the surgical trainee. Describe the improvement/outcome of the intervention. This intervention offers both immediate and long-term benefits with measurable outcomes at the individual, institutional, and patient care levels. In the short term, residents refine leadership competencies through hands-on experience and reflective mentoring, developing skills essential for effective healthcare leadership. Over time, participants cultivate sustainable leadership habits that enhance clinical practice and position them for future leadership roles. Additionally, the fellow's process improvement work contributes to hospital-wide metrics, yielding measurable improvements in patient outcomes and healthcare quality. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. This model can be replicated at other institutions by leveraging existing partnerships with the clinical learning environment and aligning institutional priorities with residency training goals. A primary challenge lies in securing commitment from multiple stakeholders, including executive leaders willing to mentor and provide meaningful feedback. Success also depends on tailoring the fellowship to meet the specific needs and resources of each program and its partner. Overcoming these barriers requires thoughtful coordination and shared commitment to fostering leadership development within surgical education.

 

 

IMPROV GAMES FOR NON-TECHNICAL SKILLS TRAINING
Priya A Rajdev, MD FACS, University of Arizona College of Medicine - Phoenix; University of Arizona College of Medicine - Phoenix

What problem in education is addressed by this work? Non-technical skills such as communication, empathy, situational awareness, leadership, and others can be difficult to teach. Apart from hands-on technical skill simulation labs, adults are typically not free to use “play” as a form of individual and group learning, especially in high-stakes environments such as surgical residency. With limited time to learn before entering practice, residents need novel ways to acquire many of these skills in concentrated sessions. Describe the intervention: We employed a series of simple improvisational theater games that focused on key skills including listening, situational awareness, and empathy. These games were played during two separate 90-minute sessions and included: 1) mirroring pantomime, 2) counting to 10 with eyes closed, 3) “Yes, But” versus “Yes, And” conversations, 4) improvised story circle, 5) appreciation round, and 6) a situational awareness game. This final game is designed to be more challenging than the others: a group creates two to three sequences of words from different categories (i.e. first name, fruit, animal), then, standing in a circle, they recite these separate word sequence loops simultaneously, trying as a group not to drop any one category/sequence. Describe the improvement/outcome of the intervention. Multiple non-technical skills were addressed in each game, and residents enjoyed playing the simple yet challenging games that simultaneously appealed to competitive natures while allowing for fun, consequence-free, exploratory learning. As the residents played in groups of variable sizes and people, they were also required to stretch discomfort around interpersonal interactions and develop camaraderie throughout the experience. Feedback about the sessions was positive, with many residents specifically highlighting the opportunity to interact with and learn about their colleagues in a creative way while at work. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. In addition to in-person medical improv workshops (e.g. Medical Improv Train-the-Trainer Course at Northwestern Feinberg School of Medicine, Alan Alda Center for Communicating Science at Stony Brook University), theater warm-up games instructions/videos are widely accessible on the internet and are used in a variety of settings from grade schools to corporate boardrooms as a way to cultivate open environments, camaraderie, and non-judgemental listening. Barriers include enthusiasm and buy-in from residents and faculty alike; apart from any cost of attending a training course if needed, the greatest cost to the program will be time. We suggest that as institutions build their own non-technical skills curricula, it will be helpful to have a dedicated champion at an institution to help introduce this form of low-stakes, high-yield play into the high-pressure environment of surgical residency.

 

 

PORCINE ORGAN RECOVERY COLLABORATIVE (PORC): EX VIVO SIMULATION MODELS FROM NON-SURVIVAL PROCEDURES
Shannon Marie Barter, MD, Duke University; Duke University

What problem in education is addressed by this work? Porcine tissue is an excellent model for surgical simulation. Commercial companies offer explanted porcine tissue for simulation, which costs money and the life of an animal. We sought to procure porcine tissue for ex vivo models by collaborating with groups using swine in non-survival procedures. Describe the intervention: Surgical trainees were trained to procure models from swine used in non-survival procedures. After euthanasia, midline sternotomies and laparotomies were performed to procure: heart-lung bloc, liver with gallbladder and long-segment common bile duct, stomach from esophagus to D1, small bowel segments (20cm each), kidneys, splenic vein, aortic trifurcation (~2cm iliac artery), and abdominal wall. The organs were preserved using a vacuum sealer and frozen at -20°C. The organs were thawed and used for various simulations for which model satisfaction was tracked. Describe the improvement/outcome of the intervention. This initiative has resulted in many ex vivo models, including skin suturing techniques, bowel anastomosis (hand-sewn, stapled; open, laparoscopic and robotic), ostomy creation, kidney transplant anastomosis, gastrojejunostomy, cholecystectomy, hepaticojejunostomy, pancreaticojejunostomy, lung resection, coronary artery dissection, and valve replacement. For each of these labs, trainee satisfaction ratings on a 5-point scale averaged 4.6 (n= 63). As a result of these new models, there has been a reduction of porcine labs from 25 in 2023/24 to 14 in 2024/25, resulting in an estimated saving of ~25 animals and $6100. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. Procured porcine tissue is an affordable and efficient way to provide models customized to specific simulation needs. An institution conducting large animal research could utilize this solution to optimize the 3Rs (Replacement, Reduction, and Refinement) of animal usage. Aside from administrative permissions, programs must invest in a vacuum-sealing device and a freezer for storage. The trainees procuring these models gain valuable technical skills which is a bonus of this project.

 

 

BINGO: A NOVEL APPROACH TO TEACHING THIRD YEAR MEDICAL STUDENTS ON A GENERAL SURGERY CLERKSHIP
Caitlin Silvestri, MD, Columbia/New York Presbyterian Hospital; Columbia/New York Presbyterian Hospital

What problem in education is addressed by this work? Great variation still exists in the structure and administration of surgical clerkships. Not surprisingly, previous studies have shown that across surgical clerkships, there are substantial differences in both teaching and practical skills.This variation can lead to unclear expectations and a substandard learning experience. Within medical education, setting clear expectations and learning objectives plays a large role in creating a successful learning environment for the trainee. Specifically within undergraduate medical education (UME), clearly defining a medical student’s role and assigning specific responsibilities is key for developing a clinically competent medical student. Despite this, the literature shows a lack of clear and consistent learning expectations across all stakeholders. Discrepancies between medical student, resident, and faculty expectations have been shown in areas such as involvement on morning rounds, note writing, priority of skills learned on the clerkship, components of evaluation, practical skills, and most troubling, value to the team. This learner-teacher mismatch in expectations often leads to poor engagement, non-standardized experiences, and has been shown to be a negative contributor to the surgical learning environment. Describe the intervention: The intervention involves the use of a gamified BINGO card that contains both mandatory and optional clinical tasks mapped to our institution’s clerkship learning objectives as well as the AAMC's core Entrustable Professional Activities (EPAs). The card is distributed to third-year medical students during their general surgery clerkship, and students complete tasks as they progress through the rotation. Each task is correlated to a specific work-based assessment (WBA) that the evaluating resident or faculty will fill out before signing off on the task. Using gamification, students are motivated to achieve "BINGO" by completing rows of tasks, with an additional challenge to fill the entire card by the end of the clerkship. This structured, engaging approach encourages active participation, helping students gain a clearer understanding of their roles and responsibilities during the rotation. Describe the improvement/outcome of the intervention. The intervention aims to enhance student engagement, clarify expectations, and reduce the gap between learners and teachers. While official pre- and post-survey data is still being collected, anonymous end-of-rotation feedback has indicated that the BINGO card serves as a useful tool for clarifying expectations, improving feedback, and increasing awareness of learning opportunities during the clerkship. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. We have created a template BINGO card that can be customized by each institution and, if applicable, by each rotation site within an institution. While the core concept remains consistent, each institution can tailor the BINGO card to fit its specific clerkship objectives and learning opportunities. Barrier #1: Time investment required from faculty and residents to track and confirm students' completion of tasks. Solution: Offer resident/faculty development sessions to emphasize the educational benefits of the tool, and implement automated systems or check-ins to reduce the manual workload. Additionally, utilization of QR codes for completion, that are present on the BINGO card itself, allows for streamlined process. As this becomes incorporated in the clerkship, it should streamline overall teaching efforts of medical students on the clerkship Barrier #2: Limited time during clinical rotations for students to complete all tasks on the BINGO card. Solution: Adjust the number of mandatory tasks to ensure they are feasible within the clinical schedule, and clarify priorities during orientation to focus on high-impact learning activities. Barrier #3: Ensuring consistent task completion and usage across different faculty and resident members. Solution: Provide clear guidelines and standardized rubrics for evaluating tasks, and involve faculty in customizing the BINGO card to ensure buy-in and consistency. While this process may be time-intensive, especially for institutions without existing work-based assessments, it is crucial to prevent the BINGO card from becoming merely a "logbook." Instead, the goal is to provide standardized assessment and meaningful feedback on students’ performance of clinical tasks.

 

 

ENGAGING FUTURE CLINICIANS: HOLOPATIENT SIMULATIONS FOR BEDSIDE PROCEDURE EDUCATION
Jenny Bui, MD, MPH, University of Michigan, Section of Thoracic Surgery, Ann Arbor Michigan; University of Michigan, Section of Thoracic Surgery, Ann Arbor Michigan

What problem in education is addressed by this work? This work addresses a critical problem in medical education: the challenge of efficiently and effectively training clinicians in essential procedural skills amidst growing workforce shortages and evolving patient safety standards. Traditional training methods are often limited by the need for instructor-led sessions and live patient interactions, which can be resource-intensive and pose risks to patient safety. Describe the intervention: Utilizing eXtended Reality (XR) technology, we have developed a procedural training platform for teaching hands-on procedural skills for medical or surgical training. Leveraging Microsoft 365 Guides, bedside procedures, such as central venous catheter placement and extracorporeal membrane oxygenation, are being developed in modules for learners to develop proficiency and competency using the Microsoft HoloLens 2, an XR device which allows the user to interact with both the physical world and virtual holographic elements. The platform is designed to improve both technical precision and non-technical skills such as decision-making, situational awareness, and communication within a controlled environment. Describe the improvement/outcome of the intervention. Pilot testing of the curriculum indicated students using the Hololens2 device rated it as highly usable, engaging, and adoptable compared to the traditional lab setting. Following XR training, students passed the competency training with 100% accuracy and faculty time was reduced by 75%. By offering a standardized training experience that can be tailored to individual learning speeds and needs, this intervention addresses the variability often encountered in traditional apprenticeship-based medical education. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. To support broad dissemination, the application will be made freely available for download on the Microsoft App Store, allowing any interested institution to join a multi-institutional research protocol. Additional institutions will be recruited through NSF IUCRC’s Medical Innovations in eXtended Reality (MIXR) network to share protocols for XR procedural simulation, enabling further validation studies across various academic settings. Potential barriers, such as the initial financial investment in XR hardware and software and the need for faculty training, could be addressed through grants, institutional funding, and partnerships with XR developers to help reduce these costs.

 

 

REPLACING THE TRADITIONAL CHAIR LETTER OF RECOMMENDATION: USING A STRUCTURED EVALUATIVE LETTER IN SURGERY (SELS) TO ENHANCE HOLISTIC APPLICANT REVIEW WITH COMPETENCY-BASED PERFORMANCE SUMMARY
Lindsey Mossler, MD, Indiana University School of Medicine; Indiana University School of Medicine

What problem in education is addressed by this work? Surgery residency programs have traditionally required a letter of recommendation from the departmental chair. Often, these letters seem to lack objective performance data, regurgitate information otherwise found on the application and are impersonal. Describe the intervention: The surgical education team at Indiana University School of Medicine has implemented a structured evaluative letter in surgery (SELS) in place of a more traditional chair letter of recommendation for our students applying to general surgery residency. This letter provides an objective, competency-based review of the applicant’s medical school performance in surgery. The applicant’s performance on the Surgery Clerkship as well as the General Surgery Sub-Internship is detailed in the SELS with additional information to cover important competency areas. Describe the improvement/outcome of the intervention. The education team and our departmental chair have received informal feedback from various program directors highlighting the innovative and useful nature of the SELS in comparison to the classic chair letter. We have utilized the SELS in place of the chair letter for three application cycles, including the current cycle. In the first two cycles we have seen a 100% match rate for General Surgery applicants with varying levels of competitiveness, further supporting the usefulness of the SELS. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. The basic framework of the SELS could easily be adapted by other institutions. A potential barrier is the amount of time and work that goes into generating the SELS for each student. At IUSM we have a surgical education team with protected time that makes this possible.

 

 

YES, AND: FOSTERING WELLNESS AND PROFESSIONAL GROWTH THROUGH MEDICAL IMPROV
Minna Wieck, MD, UC Davis; UC Davis

What problem in education is addressed by this work? Physician wellness, personal growth, communication, and self-awareness are ACGME milestones with well-defined behavioral descriptions of mastery that we expect general surgery residents to achieve. Exactly how they are supposed to learn and develop these competencies is not well defined. Thus, we sought to use medical improv as a novel and engaging teaching method for general surgery residents to build listening and communication skills and learn to find comfort in the present moment – however uncomfortable or unexpected – while fostering community within our training program. Describe the intervention: . Twelve senior residents participated in a two hour medical improv session led by two faculty with a background in improv comedy. The agenda included a short introduction to the applied improv skills and learning objectives, active participation in exercises to practice those skills, and then a facilitated group discussion on the clinical/interprofessional application of the skills learned. Games focused on a variety of skills including active listening, collaborative conversations, team building, non-verbal communication, self-reflection, and gratitude. Describe the improvement/outcome of the intervention. Following the first session, 9/12 (75%) residents stated they were confident in their active listening skills. Eleven residents (92%) felt they had the skills to create collaborative conversation with others. Eight residents (66%) were comfortable adapting to uncertainty. Free text comments expressed appreciation for a chance to learn useful tips for leadership, a space to learn and grow, and the opportunity to practice listening deeply and thinking on one’s feet. What they enjoyed the most was doing something seemingly informal but meaningful with their co-residents. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. Medical Improv is a flexible, low cost, and approachable means of helping surgical residents develop essential non-technical skills while also building community and wellness. This format can easily be adapted to differences in learning environment and residents’ preferences. Although having facilitators comfortable with improv comedy can optimize the experience for trainees, the detailed curriculum can easily be implemented by novices as well. Finding an adequate block of protected time, especially if multiple sessions are planned, can also be a potential barrier. This can be mitigated by incorporating this short session into existing educational time or into a longer resident retreat. Individual games can also be used as a brief ice breaker in other settings to still provide benefit.