Surgical Residency Training Research Articles

Intensive hands-on microsurgery course provides a solid foundation for performing clinical microvascular surgery.

Microvascular surgery requires highly specialized and individualized training; most surgical residency training programs are not equipped with microsurgery teaching expertise and/or facilities. The aim of this manuscript was to describe the methodology and clinical effectiveness of an international microsurgery course, currently taught year-round in eight countries. In the 5-day microsurgery course trainees perform arterial and venous end-to-end, end-to-side, one-way-up, and continuous suture anastomoses and vein graft techniques in live animals, supported by video demonstrations and hands-on guidance by a full-time instructor. To assess and monitor each trainee's progress, the course's effectiveness is evaluated using "in-course" evaluations, and participant satisfaction and clinical relevance are assessed using a "post-course" survey. Between 2007 and 2017, more than 600 trainees participated in the microsurgery course. "In-course" evaluations of patency rates revealed 80.3% (arterial) and 39% (venous) performed in end-to-end, 82.7% in end-to-side, 72.6% in continuous suture, and 89.5% (arterial) and 62.5% (venous) one-way-up anastomoses, and 58.1% in vein graft technique. "Post-course" survey results indicated that participants considered the most important components of the microcourse to be "practicing on live animals", followed by "the presence of a full-time instructor". In addition, almost all respondents indicated that they were more confident performing clinical microsurgery cases after completing the course. Microvascular surgery requires highly specialized and individualized training to achieve the competences required to perform and master the delicate fine motor skills necessary to successfully handle and anastomose very small and delicate microvascular structures. The ever-expanding clinical applications of microvascular procedures has led to an increased demand for training opportunities. By teaching time-tested basic motor skills that form the foundation of microsurgical technique this international microsurgery-teaching course is helping to meet this demand.

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review.

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles. Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression. Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included. Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition. Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

Freestyle Deliberate Practice Cadaveric Hand Surgery Simulation Training for Orthopedic Residents: Cohort Study.

BackgroundCadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact.ObjectiveThe objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training.MethodsThis study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study.ResultsThe most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training.ConclusionsFreestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work.

Determinants of satisfaction and self-perceived proficiency of trainees in surgical residency programs at a single institution

BackgroundWe aimed to identify factors contributing to training program satisfaction and self-perceived proficiency of residents in 5 integrated surgical residency programs within the same referral institution.MethodsWe conducted a cross-sectional survey including all senior surgical residents in all integrated sub-specialty and general surgery residency programs at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Training programs were assessed on 6 educational components including operative case volume and diversity, intra-operative hands-on training, morning teaching sessions, seminars, ward rounds, and research opportunities.ResultsOf 82 eligible residents, 69 (84.1%) responded to the survey. Overall resident satisfaction (rated from 0–10) varied between the 5 training programs, from a mean of 6.03 to 7.89 (overall p = 0.03). The percentage of residents who agreed they would be proficient by the end of their training ranged from 44.2%-88.9%. General surgery residents had the lowest overall satisfaction score, and lowest scores in all educational components except seminar teaching. In multivariable analysis, operative case volume and diversity (AOR 3.67; 95% CI, 1.24–10.83; P = 0.019), and hands-on training (AOR 4.15; 95% CI, 1.27–13.5; P = 0.018) were significantly associated with overall resident satisfaction. In ordinal logistic regression, hands-on training (OR 3.94, 95% CI, 1.69–9.2; P = 0.001), and seminar sessions (OR 2.43, 95% CI, 1.11–5.33; P = 0.028) were significantly associated with self-perceived proficiency.ConclusionDifferent surgical residency training programs within the same institution had divergent resident satisfaction scores and proficiency scores. Operative case volume and diversity, and intraoperative hands-on training are the most important predictors of resident satisfaction while hands-on training and seminar sessions independently predicted self-perceived proficiency. Attention to these key components of resident education is likely to have a strong effect on training outcomes.

Acquisition of endoscopic nasal surgery skills with a lamb’s head model

ObjectivesTo evaluate the acquisition of surgical skills by otolaryngology residents and established the minimum number of dissections of a lamb’s model to be performed before practicing on human patients. MethodsNineteen second-year otolaryngology residents performed ten dissections each, five on each nasal cavity, always practicing the same three surgical procedures on the lamb model. Each student’s training lasted 2-months, and the entire training intervention lasted 4-years, over four generations of residents. All dissections were recorded and were selected at random for examination by two independent otolaryngology surgeons, who were otherwise not involved in the research. Assessment of the 190 dissections used an instrument validated for surgical training of medical residents. ResultsTo a 1% significance level, statistical analysis revealed increased performance and satisfactory results were observed after the sixth dissection. Furthermore, after the eighth dissection, skill acquisition was relevant and sustained. ConclusionTraining in endoscopic nasal surgery on a lamb’s head model improves surgical skills and handling of surgical instruments. Our results showed the relevance of the lamb model for training in otolaryngology surgery, impacting on patient safety. Level of evidence2.

The Successful Implementation of a Laparoscopic Simulation Training Program in the Dominican Republic

IntroductionMount Sinai Hospital in New York introduced a laparoscopic surgery simulation center to a public hospital in Santiago, Dominican Republic to determine the feasibility of training programs in low-and-middle income countries (LMICs). MethodsIn August 2018, recruitment and preliminary data were collected at the Hospital Jose Maria Cabral y Báez in Santiago, Dominican Republic. The simulation room consists of three simulation stations. Residents were required to practice 1 h/wk guided by a general surgery postgraduate year 3 (PGY3) Mount Sinai resident. Number of hours practiced was self-reported and follow-up data was collected in June 2019. The study endpoints include times on three simulated laparoscopic tasks including peg-transfer, precision cutting, and intracorporeal knot tying. Wilcoxon-signed rank tests were used for statistical analysis. ResultsThe partnership between hospitals allowed for successful integration into the Dominican general surgery training. Over 10 mo, residents averaged 25 h of practice (range: 8-35 h; SD 9.95 h). In total, 85% of the residents participated in the study (5 postgraduate year 1 [PGY1], 2 postgraduate year 2 [PGY2], and 4 postgraduate year 3 [PGY3]). Resident median simulation times significantly improved for precision cutting (3:49 min versus 2:09 min, P = 0.002) and intracorporeal knot tying (5:20 min versus 2:47 min, P = 0.037). There was neither significant difference in peg-transfer times nor performance between resident years (P = 0.12). ConclusionsThis study demonstrates the successful integration of a laparoscopic simulation program into an LMIC surgical resident training program. With commitment from local institutions and external resources, establishing laparoscopic simulation centers are feasible and expandable, thereby allowing general surgery residents in other LMICs, the opportunity to improve their laparoscopic skills.

Value of robotic surgery simulation for training surgical residents and attendings: a systematic review protocol

IntroductionRobotic surgery is a method of minimally invasive surgery performed through small incisions using a remote robotic console. Surgical residents and attendings participate in simulation training to be able to...

The development of visuospatial abilities and their impact on laparoscopic skill acquisition: a clinical longitudinal study

ObjectivesTo investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes.BackgroundLaparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency.MethodA longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training.ResultsLaparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months.ConclusionIn this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.

Surgical residency training program in Somalia: Outcomes of 8 years

Objective Improving global surgery through postgraduate medical training in Africa is needed. In this context, implementing surgical residency programs into international developments for global surgery might play a great role to achieve successful results in low-income countries. The aim of this study is to provide insight about postgraduate surgical training program that was initiated in Somalia where there was no prior formal surgical residency program. Methodology General surgery residency program was initiated within the collaboration of Istanbul Medeniyet University and Benadir University. Medical doctors from Somalia, who were successful on enrollment exams, were selected for program. All residents completed a 3-year of theoretical and practical training, continuing 2 months at Istanbul Medeniyet University Department of General Surgery each year. Results Since 2013, 24 residents graduated from the program and 22 of them currently work as attending physicians in Somalia. Abdominal wall hernias, proctological diseases, cholelithiasis, thyroid diseases and breast diseases are the most common pathologies within the elective operations by graduated general surgeons. Also, appendectomy, infection-induced perforation or ischemia of colon and small bowel and acute mechanical intestinal obstruction due to tumors and adhesions are the most common emergency surgeries. Interventions due to blunt and penetrating trauma are frequently performed. Conclusions This surgical residency program provides surgical care and supports health systems in Somalia. We believe such programs are important to reduce global burden of surgical diseases.

Peer-to-Peer Trauma-Informed Training for Surgical Residents Facilitated by Psychiatry Residents.

This article describes the implementation of trauma-informed care (TIC) didactic training, using a novel, interdisciplinary peer-to-peer teaching model to improve confidence surrounding trauma-informed practices in a surgical residency program. Eight psychiatry residents and two medical students with a background in psychological trauma and TIC and an interest in medical education were recruited to participate in three 2-hour "train the trainer" sessions led by a national expert in TIC. Eight psychiatry residents and two medical students subsequently developed and delivered the initial TIC training to 29 surgical interns. Training included the neurobiology of psychological trauma, principles of trauma-informed care, and developing trauma-informed curricula. Surgical interns reported significantly improved understanding of the physiology of trauma, knowledge of TIC approaches, and confidence and comfort with TIC and practices. Among surgical interns, understanding of the physiology of the fear response increased from 3.36 to 3.85 (p = 0.03). Knowledge of the neurobiology of trauma improved between pre- and post-training surveys (2.71 to 3.64, p = 0.006). Surgery interns also expressed an improved understanding of the connection between fear, trauma, and aggression (3.08 to 4.23, p = 0.002) from pre- to post-training surveys. Post-training knowledge of trauma-informed approaches increased from 2.57 to 4.71 (p < 0.001) and confidence in delivering TIC on the wards increased from 2.79 to 4.64 (p < 0.001). This TIC curriculum delivered via a peer-to-peer training model presents an effective way to improve comfort and confidence surrounding TIC practices and approaches in a surgical residency training program.

Surgical Faculty’s Perspectives on the Unknown Utility of Alcohol‐Preservation in Surgical Resident Education

Under ideal circumstances, surgical skills training should emulate live surgical conditions as closely as possible. While new anatomically accurate models and virtual/augmented reality simulators make surgical anatomical knowledge acquisition more accessible, research shows that these resources are limited in their ability to fully reflect the live human anatomy, and thus the animal and human body donor models remain the gold standards for surgical simulation (Stefanidis et al., 2013, Venne et al., 2020). Previously, there have been studies comparing the porcine and human body donor models. However, very little is known about alcohol‐preserved human body donors in the context of surgical training and education (Balta et al., 2015). The objective of our study was to examine the alcohol‐preservation technique and to further elucidate its utility in general surgery resident education. Utilizing semi‐structured interviews, we analyzed qualitative data obtained from the accounts of surgical faculty who experienced both the porcine and alcohol‐preserved models at The Ohio State University. Results indicated that the porcine and alcohol‐preserved human body donor models were preferred for different aspects of surgical training. While the porcine model was preferred for its ability to teach tissue‐handling and to simulate live blood flow, the alcohol‐preserved model was unanimously preferred for its anatomical relevance. Surgical faculty specifically noted that while there is anatomical overlap between the two models with the anatomy of the rectum, “the small bowel and colon are dramatically different, which does not give the full breadth of colon resection needed for the human model.” The alcohol‐preserved model was also preferred for its ability to teach advanced surgical procedures in low‐stake environments, with a surgical faculty guiding them in a stepwise fashion, and the model was regarded as superior in all aspects as compared to formalin‐fixed human body donors. From the results, it was concluded that the alcohol‐preserved human body donor model showed unique utility in the context of surgical resident education, simulating live operating conditions more accurately as compared to the formalin‐fixed model, and being more anatomically accurate than the porcine model. The findings of this study reflect a significant step in improving surgical resident training and education. Surgical technical proficiency is intimately linked with a surgeon’s amount of experience, and by elevating surgical resident preparation, patient surgical outcomes can likely be improved. Future directions of our research involve the continued refinement of the alcohol‐ and soft‐preservation techniques in order to more accurately simulate live operating conditions, to further improve surgeon training and preparation, translating to better future patient surgical outcomes.

Continuous monitoring of surgical bimanual expertise using deep neural networks in virtual reality simulation

In procedural-based medicine, the technical ability can be a critical determinant of patient outcomes. Psychomotor performance occurs in real-time, hence a continuous assessment is necessary to provide action-oriented feedback and error avoidance guidance. We outline a deep learning application, the Intelligent Continuous Expertise Monitoring System (ICEMS), to assess surgical bimanual performance at 0.2-s intervals. A long-short term memory network was built using neurosurgeon and student performance in 156 virtually simulated tumor resection tasks. Algorithm predictive ability was tested separately on 144 procedures by scoring the performance of neurosurgical trainees who are at different training stages. The ICEMS successfully differentiated between neurosurgeons, senior trainees, junior trainees, and students. Trainee average performance score correlated with the year of training in neurosurgery. Furthermore, coaching and risk assessment for critical metrics were demonstrated. This work presents a comprehensive technical skill monitoring system with predictive validation throughout surgical residency training, with the ability to detect errors.

Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review.

Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review.

Robotic cardiac surgery training during residency: Preparing residents for the inevitable future

Unlike other surgical residency training programs including thoracic surgery, robotic cardiac surgery skill training is minimal or absent in residency curricula. A review was conducted to identify residents' exposure to robotic cardiac surgery training based on databases including PubMed, MEDLINE and Google Scholar. Published papers and cardiothoracic surgical societies with robotic cardiac surgery training courses were reviewed. Robotic cardiac surgery training for residents is almost non-existent. Strategies to establish proper robotic cardiac surgical training for residents include implementing simulation training, implementing hour requirements and establishing wet/dry lab model training in a progressive fashion. As robot-assisted cardiac surgery becomes increasingly commonplace, it will be imperative to provide training for residents with dedicated opportunities to develop their skills in robotic cardiac surgery.

Emergent Surgical Airway Skills: Time to Re-evaluate the Competencies.

IntroductionOne of the most challenging scenarios an anesthesia provider can face is treating a can't intubate can't ventilate (CICV) patient. The incidence of CICV is estimated to be around one in 10,000 cases. According to the American Society of Anesthesiology Closed Claims Study, adverse respiratory events are the most common type of injury, with difficult intubation and ventilation contributing to the majority of these cases. The objective of this non-interventional quality improvement project was to evaluate the prior training, exposure, and self-reported confidence in handling the CICV scenario among anesthesia providers at Henry Ford Hospital in Detroit, MI.MethodsAn online questionnaire was distributed via email to all residents, certified registered nurse anesthetists (CRNAs), and attending anesthesiologists in March 2021. The email contained a link to an online questionnaire via Microsoft Forms (Microsoft Corporation, Redmond, WA). Univariate group comparisons were carried out between the respondents’ role (attending, CRNA, or resident), as well as between the number of years that the respondents were in practice (< 5 years, 5-10 years, > 10 years).ResultsOut of the total 170 anesthesia providers, 119 participated in the study where 54 (45%) were attendings, 44 (37%) were residents, and 21 (18%) were CRNAs. The majority (75%) did not know the surgical airway kit location, and 87% had not performed the surgical airway procedure before. The vast majority (96.7%) recommended simulation training compared to online training or lecture series, and just over 50% recommended annual training frequency. When looking at the differences in responses based on years of experience as an anesthesia provider, the majority of those with > 10 years in practice knew how to perform the surgical airway technique while respondents with < 5 years did not know how to perform the technique, and 50% of those with five to 10 years experience knew how to perform the surgical airway procedure for a CICV scenario.ConclusionAlthough there were many significant differences observed between the various provider roles and years in practice, surprisingly, the responses revealed both a lack of experience and confidence in performing the surgical airway procedure in all provider roles. These findings highlight a need for better emergency airway teaching and training. These findings will be used to guide the design and implementation of improved surgical airway training for residents, CRNAs, and attending anesthesiologists with the goal of better preparedness for handling a CICV scenario.

A Comparative Study of Single-Layered Versus Double-Layered Intestinal Anastomosis.

Background: Intestinal perforations requiring resection anastomosis of the gastrointestinal tract (GIT) or the formation and closure of temporary intestinal stoma are prevalent worldwide. This prospective comparative study was done to assess the efficacy and safety of single-layered anastomosis compared to a double-layered anastomosis.Methods: Patients undergoing intestinal anastomosis with either of these two techniques were observed prospectively for various outcome parameters like time taken for anastomosis, and that for entire surgery, postoperative complications, etc. Data obtained were analyzed for statistical significance by applying the chi-square test and student's “t-test.”Results: Duration for fashioning the anastomosis was significantly lesser for a single layer anastomosis than double (mean [±SD] for single layer was 19.57 ± 2.25 minutes and for double layer group was 30 ± 2.59 minutes, p=0.002). There was no statistical difference in the postoperative complications between the two groups. The postoperative incomplete intestinal obstruction was reported in three cases of the double layer group.Conclusion: Single-layered gastrointestinal anastomosis (GIA) resulted in a significant reduction in time, without any difference in complications. Additionally, it is easier to train surgical residents in the single-layered technique which is particularly important in the setting of a teaching institute and can be recommended for intestinal anastomosis.

Impact of COVID-19 on surgical residency training programs in Mexico City: The third victim of the pandemic. A resident's perspective.

The aim of this study is to assess the perceptions of the impact of health-care disruption due to COVID-19 on the academic training and skills of surgical trainees. We developed a 32-question survey assessing the clinical and surgical impact of COVID-19 on surgical training programs and proposals to compensate for the decrease in surgical education. We got 453 responses of surgical trainees in Mexico City. Sixty-six percent of the respondents answered that their centers had converted to the exclusive attention of COVID-19 patients. Ninety-five percent reported a decrease in surgical skills learning and 91.8% reported a decrease to clinical exposure. On proposals, 75.6% reported that it is essential to take the necessary measures to recover the clinical and surgical milestones lost. In the binary logistic regression analysis, we found that the postgraduate year (≥ PG-Y3) was statistically significant factor (p ≤ 0.000) related to a favorable opinion to developing an academic contingency plan and postponing the end of the academic residency year. More than 90% of the survey respondents reported having been affected by COVID-19 mitigation strategies. Our data calls for urgent training adjustments by hospital and university program leaders to mitigate downstream educational repercussions.

Becoming Artemis's Mother.

This perspective piece describes the author's evolving relationship to motherhood during surgical residency training, and how motherhood became a source of professional ambition despite persistent gender inequity that exists in academic surgery.

Learning should never stop: a survey of surgery residents and supervisors on online teaching during COVID-19 pandemic

Background: The pandemic has imposed a prodigious limitation on surgical training and has disrupted hospital procedures, hindering continuing medical training. We have established an online classroom platform at our institute to pursue medical education, which has been a new experience for our residents and consultants.Method: Across-sectional survey was conducted in the department of general surgery to know the perception of surgical consultants/registrars and junior residents regarding online classes and conventional teaching methods. Survey was conducted online, wherein questionnaires related to online teaching were circulated to resident surgeons and consultants/registrars.Results: A total of 91 surgery residents and 26 surgical supervisors consisting of faculty members and registrars completed the survey. Junior residents provided encouraging feedback and supported online education in the COVID-19 period; they felt that courses were well discussed, except clinical case presentation. A total of 84.6% of surgery residents and all the surgical supervisors felt that lack of a functional operating theatre impeded their training. Majority of surgical supervisors (66%) were moderately satisfied by the quality of online training, whereas junior residents (79%) were very to extremely satisfied and most (83%) approved online classes in future. Majority of junior residents (90%) found the virtual platform very easy to use, opposite to surgery supervisors.Conclusions: Our study demonstrated that online education is a feasible way to train surgical residents. However, since surgical specialties depend heavily on practical experience, it is very important to implement new ways of acquiring practical skills.

Overcoming Systems Factors in Case Logging with Artificial Intelligence Tools

Case logs are foundational data in surgical education, yet cases are consistently under-reported. Logging behavior is driven by multiple human and systems factors, including time constraints, ease of case data retrieval, access to data-entry tools, and procedural code decision tools. We examined case logging trends at three mid-sized, general surgery training programs from September 2016-October 2020, January 2019-October 2020 and May 2019-October 2020, respectively. Across the programs we compared the number of cases logged per week when residents logged directly to ACGME versus via a resident education platform with machine learning-based case logging assistance tools. We examined case logging patterns across 4 consecutive phases: baseline default ACGME logging prior to platform access (P0 "Manual"), full platform logging assistance (P1 "Assisted"), partial platform assistance requiring manual data entry without data integrations (P2 "Notebook"), and resumed fully integrated platform with logging assistance (P3 "Resumed"). 31,385 cases were logged utilizing the platform since 2016 by 171 residents across the 3 programs.Intelligent case logging assistance significantly increased case logging rates, from 1.44 ± 1.48 cases by manual entry in P0 to 4.77 ± 2.45 cases per resident per week via the platform in P1 (p-value < 0.00001). Despite the burden of manual data entry when the platform's data connectivity was paused, the tool helped to increase overall case logging into ACGME to 2.85 ± 2.37 cases per week (p-value = 0.0002). Upon resuming the data connectivity, case logging levels rose to 4.54 ± 3.33 cases per week via the platform, equivalent to P1 levels (insignificant difference, p-value = 0.57). Mapping the influence of systems and human factors in high-quality case logs allows us to target interventions to continually improve the training of surgical residents. System level factors such as access to alternate automation-drive tools and operative schedule integrated platforms to assist in ACGME case log has a significant impact on the number of cases captured in logs.