Surgical Residency Programs Research Articles

Educational needs of the EAES young surgeons.

Surgical residency programs are facing ongoing challenges since the pandemic. The Young Member (YM) Task Force of the European Association for Endoscopic Surgery (EAES) has been created to support surgical residents and surgeons under 40, promoting activities that could be useful for young surgeons and to improve networking between members of different countries. This project aimed to explore educational needs among European surgical residents to inform the EAES curriculum for young surgeons. Within the EAES surgical society, the YM developed a survey to capture residents' views on their professional needs. Different aspects were considered, from demographic information to the major topics of interest on a professional side. Semi-automatic answers and personal suggestions have been gathered and considered for the analysis. Data were captured from 386 respondents across 57 different countries, major responders were represented by the group of 31-35years old (40%). Considering professional growth, young surgeons rely on scientific research (56%), but they struggle finding adequate support of facilities. In the education and training section, fellowships and hands-on-courses (27%) were the most proficient activities. Mentorships and webinars were important to develop leadership, as well as social events to build up a professional network. This project has identified young surgeons' educational and professional needs that can inform the EAES future projects and activities.

Sculpting the good surgeon or excising the bad one: How clinical teachers could perpetuate attrition in surgical residency programmes.

Attrition in surgical residencies remains a significant issue, with traditional research focusing mainly on individual and programme factors. This study explores the role of clinical teachers (CTs) in influencing attrition rates. CTs are essential in moulding residents' training, serving both as enablers of workplace learning and guardians of their medical fields. We employed a hermeneutic phenomenology framework to understand the sociocultural impacts on attrition. Data were collected through semi-structured interviews involving 19 CTs, 3 residents who left the programme and 2 who underwent remediation, following a six-step hermeneutic phenomenological analysis process. The entrenched 'good surgeon' narrative within the department demanded selflessness and total dedication, which CTs reinforced, thereby normalising a rigorous and challenging environment. This has led to attrition when residents fail to meet these challenges or choose to disengage from the system. We illustrated that CTs were pivotal in perpetuating these expectations, contributing significantly to resident attrition. CTs played a crucial role in resident attrition by enforcing a stringent cultural norm within surgical training programmes. Addressing this issue requires a visible change in CTs' role to foster a more supportive educational environment. Emphasising the beneficial aspects of the 'good surgeon' narrative and mitigating its adverse impacts is essential for reducing attrition rates and assisting all residents, including those facing challenges, in successfully completing their training.

MCQs in-training examination scores of the surgical residency program in Thailand: the relationship between medical school vs public health-based training institutions

BackgroundThis study aims at investigating and evaluating the categorical knowledge of residency using an internet-based examination.MethodsAll in-training examinees from 32 Thailand’s general surgery residency training institutions participating in the online examination. One hundred fifty Multiple Choice questions (MCQs) were selected for this examination from a pool of previous MCQs used for board certification examinations. Baseline chracteristic of the examinee including residency year, training institution (medical schools and public health-based training institutions), regional-based area of the institution, overall test score, scoring by subcategory, total time to complete the examination, and the length of accredited as a training centre time were collected and analysed.ResultsTotal 613 examinees. The mean total score of 1st and 3rd year residency of a public health hospital institution differed from those with medical school-based training. On average, the scores in 4 out of 10 categories of residency from medical school training institutions were higher. However, residency from institutions with over 7 years of experience tended to score higher in the Liver, Biliary and Pancreas category.ConclusionsThe average scores of MCQs exams which reflect the medical knowledge for general surgical residency training at medical schools do not significantly differ from those of individuals undergoing public health training. Additionally, the mean scores of MCQs exams did not differ between high-experience training institutions and recent accredited training centers.

Using resident performance on Step 2 to predict surgical residency success

ObjectiveTo determine whether performance on Step 2 CK can be used to predict adverse academic outcomes in surgical residency. MethodsSurgical resident data from a single institution was used. Step 2 scores of each resident were normalized against the average Step 2 CK score for each cohort's application cycle (ie, resident who scored 246 on a year with a national average of 246 would have a normed score of 1; resident with a score >246 would have a normed score >1 etc). All adverse events were classified, and logistic regression analysis was used to determine the effects of the Step 2 scores. Adverse academic outcomes were defined. ResultsNinety-two surgical residents were evaluated with 7,182 faculty evaluations reviewed. Lower Step 2 CK scores demonstrated an increased likelihood of lower American Board of Surgery In-Training Examination performance <25% (P = .011). The remaining adverse events, including passing the Qualifying Examination (P = .998), passing the Certifying Examination (P = .778), early withdrawal from the surgical residency program (P = .565), failure on mock orals during postgraduate years 4 and 5 (P = .731; P = .600), as well as selection of administrative chiefs (P = .565), all demonstrated no correlation. ConclusionEmphasis has historically been placed on board examinations like Step 2 CK to predict overall success in residency and is used as an important metric during the interview process. However, these findings demonstrate that although lower scores on Step 2 CK correlate with a lower quartile on the American Board of Surgery In-Training Examination during general surgery residency, the examination cannot predict success in all areas of surgical residency.

Reproductive Planning and Infertility: Training the Next Generation of Surgeons

Female surgeons face increased rates of fertility challenges compared to the general population. We aim to understand surgical trainees' understanding and perspectives on family planning. A 35-question survey was emailed to program directors at all US surgical residency programs for distribution to residents. Descriptive analyses were performed to evaluate resident understanding and perspectives on family planning and fertility treatments. A total of 121 residents responded to the survey. Most were female (n​=​78; 65​%). Responders indicated the need to postpone pregnancy during training (female: n​=​48, 64​% vs male n​=​18, 45​%; p​=​0.09). Potential negative career consequences (n​=​50; 42​%), limited leave benefits (n​=​47; 39​%), and lack of childcare (n​=​45; 38​%) were primary reasons for postponing pregnancy. Only nine responders (8​%) received fertility-preservation education. Surgical trainees delay pregnancy for career and social support concerns and are interested in reproductive preservation. Fertility education could provide needed support for trainees.

Phacoemulsification to MSICS: A transfer of skills study in a simulated environment.: Transfer of phacoemulsification surgical skills to MSICS.

To investigate if phacoemulsification experience impacts and transfers to the skill acquisition of novices in manual small incision cataract surgery (MSICS) within a simulation environment. Copenhagen Academy for Medical Education and Simulation, Denmark. Prospective controlled experimental study. The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to either have 1) proficiency on the EyeSi surgical simulator (PG; phaco group) or 2) no prior extensive exposure to the EyeSi simulator or any phacoemulsification surgery experience as a primary surgeon (CG; control group). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including nine modules and 30 steps (points). A pass/fail score was determined at 20 points (out of 30 points). Performance scores were analyzed using independent samples t-tests, pass rates using Fisher's exact test, and individual modules using Fisher-Freeman-Halton analysis. The PG performed significantly better in terms of overall performance score (mean SD, PG; 21.8 points 2.3 versus CG; 18.9 points 2.2, p = 0.002, t-value = -3.39) and pass rates (PG; 72 % versus CG; 22%, p = 0.018). The sub-analysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules. The results suggest a positive inter-procedural transfer of skills between phacoemulsification and MSICS. Pretraining and experience in phacoemulsification demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that phacoemulsification experience provides an advantage before MSICS training in surgical residency programs.

Elevating Residency Match Success: The Potential Impact of a Home Program on the Surgical Match Rate

IntroductionHome residency programs can provide medical students with opportunities for networking, mentorship, research, and exposure to surgeries. The goal of this project was to understand the potential impact of home surgical residencies on student match rates into specific surgical specialties. MethodsThis 5-year retrospective study (2019-2023) analyzed 12,916 matched applicants from 155 United States MD programs through publicly available match lists. Odds ratios (ORs) were used to determine the likelihood of students from institutions with home surgical residency programs (home programs) matching into desired surgical specialties compared to students from institutions without home programs. Additional variables included the Alpha Omega Alpha and the Gold Humanism Honor Society statuses of the medical school, the number of faculty, and the type of residency program. ResultsOf the matched applicants, 11,442 had home programs resulting in a 39.1% match rate into surgical specialties compared to a 22.3% match rate for students without a home program (OR: 1.76) (P < 0.001). Of the applicants with a home program compared to those without a home program, 69.2% matched into an academic residency (OR: 1.06), 7.7% matched into a community residency (OR: 0.90), 13.6% matched into a combined residency (OR: 0.95), and 2.5% matched into a military residency (OR: 1.31). ConclusionsMedical students graduating from institutions with home programs were 1.76 times more likely to match into a surgical residency program compared to those graduating from institutions without a home program. Future studies should look at how access to certain resources may influence a student's match rate.

Interest in Cardiothoracic Surgery Among the American College of Osteopathic Surgeons' Medical Students.

As more integrated cardiothoracic (CT) surgical residency programs are developed, there is increased interest in factors influencing specialty selection during undergraduate medical education. This study aimed to nationally assess interests and perceptions of CT surgery from medical students pursuing surgery and factors influencing such interests. Active members of the American College of Osteopathic Surgeons - Medical Student Section were invited to complete an original survey. Means and 95% confidence intervals were calculated and graphed for questions using Likert scale responses. The comparison of mean responses for students in preclinical versus clinical years was assessed by a Kruskal-Wallis non-parametric ANOVA. Differences between response proportions were assessed via Bonferroni Comparison of Column Proportions. There were 306 surveys completed. Interest in CT surgery was indicated by 10.24% of respondents with preclinical students comprising 84.3% of those responses. Most students interested in CT surgery experienced certain factors including clinical exposure (78.4%), shadowing (81.8%), volunteering (57.1%), and significant personal/life events (86.2%) before medical school. Preclinical students noted exposure to CT surgery during preclinical years would further increase their interest when compared to clinical students (μ=4.12 versus μ=3.51, P<0.000). Importantly, clinical students feel significantly less supported by their school to pursue CT surgery compared to preclinical students (μ=2.45 versus μ=3.40, P<0.000). All factors establishing interest in CT surgery occurred before students entered medical school and during preclinical years. While there are negative perceptions associated with CT surgery, these may be ameliorated with increased support and resources for CT surgery during the preclinical years.

Does Game-Based Learning Promote Academic Engagement Among Millennial Oral and Maxillofacial Surgery Residents?

BackgroundHouse staff participating in surgical residency programs are often comprised of adult learners from the millennial generation (Gen Y). With the increasing gap in both age and learning styles between these residents and their educators, their educators are struggling to keep them academically engaged. PurposeThe purpose of this study was to measure the association between implementing a digital online Jeopardy!® (Sony Pictures Studios, Culver City, CA) style game (digital game) (Factile© Solace Creative, LLC, Melbourne Beach, FL) into oral maxillofacial surgery (OMS) resident didactic training and Oral and Maxillofacial Surgery In-service Training Examination (OMSITE) scores. Study Design, Setting, SampleThis study was a retrospective cohort study conducted at The New York Presbyterian Hospital/Weill Cornell Medicine (NYP/WCM). OMS residents who took the OMSITE exam were included in the study. Exclusion criteria included OMS residents who did not take the OMSITE in a given year. Independent VariableThe independent variable was the timing of the implementation of the digital game, divided into before and after implementation. Main Outcome VariablesThe primary outcome variable was OMSITE scores. CovariatesCovariates included demographics (age, gender, race), year of training, and number of examination attempts. AnalysesDescriptive and bivariate statistics included Fisher's exact test and Wilcoxon rank sum test. Linear mixed modeling was performed to take into account multiple observations per participants. ResultsThe sample composed of 14 resident subjects with a median age of 27.5 [27.0, 28.7]. Females represented 29% of the cohort. Seventy-one percent of the participants were PGY-1. The median (interquartile range [IQR]) OMSITE score pre-implementation: 61 (48,71) and post-implementation: 79 (68,87). On average, the OMSITE scores, improved significantly following the implementation of this study modality (p < 0.001). ConclusionsDigital games may be an effective learning tool to prepare residents for OMSITE by promoting academic engagement.

Surgical Residency Training in Nigeria: An Audit Through the Lenses of the Trainee and Trainer

IntroductionResident doctors constitute an important workforce of the Nigerian healthcare system wherein they undergo structured training to become competent specialists in different fields of medicine. The aim of this survey was to audit the surgical residency training process, incorporating both the trainer's and the trainee's perspectives, with a view to improving both residency training and overall patient care. MethodsThis was a multicenter descriptive cross-sectional study involving consultant surgeons and surgical trainees in selected tertiary healthcare institutions in Nigeria. A link to an online semi-structured and pretested questionnaire was sent to study participants whose agreement to fill out the questionnaire was taken as implied consent for the study. The perception of respondents on key areas of surgical residency training like the quality of training, skill acquisition, mentorship, supervision, operative exposures, research, funding, didactic sessions, and work schedule was assessed using a Likert scale. Their perceived challenges to training and measures to improve the quality of training were recorded. Data were analysed using version 23 of the SPSS. ResultsA total of 127 participants (25 trainers and 102 trainees) were recruited with a mean age of 34.8 ± 3.5 y for the trainees and 47.5 ± 6.9 y for the trainers. The majority of both the trainers and trainees (72%, n = 18 and 93%, n = 96, respectively) were dissatisfied with the quality of surgical residency training in Nigeria with the trainers (88%, n = 22) and trainees (97.1%, n = 99) mostly agreeing that surgical training should be standardized across training centres in Nigeria. The trainees and trainers rated mentorship, research, funding, and overall quality of surgical residency training as inadequate, while most of the trainees and trainers rated supervision of trainees as adequate. The trainees predominantly identified poor training facilities as the most important challenge to surgical residency, followed by high clinical workload, while the majority of the trainers identified workplace bullying and high clinical workload as being the predominant factors. The nine-pronged recommendations by both the trainers and trainees to improve surgical training in Nigeria include mentorship program for trainees, funding of surgical residency training, provision of facilities and equipment for training, adequate supervision of trainees by trainers, job description and defined work schedule for trainees, health insurance of patients, overseas training of trainees during the residency program, improved remuneration of trainees, and adequate motivation of trainers. ConclusionsThe quality of surgical residency training in Nigeria is perceived as suboptimal by trainees and trainers. Perceived common challenges to surgical residency training include poor training facilities, workplace bullying, and high clinical workload. Adequate funding of surgical residency program, standardized mentorship, and training of trainees with improved remuneration of trainees and motivation of their trainers would enhance the overall quality of surgical residency training in Nigeria.

Increasing Underrepresented Minority Representation in a General Surgery Residency Program Utilizing a 3-Phase Strategy.

Underrepresented minority groups (URMs) in surgery are not significantly increasing despite evidence suggesting that diversity in health care providers leads to excellent patient outcomes and care. Efforts to increase URM representation in surgical residency programs are essential for addressing disparities and improving health care delivery. This retrospective study outlines a three-phase strategy implemented at a large academic-affiliated hospital to increase URM representation in its general surgery residency program. The strategy encompassed interview selection with a holistic review and implicit bias training for interviewers, modification of the interview scoring rubric, and post-interview recruitment efforts, including a virtual second look event for URM applicants. Following the implementation of these strategies, the URM match rate improved from 0 to 33.3% in the first year and was sustained at 33.3% in the subsequent year. Consequently, the representation of URMs in the residency program rose from 6.7% before our intervention to 13.3% afterwards. This structured approach successfully increased URM representation in a surgical residency program, affirming the success of targeted recruitment strategies. By promoting a diverse and inclusive environment, the program better reflects the community it serves, with aims at improved patient care and patient satisfaction.

Residents' Perspectives of Pregnancy and Growing a Family During Surgical Training: A Review of the Literature.

As more female surgical residents choose to start families during training, concerns regarding program support and peer perceptions emerge. Delayed parenthood, stress, and even attrition can result from inadequate support systems. Database search (MEDLINE, PubMed, EMBASE) in June 2022 identified 17 relevant studies published between 2012-2022, including systematic reviews and qualitative surveys, focused on surgical residents/fellows and program directors. The thematic analysis explored themes related to supporting residents navigating parenthood. Thematic analysis of 17 studies (systematic reviews and qualitative surveys with residents/fellows and program directors) identified key recurring themes related to challenges experienced by surgical residents navigating parenthood. The themes includedmodified work schedules, mentorship programs, cross-coverage plans, lactation support, childcare options, and clear leave policies. By understanding these challenges and implementing tailored support strategies, surgical residency programs can foster a more inclusive and supportive environment for residents starting families. This can improve resident well-being, reduce attrition, and create a significantly more enjoyable training experience for all involved. This review aims to provide insight into residents' difficulties while pregnant or considering pregnancy and identify changes programs could implement to promote a more supportive culture for pregnant residents.

Relationship Between National Residency Matching Program (NRMP) Rank Order and Otolaryngology Residency Performance.

The process of resident recruitment is costly, and our surgical residency program expends significant time on the resident selection process while balancing general duties and responsibilities. The aim of our study was to explore the relationship between otolaryngology-head and surgery (OHNS) residents' National Residency Matching Program (NRMP) rank-list position at our institution and their subsequent residency performance. Retrospective cohort study. Single site institution. We retrospectively reviewed 7 consecutive resident classes (2011-2017) at a single tertiary OHNS residency program. We reviewed each resident's absolute rank order in the NRMP matches. Measures of residency performance included overall faculty evaluation during postgraduate year 5 (PGY5), annual in-service examination scores (scaled score), and the number of manuscripts published in peer-reviewed journals. Correlations between NRMP rank order and subsequent residency performance were assessed using Spearman's rho correlation coefficients (ρ). Twenty-eight residents entered residency training between 2011 and 2017. The average rank position of the trainees during this study was 9.7 (range: 1-22). We found no significant correlation between rank order and faculty evaluation during PGY5 (ρ = 0.097, P = .625) or number of publications (ρ = -0.256, P = .189). Additionally, when assessing the association between rank order and annual Otolaryngology Training Examination-scaled scores, no statistically significant relationship was found between the 2 (P > .05). Our results showed that there were no significant correlations between OHNS rank order and various measures of success in residency training, which aligns with existing literature. Further investigation of this relationship should be conducted to ensure the applicability of our findings.

A Pilot Study in Fatigue Risk Management Among Obstetrics and Gynaecology Residents at the University of Alberta

ObjectivesCombatting fatigue is an ongoing challenge in surgical residency programs impacting both patient care and resident well-being. There is a gap in understanding the nuances of fatigue perpetuation, especially where it relates to specific on-call duties. This pilot study seeks to explore the extent of sleep deprivation among Obstetrics and Gynecology (OBGYN) residents and identify obstacles to obtaining adequate rest. MethodsA survey was sent out to all OBGYN residents at the University of Alberta, collecting demographic and baseline sleep information and assessing perceived barriers to sleep. Residents then self-selected for participation in the second portion which involved recording all pages in a 12-hour shift and assigning an acuity rating to them. Mixed methods were used including thematic analysis of the page acuity survey and descriptive statistics for the primary survey. ResultsIn total, 21 residents completed the initial survey (67.7%) and 17 12-hour shifts were recorded. While junior residents (postgraduate year 1–2) and those carrying the low-risk pager slept less on call and had less sleep on days without call, barriers to sleep were not different when compared to senior residents and those carrying the high-risk pager. While low-risk and high-risk shifts had different primary contributors to fatigue (volume and acuity, respectively) both groups attributed fatigue to non-urgent pages. On review of pages, 49.4% were perceived as non-urgent. A total of 81% of residents supported the development of problem boards to reduce the number of non-urgent pages. ConclusionsThis pilot study demonstrated residents, regardless of seniority or shift, found non-urgent pages to be a significant contributor to on-call fatigue and supported the use of problem boards to reduce pages. Our approach can provide a framework for other institutions to learn more about resident fatigue and non-urgent paging in their program.

Gender trends in Canadian medicine and surgery: the past 30 years

BackgroundWhile the number of women entering medicine has steadily increased since the 1970s in Canada, the gender composition along each stage of the medical training pathway has not been comprehensively reported. We therefore sought to systematically examine the gender composition of students, residents, and practicing physicians over the past 30 years in Canada.ResultsIn this cross-sectional analysis of Canadian medical trainees including MD applicants (137,096 male, 169,099 female), MD students (126,422 male, 152, 967 female), MD graduates (29,413 male, 34,173 female), residents by the decade (24,425 male, 28,506 female) and practicing surgeons (total 7,457 male, 3,457 female), we find that increased female representation in medicine is not matched by representation in surgery, with the key being the specialty choice process. The likelihood of female applicants matriculating to medical school was less than male applicants in the 90s (OR 0.92, 95% CI 0.92–0.93), greater in the early 2000s (OR 1.03, 95% CI 1.03–1.04), and has since balanced out (OR 1.00, 95% CI 1.00-1.01), with medical school classes being nearly 60% female for the past two decades. Despite this, females have remained underrepresented in most surgical residency programs, with odds of female medical students entering surgical residency other than Ob/Gyn being about half that of male students (OR 0.56, 95% CI 0.44–0.71), resulting in a slow increase in practicing female surgeons of less than 0.5% per year in many surgical disciplines and projected parity decades or centuries in the future.ConclusionsWhile undergraduate medical education has been majority female in Canada for nearly three decades, females remain greatly underrepresented in the physician workforce within surgical specialties. To build a representative medical workforce equipped to care for diverse patient populations, factors influencing the specialty choices of early career physicians will need to be examined and addressed.

Learning curve of ultrasound-guided surgeon-administered transversus abdominis plane (UGSA-TAP) block on a porcine model

BackgroundSurgeons commonly perform ultrasound-guided Transversus Abdominis Plane blocks to manage acute pain following abdominal surgeries. There is no consensus on whether surgeons should undergo basic hands-on training to perform TAP blocks or if video-based learning is sufficient. We theorized that simulation-based learning is superior to video-based learning. In the present study, we present the analysis of technical skills of UGSA-TAP block performance on a live porcine model by general surgery trainees after undergoing video or simulation-based learning. MethodsWe performed a prospective, double-blinded, randomized study. Ten surgery residents and two surgery critical-care fellows (n = 12) without prior experience in performing the TAP block were recruited. The participants were randomized either into a video-based or simulation-based training group. After that, all participants performed a TAP block on a live anesthetized pig, which was recorded and scored by three blinded anesthesiologists. All participants completed a post-performance survey to assess their confidence in gaining competency in the UGSA-TAP block. Statistical analyses were performed to assess the differences between the two groups. P < 0.05 was considered statistically significant. ResultsAll simulation-based learning participants successfully performed a survey scan, identified the three muscular layers of the abdominal wall, and identified the transversus abdominis plane compared to 50 %, 50 %, and 33 % video-based learning group participants for the respective parameters (p < 0.05). While some performance metrics showed no statistically significant differences between the groups, substantial effect sizes (Cohen's ℎ up to 1.07) highlighted notable differences in participants' performance. Both groups exhibited confidence in core competencies, with varied rates of satisfactory skill execution. Performance assessed using a global rating scale revealed a higher passing rate for the simulation group (83 % vs. 33 %). Participant feedback via the Likert scale reflected confidence post-training. Inter-rater reliability (0.83–1) confirmed the robustness of study evaluations. ConclusionThe UGSA-TAP block curriculum should be introduced into the surgical residency programs with an emphasis on simulation-based learning to enhance the procedural skills of the trainees before transitioning to surgical patients.

How Patient Care During COVID-19 Pandemic Improved Subsequent Surgical Training: An Appraisal and Introspection

Surgical residency program across the world saw a dramatic change during the COVID-19 pandemic. Various new technologies like virtual methods of learning, simulation programmes were developed to continue training of the surgical residents. To find out how COVID-19 improved surgical training, we searched the literature and shortlisted 34 articles relevant to the topic and reviewed them. Most of the articles pointed out how physical form of training in surgical residency was converted to virtual platforms and simulation programmes. Literature also points how COVID-19 has led to the improved care of critically ill patients by the surgical residents in the post-COVID era. Team work and working together with all specialties were other areas that saw significant changes. We hope to put forward the positive changes in the surgical residency programmes encountered during COVID-19 and to carry forward these lessons for better training of residents in the future.

Developing an Evidence-Based Ethics Education Program for Surgical Residents in Guatemala.

This study assessed 2 modalities for teaching responsible conduct of research and human subjects protection (RCR/HSP) to surgical residents in Guatemala-an "off the shelf" online curriculum and a new in-person curriculum specific to the local context. In 2018, 160 surgical residents in 3 large urban hospitals in Guatemala City completed 2 online programs in RCR/HSP. Residents in the intervention arm also completed 7 weeks of in-person training. Pre- and post-assessments tested awareness of key concepts with particular attention to international and Guatemalan research regulations. Group differences in matched (pre- and post-) mean scores were analyzed using t-tests. One hundred forty residents completed pre- and post-training assessments and were included in the analytic sample. Overall mean scores improved modestly from 52.7 to 58.7 points out of 100. Intervention-arm trainees reported greater confidence in recognizing ethical issues, understanding legal and ethical requirements for research, and identifying, reporting and avoiding scientific misconduct than control-arm trainees. Given the limited availability of RCR/HSP faculty, financial resources, and time in the surgical training schedule, the investigators recommend that academic authorities in Guatemala consider online training programs in RCR/HSP in all surgical residency programs as an affordable and scalable strategy to build ethical research skills in its surgical workforce. Investment in human resources to support in-person ethics education as a way to build self-efficacy in ethical decision-making should be considered.

Exploring Medical Students’ Perceptions of Peer-to-Peer Interactions Related to Applying to a Surgical Residency

The objectives were to (1) identify themes related to competitive peer-to-peer interactions elicited from the lived experiences of undergraduate medical students, and (2) understand how these experiences influenced medical students' choices related to surgical residency programs. A qualitative descriptive methodology, with purposive and maximal variation sampling (e.g., selection based on medical school location; gender), was adopted for this study. Temerty Faculty of Medicine, University of Toronto. Participants were 15 undergraduate medical students from 4 medical schools in Ontario, Canada, who agreed to an individual semi-structured interview by Zoom or telephone. Peer-to-peer interactions influence students' perception of self and identity formation related to surgical specialty decision-making and interest. These interactions were shown to hold greater value, specifically for information gathering. Identity formation, related to pursuing a surgical residency, was influenced by the attitudes and perceptions of competition with peers throughout medical school. Cultures of competition were seen to dictate peer-to-peer interactions and their associated value, with their perception and experience differing between medical schools. Peer-to-peer interactions and a culture of competition have inherent roles in the residency decision-making process. We observed that student background and pre-formed relationships influenced how students perceived and responded to competition. Addressing the culture of competitiveness associated with peer-to-peer interactions along with considering student background and pre-existing relationships may provide insight into how medical educators can tailor learning experiences that limit the detrimental effects of hidden curriculum influences.

C-CASE 2023: Promoting Excellence in Surgical Education01. Near-peer tutoring: an effective adjunct for virtual anatomy learning02. Surgical Exploration and Discovery: perspectives on student-led debriefs in undergraduate surgical education03. How are emotions of medical residents and faculty in general surgery affected by new assessment mandates implemented in medical education?04. Equity, diversity and inclusion in medical residency: a Web-based analysis of Canadian

C-CASE 2023: Promoting Excellence in Surgical Education01. Near-peer tutoring: an effective adjunct for virtual anatomy learning02. Surgical Exploration and Discovery: perspectives on student-led debriefs in undergraduate surgical education03. How are emotions of medical residents and faculty in general surgery affected by new assessment mandates implemented in medical education?04. Equity, diversity and inclusion in medical residency: a Web-based analysis of Canadian