Junior Surgical Residents Research Articles

Training the Next Generation of Transplant Surgeons With a 3-Dimensional Trainer: A Pilot Study.

In the United States, no published guidelines promote exposure to technical variants (ie, living donor or split liver) during transplant fellowship. Simulation with hands-on liver models may improve training in transplantation. This pilot study addressed 3 overall goals (material and model creation tools, recruitment rates and assessment of workload, and protocol adherence). A patient-specific hands-on liver model was constructed from clinical imaging, and it needed to be resilient and realistic. Multiple types of materials were tested between January 2020 and August 2022. Participants were recruited stepwise. A left lateral segmentectomy simulation was conducted between August 2022 and December 2022 to assess protocol adherence. Digital anatomy 3-dimensional printing was considered the best option for the hands-on liver model. The recruitment rate was 100% and 47% for junior attendings and surgical residents, respectively. Ten participants were included and completed all the required surveys. Seven (70%) and 6 (60%) participants "agreed" that the overall quality of the model and the material were acceptable for surgical simulation. Five participants (50%) "agreed" that the training improved their surgical skills. Nine participants (90%) "strongly agreed" that similar sessions should be included in surgical training programs. Three-dimensional hands-on liver models have the advantage of tactile feedback and were rated favorably as a potential training tool. Study enrollment for further studies is possible with the support of leadership. Rigorous multicenter designs should be developed to measure the actual impact of 3-dimensional hands-on liver models on surgical training.

Hand Sewn Anastomosis Skill Acquisition and In Vivo Transfer Using 3D-Printed Small Bowel Simulator

IntroductionGeneral surgery residents need to master the hand-sewn bowel anastomosis (HSBA) technique. However, practice opportunities outside of the operating room are rare, and commercial simulators are often costly. The objective of this study is to assess the efficacy of a new, affordable silicone small bowel simulator, made with a three-dimensional (3D) printed mold, as a training tool to learn this technique. MethodsThis was a single-blinded pilot randomized controlled trial comparing two groups of eight junior surgical residents. All participants completed a pretest using an inexpensive, custom developed 3D-printed simulator. Next, participants randomized to the experimental group practiced the HSBA skill at home (eight sessions), while those randomized to the control group did not receive any hands-on practice opportunities. A posttest was done using the same simulator as for the pretest and practice sessions, and the retention-transfer test was performed on an anesthetized porcine model. Pretests, posttests and retention-transfer tests were filmed and graded by a blinded evaluator using assessments of technical skills, quality of final product, and tests of procedural knowledge. ResultsThe experimental group significantly improved after practicing with the model (P = 0.01), while an equivalent improvement was not noted in the control group (P = 0.07). Moreover, the experimental group's performance remained stable between the posttest and the retention-transfer test (P = 0.95). ConclusionsOur 3D-printed simulator is an affordable and efficacious tool to teach residents the HSBA technique. It allows development of surgical skills that are transferable to an in vivo model.

Transition Tuesdays for junior surgical residents: teaching surgical decision-making through a screen

<h3>Summary</h3> The COVID-19 pandemic has substantially affected surgical training and the autonomy of surgical trainees in the clinical setting, with notable decreases in operating room exposure and experience. For trainees who are transitioning into roles as senior residents, these changes have limited opportunities during a critically formative period in their training. We discuss the implementation of a modified case-based instructional curriculum for intermediate-level surgical trainees, and suggest strategies to bridge the gap in clinical and operative decision-making while using a virtual learning format.

Merits and demerits of entrustable professional activities for assessments of surgical residents: A systematic review

: For competency-based medical education (CBME), there has been increasing focus on entrustable professional activities (EPA) as one of the modalities for assessment of competence. This study aims to investigate the effectiveness, the merits and the demerits of EPAs for evaluation of the competency of the surgical trainees. : We performed a systematic literature search in PubMed, EMBASE, MEDLINE, and ERIC. Keywords used for searching included “entrustable professional activity”, “surgery”, “surgical”, “resident” and “residency”. The search was limited to the English language but not limited to the publication time. The searched articles were included in this study if the searched articles were related to “entrustable professional activity” and “surgical residency”. : Included studies were published from 2016 to 2022 and were written in English. : From 67 studies retrieved from the databases, 12 articles were included in this study after screening. There were totally 1990 surgical residents and 1165 faculty included in these studies. : By EPA assessments, it was found the performance of the senior residents was better than that of the junior residents. However, there was no significant difference between junior surgical residents and medical students for the abilities of using concise, clear and comprehensive professional clinical language to do a handover with other health care professionals. There were significant amount of surgical residents had no or faint idea about EPA assessments. Regardless of pre-operative, intra-operative and post-operative assessments, EPAs could be as effective as milestones for evaluation. : EPAs could be a good tool for assessment of the abilities of surgical residents and could differentiate the abilities between senior and junior surgical trainees, but multiple EPAs should be used for comprehensive evaluation and the ability of communication with other professional healthcare givers by using clear, concise and comprehensive clinical language seemed to be left behind.

One size does not fit all: identifying differences in intraoperative teaching preferences of junior versus senior surgical residents

One size does not fit all: identifying differences in intraoperative teaching preferences of junior versus senior surgical residents

Leadership Development Among Junior Surgery Residents: Communication and Perception.

Leadership is necessary for effective health care teams, particularly for surgeons. Trainees similarly must acquire foundational leadership skills to maximize effectiveness. However, surgical leadership is rarely formally assessed, particularly for junior trainees. We aimed to establish themes of communication, perception and engagement styles, as well as strengths and weaknesses among junior surgical residents at a single institution. The Data Dome Inc. (datadome.com) DISC personality assessment was administered in 2018-2021 to junior residents at an academic general surgery training program at a single institution. Resident demographics were recorded, and themes from deidentified reports were analyzed by year (PGY-1 and PGY-2) using JMP 16 Pro Text Explorer. PGY-1 communication was most frequently described as "accomplished best by well-defined avenues" with "duties and responsibilities of others who will be involved explained" in "friendly terms." PGY-2 communication involved "deal [ing] with people," "strong feelings about a particular problem," and being "good at giving verbal and nonverbal feedback." In ideal environments, PGY-1s self-perceived as "good listener [s]," "good-natured," and "team player [s]." However, under stress, PGY-1s were perceived by others as "poor listener [s]," "self-promoter [s]," "detached," and "insensitive." In ideal environments, PGY-2s were also "good listener [s]," "good-natured," and "team player [s]." However, under stress, PGY-2 external perception was "overly confident," "poor listener [s]," and "self-promoter [s]." Clear expectations, friendly work environments, and opportunities to succeed are key to effectively train junior surgical residents. In environments where time is often a limited resource, surgical simulation, stress training, and standardized teaching methods from attending surgeons are needed to develop competent trainees.

Are 3D-printed Models of Tibial Plateau Fractures a Useful Addition to Understanding Fractures for Junior Surgeons?

Tibial plateau fractures are often complex, and they can be challenging to treat. Classifying fractures is often part of the treatment process, but intra- and interobserver reliability of fracture classification systems often is inadequate to the task, and classifications that lack reliability can mislead providers and result in harm to patients. Three-dimensionally (3D)-printed models might help in this regard, but whether that is the case for the classification of tibial plateau fractures, and whether the utility of such models might vary by the experience of the individual classifying the fractures, is unknown. (1) Does the overall interobserver agreement improve when fractures are classified with 3D-printed models compared with conventional radiology? (2) Does interobserver agreement vary among attending and consultant trauma surgeons, senior surgical residents, and junior surgical residents? (3) Do surgeons' and surgical residents' confidence and accuracy improve when tibial plateau fractures are classified with an additional 3D model compared with conventional radiology? Between 2012 and 2020, 113 patients with tibial plateau fractures were treated at a Level 1 trauma center. Forty-four patients were excluded based on the presence of bone diseases (such as osteoporosis) and the absence of a CT scan. To increase the chance to detect an improvement or deterioration and to prevent observers from losing focus during the classification, we decided to include 40 patients with tibial plateau fractures. Nine trauma surgeons, eight senior surgical residents, and eight junior surgical residents-none of whom underwent any study-specific pretraining-classified these fractures according to three often-used classification systems (Schatzker, OA/OTA, and the Luo three-column concept), with and without 3D-printed models, and they indicated their overall confidence on a 10-point Likert scale, with 0 meaning not confident at all and 10 absolutely certainty. To set the gold standard, a panel of three experienced trauma surgeons who had special expertise in knee surgery and 10 years to 25 years of experience in practice also classified the fractures until consensus was reached. The Fleiss kappa was used to determine interobserver agreement for fracture classification. Differences in confidence in assessing fractures with and without the 3D-printed model were compared using a paired t-test. Accuracy was calculated by comparing the participants' observations with the gold standard. The overall interobserver agreement improved minimally for fracture classification according to two of three classification systems (Schatzker: κconv = 0.514 versus κ3Dprint = 0.539; p = 0.005; AO/OTA:κconv = 0.359 versus κ3Dprint = 0.372; p = 0.03). However, none of the classification systems, even when used by our most experienced group of trauma surgeons, achieved more than moderate interobserver agreement, meaning that a large proportion of fractures were misclassified by at least one observer. Overall, there was no improvement in self-assessed confidence in classifying fractures or accuracy with 3D-printed models; confidence was high (about 7 points on a 10-point scale) as rated by all observers, despite moderate or worse accuracy and interobserver agreement. Although 3D-printed models minimally improved the overall interobserver agreement for two of three classification systems, none of the classification systems achieved more than moderate interobserver agreement. This suggests that even with 3D-printed models, many fractures would be misclassified, which could result in misleading communication, inaccurate prognostic assessments, unclear research, and incorrect treatment choices. Therefore, we cannot recommend the use of 3D-printed models in practice and research for classification of tibial plateau fractures. Level III, diagnostic study.

The development and evaluation of “Training the trainer” curriculum for surgical residents: Feasibility study

BackgroundOver the last decades, there has been greater emphasis on enhancing teaching skills and concepts of Train-The-Trainer (TTT) have been widely adopted across surgical training programs. Current TTT curricula, however, mostly address teaching generic principles without specific guidance on how to teach technical skills among residents. The aim of this proof-of-concept study was to design a bespoke TTT curriculum for surgical technical skills and evaluate its impact. Material and methodsA bespoke TTT curriculum was developed to address key teaching surgical skills including a training framework, and performance enhancing feedback. The curriculum was delivered to 41 junior surgical residents in this feasibility study and focused on promoting a training framework including three domains; “set” involving pre-operative preparation, “dialogue” referring to teaching techniques and “closure” covering structured feedback. It was evaluated using Kirkpatrick's model: (i) course feedback; (ii) training quality assessment on a suturing simulated scenario using (a) Competency Assessment Tool (CAT) and a (b) Structured Training Trainer Assessment Report (STTAR) tool; (iii-iv) follow-up survey after one year. ResultsThe TTT curriculum was well-perceived, with a median score of 4/5 (“agree”) across all components of evaluation forms. The simulated training scenario demonstrated a significant reduction in suturing errors following delivery of training (pre-TTT [4.25; IQR:4.42]; post-TTT [2.34; IQR:2.38], p-value = 0.014). Improvement in teaching was also noted and reflected in ‘Set’ (pre-TTT [3.50; IQR: 3.00] and post-TTT [5.00; IQR: 0.00], p-value = 0.019) and ‘Closure’ (pre-TTT [4.75; IQR: 1.88] and post-TTT [5.00; IQR: 0.00], p value = 0.007). 25% of participants contributed to the long-term survey highlighting that most practiced skills within 6 months of the curriculum with positive feedback from their learners. ConclusionThis proof-of-concept study confirms the feasibility and acceptability of delivering a bespoke Train-The-Trainer curriculum to surgical residents. It provides a structured training framework that can enhance teaching technical skills.

Core training and surgical opportunities: a UK-based analysis

The COVID-19 pandemic, the new Intercollegiate Surgical Curriculum Programme curriculum and the European Work Time Directive significantly reduced surgical exposure for trainees. This study analyzed the operative experience of Phase 1 trainees (CT1/ST1 vs. CT2/ST2) against the Annual Review of Competence Progression (ARCP) criterion of 120 procedures yearly. National survey research in October 2021. Study end-point was the completion of >4 weekly procedures, equivalent to 120 cases per year. Chi-square test and multivariate regression analysis were performed. 205 participants from 5 Deaneries were included, 48.3% were CT1/ST1 and 51.7% were CT2/ST2. About 54.5% of year-1 and 50% of year-2 trainees were 28 30 years old, 55.6% and 50.9% were male, and 39.4% and 38.7% were White British. About 39.4% of CT1/ST1 and 22.6% of CT2/ST2 performed <4 weekly procedures (P = 0.01), with no difference in the "Observed" (P = 0.6) or "Assisted" (P = 0.3) number of cases. CT2/ST2 recorded more "ST-S" (p 0.04), "S-TU" (P = 0.03), and "Performed" (P = 0.02) operations. For CT1/ST1, older age (HR 2.4, 95% CI [1.1; 5.3], P = 0.02) and southern deaneries (HR 1.7, 95% CI [1.2; 2.4], P = 0.004) were independent factor for <4 weekly procedures. For CT2/ST2, northern regions were associated with more favorable training (HR 1.4, 95% CI [1.1; 1.7], P = 0.01). Over one third of Phase 1 trainees do not meet the ARCP requirement of >120 procedures annually. Age and region of training are independent factors in the number of logbook cases. This research focuses on training opportunities for junior surgical residents across the United Kingdom. The degree and type of exposure to the operating theatre have a significant impact on the development of surgical competencies. These are undoubtedly related to patient outcomes, as the quality of care delivered to patients and relatives greatly relies on the training background of future consultant surgeons.

Medical Student Mentorship in Surgery: Lessons Learnt and Future Directions

Mentorship is one of the cornerstones of surgical education, providing students with the tools to navigate the challenges of the transition from a trainee to a surgeon. Our study aims to describe the characteristics of successful mentorship of medical students who successfully matched into surgical fields, and to provide medical students practical information on how to successfully find and maintain successful mentoring relationships. In this multi-center cross-sectional observational study, 2 surveys; 1 for mentees, defined as junior surgical residents (medical students who matched into surgical specialties), and 1 for mentors, defined as staff surgeons, were used to collect data between August 1, 2020 to November 1, 2020. The study was retrospective in nature and did not directly assess survey participants while they were in medical school, but rather while they were residents, retrospectively answering regarding their experiences as medical students. The surveys contained 24 questions pertaining to demographics, the dynamics of mentor-mentee relationships, qualities sought in a mentee, and barriers/benefits to mentorship. A total of 111 attending surgeons and 138 surgical residents completed the surveys. Seventy-eight percent of surgeons had mentored at least 1 medical student, while 74.6% of residents had at least 1 mentor during medical school. The top three mentee qualities reported by mentors were willingness to learn, being a hard worker, and curiosity. There was a significant disparity between mentors' and mentees' perceptions of the importance of scientific curiosity as a mentee trait (p < 0.05). Mentors and mentees have different perceived barriers to forming successful mentorships. While the majority of students have experienced fruitful mentoring relationships, the differences in perception of mentors and mentees still represent barriers to be overcome to allow mentorship in surgery to flourish.

Structured Training for Laparoscopic Appendectomy for Residents (STAR Trial)–A Randomized Pilot Study

Laparoscopic appendectomy is a common operation that is frequently performed by junior surgical residents. We investigated the effect of a structured training program on the proficiency of junior residents in acquiring skills necessary in this operation. This is a randomized pilot trial. Between December 2014 and July 2018, twenty junior residents were recruited for this study. 11 were randomized to receive a structured training program of supervised, task-specific training. Each resident subsequently performed ten cases of laparoscopic appendectomy with their performance assessed for the last 5. The GOALS scale was used as the primary endpoint. Secondary endpoints were perioperative outcomes. The effect of intervention on these outcomes were evaluated assuming a linear mixed effect multi-level model. The study was single-blinded as the assessors did not know which group each resident belonged to. There were no statistically significant differences in the total GOALS score or any of its individual domains. After adjusting for the number of operations done within the trial, the mean difference between the total GOALS score was 0.07 (95% CI -0.76 to 0.90, P=0.866). Blood loss, hospital stay and postoperative complication rates were similar. There was suggestion of a shorter operative time (effect estimate -9.03, 95% CI -19.56 to 1.50) in the intervention arm although statistical significance was not achieved. No avoidable adverse events due to this study were recorded. Structured training program did not significantly improve surgical performance and outcomes in laparoscopic appendectomy in this pilot trial. Despite these findings, residents can still potentially mount their learning curves in laparoscopy earlier in a safe environment with such a program which is especially important in the era of minimally invasive surgery.

Implementation of flipped classroom combined with case- and team-based learning in residency training

The core problem of Chinese resident doctor training is that medical educators present content in an attractive teaching mode to make students more motivated to learn and improve their clinical thinking ability, humanistic care, and practical ability. The traditional classroom mode of teaching cannot meet the needs of modern medical education. The purpose of this study is to explore the benefits and challenges of the flipped classroom (FC) combined with case- and team-based learning (FC-CTBL) for residency training. In this study, 60 junior surgical residents of Xiangya Medical College were enrolled. "Diabetic foot" was selected as the content of this study. Residents were divided into an FC-CTBL group and an FC group. FC-CTBL and FC were compared on the basis of residents' feedback questionnaires, residents' learning burden, test scores from a pre-quiz, and objective structured clinical examinations (OSCE). Residents were more satisfied with the FC-CTBL model compared with FC. In the FC-CTBL group, more participants said that the course improved their teamwork skills, analytical skills and their confidence in tackling unfamiliar problems. Residents in the FC-CTBL group also spent significantly less time preparing for class and performed better in the OSCE than those in the FC group. FC-CTBL stimulates residents' learning motivation, decreases their workload, improves their performance in the OSCE and may help to enhance clinical thinking and teamwork skills. The FC-CTBL approach is a good option for residency training.

Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect?

BackgroundGender bias may represent a threat to resident assessment during surgical training, and there have been concerns that women might be disadvantaged. There is a lack of studies investigating gender differences in ‘entry-level’ real-life procedures, such as laparoscopic appendectomy. We aimed to explore potential gender disparities in self-evaluation and faculty evaluation of a basic surgical procedure performed by junior surgical residents in general surgery.MethodsA structured training program in laparoscopic appendectomy was implemented before undertaking evaluation of real-life consecutive laparoscopic appendectomies by junior residents in general surgery. Resident and faculty gender-pairs were assessed. Intraclass correlation coefficient (ICC) was calculated using a single-rater, consistency, 2-way mixed-effects model.ResultsA total of 165 paired sessions were completed to evaluate resident–faculty scores for the procedure. Overall, 19 residents participated (43% women) and 26 faculty (42% women) were involved. The overall correlation between faculty and residents was good (ICC > 0.8). The female–female pairs scored higher for most steps, achieving excellent (ICC ≥ 0.9) for several steps and for overall performance. Female residents were more likely to give a higher self-evaluated score on own performance particularly if evaluated by a female faculty. Also, female trainees had highest correlation-score with male faculty.ConclusionsThis study found higher performance scores in female surgical residents evaluated during real-time laparoscopic appendectomy. No negative gender bias toward women was demonstrated. Better insight into the dynamics of gender-based interaction and dynamics in both training, feedback and influence on evaluation during training is needed when evaluating surgical training programs.

Effect of Emotional Response on the Performance of a Simulated Laparoscopic Task.

An emotional state impacts task performance and cognition. However, evidence of the effect of an induced emotional state on laparoscopic performance has not yet been documented. We investigated whether surgical residents in whom a positive emotion had been induced would produce a better laparoscopic task performance than residents in whom a negative emotional state had been induced. This controlled laboratory study recruited a total of 53 junior surgical residents who were divided into 3 groups. Each group was required to watch 1 of 3 ten-minute videos designed to evoke a positive, neutral, or negative emotion before performing a laparoscopic cholecystectomy on a virtual simulation model. Task performances, as evaluated by a global assessment form and psychomotor metrics that included task time, errors, and path lengths, were compared between the 3 groups. Video watching induced different emotions, as measured by a Visual Analog Scale on feelings. The task time was significantly shorter in the positive (13.7 ± 2.5 minutes) than in the neutrally (17.7 ± 3.9 minutes) and the negatively (18.5 ± 3.8 minutes) induced-emotion groups (P < 0.001).Participants in the positive emotion group completed a laparoscopic cholecystectomy with a significantly lower error rate (2 vs. 4 vs. 7, P = 0.036) and shorter right-handed path length (1089.6 ± 250.6 cm vs. 1287.2 ± 355.5 cm vs. 1410.3 ± 304.1 cm, P = 0.010) than the participants in the neutral and negative emotion groups. A positive emotion can enhance a simulated laparoscopic task performance as assessed by task time and path length. The results indicate that we might improve surgical task performance by adjusting the surgeon's emotional state. We plan a future study that will continue to investigate whether positive emotions can facilitate skill learning.

Laying the Foundation: Delineating Actionable Technical and Clinical Learning Goals for Junior Surgical Residents

Woelfel, Ingrid MD; Linda Ackah, Ruth MD; Eldon Harzman, Alan MD, FACS; Lenora Cochran, Amalia MD, FACS; (Phoenix) Chen, Xiaodong PhD Author Information

The moral compass in The COVID-19 era: The line between empathy and eagerness of the young surgical generation. A multidisciplinary point of view from first year residents (PGY-1)

The COVID-19 pandemic has been affecting surgical residents in many ways and to varying degrees. While the senior surgical residents have been facing a drastic decrease in the operation time, the junior surgical residents have been exposed to an increased number of beside procedures. However, both of them have been affected by an increased exposure to deaths. This sudden exposure to this amount of deaths can, and has been, greatly impressing mostly the young surgeon generation, still green and impressionable. PGY-1 residents have been balancing emotional confusion between the eagerness of learning new procedures and the anguish coming from facing the loss of patients that they have been trying so hard to save day by day. This situation is leading to an increase in burn-out cases, mostly from the general physicians and health care providers. The real effect of this emotional distress is still unknown and it will be topic of further studies once situation is resolved. This article is described using a multidisciplinary approach, giving a PGY-1 personal point of view and an inner philosophical prospective.

Using rapid cycle deliberate practice to improve primary and secondary survey in pediatric trauma

BackgroundOptimal performance of the primary and secondary survey is the foundation of Advance Trauma Life Support care. Despite its importance, not all primary surveys completed at level 1 pediatric trauma centers are performed according to established guidelines (Gala et al., Pediatr Emerg Care 32:756–762, 2016, Carter et al., Resuscitation 84:66–71, 2013). We hypothesize that rapid cycle deliberate practice (RCDP) will improve surgical residents’ confidence in performing the primary and secondary survey.MethodsWe developed a curriculum to teach surgical interns the principles of performing the primary and secondary survey using RCDP. Surveys distributed after each session assessed the impact of the curriculum on learner confidence and perception that this curriculum would benefit patient care. Questions were scored on a 5-point Likert scale. Sixteen surgical interns participated during intern orientation and 100% of the participants completed the post curriculum survey.ResultsThirteen (81%) of participants agreed or strongly agreed that the simulation would impact future performance in the pediatric trauma bay. The curriculum also significantly improved the confidence of our learners to perform trauma surveys (p < 0.001).ConclusionThis curriculum improves the confidence of junior surgical residents in learning the primary and secondary survey. Most learners enjoyed the session and felt that the curriculum would positively impact their performance.

What is the value of 3D virtual reality in understanding acetabular fractures?

Acetabular fractures are difficult to classify owing to the complex three-dimensional (3D) anatomy of the pelvis. 3D printing helps to understand and reliably classify acetabular fracture types. 3D-virtual reality (VR) may have comparable benefits. Our hypothesis is that 3D-VR is equivalent to 3D printing in understanding acetabular fracture patterns. A total of 27 observers of various experience levels from several hospitals were requested to classify twenty 3D printed and VR models according to the Judet-Letournel classification. Additionally, surgeons were asked to state their preferred surgical approach and patient positioning. Time to classify each fracture type was recorded. The cases were randomized to rule out a learning curve. Inter-observer agreement was analyzed using Fleiss' kappa statistics (κ). Inter-observer agreements varied by observer group and type of model used to classify the fracture: medical students: 3D print (κ = 0.61), VR (κ = 0.41); junior surgical residents: 3D print (0.51) VR (0.54); senior surgical residents: 3D print (0.66) VR (0.52); junior surgeons: 3D print (0.56), VR (0.43); senior surgeons: 3D print (κ = 0.59), VR (κ = 0.42). Using 3D printed models, there was more agreement on the surgical approach (junior surgeons κ = 0.23, senior surgeons κ = 0.31) when compared with VR (junior surgeons κ = 0.17, senior surgeons 0.25). No difference was found in time used to classify these fractures between 3D printing and VR for all groups (P = 1.000). The Judet-Letournel acetabular classification stays difficult to interpret; only moderate kappa agreements were found. We found 3D-VR inferior to 3D printing in classifying acetabular fractures. Furthermore, the current 3D-VR technology is still not practical for intra-operative use.

Application of scenario simulation teaching in cardiopulmonary resuscitation training for junior surgical residents

Objective To explore the effect of scenario simulation teaching method in the training of cardiopulmonary resuscitation (CPR) for junior surgical residents. Methods 133 junior residents (working life<3 years) in the author's hospital rotating Cardiac Surgery department were selected and divided into control group (n=65) and observation group (n=68), in which the control group adopted traditional classroom teaching: teacher explanation-demonstration-student practice-teacher counseling; the observation group adopted scenario simulation teaching: teacher explanation-demonstration-student practice-teacher counseling scenario simulation. Before and after training, two groups both received the CPR theory and double operation assessment, comparing the difference of assessment scores between groups before and after training. Results There was no statistically significant difference in the demographic characteristics between the two groups. The assessment scores of CPR theory and operation were improved in both groups after training, and there were significant differences (P=0.000). There were no statistically significant differences in the CPR theory and operation assessment scores between the two groups before training (P>0.05); compared with the scores of CPR operation between the two groups after training, the observation group [(84.62±3.94)] was significantly higher than that of the control group [(79.68±5.45)] and there were significant statistical differences (P=0.000), while there was no statistically significant difference in CPR theory assessment scores between the two groups (P>0.05). Conclusions Both traditional classroom teaching and scenario simulation teaching methods could improve the CPR theory and skill level of the surgical junior resident, but situational simulation teaching method is better than traditional classroom teaching method in improving students' CPR performance. Key words: Scenario simulation teaching method; Cardiopulmonary resuscitation; Junior surgical resident; Training model

Trauma Technical Skill and Management Exposure for Junior Surgical Residents – The “SAVE Lab 1.0”

The "Surgery for Abdomino-thoracic ViolencE (SAVE)" animate lab engages surgical residents in the management of complex penetrating injuries. We hypothesized that residents will improve their understanding of the management of trauma patients and will perform skills that they have not previously performed in training. Pre- and postlab assessments were reviewed from surgical residents participating in the SAVE lab over 2 years (2017-2018). Residents of varying levels were grouped and reviewed "real-life" trauma scenarios with supplemental imaging. Seniors were tasked with creating injuries while juniors performed as primary surgeons under supervision. Each successive scenario increased in difficulty, from hollow viscus injury and solid organ disruption, to great vessel and cardiac injuries with the goal to "SAVE" the patient. Assessments included a pre- and postlab multiple-choice questionnaire of trauma management knowledge and a survey of completed technical skills. Academic General Surgery residency program. General, Vascular, Urology, and Plastic Surgery PGY1 to PGY5 residents. One hundred and nineteen residents participated in the SAVE lab in 2017 and 2018. PGY1 to PGY4 residents showed significant improvement in knowledge of trauma management on matched pre- and postlab assessments. The most significant improvement was seen in the PGY1 and PGY2 residents, with scores increasing by 21% (p < 0.001) and 13% (p < 0.001), respectively. PGY1-3 residents had a significant increase in new technical skills acquisition. PGY5 residents showed no significant changes in either realm. The SAVE lab was effective in increasing junior surgical residents' technical skills as well as fund of knowledge related to complex trauma care. While seniors had previously performed most of these skills as reflected in their assessments, the SAVE lab provided a way for them to assume the role of team leader, guiding management of complex, and high acuity situations. Future endeavors include teamwork and leadership skills' assessment through the SAVE lab.