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Background: Many U.S. medical schools are modifying their curricula with limited understanding of the impact on students' clinical knowledge., Methods: The surgical rotations and Surgery Shelf Exam score reports of 1514 students at a single medical school over nine academic years (2010-2018), which included a four-year transition period to a condensed pre-clerkship curriculum. Subject-specific results were compared by rotation type using Mann-Whitney tests. Regression analysis was used to assess the relationship between scores and time., Results: Data from 1514 students were included. Shelf scores decreased each year of the transition curriculum compared to the reference year (2014-2015). However, clinical exposure to specific rotations resulted in better scores in related shelf subjects. For example, students who rotated on Vascular Surgery achieved statistically better scores on the related subject than their colleagues (3.62 vs. 3.44; p = 0.0014)., Conclusions: The transition curriculum was associated with a lower performance on the surgical shelf exam when compared to the traditional curriculum, regardless of when surgery was taken during their clerkship year., Competing Interests: Declaration of competing interest None., (Copyright © 2020. Published by Elsevier Inc.)

Background: Medical student procedural participation is increasingly limited, creating concerns over poor preparation for internship. Inadequate experiences may also compromise patient safety. This study explores variances in procedural entrustment of medical students between core clerkships during the first clinical year., Methods: Students completing their first clinical year were surveyed on procedure participation. Holistic entrustment decisions are complex, thus participation was used as an objective proxy for entrustment., Results: 138 students responded (66% response rate); 89% (123/138) wished they had performed more procedures. Students had higher participation rates during procedural clerkships (surgery, obstetrics/gynecology). Entrustment was highest during surgery, and lowest during pediatrics. Surgery gave statistically significantly higher entrustment for subcuticular suturing (compared to obstetrics/gynecology) and nasogastric tube removal (compared to internal medicine). Entrustment was generally inversely proportional to procedure complexity within each specialty., Conclusions: Students encounter higher entrustment during procedural clerkships, especially surgery. Targeted areas for increased procedural involvement can be identified in all specialties., Competing Interests: Declaration of competing interest The authors of no conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The impact of fellowship training on general surgery residency has remained challenging to assess. Surgical resident perceptions of fellow-led and resident-led surgical services have not been well described., Methods: Retrospective cross-sectional data were collected from residents' service evaluations from 7/2014 through 7/2017. Surgical services were categorized as resident-led or fellow-led. 31 variables were evaluated and collapsed into 7 factors including clinical experience, educational experiences, clinical staff, workload, feedback, treatment of residents, and overall rotation., Results: Among all PGY levels, fellow-led surgical services were rated significantly higher (p < 0.05) regarding clinical experience, clinical staff, treatment of residents, and overall rotation. PGY1-2 residents rated resident-led services significantly higher in the area of educational experiences, while PGY 3 residents rated resident-led services higher in the area of workload. However, PGY4-5 residents rated fellow-led services significantly higher in all 7 categories. Individual fellow-led services were rated significantly higher for various categories at different PGY levels., Conclusions: Surgical residents appear to value the educational experiences of fellow-led services. Each fellow-led service may ultimately provide unique educational opportunities and resources for different PGY levels., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Being left-handed (LH) is considered a disadvantage in surgical training. We sought to understand the perspectives of LH trainees and surgical educators on the challenges and modifications in training LH surgeons., Methods: A survey was distributed to surgeons, surgical residents, and medical students about challenges teaching and learning surgical technique., Results: 25 LH surgeons, 65 right-handed (RH) surgeons, and 39 LH trainees completed the survey. Compared to LH surgeons, RH surgeons reported more difficulty (46% vs 16%, p = 0.003) and less comfort teaching LH trainees (28% vs 4%, p = 0.002), and 10 (15%) reported that LH trainees have less technical ability. RH surgeons identified challenges translating technique to LH trainees and physical limitations of an environment optimized for right-handed mechanics., Conclusions: The disadvantage LH surgical trainees face is due to barriers in training rather than inherent lesser ability. Nonetheless, minimal modifications are made to overcome these barriers., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Medical students often report a lack of timely, useful feedback during clerkship rotations. The purpose of this study was to develop a novel Minute Feedback System and determine whether it would generate frequent, high quality, documented feedback for students during the third year surgery clerkship., Methods: The Minute Feedback System was created using the Qualtrics © survey software platform and piloted with surgery clerkship students. These students were surveyed about the frequency and quality of feedback and their overall rating of the surgery clerkship and compared to students who did not use the feedback system., Results: The initial pilot of the Minute Feedback System involved 6/34 M3 surgery clerkship students and generated a total of 70 unique comments from faculty and residents over 3 weeks. When the 6 pilot students were compared to the 28 students without access to the Minute Feedback System, they respectively rated the frequency of feedback 4.50 vs 2.83 (p < 0.01); the quality of feedback 4.70 vs 3.33 (p < 0.01) and the overall rating of the surgery clerkship 4.67 vs 4.05 (p < 0.01) higher. The system was then made available to all students on the M3 surgery clerkship (n = 31) over the subsequent 2 month rotation. 354 unique feedback comments were generated from 399 student requests (89% response rate). Students using the Minute Feedback System (n = 31) compared to students in the previous academic year without (n = 170) rated the quality of feedback (3.76 vs 3.4, p < 0.01), that feedback was provided during clerkship (100% vs 90%, p < 0.01) and the overall quality of the clerkship (3.94 vs 3.87, p = 0.2) higher., Conclusion: The novel Minute Feedback System allows for frequent, timely, useful and documented feedback to medical students., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Surgical faculty teach medical students and residents within the same environment; however, each group may require different teaching methods. The aim of this study was to identify teaching components valued by these sets of learners., Methods: Teaching evaluations for 43 surgical faculty members who received yearly evaluations from students and residents were analyzed. Highest and lowest ranked educators in medical student evaluations were traced to corresponding rankings in resident evaluations. Thematic analysis was conducted on written comments., Results: Educators rated the highest in the medical student group were spread out among the residents' rankings, with several educators being rated the lowest. Similar patterns were observed in reverse for faculty rated highly by residents., Conclusions: Residents and medical students value faculty teaching using different criteria, with residents more focused on operative autonomy and medical students focused on approachability. Using one group to define best teaching methods is insufficient as learners value different optimal attributes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Certain operative cases occur unpredictably and/or have long operative times, creating a conflict between Accreditation Council for Graduate Medical Education (ACGME) rules and adequate training experience., Methods: A ProModel-based simulation was developed based on historical data. Probabilistic distributions of operative time calculated and combined with an ACGME compliant call schedule., Results: For the advanced surgical cases modeled (cardiothoracic transplants), 80-hour violations were 6.07% and the minimum number of days off was violated 22.50%. There was a 36% chance of failure to fulfill any (either heart or lung) minimum case requirement despite adequate volume., Conclusions: The variable nature of emergency cases inevitably leads to work hour violations under ACGME regulations. Unpredictable cases mandate higher operative volume to ensure achievement of adequate caseloads. Publically available simulation technology provides a valuable avenue to identify adequacy of case volumes for trainees in both the elective and emergency setting., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Roux-En-Y gastric bypass (RYGB) has been the preferred operative treatment for morbid obesity. Recently, laparoscopic RYGB has been described. We reviewed our data and believe that open RYGB is still the better option., Methods: One hundred three consecutive cases were retrospectively reviewed for preoperative conditions, perioperative outcomes, and postoperative complications with weight/health changes., Results: The mean follow-up was 5 months. The mean percent excess body weight loss was 33%. Comorbidities improved 50% of the time. The mean operative time was 117 minutes with blood loss averaging 208 cc. The mean intensive care unit stay was 1.3 days, with a total hospital stay of 4.4 days. There was an 8% major complication rate and a 1% mortality rate., Conclusions: The health improvement and complication rates are comparable to published series on laparoscopic RYGB. With the technical complexity of the laparoscopic technique, open RYGB should remain the current standard of care, in most centers.