ASE 2024 Abstracts

BACKGROUND: Laparoscopic Common Bile Duct Exploration (LCBDE) was initially described in the mid-1990s as a method of treating choledocholithiasis. However, endoscopic retrograde cholangiopancreatography remains the primary treatment in part due to a lack of exposure to LCBDE during surgical training. Currently, the average general surgery resident in the United States performs less than one LCBDE during their entire surgical training. We sought to look at exposure to LCBDE during surgical training following the development of an LCBDE program in 2019.

METHODS: Residents from an academic general surgery residency program were included in this study. Resident exposure was identified via two methods. First, a chart review of all LCBDE cases performed since the development of the program in 2019 was performed to identify each resident who participated in each case. Secondly, the ACGME case logs for all graduating chief residents between 2017 and 2023 were obtained and cross-referenced with procedure codes to obtain total case numbers.

RESULTS: A total of 159 residents were included in the study. Prior to the implementation of LCBDE in 2019, none of the chief residents had exposure to LCBDE. Afterward, the number of LCBDE cases performed yearly increased from 8 cases/year in 2019 to 32 cases/year in 2023. Simultaneously, there was a 3.6-fold increase in the average number of LCBDE cases performed by graduating chief residents (0.1 vs 3.6, p<0.0001). Junior residents experienced statistically significant increased exposure to LCBDE compared to those residents prior to implementation, with the current post-graduate year 3 class performing an average of 2.27 cases per resident (p<0.0001).

CONCLUSIONS: Since the implementation of LCBDE at this institution, graduating chief residents have experienced a 3.6-fold increase in exposure to LCBDE. Similarly, junior resident participation in these cases significantly increased, showing earlier exposure to LCBDE. The development of robust LCBDE programs, coupled with simulation, training, and didactics, can better prepare residents to perform this procedure in practice.

Figure 1: The average number of LCBDE cases performed by chief residents between 2017 and 2024. Boxes represent the mean number of cases per resident, while the lines represent the standard error of the mean.

Introduction: Preparing fourth year medical students to transition to begin surgical intern year is a widely studied topic in surgical education. Studies have identified methods to fill the gap to ease the transition, including a ‘bootcamp’ style training during orientation. This study describes a peer-developed surgical bootcamp at a single institution’s general surgery residency intern orientation. 

Methods: Two postgraduate year two (PGY2) residents with input from other residents and under the general guidance of the faculty intern orientation director, identified 18 topics that were the most practical to review. Lectures were created by the two PGY2 on Microsoft PowerPoint. Accuracy of the material was reviewed by the faculty intern orientation director. Discussion topics included: Using the electronic medical record, preparing for rounds, writing notes, pre-oping patients, and writing admission, discharge, and post-op orders. Case based discussions led by eight PGY2s were conducted on topics of round presentation, when to call senior residents, common surgical issues, among others. 19 interns participated in the surgical bootcamp. Pre, post, and three-month follow up surveys were conducted using a Likert scale evaluated self-reported intern preparedness with 9-10 questions. 

Results: All nineteen interns completed the pre and post surveys. 18/19 interns completed the three-month follow-up survey. 5/19 respondents reported feeling prepared to begin surgical internship in the pre-survey; 18/19 responded feeling prepared after the bootcamp. 3/19 respondents initially reported feeling comfortable managing common surgical issues, which grew to 13/19 after the bootcamp. After three months of surgical internship, 100% of the respondents reported feeling prepared after the bootcamp and feeling less anxious/nervous.

Conclusion: Our bootcamp intervention demonstrated an overall positive impact on the intern’s confidence and preparedness for starting a surgical internship. The positive effects were especially pronounced in easing anxiety and fostering connections with other residents which were reinforced in the three-month follow-up survey results. Given that these are self-reported perceptions of preparedness, further investigation is needed to determine if the perceptions translate into enhanced performance especially in the early stages of a surgical internship.

Background

Approximately 36% of general surgery residents will undertake a full-time research fellowship during residency, with average length of 1.7 years. Residents suffer technical skills decay during this period. Little data exists on the use of simulation to support resident re-entry to clinical duties. We implemented a re-entry simulation lab dubbed REASSURE and hypothesized that it would improve resident confidence and support self-directed learning.

Methods

This was a single-center quasi-experimental study undertaken with 9 residents returning from 1-2 years of professional development to clinical PGY3. Objectives were written based on PGY3 rotations and a learner needs assessment. Residents participated in a three-hour REASSURE skills lab precepted by faculty on perfused cadaver models. Learner feedback was elicited using a retrospective pre-post survey design. Data were compared with the Wilcoxon signed-rank test.

Results

All learners found the re-entry lab quite or extremely helpful. Resident confidence increased in performing upper endoscopy (on a five-point scale, median (IQR): pre-lab 3 (1), post-lab 4 (1)); obtaining laparoscopic access to the abdomen (pre-lab 3 (0), post-lab 4 (0)); and performing a resuscitative thoracotomy (pre-lab 3 (2), post-lab 3 (1)), all p<0.05 (figure). Confidence to perform a reference unpracticed skill, intracorporeal knot tying, was unchanged (pre-lab 3 (2), post-lab 3 (2), p>0.1). When asked about elements of self-directed learning, residents found the lab quite helpful for identifying learning goals (on a five-point scale, mean 4.1), developing a strategy for achieving their learning goals (mean 4.2), and developing a strategy to assess progress toward goals (mean 4.1), and somewhat helpful for identifying alternate strategies if the initial plan was unsuccessful (mean 3.9). Open-ended comment themes valued the perfused cadaver model and the faculty-precepted practice and encouraged continued implementation of REASSURE in future years.

Conclusions

A re-entry simulation lab reviewing open, laparoscopic, and endoscopic skills for residents returning from professional development to PGY3 was perceived as valuable and was associated with improved resident confidence in these operative skills. REASSURE was also perceived as helpful for self-directed learning, which is critical for competency-based education. Future studies should explore the effect of similar labs on measures of technical skill.

Introduction

The surgery clerkship challenges medical students to learn and improve in multiple areas including clinical knowledge, technical skills, and situational awareness. Senior medical students who recently completed surgery rotations are uniquely equipped to serve as teachers for clerkship students. We created and evaluated a “Near Peer” teaching program in which senior medical students were trained to create and deliver didactics to surgery clerkship students.

Methods

Near Peers self-selected from a single medical school and completed three sessions on foundations of adult learning theory as applied to surgical education. Near Peers were surveyed about their confidence in teaching before and after each session. The Near Peers then created and taught twelve didactics covering surgical skills for clerkship students. Learners completed pre- and post-session surveys online for each didactic, which collected data on a 5-point Likert scale assessing self-perceived confidence in specific skills. Scale data were analyzed comparing pre- and post-session means with paired, two-tailed, t-tests.

Results

Seven medical students volunteered to be Near Peers. Following the training sessions, Near Peers reported improved confidence in providing feedback, developing psychological safety, teaching technical skills, and creating didactics. The three didactics taught to students transitioning to the core clinical year averaged 75 paired pre- and post-session responses per didactic (55% response rate). The students reported significantly improved confidence in all domains of daily workflow and expectations as well as preparing for rounds, shelf exam, and operating room (Figure 1). The nine didactics created by Near Peers during the surgery clerkship similarly resulted in improved student confidence in additional surgical skills.

Figure 1: Pre- and Post-Session Means of Clerkship Students’ Self-Perceived Confidence in Topics Taught During “A Typical Day on the Surgery Clerkship.” Error bars mark 95% CI. All p-values are <0.001.

Discussion

The Near Peer training program prepared senior medical students to create and teach didactics on essential surgical skills to over one hundred clerkship students. These sessions resulted in notable improvement in learners’ self-perceived confidence in surgical skills. Medical schools should consider development of local Near Peer teaching programs to address surgical learning needs while also cultivating participants’ skills as educators.