Early-career Surgeons Research Articles

From Moral Injury Vulnerability to Protective Equity: The Voyage Every Surgeon Must Take.

To examine the relationship between moral injury and surgical practice, further explore the concept of protective equity, and understand its role in mitigating the impact of morally injurious events throughout a surgical career. Moral injury in healthcare settings has evolved from Jonathan Shay's original definition, modified by Brett Litz and others, to encompass the psychological impact of adverse patient outcomes on medical practitioners. Early career surgeons may be particularly susceptible to moral injury, yet the factors influencing this vulnerability remain poorly understood. An analysis of existing literature on moral injury in healthcare, combined with an examination of surgical career trajectories and outcome reporting was conducted. The concepts of protective equity and vulnerability are introduced, defined, and theoretically extrapolated across a surgical career. Evidence suggests that surgical complications significantly contribute to moral injury, particularly among early career surgeons. We propose a model wherein protective equity accumulates over a surgical career, whereas vulnerability follows an M-shaped curve with peaks in early and late career. Early career surgeons face a precarious imbalance of low protective equity and high vulnerability, especially immediately post-training. Strategies to address this dynamic include providing: specific education when onboarding faculty, and longitudinal peer support by senior, trained surgeons.

The 2024 American Orthopaedic Association-Japanese Orthopaedic Association Traveling Fellowship.

In 1992, the American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) Traveling Fellowship was created to develop and enhance collaboration between the Japanese and American orthopaedic communities. The fellowship is geared to early-career surgeons and fosters clinical and cultural exchange between members of the 2 countries. In 2024, the fellows hailed from around the United States: Kelly K. Hynes, Lucas S. McDonald, Joshua A. Parry, Joseph H. Schwab, and Byron F. Stephens all participated in the program. During the 3-week fellowship, the fellows visited 8 academic centers across Japan and attended the JOA Annual Meeting in Fukuoka. This experience was incredibly rewarding, both clinically and professionally, and all the fellows returned home with novel ideas for their clinical practices.

Perceptions of the White Coat: Generational, Regional, and Gender Differences Among Surgeons

IntroductionRecent studies have evaluated patient perception of physician attire; however, few studies have considered physician perceptions of workplace attire. This study aimed to assess current trends regarding attire preferences among surgeons. MethodsA national, population-based survey was distributed via email and “X” (Twitter). Participants were asked to complete an online questionnaire regarding their perception of the white coat, preferred attire in clinical settings, and reasons for choice of attire. ResultsOf 481 participants, 172 (36%) were attendings, 164 (34%) were residents, 125 (26%) were medical students, and 20 (4%) were fellows. Those who practiced in the Midwest region were more likely to wear a white coat daily (35.1% versus 28.5% South, 23.5% Northeast, 20.0% West, P < 0.05). Late career surgeons (practicing >20 y) were more likely to wear a white coat in the hospital and wear it daily (56% versus 36% of middle-career surgeons, 34% early-career surgeons, and 26% in training, P < 0.05). Women surgeons more frequently wore a white coat in clinic (64% versus 54% men, P < 0.05), reported that wearing a white coat was influenced by their program's culture (61% versus 46% of men surgeons, P < 0.05), that they would stop wearing a white coat if other members of their department stopped (50% versus 35% of men, P < 0.05), and that they believe the white coat helps distinguish female doctors from nurses (61% versus 50% of men surgeons, P < 0.05). ConclusionsThis study demonstrates generational, regional, and gender differences among surgeons in their perception of the white coat at a national level.

Identifying and addressing mentorship gaps in European trauma and emergency surgical training. Results from the Young European Society of Trauma and Emergency Surgery (yESTES) mentorship survey

PurposeEuropean training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES).MethodsUtilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship.ResultsFindings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring.ConclusionsOur survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community.

Surgeon perspectives on preference cards and environmental stewardship.

Refinement of surgical preference cards may reduce waste from surgery. This study aimed to characterize surgeon perceptions and practices regarding preference card maintenance, identify barriers to updating preference cards, and explore whether opinions on environmental stewardship relate to preference card maintenance. This was a mixed methods survey performed at a single tertiary academic medical center. Surgeons completed questions on accuracy, frequency of updates, and perceived environmental impact of their preference cards. Responses were compared between early career and mid-to late-career surgeons using Kruskal-Wallis, chi-squared, and Fisher's exact tests. The response rate was 46.4% (n=89/192). Among respondents, 46.1% (n=41/89) rarely or never updated preference cards. Nearly all (98.9%, n=87/88) said some of their cases had unused items on their cards. Most (87.6%, n=78/89) made updates via verbal requests. Unfamiliar processes (83.7%, n=72/86) and effort required (64.0%, n=55/86) were viewed as barriers to card maintenance. Most agreed that more frequent updates would reduce waste (80.5%, n=70/87), but respondents did not feel knowledgeable about the environmental impact of items on their cards (62.1%, n=54/87). Mid-to late-career surgeons were less likely to update their cards annually or more often compared to early career surgeons (18.9%, n=7/37 vs. 57.1%, n=24/42, p<0.001). No other responses varied significantly between early career and mid-to late-career surgeons. Surgeons acknowledged the utility of preference card maintenance in environmental stewardship, but unfamiliar systems and perceived effort hindered preference card review. Greater attention to preference card maintenance would promote environmentally sustainable practices in surgery.

Surgical step recognition in laparoscopic distal gastrectomy using artificial intelligence: a proof-of-concept study.

Laparoscopic distal gastrectomy (LDG) is a difficult procedure for early career surgeons. Artificial intelligence (AI)-based surgical step recognition is crucial for establishing context-aware computer-aided surgery systems. In this study, we aimed to develop an automatic recognition model for LDG using AI and evaluate its performance. Patients who underwent LDG at our institution in 2019 were included in this study. Surgical video data were classified into the following nine steps: (1) Port insertion; (2) Lymphadenectomy on the left side of the greater curvature; (3) Lymphadenectomy on the right side of the greater curvature; (4) Division of the duodenum; (5) Lymphadenectomy of the suprapancreatic area; (6) Lymphadenectomy on the lesser curvature; (7) Division of the stomach; (8) Reconstruction; and (9) From reconstruction to completion of surgery. Two gastric surgeons manually assigned all annotation labels. Convolutional neural network (CNN)-based image classification was further employed to identify surgical steps. The dataset comprised 40 LDG videos. Over 1,000,000 frames with annotated labels of the LDG steps were used to train the deep-learning model, with 30 and 10 surgical videos for training and validation, respectively. The classification accuracies of the developed models were precision, 0.88; recall, 0.87; F1 score, 0.88; and overall accuracy, 0.89. The inference speed of the proposed model was 32 ps. The developed CNN model automatically recognized the LDG surgical process with relatively high accuracy. Adding more data to this model could provide a fundamental technology that could be used in the development of future surgical instruments.

Single Center Neurosurgical Outcomes and Trends in Endoscopic Endonasal Resection of 297 Sellar/Suprasellar Tumors Stratified by Duration of Neurosurgical Career

Endoscopic endonasal transsphenoidal surgery (EETS) is a common treatment for sellar and suprasellar tumors. While endoscopic training has improved over the years and formal fellowship training is now broadly available, the operative nuances of EETS conjectures the existence a learning curve as a neurosurgeon matures with experience. We aim to evaluate operative outcomes of three different experience levels of neurosurgeons over time at a single institution. We reviewed all adult patients who underwent EETS at Loyola University Medical Center by three early career, one mid-career, and two late career neurosurgeons from 2007 to 2023. A comparative assessment of patient demographics, tumor features, and surgical outcomes was done using metrics such as length of surgery, rates of gross total resection (GTR) and symptomatic improvement (SI), new postoperative steroid dependence, and development of diabetes insipidus (DI). T-tests and Chi-Square were used to statistically evaluate the study cohorts. A total of 297 patients underwent EETS. One hundred and three (35%) were operated on by an early career, 122 (41%) by a mid-career, and 72 (24%) by a late career neurosurgeon. Late-career surgeons had shorter operation times (144 vs. 180 minutes with early and mid-career, p=0.029) and increased GTR rates (p=0.008). There were no significant differences between the SI rates amongst various surgeon experience levels. Although not statistically significant, early-career neurosurgeons had lower rates of new postoperative steroid dependence. Patients of early career surgeons experienced significantly less DI (15% vs 40%, p=0.004). Late-career neurosurgeons had shorter operation lengths, achieved higher rates of GTR, and their patients experienced significantly higher rates of DI. Overall outcomes remained stable throughout the course of 16 years between different surgeon experience levels.

Influence of Training Background on Elbow Arthroplasty Case Numbers: An Analysis of the American Board of Orthopaedic Surgery Part II Oral Examination Case List Database.

This study aimed to evaluate the influence of training background on the frequency and indications of elbow arthroplasty performed by early-career surgeons. A review of the American Board of Orthopaedic Surgery Part II Oral Examination Case List database from 2010 to 2021 was completed. The number of cases performed by surgeons from each individual training background were calculated and compared with the total number of surgeons who completed each fellowship during the study period. Hand surgeons performed the most elbow arthroplasty cases (132, 44%), but a higher percentage of shoulder/elbow surgeons performed elbow arthroplasty in comparison (15% vs. 7%). The mean number of TEA cases performed by shoulder/elbow surgeons was significantly higher than in other subspecialties (P < 0.01). However, when comparing only surgeons who performed elbow arthroplasty during the board collection period, there was no significant difference between training backgrounds (P = 0.20). While hand surgeons performed the most elbow arthroplasty cases, a higher percentage of shoulder/elbow surgeons performed elbow arthroplasty during the study period. The high prevalence of distal humerus fracture as an indication for arthroplasty reflected a shift in indications and was not related to training background.

Surgeon perceptions of personality as an influencing factor on anastomotic decision-making: A qualitative analysis.

Surgeon personality is a factor influencing rectal anastomotic decision-making. However, it is unclear how or why this may be the case, or what aspects of personality are involved. The aim of this study was to investigate the views of colorectal surgeons on how their individual personality may influence variation in anastomotic decision-making. Purposive sampling was used to invite certified UK-based colorectal surgeons to participate, with individual interviews used for data collection. Participants were recruited until ongoing data review indicated no new codes were generated (i.e. data sufficiency). Data were analysed thematically following Braun and Clarke's six-step framework. Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes relating to personality and decision-making were identified: (1) surgeon development and training and (2) patient-surgeon interactions, each with relevant subthemes. Surgeons described how their personality may influence patients' postoperative outcomes (e.g. decision-making, team working and communication) and potential mechanisms for how their personality may influence operative risk-taking. Following anastomotic leakage, surgeons described a disproportionate sense of guilt and responsibility. There appears to be a significant transition in responsibility from trainee to newly appointed consultant, which may be part of the 'hidden curriculum' of surgical training. Colorectal surgeons have described their perceptions of how personality traits may impact variation in decision-making and patient outcomes for the first time. Early career surgeons felt ill-prepared for the level of guilt experienced when managing complications. Surgeons appear open to personality assessment if this was through an educational lens, with the aim of improving decision-making following complications and overall performance.

Behind the pattern: General surgery resident autonomy in robotic surgery

ObjectiveRobotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents’ opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). MethodsGeneral surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2–5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. ResultsResident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons’ perceived operative time pressure inversely affected resident ICT. ConclusionsThis study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.

Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages

BackgroundPractice patterns and potential quality differences among surgical oncology fellowship graduates relative to years of independent practice have not been defined.MethodsMedicare claims were used to identify patients who underwent esophagectomy, pancreatectomy, hepatectomy, or rectal resection for cancer between 2016 and 2021. Surgical oncology fellowship graduates were identified, and the association between years of independent practice, serious complications, and 90-day mortality was examined.ResultsOverall, 11,746 cancer operations (pancreatectomy [61.2%], hepatectomy [19.5%], rectal resection [13.7%], esophagectomy [5.6%]) were performed by 676 surgical oncology fellowship graduates (females: 17.7%). The operations were performed for 4147 patients (35.3%) by early-career surgeons (1–7 years), for 4104 patients (34.9%) by mid-career surgeons (8–14 years), and for 3495 patients (29.8%) by late-career surgeons (>15 years). The patients who had surgery by early-career surgeons were treated more frequently at a Midwestern (24.9% vs. 14.2%) than at a Northeastern institution (20.6% vs. 26.9%) compared with individuals treated by late-career surgeons (p < 0.05). Surgical oncologists had comparable risk-adjusted serious complications and 90-day mortality rates irrespective of career stage (early career [13.0% and 7.2%], mid-career [12.6% and 6.3%], late career [12.8% and 6.5%], respectively; all p > 0.05). Surgeon case-specific volume independently predicted serious complications across all career stages (high vs. low volume: early career [odds ratio {OR}, 0.80; 95% confidence interval {CI}, 0.65–0.98]; mid-career [OR, 0.81; 95% CI, 0.66–0.99]; late career [OR, 0.78; 95% CI, 0.62–0.97]).ConclusionAmong surgical oncology fellowship graduates performing complex cancer surgery, rates of serious complications and 90-day mortality were comparable between the early-career and mid/late-career stages. Individual surgeon case-specific volume was strongly associated with postoperative outcomes irrespective of years of independent practice or career stage.

Increasing early career surgeon engagement in the Society for Vascular Surgery: a report of the Society’s Young Surgeons Section Steering Committee

When examining the United States surgical workforce, a shortage of approximately 30,000 surgeons is predicted by 2030. This shortage is attributed to the increasing surgical needs of the nation’s aging population and the increased rate of retirement in the surgeon workforce. As such, the surgeon workforce will rely on Millennials and Generation Z to grow and expand their role in health care. To address these changes, the Society for Vascular Surgery (SVS) established the Young Surgeons Section (YSS) in 2022 after formal approval by the Society’s Executive Board. The YSS Steering Committee set forth in 2022 with an initial charge focused on identifying the needs of this demographic, beginning to develop educational content focused on early career surgeons, providing and advocating for leadership opportunities within the SVS, and assisting the Society in its membership recruitment efforts. The goal of this report is to provide the context under which the YSS was started, outline the major accomplishments of the Section over its first 2 years, and to begin to discuss the needed next steps for the SVS to ensure continued engagement.

The contribution of early-career surgeons to the Society for Vascular Surgery Annual Meeting

ObjectiveThe Society for Vascular Surgery (SVS) recently established the Young Surgeons Section (YSS), open to early career vascular surgeons in their first 10 years of practice and dedicated to providing resources and advocacy to foster early career development, and to encourage diversity, equity, and inclusion within the society. Research was identified as a priority area of focus by members of this group of surgeons. This study aims to evaluate the current contribution of early career surgeons to research presented at the Vascular Annual Meeting (VAM). MethodsAbstracts presented at plenary sessions of the 2021 and 2022 SVS VAM were reviewed. Senior authors for each abstract were identified and categorized as ‘early career’ (EC, first 10 years of practice) or ‘later career’ (LC) and categorized by gender. Information from abstracts including subject matter and subsequent conversion to manuscript publication was collected. Finally, likelihood of abstract presentation on early meeting days compared with the final meeting day was evaluated. ResultsA total of 103 abstracts were presented at plenary sessions of VAM during the two-year study period. Thirty abstracts had EC senior authors (29.1%). The most common topics for EC abstracts were aorta and peripheral artery disease (PAD), whereas the most common for LC abstracts were aorta and cerebrovascular disease, followed by PAD. Sixty abstracts were converted to manuscript publication (58.3%; n = 20 EC, n = 40 LC). The conversion rate for EC authors was higher than that of LC authors (66% EC vs 55% LC). Sixteen LC senior authors had multiple abstracts each that accounted for 41.7% of all plenary abstracts presented, of which 55.8% were converted to publication. Five EC authors had multiple abstracts that contributed 9.7% of the overall abstracts, with a 70% publication rate. Despite a higher rate of publication, manuscripts by EC senior authors were more likely to be presented on the final conference day (odds ratio, 3.06; 95% confidence interval, 1.25-7.45). The proportion of EC abstracts written by women senior authors was 50% as compared with only 8.2% of LC abstracts (P < .0001). ConclusionsEC surgeon scientists contribute significantly to research presented at VAM with work that is similar in subject matter and publication success in peer-reviewed journals to that of LC senior authors. EC senior authors represent greater membership diversity. EC surgeon-scientists may benefit from recognition by broader audiences at subsequent meetings. SVS efforts to establish a YSS Research Working Group is a productive first step in providing resources and recognition for EC surgeons.

Impact of surgeon volume, experience, and training on outcomes after arthroscopic rotator cuff repair: a nationwide analysis of 1489 surgeons

BackgroundGiven the complexity of arthroscopic rotator cuff repair (ARCR) and increasing prevalence, there is a need for comprehensive, large-scale studies that investigate potential correlations between surgeon-specific factors and postoperative outcomes after ARCR. This study examines how surgeon-specific factors including case volume, career length, fellowship training, practice setting, and regional practice impact two-year reoperation rates, conversion to total shoulder arthroplasty (anatomic or reverse) (TSA), and 90-day post-ARCR hospitalization. MethodsThe PearlDiver Mariner Database was used to collect surgeon-specific variables and query patients who underwent ARCR from 2015 to 2018. Patient outcomes were tracked for two years, including reoperations, hospitalizations, and ICD-10 codes for revision rotator cuff repair (RCR) laterality. Hospitalizations were defined as any emergency department (ED) visit or hospital readmission within 90 days after primary ARCR. Surgeon-specific factors including surgeon case volume, career length, fellowship training, practice setting, and regional practice were analyzed in relation to postoperative outcomes using both univariate and multivariate logistic regression. Results94,150 patients underwent ARCR by 1,489 surgeons. On multivariate analysis, high volume surgeons demonstrated a higher risk for two-year total reoperation (OR = 1.06, 95% CI: 1.01-1.12, P = 0.03) and revision RCR (OR = 1.06, 95% CI: 1.01-1.12, P = 0.02) compared to low volume surgeons. Early-career surgeons showed higher rates of 90-day ED visits (mid-career surgeons: OR = 0.78, 95% CI: 0.73-0.83, P < 0.001; late-career surgeons: OR = 0.73, 95% CI: 0.68-0.78, P < 0.001) and hospital readmission (mid-career surgeons: OR = 0.74, 95% CI: 0.63-0.87, P < 0.001; late-career surgeons: OR = 0.73, 95% CI: 0.61-0.88, P = 0.006) compared to mid- and late-career surgeons. Sports Medicine and/or Shoulder and Elbow fellowship-trained surgeons demonstrated lower two-year reoperation risk (OR = 0.95, CI: 0.91-0.99, P = 0.04) and fewer 90-day ED visits (OR = 0.93, 95% CI = 0.88-0.98, P = 0.002). Academic surgeons experienced higher readmission rates compared to community surgeons (OR = 1.16, 95% CI = 1.01-1.34, P = 0.03). Surgeons practicing in the Northeast demonstrated lower two-year reoperation (OR = 0.88, 95% CI: 0.83-0.93, P < 0.001) and revision (OR = 0.88, 95% CI: 0.83-0.94, P < 0.001) rotator cuff repair risk, compared to surgeons in the Southern United States. ConclusionsHigh-volume surgeons exhibit higher two-year reoperation rates after ARCR compared to low-volume surgeons. Early-career surgeons demonstrate increased hospitalizations. Sports Medicine or Shoulder and Elbow Surgery fellowships correlate with reduced two-year reoperation rates and 90-day ED visits.

Is There Still a Learning Curve for Primary TAA After Completing a High Volume Ankle Replacement Fellowship? A Multicentered Study

Introduction/Purpose: The learning curve in Total ankle arthroplasty(TAA) has long been reported. Surgeon experience of five to twenty-five ankle replacements have been shown to decrease various perioperative and long term complications in this complex surgery. Fellowship programs with high-volume ankle arthroplasty experiences have been suggested to mitigate this learning curve and provide benefit to early career surgeons with TAA outcomes. The purpose of this study was to evaluate the learning curve for TAA in two high-volume surgeons practices through the first three years of practice. Both surgeons completed fellowships and participated in more than 100 ankle replacements each. We hypothesized that experience during fellowship will help minimize complications and negate any learning curve previously established in the literature. Methods: Prospectively collected data was retrospectively reviewed on all patients who underwent primary TAA surgery during the first three years of clinical practice after fellowship in this IRB approved, multi-centered study. Patient demographics and clinical data, radiographic outcomes, and patient reported outcomes were collected on all patients. Patients undergoing revision TAA (as a first surgery), patients without a minimum of 2 years follow-up, and patients undergoing arthrodesis conversion to TAA were all excluded. The data was analyzed using Chi Squared test and the Moving Average Method where appropriate. All statistical analysis was performed by someone with an expertise in biostatistics. Results: Eighty-seven patients (67.8% male, avg. age 64) met inclusion criteria for the study. Average tourniquet time (111.9 min) and fluoroscopy time(106.3 secs) decreased as surgeon experience increased, with the this trend stabilizing after patient 20. Complication rate (wound complication, infection, return to OR, intraoperative fracture, etc.) was similar throughout the study period. No differences were seen in component positioning (postop AP TT angle, Postop Lateral TT angle), PROMIS Pain interference, PROMIS Depression, or PROMIS Physical function with regards to time during the study. Statistically significant differences (improvements) were seen in in the following postoperative measurements when compared to preoperative values: AP TT angle, Lateral TT angle, and PROMIS Pain Interference/Depression/Physical function. Conclusion: Learning curve as it relates to intraoperative fluoroscopy time and intraoperative tourniquet time remained even after completing a high volume TAA fellowship but clinical and PROs did not show this same trend. Radiographic measurements, complications (both intraop and postop), and patient reported outcomes did not show a time sensitive change after fellowship. Though some variables did show the maintenance of a learning curve, this multi-centered study suggests that completion of a high volume TAA fellowship can mitigate some variables in the learning curve. Study Data Summary

Surgeon Factors and Trends Associated With the Use of Subacromial Decompression at the Time of Rotator Cuff Repair

Subacromial decompression (SAD) has historically been described as an essential part of the surgical treatment of rotator cuff disorders. However, investigations throughout the 21st century have increasingly questioned the need for routine SAD during rotator cuff repair (RCR). Our purpose was to assess for changes in the incidence of SAD performed during RCR over a 12-year period. In addition, we aimed to characterize surgeon and practice factors associated with SAD use. Records from two large tertiary referral systems in the United States from 2010 to 2021 were reviewed. All cases of RCR with and without SAD were identified. The outcome of interest was the proportion of SAD performed during RCR across years and by surgeon. Surgeon-specific characteristics included institution, fellowship training, surgical volume, academic practice, and years in practice. Yearly trends were assessed using binomial logistic regression modeling, with a random effect accounting for surgeon-specific variability. During the study period, 37,165 RCR surgeries were performed by 104 surgeons. Of these cases, 71% underwent SAD during RCR. SAD use decreased by 11%. The multivariable model found that surgeons in academic practice, those with lower surgical volume, and those with increasing years in practice were significantly associated with increased odds of performing SAD. Surgeons with fellowship training were significantly more likely to use SAD over time, with the greatest odds of SAD noted for sports medicine surgeons (odds ratio= 3.04). Although SAD use during RCR appears to be decreasing, multiple surgeon and practice factors (years in practice, fellowship training, volume, and academic practice) are associated with a change in SAD use. These data suggest that early-career surgeons entering practice are likely driving the trend of declining SAD. Despite evidence suggesting limited clinical benefits, SAD remains commonly performed; future studies should endeavor to determine factors associated with practice changes among surgeons.

O52: Empowering Medical Students and Early Career Surgeons in Critical Appraisal of AI Research: Design and Evaluation of a Pilot Course

Abstract Introduction As artificial intelligence (AI) plays an increasing role in surgical practice, there is a need for surgeons to understand and evaluate literature surrounding the use of AI. There is currently a lack of training in this area for medical students and surgical trainees. We designed and assessed the impact of a short educational course. Methods A two-day online course was held, consisting of lectures and small-group discussions surrounding the fundamentals and appraisal of AI literature with a focus on neurosurgery. Participants included individuals working in neurosurgery (trainees, consultants and researchers) and medical students interested in surgery. A Qualtrics survey was distributed before and after the course. Participants’ knowledge was assessed before and after using 15 multiple-choice questions. Individuals allocated to the course’s waiting list completed a control survey. Results 62 participants (33 participants, 29 waitlist controls) attended the course and completed the pre-course survey. After the course, participants significantly improved in their knowledge of AI (mean difference = 3.86, 95% CI = 2.97-4.75, p-value &amp;lt; 0.0001) and confidence in critically appraising AI literature (p-value = 0.002). Differences in knowledge (mean difference = 3.15, 95% CI = 1.82-4.47, p-value &amp;lt; 0.0001) and confidence (p-value &amp;lt; 0.0001) were also found when compared to the control group. Significant differences were maintained when medical students or researchers were excluded from analysis. Conclusion Short courses that are tailored to the specialty and experience of surgical trainees and medical students can improve their understanding of AI, without the need for in-depth technical knowledge or programming skills.

Global practice patterns of preoperative image reconstruction for liver surgery

BackgroundThree-dimensional (3-D) liver modeling is used globally; however, its actual practice is limited to a few centers. This study aimed to assess practice patterns and barriers to the use of 3-D modeling among liver surgeons worldwide. MethodsA survey approved by the International Hepato-Pancreato-Biliary Association research council consisting of 27 questions was conducted using an online questionnaire. Incomplete responses were excluded. ResultsOf 235 respondents from 46 countries, 81.3% reported experience with 3-D modeling; however, only 21% used it in > 75% of cases. Surgeons using 3-D reconstruction were older (P = .025), worked more frequently at academic facilities (P = .007), and had more years of experience (P = .001), especially in minimally invasive liver surgery (MILS) (P = .038). In addition, 3-D rendering was performed by surgeons in 50.8% of cases. Liver volumetry was the most frequent indication (80.1%), and decreased postoperative complications were the main perceived benefit (53.6%). ConclusionsMore experience in liver surgery because of seniority, case volume, and openness to novel technology (MILS) is associated with a greater appreciation for the value of 3-D modeling. Our results suggest the need for senior surgeons to help early-career surgeons consider 3-D modeling for the reported benefit of reduced intra- and postoperative complications.

Examining early career surgeon performance: the most common procedures and their associated complication rates

Examining early career surgeon performance: the most common procedures and their associated complication rates

Technical Aspects of Mitral Valve Replacement: A Guide for Beginners

Mitral valve replacement is a surgical procedure to replace a damaged or diseased mitral valve in the heart. There are different techniques for mitral valve replacement, including open-heart surgery and minimally invasive heart surgery. Here, we describe detailed steps of mitral valve replacement with a mechanical bileaflet valve which can be used by early career surgeons as a reference to perform safe cardiac surgery.