ASE 2024 Abstracts

What problem in education is addressed by this work? Participating in academic research is important for medical students and surgical residents both for skill development and career progression. However, research productivity is often dependent on the availability of mentors and research infrastructure, such as the availability of data scientists or biostatisticians. Researchers without such infrastructure are left at a disadvantage in pursuing and publishing academic work. Describe the intervention: We used GPT-4 with Advanced Data Analytics (a version of ChatGPT) as an autonomous research assistant. First, we imported a CSV file of raw data into GPT-4 and asked the AI to study the dataset, perform descriptive analysis and suggest further analyses. We then specifically asked for analyses of interest to us, help choosing the right statistical methods, and assistance generating figures. GPT-4 provided relevant analyses, reproducible code we could run on our own, and graphs. We utilized this workflow in the preparation of two ASE abstracts. Describe the improvement/outcome of the intervention. GPT-4 served as a valuable research assistant, providing descriptive analysis of our data, suggesting potential statistical tests, and answering clarification questions when prompted. In less than two hours of work per abstract, we were able to obtain preliminary answers to our research question, obtain reusable code elements, and draft figures after importing a raw data file. 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 technology is available to the public and can be used by any student, resident, or surgeon who needs help with data analysis, statistics, or figure preparation. This technology has a few barriers. The largest barrier at present is a lack of knowledge on how to use these tools, and workshops and demonstrative presentations can help others learn about the technology and disseminate it within their own institutions. Second, it requires a subscription fee of 20 dollars per month; however, this is far less than a full-time statistician and could be funded by the institution or research lab. Third, GPT-4 should not be used with data containing protected health information, although alternative enterprise-level AI implementations exist that can overcome this limitation.

What problem in education is addressed by this work? Physician workforce diversity is vital to advancing health equity, yet Black individuals currently make up 6% of surgeons and their representation relative to the population continues to decrease (Ly, 2022). Pipeline and early exposure programs attempt to combat this issue by guiding underrepresented minorities (URM) through educational and training stages, but “leaky” pipelines limit any substantial change (Abelson, 2018). Creative recruitment strategies are necessary to provide early exposure and repair said pipeline leaks. Describe the intervention: Braids, Twists, and Surgical Knots (BTSK) is a novel initiative encouraging Black girls to consider a career in surgery by connecting it to the culturally significant topic of Black hair. In partnership with a local organization, 17 girls from 6 - 12th grade were recruited to participate in seminar sessions, including a panel discussion between Black women surgeons in various subspecialties and a moderated conversation between professional hairstylists and a plastic surgeon. Subsequent workshops demonstrated the technical similarities between suturing, sewing, knot-tying, and braiding, and students were sent home with practice surgical kits. Describe the improvement/outcome of the intervention. Based on pre- and post-workshop survey results, the event was the first time all responding participants (n=13) met a Black woman in at least one surgical specialty. On average, participants had a greater interest in surgery after the program and perceived the career as more attainable. Similarly, one surgeon described the power of the initiative, “...thinking of hairstyling as a skill that can be advantageous in a career as prestigious as surgery, and framing it in their minds early that they have always had what it takes—they have a skill set that a majority currently in that space do not—I think that is powerful and I’m very happy to be involved in such a revolution.” 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. Following additional iterations and data collection, a final curriculum will be proposed to the Student National Medical Association as a model for culturally-centered outreach programming to incorporate at institutions nationwide. The model, though currently centered on Black hair and empowerment, can also be extrapolated for other URM groups with the potential barrier of identifying relevant cultural foci. By working with other national medical identity groups to overcome this barrier, we hope to establish a new entry point for historically underrepresented populations and bridge the gap between healthcare, culture, and community.

What problem in education is addressed by this work? Trauma resuscitations can be loud and chaotic with multiple moving pieces in this multidisciplinary approach. Thus it is critical to develop a system for multidisciplinary team training to improve team communication, resident education and growth, and ultimately quality of care of patients at an academic institution. Describe the intervention: First, institutional trauma resuscitation guidelines were updated with an interdisciplinary approach followed by guidelines orientations and simulations performed first in small groups. Upon completion of this first phase we developed and implemented multidisciplinary trauma simulations performed at our interdisciplinary simulation center filling all of the designated roles of the trauma resuscitation team. Now we are transitioning to in-situ multidisciplinary trauma simulations in the trauma bay and utilizing a trauma resuscitation video review tool to evaluate pre and post intervention trauma resuscitations. Describe the improvement/outcome of the intervention. Our trauma division has noticed a significant improvement in the trauma resuscitations with regards to trauma team roles/responsibilities and communication in the trauma bay. A formal video review is under way with data collection in process and we expect to see statistically significant improvements in multiple subjective and objective outcome measures for the resuscitations. Of note, with the implementation of multidisciplinary simulations and dedicated trauma lead and floor positioning signs a recent survey demonstrated that the clarity of roles position increased from 48% to 90%. We expect the continued use of trauma simulation will help streamline trauma resuscitations by clearly identifying roles, improving communication, and improving the quality of patient care. 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. A multidisciplinary trauma simulation curriculum could be a valuable addition to any major academic center with rotating learners in multiple disciplines. Specific barriers include multi-specialty buy-in, simulation resources, and evaluation tools. We are able to discuss at length ways to address barriers to buy-in such as interdisciplinary collaboration on institutional guidelines, how to work with a wide range of simulation resources from low fidelity small group drills to high fidelity simulations, and lastly how we developed a video review tool to evaluate actual trauma resuscitations throughout the various phases of the project.

What problem in education is addressed by this work? Gamification, specifically utilizing escape rooms, has been employed in medical education to enhance engagement, motivation, and learning, particularly among medical students. However, its potential to foster interprofessional work ethics and integration with clinical teams remains an underexplored area in the literature. We propose that interprofessional teamwork and dynamics between residents, nurses, and medical students can be improved using escape room as the training platform. Describe the intervention: In a pilot study involving 12 participants, we tailored escape room scenarios to four medical specialties: General Surgery, Emergency Medicine, Pediatrics, and Internal Medicine. Each team, composed of a resident, a nurse, and a medical student, competed to solve specialty-specific cases, such as acute appendicitis, pulmonary embolism, and bacterial meningitis, within the shortest time. Subsequently, participants used a 5-point Likert scale questionnaire to assess their perceptions and experiences. Describe the improvement/outcome of the intervention. Our participants, aged 21 to 40, included 58% females and 42% males, with an equal distribution of residents, nurses, and medical students. A significant 80% strongly agreed that the escape room enhanced teamwork and served as a valuable team-building exercise. Regarding its impact on clinical decision-making in a healthcare setting, 33.3% strongly agreed, 33.3% agreed, 8.3% disagreed, and 16.7% neither agreed nor disagreed. As for its ability to stimulate critical thinking to solve complex medical problems, 33.3% strongly agreed, 25% agreed, 25% were neutral, and 16.7% strongly disagreed. Overall, 66.7% expressed a strong intention to recommend their colleagues to participate in an escape room. 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 conclusion, escape rooms prove to be an effective team-building exercise, facilitating the integration of diverse learner groups (residents, medical students, nurses) and enhancing their teamwork in clinical settings. However, our results suggest that they may not be the ideal modality for teaching clinical knowledge. Therefore, we propose escape rooms as an effective interprofessional learning platform primarily for promoting teamwork when theoretical knowledge is not the primary learning objective. Designing the scenarios were the main challenge, but this was overcome by taking content-experts on board.

What problem in education is addressed by this work? Surgical education is now a viable pathway for scholarship and academic promotion; however, it can be difficult for trainees and faculty to engage in meaningful surgical education research due to lack of training, resources, or mentors. Collaborative efforts are necessary to share knowledge within the surgical education community and create impactful work to advance the field. Delays or breakdowns in communication between corresponding authors are common barriers to effective collaboration that can greatly impede the completion of even well-resourced projects. Describe the intervention: We present a novel approach to collaborative scholarly writing which diverges from traditional linear editing formats and expedites the creation of high quality published work in a collaborative fashion. At weekly meetings run by the Collaboration of Surgical Education Fellows (CoSEF), resident members present topics within surgical education that they feel could leverage the collective experience of our members to craft an impactful piece of scholarly work (i.e., a perspectives piece); if the topic fosters deep discussion and elicits thought-provoking ideas, the original presenter will draft the piece and post it to our shared drive. CoSEF members then edit and add to the piece asynchronously within a given time frame, and the lead author will consolidate ideas into a cohesive piece, and produce a final draft. Describe the improvement/outcome of the intervention. This process has resulted in the recent publication of our first CoSEF perspectives piece in Annals of Surgery Open (doi: 10.1097/AS9.0000000000000306), with four perspectives pieces (by three different lead residents) pending submissions in the next 2 months. This approach represents an improvement over traditional linear academic editing and writing methods in a process that more closely resembles a virtual writing workshop; all authors involved understand the intent and goals of the piece through direct conversation and brainstorming with the lead author, and editors provide meaningful edits asynchronously and expediently. The ongoing discussion and open editing process between many qualified and experienced authors allows for a multitude of perspectives and insights that may be richer than those of a smaller group of authors. This abstract itself was written utilizing the synergistic workflow format described above. 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 believe that this approach to producing scholarly work can be utilized for faculty (in surgical departments, committees, or organizations), residents (through CoSEF or other collaborative groups), or medical students (within their institutions). The benefits of this approach include: the ability to make professional connections, learn from colleagues’ different backgrounds and skill sets, efficiently create deliverables during a tight research timeline or during busy clinical rotations, and foster inter-institution collaboration, all of which result in an expedited yet high value product. Barriers to implementation of this approach include: lack of buy-in from collaborators, rapid accumulation of feedback, and authorship order. First, CoSEF has enjoyed a collaborative and collegial environment that makes this format work well; however, medicine is an extremely competitive field and there may not always be buy-in from collaborators or a preexisting community to facilitate the success of this format. Second, the large volume of feedback received can occur quickly and this can be arduous for the lead author to sort through; to mitigate this, the lead author can temporarily halt comments from other authors in order to consolidate ideas. Finally, given the real-time editing process, it can be challenging to determine the relative amount of work each author contributed; to avoid this, it can be helpful to discuss the authorship order in advance, but also be intentional with selecting like-minded collaborators who are supportive and invested in each other’s success.

What problem in education is addressed by this work? Delivering timely and actionable feedback is critical for medical trainee performance improvement. However, most steps of this process are time intensive and challenging. For example, program directors (PDs) have to curate feedback from several faculty, which can be of variable quality, synthesize the information, map it to core competencies outlined by the Accreditation Council for Graduate Medical Education (ACGME), and generate performance improvement plans. Residents and faculty also have to undergo a similar process for medical students on clerkship. Generative artificial intelligence (AI) technologies such as GPT-4 may be able to help offload the burden of these tasks and improve the quality of feedback that trainees receive. Describe the intervention: We piloted the use of GPT-4 in several contexts related to medical student and resident feedback. First, one of the PDs in our group used GPT-4 to summarize feedback from various attendings and generate performance improvement plans for residents. Second, we entered 50 feedback elements from medical students following their core surgery clerkship and asked GPT-4 to suggest action items that could improve the clerkship experience. Finally, we entered a bi-annual resident evaluation and prompted GPT-4 to create a learning plan to address opportunities for improvement. Describe the improvement/outcome of the intervention. Together, these pilot experiments represent exciting applications of generative AI to streamline the feedback and remediation process for students, residents, clerkships, and programs at large. While we do not intend for GPT-4 to replace the human element critical to this process, it can offload the burdensome and time-intensive process of synthesizing disparate sources of feedback and extracting common themes. This can help PDs and clerkship directors focus their time on developing personalized plans for trainees and implementing program-wide improvements. 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. All of our pilot testing was done using a commercially available and well-known large language model (LLM). We can disseminate our prompts, allowing others to easily replicate what we have done. There are several barriers to wide adoption of this technology. First, there may be concerns about sharing confidential feedback information with a LLM. Second, the technology we used costs 20 dollars per month, which should not be inaccessible to most programs. If it is, there are open-source free models available. Third, there is likely to be continued fear and hesitance about using AI in educational contexts. We think sharing this work and working with societies like ASE can help streamline innovation while also developing best practices and guidelines for responsible AI use.

What problem in education is addressed by this work? Social determinants of health (SDH) heavily contribute to surgical patients' outcomes, leading to disparate care for socially vulnerable patients. We aim to equip members of the surgical care team (residents, faculty, nursing staff, case management, social work and other allied health professionals) with a tool kit to identify SDH that could lead to surgical inequity with the ultimate goal of mitigating disparities in care. Describe the intervention: A needs-assessment was administered to members of the surgical care team to identify resource needs and potentially modifiable SDH gaps for patients admitted to surgical units. Resources will be compiled and developed into a toolkit to include materials on SDH education (modules on disparity topics, tools to discuss SDH with patients) and interventions (translation services, discharge services, integrative medicine options). Education will be provided to users of the toolkit on how to access the resources and appropriately use them to address the complex needs of their patients to mitigate potential disparities. Describe the improvement/outcome of the intervention. The toolkit will be evaluated using the technology acceptance model (TAM) by measuring if the toolkit is useful and usable —the two main cognitive requirements to adopting a new technology. These will be measured by a pre- and post-implementation survey which assesses (1) knowledge gained from resources available to surgical patients (2) ease of access in identifying and disseminating relevant resources (3) increase in productivity (4) likeability of toolkit and (5) intention to use the toolkit. Actual use of the online toolkit will be monitored by frequency of use (e.g. clicks on resources) over 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. Several aspects of this toolkit are universally applicable and has the ability to serve as a model for other institutions to adapt and replace materials relevant to their own hospital system. Barriers to implementation include the need for a wide range of resources for many stakeholders, promotion of the toolkit to facilitate utilization and ensuring toolkit resources remain active and relevant. To mitigate these barriers, we have collaborated with multi-disciplinary team members, will use digital and physical reminders for rotating staff (residents, traveling), and implement a feedback system within the toolkit monitored by our resident run DEI committee.

What problem in education is addressed by this work? Rotating in the fast-paced surgery clerkship is a stressful and challenging time for third year medical students, leading to decreasing learning satisfaction and efficacy as well as declining wellbeing and career interest in surgery. Therefore, we piloted a resident coaching program for surgery clerkship students in 2020 that was formally implemented in 2021. We hypothesized that general surgery residents were the best candidates to effectively coach and promote clerkship students’ learning efficacy and satisfaction in the surgical training environment. Describe the intervention: Using convenience sampling, we conducted individual interviews with a cohort of coached surgery clerkship students after they completed the 3rd year of medical school training to elicit the longitudinal insights into their surgery clerkship learning and the effect of resident coaches. All interviews were recorded and transcribed. We used a framework method to analyze the data until we reached thematic saturation. Describe the improvement/outcome of the intervention. To date, we interviewed seven coached clerkship students, with interviews lasting approximately 40-50 minutes. Thematic analysis suggested that: 1) compared to other core clerkship rotations, surgery is the most difficult one; 2) resident coaches have a positive impact on students’ surgical clerkship learning practically and psychologically; and 3) students are reluctant to go to faculty preceptors/clerkship directors but prefer seeking help from peers and resident coaches about clerkship training related questions, while turning to their families/friends for personal problems. In the future, resident coaches can enhance the support/role in strengthening student preparedness for service-specific surgical rotations by: 1) clarifying service-specific learning expectations/tasks ahead of time, and 2) increasing in-person connections with students. 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 resident-student coaching intervention has a great potential to be used by other institutions that meet either or both of the following criteria: 1) medical schools that enroll similar or fewer medical students per year than our institution (i.e., 190-210 students per year), and 2) residency programs that recruit similar or more residents per year than our residency program (i.e., 7 chief residents per year). At the operational level, there are three potential implementation barriers for programs who are interested in this coaching intervention: 1) Lack of Resident Leads: programs must identify a passionate resident as the Lead to administrate the resident-student coaching program, (e.g., recruit resident coaches, match residents with students) with support from the clerkship coordinator; 2) Lack of assessment data: programs should routinely collect student feedback (e.g., exist surveys) to help program leadership monitor and improve the coaching intervention; 3) Lack of recognition: Programs are recommended to set up an award mechanism to recognize residents who truly commit to serving as resident coaches to continuously motivate more residents to join.

What problem in education is addressed by this work? The problem addressed by this work is the lack of effective patient-provider communication, particularly regarding goals of care (GoC), prior to major surgery. Discussions involving surgeons, primary care providers, and anesthesiologists are often deferred or left incomplete due to providers' discomfort and inexperience in navigating these sensitive conversations. The work aims to address this issue by using a language model (ChatGPT) to simulate GoC conversations, providing a training tool for general surgery and anesthesia resident physicians to improve their communication skills and enhance the alignment of surgical outcomes with patients' values and preferences. Describe the intervention: The intervention involves using ChatGPT, a state-of-the-art language model, to create simulated patient-provider conversations focusing on goals of care (GoC) prior to major surgery. These simulations offer a realistic and interactive environment where resident physicians can engage in conversations with "synthetic patients" based on common clinical scenarios, receive specific feedback, and refine their communication techniques, all without the pressure or risks of real-world clinical interactions. Describe the improvement/outcome of the intervention. The expected improvement or outcome of the intervention is to enhance communication competencies among resident physicians in both the general surgery and anesthesia disciplines. This, in turn, is anticipated to lead to increased patient satisfaction and improved alignment of surgical outcomes with patients' values and preferences. Dually, it will equip residents with the necessary skills to have goals of care discussions with their patients as attending surgeons and anesthesiologists. Overall, this intervention aims to revolutionize how educators prepare trainees for difficult and important patient-provider conversations in the context of major surgery. 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 intervention can be applied at general surgery and anesthesia programs across the country through the development of an open access case-based curriculum, which not only employs the use of ChatGPT to simulate patient-provider conversations before major surgery, but also integrates existing palliative care education, ethical guidelines, and feedback based learning strategies. Some the barries that may exist to implementation include the busy schedules of residents and finding skilled educators. These challanges can be overcome through having institutional and program director support and working directly with palliative care physicians and faculty specializing in surgical palliative care to help champion and lead these efforts.

What problem in education is addressed by this work? Training for beside procedures – such as central line insertion, chest tube insertion, and intubation – typically includes a combination of knowledge-based instruction, hands-on simulation, and assessor assessment to establish competence. Unfortunately, knowledge-based instruction is often limited to brief text resources and/or pre-recorded videos, with the alternative instructor-led training presenting logistical challenges due to busy trainee schedules. Furthermore, given that text and video resources are only minimally engaging, trainees may arrive to simulation sessions under-prepared with regard to both procedural knowledge and confidence. Describe the intervention: Immersive virtual reality (iVR) has emerged as an affordable teaching modality, now with several viable use cases in the realm of medical education; we are seeking to expand our institutional use of this technology to include procedural training. Prior data from our institution and others have demonstrated increased learner engagement and self-rated confidence when learning via iVR platforms. However, with the exception of two small studies, direct benefits vis-à-vis hands-on procedural training are largely untested. Describe the improvement/outcome of the intervention. In an effort to leverage the benefits of iVR, we filmed and produced a custom iVR central line training video, which gives trainees the sense that they are standing at the bedside with a senior resident instructor walking them through the procedure. We are seeking to confirm known improvements in procedural confidence, while adding to the literature with direct assessment of procedural knowledge, knowledge retention, and testing hands-on simulation performance in a prospective, randomized-controlled fashion against non-VR teaching modalities. At the time of submission we have crossed the half-way point of our data collection, and we are excited to share our experience thus far. 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. Although still in the data collection phase, our hope is that sharing this work will spark further interest in iVR at training programs across the country, as this modality offers an unlimited canvas of possibilities in surgical education. The cost of entry to use this modality is reasonable, with a single iVR headset costing approximately $350 USD, which can be shared among multiple users. Institutions can create their own content if they wish to purchase a 360-degree camera – but ideally, learning materials will be derived from multi-center collaboration and widely available to surgical trainees across the country and globally.