Trainee Poster Session I: Well-Being and Professional Development
Introduction: Early identification of students who are at risk of failing their clerkship exams is crucial to connect students with appropriate resources. There is currently little data published on this topic. The goal of our project is to determine if there exists a correlation between NBME Self-Assessment Practice Exam scores taken in the first half of the clerkship and final Shelf exam score. If we can determine a “red flag” score that correlates with a high risk of failing, we can identify students who would benefit most from targeted support.
Methods: NBME Clerkship Shelf Self-Assessments were purchased for each student on every clerkship by our institution. Students on their surgery clerkship were asked to take this exam within the first half of their rotation and report their scores. Practice and final shelf scores were matched for each student and deidentified. Descriptive statistics and univariate linear regression were performed to develop a model for shelf score prediction. A series of odds ratios were also performed to identify a score that identified a high odds ratio for failing.
Results: Univariate linear regression comparing practice NBME self-assessment scores vs final shelf score revealed a significant b coefficient of 3.83 (CI: 3.78-3.89, p = 5.9E-113, R2 = 0.97). Individual linear regressions were performed for each “block” (table 2) with similar outcomes. A series of odds ratios were performed at Self-Assessment scores of 12 (OR 18.3, CI: 5.08-80.3), 13 (OR: 18.4, CI: 5.64-67.3), 14 (OR: 7.5, CI: 2.4-24.2), 15 (OR: 7.3, CI: 2.3-23.4), 16 (OR: 6.4, CI: 1.9-21.8), 17 (OR: 10, CI 2.1-46.5) and 18 (OR: 0.9/0).
Discussion: Our data demonstrate a very strong linear correlation between self-assessments and final shelf scores with an R2 of nearly one, allowing for relatively reliable outcome prediction. Using both the linear regression and odds ratios, we decided a practice score of 18 or less may warrant directed academic support for the student as this point estimates a 50% chance of passing. Implementation will allow for identification of students struggling with the goal of initiating corrective action early enough to prevent students from failing.
Purpose: Extramural funding is critical to career success and advancement in academic surgery, and surgical residents can apply for both societal and federal funding. Many federal funding mechanisms require proposals to be submitted before residents’ formal research years. The purpose of this study is to elucidate residents’ experience and self-efficacy with the grantsmanship process in order to ultimately influence curriculum design.
Methods: A validated grantsmanship self-efficacy assessment inventory was distributed for voluntary completion at an academic General Surgery training program with two years of dedicated research. The survey covers three domains: conceptualizing, designing, and funding a study. All questions are scored 0 to 10 with 0 indicating no confidence and 10 indicating complete confidence. Median scores for the three domains were calculated for all respondents and compared between training years using Kruskal-Wallis with post-hoc Dunn testing.
Results: Forty-four surveys were completed with a response rate of 84%. Twenty-seven residents (61%) intended to pursue a career in academic surgery. Thirty-five residents (79%) reported having no formal grant training. Twenty-nine residents (66%) had read two or fewer grants, indicating low rates of informal grantsmanship training. While most residents (71%) had submitted at least one grant proposal, 41% had not successfully secured funding.
Overall, resident self-efficacy in grantsmanship improved throughout the training years with the greatest changes being in their comfort with conceptualizing and funding a study. There was a significant difference in conceptualizing studies (p=0.028) and understanding of funding processes (p=0.003) but no difference in study design scores (p=0.212) among all training years. Dunn testing identified specific differences between PGY3 and PGY7 comfort with conceptualizing studies (median 4.5 vs. 7.5, p=0.003) and understanding of funding mechanisms (median 2.0 vs. 7.5, p=0.003).
Conclusions: General Surgery residents have limited exposure to formal teaching in grantsmanship early in their training. While comfort with conceptualizing and funding studies does increase throughout the training years, this often develops after critical funding deadlines have already passed and can disadvantage surgical residents interested in academic careers. A curriculum that emphasizes familiarity with the grant writing and funding processes may better facilitate long term career success.
Background: Understanding the factors that influence medical students' interest in surgery during their third year rotations is crucial to their future career. We conducted a single-institution study to evaluate the effect of operative involvement on third-year medical students' interest in surgery.
Methods: Two cohorts of third-year medical students who completed surgical rotations in 2023 at a single academic medical center were surveyed. Surveys were administered at the end of the rotation to assess students' baseline perceptions and changes in their interest in surgery as a career. Students are assigned to specific services for two or four weeks based on personal preference and availability. Students were asked to rate their interest in surgery before and after their rotation on a Likert scale ranging from “0- no interest” to “5- exclusive interest,” as well as asked selective criteria and open-ended prompts for qualitative feedback.
Results: A total of 25 students were eligible for the study and 15 responded (response rate 60%). Students scrubbed in an average of 6.6 times per week, with 75% satisfied with their operative exposure. Overall, interest in pursuing surgery as a career increased from 2.3 pre-rotation to 3.0 post-rotation. Students on Emergency General Surgery (EGS) service, who had more operative exposure (scrubbed in 7.7 times per week), showed an increase in interest (pre-rotation 2.3, post-rotation 4.3). Students on an elective surgical service scrubbed in 5.0 times per week and reported a decrease in interest (pre-rotation 2.4, post-rotation 2.3). Across all services, interest in surgery increased for students who scrubbed in ≥6 times per week compared to students who scrubbed less. Key factors affecting interest in surgery included faculty engagement, resident engagement, perceptions of wellness/lifestyle, and types of surgical operations viewed/involved in (all >8/15).
Conclusion: Actively involving third-year medical students as members of the surgical team during their surgery rotation significantly enhanced their interest in pursuing a career in surgery. This single-institution study underscores the importance of hands-on experience in influencing students' perceptions and career aspirations. Furthermore, the number of cases students participated in during their rotation were positively correlated with their interest in surgery.
Background: Upwards of 79-88% of practicing surgeons report musculoskeletal pain due to operating. Initial symptoms begin during residency for most, with neck pain as the most frequent, severe, and disabling site. This prospective study hypothesized that a simple 8-minute daily exercise intervention performed over 8 weeks could decrease neck pain experienced by surgeons.
Methods: Surgical residents and faculty who experienced neck pain due to operating were invited to participate in this prospective cohort study. Baseline demographic information, activity, and pain levels were obtained from all participants. After training, participants were asked to perform 4 exercises for 2 minutes each daily over an 8-week period. Exercises included 1) cervical spine stretching, 2) combined pectoral stretching and isometric strengthening for posterior spinal musculature, 3) elastic band strengthening for rotator cuff and scapular retractors, and 4) self-mobilization of thoracic and lower cervical spine. Weekly, participants reported worst neck pain, perceived surgical workload for the week, and estimated exercise adherence.
Results: Thirty-eight surgeons enrolled in the study (13 faculty, 25 residents) of whom 47% were female. Baseline pain was 5.3±1.2/10 and perceived surgical workload measured 5.5±2.2/10. Twenty-six surgeons completed the entire 8-week intervention (8 faculty, 18 residents). There was no difference in gender, level of training, initial pain, or operative workload between those who did and did not complete the study. Among those completing the study, there was a significant decrease in reported worst neck pain from baseline (5.1±1.1) to 4 weeks (3.3±1.8, p<0.001 vs baseline) and on to 8 weeks (2.6±1.6, p<0.001 vs baseline). Four weeks after study completion, worst neck pain remained lower than baseline (2.9±2.2, p<0.001). Exercise adherence was highest in the first four weeks (67±28%) and dropped significantly during the last 4 weeks (55±35%) of the study (p=0.02).
Conclusion: A simple 8 minute daily exercise program reduces the worst level of neck pain in surgeons. The exercises could be taught to junior residents to aid in improving wellness and career longevity. Enhancing exercise adherence will be key in realizing benefit. Future research should incorporate reinforcement and adaptation to assure exercises remain appropriate and are modified as participants’ needs evolve.
Introduction:
The Enneagram represents a model composed of nine different personality types (Figure 1). In contrast to the Myers-Briggs Type Indicator (MBTI), the Enneagram seeks to focus on internal motivators versus 16 personality types. There is increased interest in transitioning towards personalized learning from standardized teaching. Individualized education has shown improved performance in various professional domains such as the financial field. There are little Enneagram data within medicine and surgery. Surgical residency remains a rigorous journey, involving both physical and mental fortitude. Our objective was to assess the prevalence of certain personality types among surgical residents.
Methods:
This is a multi-institutional observational study involving two general surgery residency programs. A free web-based survey composed of 105 questions on a 5-point Likert scale was administered. Resident participation was voluntary involving residents from PGY-1 to PGY-6. Institutional IRB approval was obtained.
Results:
Forty of forty-six residents completed the survey. Results were obtained from PGY 1-6. The most common personality types were Enneagram Types 1 and 3 with ten residents in each type identified. No resident identified as Type 4, and only one resident identified as Type 7. Five residents identified as Type 2, four residents identified as Type 5, three residents identified as Type 6, four residents identified as Type 8, and three residents identified as Type 9.
Conclusion:
Surgical residents appear to have a predominance of Type 1 and Type 3 personalities, known as “The Perfectionist” and “The Achiever.” Type 4 and Type 7 personalities, known as “The Individualist” and “The Enthusiast,” were the least common personality types seen. We plan to expand this study to include other medical specialties and attending surgeons. These data will be correlated with professional fulfillment, burnout, and resiliency indices. The Enneagram may be a useful adjunct in evaluating future applicants for residency selection. Overall, our surgery programs found a predominance in specific Enneagram personality types. This can be used to guide individualized feedback for current residents in interprofessional communication and personal reflections about strengths and limitations.
Background: The ACGME requires residents to learn and apply quality improvement (QI) models during residency training as part of the systems-based practice competency. While most consider use of these frameworks to address patient care concerns, QI concepts can be applied to other issues as well, including resident wellness, specifically resident nutrition. We employed a QI framework to evaluate the need for change, and create solutions for, resident meal cards at a large academic institution.
Methods: A task force was formed with relevant stakeholders. The team chose the DMAIC framework (Define, Measure, Analyze, Improve, and Control) (Figure1). Surveys were administered using Qualtrics (trainees) and Smartsheet (administrators).
Results: The task force Defined the problem: meal card money allocation seemed inconsistent and inadequate for residents taking call. No formal analysis had previously been undertaken.
Measure/Analyze: Surveys administered to residents and fellows demonstrated unanimously that money for meals improved wellness but that >60% of respondents were unsatisfied with the current allocation. Surveys administered to program administrators showed allocation of funds across programs at our institution to be program dependent despite clear guidelines in the resident handbook. The hospital reported annual budgets for resident meal cards. Finally, data gathered from similar large academic programs revealed novel ideas for allocation of meal funds.
Improve: Task force discussions resulted in a pilot program distributing a monthly stipend to residents on a primary inpatient service, taking in-hospital call, emergency department shifts, or taking home call with >25% call-in rate.
Control: Pilot survey identified areas for improvement including iterative changes such as stipend allotment in 3-month increments and potential adjustment for average hours worked per program.
Conclusions: Application of DMAIC QI framework improved standardization of resident meal card funds and prompted iterative changes for improvement. On-call meal funds are vital to resident/fellow wellness but are ultimately dependent on institutional budget. Administration of pilot program with routine, solicited feedback resulted in continued investment from residents, GME, and hospital affiliates. QI-based iterative changes can be used to help improve residents/fellows access to funds for nutrition.
Figure 1. DMAIC (Define, Measure, Analyze, Improve, Control) methodologic approach to continuous improvement (Lean Six Sigma).