Surgical Training Programs Research Articles

Evolution of Learning Styles in Surgery Comparing Residents and Teachers: Cross-Sectional Study.

Studies confirm a relationship between learning style and medical career choice in the learning style patterns observed in distinct types of residency programs. Such patterns can also be applied to general surgery, from medical school to the latest stages of training. Aligning teaching strategies with the predominant learning styles in surgical residency programs has the potential to make training more effective. This study aimed to determine the learning styles of general surgery residents and professors in a Brazilian teaching hospital and compare the results with the existing literature. This was a cross-sectional study conducted in a teaching hospital of a public university in Brazil. Thirty-four general surgery residents of any year of training and 30 professors participated in the study. Participants completed a sociodemographic survey and David Kolb's Learning Style Inventory. This was used to classify participants into one of four distinct types of learners: accommodating, diverging, assimilating, and converging. The relationship between sociodemographic data and learning styles was analyzed using the Fisher test, adjusted using the Bonferroni method, and the effect size was measured using the Cramer V test. The learning style distribution was similar in both groups, with 43,75% diverging, 42,18% accommodating, 10.93% assimilating, and 3.12% converging styles. A significant relationship was found between sex and learning style (P=.049) and between age and learning style for professors (P=.029). The effect sizes were strong (0.46) and very strong (0.506). The prevalence of learning styles among general surgery residents and professors at this Brazilian hospital differs from that observed in previous studies, with more diverging and accommodating learners and fewer converging learners, suggesting a shift in learning styles. Understanding learning styles is important for effective surgical training programs. Further research with larger and more diverse populations is needed to confirm these results and explore the factors contributing to the observed differences in learning styles.

Identifying Recent Trends in the Prevalence of International Medical Graduates Entering the Surgical Workforce in the United States.

Identifying Recent Trends in the Prevalence of International Medical Graduates Entering the Surgical Workforce in the United States.

Evaluating Access Improving Interventions: An Economic Evaluation of Surgical Task-Shifting for C-Sections in Sierra Leone.

Access to safe, timely and affordable surgical care is lacking globally. Less than 6% of all surgical operations are carried out in low- and middle-income countries, where over a third of the world's population lives. CapaCare, an NGO operating in Sierra Leone, have developed a surgical training programme (STP) for Associate Clinicians based on principles of task-shifting to improve access. Interventions to increase healthcare access have the same value evidence requirements as new technologies but their evaluation presents methodological challenges as access is not routinely incorporated explicitly in economic evaluations. To evaluate the cost-effectiveness of surgical task-shifting in Sierra Leone, implemented through the CapaCare STP, to increase provisionof caesarean section (C-section). We evaluated the impact of the STP on the provision of C-section and subsequent maternal and child outcomes, measured in disability-adjusted life-years (DALYs), relative to the costs using a healthcare system perspective and decision-tree model parameterised using data from surgical logbooks, national data, and the literature. Results indicate that the surgical task-shifting programme in Sierra Leone would be considered cost-effective in increasing provision for C-section. It is cost saving (USD -16.77) and results in 2.14 DALYs averted, per women with an indication for C-section, due to avoidance of maternal and child deaths as well as reduced complications. Investment in surgical task-shifting initiatives should be considered by policymakers as a potentially cost-effective way to increase access to quality surgical services. Future evaluations of access-increasing interventions should seek to capture the distributional impact of this strategy and system benefits.

Smart Kidney Stone Basket: A Proof of Concept With Digital Feedback Force Monitoring

Abstract Ureteroscopy with stone extraction devices is a common treatment for urolithiasis but carries risks, such as ureteral wall avulsion due to excessive withdrawal forces. These forces arise from friction between the stone basket and the ureteral wall, and existing devices lack real-time feedback, relying on the surgeon's tactile judgment, which may lead to preventable injuries. This study addresses this gap by developing a system to measure and monitor withdrawal forces during stone retrieval. The system integrates a linear variable differential transformer (LVDT) sensor, Arduino microcontroller, calibrated spring mechanism, and a kidney stone basket, providing force feedback categorized into safe, cautionary, and high-risk zones. Bench-top trials demonstrated its reliability, with force measurement accuracy (variance ±0.05 N) and classification into safe (<5.396 N), cautious (5.396 N–9.809 N), and dangerous (>9.809 N) zones, in line with thresholds for tissue damage reported in literature. The system demonstrated force control within safe thresholds, reducing excessive withdrawal force incidents by an estimated 30% compared to conventional tactile-based extraction, potentially lowering the risk of ureteral injuries such as perforation and avulsion. Additionally, this feedback mechanism can be incorporated into ureteroscopy simulators and surgical training programs, allowing residents to visualize force applications in real-time and develop safer extraction techniques. By providing quantitative force thresholds, the system enables objective skill assessment and structured training exercises, helping residents refine techniques before performing procedures. Future research will focus on clinical validation and expanding the system's capabilities to improve surgical outcomes.

ADVANCING SURGICAL TRAINING IN PAEDIATRIC HIP WASHOUT: THE EDUCATIONAL VALUE OF CADAVERIC DEMONSTRATION

IntroductionSurgical washout of the hip can be a life-saving procedure in the management of septic arthritis. Due to its time-sensitive nature, transfer to a tertiary paediatric centre may not always be possible, requiring proficiency from all trauma and orthopaedic surgeons. Limited training opportunities, however, present challenges in achieving proficiency. Cadaveric demonstration may serve as a relatively low-cost building block to bridge this gap. This study evaluates the effectiveness of cadaveric demonstration as a teaching tool for hip washout, focusing on its impact on trainee confidence and perceived usefulness.MethodsA cadaveric demonstration was conducted by a paediatric consultant surgeon for orthopaedic registrars in the Mersey deanery. Trainee confidence was assessed pre- and post-session using a 10-point scale. Paired t-tests were used to evaluate changes in confidence scores, with significance defined as p<0.05. Trainees also assessed the session's usefulness and provided feedback on whether cadaveric dissection could foster transferable clinical competence.ResultsTwenty-nine orthopaedic registrars (ST3–ST7) participated in the session. Mean confidence scores improved significantly from 4.9 ± 2.04 pre-session to 7.66 ± 1.32 post-session (p<0.001). The session's perceived usefulness averaged 9.67/10, and 97% of participants felt cadaveric dissection could achieve transferable clinical competence.ConclusionCadaveric demonstration enhances trainee confidence and serves as a valuable, low-cost adjunct for training in infrequent, time-sensitive procedures. Its integration into surgical training programmes warrants consideration, with further evaluation needed on the role of dissection in teaching surgical hip washout.

A Survey Assessment of Psychological Safety in Colon and Rectal Surgery Residents and Comparison to General Surgery Residents.

A Survey Assessment of Psychological Safety in Colon and Rectal Surgery Residents and Comparison to General Surgery Residents.

The Anatomy of Gossip: Dissecting Dynamics and Impacts in Surgical Residency.

The Anatomy of Gossip: Dissecting Dynamics and Impacts in Surgical Residency.

Needlestick injury incidence and reporting in Irish surgical trainees.

Needlestick injury incidence and reporting in Irish surgical trainees.

Quantitative metrics for evaluating surgical dexterity using virtual reality simulations.

This study develops and evaluates quantitative metrics to assess surgical dexterity within virtual reality (VR) simulations to enhance surgical training and performance. By employing advanced VR technology, this research systematically investigates the influence of controlled experimental factors-posture, handedness, and visual magnification-on surgical performance. The impact of human factors such as surgical specialty, experience, and lifestyle factors like sleep and caffeine consumption on surgical dexterity is also analyzed. The findings reveal that seated posture, dominant hand usage, and enhanced visual magnification significantly improve surgical precision and efficiency. Contrary to common beliefs, lifestyle factors such as sleep duration and coffee consumption showed minimal impact on performance metrics. The study highlights the potential of VR simulations to provide a controlled, replicable, and safe environment for surgical training, emphasizing the importance of personalized training protocols that cater to individual surgeon's needs. The insights from this research advocate for integrating quantitative, objective metrics in surgical training programs to refine and accelerate dexterity acquisition, ultimately aiming to improve patient outcomes and surgical care.

Utilizing the DiSC Assessment in Surgical Residency Leadership Training to Address Communication Skill Acquisition: A Kern Six-step Approach to Curriculum Development.

Utilizing the DiSC Assessment in Surgical Residency Leadership Training to Address Communication Skill Acquisition: A Kern Six-step Approach to Curriculum Development.

Effectiveness of Silent Mentor Program (SMP) Workshop on Enhancing Confidence in Surgical Skills.

Simulation-based surgical skills workshops using 'Silent Mentors' are employed in numerous surgical training programs worldwide, yet empirical evidence on their effectiveness remains limited. The objective of this study was to investigate whether participation in the surgical skills workshop within the Silent Mentor Program (SMP) resulted in an improvement in the surgical skills of the workshop attendees. Participants in the SMP at Universiti Malaya during the period from May 15, 2022, to September 24, 2023, were included in the study. Participants self-evaluated their surgical skill confidence levels in four fundamental surgical skills (chest tube insertion, central venous line insertion, endotracheal intubation, and skin suturing). The pre-workshop confidence scores were assessed and compared with immediate post-workshop scores. The findings demonstrated that after the training, participants exhibited higher confidence in all four fundamental surgical skills. Skin suturing demonstrated the highest total confidence score post-workshop, with a median of 21 and an interquartile range (IQR) of 18-24. Endotracheal intubation and chest tube insertion followed closely, both with a median of 19. Conversely, central line insertion displayed the lowest total confidence score, registering a median of 18 (IQR=16-21). No statistically significant differences were observed in the confidence level scores for chest tube insertion, central line insertion, and endotracheal intubation between pre- and post-workshop assessments across all demographic characteristics. In conclusion, utilizing silent mentors in surgical skills training enhances proficiency in all four fundamental surgical skills, with skin suturing demonstrating particularly noteworthy improvements. The consistent confidence levels across demographic factors suggest the workshop's effectiveness across a broad spectrum of participants.

IBC Oxford University Oral Abstract 49 - AI-assisted surgical fellowship training assessment through laparoscopic sleeve gastrectomy video analytics

Abstract Background The advent of artificial intelligence (AI) in surgical training presents a transformative opportunity to enhance the assessment and education of surgical fellows. This study investigates the application of AI in evaluating the performance of surgeons by analyzing videos of laparoscopic sleeve gastrectomy procedures uploaded to a specialized platform, Surgeryview.ai. Methods Three surgeons contributed to this study: two were professor bariatric surgeons and one was a fellow bariatric surgeon in training. A total of 466 videos of gastric sleeve surgeries were analyzed. Of these, 413 videos were performed by the professor surgeons (Surgeon 1: 180, Surgeon 2: 233) between September 2022 and May 2024, and 53 surgeries were performed by the fellow surgeon in training over a period of 10 months (August 2023–May 2024). The analyzed videos were chosen randomly, and any surgeries Involving an additional procedure to the gastric sleeve (for example hiatal hernia repair) were excluded. Patient data, including gender, age, and initial BMI, were recorded, ensuring anonymity. Results The AI platform provided comprehensive longitudinal analytics, detailing the time taken to complete each surgical step: access to the abdominal cavity, greater curvature dissection, stapling, specimen removal, oversewing, and leak test. The platform also analyzed the impact of patient demographics on surgery time. Professors showed consistent efficiency, while fellows demonstrated significant improvement over time. Notably, surgery duration was influenced by patient-specific factors such as BMI and age. The fellow bariatric surgeon in training showed significant improvement across all metrics over the trimesters, with overall surgery time reduced by approximately 23.83%, greater curvature dissection (step 2) time by 28.37%, and oversuture of the staple line (step 5) time by 28.74%. When broken down by BMI, age, and gender, indicate that improvements are generally consistent across these variables, with the most significant improvements seen in lower BMI and younger age groups. These advancements indicate that the fellow has substantially closed the performance gap, particularly in the critical surgical steps. Conclusion AI assisted platforms like Surgeryview.ai offer valuable insights into surgical performance, enabling objective assessment and personalized feedback for fellows. This technology can enhance surgical training programs by identifying specific areas for improvement and tracking progress over time, ultimately aiming to standardize surgical education and improve patient outcomes.

Assessing the efficacy of a virtual reality lower leg fasciotomy surgery training model compared to cadaveric training

BackgroundVirtual reality (VR) holds great potential in education that has not been actualized in surgical training programs; much of the research into medical applications of VR have been in management and decision making rather than procedural training. This pilot study assessed the feasibility of virtual reality surgical educational training (VR-SET) in open trauma surgery procedures compared to in person cadaver-based training (CBT). In traditional surgical educational settings multiple trainees share a cadaver, often due to logistical and fiscal limitations precluding routine one-to-one trainee to cadaver ratios. Thus, some procedures are learned via observation of a fellow trainee performance on the cadaver rather than hands on performance. Cadaveric training opportunities are also less frequent for those practicing in low resource environments such as rural communities, smaller medical facilities and military combat zones.MethodsMedical students (4th year, n = 10) who completed VR-SET training were compared to a control group (residents, n = 22) who completed an in-person Advanced Surgical Skills for Exposure in Trauma (ASSET) course. Participants were evaluated on performance of a lower extremity fasciotomy on a cadaver.ResultsVR-SET study participants decompressed an average of 2.45 ± 1.09 (range 1 to 4) compartments compared to the control group decompressed had an average of 2.06 ± 0.93 (range 0.5 to 4), statistically indistinguishable between the groups (p = 0.35). Numerical scores for anatomic knowledge, surgical management, and procedure performance were also not significantly different between groups. Control subjects had significantly higher pathophysiology knowledge and surgical technique scores.ConclusionsOverall, VR-SET participants were indistinguishable from the in-person CBT cohort in number of compartments successfully decompressed. This pilot study suggests utilization of VR technologies in trauma educational settings may be effective and considered as a cost-effective solution for training to supplement cadaveric based courses.

Regional disparity in surgical residency training and work environment between urban and regional hospitals: an additional perspective from a nationwide survey of surgical residents.

To investigate the current status of regional disparities in surgical residency training between urban and regional hospitals. Based on a nationwide online questionnaire survey of newly certified surgical trainees, the responding residents were divided into the following two groups according to the size of the city in which they had trained: the urban city group (UC group; population > 1 million) and the regional city group (RC group; population < 1 million. Surgical education and work environment of the two groups were compared. The UC group (n = 317, 42%) was characterized by greater post-graduate experience, older age, a higher proportion of female surgeons, and a higher percentage of full-time working partners relative to the RC group (n = 439, 58%). More residents in the UC group were from urban areas, whereas the RC group had more residents from regional areas. No differences were observed in the number of surgeries performed, published papers, opportunities for off-the-job training, or satisfaction with the surgical residency training program. With the exception of higher income in the RC group, no differences were observed for other factors related to the work environment. There was little regional disparity regarding the impressions of surgical residency training between urban and regional cities, including surgical education and work environment.

Availability of Lactation Policies and Facilities for ACGME-Accredited Surgical Residency Training Programs.

Availability of Lactation Policies and Facilities for ACGME-Accredited Surgical Residency Training Programs.

Tying measurement to action in equity, diversity, and inclusion work in academic surgical departments.

Strategies to address inequities, bias, and discrimination that disadvantage Canadian physicians from marginalized groups are urgently needed. We describe a multilevel needs assessment of equity, diversity, and inclusion (EDI) in 2 departments of surgery that focused on identifying evidence-based interventions. We invited members of the departments of surgery at the University of Calgary and the University of Saskatchewan to complete the Diversity Engagement Survey (DES), a 22-item instrument designed to understand workplace engagement and inclusion among physicians, with higher scores indicating greater engagement and inclusion. Leaders completed a Leadership EDI Readiness Assessment to understand their own barriers to EDI work and an Organizational EDI Readiness Assessment to understand structures for EDI in their division. Leaders were provided resources and interventions to address the identified gaps in these assessments. The most common organizational gaps in structures for EDI work in surgical divisions and training programs (n = 34, 37.4%) were in community outreach and measurement and reporting. Surgeons who identified as cisgender men (n = 101) felt more engaged and included than those who identified as cisgender women (n = 43; 3.81 [standard deviation (SD) 0.73] v. 3.51 [SD 0.78]; p = 0.04). White cisgender men (n = 66) had the highest feelings of engagement and inclusion (mean 3.95 [SD 0.62]). Participating surgical sections and training programs were directed to evidence-informed initiatives to improve community outreach and measurement and reporting to address EDI in their settings. Our findings support that gender and racial or ethnic identities influence the workplace experiences of surgeons in Canada. A multilevel approach to EDI work in surgical departments can direct leaders to areas for intervention.

Enhancing Surgical Robotic Skills Through Performance-Guided Training: A Swimmer's Approach for Defining Key Metrics.

In swimming, a combination of strength, endurance, and targeted skill training significantly enhances performance, particularly by balancing aerobic and anaerobic conditioning. Similarly, in surgery, improving motor control and stamina during lengthy operations, particularly for precise movements like suturing or tissue manipulation, is essential. This literature review aims to explore the parallels between the training paradigms of elite swimming and robotic-assisted surgical practice, focusing on skill acquisition, training methodologies, and performance-guided feedback systems. The hypothesis suggests a significant link between these training principles, offering opportunities to optimize surgeon training, particularly in robotic-assisted surgery. A systematic review was conducted following PRISMA guidelines. A thorough examination of existing literature in both elite swimming and robotic-assisted surgery training identified key elements of skill development, feedback mechanisms, and structured progression. Sources included peer-reviewed studies on swimming techniques, cognitive training in surgery, and simulation-based training programs that emphasize performance-driven improvements. The review identified significant parallels between swimming and robotic-assisted surgery training, with both fields emphasizing structured, feedback-driven approaches to enhance precision and skill. Techniques such as video analysis in swimming and real-time digital feedback in surgery were found to be effective in improving outcomes. Simulation-based training also plays a crucial role in refining skills and promoting adaptability in both disciplines. Applying elite swimming methodologies, particularly those centered on feedback, precision, and structured progression, could help develop key metrics to enhance surgical training programs, in robotic-assisted surgery. Future research could further optimize surgeon training, potentially leading to improved performance and better patient outcomes in robotic procedures.

Challenges and Innovations in Minimally Invasive Surgery for Pediatric Patients in Africa: A Comprehensive Review.

Minimally invasive surgery (MIS) has proven to be a successful, developing improvement in surgical practice. Allowing surgeons to operate with minimal incisions, ensures the completion of such procedures with minimal damage to the patient and provides recovery in a shorter time. The use of MIS in the pediatric population has also been growing with the increased involvement of surgeons in the evaluation of training and expertise. In Africa, however, the growth of MIS in the pediatric population faces some obstacles which are in research and innovation, cost, and affordability. Additionally, to the scarcity of resources, the limited number of pediatric surgeons available leads to a substantial workload that affects the quality of care. This paper aims to evaluate the challenges facing MIS in Africa and assess its potential in the future. Data were collected through online databases such as PubMed, Google Scholar, Ovid MEDLINE, and Embase. The research team reviewed all relevant articles regarding MIS in Africa and pediatrics. The utilization of MIS in the pediatric population in Africa faces some major challenges. In addition to the limited resources, there is a significantly disproportionate number of physicians per population, and the training received by pediatric surgeons rarely incorporates minimally invasive techniques. This leaves a lot of work to be done to allow better access to MIS on the African continent. The recent advances by Africans in minimally invasive and endoscopic surgical training programs, as well as the establishment of minimally invasive centers, show great promise in the attempt to increase the utilization of MIS in Africa. The work done to grow the field of MIS application in Africa is commendable, but efforts need to be strengthened and focus needs to be given to ensure the sustainability of these programs. Furthermore, the work accomplished by countries like Egypt, Senegal, and Nigeria will serve as a huge teaching point to increase the technical expertise of surgeons in the region.

The future of surgical training – what would the ideal postgraduate surgical training programme look like in 2035?

The future of surgical training – what would the ideal postgraduate surgical training programme look like in 2035?

Structured hernia surgery training program for general practitioners in Rwanda - feasibility and evaluation

BackgroundHernias are among the most common surgical conditions worldwide, with significant prevalence in Africa. However, according to recent WHO statistics, Africa faces a critical shortage of trained surgeons. Structured surgical training programs are also scarce. Since 2016, Surgeons for Africa in collaboration with Operation Hernia have developed structured training course on hernia surgery specifically for surgeons in Rwanda. Due to the severe shortage of surgeons, a new initiative was launched in 2023 to train general practitioners (GPs) to support the country’s surgical care needs. This study aims to assess the feasibility and effectiveness of these training programs for general practitioners.MethodologySix standardized questionnaires were used to evaluate the structured training program before, during, and after the one-and-a-half-week courses conducted in Rwanda. Both trainees and trainers completed the relevant evaluations. The results were anonymized, ummarized using descriptive statistics, and statistically analysed. Trainers also assessed the surgical competence of each participant at the end of the course.ResultsBetween 2023 and 2024, 47 general practitioners received hernia surgery training in several Rwandan hospitals. The course significantly improved both the theoretical knowledge and practical surgical skills of the participants. Of the 47 GPs, 22 were able to independently perform simple inguinal hernia surgeries after the training. Three were able to perform complex inguinal hernia repairs independently. 12 participants required minimal supervision, while 22 required full supervision.ConclusionThis study confirms the feasibility and effectiveness of a standardized hernia surgery training program for general practitioners in Rwanda. The results demonstrate the rogramme’s potential to address the surgical care gap by enabling GPs to perform basic hernia surgeries.