ASE 2024 Abstracts - The Association for Surgical Education

Thinking Out of the Box Presentations

CRITICAL REFLECTION THROUGH INTRAOPERATIVE VIDEO REVIEW FOR SURGICAL TRAINEES
Carl Engelke, MD, PhD, Emily Huang, MD, MAEd; The Ohio State University

What problem in education is addressed by this work? Residents learn only a fraction of the lessons from each operation they complete. This is likely due to the high intrinsic cognitive load of complex task completion for novices, thus simply “doing” does not yield great progress case-to-case. However, we propose to more fully realize these learning opportunities through reflective practice centered around intraoperative video review, a simple yet powerful tool. Describe the intervention: Participating residents on appropriate clinical rotations record and review a laparoscopic or robotic operation they have completed once every four weeks. Following review, they edit footage to 5-10 minutes with reflective narration, as well as complete a written reflective exercise on each operative performance and in summary at the completion of the program. Concurrent performance evaluations and written reflections are completed by the attending operative surgeon as well as a surgical coach who reviews the edited footage. Describe the improvement/outcome of the intervention. We believe this program has the potential to dramatically accelerate operative learning for residents (Figure 1). We will evaluate the quality of reflective analysis of the trainee surgeon as compared to faculty surgeons for operations performed. Additionally, we will assess the overall impact of the video review program through participants’ reflections on how reviewing operative footage impacted their experiential learning cycle. 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 simplicity of our intervention (watch video -> reflect) in itself suggests broad applicability among institutions and procedural training programs. We have deliberately structured our study to identify challenges to implementation with regard to interaction with the technology. And with the significant growth of video-recording capabilities, we anticipate that capacity to implement a similar program will exist or could be obtained at most training programs.

“YOU’RE NOT AN IMPOSTER”: A SMALL GROUP CURRICULUM TO IDENTIFY AND MITIGATE IMPOSTER SYNDROME AMONG SURGICAL TRAINEES
Kimberly Hendershot, MD, Tasha Posid, MA, PhD, ; University of Alabama-Birmingham, The Ohio State University Wexner Medical Center

What problem in education is addressed by this work? Imposter Syndrome (IS)—persistent self-doubt and fear of being “found out” despite objective success—is increasingly recognized among surgical trainees and contributes to burnout, anxiety, and attrition. Despite its prevalence, few structured educational interventions target IS within surgical training, representing a critical gap in trainee wellbeing and professional identity development. We will report on development, content, measurable metrics of success, and plans for pilot implementation and scale-up. Describe the intervention: Building on findings from a multi-institutional ASE Graduate Surgical Education study (preliminary data attached, presented previously at ASE 2025) identifying modifiable contributors to IS, we are developing and piloting a structured small-group curriculum for surgical residents. The curriculum introduces core IS concepts, explores common triggers in surgical training, and teaches evidence-based strategies for recognition and mitigation through guided reflection, peer discussion, and practical skill-building (e.g., cognitive reframing, feedback calibration, peer validation). Describe the improvement/outcome of the intervention. Pilot implementation at 2–3 surgical residency sites is expected to demonstrate strong engagement and high perceived relevance. Trainees are anticipated to report improved awareness and normalization of IS experiences, increased confidence applying mitigation strategies, and sustained reduction in IS severity as measured by Clance Imposter Phenomenon Scale (CIPS) scores at 3- and 6-month follow-up. 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 curriculum is designed for dissemination through ASE networks and can be implemented with minimal resources using a facilitator guide, resident workbook, and case-based discussion materials. Anticipated barriers include time constraints and facilitator comfort with psychosocial topics; these can be addressed by integrating sessions into existing didactic or wellness curricula and offering a brief facilitator training module to standardize delivery.

7TAPS MICROLEARNING AS A MECHANISM OF SPACED REPETITION FOR FACULTY DEVELOPMENT
Factor Matthew, MD¹, Rebecca L Hoffman, MD, MSCE²; ¹Geisigner, ²Geisinger

What problem in education is addressed by this work? Retention and incorporation of information transmitted via faculty development sessions is questionable, and most success of these programs is measured by attendance and satisfaction immediately following the session. Yet, one of the most important barriers to have been identified in literature (where the literature is sparse) is a lack of follow up activities. In non-medical disciplines, spaced repetition via microlearning activities has been shown to improve engagement while offering flexibility and reducing cognitive load. Describe the intervention: The 7Taps microlearning platform was utilized to deliver 3 spaced-repetition microlearning sessions over 4 months following a growth mindset workshop delivered to faculty and residents. Each session was delivered as a <7 min focused educational module which utilized self-reflection, polls, and multiple choice questions to foster engagement/interaction. Describe the improvement/outcome of the intervention. The 7Taps platform is able to provide analytics for usage and responses to posed questions. Typically, 38 users accessed the platform, 31% identified themselves as equally fixed and growth mindset and 34% mostly growth, and users identified examples of fixed triggers as "I get frustrated when I teach something to someone the way I think should result in mastery, but the person does not improve like I anticipated them to improve" and "Passive aggressive or just straight up aggressive comments from attendings either in a normal tone or yelled at us." More than 75% of users rated these sessions as 5 stars. 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. Microlearning is a concept that can be applied regardless of using the 7Taps platform; however, the 7Taps platform is commercially available at a low price that can be incorporated into a GME budget. The modules can be easily created using artificial intelligence (and then edited), created from an existing policy/presentation/pdf, or created de novo by the author/editor, which translates into minimal time for the creator (overcoming the barrier of time). Furthermore, this concept can be applied to resident education (follow up for didactics, or targeted towards ABSITE needs) or patient education (which means cost could be shared with the clinical entity), which we are also implementing at our institution.

BUILDING BETTER HANDS: USING OCCUPATIONAL THERAPY TO ENHANCE READINESS BEFORE SURGICAL RESIDENCY
Matthew P Zeller, DO, Angelina Chilacot, OTR/L, CHT, AIPCC, Marcie Feinman, MD, MEHP, FACS; Sinai Hospital of Baltimore

What problem in education is addressed by this work? This initiative targets technical readiness and ergonomic awareness within surgical residents. By integrating occupational therapy assessment into resident onboarding, the evaluation identifies individual strengths and potential improvement opportunities before training. This approach aims to assist with proactive strength development, wellness, and sustainable surgical performance. Describe the intervention: To enhance early technical skill acquisition and ergonomic awareness, our general surgery residency integrated a structured Occupational Therapy (OT) upper extremity and hand functional assessment prior to onboarding. Each incoming PGY1 underwent evaluation of upper extremity and hand ergonomic health, fine motor coordination, strength, dexterity, and peripheral neurological status. Residents received individualized reports with suggestions for exercises to maximize performance, promoting early awareness of hand ergonomics and strategies to reduce the learning curve in surgical skill development. Describe the improvement/outcome of the intervention. Across two intern cohorts from 2024–2025 (n=8), residents completed a follow-up survey four months into training, assessing the perceived value of the OT assessment using a 5-point Likert scale. They rated the experience highly, finding it helpful for residency preparation (mean 4.5 ± 0.5), useful during training (4.0 ± 0.8), positively impactful in the operating room (3.75 ± 0.9), and worth their time (4.9 ± 0.4); 75% implemented OT recommendations and 25% pursued additional follow-up. Feedback emphasized improved ergonomic awareness, confidence, and intentional self-improvement early in training. 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 baseline upper extremity and hand assessment was easily implemented at our institution and can be scaled to other programs with OT partnerships using standardized templates for consistent feedback and reproducibility. Potential barriers include limited OT staffing, time constraints, and higher costs for larger programs, which can be mitigated through streamlined protocols and the involvement of OT trainees. Scheduling assessments before orientation avoids disruption to clinical duties and enhances feasibility across diverse surgical training programs.

DEVELOPING A CURRICULUM FOR ABDOMINAL SURGICAL DRAIN REMOVAL AS AN ENTRUSTABLE PROFESSIONAL ACTIVITY FOR THIRD YEAR MEDICAL STUDENTS IN SURGERY CLERKSHIP.
Stephen G Andrews, BS¹, Carl Engelke, MD, PhD², Mason Darner, BS¹, Emma Merquetegui-Lucke, BS¹, Emily Huang, MD, MAEd²; ¹The Ohio State University College of Medicine, ²The Ohio State University Wexner Medical Center

What problem in education is addressed by this work? During the surgery clerkship, medical students need to identify ways to participate actively in the care of patients and engage in safe and effective procedural learning. Herein, we describe a curriculum that models the entrustable professional activity, or EPA, framework of competency-based surgical education via instruction on the bedside removal of abdominal surgical drains. The goal of this program is to accelerate student competence for a minor bedside procedure through a stepwise porcine simulation to a prospective entrustment model. Describe the intervention: Abdominal surgical drain removal was identified through a needs assessment as an appropriate skill for clerkship students to develop procedural independence. Participants are instructed on the insertion and removal of a surgical drain using a porcine side to model the human abdominal wall. Students are then tasked to gain prospective entrustment from a supervising resident to perform the procedure independently. Describe the improvement/outcome of the intervention. The intended outcome of this curriculum is to allow students to develop a framework for learning surgical procedures in a safe and approachable way and assess the applicability of the EPA framework in medical student surgical education and implications for student entrustment on the wards. 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. Using a porcine model to instruct ubiquitous surgical skills, such as abdominal surgical drain removal, would be relevant to medical students at all institutions or for other minor bedside procedures. Barriers for Implementation: The main barrier for implementation is a time investment on the part of students and residents. Additionally, there will be differences in resident trust in medical students to perform the procedure with minimal to no direct supervision.

A NUDGE IN THE RIGHT NOTE: BOOSTING EPA COMPLETION WITH AN OPERATIVE NOTE TEMPLATE
Maxwell J Presser, MD, MPH, Shushmita Ahmed, MD, Minna Wieck, MD; University of California, Davis

What problem in education is addressed by this work? The American Board of Surgery has developed 18 core Entrustable Professional Activities (EPAs) as a competency-based educational assessment tool for general surgery trainees. While completion of each EPA only takes a few minutes, consistent completion still requires an additional mental burden for both residents and faculty to remember to complete a microassessment. We aimed to reduce the mental burden of remembering to complete an EPA by embedding a reminder into a standardized operative note template in the electronic health record, thereby incorporating it into the existing workflow of both residents and faculty. Describe the intervention: A one-sentence reminder to complete an EPA was programmed to be displayed in an operative note template (i.e., Epic “SmartText”) shared among all general surgery services. The reminder states: “Have you completed an EPA for this case? Remember EPAs include pre-op, intra-op and post-op skills, and you can complete an EPA for any phase of care on the SIMPL app or via this link.” This text disappears upon signing the operative note and does not appear in the patient’s electronic health record. Describe the improvement/outcome of the intervention. This operative note-embedded reminder was implemented on October 16th, 2025, so data is still extremely limited and preliminary. Anecdotal feedback has been positive, and there have been no reports of this reminder interfering with the baseline experience of signing the operative note. Next steps will involve an interrupted time series to evaluate the impact of the operative note-embedded reminder 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. Given that Epic’s market share is upwards of 40% and the ease of programming a reminder like this, many general surgery residency programs would be able to implement a similar EPA completion reminder within the electronic health record. Cerner and other electronic health records also have “dynamic documentation” capabilities, which could allow for embedded EPA completion reminders for faculty and residents who do not use Epic. With these features, the electronic health record can be a useful tool for faculty and residents without remaining permanently documented in patients’ medical records.

IMPROVING SURGICAL ETHICS EDUCATION WITH ETHICS-THEMED M&MS
Sofia Cohen, BA, , Annie Hess, MD; Washington University in St Louis School of Medicine

What problem in education is addressed by this work? Ethics is an integral part of surgical practice, yet structured ethics education is not a ubiquitous facet of surgical training. Multiple studies have shown that surgical residents, and even attendings, lack confidence in their ability to recognize and manage ethical dilemmas, and the most effective way to teach ethical concepts has not been determined. By applying a novel intervention of presenting ethical cases during morbidity and mortality conferences (M&Ms) and creating a forum for discussion of ethical topics, we hope to inspire surgical residents and faculty to feel more confident in navigating ethical dilemmas that arise in the clinical space. Describe the intervention: Utilizing the established format of weekly surgical M&Ms, one conference bimonthly was dedicated to a discussion of a case with a challenging ethical element and key concept drawn from the SCORE modules for resident education. Clinical cases were identified by surgical faculty in charge of the ethics thread of the surgical residency curriculum. After a brief presentation of the case and how it tied to at least one of the core ethics concepts identified by SCORE, an open, facilitated discussion was conducted between faculty and residents to consider the intricacies and key ethical principles of the case. Describe the improvement/outcome of the intervention. A knowledge assessment of medical ethics was administered prior to the initiation of Ethics M&Ms and at the end of the academic year that contained six M&Ms. Following the intervention, median knowledge scores improved for both residents (6/10 to 7.5/10) and attendings (5/10 to 7/10). Residents demonstrated a statistically significant improvement in their confidence to recognize key ethical dilemmas, such as futility (p=0.01) and substitute decision making (p=0.007), and qualitative feedback confirmed that both residents and faculty found the sessions valuable. 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. Based on our post-intervention survey data and qualitative feedback, ethics-themed M&Ms could be incorporated into other institutions’ M&M process with relative ease. The primary barrier is identifying faculty with the ethics expertise to facilitate these complex discussions. This can be overcome by formally partnering with the hospital ethics committee or by designating and supporting a faculty champion within the department to lead the initiative.

INDIVIDUALIZED PREGNANCY PLANS: A NOVEL, FLEXIBLE SUPPORT FRAMEWORK FOR EXPECTING PARENTS IN SURGICAL TRAINING
Emma GILMAN Burke, M.D., Michele Loor, M.D., Ronald Cotton, M.D.; Baylor College of Medicine

What problem in education is addressed by this work? Surgical trainees face disproportionately high rates of infertility and pregnancy complications compared to the general population, yet many surgical training programs lack structured, learner-centered support for expecting residents and fellows. These unmet needs can foster inequities in training experiences and create undue stress during this major life transition. We created a flexible, individualized program to support birthing and non-birthing surgery trainees through pregnancy and reintegration to the workplace postpartum. Describe the intervention: We created two Individualized Pregnancy Plans (IPPs), one for birthing parents and another for non-birthing parents, an innovation modeled after individualized education plans. These flexible documents facilitate proactive, collaborative planning between trainees and program leadership to identify potential needs, resources, and services needed during and immediately after pregnancy. The IPPs are reviewed at the time a pregnancy is disclosed and may be revisited at any time to allow for changes in modifications as circumstances change. Describe the improvement/outcome of the intervention. Prior to review of the IPPs by our institution’s Graduate Medical Education (GME) Office, we solicited comments from residents and fellows within the department. This provided an opportunity for trainees, regardless of their parental status, to provide feedback on the plan and to generate buy-in. The finalized IPPs have now been approved by our GME Office and are implemented within our department; initial user feedback has been positive. 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 IPP template is entirely customizable to the available resources, needs, and policies within different surgical training programs; our department is creating a separate version based on these templates for advanced practice providers and faculty. The most significant barrier to implementation is lack of awareness or engagement by educational leadership and trainees. Creating a faculty and trainee champion for the IPPs within the department is important to ensure program success and sustainability.

THINKING INSIDE THE BOX: A SHOEBOX SURGICAL SKILLS TRAINER FOR RURAL HIGH SCHOOL STUDENTS
Sam Shapiro, BS¹, Dylan Langland, BS¹, Trevor Mallavia, BS², Michael Demangone, BS¹, Priya Rajdev, MD³; ¹University of Arizona College of Medicine – Phoenix, ²Brigham Young University, ³University of Arizona College of Medicine – Phoenix, Banner – University Medical Center Phoenix

What problem in education is addressed by this work? There remains a persistent lack of representation of underrepresented minorities and disadvantaged students in medicine, particularly in surgical fields, and early exposure to mentorship is often inaccessible to high school students in underserved communities. Simultaneously, medical students have few structured opportunities to practice healthcare communication with nonmedical audiences or to mentor future generations in a near-peer way. This project bridges this gap by providing interactive, hands-on learning and mentorship delivered by medical students to rural Native communities in Arizona. Describe the intervention: Medical students designed a hands-on surgical skills workshop for high schoolers around a low-cost, low-fidelity toolkit—crafted from a shoebox, rubber bands, clothespins, felt, and a matchbox—to foster technical ability and personal confidence. High school students assembled their own take-home kits, then participated in an instructional session on knot-tying, instrument handling, and dexterity drills paired with an interactive mentorship discussion highlighting diverse pathways into medicine, personal stories, and encouragement toward STEM fields. By combining these three components (building, using, and imagining/future-projecting), this grassroots intervention sought to demystify the medical profession, empowering students with a concrete vision of themselves as capable problem-solvers and reinforcing the belief that the path to becoming a doctor can start anywhere—even in a shoebox. Describe the improvement/outcome of the intervention. High school students reported increased confidence in their ability to succeed in medicine/STEM fields and were more motivated to explore healthcare careers; qualitative feedback highlighted that personal mentorship and hands-on activities made medicine feel more tangible and achievable. Medical students were able to practice near-peer teaching and mentorship, and early reflections on the intervention suggest a positive impact on professional identity formation for those considering academic or rural careers. In this bi-directional exchange, both groups of students built self-efficacy, a foundational construct in educational theory. 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 shoebox trainer and teaching model is scalable and could be adopted by medical schools partnering with local high schools and community leaders. Barriers may include time constraints in medical students’ schedules and lack of existing school partnerships, which can be mitigated through institutional support, early coordination with both university and high school faculty champions, and leveraging participation via student interest groups. Providing a standardized implementation guide detailing (1) the components of the shoebox trainer, (2) the structure for the three-part session curriculum, and (3) a teaching guide helps ensure quality and reproducibility.