Surgical Competence Research Articles

Implementation of an Optimized Preoperative Checklist for Endoscopic Sinus Surgery Within a Multiinstitutional Resident Education Curriculum.

Preoperative review of computed tomography (CT) imaging assists with endoscopic sinus surgery (ESS) planning, where trainees may benefit from a systematic approach. We have previously developed an optimized preoperative checklist for sinus CT imaging using an iterative modified Delphi method. In this study, we assess the utility of an optimized preoperative checklist for residents performing ESS. Resident sinus CT scan education consisted of a preintervention questionnaire, an 18-min video outlining the optimized preoperative checklist, and a delayed postintervention questionnaire; these were distributed via Qualtrics to otolaryngology residents across 5 training programs in the NY metro area. The preintervention questionnaire contained 25 survey questions and a 225-point quiz on sinus CT anatomy; the delayed postintervention questionnaire contained the same 25 survey questions and a second, distinct 225-point quiz. In total, 74 residents completed the preintervention questionnaire, 47 completed the postintervention questionnaire, and 36 completed both. Among residents completing both questionnaires, the average preintervention quiz score was 136.8 ± 24.0 and the average postintervention quiz score was 156.0 ± 23.5 (P < .001). Resident habitual utilization of a systematic preoperative CT imaging checklist increased significantly from 21.6% to 72.9% as a result of the curriculum intervention. We find that an educational program centered on an iteratively optimized preoperative checklist for ESS improves the ability of trainees to identify critical sinus CT structures. Further integration of checklists and educational curricula may enhance rhinology education efforts and improve surgical anatomy competency.

Assessment of Surgical Competences for Neck Dissection and Total Laryngectomy on Revascularized Cadaver Models: Onco-Neck-Score and Onco-Larynx-Score.

In surgical simulation, evaluation tools are necessary to allow the overall and specific level of each gesture to be assessed for learners, to allow active feedback and follow-up. The aim of this study was to create and validate a scale for the assessment of competences for neck dissection (ND) and total laryngectomy (TL) in head and neck surgical oncology simulation specific for revascularized cadavers' models. Two independent scales were created for ND and TL based on a two-round Delphi method. The scales were used during ND and TL simulation sessions on SimLife® (Symedis, Poitiers, France) model. Surgical steps were scored by 2 independent observers. To assess its ease of use, a questionnaire was answered by senior surgeons (SS) at the end of the sessions. Fifteen items were included in the final version for ND scale and 20 for TL scale. The results of 14 lateral ND and 8TL were included. The mean score was higher for SS (69 ± 6.4; 87.5 ± 8.5) than for residents (36.5 ± 11; 57.5 ± 13.2) for ND (P = 0.0006) and TL (P = 0.028) respectively. Six SS strongly agreed that this tool had a positive impact on resident training with stepwise feedback and accurately represented their competences. We developed a pedagogic tool built to assess surgical competence for head and neck surgical oncology on revascularized cadaver models. This tool has a good construct validity thanks to the expert reviewing with Delphi method and appears to have fine acceptability by the SS.

What factors influencing surgical nurses' competence in implementing person-centered care in the perioperative period?: A cross-sectional study.

Strengthening the capability of clinical surgical nurses to provide person-centered care (PCC) requires a thorough analysis of several related factors. This study used a descriptive cross-sectional design to investigate the factors that influence surgical nurses' perioperative competency in the performance of PCC in Anhui, China. A convenience sampling was implemented to administer a questionnaire survey to 437 nurses with more than 1 year of experience working in surgical wards. A web-based cross-sectional questionnaire evaluated the participant's general sociological information, empathy, job burnout, and nursing competence. The questionnaire were designed and published through the online platform Questionnaire Stars, and the link was distributed through the Internet and WeChat media by the nursing department of their hospital. Data were collected from June to September 2023 and processed by descriptive, correlation, and stepwise multiple regression analyses. Participants with high levels of empathy (β = 0.502, P < .001), low levels of job burnout (β = -0.288, P < .001), humanistic nursing training (β = 0.167, P < .001), and personnel agency (β = 0.083, P < .001) showed better PCC competence. The regression model analysis showed that 4 influencing factors explained 59.2% of the variance (F = 158.930, P < .001, adjusted R2 = 0.592). These findings suggest that steps should be taken to strengthen the key factors, such as improving empathy, minimizing job burnout, offering more humanities training, and enhancing personalities, to reinforce PCC competency.

Commentary: Assessing surgical competency of novice surgeons using a three-dimensional heads-up display microscope.

Commentary: Assessing surgical competency of novice surgeons using a three-dimensional heads-up display microscope.

A NOVEL TRAINING MODEL TO IMPROVE VASCULAR ANASTOMOSIS IN DEEP CAVITY WITH LIMITED ACCESS

Vascular surgery, particularly the anastomosis of blood vessels in deep cavities, poses significant challenges due to limited access and visibility. Traditional dental and surgical education often focuses on superficial techniques, leaving a gap in training for deep cavity procedures. This study introduces a new training model designed to address this gap and enhance skills in vascular surgery. Objective: To improve skills in performing vascular anastomosis in deep cavities, which presents greater difficulty compared to superficial areas, through the use of an improvised training model. Methods: This prospective observational study was conducted at the Combined Military Hospital, Rawalpindi, from 1st September 2023 to 29th February 2024. The improvised training model is box-shaped with a depth akin to the aorta, made of silicone rubber, and features a removable cap for easy cleaning and reuse. The model provides a realistic environment for practicing deep cavity vascular anastomosis. Participants, including experienced and novice surgeons, used the model to assess its effectiveness in enhancing surgical skills. Results: The model was highly effective in improving surgical techniques, with volunteer surgeons reporting an 82.9% enhancement in their skills and experiences. First-time users also noted significant improvements in their surgical competencies. Quantitative analysis showed that the model was perceived as cost-effective (71.4%) and reusable (74.3%). Participants commented on the realism of the model, particularly its depth and complexity, which facilitated repeated practice without the need for animals or cadavers. Conclusion: The study suggests that this improvised training model can significantly enhance skills in vascular anastomosis, particularly in deep cavity situations. The model is affordable, portable, durable, and provides a realistic simulation of aortic anastomosis in restricted spaces. Further studies are needed to validate its efficacy in broader contexts and its impact on patient outcomes.

Use of e-learning platforms to monitor surgical competencies in medical universities

The emergence of e-learning platforms as a potential means of advancement is not new, but their use has increased significantly during the COVID-19 epidemic. Distance learning presents users with not only problems but also user-centered solutions. The purpose of this study is to review the literature on e-learning platforms used in medical schools to formulate a research strategy to implement an e-learning platform for surgical competency control. To achieve the objective, a search was conducted for articles cited in PubMed, Research Gate, Google Scholar, Web of Science and Scopus databases from journals and conference proceedings published between 2015 and 2023. Literature in the study area was systematized to explore the experiences of users of e-learning platforms in medical schools to provide a basis for a methodological framework.The proposed structure or content analysis model can be used for further e-learning research and guide the successful implementation of e-learning and surgical competency monitoring systems in medical HEIs. An important area of focus is the study of the advantages and disadvantages of specific e-learning methods, as their benefits have not been fully explored and are mainly related to e-learning platforms. Here we consider various features of e-learning in the context of its implementation in the system of medical education in Kazakhstan and other foreign countries.

Evaluation of the impact of short term manual small incision cataract surgery (MSICS) training program on trainees with varying prior surgical experience using international council of ophthalmology-ophthalmology surgical competency assessment rubrics (ICO-OSCAR).

To assess the learning curve of MSICS in three different groups of trainees with varying prior MSICS experience. To evaluate the effectiveness of ICO OSCAR for objective assessment of surgical skill transfer. Ninety-five MSICS trainees were divided into three groups as 1st year resident, fellow and external trainee. Each group were evaluated for their surgical skill acquisition during one month MSICS training program using ICO-OSCAR. Each trainee performed an average of 19 surgeries. The progress in the learning curve of the three groups of trainees was analyzed by evaluating the mean scores in sets of five consecutive cases. Complications during the training period were also noted. The study evaluated a total of 1842 cases. The fellows and external trainees, with prior MSICS experience, had an initial mean score of 57.57 ± 16.16 and 56.86 ± 17.82 respectively, whereas the 1st year resident group had a relatively low initial mean score of 45.91(p = 0.009). The difference in mean scores between the 1st year resident group and other groups significantly reduced towards the end of training. The most common complications made by 1st year residents were in sclero-corneal tunnel construction. The external trainee group had statistically significant higher rates of zonular dialysis in the study. ICO-OSCAR is an effective tool for assessing MSICS training program. Structured short term MSICS surgical training program is effective in surgical skill transfer, especially in novice surgeons.

Mentoring in urology: A way to improve confidence in surgical and clinical competencies.

Mentoring in urology: A way to improve confidence in surgical and clinical competencies.

Assessing the surgical competency of novice surgeons by using a three-dimensional heads-up display microscope.

To evaluate the surgical performance of novice surgeons operating on a three-dimensional (3D) heads-up display system compared to those using a traditional microscope (TM). Prospective study design in a private practice setting. Twenty novice surgeons with similar experiences in cataract surgery were selected. Each surgeon performed 20 phacoemulsification cataract surgeries: 10 surgeries on the 3D heads-up display microscope, and 10 surgeries using a TM system. Data were collected from a total of 400 patients operated on by 20 surgeons. Outcome measures were recorded and graded according to the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric-Phacoemulsification system. The main outcome measure was mean surgical competency scores. Overall, 400 data points were equally distributed between TM (200) and 3D (200) surgeries. The mean surgical competency scores were 60.19 (11.41) for TM surgeries and 62.99 (11.11) for 3D surgeries. 3D surgeries had significantly higher surgical competency scores than TM surgeries ( P = 0.013). The mean surgical duration for TM and 3D surgeries was 35.98 (6.02) min and 34.31 (7.12) min, respectively. 3D surgeries took significantly less time than TM surgeries ( P = 0.012). The overall mean best corrected visual acuity in the logarithm of the minimum angle of resolution units was 0.27 (0.42); in TM and 3D surgeries, it was 0.28 (0.43) units and 0.26 (0.41) units, respectively. The 3D heads-up display system enhances stereopsis in cataract surgery, making it a valuable training tool for novice surgeons in phacoemulsification procedures.

Automated detection of steps in videos of strabismus surgery using deep learning

BackgroundLearning to perform strabismus surgery is an essential aspect of ophthalmologists’ surgical training. Automated classification strategy for surgical steps can improve the effectiveness of training curricula and the efficient evaluation of residents’ performance. To this end, we aimed to develop and validate a deep learning (DL) model for automated detecting strabismus surgery steps in the videos.MethodsIn this study, we gathered 479 strabismus surgery videos from Shanghai Children’s Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, spanning July 2017 to October 2021. The videos were manually cut into 3345 clips of the eight strabismus surgical steps based on the International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR: strabismus). The videos dataset was randomly split by eye-level into a training (60%), validation (20%) and testing dataset (20%). We evaluated two hybrid DL algorithms: a Recurrent Neural Network (RNN) based and a Transformer-based model. The evaluation metrics included: accuracy, area under the receiver operating characteristic curve, precision, recall and F1-score.ResultsDL models identified the steps in video clips of strabismus surgery achieved macro-average AUC of 1.00 (95% CI 1.00–1.00) with Transformer-based model and 0.98 (95% CI 0.97-1.00) with RNN-based model, respectively. The Transformer-based model yielded a higher accuracy compared with RNN-based models (0.96 vs. 0.83, p < 0.001). In detecting different steps of strabismus surgery, the predictive ability of the Transformer-based model was better than that of the RNN. Precision ranged between 0.90 and 1 for the Transformer-based model and 0.75 to 0.94 for the RNN-based model. The f1-score ranged between 0.93 and 1 for the Transformer-based model and 0.78 to 0.92 for the RNN-based model.ConclusionThe DL models can automate identify video steps of strabismus surgery with high accuracy and Transformer-based algorithms show excellent performance when modeling spatiotemporal features of video frames.

Surgical Competency Assessment Using Entrustable Professional Activities

Surgical Competency Assessment Using Entrustable Professional Activities

Abstract 3009: Progressive Structured Simulation-based Surgical Training Program (PROCESS) - Open Vascular Surgery: Study Protocol For A Cross-over, Randomized, Double-blinded Clinical Trial.

Objective: Vascular surgery has been directed towards endovascular approaches; however, not all patients qualify for these procedures. Open vascular surgery (OVS) remains an alternative, demanding a steep learning curve. Exposure to these procedures has declined resulting in a lack of standardization in acquiring OVS skills. Simulation is a solution to this challenge. However, in OVS, there is scarce evidence for structured programs. The measurement of surgical skills is based on objectively assessable subjective tools; yet, they have limitations as evaluators may introduce inherent individual biases. We aim to compare the effectiveness of technical surgical competencies acquisition between a structured progressive simulation-based training program and isolated experience-based training in OVS. Methods: We will conduct a randomized double-blind crossover clinical trial. A control sequence and an intervention sequence of three subgroups with different exposure levels to the simulation program are proposed using 3D printed models. Group 1: open abdominal aortic repair (AAOR), Group 2: vascular anastomosis (VA) and AAOR, and Group 3: specific micro-surgical skills, VA and AAOR. Surgical residents of general, vascular, or cardiovascular surgery programs will be included. Sample size calculation resulted in 45 participants, 15 in each group. Double blinding will involve participants and external evaluators. Randomization will occur in block randomization and permuted block randomization. Results: We anticipated that the structured and progressive simulation-based training program objectively enhances technical surgical competencies. We expect to determine a significant difference in the acquisition of technical surgical competencies based on the progression through different modules within the program and validate the reliability of an assessment tool based on objective metrics for technical surgical competencies in OVS. Conclusion: We hope this initiative will impact the formation of future vascular surgeons, complementing experience-based training with simulation-based programs in OVS. Ensuring that the trainee obtains all the necessary tools to perform OVS and standardize an objective assessment evaluation method.

Intervention for critical aortic stenosis in Hutchinson-Gilford progeria syndrome.

Hutchinson-Gilford Progeria Syndrome (HGPS) is an ultra-rare genetic premature aging disease that is historically fatal in teenage years, secondary to severe accelerated atherosclerosis. The only approved treatment is the farnesyltransferase inhibitor lonafarnib, which improves vascular structure and function, extending average untreated lifespan of 14.5 years by 4.3 years (30%). With this longer lifespan, calcific aortic stenosis (AS) was identified as an emerging critical risk factor for cardiac death in older patients. Intervention to relieve critical AS has the potential for immediate improvement in healthspan and lifespan. However, HGPS patient-device size mismatch, pervasive peripheral arterial disease, skin and bone abnormalities, and lifelong failure to thrive present unique challenges to intervention. An international group of experts in HGPS, pediatric and adult cardiology, cardiac surgery, and pediatric critical care convened to identify strategies for successful treatment. Candidate procedures were evaluated by in-depth examination of 4 cases that typify HGPS clinical pathology. Modified transcatheter aortic valve replacement (TAVR) and left ventricular Apico-Aortic Conduit (AAC) placement were deemed high risk but viable options. Two cases received TAVR and 2 received AAC post-summit. Three were successful and 1 patient died perioperatively due to cardiovascular disease severity, highlighting the importance of intervention timing and comparative risk stratification. These breakthrough interventions for treating critical aortic stenosis in HGPS patients could rewrite the current clinical perspective on disease course by greatly improving late-stage quality of life and increasing lifespan. Expanding worldwide medical and surgical competency for this ultra-rare disease through expert information-sharing could have high impact on treatment success.

Effects of Standardized Patient Simulation and Mobile Applications on Nursing Students' Clinical Competence, Self-Efficacy, and Cultural Competence: A Quasi-Experimental Study.

Simulation-based education has emerged as an effective approach in nursing education worldwide. We aimed to evaluate the effectiveness of a surgical nursing education program based on a simulation using standardized patients and mobile applications among nursing students. A mixed-methods design with a quasi-experimental longitudinal approach and focus group interviews was employed. The data were collected from 130 third-year nursing students at three different time points who were equally divided into experimental and control groups. This study measured the level of clinical surgical nursing competence, self-efficacy in clinical performance, cultural competence, and satisfaction with simulation experience. Four focus group interviews were conducted using open-ended questions to explore the participants' perspectives on the course's efficacy and satisfaction. There were statistically significant differences in clinical surgical nursing competence (F = 8.68, p < 0.001), self-efficacy in clinical performance (F = 13.56, p < 0.001), and cultural competence (F = 10.35, p < 0.001) across time between the intervention and control groups. Student satisfaction with the simulation-based training was high, particularly regarding debriefing and reflection, with an overall mean satisfaction level of 4.25 (0.40). Students' perspectives regarding integrated hybrid training are categorized into three themes: educational achievement, dynamic learning experiences, and satisfaction and suggestion. Simulation-based learning provides a dynamic and immersive educational experience that enables undergraduate nursing students to develop and refine essential clinical skills while also fostering confidence and cultural competence.

Unveilling the hidden skillset: exploring non-technical skills in surgical education across spanish medical universities.

Non-Technical Skills (NTS) are cognitive, social, and personal resource skills that are crucial in complex and high-risk environments. The aims of our research are to determine the prevalence and content of NTS in the surgical rotation teaching guides of the Medicine Degree programs in Spanish Universities, to identify the most prevalent types and subtypes of NTS, and to analyze factors associated with the prevalence of surgical NTS in Medical Schools in Spain. Descriptive observational cross-sectional study involving the identification and collection of competencies outlined in the surgical rotation teaching guides of Spanish Medical Schools. Information regarding university performance was obtained from the Foundation for Knowledge and Development Ranking webpage. The "Non-Technical Skills for Surgeons" (NOTSS) system was used to classify each competency in the teaching guides as NTS (categories and elements) and technical skills. Disagreements were resolved through group consensus. A total of 1,846 competencies were analyzed in surgical rotations of the Medicine Degree programs across 40 Spanish Universities, with 99 competencies identified as surgical NTS, accounting for 5% of the total. The most frequently identified surgical NTS were "Decision Making" (46%), "Communication & Teamwork" (25%), and "Leadership" (19%). Additionally, several NOTSS were not identified in any institution. Public universities and those including a greater number of competencies had a higher rate of surgical NTS competencies, and we did not find a correlation between surgical NTS competencies and quality indices of University Centers. There is a limited presence of surgical NTS in the educational plans of Spanish Universities.

Head rotation and the perception of eyelid height and contour

PurposeEffective visual perceptual processing is one of the many components of surgical competence. Human face identification is most efficient when viewed upright. However, it is not yet clear how this...

Evaluation of Student Expectations and Clinical Competence Skills Performance during Surgery Clerkship Programme: A Comprehensive Study

The existence of a good clerkship system and quality lecturers will undoubtedly enhance the medical students’ knowledge and skills that align with their competencies. This study aimed to evaluate the achievement of surgical competence based on the expectations of students following clinical clerkships in a surgical department. This study included medical students who participated in a clinical clerkship in the surgical department using a mixed method with a sequential explanatory design as a quantitative approach. Pre- and post-tests were also used to assess changes in student knowledge, qualitative results were obtained from focus group discussions (FGD), and standardised questionnaires were used to assess student skills expectations and achievements. The results showed a significant increase in students’ knowledge after participating in a clinical clerkship, with a mean difference of 3.94 [standard deviation (SD) = 10.67]. However, only three of the skills met students’ expectations during clinical clerkship. This was attributed to a lack of opportunities to practice the skills that students had acquired, the presence of too many students, limited time, and a shortage of practical placements in regional hospitals. Most students perceived the majority of lecturers as nurturing and proficient. However, some lecturers are often occupied with their commitment, resulting in infrequent student interactions. The clinical clerkship system for the Department of Surgery at the Faculty of Medicine, Hasanuddin University effectively enhanced student knowledge, but it needs to be improved to meet their skill expectations.

Utility of real-time 3D visualization system in the early stage of phacoemulsification training.

To determine the teaching effects of a real-time three dimensional (3D) visualization system in the operating room for early-stage phacoemulsification training. A total of 10 ophthalmology residents of the first-year postgraduate were included. All the residents were novices to cataract surgery. Real-time cataract surgical observations were performed using a custom-built 3D visualization system. The training lasted 4wk (32h) in all. A modified International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) containing 4 specific steps of cataract surgery was applied. The self-assessment (self) and expert-assessment (expert) were performed through the microsurgical attempts in the wet lab for each participant. Compared with pre-training assessments (self 3.2±0.8, expert 2.5±0.6), the overall mean scores of post-training (self 5.2±0.4, expert 4.7±0.6) were significantly improved after real-time observation training of 3D visualization system (P<0.05). Scores of 4 surgical items were significantly improved both self and expert assessment after training (P<0.05). The 3D observation training provides novice ophthalmic residents with a better understanding of intraocular microsurgical techniques. It is a useful tool to improve teaching efficiency of surgical education.

Implementation and Impact of an Adapted Digital Perioperative Competency-Building Tool to Enhance Teaching, Learning And Feedback in Postgraduate Competency-Based Medical Education

The purpose of this educational intervention was to introduce, iteratively adapt, and implement a digital formative assessment tool in a surgical speciality. The study also evaluated the intervention's impact on perioperative teaching, learning, feedback, and surgical competency. A participatory action research model with a mixed methods approach. This study was performed over 10 months in an institutional hospital in South Africa with a general surgery department. Twelve supervising surgical trainers/faculty and 12 surgical trainees/residents consented to participate in the intervention. The first 4 months of the intervention focused on relationship building, a multi-stakeholder contextual needs assessment and training sessions to support a shared mindset and shift in the teaching and learning culture. The final adapted perioperative competency-building tool comprised a 23-item assessment with four open-text answers (Table 1). Over the following 6-month period, 48 workplace-based competency-building perioperative evaluations were completed. Most trainees took less than 5 minutes to self-assess (67%) before most trainers (67%) took less than 5 minutes to give oral feedback to the trainee after the perioperative supervised learning encounter. On average, the digital tool took 6 minutes to complete during the bidirectional perioperative teaching and learning encounter with no negative impact on the operational flow. All trainers and trainees reported the training and implementation of the digital tool to be beneficial to teaching, learning, feedback, and the development of surgical competency. Analysis of the completed tools revealed several trainees showing evidence of progression in surgical competency for index procedures within the speciality. The focus groups and interviews also showed a change in the teaching and learning culture: more positively framed, frequent, structured, and specific feedback, improved accountability, and trainee-trainer perioperative readiness for teaching. Highlighted changes included the usefulness of trainee self-assessment before perioperative trainer feedback and the tool's value in improving competency to Kirkpatrick Level 4. Implementing an adapted digital Workplace-Based Assessment (WBA) tool using a participatory action research model has proven successful in enhancing the effectiveness of supervised perioperative teaching and learning encounters. This approach has improved teaching and feedback practices, facilitated the development of surgical competency, and ultimately impacted the overall culture to Kirkpatrick level 4. Importantly, it has positively influenced the trainee-trainer relationship dynamic. Based on these positive outcomes, we recommend using this effective method and our relationship-centred framework for implementing formative competency-building tools in future studies. By doing so, larger-scale and successful implementation of Competency-Based Medical Education (CBME) could be achieved in various contexts. This approach can potentially enhance teaching and learning encounters, promote competency development, and improve the overall educational experience for surgical trainees and trainers.

Accreditation Council for Graduate Medical Education Milestone Training Ratings and Surgeons’ Early Outcomes

National data on the development of competence during training have been reported using the Accreditation Council for Graduate Medical Education (ACGME) Milestones system. It is now possible to consider longitudinal analyses that link Milestone ratings during training to patient outcomes data of recent graduates. To evaluate the association of in-training ACGME Milestone ratings in a surgical specialty with subsequent complication rates following a commonly performed operation, endovascular aortic aneurysm repair (EVAR). This study of patient outcomes followed EVAR in the Vascular Quality Initiative (VQI) registry (4213 admissions from 208 hospitals treated by 327 surgeons). All surgeons included in this study graduated from ACGME-accredited training programs from 2015 through 2019 and had Milestone ratings 6 months prior to graduation. Data were analyzed from December 1, 2021, through September 15, 2023. Because Milestone ratings can vary with program, they were corrected for program effect using a deviation score from the program mean. Milestone ratings assigned to individual trainees 6 months prior to graduation, based on judgments of surgical competence. Surgical complications following EVAR for patients treated by recent graduates during the index hospitalization, obtained using the nationwide Society for Vascular Surgery Patient Safety Organization's VQI registry, which includes 929 participating centers in 49 US states. The study included outcomes for 4213 patients (mean [SD] age, 73.25 [8.74] years; 3379 male participants [80.2%]). Postoperative complications included 9.5% major (400 of 4213 cases) and 30.2% minor (1274 of 4213 cases) complications. After adjusting for patient risk factors and site of training, a significant association was identified between individual Milestone ratings of surgical trainees and major complications in early surgical practice in programs with lower mean Milestone ratings (odds ratio, 0.50; 95% CI; 0.27-0.95). In this study, Milestone assessments of surgical trainees were associated with subsequent clinical outcomes in their early career. Although these findings represent one surgical specialty, they suggest Milestone ratings can be used in any specialty to identify trainees at risk for future adverse patient outcomes when applying the same theory and methodology. Milestones data should inform data-driven educational interventions and trainee remediation to optimize future patient outcomes.