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Objective: We aimed to: 1) create a Surgical Education Time-Out Tool (SET-OuT) checklist training module for faculty utilizing a highly-realistic simulation and 2) assess faculty and resident perioperative educational experiences pre- and post-SET-OuT intervention., Design, Setting, and Participants: We recruited gynecologic surgical faculty and PGY1 to PGY3 obstetrics and gynecology (OBGYN) residents from the University of Utah. Each enrolled participant completed a baseline and 9-month survey about their educational experiences and SET-OuT satisfaction. Faculty enrollment required completion of highly-realistic SET-OuT simulation with a simulated resident actor. We compared individual measures and composite teacher self-efficacy scale and composite resident procedural self-confidence scale between time points using rank sum tests. We converted Likert-scale items to 5-point scales and used mixed linear models to investigate whether relationships persisted after accounting for individual surgeons' and residents' effects., Results: Twenty-five of 62 (40%) faculty and 15/17 (88%) residents enrolled with 100% baseline survey completion. Twenty of 25 (80%) faculty and 12/15 (80%) residents completed the 9-month survey. Faculty scored a median 34/45 points on the self-efficacy scale at baseline and 41/45 points at 9 months (p < 0.01). Faculty demonstrated a 0.9-point improvement in teaching performance satisfaction (p < 0.01). Residents' procedural self-confidence was 16.5/30 at baseline and 22/30 at 9-months (p = 0.01) and felt their value and input in the surgical education experience improved. Residents reported improved satisfaction with feedback at 9-months compared to baseline (p = 0.01). Faculty and residents reported 85% and 100% satisfaction with the ETO as a teaching tool, respectively., Conclusions: Implementation of a perioperative SET-OuT improved faculty teaching self-efficacy and resident procedural confidence. Both groups highly rated the SET-OuT as an acceptable perioperative teaching tool., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Trauma remains a leading cause of death, both for individuals under 40 in North America, and globally, where it contributes to ~10% of deaths annually. Thoughtful, timely, balanced resuscitation, especially in the peri-operative period for unstable injured surgical patients, is vital for optimizing outcomes. The advanced trauma life support protocol plays a pivotal role in early evaluation and management, emphasizing hemorrhage control and resuscitation strategies., Objective: This narrative review provides a structured, evidence-based framework aimed at enhancing the educational experience of surgical trainees. It outlines key principles in peri-operative trauma resuscitation, emphasizing timely intervention, goal-directed fluid therapy, and damage control surgery (DCS) to improve patient outcomes., Methods: A comprehensive Scale for Quality Assessment of Narrative Review Articles -guideline compliant literature search was conducted using PubMed and Google Scholar for English-language articles published between January 2000 and February 2024. The search included relevant medical subject headings terms. Additional studies were identified from reference lists. Extracted data were reviewed and organized using thematic analysis, focusing on historical perspectives, evidence-based practices, and the concept of DCS., Results: Key findings from the 55 relevant studies selected underscore the importance of balanced fluid and blood product administration, the use of permissive hypotension in hemorrhagic shock, and the application of DCS principles. This review highlights educational strategies that foster a deeper understanding of trauma resuscitation practices, offering practical insights through case studies and technological innovations., Conclusion: This review serves as an educational resource for surgical trainees, equipping them with a robust understanding of evidence-based trauma resuscitation. By integrating historical context, modern practices, and emerging technologies, the review aims to enhance both the theoretical knowledge and practical skills necessary for managing unstable trauma patients. Emphasis is placed on interdisciplinary teamwork, continuous education, and personalized resuscitation strategies to improve clinical outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To explore which educational interventions have been used to address communication skill in surgical residents., Design: Systematic review., Results: Several interventions have been used to improve communication skill in residency, including simulation, standardized patients, and didactic teaching. These interventions vary widely, yet the majority of interventions tend to result in improvement in resident communication skill., Conclusions: Communication is an essential skill for surgical trainees to learn. Integration of communication-focused educational interventions can lead to improved skill development in surgical residents., (Copyright © 2024. Published by Elsevier Inc.)

Genelyn is a proprietary embalming solution used for preserving cadavers for surgical skill training (SST) and undergraduate teaching. The aim of this review is to examine the Genelyn embalming method critically by analyzing scientific publications that have employed this method for SST and undergraduate education. The systematic review process involved searching for all relevant articles in PubMed, Google Scholar, and Embase using the keywords "Genelyn," Genelyn embalming," "Genelyn embalmed cadaver," and "surgical skill training. All studies on Genelyn embalming published up to August 14, 2024, in the English language were eligible for inclusion. The literature review yielded 92 studies, 43 of which met the inclusion criteria. The Anatomical Quality Assurance (AQUA) tool from the International Evidence-Based Anatomy (iEBA) working group was used to assess and analyze the risk of bias in all the selected full-text articles. The selected studies reported that Genelyn embalming provided life-like joint range of motion, tissue pliability, and color. Cadaveric studies assessing embalming solutions typically had smaller sample sizes, and few of them compared Genelyn embalmed cadavers (GECs) with the other soft embalming solutions. Unlike Theil's embalming, Genelyn embalming is cost-effective, with easy steps for the preparation and storage of the solution and convenient handling of cadavers. Therefore, GECs serve as an efficient tool for SSTs., (© 2024 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Introduction: Prehospital triage is critical to ensure timely activation of trauma center resources. Undertriage (UT) results in higher morbidity and mortality. To minimize this risk, the American College of Surgeons Committee on Trauma recommends trauma centers aim for a UT rate below 5%. Our center has a 3-tiered triage system aimed at optimizing resource allocation. We hypothesized that a trauma triage criteria educational module (TCEM) would 1) improve emergency medical services (EMSs) provider confidence and accuracy in triage and 2) improve our UT rate., Methods: From July to November 2022, the TCEM was presented to 8 local EMS agencies who transport patients to our Level 1 trauma center. Preclass and postclass surveys assessed EMS provider triage confidence using a Likert scale 1-5. Validated trauma scenario questions were used to measure triage accuracy. The UT rate was compared between January-May 2022 (pre-TCEM) to January-May 2023 (post-TCEM) using trauma registry data. Data were analyzed using paired Wilcoxon signed rank and t-tests., Results: 72 prehospital providers participated in TCEM, most were Caucasian (65.3%), non-Hispanic (84.7%), males (77.8%) with emergency medical technician-basic certifications (90.3%). There was a significant increase in triage confidence from pre-TCEM to post-TCEM (2 versus 5; P < 0.001) and accuracy (23.2% versus 88.9%; P < 0.001). Regression analysis did not indicate a significant difference in confidence or accuracy based on years of experience, paid or volunteer provider status, or transport volume per week. The UT rate remained stable after TCEM initiation (2.3% versus 2.0%; P < 0.669)., Conclusions: This novel community based educational program demonstrated improvements in EMS provider confidence and accuracy regarding prehospital trauma triage. Outreach programs like these are often well received by EMS, and implementation is highly reproducible at other centers., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The Gender Equity Initiative in Global Surgery organization launched a mentorship program to address the limited opportunities available in low-and-middle-income countries (LMICs). We aimed to evaluate the utility of the virtual program in bridging this critical gap., Methods: A retrospective review of program surveys containing quantitative and qualitative questions from 2022 to 2023 was performed., Results: Of n ​= ​193 applicants, 81.3 ​% (157/193) identified as women, and 69.4 ​% (134/193) reported no prior mentorship. Applicants were from 41 countries (35 LMICs). The most requested specialties were general surgery (27.9 ​%, 54/193), neurosurgery (18.1 ​%, 35/193), and cardiothoracic surgery (11.4 ​%, 22/193). 55.9 ​% (108/193) preferred mentors from other countries (United States, United Kingdom, Canada), while 13.9 ​% (27/193) preferred mentors from their country. Ultimately, 48 applicants were matched with 13 mentors., Conclusions: Demand for the program surpassed capacity, highlighting a need for mentorship opportunities for women overall, particularly in LMICs., Competing Interests: Declaration of competing interest All authors have no financial interests related to this study to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator., Methods: We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS)., Results: Videos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ​± ​1.05 and GQS of 3.06 ​± ​0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty., Conclusions: This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To assess the impact of a deceased donor organ procurement training workshop on the transplant fellow's confidence and proficiency in organ recovery. This pilot workshop was designed to address the current gap in the transplant fellow's training in North America., Design: Participants' confidence and competence in deceased donor organ recovery were assessed pre- and postworkshop (immediate, 1- and 6-month) using a survey questionnaire. Participants' responses were compared using T-test and Wilcoxon tests before and after the workshop., Participants: The hepatopancreatobiliary-transplant fellows from the University of Toronto participated in the workshop., Results: Seven fellows participated, with 57% reported very limited exposure to deceased donor operations in the past year. Fellows' confidence improved significantly immediately postworkshop (69% vs. 85%, p = <0.05), persisting at 1 month (86%, p = <0.05) and 6 months (91%, p = <0.05). Competence scores also demonstrated improvement postworkshop (88% vs. 78%, p = 0.3), remaining constant at 1 month (88%, p = 0.18), and further increasing at 6 months (92%, p = 0.19)., Conclusion: This pilot study represents a notable step as the first workshop tailored for transplant fellows in Canada, demonstrating sustained improvement in both confidence and competence for deceased donor organ procurements. The study is limited by results from a single center and small sample size, impacting the generalizability of findings. However, the workshop addresses variability in transplant fellows' exposure and confidence levels, emphasizing the importance of structured training in organ procurement to enhance skills and readiness for real-time procedures., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Here we describe the development and pilot testing of the first artificial intelligence (AI) software "copilot" to help train novices to competently perform flexible fiberoptic laryngoscopy (FFL) on a mannikin and improve their uptake of FFL skills., Methods: Supervised machine learning was used to develop an image classifier model, dubbed the "anatomical region classifier," responsible for predicting the location of camera in the upper aerodigestive tract and an object detection model, dubbed the "anatomical structure detector," responsible for locating and identifying key anatomical structures in images. Training data were collected by performing FFL on an AirSim Combo Bronchi X mannikin (United Kingdom, TruCorp Ltd) using an Ambu aScope 4 RhinoLaryngo Slim connected to an Ambu® aView™ 2 Advance Displaying Unit (Ballerup, Ambu A/S). Medical students were prospectively recruited to try the FFL copilot and rate its ease of use and self-rate their skills with and without the copilot., Results: This model classified anatomical regions with an overall accuracy of 91.9% on the validation set and 80.1% on the test set. The model detected anatomical structures with overall mean average precision of 0.642. Through various optimizations, we were able to run the AI copilot at approximately 28 frames per second (FPS), which is imperceptible from real time and nearly matches the video frame rate of 30 FPS. Sixty-four novice medical students were recruited for feedback on the copilot. Although 90.9% strongly agreed/agreed that the AI copilot was easy to use, their self-rating of FFL skills following use of the copilot were overall equivocal to their self-rating without the copilot., Conclusions: The AI copilot tracked successful capture of diagnosable views of key anatomical structures effectively guiding users through FFL to ensure all anatomical structures are sufficiently captured. This tool has the potential to assist novices in efficiently gaining competence in FFL., Level of Evidence: NA Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Strong performance in neurosurgical sub-internships is a vital component of a successful residency application and requires adequate familiarity with clinical knowledge and technical skills that may not be covered in standard medical school curricula. Accordingly, a need exists for immersive and comprehensive sub-internship preparation programs that respect time and resource limitations, are optimized based on longitudinal student feedback, provide opportunities for mentorship, and foster enthusiasm for neurosurgery. Therefore, residents at a single institution designed and implemented a comprehensive curriculum for a one-day sub-internship academy., Methods: Academy curriculum involved hands-on and discussion-based elements split into three workshops. Anonymous surveys were conducted immediately following the academy and upon completion of sub-internships to evaluate participant perceptions on the utility of the academy., Results: Twelve medical students participated in the inaugural neurosurgery sub-internship academy. Nine responded to the immediate post-survey, which revealed the following ratings: the overall program was rated as having maximal impact on sub-internship readiness and enthusiasm for neurosurgery by eight (88.9%) and seven (77.8%) respondents, respectively. A largely positive impact on access to mentorship was observed. Six participants responded to a post-sub-internship survey, and all six indicated they agreed or strongly agreed that the academy prepared them to perform well., Conclusions: Student perceptions of the relevance and utility of the sub-internship academy were positive, and the program fostered enthusiasm for neurosurgery and provided opportunities for mentorship. The participants indicated the academy positively impacted their sub-internship performance, and areas for improvement to guide future iterations of the academy were identified., (Copyright © 2024. Published by Elsevier Inc.)

Background: Committees dedicated to diversity, equity, and inclusion (DEI) are not commonplace within departments of surgery. Even rarer are joint initiatives for residents and faculty. We aim to describe the creation of a collaborative committee within a department of surgery to better foster and advance the ideals of DEI., Methods: An informal needs-assessment was performed amongst the general surgery residency, advanced practice practitioners, and faculty. Other DEI groups throughout the institution were engaged for feedback and interdisciplinary collaboration., Results: Gaps were identified in social support for those from diverse backgrounds, advocacy and recruitment, general DEI education, and research. Three pillars were formed: Social Support, Education and Advocacy, and Research. The overall group and each pillar are co-led by residents and faculty. In less than a year, the group has launched a cultural complications morbidity and mortality curriculum, hosted the first city-wide LGTBQ+ in surgery event, created a safe space for discussion and support, and advocated for recruitment DEI initiatives. So far, the group consists of 48 residents, faculty, advanced practice practitioners, and staff., Conclusions: An intentional, collaborative effort between residents and faculty in a department of surgery can successfully result in an effective partnership to advance DEI initiatives., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: There are limited opportunities to practice surgical skills and techniques in residency. Therefore, it is important to explore strategies which optimize surgical simulation experiences to enhance learning outcomes and skill retention., Methods: Novice medical students (n = 29) were recruited to participate in a Fundamentals of Laparoscopic Surgery (FLS) peg transfer task training. Participants were randomly assigned to a control group, practicing the peg transfer task independently, or an experimental group, practicing with time pressure. Participant skill assessments were completed before the training, after the training, and 8-weeks after the training. Subjective and objective stress measurements were taken in the form of self-report surveys and heart rate variability data, respectively., Results: For all the skill assessment measurements, there was no difference between groups in performance on the FLS task. Both groups showed improvement in performance after the training compared to before. The experimental group reported higher stress during and after the training period compared to the control group; however, there was no difference between groups on heart rate variability metrics., Conclusion: Time pressure while practicing an FLS task did not significantly impact learning acquisition or retention. However, the experimental group reported higher levels of stress. This preliminary study suggests time pressure does not confer an enhanced surgical skill learning experience for novices., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Our study investigated the effects of surgical training on residents' personal relationships. It aimed to address the gaps in understanding of how the surgical training commitment can influence relationship stability, decision-making, and life planning within this unique professional group., Design: We used cross-sectional survey methodology to gather data on the intricacies of relationship dynamics amid the rigors of surgical training. The survey focused on marital status, relationship dynamics, personal life choices, the challenges and rewards of dual-healthcare relationships, and the support networks that individuals and couples rely on., Setting: All surgical departments at The Johns Hopkins Hospital., Participants: The study comprised 111 participants, including residents, fellows, and attending surgeons. Of those reporting sex, 56/105 (53%) were female, and the predominant age category was 25 to 34 years, making up 61/104 (59%) of respondents., Results: The majority (73/105, 70%) of respondents were or had been married, and 50/96 (52%) had partners in the medical field. Among those in a dual-healthcare relationship, 38/46 (83%) reported that their relationship was strengthened through understanding and empathy, yet 37/46 (80%) acknowledged complications in work-life balance. However, women were significantly more likely than men to report at least one negative effect of a dual-healthcare relationship (84% [16/19] versus 22% [6/27], p = .003). Among those with partners outside medicine, 39/46 (85%) acknowledged that their partner had to adjust their lifestyle significantly. A considerable number (73/92, 79%) postponed life events such as starting a family, and 57/85 (67%) experienced relationship strain due to long working hours., Conclusions: Residents in dual-healthcare couples derived support from their relationships, but surgical training placed a significant strain on residents' personal relationships and often prompted residents to postpone major life events such as starting a family. Enhanced support systems and targeted interventions are needed to assist surgical professionals in navigating the complexities of balancing a demanding career with personal life., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Practical simulation training with proper haptic feedback and the fragility of the human body is required to overcome the long learning curve associated with laparoscopic inguinal hernia repair (LIHR). However, few hernia models accurately reflect the texture and fragility of the human body. Therefore, in this study, we developed a novel model for transabdominal preperitoneal (TAPP) LIHR training and evaluated its validity., Methods: We developed a high-quality mock peritoneum with a hydrated polyvinyl alcohol layer and a unique two-way crossing cellulose fiber layer. To complete the simulation, the peritoneum was adhered to a urethane foam inguinal base with surgical landmarks. Participants could perform all the procedures required for the TAPP LIHR. Twenty-four surgeons performed TAPP LIHR simulation using a novel simulator. Their opinions were rated on a 5-point Likert scale. Additionally, 6 surgical residents and 10 surgical experts performed the procedure. Their performance was evaluated using the TAPP checklist score and procedure time., Results: Most participants strongly agreed that the TAPP LIHR simulator with an exchangeable peritoneum model was useful. The participants agreed on the model fidelity for tactile sensation, forceps handling, and humanlike anatomy. In comparisons between surgical residents and experts, the experts had significantly higher scores (10.6 vs. 17.2, p < 0.05) and shorter procedure times (92.3 vs. 55.9 min; p < .05) than did surgical residents., Conclusions: We developed a high-quality exchangeable peritoneal model that mimics the human peritoneum's texture and fragility. This model enhances laparoscopic simulation training, potentially shortening TAPP LIHR learning curves., (© 2024 The Author(s). Asian Journal of Endoscopic Surgery published by Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

Background: A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes. We sought to evaluate how intraoperative coaching and resident autonomy differ based on the use of a single- versus dual-console robot., Methods: Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty coaching based on the Wisconsin Surgical Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework., Results: Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments)., Conclusions: Qualitative analysis highlights that despite similar survey-based faculty ratings across domains, coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To evaluate the effectiveness of a "telestration" system in which the mentor annotates the view of the surgical field, for endoscopic transsphenoidal surgery (ETS)., Methods: The use of telestration was evaluated for sellar floor-opening during ETS and for a task performed using ETS simulation training. During ETS, the mentor outlined the opening area of the sella turcica on the monitor and then the trainee surgeon opened the sella, either with the telestration displayed (telestration (+) group, n = 8) or without (telestration (-) group, n = 7). In the task using an ETS training model, 18 subjects were asked to touch the indicated targets with the forceps, once with the instructions given via telestration and once with verbal instructions only., Results: During ETS, the telestration (+) group had a significantly higher concordance rate between the planned bone window and actual bone window than the telestration (-) group (92.97 ± 4.16% vs. 77.57 ± 10.51%, P = 0.014). In the ETS model, the time required to finish the task was significantly less with telestration than with verbal instructions alone (P = 0.002). None of the subjects had errors when telestration was used, while subjects made an average of 0.33 ± 0.59 errors and had to re-listen to the instructions 0.27 ± 0.46 times when only verbal instructions were given., Conclusions: The use of the telestration system during ETS facilitated the communication of the mentor's intentions to the trainee surgeon and contributed to safer, more accurate surgery. The system was also thought to be useful in reducing operative time., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Evaluate the utility of a low cost, portable surgical simulator (GlobalSurgBox) for surgical teaching and its ability to dismantle barriers faced by trainers when attempting to use surgical simulation., Design: An anonymous survey was administered to surgical trainers who were involved in leading simulation events using the GlobalSurgBox in the past 2 years. The survey was designed to understand current barriers to using simulation as a trainer, and the utility of the GlobalSurgBox in overcoming these barriers., Setting: Academic medical training centers or conferences in the United States, Rwanda and Kenya., Participants: 10 practicing surgeons, 3 practicing physicians, 11 surgical residents, 15 medical students and 1 anesthesia resident., Results: The top 3 barriers for effective teaching were lack of convenient access to the simulator (50%), lack of trainer time (43%) and cost (28%). After using the GlobalSurgBox, 100% and 98% of respondents felt that it encourages more practice and offers significant advantages over current simulators in their program. About 90%, 88% and 70% of respondents believed that the GlobalSurgBox makes surgical simulation more convenient, affordable, and compatible with trainer time limitations, respectively. 83% of trainers agreed that it is a good replica of the operating room experience, and 85% practicing physicians were more likely to give autonomy to trainees after demonstrating competence on the GlobalSurgBox., Conclusion: The GlobalSurgBox mitigates several barriers surgical educators experience when practicing surgical skills with trainees. The convenience of the GlobalSurgBox can help facilitate the development of foundational surgical skills outside of the operating room., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Artificial intelligence continues to play an increasingly important role in modern health care. ChatGPT-3.5 (OpenAI, San Francisco, CA) has gained attention for its potential impact in this domain., Objective: To explore the role of ChatGPT-3.5 in guiding clinical decision-making specifically in the context of pancreatic adenocarcinoma and to assess its growth over a period of time., Participants: We reviewed the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines for the Management of Pancreatic Adenocarcinoma and formulated a complex clinical question for each decision-making page. ChatGPT-3.5 was queried in a reproducible fashion. We scored answers on the following Likert scale: 5) Correct; 4) Correct, with missing information requiring clarification; 3) Correct, but unable to complete answer; 2) Partially incorrect; 1) Absolutely incorrect. We repeated this protocol at 3-months. Score frequencies were compared, and subgroup analysis was conducted on Correctness (defined as scores 1-2 vs 3-5) and Accuracy (scores 1-3 vs 4-5)., Results: In total, 50-pages of the NCCN Guidelines® were analyzed, generating 50 complex clinical questions. On subgroup analysis, the percentage of Acceptable answers improved from 60% to 76%. The score improvement was statistically significant (Mann-Whitney U-test; Mean Rank = 44.52 vs 56.48, P = .027)., Conclusion: ChatGPT-3.5 represents an interesting but limited tool for assistance in clinical decision-making. We demonstrate that the platform evolved, and its responses to our standardized questions improved over a relatively short period (3-months). Future research is needed to determine the validity of this tool for this clinical application.

Objective: As surgical residents continue in their training, they are expected to not only take part in more complicated procedures, but to also serve as leaders in their respective care teams. While surgical skills are intensively taught in surgical residency programs, leadership is often learned informally, to the detriment of residents. Our curriculum was developed and implemented to provide foundational knowledge for surgical residents as they take on senior roles so that they may successfully act as leaders. This educational workshop was effective and efficient and can be applied at other residency programs that seek to improve the leadership skills of their residents., Design: Implementation of a 3-day program focused on leadership, surgical skills, and career development to provide rising PGY-4 surgical residents with the abilities necessary for successful training., Setting: This program was implemented at the University of Minnesota General Surgery residency program., Participants: Rising PGY-4 general surgery residents., Results: The program consisted of a 3-day workshop which all rising PGY-4 residents participating in before transitioning into their respective roles. The program was led by the general surgery faculty., Conclusions: Curricula focused on developing leadership skills in residents can be effectively applied in a time-efficient manner that can benefit the residents as they move into official leadership roles on the care team., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: In surgery, simulated-based training improves the knowledge and interpersonal skills needed for surgeons to improve their performance and meet the "never the first time on a patient" imperative. The objective is to evaluate the effects of a 2017 reform on surgeon's accessibility to simulation-based training, five years after the implementation of the program, and to gauge surgeon satisfaction., Methods: A 27-item national online survey was sent to all surgical residents and fellows in the 13 surgical specialties., Results: Among 523 responses, 405 (77.4%) were residents and 118 (22.6%) were surgical fellows. Two hundred forty-seven (47.2%) of surgical residents and fellows stated they did not have a simulation structure or simulation program in the town of their university hospital center. Two hundred thirty-five (44.9%) reported having simulation training programs and 41 (7.8%) reported having easy and free access to their simulation structure. Regarding simulation-based training, 44.6% of surgical residents and fellows had never received training in technical skills on simulators, 82.2% had never received training in teamwork or interprofessional skills and 76.1% had never received training in behavioral or relational skills. There was a significant difference between the degree of satisfaction of residents at the beginning and at the end of the study (P=0.02)., Conclusion: Simulation is a well-established educational tool, but there are still strong inequalities between universities. Despite the national deployment of simulation-based teaching programs and institutional efforts, surgical simulation is insufficiently developed in France, and learner satisfaction is poor., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: Simulation-based training often fails to meet the needs of low- and middle-income countries with limited access to high-cost models. We built on an existing surgical simulation curriculum for medical students in Rwanda and assessed students' experience., Methods: Based on a contextual simulation-based education curriculum that was piloted in 2022, our team designed and delivered an intensive week-long surgical simulation course for medical students. We increased interactive clinical scenarios using high-fidelity mannequins, improved and added benchtop models for training, and incorporated a new postcourse assessment of students' experiences using a survey on the first Kirkpatrick level to determine sessions with the highest utility. Modules included informed consent, preoperative patient preparation, trauma simulations, and procedural skills. The final day focused on integrating and applying skills learned throughout the week in an interactive circuit., Results: Thirty-six students participated in the 5-d simulation course and 24 completed an end of course survey. When asked about their exposure to simulation prior to the course, 20/24 (83%) students reported "a lot" and 4/24 (17%) reported "a little", 24/24 (100%) strongly agreed that simulation is a valuable educational tool and 23/24 (96%) felt that the week enhanced their knowledge and skills to "a great extent". The modules with the highest self-rated level of engagement were the interactive trauma simulations, knot-tying and suturing practice and competition, and a model-based session on cutaneous lesions. The lowest ranked session was the interactive circuit on integrated skills., Conclusions: Implementing a locally-informed and locally-sourced surgical simulation curriculum is feasible and effectively engages medical students in low-income settings., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Many surgical residencies have passed along attendings preferences and procedural knowledge as a highly utilized but informal resource. The objective was to assess the effect of providing operative steps and attending preferences on surgical resident performance., Design: This was a prospective observational study with a survey-based design., Setting: We created and shared vascular surgery operative steps including institutional and attending preferences with junior residents at the Massachusetts General Hospital., Participants: There were a total of 31 residents who completed a survey to assess self-perception of performance in operative knowledge and Accreditation Council for Graduate Medical Education (ACGME) Milestone criteria., Results: Advice from colleagues was the most utilized resource, followed by web-based materials. Of the web-based materials, almost all residents utilized Google searches over other web-based resources designed to specifically help surgical trainees. The vascular surgery resource was used by 90% of residents more than 3 times per week to prepare for operative cases. There was significant improvement in patient positioning, instrument selection, operative field exposure, anatomy, sequence of procedure, procedure choices, and peri-operative care knowledge., Conclusions: Development of institutional resources that specifically capture attending surgeon procedural variations can improve resident performance, encourage resident autonomy, and provide a catalog of approaches to challenging operative situations., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe the construction and use of a percutaneous pelvic fixation model, evaluate its translational validity among fellowship-trained orthopedic trauma surgeons, and investigate the importance of specific criteria for effective competency-based assessment of pelvic fixation techniques., Methods: Five orthopedic trauma surgeons were asked to place percutaneous wires on a pelvic fixation model, including anterior column (antegrade/retrograde), posterior column (antegrade/retrograde), supra-acetabular, transsacral, and iliosacral. Evaluation criteria included successful wire placement, redirections, cortical breaches, procedure duration, radiation exposure, and quality of fluoroscopic views. Following completion, participants were provided a survey to rate the model., Results: There were no differences between approaches on successful screw placement, wire redirections, or fluoroscopic quality. Antegrade approaches to the anterior and posterior columns took longer (p = 0.008) and used more radiation (p = 0.02). There was also a trend toward more cortical breaches with the antegrade anterior column approach (p = 0.07). Median ratings among surgeons were 4 out of 5 for their overall impression and its accuracy in tactile response, positioning constraints, and fluoroscopic projections. Learning parameters considered most important to the progression of trainees (most to least important) were successful screw placement, corridor breaches, wire redirections, quality of fluoroscopic views, radiation exposure, and procedure duration., Conclusion: In being affordable, accessible, and realistic, this percutaneous pelvic fixation model represents an opportunity to advance orthopedic surgery education globally. Future research is needed to validate the findings of this pilot study and to expand upon how trainees should be evaluated within simulations and the operating room to optimize skill progression., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: The use of robotic systems for microsurgery has gained popularity in recent years. Despite its drawbacks, such as increased learning time and lack of haptic feedback, robot-assisted microsurgery is beneficial for emergency care due to its reduced risk of tremor and fatigue. The Symani Surgical System® is 1 example of this advanced technology. The device offers a range of possibilities in the field of microsurgery by combining precision and dexterity, revolutionizing microsurgical procedures. This article explores the applications of the Symani in microsurgical procedures in emergency hand trauma care, highlighting its advantages and limitations. Material and Methods: We present the results of 62 anastomoses of blood vessels under .8 mm diameter after hand trauma. 31 anastomoses were conducted using the Symani Surgical System®, and the other 31 were done as a control group in hand-sewn technique. Study Sample: The patient characteristics, including sex, age, and risk factors, were matched. Results: We found no significant differences in the anastomosis surgery length when performed with the Symani (arterial 17.3 ± 1.9 min; venous 11.5 ± 1.3 min) vs the hand-sewn technique (arterial 16.1 ± 1.4 min; venous 10.2 ± 1.8 min). Additionally, the learning curve consistently decreased over time, with the 10th surgery taking 30% (arterial) less time. Conclusion: Our study indicates that robot-assisted microsurgery can help surgeons maintain a relaxed and focused state while producing results comparable to hand-sutured procedures in emergency care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: There is an ongoing national shortage in the vascular surgery (VS) workforce. To increase interest in the specialty, the Society for Vascular Surgery (SVS) Resident and Student Outreach Committee (RSOC) developed a dedicated general surgery (GS) resident and medical student (MS) program at the Vascular Annual Meeting (VAM) and invested in a scholarship program to help reduce attendee expenses. This study assesses the program's effectiveness, correlating recipient feedback with the likelihood of matching into a VS training program., Methods: Records related to the SVS VAM GS resident and MS program from 2013 to 2023 were reviewed, focusing on attendee evaluations of the program. The program included a simulation session from 2013 to 2019. VS training program match rates among scholarship recipients were determined. The annual average match rate in VS was used to divide the survey responses into two groups: below average (BA) and above average (AA) match rate groups. Survey responses were based on a 5-point Likert scale and allowed for comments. Responses were divided into high value, strongly favoring the activity (scores 4-5), and low value (scores 1-3) categories. The survey responses from the group of years with AA match rates were compared with the group of years with BA rates., Results: The SVS awarded 1040 GS resident and MS travel scholarships over the 10 years assessed. Overall, applicants had a 43% success rate in receiving a scholarship. During the study period, the annual number of applicants increased, whereas the number of scholarships and match success rates significantly decreased. The average match rate into VS among scholarship recipients was 50.2%. The survey response rate was 33%. During AA match rate years, evaluations for simulation allotted time and lectures were significantly more likely to be high value compared with BA years. Simulation content and the residency fair consistently had the most favorable evaluations (>90% high value), and overall, the program had a consistently positive impact on recipients' interest in VS (>90% high value). Trainees in the AA group were significantly more likely to provide positive comments (73% vs 55%; P < .001). Numerous recipients commented on the need for a dedicated space to interact with faculty and mentors and highlighted simulation as the standout aspect of the program., Conclusions: The SVS VAM RSOC program is positively correlated with attendee interest in VS, with approximately 50% of scholarship recipients matching into the field. The quality of the program and the number of scholarships correlate with VS match rates. Additional investments in similar programs could help close the workforce gap., Competing Interests: Disclosures C.I.O.C. has a patent for U.S.S.N. 10,524,891 and is a consultant for enVVeno Medical Corporation., (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: The healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions, of which one-third comes from operating rooms (ORs). As a result, there is great interest in decarbonizing the OR and surgical care. However, surgical residents are not routinely educated on the negative environmental impact of surgery or how to reduce it. In this paper, we present a formal needs assessment for a sustainability curriculum geared towards surgical residents., Methods: Using Kern's Six-Step Framework for curriculum development, we conducted focus groups with surgical residents to perform a targeted needs assessment on 3 main topics: 1) the current state of surgical sustainability curricula; 2) resident knowledge regarding the environmental impact of surgery and barriers to sustainable practice; and 3) preferred educational methods and topics within sustainability education. We audio-recorded all focus groups and performed thematic analysis using anonymized transcripts., Results: Fourteen residents participated in 3 focus groups, from which a qualitative analysis revealed 4 themes. First, surgery residents receive limited formal teaching on the negative environmental impact of surgical care or how to reduce this impact. Second, surgery residents have variable levels of prior education about and interest in sustainability in surgery. Third, several barriers prevent the implementation of sustainable changes in surgical practice, including a lack of institutional initiative, cultural inertia, concerns about workflow efficiency, and limited formal education. Finally, residents prefer to learn about practical ways to reduce waste, specifically through interactive approaches such as quality improvement initiatives., Conclusions: Given the increasing importance of sustainability in surgery, there is an urgent need for formal resident education on this topic. This needs assessment provides a valuable foundation for future sustainability curriculum development., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: The Lower Anogenital Squamous Terminology (LAST) Project recommended unified classification for HPV-associated squamous lesions of the lower anogenital tract, using a 2-tiered nomenclature in 2013. Adherence to the new nomenclature worldwide is unknown. This study aims to assess the trend of the use of the two-tiered High Squamous Intraepithelial Lesion and Low Squamous Intraepithelial Lesion (HSIL/LSIL) as opposed to the traditional three-tiered Anal Intraepithelial Neoplasia (AIN I/II/III) classification as suggested by the LAST Project., Methods: A literature search on full-text English language studies of premalignant anal lesion was performed on PubMed from 2002-2022. The studies were categorized by continent, and the prevalence of HSIL/LSIL classification vs AIN I/II/III was calculated., Results: 546 studies and 251 studies were identified using the AIN I/II/II and the HSIL/LSIL classification respectively. Global trend suggested a statistically significant downward trend in the use of the two-tiered nomenclature system in publications globally. Regional trend including North America, Europe, and other (Asia and Latin America) showed variance in adoption of the two-tiered nomenclature system., Conclusion: Despite multidisciplinary collaborative effort, adherence to the recommendations to use the two-tiered system for HPV-associated premalignant anal lesions continues to be suboptimal. Further efforts are needed to identify the cause of poor adherence to be able to create strategies that reinforces unification of terminology and integration of LAST the recommendations., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Simulation is used across surgical specialties for skill enhancement. The choice and assessment method of a simulator varies across literature. In the age of endovascular approach, trainees have limited exposure to open lower limb bypass procedures which needs attention. This review aims to assess the utility of simulation training in lower limb bypass surgery using Kirkpatrick's model., Methods: Using PRISMA statement, we included all the studies done on simulators in lower limb bypass surgical procedures for this systematic review. The primary outcome was to assess the effectiveness of different types of simulation used for lower limb bypass surgery using the Kirkpatrick's model for training evaluation., Results: An initial search identified 295 articles out of which 7 articles were found to be eligible for this systematic review. A variety of simulators were used including cadavers and synthetic models. Most studies ( n =5) found the use of simulation as an effective tool in achieving technical competence. All the five studies we found at level 2 on Kirpatrick's model evaluation., Conclusion: Most of the existing studies are at level 2 of Kirkpatrick's model which reflects learning changes in trainees after simulation. Feedback mechanism needs to be evolved where the improvement after simulation training can be gauged by its replication in clinical practice and improved patient care practices corresponding to the highest level of Kirkpatrick's model., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: As the needs and curricula of surgical residencies evolve, recent studies have focused on identifying factors that may be related to faster and more efficient surgical skill acquisition, such as experience with playing video games, sports, and other dexterous activities. The aim of this study was to elucidate the relationship between instrumental musical experience and laparoscopic surgical skill performance as well as to provide an overview of the available literature on this topic., Methods: A query from database inception to January 2023 of the PubMed database for literature discussing the association of musical experience and surgical skills was conducted. One hundred and twelve publications were sorted for relevance, yielding 16 included studies. The details of these studies were organized in a table and further analyzed. Study participants answered several questions regarding their personal instrumental musical experience and rotated through two minimally invasive surgery (MIS) skills stations. Participants received a score for each station based on level of performance. Descriptive statistics as well as non-parametric analyses and Spearman's correlations were calculated when appropriate to determine any associations between musical experience and laparoscopic surgical skill performance., Results: One hundred individuals participated in the study. Fifty-one of the participants indicated that they played at least one musical instrument, and twelve (9.0%) of these individuals played more than one instrument. There was no statistically significant difference or correlation in scores between individuals that played an instrument and those that did not (p > 0.05). Playing a greater number of instruments did not significantly correlate with increased performance (p > 0.05). There was also no statistically significant difference or correlation in scores within the group that played instruments based on instrument type or number of years playing an instrument (p > 0.05)., Conclusions: Experience playing musical instruments did not confer an advantage in MIS skills tested in the present study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: With the rapid advancement of technology, minimally invasive surgery, particularly laparoscopic surgery, has made significant progress in the field of surgery. Despite the advantages of laparoscopic surgery, a systematic training system for laparoscopic procedures is lacking in Chinese postgraduate medical education. Our study aims to explore the prevalence of laparoscopic training among resident and attending physicians in China and to assess the current state of training programs., Methods: A 10-item questionnaire was distributed to 1,750 resident and attending physicians specializing in surgery across China, with 1,324 valid responses (75.7% response rate). The survey focused on demographics, training curriculum content, and feedback on training effectiveness. Data analysis was conducted using Microsoft Excel and IBM SPSS., Results: Among the 1,324 respondents, 30.7% reported receiving laparoscopic training, primarily at the attending physician stage. Only 4% of resident physicians and 14% of attending physicians could independently perform complex laparoscopic surgeries. Most respondents (76.6%) could only assist in surgeries. The majority expressed a desire for more frequent and longer training sessions, with suture training being identified as the most beneficial., Conclusions: This study underscores the critical need for comprehensive laparoscopic training in China. Early, frequent, and structured training programs are essential for developing proficient laparoscopic surgeons. Future initiatives should focus on expanding access to training at all levels of medical education, ensuring continuous skill development and improved surgical care quality., (© 2024. The Author(s).)

Objectives: During the past decade simulation has become standard in most surgical training programs, but objective evaluation of the performance has been a challenge. The optimal components of open surgery's simulation have also been questioned. The goal of this study was to evaluate the benefit of adding a hands-on exercise prior to a formal vascular training course. The participants' performance was objectively evaluated using Computional Fluid Dynamics (CFD) assessment of vascular anastomoses., Methods: In this study 51 residents participated in an on-line surgical hands-on training course, performing six end-to-side anastomoses. The residents were randomly divided into two groups. Group 1. also underwent basic surgical skill training (BSST) before starting the vascular course. The groups were compared based on CFD assessment of vascular anastomoses, combined with on-line personalized feedback., Results: Among measured parameters of functional assessment, the mean of six anastomoses showed significantly better results in Group 1. when compared with control Group 2 (Oscillatory Shear Index: 0,022 vs. 0,025 p=0,002; Maximum pressure: 7939 vs. 7971 p=0,00037; Velocity: 0,12 vs. 0,12 p=0,0000; Helicity: 297 vs. 393 p=0,0065; Vorticity: 5258 vs. 6628 p=0,0019; Wall Shear Stress: 1,83 vs. 1,97 p= 0,000047). These results showed no significant correlation between participants' experience level, specialization, and workplace., Conclusions: BSST before a formal vascular simulation course positively affects the anastomosis quality, independent of experience level, specialization, and workplace. BSST is suggested before a vascular course to improve performance and progress. Further studies are needed to analyse the impact of this combined simulation training on performing anastomoses., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In this work, we present a computer vision model for automatic otologic drill motion analysis during mastoidectomy and detail how to implement a computer vision model for real-time use. Automated real-time surgical analysis has the potential to enable efficient methods for technical skill assessment and broadly transform the landscape of surgical education. Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Mastoidectomy surgical training is challenging due to the complex nature of the anatomical structures involved. Traditional training methods based on direct patient care and cadaveric temporal bone training have practical shortcomings. 3D-printed temporal bone models and augmented reality (AR) have emerged as promising solutions, particularly for mastoidectomy surgery, which demands an understanding of intricate anatomical structures. Evidence is needed to explore the potential of AR technology in addressing these training challenges., Methods: 21 medical students in their clinical clerkship were recruited for this prospective, randomized controlled trial assessing mastoidectomy skills. The participants were randomly assigned to the AR group, which received real-time guidance during drilling on 3D-printed temporal bone models, or to the control group, which received traditional training methods. Skills were assessed on a modified Welling scale and evaluated independently by two senior otologists., Results: The AR group outperformed the control group, with a mean overall drilling score of 19.5 out of 25, compared with the control group's score of 12 (p < 0.01). The AR group was significantly better at defining mastoidectomy margins (p < 0.01), exposing the antrum, preserving the lateral semicircular canal (p < 0.05), sharpening the sinodural angle (p < 0.01), exposing the tegmen and attic, preserving the ossicles (p < 0.01), and thinning and preserving the external auditory canal (p < 0.05)., Conclusion: AR simulation in mastoidectomy, even in a single session, improved the proficiency of novice surgeons compared with traditional methods., Level of Evidence: NA Laryngoscope, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Study Objective: Ob/Gyn resident experience with robotic gynecologic surgery has been evaluated at time of graduation, but no specific surgical procedures were identified to differentiate the experiences of residents at each level. This study proposes to determine which factors are correlated with more hands-on robotic surgery experience and resident satisfaction., Design: An IRB-approved, 15-question survey was distributed electronically. 98 responses were received for a rate of 44%. Linear regression and ANOVA statistical analysis were performed., Setting: Current residents at eight Ob/gyn residency programs in the US were surveyed., Patients: N/A INTERVENTIONS: Survey administration MEASUREMENT AND MAIN RESULTS: The majority of respondents were satisfied (48%) or had neutral feelings (20%) with regard to their robotic surgery experience. All respondents reported experience with uterine manipulation or bedside assisting by PGY2. Earliest experience performing hysterectomy was most common in PGY2 or PGY3. Seventy-six percent of PGY3 or PGY4 residents report operating on the console for some or all major robotic surgeries, with 69% having participated in greater than 20 robotic surgery cases during residency. Only exposure to MIGS faculty is significantly associated with high robotic surgery experience (p=.022). Overall satisfaction with robotic surgery experience increased significantly with higher level of participation (p<.0001), particularly operating at the console during some or most of the surgery; longitudinal experiences with hysterectomy, myomectomy, and salpingectomy/oophorectomy (p<.05); but not with solely bedside assisting or vaginal cuff closure. Factors limiting robotic console experience included case time constraints, lack of first assists, case complexity, and attending comfort., Conclusions: Ob/Gyn resident satisfaction with training is significantly related to level and duration of robotic surgery participation. MIGS faculty contribute to more resident experience, and limiting factors include time constraints, case complexity and lack of first assists. These results can provide a framework for structuring resident training in robotic surgery., Competing Interests: Declaration of competing interest Dr. Snyder previously owned personal stock in Intuitive Surgical within the past 3 years, totaling less than $2000. We have no other conflicts of interest to report., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Patients with anorectal malformations (ARMs) may have concurrent gynecologic abnormalities. As patients grow, they typically transition from pediatric subspeciality care and seek adult OB/GYN related services. We aimed to assess adult OB/GYN physicians' knowledge, competency, and comfort meeting the sexual and reproductive health care needs of patients with ARM., Methods: We performed a cross-sectional observational survey-based study of graduates from a single academic OB/GYN residency program from 2013-2022. Physicians were surveyed on experience, comfort, and challenges caring for patients with ARMs and given a knowledge assessment. Descriptive and comparative statistics between those who did and did not complete a pediatric and adolescent gynecology (PAG) rotation were generated., Results: There were 59 respondents (53.6%). Fewer than half (39.0%) report caring for a patient with ARM, an appendicovesicostomy (12.3%) or an appendicostomy (5.4%). Most felt uncomfortable (80.4%) or felt they lacked competence caring for these patients (81.8%). The majority (64.3%) felt ARMs should be discussed in residency. Only one physician (1.7%) answered all questions in the knowledge assessment correctly; 33.9% did not answer any question correctly. On subgroup analysis, more physicians completing a PAG rotation recalled learning about ARMs (83.3 vs 51.9%, p=0.03); however, there were no differences in experience, comfort, competence, or willingness to learn., Conclusion: OB/GYN providers report lack of knowledge and comfort in caring for patients with ARMs. Development of a standardized OB/GYN residency curriculum and education for practicing OB/GYN physicians is necessary to allow access to knowledgeable sexual and reproductive health for this patient population., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: The usage of specific ICD-10 diagnosis codes significantly influences hospital reimbursement compared to non-specific codes. This study hypothesized that a formal orientation program for pediatric surgery residents would enhance the selection of accurate and specific diagnosis codes for acute appendicitis such as K35.30 for "Acute appendicitis with localized peritonitis" rather than K35.80 for "Unspecified acute appendicitis," thereby improving hospital reimbursement., Methods: We implemented a comprehensive orientation for pediatric surgery residents at our institution in late 2020, a component of which emphasized the importance of having specific ICD-10 diagnosis codes. We conducted a retrospective analysis of laparoscopic appendectomy billing data for pediatric patients, comparing the use of specific versus unspecified diagnosis codes and associated hospital reimbursement rates before (2020) and after (2022) the program's initiation. Patients without payment were excluded. Statistical significance was determined by a two-tailed p-value of ≤0.05., Results: Analysis of 267 patient records showed a significant increase in the use of the specific diagnosis code (K35.30) from 3.6% in 2020 to 87.5% in 2022 (p < 0.0001). Adjusted for inflation and billing changes, mean hospital reimbursement per case increased by $661 (from $4414 to $5,075, p = 0.027), totaling an additional $84,616 in 2022, just for a single subset of appendicitis patients., Conclusions: A targeted resident orientation program significantly improves the use of specific ICD-10 codes for acute appendicitis, leading to increased hospital reimbursement. Such programs represent a valuable approach for enhancing the financial outcomes of pediatric surgical care while reinforcing the importance of accurate medical documentation., Study Design: Retrospective., Level of Evidence: III., Competing Interests: Conflicts of interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Australia continues to suffer from a geographical maldistribution of general surgical services with only 20% of general surgeons working rurally despite 29% of Australia's population residing outside major metropolitan centres. This qualitative study explored the impact of human capacity and infrastructure upon rural general surgery provision., Methods: This qualitative study employed semi-structured interviews of rural general surgeons. Participants were recruited via the Royal Australasian College of Surgeons (RACS) Rural newsletter and purposive sampling. All interviews were conducted between January 2023 and April 2023. Transcripts were transcribed, de-identified, and thematically analysed., Results: Two female and 20 male rural general surgeons were interviewed from seven of the eight Australian State or Territories. Four main themes were identified which reflected the impact of human capacity and infrastructure upon Australian rural general surgery provision: (1) small hospital syndrome - and the impact, (2) the rural general surgeon identity, (3) infrastructure and disempowerment and (4) over-reliance on visiting surgeons., Conclusion: Improving access to equitable general surgical care for rural Australians requires appropriate infrastructure and a well-trained, sustainable multidisciplinary surgical team (human capacity). A greater understanding of the issues may help drive rational, long-term supportive solutions., (© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Introduction: Autonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the 'teaching assistant (TA)' case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce., Methods: A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume., Results: Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 ​% increase; τ ​= ​0.610, p ​= ​0.001). There was a concurrent 72.7 ​% increase in TA cases from a median of 22-38 (τ ​= ​0.574, p ​= ​0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018-2019 and 2016-2017. The uptrend in TA cases was associated with the significant increase in colorectal (τ ​= ​0.559, p ​= ​0.001), general surgery-other (τ ​= ​0.404, p ​= ​0.018), and hepatopancreaticobiliary (HPB) (τ ​= ​0.596, p ​= ​0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ ​= ​0.956, p=<0.001), HPB (τ ​= ​0.713, p=<0.001) and colorectal (τ ​= ​0.522, p ​= ​0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ ​= ​-0.485, p ​= ​0.006) and vascular surgery (τ ​= ​0.603, p ​= ​0.001) dropped significantly. The procedural category with the highest chief and TA volume was 'colorectal tract - large intestine.' Most procedural categories (53.49 ​%) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023., Conclusions: Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely., Competing Interests: Declaration of competing interest The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Anatomical understanding is an important basis for medical teaching, especially in a surgical context. The interpretation of complex vascular structures via two-dimensional visualization can yet be difficult, particularly for students. The objective of this study was to investigate the feasibility of an MxR-assisted educational approach in vascular surgery undergraduate education, comparing an MxR-based teaching-intervention with CT-based material for learning and understanding the vascular morphology of the thoracic aorta., Methods: In a prospective randomized controlled trial learning success and diagnostic skills following an MxR- vs. a CT-based intervention was investigated in 120 thoracic aortic visualizations. Secondary outcomes were motivation, system-usability as well as workload/satisfaction. Motivational factors and training-experience were also assessed. Twelve students (7 females; mean age: 23 years) were randomized into two groups undergoing educational intervention with MxR or CT., Results: Evaluation of learning success showed a mean improvement of 1.17 points (max.score: 10; 95%CI: 0.36-1.97). The MxR-group has improved by a mean of 1.33 [95% CI: 0.16-2.51], against 1.0 points [95% CI: -0.71- 2.71] in the CT-group. Regarding diagnostic skills, both groups performed equally (CT-group: 58.25 ± 7.86 vs. MxR-group:58.5 ± 6.60; max. score 92.0). 11/12 participants were convinced that MxR facilitated learning of vascular morphologies. The usability of the MxR-system was rated positively, and the perceived workload was low., Conclusion: MxR-systems can be a valuable addition to vascular surgery education. Further evaluation of the technology in larger teaching situations are required. Especially regarding the acquisition of practical skills, the use of MxR-systems offers interesting application possibilities in surgical education., (© 2024. The Author(s).)

The rapid uptake of minimally invasive antireflux surgery has led to interest in learning curves for this procedure. This study ascertains the learning curve in laparoscopic and robotic-assisted antireflux surgery. A systematic review of the literature pertaining to learning curves in minimally invasive fundoplication with or without hiatal hernia repair was performed using PubMed, Medline, Embase, Web of Science, and Cochrane Library databases. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase. Twenty-five studies met the eligibility criteria. A meta-regression analysis was performed to quantitatively investigate the trend of number of cases required to achieve surgical proficiency from 1996 to present day. Using a mixed-effects negative binomial regression model, the predicted learning curve for laparoscopic and robotic-assisted antireflux surgery was found to be 24.7 and 31.1 cases, respectively. The meta-analysis determined that surgeons in their learning phase may experience a moderately increased rate of conversion to open procedure (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.28, 4.64), as well as a slightly increased rate of intraoperative complications (OR 1.60; 95% CI 1.08, 2.38), postoperative complications (OR 1.98; 95% CI 1.36, 2.87), and needing reintervention (OR 1.64; 95% CI 1.16, 2.34). This study provides an insight into the expected caseload to be competent in performing antireflux surgery. The discrepancy between outcomes during and after the learning curve for antireflux surgery suggests a need for close proctorship for learning surgeons., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Interprofessional education, an approach where healthcare professionals from various disciplines learn with, from, and about each other, is widely recognized as an important strategy for improving collaborative practice and patient outcomes. This narrative review explores the current state and future directions of interprofessional education in cardiothoracic surgery. We conducted a literature search using the PubMed, Scopus, and Web of Science databases, focusing on English-language articles published after 2000. Our qualitative synthesis identified key themes related to interprofessional education interventions, outcomes, and challenges. The integration of interprofessional education in cardiothoracic surgery training programs varies across regions, with a common focus on teamwork and interpersonal communication. Simulation-based training has emerged as a leading modality for cultivating these skills in multidisciplinary settings, with studies showing improvements in team performance, crisis management, and patient safety. However, significant hurdles remain, including professional socialization, hierarchies, stereotypes, resistance to role expansion, and logistical constraints. Future efforts in this field should prioritize deeper curricular integration, continuous faculty development, strong leadership support, robust outcome evaluation, and sustained political and financial commitment. The integration of interprofessional education in cardiothoracic surgery offers considerable potential for enhancing patient care quality, but realizing this vision requires a multifaceted approach. This approach must address individual, organizational, and systemic factors to build an evidence-based framework for implementation., Competing Interests: The authors declare that the review was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Lampridis, Scarci and Cerfolio.)

Palliative care (PC) underutilization stems from provider conflicts and the belief that PC involvement may confuse patients. We hypothesized medical students, less exposed to these barriers and misconceptions, would be more likely to consult PC than residents/fellows. A survey of 88 medical students, residents, and fellows was conducted, querying the appropriateness of PC utilization in clinical scenarios. Students were more likely to consult PC than trainees when PC was not indicated (47.2% vs 22.9%, P = .02). In the two cases where PC was indicated, there was no difference in PC utilization among students and trainees (92.5% vs 91.4%, P = .86; 90.6% vs 100%, P = .06). When stratifying participants into medical and surgical specialties, or career interests regarding students, there was no difference in rates of PC consultation. This suggests medical education advancements are producing physicians adept at identifying patients needing PC and willing to integrate a PC service into patient care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices., Methods: We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group., Results: The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017)., Conclusion: This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: General surgeons in rural communities face unique challenges due to broad scopes of practice with limited support and difficulties providing training. In 1998, this academic medical center initiated a rural program consisting of senior level rotations in rural communities. We surveyed past residents to determine scope of practice, level of preparedness, and recommendations., Methods: The survey was sent to n = 89 residents and n = 34 surveys were completed. Of those, 85% took part in the rural program, 23.5% practice in a zip code defined as rural by HRSA, and 53% had fellowship training most commonly vascular (n = 5), critical care (n = 5), cardiothoracic (n = 3), and MIS (n = 3). Most common procedures reported were MIS (64.7%), vascular (38.2%), cardiothoracic (26.5%), hepatobiliary (23.5%), and pediatric (23.5%)., Results: Over 97% of participants were satisfied/very satisfied with their overall program, and 94% were satisfied/very satisfied with their preparedness for rural surgery. When prompted with, "A general surgery program must have some type of rural specific specialized curriculum and extended rotations to facilitate a career path in rural general surgery," 41.2% responded strongly agree, 47.1% agree, and 11.8% neutral. Recommendations for bolstering a rural program included urology (59%), MIS (59%), vascular (56%), OBGYN (47%), and pediatrics (38%). Regarding non-surgical education, residents felt underprepared for billing (79.4%) and administration (50.0%)., Discussion: Although satisfaction scores were high, improvements to better prepare surgeons for rural practice include increasing residents' exposure and training in OBGYN, MIS, vascular, urology, and billing and administration. These results should direct programs to prepare surgeons for effective rural practice., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: In 2021, the structural determinants of health (SDOH) were added to the Accreditation Council of Graduate Medical Education common program requirements for all accredited residency programs, including general surgery. In this study, we sought to explore the current scope of, and concepts used in, health disparities curricula for general surgery residents, specifically investigating how general surgery residents learn about health disparities and the SDOH., Methods: We searched PubMed, EMBASE, Education Research Complete (EBSCOhost), and Web of Science Core Collection using keywords related to health disparities and the SDOH. Inclusion criteria consisted of all studies published after 2005 that discussed health disparities curricula for Accreditation Council of Graduate Medical Education-accredited general surgery residency programs. Five thousand three hundred seventeen articles were screened using a two-phase process. Data extraction and analysis was performed using critical review methods., Results: Seventeen articles were identified. Within these articles, seven unique health disparities curricula were found. All seven of the identified curricula employed cultural frameworks as methods to mitigate health disparities. Three curricula, all published after 2011, included education on the SDOH. A wide variety of educational methods were utilized; in-person didactics was the most common., Conclusions: In the current literature, culture continues to play a large role in health disparities training for general surgery residents. Though further efforts are needed to understand the methods used in programs that have not published scholarly work, it is imperative to ensure that residents are provided with the sociopolitical perspective needed to understand the SDOH and serve all patients, including those affected by health disparities., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Resident physicians play an important role in teaching the next generation of health-care providers, yet limited research has explored factors influencing effective teaching, such as preresidency experiences or barriers within residency. This study examines residents' prior teaching experience, its correlation with teaching attitudes, and identifies potential barriers to sustained teaching engagement., Methods: This cross-sectional study surveyed residents across multiple specialties at a single academic center. The survey assessed preresidency teaching experience, perceived barriers, and attitudes toward teaching. Univariate and multivariate analyses identified differences in teaching attitudes based on prior teaching experience and gender., Results: Ninety-two residents across 11 specialties participated (52.2% female). Internal Medicine (28.3%) and General Surgery (26.1%) had the highest representation. Two-thirds of respondents (69.6%) had formal teaching experience before residency. After adjustment, prior teaching experience and male gender were associated with feeling prepared to teach medical students (P = 0.014 and P = 0.001). Male gender was also linked to confidence in teaching material on the wards (P = 0.015). Barriers identified included time constraints (73.9%), lack of content clarity (28.3%), and uncertainty about teaching methods (33.7%)., Conclusions: Residents with prior teaching experience exhibit higher levels of preparedness, content clarity, and confidence in their teaching abilities, underscoring the importance of teaching experience before residency. This study also identified significant barriers to effective teaching, including time constraints, lack of content clarity, uncertainty about teaching methods, and perceived disinterest from medical students. Addressing these barriers is essential for optimizing medical student education., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Provider burnout is a work-related syndrome that is under-recognized, under-reported, and has negative repercussions on the individual, system, and patients. This study investigated burnout incidence and its association with wellness characteristics such as resilience, psychological safety, and perceptions of the workplace to inform future work in improving well-being., Methods: Electronic surveys were sent to 153 physicians and advanced practice providers (APPs) in the department of surgery at a single institution. Survey topics included demographics, intention to stay, engagement, and items from validated measures for workplace perceptions including work pace/stress (Mini Z), burnout, psychological safety, and resilience. Descriptive statistics, bivariate associations, and logistic regression were used to evaluate responses., Results: Overall response rate was 47%. The majority of providers reported feeling burned out (56%), and 48% indicated they would probably leave the organization within three years. Additionally, 61% reported being satisfied with their job and 55% felt that they contributed professionally in the ways they value most (meaningful work/engagement). Significant predictors for burnout included negative work environment perceptions (work pace/stress), low resilience, low meaningful work, and professional role (physician vs APP)., Discussion: Maintaining a healthy workforce requires investigation into the factors that support workplace well-being. The strongest predictors of burnout were work pace/stress. Protective factors against burnout were psychological safety and resilience. An organizational culture that promotes psychological safety, as well as workplace improvements to enhance providers' sense of meaning in work, and decreasing work pace and stress may contribute to the prevention of burnout and the retention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To propose a novel quality metric tool for retrospectively examining ESS performed on chronic rhinosinusitis (CRS) patients, ultimately to facilitate clinician self-assessment and optimize care provision within this population., Design: Quality improvement study., Setting: Multi-center., Participants: Observational, prospective research database of adult patients with medically recalcitrant CRS, presenting to seven North-American academic rhinology centers, who underwent ESS between 2011 and 2021. Participant characteristics, comorbidities, and preoperative study measures were collected., Main Outcomes and Measures: A simple ratio of preoperative Lund-Mackay (LM) score to the number of sinus regions operated on during the course of ESS was determined for each participant and dichotomized into ratios of >1.0 or <1.0., Results: 828 study participants with medically recalcitrant CRS met final study inclusion, of which 47.8 % were male with an average age of 49.0 years. Approximately 50.9 % of participants had a history of previous ESS. Overall mean ratio between preoperative LM scores and numbers of surgically addressed sinuses for all patients with CRS (n = 828) was 1.61 (range: 0.00-6.00), with a minority of subjects (n = 108; 13.0 %) found to have ratios below 1.00. Mean ratios between patients who underwent primary ESS versus revision ESS were not statistically different (2.00 [±0.83] vs 1.98 [±0.88]; 0.02 %, 95 % CI -0.10, 0.14; P = 0.76), whereas differences in mean ratios between CRSsNP patients (without nasal polyposis) and CRSwNP patients (with nasal polyposis) were statistically significant (1.78 [±0.93] vs 2.26 [±0.67]; 0.48 %, 95 % CI 0.37, 0.59; P ≤ 0.001)., Conclusions and Relevance: This quality metric ratio represents a simple operational means for clinicians to integrate qualitative methodology into self-reflection when evaluating the extent of ESS performed on CRS patients. Its use as a clinical tool for retrospective self-reflection enables the surgeon to identify areas for improvement, assess situational specifics, and hone their craft., Competing Interests: Declaration of competing interest Authors report no conflicts of interest or disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)