ASE 2024 Abstracts - The Association for Surgical Education

Thinking Out of the Box - Videos Only

EMPHASIZING TACTILE FIDELITY OVER VISUAL FIDELITY IN MODELS FOR SURGICAL SKILLS SIMULATION
Umer Hasan Bhatti, MBBS, Mayo Clinic; Mayo Clinic

What problem in education is addressed by this work? The development of psychomotor skills is qualitatively different from other components of an educational curriculum. Attempts at fidelity in the simulation teaching of psychomotor operative and technical skills are increasingly focused on achieving visual fidelity, based on Thorndike’s argument that the transfer of skills from the training environment to the operational environment is maximized when one perfectly matches the other. However, perception is multimodal, and attempts to teach technical skills by presenting detailed information to only a few sensory systems (eg, vision) excludes key information from other sensory systems (touch, balance, proprioception), requiring the learner to invest additional effort to discount or compensate for this mismatch. Describe the intervention: We propose an approach to (and examples of) creating cost-effective models with a strong emphasis on tactile fidelity, requiring learners to assume the correct posture, correct arm/hand movements, and to feel the right amount of resistance from model “tissue”. The tactile component of the model is not overtly taught, rather is perceived by the learner and “guided” by the design of the model when following verbal commands/demonstration of technique from the instructor. Describe the improvement/outcome of the intervention. Simulation teaching of technical skill with the correct kinesthetics (touch, proprioception) and tissue “tension” increases learner engagement and is expected to translate into a shorter adjustment period in the operative environment. 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 lower cost than commercial simulation products and the easy availability of materials should make this teaching method easily reproducible across a variety of institution and program sizes. Model and simulation setup, descriptions, “how to” guides are intended to be freely available on request.

VERSATILE LOW-COST LAPAROSCOPIC APPENDECTOMY SIMULATION FOR MULTI-PORT AND SINGLE PORT APPENDECTOMIES
Daniel Mimbs Alligood, MD, Washington University in St. Louis; Washington University in St. Louis

What problem in education is addressed by this work? Surgical residents primarily receive laparoscopic training in the operating room and simulation lab using multiple ports. However, the advancement and increased prevalence of single port methods underline the need for single port simulation models. This model seeks to use readily available materials for trainee education. Describe the intervention: Inspired by the previously published APATH surgical appendectomy model, we create a low-cost model that simulates the rate limiting step of the single port appendectomy – proper visualization of the appendix. A 12mm port is placed in a laparoscopic trainer set and both a 5mm laparoscopic camera and 5mm grasper are introduced. Using this working port, the goal is to locate and eviscerate the appendix through the 12mm port site. The appendix is made from a surgical glove containing 4x4 gauze, and the overlying small bowel is modeled using large Penrose drains filled with ultrasound gel; all materials are sutured to a flexible foam base (Figure 1-2). Describe the improvement/outcome of the intervention. This new laparoscopic appendectomy model will be used to introduce surgical juniors to the single port appendectomy technique. Moreover, this model can be applied to a multiport simulation. To validate our simulation method, surgical juniors will longitudinally perform a multi-port and single port appendectomy using this model. Outcomes of this study include qualitative surveys regarding the trainees’ perceptions and confidence in the single port method as well as quantitative measurements regarding each trainees performance in the simulation scenario. 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 laparoscopic appendectomy model is a low-cost and versatile model that can be created from expired operating room materials. This model provides a low-cost method for introducing surgical juniors to the single port laparoscopic appendectomy technique. We do acknowledge this model requires an element of creativity which may alter trainees’ experience; however, to mitigate this a detailed instructional video and pamphlet would accompany any distribution.

C.A.L.E.N.D.A.R.: CHAMPIONING ACTIVE LIFESTYLE ENGAGEMENT AND NURTURING DAILY ACCOUNTABILITY IN RESIDENTS
Claire Wilson, BS, MS, MD, Wellspan York Hospital; Wellspan York Hospital

What problem in education is addressed by this work? High rates of burnout among surgical residents impact not only their well-being but also their learning, clinical performance, patient care, and retention. By introducing a calendar-based initiative with incentives, this study aims to assess the impact of a structured wellness calendar in shaping daily health behaviors among general surgery residents and foster long-term wellness habits and its ultimate impact on burnout reduction. Describe the intervention: A structured wellness calendar was implemented, focusing on nine dimensions of wellness with daily activities and incentives. A wellness committee, including resident representatives from each year, designed, and facilitated individual and group activities to foster a supportive wellness culture. Data on resident engagement, wellness behaviors, and burnout levels Burnout and wellness levels were assessed using a modified version of the Maslach Burnout Inventory at baseline, midpoint, and post-intervention, enabling detailed analysis of changes in resident engagement and wellness behaviors at baseline, and at 6-month post-initiation of the C.A.L.E.N.D.A.R. Describe the improvement/outcome of the intervention. The wellness initiative led to significant improvements, including an increase in residents' average daily steps from 6,000 to 9,000 and consistent engagement in mindfulness practices. Additional activities, like the "venting” and “gratefulness jars, fostered emotional resilience, while overall trends in the modified Maslach Burnout Inventory (MBI) showed reduced burnout indicators. These outcomes suggest enhanced physical activity, emotional support, and overall well-being among participants. 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 wellness calendar, with tailored activities across nine wellness dimensions, can be easily adapted for surgery residents at other institutions. The intervention uses themed days like "Thoughtful Thursday" and "Self-Care Saturday" for easy integration into schedules, and most activities are free or low-cost, minimizing financial barriers. To overcome time constraints and ensure alignment with the culture of surgery programs, the calendar is designed to fit seamlessly into existing routines, making it a practical and sustainable wellness tool.

“SHOULD I CONSULT SURGERY?” INSTITUTIONAL GUIDELINES AT THE TAP OF A CELL PHONE
Rodrigo G Gerardo, MD, Dayton Children’s Hospital; Dayton Children’s Hospital

What problem in education is addressed by this work? Institutional guidelines are essential in assisting providers with the tools they need to make clinical decisions but these guidelines are often difficult to view or documented on paper files which make instantaneous care impossible to provide. Describe the intervention: We digitalized the pediatric surgery guidelines from our institution and provided accessibility via a QR code that was readily available at resident work areas. Describe the improvement/outcome of the intervention. Residents from various specialties are able to make clinical decisions swiftly and without the assistance of the pediatric surgical team leading to more efficient disposition and/complete work up at the time of surgical consultation. Since the implementation of the QR code, our institution moved to secured guidelines on proprietary intranet. 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 pilot model for quickly accessible surgical guidelines and algorithms can be applied to any institution with minimal effort and no financial cost at all with the utilization of free applications for data storage and QR code creation. During our presentation, we will highlight our process.

DEVELOPMENT OF A ROBOTIC VENTRAL HERNIA TRAINING MODEL AND CURRICULUM
Rebecca Elizabeth Wu, MD, Houston Methodist Hospital; Houston Methodist Hospital

What problem in education is addressed by this work? The traditional “see one, do one, teach one” training method can pose a threat to patient safety and decrease operating room efficiency. As we transition away from this method, new teaching approaches are required to allow residents to practice skills, develop efficiency, and model safety prior to encountering a patient in the operating room. Describe the intervention: We developed an easily reproducible ventral abdominal hernia model with affordable, reusable materials. No live tissue, cadavers, or expensive medical models are required for this simulator. Prior to model use, an educational training video is distributed for resident review of procedural steps with fundamental techniques and advanced tips for efficiency demonstrated in the video that are translatable to in-vivo operating room experiences. Describe the improvement/outcome of the intervention. The primary outcomes of this trainer are to teach the basic steps of ventral abdominal hernia repair as well as tips and tricks to be successful, safe, and efficient in the operating room. Repetitive practice on the model prior to entering the operating room will allow resident confidence in the steps of the procedure, as well as autonomy in the OR because their model repetitions allow them to easily demonstrate efficiency and safety during the operation. 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 materials for the model are easily attainable and affordable to allow reproducibility with minimal cost. Acquiring a robotic console and its associated instruments and the robotic thorax model is the largest barrier for institutional practice and may require assistance from a robotic industry representative. However, we do note that the practice model is readily transportable and can be moved easily to access robotic consoles or trainers wherever they are available within a practice institution.

DESIGN OF GENERAL SURGERY ROBOTIC SURGERY CURRICULUM USING MASTERY LEARNING
Chase Christian Marso, MD, Massachusetts General Hospital; Massachusetts General Hospital

What problem in education is addressed by this work? As the prevalence of robotic surgery expands across general surgery, training surgical residents to operate safely and proficiently using robotic platforms is critical. Without standardized curricula and objectives, it can be difficult for trainees to continually progress their robotic technical skills. It is also difficult for training programs to assess competence and convey qualifications regarding residents ability to operate using robotic platforms. Describe the intervention: A robotic surgery curriculum was developed in alignment with existing curricula and according to national consensus recommendations. An innovative framework utilizing mastery learning theory was applied to the curriculum to promote stepwise and standardized resident progression. Describe the improvement/outcome of the intervention. Existing robotic curricula do not incorporate assessment tools throughout resident learning and progression. Using mastery learning, assessments were strategically integrated throughout our curriculum to ensure residents are appropriately advanced to higher level learning and technical skills. Assessments also provide opportunities for structured feedback, coaching, and remediation, as necessary. 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. Our curriculum and assessment elements were specifically designed to include the core elements of robotic surgery training, allowing general surgery programs to readily adopt or adapt our curriculum with only minor, institution-specific modifications. No specific training is required to administer mastery learning assessments. A robotic surgery training console is required in our curriculum and for mastery learning assessment, which represents a potential barrier to implementation.

DEVELOPMENT AND IMPLEMENTATION OF A RURAL SURGERY INITIATIVE: A NOVEL APPROACH TO TRAINING A TRUE GENERAL SURGEON
Emily Talley Hammond, MD, Medical College of Georgia; Medical College of Georgia

What problem in education is addressed by this work? With increasing specialization in surgery, there has been a decrease in exposure of residents to the “true” general surgeon during training. Rural or community surgery rotations are increasingly prevalent in general surgery programs in the United States and these experiences are becoming an ACGME requirement as of 2025. We have recognized the value in providing trainees with the experience necessary to prepare for practice in areas where broad-based general surgeons are needed, and thus have developed a rural surgery initiative at our institution. We have studied case logs to quantify the benefit of rural rotations and are working toward creating a formal rural surgery track. Describe the intervention: Rural/community surgery rotations were established in our general surgery residency rotation curriculum in 2019. During the PGY 2-4 years residents went to four different rural/community surgery rotation sites which offered experiences fundamentally different than those offered at our large tertiary referral center. Case logs for current residents and recently graduated residents were stratified for each site. Describe the improvement/outcome of the intervention. The rural rotation case logs demonstrated robust operative experiences for junior residents as with unique opportunities for operative autonomy. The rural rotations offered valuable training experiences that are less accessible at our home institution, namely in endoscopy and endocrine cases, due to the lack of subspecialists in other fields such as gastroenterology and otolaryngology at the rural sites. Residents logged a relatively high volume of cases at the rural sites compared to similar time periods at the home institution. 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. Rural surgery rotations included in our general surgery program enrich ACGME case numbers and provide a wide variety of cases in a relatively short amount of time. Through integrating rural surgery rotations in general surgery training, we believe we are continuing the process of training a “true” general surgeon with a practice ready comprehensive skill set. Our current model could be implemented at other institutions through outreach to underserved areas and potentially lead to increasing the number of residency spots to mitigate scheduling strains while not compromising resident operative experience.

EVOLVING MOCK ORALS AS A TOOL FOR TEACHING, EVALUATION, AND PREPARATION
Sydne Muratore, MD, Saint Joseph Hospital Noelle Bertelson, MD, MPH, Saint Joseph Hospital; Saint Joseph Hospital

What problem in education is addressed by this work? Mock oral exams have been used primarily for preparation for the American Board of Surgery Certifying Exam (CE). This may consume valuable and scarce education time in order to prepare chief residents for the CE. Commonly utilized mock oral strategies do not provide adequate, frequent assessment nor feedback for large numbers of multi-level residents over the course of each year. Describe the intervention: In 2024, we transitioned from a monthly mock oral practice session with three senior residents completing faculty-prepared scenarios in front of the entire resident body to a comprehensive monthly plan using a small group format with scenarios designed and scripted for each postgraduate year (PGY) level. Multiple residents of all levels complete scenarios, receive feedback on content and oral exam skills, and are subsequently evaluated based on their demonstration of knowledge. We also conduct formal multi-institution mock oral exams biannually for PGY 4 and 5 residents, formatted to simulate the CE and utilizing a scripted exam with a checklist of key points to pinpoint knowledge deficits, assess oral board strategies, and assist preparation for the CE. Describe the improvement/outcome of the intervention. This dual strategy of monthly program-wide mock oral examinations and biannual senior resident mock oral examinations provides an opportunity for residents and faculty to identify individual knowledge deficits, provide teaching on key points of surgical knowledge, and prepare for the CE. It has been met with widespread approval by all levels of participating residents, and it has allowed the program to provide more frequent formal assessment and feedback on academic progression instead of relying primarily on yearly ABSITE (American Board of Surgery In Training Exam) scores. 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 two-pronged approach is adaptable to most programs, with a monthly format for resident education, evaluation, and feedback and a multi-institution exam for oral board preparation. The greatest barrier to implementation in many programs is the time commitment to prepare the monthly exams and the biannual multi-institution exam. Enlisting the help of non-core faculty and outside institution surgeons and developing a repository of scenarios for multiple institutions or Association of Program Directors in Surgery members are strategies to mitigate the time burden.

CREATING AN INNOVATION PROGRAM WITHIN ACADEMIC SURGERY: ENGAGING STAKEHOLDERS AND BUILDING SUSTAINABLE INFRASTRUCTURE
Candice Stegink, University of Michigan; University of Michigan

What problem in education is addressed by this work? This work addresses the gap in traditional surgical education and faculty development, where there is limited emphasis on fostering innovation, interdisciplinary collaboration, and translating clinical insights into practical solutions. It tackles the need for a structured framework that integrates innovation training into both residency and faculty development programs, ensuring that surgical trainees and faculty are equipped with the skills and resources necessary to drive meaningful clinical advancements and effectively engage with multidisciplinary teams. Describe the intervention: The intervention involves establishing a structured innovation program within academic surgery that integrates a flexible, accessible curriculum on innovation methodologies, such as design thinking and agile project management, into both residency and faculty development. It includes dedicated staff to support operations, mentorship, and collaboration with multidisciplinary teams, as well as partnerships with technology transfer offices to guide the commercialization of innovations. This program empowers residents and faculty to co-develop and implement solutions to clinical challenges, driving advancements in healthcare delivery. Describe the improvement/outcome of the intervention. The intervention leads to enhanced innovation capacity among both residents and faculty, fostering a culture of continuous improvement in surgical education and clinical practice. Participants gain practical skills in problem-solving, interdisciplinary collaboration, and innovation, which result in the development of novel solutions to clinical challenges. Additionally, by engaging with technology transfer offices, the program accelerates the commercialization of innovations, contributing to improved patient outcomes and institutional growth in intellectual property and translational research. 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 other institutions by adapting the innovation curriculum to local clinical needs, securing leadership support, and forming multidisciplinary teams across departments. Identified barriers may include limited resources, resistance to change, and difficulty in engaging diverse stakeholders. These challenges can be overcome by obtaining leadership buy-in through demonstrating the program’s potential for improving clinical outcomes, leveraging partnerships with technology transfer offices for commercialization support, and allocating dedicated staff to facilitate collaboration, mentorship, and resource management across disciplines.