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Introduction: Innovation education programs can help guide and empower surgeons and surgical trainees through the many steps to analyze and de-risk novel ideas to impact healthcare or care delivery. Providing quality programming that is conducive to a surgeon's busy schedule is an ongoing challenge, but even more so for a surgical trainees' schedule. Through a needs assessment and applying lean principles, the "Surgical Trainee Agile Innovation and empoweRment" (STAIR) framework was created to encourage surgical trainees to participate in innovation programming., Objective: Numerous works have explored the design and development of learning experiences to support physician innovators. However, there is a lack of evidence supporting frameworks that contribute to innovation empowerment for surgical trainees as a complement to the demands of clinical practice. The following catalogs the systematic design and development of a novel innovation and discovery agile framework tailored to surgical residents with original innovation ideas., Design and Setting: The course designed to implement the "Surgical Trainee Agile Innovation and empoweRment" (STAIR) is funded through the Department of Surgery at the University of Michigan. It is an 8-week team-based innovation course designed for surgical residents to learn and apply fundamental innovation concepts to clinical problems., Participants and Results: Surgical trainees in all programs at the host institution are all eligible to participate. A total of four innovation teams were selected to participate in inaugural course., Conclusions: The novel instructional design and development of this course encouraged participation in surgical innovation programming. The course aided the development of innovative ideas and inspired interest in innovation among surgical trainees. The STAIR framework is exemplary for inspiring and facilitating innovation among surgical trainees, enhancing the professional experience., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

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.)

Teaching and mentorship have a long history in surgical education, but with a growing focus on safety, quality improvement, and continuous professional development, it is clear that the current training system is inadequate. Challenges from changes in residency training, financial constraints, rapidly increasing knowledge, and limited faculty time due to increasing clinical, academic, and research demands require that new approaches are developed, including simulation and online resources. Although coaching is used effectively in other disciplines, surgical coaching remains relatively uncommon. Coaching encourages self-reflection using facilitated feedback individualized to each surgeon's needs and goals and can benefit surgeons at all levels., (Copyright © 2019 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: Student mistreatment is often a major concern during the surgery clerkship. We hypothesized that mistreatment is decreasing and that career choice may reflect perceived mistreatment., Methods: We surveyed 2319 physicians about their surgery clerkships. Mistreatment reporting was correlated to physician specialty and medical school graduation year., Results: The response rate was 18.9% (440/2319). Recent graduates reported less mistreatment than more senior graduates (24.3%-50%, p = 0.0198). General surgeons (3/31, 9%), neurologists (1/7, 14%), and subspecialty surgeons (8/35, 19%) reported the lowest mistreatment rates. Psychiatrists (9/16, 56%), internists (31/69, 45%), pathologists (5/13, 38%), and emergency physicians (5/14, 36%) reported the highest rates. The reported rate of mistreatment by nonsurgeons was higher than surgeons (30.4% versus 14.3%, p < 0.0046). Mistreatment included sexual harassment, verbal abuse, and lack of teaching., Conclusions: Mistreatment during surgery appears to be improving. Its perception varies by the field of training, indicating variable interpretations of what constitutes mistreatment., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To compare faculty-to-student feedback rates from 2 different data sets: direct observation cards (direct evidence) and end-of-clerkship questionnaires (ECQs, secondary student reporting). We as authors hypothesized that direct evidence from observation cards would yield higher rates of feedback, compared with student-reported ECQs., Design: Data were gathered from 2 consecutive medical classes of the third-year surgical clerkship. Data were analyzed retrospectively. Subjects and authors were blinded during data collection and analysis., Setting: University of Michigan Medical School (UMMS) and University of Michigan Health System (UMHS). UMHS is an academic tertiary care center, located in Ann Arbor, Michigan., Participants: Data were gathered from all third-year medical students completing the surgical clerkship from 2012 to 2014. Data were available for 309 students, compared to 313 students who graduated from UMMS during that time., Results: Directly measured rates of feedback showed higher rates of midclerkship feedback (95.43% vs 83.57%, p < 0.05), feedback on an observed history-taking (97.62% vs 84.87%, p < 0.05), and feedback on an observed physical examination (99.67% vs 79.71%, p < 0.05), when compared with the ECQ., Conclusion: These data suggest that solely using ECQs to assess feedback rates may be inadequate. The use of multiple methods to assess feedback may therefore be a prudent choice for surgical clerkships., (Copyright © 2017. Published by Elsevier Inc.)

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.)

Objective: General surgery residents' exposure to cardiothoracic (CT) surgery rotations has decreased, which may affect resident satisfaction. We surveyed general surgery graduates to assess the relationships among rotation satisfaction, CT disease exposure, rotation length, mentorship, and mistreatment., Design: A survey assessing CT curriculum, exposure, mentorship, and satisfaction was forwarded to general surgery graduates from 17 residency programs. A Wilcoxon rank-sum test was used to assess statistical significance of ordinal level data. Statistical significance was defined as p < 0.05., Setting: This study was conducted at the University of Michigan Health System in Ann Arbor, MI, a tertiary care center., Participants: The survey was sent to approximately 1300 graduates of general surgery residency programs who graduated between the years of 1999 to 2014. A total of 94 responses were completed and received., Results: Receiving adequate exposure to CT procedures and disease management was significantly associated with higher satisfaction ratings for all procedures, particularly thoracotomy incisions (p < 0.001), empyemas and pleural effusions (p < 0.001), and lung cancer care (p < 0.001). The absence of mistreatment and good/very good mentorship were both positively associated with higher reported satisfaction (p = 0.018 and p < 0.001, respectively). Increased length of time on CT rotation was neither associated with improved levels of satisfaction nor with an improvement in the quality of mentorship., Conclusion: Rotation satisfaction is positively associated with procedure exposure, better mentorship, and the absence of mistreatment. Longer rotation length was not associated with satisfaction. Shorter rotations are not detrimental to training if they have focused clinical exposure and invested mentors to maximize resident satisfaction. These specific markers of rotation quality are useful in curricular design., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The educational resources available to general surgery residents preparing for complex thoracic surgeries vary greatly in content and target audience. We hypothesized that the preparatory resources could be improved in both efficiency of use and targeting., Methods: A formal needs analysis was performed to determine residents' knowledge gaps and desired format and/or content of an educational tool while preparing for their first lung resections. The results of the needs assessment then guided the creation of a 20-min video tool. The video was evaluated by a focus group of experts for appropriateness to the target audience, ease of use, and relevance., Results: The needs assessment illustrated that residents feel there is a paucity of appropriate resources available to them while preparing for the lung resection procedure; 82% of respondents felt that easy-to-use and concise resources on the lobectomy procedure were either "not at all" or "somewhat" accessible. Residents reported that video was their preferred format for a learning tool overall and identified a broad spectrum of most challenging procedural aspects. These results were used to guide the creation of a 20-min video tool. A focus group validated the efficacy and appropriateness of the video., Conclusions: Targeted and efficient tools for residents preparing for complex subspecialty procedures are needed and valued. These results clearly encourage further work in the creation of focused educational tools for surgical residents, especially in the format of short video overviews., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: New paradigms for training cardiothoracic surgeons have been introduced, including the integrated thoracic surgery residency. Currently, a limited number of these programs exist, and all candidates apply to both integrated thoracic and general surgery residencies. We sought to investigate the applicants' experiences applying for both types of positions., Methods: An online survey was distributed to applicants to three integrated thoracic surgery programs during a 2-year period., Results: The response rate was 50% (90 of 180). Most respondents were fourth-year medical students (81%; 72 of 89) and were interested in adult cardiac surgery (81%; 73 of 90). Sixty-one percent (55 of 90) had an interest in cardiothoracic surgery before clinical clerkships, and 93% (84 of 90) tailored their clinical education to this interest. Fifty-seven percent (49 of 86) scored above 230 on the USMLE Step 1 examination. Ninety-two percent (80 of 87) performed research during medical school, and 78% (62 of 80), specifically within cardiothoracic surgery; 76% (61 of 80) published their work. The number of general surgery interviews varied widely, but 46% (36 of 79) interviewed at one to five integrated thoracic surgery programs, and 39% (31 of 79) interviewed at six to ten integrated thoracic surgery programs. During general surgery interviews, 36% (24 of 66) received negative comments regarding applying to integrated thoracic residencies. Fifty-two percent (38 of 73) thought that their application to integrated thoracic programs diminished their chances to match at a general surgery program., Conclusions: The applicants to the integrated thoracic surgery residencies become interested in cardiothoracic surgery early and tailor their clinical education to this interest. Although they are academically successful, they report significant negativity regarding their applications to both general surgery and integrated thoracic residencies., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Work-hour restrictions have decreased flexibility in scheduling and reduced exposure to certain operative cases. These restrictions may affect a resident's ability to meet certification requirements, particularly for rare, unscheduled cases (e.g., cardiothoracic transplants). We developed a computer-based simulation model using variables such as case volume and program size to demonstrate the influence of these factors on the likelihood of certifying a set of residents on rare cases., Methods: We built a simulator to predict the probability of attaining certification for surgical residents, using cardiothoracic transplants as a test case. Inputs to the model included operating times, call schedules, and procurement travel times, as well as information on the distribution of times between transplants., Results: We simulated 100 years of schedules using our current system parameters of an average of 33 heart and 31 lung transplants per year, and assuming an Accreditation Council for Graduate Medical Education-compliant daily-rotating call schedule. Despite having enough transplants to certify all residents for lungs if all opportunities were distributed equally among residents, the certification rate achieved when constrained by arrival time (and call schedules) and work restrictions was only 55%. Our calculations show that meeting minimum transplant-certification requirements for all residents would require at least 1.5 times the expected number of annual transplants., Conclusions: Our model enables analysis of a given program's ability to certify its residents based on program size and volume. These results could be used to design alternative scheduling paradigms to improve certification rates, without requiring reductions in certification requirements or program size., (Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)