Academic General Surgery Residency Research Articles

Career Trajectory After General Surgery Residency: Do Academic Program Graduates Pursue Academic Surgery?

Determine the proportion of contemporary US academic general surgery residency program graduates who pursue academic careers and identify factors associated with pursuing academic careers. Many academic residency programs aim to cultivate academic surgeons, yet the proportion of contemporary graduates who choose academic careers is unclear. The potential determinants that affect graduates' decisions to pursue academic careers remain underexplored. We collected program and individual-level data on 2015 and 2018 graduates across 96 US academic general surgery residency programs using public resources. We defined those pursuing academic careers as faculty within US allopathic medical school-affiliated surgery departments who published two or more peer-reviewed publications as the first or senior author between 2020-2021. After variable selection using sample splitting LASSO regression, multivariable regression evaluated association with pursuing academic careers among all graduates, and graduates of top-20 residency programs. Secondary analysis using multivariable ordinal regression explored factors associated with high research productivity during early faculty years. Among 992 graduates, 166 (17%) were pursuing academic careers according to our definition. Graduating from a top-20 ranked residency program (OR[95%CI]: 2.34[1.40-3.88]), working with a longitudinal research mentor during residency (OR[95%CI]: 2.21[1.24-3.95]), holding an advanced degree (OR[95%CI]: 2.20[1.19-3.99]), and the number of peer-reviewed publications during residency as first or senior author (OR[95%CI]: 1.13[1.07-1.20]) were associated with pursuing an academic surgery career, while the number of peer-reviewed publications before residency was not (OR[95%CI]: 1.08[0.99-1.20]). Among top 20 program graduates, working with a longitudinal research mentor during residency (OR[95%CI]: 0.95[0.43-2.09]) was not associated with pursuing an academic surgery career. The number of peer-reviewed publications during residency as first or senior author was the only variable associated with higher productivity during early faculty years (OR[95%CI]: 1.12[1.07-1.18]). Our findings suggest programs that aim to graduate academic surgeons may benefit from ensuring trainees receive infrastructural support and demonstrate sustained commitment to research throughout residency. Our results should be interpreted cautiously as the impact of unmeasured confounders is unclear.

Surgical Rehabilitation for Research Residents: A Pilot Program to Offset Surgical Skill Decay

Select general surgery residents in the surgeon-scientist pipeline dedicate time away from clinical residency to conduct research. However, these research residents (RR) are vulnerable to operative skill decay. The aim of this study is to assess the feasibility of implementation and impact of an organized intervention designed to combat skill decay experienced by RR. RR were enrolled in a pilot Surgical Rehabilitation Program (SRP). The SRP is comprised of 12 cadaver-based simulation sessions and supplemented with Fundamentals of Laparoscopic Surgery-based simulation workouts. The RR were integrated with the clinical residents (CR) during the cadaver sessions and were subsequently performance tested, surveyed, and interviewed. One academic general surgery residency program graduating 8 chief residents yearly in New York. General surgery CR and residents on dedicated research years. Data were collected for all local RR (n = 8) and 77% (n = 37) of CR. Local RR conducted research within the same health system that sponsors the residency. RR experienced gaps in training ranging from 2 to 4 years. All RR were permitted to moonlight on surgical services, however performed 0 operations and only 0.88 procedures on average per shift. Although RR performed similarly to level-matched CR on basic laparoscopic tasks, they required significantly more time on laparoscopic suturing-based skills than CR (p < 0.001). RR had significantly lower confidence levels precadaver sessions but gained confidence postcadaver sessions (p < 0.05), whereas CR confidence was unchanged. Regarding the SRP, qualitative interviews revealed major themes emphasizing the integration of RR, exposure to CR and faculty, technical skill development, maintenance of surgical know-how, and improved confidence for RR. The implementation of such structured interventions, like our SRP, aimed at supporting RR over gap years is essential to help residents maintain skills and confidence needed to achieve their goals of becoming surgeon scientists.

Measuring Impact of Simulation-Based Informed Consent Training on Surgical Intern's Long-Term Confidence

Our objective was to evaluate the outcome of a training program on long-term confidence of interns and attending physicians. In this prospective cohort study, general surgery interns underwent a training program on informed consent that involved didactics, standardized patient encounters, and supplemental procedure specific guides at the start of the academic year. At the end of the academic year, we surveyed interns from the classes of 2020 (trained) and 2019 (untrained) about their experience and confidence in obtaining an informed consent. Further, we queried attending physicians on their experience and confidence in the interns at the end of each academic year. Single academic general surgery residency program based at 2 urban tertiary hospitals. General surgery interns including unmatched preliminary residents and categorical interns from general surgery, interventional radiology, and urology. Twenty-four incoming interns participated in the training program. Intern confidence discussing operation benefits improved from a median score of 4 to 5 (p = 0.03), and total confidence improved from a median score of 15 to 17.5 (p = 0.08). There was no difference in median total confidence scores (15 vs. 17.5; p = 0.21) between classes. Attending physicians had similar median total confidence scores following intervention (10 vs. 11; p = 0.87). Intern satisfaction was 80% with the didactic session, and 90% with standardized patient encounters. Twenty percent of learners used the supplemental procedure specific guides. Implementation of an intern targeted program on informed consent that incorporated didactics and standardized patient encounters was viewed as useful and may contribute to long-term improvements in confidence.

Narrative surgery: an innovative approach to surgical training

PurposeNarrative Medicine (NM) curricula have never been formally tailored to meet the needs of the general surgery resident. In this study we report on the creation, implementation and evaluation of a “Narrative Surgery” (NS) curriculum.MethodsForty- eight residents at an academic general surgery residency program participated in the NS curriculum. Twenty- eight narrative prompts with associated art/ literature were sent by email every 1–2 weeks between 08/2020 and 05/2021. Two 2- hour NS discussion sessions were held during protected teaching time. Focus groups for evaluation were held at the end of the academic year, led by impartial facilitators. Transcripts of the focus groups were analyzed by 3 independent reviewers.ResultsTwenty-two residents participated in the focus groups and were divided between 8 facilitators. Transcripts were analyzed by 3 reviewers. They created a codebook consisting of 21 codes and definitions based on resident responses. These codes were grouped during a second analysis phase into common themes using an inductive approach. Three primary themes emerged. One theme was “exploration of surgical culture” which was often affiliated with “bridging social differences.” Comments centered around how the NS curriculum helped participants identify the unique realities of surgical culture, the interplay between their own lives, and how to humanize their experiences. Another theme was a “shared sense of community” with affiliated themes of “increased conversations with resident peers,” “affiliation with shared experiences,” and an “increased sense of belonging.” Comments in this category pertained to camaraderie and commonality as a result of the NS curriculum. The last primary theme identified was “reflection on practice,” with the affiliated codes and ideas of “internal,” “reframing”, “seeing things differently”, “taking a step back”, and “validating emotions.” Comments within this theme dealt with residents processing their role in surgical culture and learning from their shared experiences.86% of residents found the curriculum beneficial to their education. Thirty- two% stated they found the discussion sessions especially helpful. Sixty- eight % stated they would be interested in further coursework. Sixty- four % stated their participation was limited to reflection or discussion with peers. When asked how the curriculum could be improved, 45% of respondents desired more discussion sessions.ConclusionsA NS curriculum can be successfully integrated into a general surgery residency program. This curriculum was warmly received, with high rates of satisfaction among participants.

Just Do It: Participation in Structured Online Curricula Reliably Improves Low ABSITE Scores

We hypothesized residents enrolled in an Accelerated Clinical Education in Surgery (ACES) program would improve their scores to above the 30th percentile. We analyzed which components of ACES correlated with improvement. A retrospective review of three academic cycles (2018-2021) at an academic general surgery residency. Residents scoring ≤30th percentile on the ABSITE were enrolled in ACES. Baseline demographics including STEP scores were collected. ACES included: (1) SCORE and DeckerMed assignments (2) Weekly faculty review sessions and (3) Monthly meeting with assigned mentor. Data were analyzed by Student's t-test, one-way ANOVA and Fisher's exact test. Twenty-six surgical residents enrolled in ACES. Compared to residents not in ACES, there was no significant difference females (15 vs. 15; p = 0.19) and STEP 2 scores (241 vs. 246; p = 0.06). Residents in ACES had significantly lower STEP 1 (225 vs. 237; p < 0.001) and STEP 3 (212 vs. 223; p < 0.001) scores. Demographics of ACES residents who subsequently scored >30th percentile were similar to those who didn't, except for STEP 3 scores (216 vs. 204; p = 0.008). For residents in ACES, the completion of assignments between July and January was significantly higher for those who subsequently achieved an ABSITE score >30th percentile: TWIS, 77% vs. 53% (p = 0.022), Decker WC, 80% vs. 49% (p = 0.009) and Decker MR, 53% vs. 29% (p = 0.016). Completion of an online practice exam prior to ABSITE also correlated with score >30th percentile (57% vs. 13%, p = 0.007). There was also no correlation between the number of faculty review sessions and ABSITE (11.5 vs.11.9, p = 0.931). Participation in a structured online program of reading and quizzes was durably effective in improving ABSITE scores >30th percentile. Completion of online assignments, rather than scores on practice tests or review sessions, appeared to be the most important factor for success.

Exploring Characteristics of Academic General Surgery Residency Applicants: A Group Concept-Mapping Approach

Holistic review, which emphasizes qualitative attributes over objective measures, has been proposed as a method for selecting candidates for surgical residency in order to improve diversity in graduate medical education, and, ultimately, the field of surgery. This study seeks to articulate desirable traits of applicants as a first-step in standardizing the holistic review process. Using Group Concept Mapping, a web-based mixed-methods participatory research methodology, residency selection committee members were asked to 1) list desirable characteristics of applicants, 2) group these into categories, 3) rate their importance to academic/clinical success on a 5-point Likert scale (1 = not at all important, 5 = extremely important), and 4) rate the degree to which each characteristic is feasible to assess on a 3-point Likert scale (1 = not at all feasible, 3 = very feasible). Grouped characteristics submitted to hierarchical cluster analysis depicted committee's consensus about desirable qualities/criteria for applicants. Bivariate scatter-plots and pattern-matching graphics demonstrated which of these criteria were most important and reliably assessed. A single academic general surgery residency training program in Western Pennsylvania. Members of the selection committee for the UPMC General Surgery Residency program who had participated in at least 1 prior cycle of applicant selection. Desirable characteristics of highly qualified applicants into an academic general surgery residency were clustered into domains of 1) scholarly work and research, 2) grades/formal assessments, 3) program fit, 4) behavioral assets, and 5) aspiration. Behavioral assets, which was felt to be the most important to clinical and academic success were considered to be the least feasible to reliably assess. Within this domain, initiative, being self-motivated, intellectual curiosity, work ethic, communication skills, maturity and self-awareness, and thoughtfulness were viewed as most frequently reliably assessed from the application and interview process. High quality applicants possess several behavioral assets that faculty deem are important to academic and clinical success. Adapting validated metrics for assessing these assets, may provide a solution for addressing subjectivity and other challenges scrutinized by critics of holistic review.

Demographic Factors Associated With Research and Career Interests in Aspiring Academic Surgeons: What are the Implications for Tomorrow's Workforce?

To evaluate the research and career interests of aspiring academic surgeons and determine the influence of demographic factors. Cross-sectional survey SETTING: Single institution, academic general surgery residency program PARTICIPANTS: Medical students invited to interview during 2019-2020 and 2020-2021 residency cycle RESULTS: One hundred fifty-four of 160 (96%) potential respondents representing 63 medical schools completed the survey, American Association for Public Opinion Research Response Rate 6. Fifty-three percent of the study population was female. Seventeen percent identified as Black, 14% Asian, 13% Latinx, 50% white, and 6% other. Respondents were most interested in education, professional development, and surgical culture (32%) followed by basic and translational science (23%), global and community health (20%), and health services (18%). On multiple logistic regression, interest in global/community health was associated with identifying as Black (OR 5.9 [2.0, 17.8] p = 0.001) and female (OR 2.7 [1.0, 7.0] p = 0.044). A plurality of participants were undecided on future specialty (n = 63, 41%). The most common specialty interests were surgical oncology (n = 28, 18%); trauma, acute care, or surgical critical care (n = 21, 14%); pediatric and cardiothoracic surgery (n = 20 for each, 13%); and abdominal transplant (n = 15, 10%). In this cross-sectional survey of highly competitive academic general surgery applicants, respondents who were underrepresented in medicine (URiM) and women were more interested in research fields with a history of lower relative NIH funding. In light of these findings, academic programs seeking a more diverse residency workforce should consider strategies beyond recruitment to promote the scholarly achievement of women and URiM residents.

General Surgery Residents' Retention of Knowledge After an Anorectal Skills Workshop.

Studies have demonstrated suboptimal resident exposure to anorectal pathology. A workshop was developed at an academic general surgery residency. This study assesses durability of learning from the workshop. Thirty-six residents participated in a skills laboratory addressing diagnosis and management of anorectal complaints. The skills laboratory was broken into didactic and hand-on skills stations. Residents completed pre-, post- and 6-mo after workshop assessments to evaluate knowledge and confidence. Knowledge and confidence-based scores pre-, post- and 6-mo after workshop were compared. Scores demonstrated retention of information. Knowledge-based question median scores improved from 63.2% pre-workshop to 73.7% post-workshop and 76.3% at 6mo (P=0.0005). Median confidence scores improved from 31 pre-workshop to 40 post-workshop, and were stable at 6mo (P=0.0001). Knowledge and confidence gained from an anorectal skills workshop was stable or improved at 6 mo. These results suggest that an anorectal curriculum is effective at improving general surgery resident background knowledge and confidence when managing anorectal complaints.

Gender role incongruency in general surgery applicants

IntroductionDeviation of an individual outside of gender normative stereotypes can limit hiring and promotion. The application, interview, and ranking process for medical students pursuing a general surgery residency has multiple opportunities for gender bias to affect an applicant's acceptance. This study examines medical students applying for a top academic general surgery residency and potential bias in perceived gender roles. Methods269 medical students were interviewed for categorical positions at an academic general surgery residency. Applicants described themselves in one word; adjectives were compiled and categorized as grindstone, ability, communal, or agentic traits. Groups were compared across applicant gender and race. Results42% of applicants were women. When comparing gender, men applicants were more likely to use a grindstone/communal adjective (73.2% vs 57.1%, p = 0.006). Men applicants were less likely to identify with an agentic adjective (21% vs 35%). ConclusionsContrary to gender stereotypes, women general surgery residency applicants tend to self-identify using ability/agentic adjectives more than men applicants. Bias training is important to mitigate the negative consequences of perceived traditional gender role-violation.

Optimizing surgical education through the implementation of a feedback curriculum

BackgroundWhile the advent of work-hour restrictions contributes to increased resident well-being, new interventions are needed to ensure that surgical residents continue to be adequately trained. Our study aims to take the evidence supportive of enhanced feedback and apply it in the real world by creating a feedback training curriculum within a surgical residency. MethodsA large academic general surgery residency program consisting of 42 residents was sequentially surveyed using the Kirkpatrick model to assess baseline attitudes towards feedback and the efficacy of a feedback training program for faculty and residents. ResultsAfter feedback training, the number of residents that believed their faculty were providing feedback effectively increased from 23% to 54%. Although limited by small sample size, improvements were likely seen in constructive feedback overall and quality feedback from senior residents. ConclusionsFormal feedback training should be incorporated into efforts to enhance educational skills among surgical faculty.

The impact of a “Residents as Teachers” Workshop at one year follow-up

Introduction“Residents as Teachers” (RaT) Workshops have been implemented in many General Surgery residency programs to improve resident teaching ability. The aim of this project was to assess whether there was significant degradation of teaching skills and knowledge one year after a RaT workshop. MethodsA 4-h interactive workshop was delivered at an academic general surgery residency program. Pre- and post-workshop assessments evaluated participants’ knowledge and confidence regarding teaching skills and they were re-evaluated one-year later. ResultsOn a 5-point Likert scale, residents improved confidence and self-perception following the workshop was stable after one year. A decrease was found in the resident's perception of the education-related training received and scores on the knowledge-based questions. ConclusionThe confidence residents obtained from single-day RaT workshop was maintained at one year, but the knowledge was not. Resident perception of their educational training may benefit from more frequent reinforcement.

New Heuristics to Stratify Applicants: Predictors of General Surgery Residency Applicant Step 1 Scores

In 2022, United States Medical Licensing Examination (USMLE) Step 1 scores will become pass/fail. This may be problematic, as residency programs heavily rely on USMLE Step 1 scores as a metric when determining interview invitations. This study aimed to assess candidate application metrics associated with USMLE Step 1 scores to offer programs new cues for stratifying applicants. Retrospective cohort study analyzing interviewed applicants to one general surgery residency program in 2019 and 2020. Applicant data analyzed included USMLE Step 1 scores, number of publications, clerkship scores, letter of recommendation scores (out of 2, scored by 0.25 interval), interview overall score (out of 5, scored by integer level), and standardized question score (out of 10). Each year, applicant's answers to one standardized behavioral question during their interview were scored by interviewers. Tertiary medical center, academic general surgery residency program. Interviewed applicants at one general surgery residency program whose applications contained complete demographic information (203 out of 247). Multiple Linear Regression revealed that higher surgical clerkship (β = 0.19, p = 0.006) and higher standardized interview question (β = 0.32, p < 0.001) scores were positively associated with applicant USMLE Step 1 score (F[7, 195] = 6.61, p < 0.001, R2 = 0.19). Letter of recommendation score, number of peer reviewed publications, gender, race, and applicant type (preliminary/categorical) were not associated with USMLE Step 1 scores. With USMLE Step 1 scores transitioning to pass/fail, surgical residency programs need new selection heuristics. Surgery clerkship scores and standardized behavioral questions answered by applicants prior to the interview could provide a holistic view of applicants and help programs better stratify candidates without USMLE Step 1 scores.

New Heuristics to Stratify Applicants: Predictors of General Surgery Residency Applicant Step 1 Scores

OBJECTIVE In 2022, United States Medical Licensing Examination (USMLE) Step 1 scores will become pass/fail. This may be problematic, as residency programs heavily rely on USMLE Step 1 scores as a metric when determining interview invitations. This study aimed to assess candidate application metrics associated with USMLE Step 1 scores to offer programs new cues for stratifying applicants. DESIGN Retrospective cohort study analyzing interviewed applicants to one general surgery residency program in 2019 and 2020. Applicant data analyzed included USMLE Step 1 scores, number of publications, clerkship scores, letter of recommendation scores (out of 2, scored by 0.25 interval), interview overall score (out of 5, scored by integer level), and standardized question score (out of 10). Each year, applicant's answers to one standardized behavioral question during their interview were scored by interviewers. SETTING Tertiary medical center, academic general surgery residency program. PARTICIPANTS Interviewed applicants at one general surgery residency program whose applications contained complete demographic information (203 out of 247). RESULTS Multiple Linear Regression revealed that higher surgical clerkship (β = 0.19, p = 0.006) and higher standardized interview question (β = 0.32, p CONCLUSIONS With USMLE Step 1 scores transitioning to pass/fail, surgical residency programs need new selection heuristics. Surgery clerkship scores and standardized behavioral questions answered by applicants prior to the interview could provide a holistic view of applicants and help programs better stratify candidates without USMLE Step 1 scores.

Virtual Recruitment in Surgical Residency Programs.

Purpose of ReviewThe Covid-19 pandemic forced residency programs to drastically change their interview processes and adopt virtual interviewing for the 2020–2021 match cycle.Recent FindingsWhile virtual interviewing decreased cost and increased convenience for applicants and programs involved in the match, it also introduced several potential disadvantages. Maximizing technological capabilities was an area of utmost concern at the start of the interview cycle, and multiple medical education organizations quickly recommended ways to move to virtual process, and to prevent and troubleshoot technical problems. However, other issues were less straightforward, such as how to address new sources of bias introduced by virtual interviewing, and how to ensure that programs and applicants could make informed decisions about their rank lists after only limited virtual interactions. Additionally, the increased convenience of interviewing raised concerns that students would accept more interviews, disrupting the established calculus programs used to determine how many interviews to offer per spot available.SummaryIn this review, we examine the benefits and disadvantages of virtual interviewing, review recommendations from the current literature on how to improve the process, and discuss what we learned from our own experience at an academic general surgery residency program over the course of this unprecedented interview season.

The Virtual Recruitment Onion: Peeling Back the Layers of the Interview Season During the COVID-era

OBJECTIVEWe sought to characterize General Surgery residency program directors’ (PDs) baseline perspective on how the COVID-19 mandated changes to the recruitment and interview processes impacted how the PDs evaluated and recruited the applicants.DESIGNAn anonymous cross-sectional questionnaire survey.SETTINGA large, mid-western academic general surgery residency program.PARTICIPANTS47 PDs of Accreditation Council for Graduate Medical Education (ACGME) accredited General Surgery residency programs.RESULTSDuring the virtual-only interviews during the COVID-19 pandemic-era 2020-21 General Surgery residency application cycle, PDs shifted their focus to virtual outreach efforts and bolstered social media presences to recruit strong applicants. Also, our study found statistically significant changes to the increased value of letters of recommendation (LORs) for the PDs when assessing an applicant's commitment to surgery. These findings suggest that the necessity of adapting to the virtual-only interview format significantly altered how the PDs recruited and evaluated applicants for the General Surgery residency match.CONCLUSIONSA complete replacement of the in-person interviews with virtual-only interviews may be challenging unless buy-in exists from key stakeholders in the surgical community. Our study highlights the PDs’ hesitation in assessing candidates’ commitment to surgery from virtual interviews alone. Incorporating virtual interviews as a part of the screening process for applicants may serve as an avenue to maximize the benefits of the virtual interview format. Furthermore, COVID-19 pandemic has normalized the growing social media presence of residency programs, adding to the changing landscape of recruiting and interviewing applicants for General Surgery residency match.

Imposter Syndrome in Surgical Trainees: Clance Imposter Phenomenon Scale Assessment in General Surgery Residents

Imposter syndrome occurs when high-achieving individuals have a pervasive sense of self-doubt combined with fear of being exposed as a fraud, despite objective measures of success. This threatens mental health and well-being. The prevalence and severity of imposter syndrome has not been studied among general surgery residents on a large scale. The primary outcomes of this study were the prevalence and severity of imposter syndrome. The Clance Impostor Phenomenon Scale was administered to residents at 6 academic general surgery residency programs. Multivariable analysis was performed to identify significant differences among groups and predictive characteristics of imposter syndrome. One hundred and forty-four residents completed the assessment (response rate 46.6%; 47.2% were male). Only 22.9% had "none to mild" or "moderate" imposter syndrome. A majority (76%) had "significant" or "severe" imposter syndrome. There were no significant differences in mean scores among male and female residents (p= 0.69). White residents had a mean score of 71.3 and non-White residents had a mean score of 68.3 (p= 0.24). There was no significant difference between PGY1 to PGY5 or research residents (p= 0.72). There were no significant differences based on US Medical Licensing Examination or American Board of Surgery In-Service Training Examination scores (p= 0.18 and p= 0.37, respectively). Imposter syndrome is prevalent among general surgery residents, with 76% of residents reporting either significant or severe imposter syndrome. There were no predictive characteristics based on demographics or academic achievement, suggesting that there is something either inherent to those choosing general surgery training or the general surgery training culture that leads to such substantive levels of imposter syndrome.

Surgical Skills Olympiad: A 4-Year Experience in a General Surgery Residency Program.

Background The acquisition of operative skills is the critical defining component of general surgery training. Performing simulated tasks has been shown to increase a resident's technical skills. As such, we devised the Surgical Skills Olympiad, an annual simulation-based skills competition. We examined our 4-year experience with the Olympiad at a large academic general surgery residency program. Objective This study aimed to use competition to motivate trainees to increase the time they spent practicing basic surgical skills, resulting in improved performance over time. Methods Teams were formed from members of each postgraduate year (PGY) class. Competition tasks were level specific: knot tying for PGY-1, basic laparoscopy for PGY-2, handsewn bowel anastomosis for PGY-3, vascular anastomosis for PGY-4, and advanced laparoscopy for PGY-5. Task scores over a 4-year period (2014–2017) were analyzed and a survey of participating teaching faculty was conducted. Results Ten faculty members responded to the survey, for a response rate of 63%. A total of 50% respondents felt that the caliber of surgical skills increased since the Olympiad was implemented. Ninety percent agreed that the Olympiad was beneficial for residents to assess their skills against their peers. Over 4 years, there was an improvement in scores for suturing task, advanced laparoscopy, and bowel anastomosis ( p < 0.05 for all three). Conclusion A residency-wide surgical skills competition can improve resident performance in technical tasks and promote faculty engagement in resident skills training.

The Resident-Run Minor Surgery Clinic: A Four-Year Analysis of Patient Outcomes, Satisfaction, and Resident Education

A resident-run minor surgery clinic was developed to increase resident procedural autonomy. We evaluated whether 1) there was a significant difference between complications and patient satisfaction when procedures were independently performed by surgical residents vs. a surgical attending and 2) if participation was associated with an increase in resident procedural confidence. Third year general surgery residents participated in a weekly procedure clinic from 2014-2018. Post-procedure complications and patient satisfaction were compared between patients operated on by residents vs. the staff surgeon. Residents were surveyed regarding their confidence in independently performing a variety of clinic-based patient care tasks. Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Post-graduate year three general surgery residents that ran the clinic as part of a general surgery rotation. 1230 patients underwent 1592 procedures (612 in resident clinic, 980 in attending clinic). There was no significant difference in the 30-day complication rate between patients operated on by the resident vs. attending (2.5% vs. 1.9%, p = 0.49). 459 patient satisfaction surveys were administered with a 79.1% response rate. There was no significant difference in the overall quality of care rating between residents and the attending surgeon (87.5% top-box rating vs. 93.1%, p = 0.15). Twenty-one residents completed both a pre- and post-rotation survey (77.8% response rate). The proportion of residents indicating that they could independently perform a variety of patient care tasks significantly increased across the rotation (all p < 0.05). Mid-level general surgery residents can independently perform office-based procedures without detriment to safety or patient satisfaction. The resident-run procedure clinic serves as an environment for residents to grow in confidence in both technical and non-technical skills. Given the high rate at which patients provide resident feedback, future work may investigate how to best incorporate patient derived evaluations into resident assessment.

Telemedicine Experience of General Surgery Trainees: Impact on Patient Care and Education.

The COVID-19 pandemic has had a significant impact on patient care, including the increased utilization of contact-free clinic visits using telemedicine. We looked to assess current utilization of, experience with, and opinions regarding telemedicine by general surgery residents at an academic university-based surgical training program. A response-anonymous 19-question survey was electronically distributed to all general surgery residents at a single academic university-based general surgery residency program. University of Southern California (USC) general surgery residency participants: Voluntarily participating general surgery residents at the University of Southern California. The response rate from USC general surgery residents was 100%. A majority of residents (76%) had utilized either video- or telephone-based visits during their careers. No resident had undergone formal training to provide telemedicine, although most residents indicated a desire for training (57.1%) and acknowledged that telemedicine should be a part of surgical training (75.6%). A wide variety of opinions regarding the educational experience of residents participating in telemedicine visits was elicited. The COVID-19 pandemic brought telemedicine to the forefront as an integral part of future patient care, including for surgical patients. Additional investigations into nationwide telemedicine exposure and practice among United States general surgery residencies is imperative, and the impact of the implementation of telemedicine curricula on general surgery resident telemedicine utilization, comfort with telemedicine technology, and patient outcomes are further warranted. Practice-based learning, systems-based practice, interpersonal and communication skills.

Love at First Click: Surgery Residency Websites in the Virtual Era

Frequently, a residency program's website is the first interaction students interested in surgery have with the program. In the setting of virtual interviews for residency in 2020, the online availability of program information is of heightened importance. We sought to assess how academic versus community-based general surgery residency programs compared with respect to certain details on their websites. A total of n = 268 surgery residency programs were investigated. Our database of website characteristics included: direct link to residency website from the American Council on Graduate Medical Education (ACGME) program page, resident research requirement, listing of residents' publications, availability of residents' demographic information, program alumni information, board pass rates, attrition rate, detail of educational/academic activities, residents' evaluation methods, diversity, and mentorship. Inter-group analyses between academic and community-based programs were performed using Pearson's Chi-squared test. Academic and community-based general surgery residency program websites were compared based on twelve (12) different parameters. Statistically significant differences were observed for eight of these comparisons: direct website access from ACGME (p = 0.007), research highlighted (p < 0.001), resident research requirement (p = 0.002), resident demographic information available (p=0.004), alumni information (p = 0.005), resident evaluation methods (p = 0.016), diversity (p < 0.001), and mentorship (p = 0.012). Across these domains, academic programs had more information available on their websites than the community programs did. The program websites did not differ significantly based on the frequency of mentioning resident publications, board pass rate, attrition rate, or resident education. Many general surgery programs are lacking detailed information on their websites. The amount of website information available on general surgery residency programs differs when comparing academic and community-based programs.