Surgical Resident Education Research Articles

Key Issues in Surgical Residency Education

In September 2022, a summit was convened by the American Board of Surgery (ABS) to discuss competency-based reform in surgical education. A key output of that summit was the recommendation that the prior work of the Blue Ribbon I Committee convened 20 years earlier be revived. With leadership from the American College of Surgeons (ACS) and the American Surgical Association (ASA) , the Blue Ribbon Committee (BRC) II was subsequently convened. This paper describes the output of the Residency Education Subcommittee of the BRC II Committee. The Subcommittee organized its work around prioritized themes including curriculum, assessment, and transition to practice. Top recommendations, time-based action steps, potential barriers, and required resources were detailed and vetted through group discussion, broader Committee review and critique, and subsequent refinement. Primary concluding emphases included transitioning to a competency-based training model, facilitating dynamically capable curricular reform emphasizing the digital transformation of surgical care, using predictive analytic assessment strategies to optimize training effectiveness and efficiency, and creating mentorship strategies to govern the transition from training to independent practice in an outcomes-accountable fashion. It was recognized that coordinated efforts across existing organizational structures will be required, informed by dataset integration strategies that meaningfully measure educational and related patient outcomes.

Trained to cut? A literature review of veterinary surgical resident training.

A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.

Is Resectoscopic Hysteroscopy a Dying Art? Creation of an Educational Instructional Video [ID 2683474

INTRODUCTION: Resectoscopic hysteroscopy is a valuable surgical technique for addressing intrauterine pathology. Within our institution, most operative hysteroscopies are performed using newer non-resectoscopic systems, potentially creating a gap in resident surgical education. We developed a novel instructional video demonstrating the components and capabilities of the resectoscopic hysteroscope. Our aim is to assess whether the instructional video increased surgeon comfort using the resectoscopic hysteroscope. METHODS: A pilot cohort study was performed with gynecologic surgery and obstetrics (GS&O) residents and staff physicians at Brooke Army Medical Center. Participants were provided access to the resectoscope surgical set throughout the study, completed a baseline survey assessing surgeon comfort, and then repeated the survey after watching the instructional video. The survey used a 5-point Likert scale with 1) very uncomfortable, 3) neutral, and 5) very comfortable. RESULTS: Of the 20 participants, 85% lacked formal resectoscope training and 45% had no prior resectoscope experience. Prior experience was limited: 55% used it less than five times and 64% had no use in the last year. At baseline, few were comfortable with setup (15%) and troubleshooting (5%). The instructional video significantly increased surgeon comfort with resectoscope setup (P<.001) and troubleshooting (P<.001). Surgeon comfort supervising a resident doubled after the instructional video (33–66%). All participants felt the video was helpful and would recommend it to others (100%; P<.01). Finally, 80% of participants would like more formal training opportunities for other surgical devices. CONCLUSION: This survey demonstrated a gap in surgical experience and comfort using the resectoscope at our institution. The novel instructional resectoscope video improved GS&O resident and staff comfort with setting up and troubleshooting the resectoscope. Staff comfort with supervising a resident using the resectoscope also increased. Future directions include expanding study population to include operating room staff and assessing post-intervention resectoscope utilization rates.

Assessment of Gender Differences in Letters of Recommendation for Physical Therapy Residency Applications.

Letters of recommendation (LOR) are an integral component of physical therapy residency applications. Identifying the influence of applicant and writer gender in LOR will help identify whether potential implicit gender bias exists in physical therapy residency application processes. Several medical and surgical residency education programs have reported positive, neutral, or negative LOR female gender bias among applicants and writers. Little research exists on gender differences in LOR to physical therapy education programs or physical therapy residency programs. Seven hundred sixty-eight LOR were analyzed from 256 applications to 3 physical therapy residency programs (neurologic, orthopaedic, sports) at one institution from 2014 to 2020. Thematic categories were developed to identify themes in a sample of LOR. Associations between writer and applicant gender were analyzed using summary statistics, word counts, thematic and psycholinguistic extraction, and rule-based and deep learning Natural Language Processing . No significant difference in LOR word counts were found based on writer or applicant gender. Increased word counts were seen in sports residency LOR compared with the orthopaedic residency. Thematic analysis showed LOR gender differences with male applicants receiving more positive generalized recommendations and female applicants receiving more comments regarding interpersonal relationship skills. No thematic or psycholinguistic gender differences were seen by LOR writer. Male applicants were 1.9 times more likely to select all male LOR writers, whereas female applicants were 2.1 times more likely to choose all female LOR writers. Gender differences in LORs for physical therapy residencies were found using a comprehensive Natural Language Processing approach that identified both a positive recommendation male applicant gender bias and a positive interpersonal relationship skill female applicant gender bias. Applicants were not harmed nor helped by selecting LOR writers of the opposite gender. Admissions committees and LOR writers should be mindful of potential implicit gender biases in LOR submitted to physical therapy residency programs.

Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness

Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness. To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship. A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022. Residents were asked, "Do you have a mentor who genuinely cares about you and your career?" Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic. A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship. One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents.

Surgical Resident Education and Performance in Extended Focused Abdominal Sonography for Trauma.

Extended focused assessment with sonography for trauma (eFAST) is a rapid triage tool aiding the detection of life-threatening injuries. In academic settings, residents perform most eFAST; however, the ACGME has no recommendations for eFAST training standards. We surveyed general surgery programs (GSPs) regarding eFAST training and established a baseline for sensitivity, specificity, and positive and negative predictive values for resident-performed eFAST. US GSP eFAST surveys were conducted by email and phone. We prospectively collected patient variables and evaluated resident performance from May to September 2022 and 2023 at an academic level I trauma center. A total of 60/339 general surgery residency programs (GSRPs) responded: Ten use Advanced Trauma Life Support (ATLS) only, n = 7 group training, n = 8 on-the-job only, and n = 33 several methods. Resident-performed eFAST had accuracy = 85.6%, sensitivity = 35.6%, specificity = 97.2%, PPV = 75%, and NPV = 87%. General surgery residency program training in eFAST is non-standardized. Sensitivity was considerably lower than the literature suggests. Positive resident-performed eFAST is generally accurate. We recommend a standardized approach to resident training in eFAST.

Clinical application of a three-dimensional-printed model in the treatment of intracranial and extracranial communicating tumors: a pilot study.

Surgical management for intracranial and extracranial communicating tumors is difficult due to the complex anatomical structures. Therefore, assisting methods are urgently needed. Accordingly, this study aimed to investigate the utility of a three-dimensional (3D)-printed model in the treatment of intracranial and extracranial communicating tumors as well as its applicability in surgical planning and resident education. Individualized 3D-printed models were created for eight patients with intracranial and extracranial communicating tumors. Based on these 3D-printed models, a comprehensive surgical plan was made for each patient, after which the patients underwent surgery. The clinicopathological data of patients were collected and retrospectively analyzed to determine surgical outcomes. To examine the educational capability of the 3D-printed models, specialists and resident doctors were invited to review three of these cases and then rate the clinical utility of the models using a questionnaire. The 3D-printed models accurately replicated anatomical structures, including the tumor, surrounding structures, and the skull. Based on these models, customized surgical approaches, including the orbitozygomatic approach and transcervical approach, were designed for the patients. Although parameters such as operation time and blood loss varied among the patients, satisfactory surgical outcomes were achieved, with only one patient developing a postoperative complication. Regarding the educational applicability of the 3D-printed model, the mean agreement for all eight questionnaire items was above six (seven being complete agreement). Moreover, no significant difference was noted in the agreement scores between specialists and residents. The results revealed that 3D-printed models have good structural accuracy and are potentially beneficial in developing surgical approaches and educating residents. Further research is needed to test the true applicability of these models in the treatment of intracranial and extracranial communicating tumors.

Levels and drivers of burnout during the COVID-19 pandemic among a diverse group of resident physicians

ABSTRACT Objectives Evidence has shown significant impacts of the COVID-19 pandemic on physicians. We hypothesized that these effects would impact surgical and non-surgical resident education differently, with non-surgical specialties being more heavily impacted by frontline work and surgical specialties losing elective cases. Methods We examined well-being and burnout among resident physicians in surgical and non-surgical specialties during the peak of the COVID-19 pandemic using the Mayo Physician Well-Being Index (WBI). Results Completed surveys were received from 110 residents, 55% of whom were in a surgical training program. 35% of respondents were identified as ‘at risk’ for burnout. Increased demands from work (adj. OR 3.79, 95% CI 1.50, 9.59, p = 0.005) was associated with an increased likelihood for being ‘at risk’ compared to those without increased demands. Odds of having increased stress level were higher amongst residents with fear/anxiety of the unknown (adj. OR 4.21, 95% CI 1.63, 10.90, p = 0.003) and more demands outside work (adj. OR 10.54, 95% CI 2.63, 42.16, p = 0.001) but lower amongst residents with more time for studying (OR 0.23, 95% CI 0.09, 0.64, p = 0.005). Risk for burnout was not significantly different between surgical and non-surgical specialties when adjusting for increased demands from work (adj. OR 1.43, 95% CI 0.60, 3.37, p = 0.0.418). Conclusion Perceived effects of the COVID-19 pandemic upon residents’ educational experience was mixed: reduced clinical volume had a negative impact, while increased time for study was perceived favorably. These findings suggest potential strategies and targets to mitigate the stress and burnout of a future crisis, whether large or small, among surgical and non-surgical trainees.

Impact of Surgical Resident Education and EMR Standardization in Enhancing ERAS Adherence and Outcomes in Colorectal Surgery

Our study aimed at investigating the degree of adherence to ERAS pathway at our institution and to evaluate the role of providing resident education and a standardized EMR order set in improving adherence and patient surgical outcomes. The study is prospective in nature and consists of two phases with a preintervention cohort to assess adherence to ERAS protocol and a postintervention cohort to evaluate improvement in adherence and patient outcomes. Adherence with the ERAS protocol was assessed across preoperative, intraoperative, and postoperative phases. The study took place at MedStar Franklin Square Medical Center in Baltimore, Maryland, involving inpatient care at a surgical ward. During the preintervention phase, patients undergoing elective colorectal surgery were identified over 6 months (N = 77), and their adherence to the ERAS protocol was assessed. Following the intervention of surgical resident and faculty education sessions on the ERAS protocol and the implementation of a standardized order set in the Electronic Medical Record, a postintervention cohort (N = 54) was selected for comparison over another 6 months. Among 77 patients who underwent elective colorectal surgery, the adherence rate to ERAS protocol was notably below 80% for most elements of the postoperative phase. When pre- and postintervention cohorts were compared, there were no significant differences in the baseline demographics and perioperative variables. After the implementation of our intervention, adherence rates were significantly improved in 7 out of 8 ERAS protocol elements of the postintervention phase. Among primary outcome measures, readmission rate (24.7% vs.9.4%; p = 0.022) and length of stay (7.3 ± 4.5 vs. 5.5 ± 3.6; p = 0.014) were significantly lower in the postintervention cohort. Although the rate of postoperative complications did not decrease significantly (33.8% vs. 31.5%; p = 0.284), there were fewer patients with postoperative ileus and surgical site infections. Outcomes were evaluated based on an 8-point score of postoperative ERAS elements. A significant decrease in mean length of stay and readmission rates is observed when at least 5 elements are completed, emphasizing the ERAS pathway's importance as a complementary bundle. Our study highlights the impact of resident education and electronic medical record standardization on ERAS adherence in colorectal surgery. This multidisciplinary approach improves adherence, reduces hospital stay, and enhances communication among healthcare providers for better patient outcomes.

Did Residents Stop Operating During COVID? Impact of COVID-19 Across VA Teaching Hospitals on Surgical Resident Education.

During the COVID-19 pandemic, elective cases across the nation were suspended, leading to major decreases in operative volume for surgical trainees. Surgical resident operative autonomy has been declining over time, so we sought to explore the effect COVID-19 had on resident autonomy within VA teaching hospitals. A retrospective analysis of surgical cases across specialties was performed using the VA Surgical Quality Improvement Program database from September 2019 to September 2021 at VA teaching hospitals. Supervision codes are recorded prospectively: attending surgeon performs the operation (AP), resident completes majority of the case with the attending scrubbed (AR), and resident is primary surgeon without attending scrubbed (RP). 20,457 cases pre-COVID decreased to 11,035 during peak-COVID (P < .001). Overall, RP cases increased from 6.5% to 7.6% during the peak (P < .001) and trended back downwards during the recovery periods. AP decreased initially (29.9%-27.7%, P < .001), but regressed back to pre-pandemic numbers. In general surgery RP cases, urgent cases such as laparoscopic cholecystectomies increased from 18.8% to 27.5%, while elective repairs decreased during the peak. Similar changes were noted across specialties. Operative cases dropped by half from pre- to peak- COVID and remained 20% below pre-pandemic volume the following year. Interestingly, RP rates increased for several specialties during the peak of the pandemic, which may have resulted from a relative higher ratio of resident personnel:case volume and shift in case distribution from elective to urgent. The increase in RP rate has begun to regress to pre-COVID levels which need to be readdressed.

Evolution and Innovations in Surgical Residency Education among Global Health Challenges

Evolution and Innovations in Surgical Residency Education among Global Health Challenges

Research training as an integral part of surgical resident education: Central Surgical Association presidential address

Research training as an integral part of surgical resident education: Central Surgical Association presidential address

Parathyroidectomy outcomes for Asians in the United States: Implications for resident surgical education

IntroductionOutcomes for Asian patients in the United States are often overlooked in the surgical literature. Surgical education includes little emphasis on reporting outcomes for Asian patients in the United States. Our null hypothesis (H0) is that there is no difference in surgical complications following parathyroid surgery between Asians and all other ethnicities in the United States. Our alternate hypothesis (H1) is that Asians have more incidences of certain complications (possibly due to culture and language barriers). MethodsData from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for parathyroidectomy and patient race. Complications within 30 days of surgery were extracted. ResultsAmong, White, Black, Asian, Pacific Islanders, Native Americans, and Hispanic patients of the United States the Asians (p = 0.018) and Blacks (p = 0.003) had increased operative time for parathyroid surgery compared to other groups. Hispanics had the most surgical complications (p = 0.025). Blacks had statistically significant longer hospital stay (p < 0.0001). Discussion/conclusionUnited States Asian patient data is not typically analyzed separately for complications. We found that in the United States Asians have increased operative time for parathyroidectomy. Future studies of healthcare inequities should include analysis of data for Asian surgical data in the United States as this may help prevent future surgical complications.

Smart surgical glasses for orofacial cleft surgery training in high- and low-income countries: A proof of concept

The coronavirus 2019 pandemic urged us to find alternatives for education through remote proctoring and international surgical collaborations among high-, middle-, and low-income countries. Smart surgical glasses are promising for remote surgical education and international surgical collaborations. This study aimed to assess the usability of smart surgical glasses during cleft surgery and explore their potential in remote surgical education and collaboration. Six plastic surgical cases were randomly selected and recorded using the RODS&CONES glasses in 4K (3840×2160p). A 23-point questionnaire was sent to one plastic surgeon, one plastic surgery resident, and eight doctors who were not trained to critically appraise the video and audio quality of the smart surgical glasses and their applicability for remote surgical education. The participants indicated that the smart glasses had several significant advantages over conventional on-site education, such as facilitating a better view of the surgical field and providing possibilities for remote interaction. The audio quality was considered excellent. The main limitations were image stabilization issues and loss of video connection due to weak wireless fidelity. All participants appreciated the use of smart glasses for remote education and considered them a promising tool for enhancing the quality of surgical education. The glasses can enable remote assistance and education of local surgical residents and may facilitate sustainable surgical collaborations among high-, middle-, and low-income countries.

From principles to practice: Implementation of entrustable professional activities (EPAs) for surgical pathology residency education in a large academic hospital

Over the past decade, competency-based medical education (CBME) has gained momentum in the United States to develop trainees into independent and confident physicians by the end of their training. Entrustable professional activities (EPAs) are an established methodology for assessing trainee development through an outcomes-driven rather than a time-based model. While EPAs have been utilized as an assessment tool for CBME in Europe and Canada, their validation and implementation in some medical specialties has occurred more recently in the United States. Pediatrics was the first specialty in the US to conduct a large-scale UME-GME pilot. Pathology Residency EPAs were published in 2018; however, implementation in training programs has been slow. We have piloted EPAs in our residency program's surgical pathology rotation and propose a unique set of 4 surgical pathology EPAs to track trainee preparedness for independent practice.

Outcomes in Minimally Invasive Sleeve Gastrectomy and Implications for Surgical Resident Education.

Introduction: Resident participation in advanced minimally invasive and bariatric surgeries is controversial. The aim of this study is to evaluate the safety of resident participation in robotic and laparoscopic sleeve gastrectomy (SG). Methods: Prospectively maintained institutional Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database was used to identify patients who underwent SG, which was performed at our institution between January, 2018, and December, 2021. Operative notes were reviewed to determine the training level of the assistant. These were then classified into 7 groups: postgraduate years 1-5 residents, bariatric fellow (6), and attending surgeons (7). Each group was stratified and their outcomes, which included duration of surgery, length of stay (LOS), postoperative complications, readmissions, and reoperations, were compared. Results: Out of 2571 cases, the assistants for the procedures were minimally invasive surgery (MIS) fellows (n = 863, 58.8%), fifth- and fourth-year residents (n = 228, 15.5%), third- and second-year residents (n = 164, 11.2%), no assistants (n = 212, 14.5%), and 134 robotic SG. Mean body mass index was higher in cases wherein the attending surgeon performed by himself (47.1, standard deviation 7.7) when compared with other groups. There were no conversions to open. Mean LOS was 1.3 days, and there was no difference between groups (P = .242). Postoperative complications were low, with 11 reoperations in 30 days (3.3%) and no difference between groups. There was no mortality in 30 or 90 days. Conclusion: Postoperative outcomes were similar for patients who underwent SG regardless of the assistant's level of training. Including residents in bariatric procedures is safe and does not affect patient safety. Encouraging residents to participate in complex MIS procedures is recommended as part of their training.

A novel 6-day cycle surgical pathology rotation improves resident satisfaction and maintains Accreditation Council for Graduate Medical Education (ACGME) milestone performance

Surgical pathology residency training in the United States lags behind other specialties in quality control and graduated responsibility to train independent pathologists capable of seamlessly entering practice after training. We observed that our traditional 3-day-cycle surgical pathology cycle (day 1–grossing; day 2 –biopsies/frozens/preview; day 3 – sign-out) consistently and negatively impacted resident education by reducing preview time, case follow-up, immunohistochemical stain (IHC) interpretation, and molecular study integration. We aimed to create a modern surgical pathology rotation that improved performance and outcomes. We innovated our rotation to enhance resident education and ensure graduated responsibility. A novel 6-day cycle was created composed of 2 grossing days, 1 frozens/biopsies/preview days, 2 dedicated sign-out days, and 1 frozens/biopsies/case completion day. Residents completed surveys before implementing the new rotation and 6 months after implementation to track self-assessment of Accreditation Council for Graduate Medical Education (ACGME) milestone performance and internal quality control metrics. Clinical Competency Committee (CCC) annual evaluations were assessed in paired PGY levels pre- and post-intervention. After implementation, there was a statistically significant improvement in self-assessment of levels 4 and 5 of ACGME milestones and improved satisfaction of quality metrics, including time for previewing, reviewing IHC, graduated responsibility, and perceived readiness for independent practice. CCC evaluations showed overall maintained performance levels, with trends towards improvements in junior resident classes. Our 6-day cycle adequately fulfills the current demands of our sizeable academic center's surgical pathology training and can be a model for pathology residencies looking to modernize their surgical pathology rotations and resident education.

Residency Program Characteristics Associated with Higher Cataract Surgery Volume

ABSTRACT Purpose Prior research has shown that ophthalmology residents improve their cataract surgery competency as they perform additional surgeries beyond the 86 minimum cases mandated by the Accreditation Council for Graduate Medical Education (ACGME). Therefore, cataract surgery volume is an important benchmark for ophthalmology programs. Understanding the possible influence of residency program characteristics on resident cataract surgery volume may help educators in identifying areas for improvement and aid applicants in choosing between programs. The aim of this study was to assess residency program characteristics associated with higher mean cataract surgery volume for ophthalmology residents. Methods We conducted a retrospective, cross-sectional analysis of the San Francisco Match Program Profile Database to assess various program characteristics from the 113 listed ophthalmology residency programs. The associations between program characteristics and the mean cataract surgery volume per graduating resident (CSV/GR) over years 2018–2021 were analyzed using multiple linear regression. Results Out of 113 listed residency programs, 109 (96.5%) were included in our study. Across all programs, the mean (SD) CSV/GR was 195.9 (56.9) cases with a range of 86 to 365 cases. In multiple linear regression analysis, the presence of a Veteran Affairs (VA) training site (β = 38.8, P = .005) and the number of approved fellows per year (β = 2.9, P = .026) were positively correlated with higher mean CSV/GR. The 85 (78.0%) programs with VA training sites had a higher mean (SD) CSV/GR of 204.1 (55.7) cases compared to 166.7 (52.7) cases in the 24 (22.0%) programs without VA sites (P = .004). The mean CSV/GR increased by 2.9 cases for each additional fellow slot after adjusting for other factors. The number of approved residents per year, affiliation with a medical school, and the number of faculty were not significantly associated with CSV/GR. Conclusion All ophthalmology residency programs included in this study currently meet or exceed the ACGME requirements for cataract surgery case numbers. The presence of a VA training site and a higher number of fellowship positions were associated with higher mean resident cataract surgery volumes. Residency programs may consider further investing in these areas when seeking to improve resident surgical education. Additionally, residency applicants prioritizing cataract surgery volume may consider these factors when evaluating programs.

Creation of an Application to Increase Surgical Resident Operative Case Coverage

Studies have shown that the confidence of surgical residents to perform procedures after completing residency can be affected by their volume of operative experiences. Many surgical residencies span multiple hospitals with a multitude of attendings providing additional educational opportunities available via cross-coverage. This study aims to evaluate the use of a mobile application (app) for operative cross-coverage to improve surgical opportunities in a large surgical residency program and decrease the number of uncovered cases. An app allowing for uncovered cases to be sent to all surgical residents was used starting March 2022. A survey was completed by residents pre- and postapp implementation. A retrospective chart review was conducted of all general surgery procedures at the 2 major hospital systems 4 months before and after implementation to evaluate resident case coverage. In the preapp survey, 71% (27/38) of residents noted cross-covering 1 or more cases a month with 90% (34/38) reporting, they were unaware of all cases available. In the postapp survey, 100% of residents reported better awareness of available cases, 97% (35/36) reported uncovered cases were more easily accessible, 100% felt the app simplified finding coverage, and 100% wanted to continue the app long-term. On retrospective review, 7210 cases were identified in the preapp and postapp period with an increased volume of cases in the postapp period. After implementation of the case coverage app, there was a significant increase in total case coverage (p = <0.001) as well as a significant increase in coverage of endoscopic (p = 0.007), laparoscopic (p = 0.025), open (p = 0.015) and robotic cases (p = <0.001). This study shows the impact that technological innovation can play in the education and operative experiences of surgical residents. This can be used to improve operative experiences of residents in various surgical fields in any training program throughout the country.

Simulation in Surgical Resident Education: A Porcine Hemostasis and Laparoscopic Model.

The steep learning curve associated with learning laparoscopic techniques and limited training opportunities represents a challenge to general surgery resident training. The objective of this study was to use a live porcine model to improve surgical training in laparoscopic technique and management of bleeding. Nineteen general surgery residents (ranging from PGY 3 to 5) completed the porcine simulation and completed pre-lab and post-lab questionnaires. The institution's industry partner served as sponsors and educators on hemostatic agents and energy devices. Residents had a significant increase in confidence with laparoscopic techniques and the management of hemostasis (P = .01 and P = .008, respectively). Residents agreed and then strongly agreed that a porcine model was suitable to simulate laparoscopic and hemostatic techniques, but there was no significant change between pre- and post-lab opinions. This study demonstrates that a porcine lab is an effective model for surgical resident education and increases resident confidence.