Surgical Training Programs Research Articles

Can Ileostomy Reversal Be Safely Performed by Surgical Residents?

Background and Objectives: The growing number of colorectal cancer patients has highlighted the importance of surgical education in colorectal surgery. Despite the negative impact of the COVID-19 pandemic on surgical training, recent changes in the Polish surgical training program have increased the number of intestinal procedures required to be completed by residents. This study aims to assess the safety of ileostomy reversal procedures performed by surgical residents. Materials and Methods: A multicenter prospective cohort study, the LILEO study, was conducted from October 2022 until December 2023 across 20 Polish surgical departments. The study included 199 patients who underwent ileostomy reversal and were divided into two groups: 139 patients operated by specialist surgeons and 60 patients operated by surgical residents. The primary outcomes measured were postoperative complications, length of hospital stay (LOS), and 30-day reoperation rate. Secondary outcomes included the severity of perioperative complications assessed using the Clavien–Dindo classification and a focused analysis of loop ileostomy reversal outcomes. Results: The median LOS was significantly shorter in the resident group (5.5 days vs. 6 days, p < 0.05). Although the overall complication rate was lower in the resident group (21.7% vs. 33.1% in the specialist surgeon group), this difference was not statistically significant (p = 0.105). The 30-day reoperation rate was 3.3% in the resident group and 8.6% in the specialist surgeon group (p = 0.179). In terms of severity, minor complications (Clavien–Dindo grades 1 and 2) were more common in the specialist group (p < 0.05). The analysis of loop ileostomy reversals revealed no significant differences in postoperative outcomes between the two groups. Conclusions: Ileostomy reversal procedures performed by surgical residents under supervision are safe and feasible, with outcomes comparable to those performed only by specialist surgeons. These findings support ileostomy reversal as a valuable procedure for developing surgical residents’ skills and do not negatively affect postoperative outcomes.

Deep learning for surgical instrument recognition and segmentation in robotic-assisted surgeries: a systematic review

Applying deep learning (DL) for annotating surgical instruments in robot-assisted minimally invasive surgeries (MIS) represents a significant advancement in surgical technology. This systematic review examines 48 studies that utilize advanced DL methods and architectures. These sophisticated DL models have shown notable improvements in the precision and efficiency of detecting and segmenting surgical tools. The enhanced capabilities of these models support various clinical applications, including real-time intraoperative guidance, comprehensive postoperative evaluations, and objective assessments of surgical skills. By accurately identifying and segmenting surgical instruments in video data, DL models provide detailed feedback to surgeons, thereby improving surgical outcomes and reducing complication risks. Furthermore, the application of DL in surgical education is transformative. The review underscores the significant impact of DL on improving the accuracy of skill assessments and the overall quality of surgical training programs. However, implementing DL in surgical tool detection and segmentation faces challenges, such as the need for large, accurately annotated datasets to train these models effectively. The manual annotation process is labor-intensive and time-consuming, posing a significant bottleneck. Future research should focus on automating the detection and segmentation process and enhancing the robustness of DL models against environmental variations. Expanding the application of DL models across various surgical specialties will be essential to fully realize this technology’s potential. Integrating DL with other emerging technologies, such as augmented reality (AR), also offers promising opportunities to further enhance the precision and efficacy of surgical procedures.

Gender-Specific and Cross-Gender Reasons for Choosing 'Surgeon' as a Career - A Scoping Review

The availability of highly qualified surgical staff in Germany has been a challenge for years. Despite various initiatives to increase the attractiveness of surgical training programs, there are still problems in attracting motivated and qualified doctors to surgery. In order to develop customized offers for recruiting junior staff, the decision-making factors must be known. To present the gender-specific and cross-gender reasons for choosing a surgical specialist training program. As part of a scoping review, studies were identified using PubMed and a subsequent reverse search to answer the research question. Data extracted from the studies were summarized narratively and categories were defined. The analysis of 12 studies revealed that men and women wanted to become a surgeon based on the characteristics of the surgical specialty, personal factors and factors related to the training position. Gender-specific differences were also identified. Specific measures are proposed to promote the next generation of surgeons.

A comparison of general surgery training programmes across 11 countries: improving understanding of the experience level of international medical graduates in the UK.

Within the past five years there has been a significant increase in the number of international medical graduates (IMGs) joining the United Kingdom's (UK) workforce. Having mentors and supervisors who understand the needs of IMGs and clinical and cultural differences in the workplace can benefit in the transition to working in a new country. Improving knowledge of and understanding differences between general surgical training programmes and grades across different countries could therefore aid in the support of IMGs within the UK. Data on general surgical training programmes of the top ten countries for the primary medical qualifications of IMGs in the UK were collected to provide comparison with the UK training programme. The following countries were included: UK, India, Pakistan, Nigeria, Egypt, Ireland, Sudan, Sri Lanka, Romania, Iraq and South Africa. Training programme lengths ranged from 3 to 10 years. Only some training programmes provide additional training and qualification in sub-specialisation in general surgery. Other differences included a requirement for internship/non specialist training prior to training, differences in lengths of time spent in other surgical specialties and a requirement for research. Understanding the training programmes of other countries may help UK surgeons to understand the prior experience of IMGs and enable them to provide better training and support.

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.

Endocrine surgery fellowship is necessary for competent endocrine surgical practice: perspectives from Australia and New Zealand.

Currently pathways to practice in endocrine surgery vary based on location and surgical training programme. International data highlights the impact of surgeon volume on outcomes, and the importance of understanding the learning curve in developing minimum training competencies. This study aims to explore how surgeons obtain competence in endocrine surgery in Australia and New Zealand, and perceptions around competence and scope of practice. A web-based survey was distributed to fellows practicing endocrine surgery. Participants were invited to complete a semi-structured interview to explore key themes around competence. Thematic analysis was performed. Responses from 87 surgeons, with 30% practicing primarily in a regional or rural area, showed 94% emphasized post-fellowship training to be competent in endocrine surgery. Median primary operator procedural volume learning curves were 50 thyroid, 30 parathyroid and 20 laparoscopic adrenalectomy procedures. Semi-structured interviews with 12 participants identified four major themes: (1) learning opportunities during general surgical education and training programmes alone are insufficient for consultant-level competence; (2) the importance of sufficient training to develop clinical decision-making, insight and judgement to appropriately select patients in the management of endocrine disease; (3) expected standards of clinical and technical performance are independent of practice location or context; (4) the importance of multi-disciplinary teams for complex cases including advanced cancers. Practicing endocrine surgeons acknowledge formal fellowship training is required to achieve competence across technical and non-technical domains. The definition of competence and expectations regarding technical outcomes are independent of practice location or context.

Pointing to success: a discussion of the role of professional achievements in the selection of specialist surgical trainees

In Australia and New Zealand, competitive selection processes for surgical specialty training programs often use a standardized curriculum vitae (CV) to assess criteria such as professional achievements. This review aims to assess the predictive validity, standardization, and implicit biases of these selection methods, as well as their implications for trainees and the diversity of surgical cohorts. The 2023 CV scoring criteria were collected for all available specialty surgical programs in Australia and New Zealand. In 2023, each of the 11 surgical craft programs published publicly available standardized CV scoring criteria. In this study, scored items that constitute 'professional achievements' were recorded and tabulated. Observational analysis of the collected data was then conducted. In 2023, each of the 11 specialty surgical craft programs published publicly available structured CVs, of which 10/11 allocated points for professional achievements. Designated points for professional achievements were classified as awards, scholarships, committee positions, and prior training courses: 4/11 programs offered points for scholarships/grants, 6/11 programs offered points for academic and/or non-academic prizes, and 8/11 programs offered points for professional development courses. Observational analysis of these findings suggests that professional achievements are desired in training program applicants. Variability in medical school opportunities and inherent heterogeneity reduce the CV's efficacy, unfairly disadvantaging some applicants. Observational analysis of hence highlights the need for future research to assess potential updates in CV parameters to enhance predictive validity, reduce bias, and promote diversity.

Novel multimodal sensing and machine learning strategies to classify cognitive workload in laparoscopic surgery

BackgroundSurgeons can experience elevated cognitive workload (CWL) during surgery due to various factors including operative technicalities and the environmental demands of the operating theatre. This can result in poorer outcomes and have a detrimental effect on surgeon well-being. The objective measurement of CWL provides a potential solution to facilitate classification of workload levels, however results are variable when physiological measures are used in isolation. The aim of this study is to develop and propose a multimodal machine learning (ML) approach to classify CWL levels using a bespoke sensor platform and to develop a ML approach to impute missing pupil diameter measures due to the effect of blinking or noise. Materials and MethodsTen surgical trainees performed a simulated laparoscopic cholecystectomy under cognitive conditions of increasing difficulty, namely a modified auditory N-back task with increasing difficulty and a verbal clinical scenario. Physiological measures were recorded using a novel platform (MAESTRO). Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were used as direct measures of CWL. Indirect measures included electromyography (EMG), electrocardiography (ECG) and pupil diameter (PD). A reference point for validation was provided by subjective assessment of perceived CWL using the SURG-TLX. A multimodal machine learning approach that systematically implements a CNN-BiLSTM, a binary version of the metaheuristic Manta Ray Foraging Optimisation (BMRFO) and a version of Fuzzy C-Means (FCM) called Optimal Completion Strategy (OCS) was used to classify the associated perceived CWL state. ResultsCompared to other state-of-art classification techniques, cross-validation results for the classification of CWL levels suggest that the CNN-BLSTM and BMRFO approach provides an average accuracy of 97% based on the confusion matrix. Additionally, OCS demonstrated a superior average performance of 9.15% in terms of Root-Mean-Square-Error (RMSE) when compared to other PD imputation methods. ConclusionPerceived CWL levels were correctly classified using a multimodal ML approach. This approach provides a potential route to accurately classify CWL levels, which may have application in future surgical training and assessment programs as well as the development of cognitive support systems in the operating room.

Basic Surgical Skill Training before a Vascular Course Improves the Quality of Vascular Anastomoses: A Randomized Controlled Trial

ObjectivesDuring the past decade simulation has become standard in most surgical training programs, but objective evaluation of the performance has been a challenge. The optimal components of open surgery's simulation have also been questioned. The goal of this study was to evaluate the benefit of adding a hands-on exercise prior to a formal vascular training course. The participants’ performance was objectively evaluated using Computional Fluid Dynamics (CFD) assessment of vascular anastomoses. MethodsIn this study 51 residents participated in an on-line surgical hands-on training course, performing six end-to-side anastomoses. The residents were randomly divided into two groups. Group 1. also underwent basic surgical skill training (BSST) before starting the vascular course. The groups were compared based on CFD assessment of vascular anastomoses, combined with on-line personalized feedback. ResultsAmong measured parameters of functional assessment, the mean of six anastomoses showed significantly better results in Group 1. when compared with control Group 2 (Oscillatory Shear Index: 0,022 vs. 0,025 p=0,002; Maximum pressure: 7939 vs. 7971 p=0,00037; Velocity: 0,12 vs. 0,12 p=0,0000; Helicity: 297 vs. 393 p=0,0065; Vorticity: 5258 vs. 6628 p=0,0019; Wall Shear Stress: 1,83 vs. 1,97 p= 0,000047). These results showed no significant correlation between participants' experience level, specialization, and workplace. ConclusionsBSST before a formal vascular simulation course positively affects the anastomosis quality, independent of experience level, specialization, and workplace. BSST is suggested before a vascular course to improve performance and progress. Further studies are needed to analyse the impact of this combined simulation training on performing anastomoses.

Analyzing the emergence of surgical robotics in Africa: a scoping review of pioneering procedures, platforms utilized, and outcome meta-analysis.

Surgical practice globally has undergone significant advancements with the advent of robotic systems. In Africa, a similar trend is emerging with the introduction of robots into various surgical specialties in certain countries. The need to review the robotic procedures performed, platforms utilized, and analyze outcomes such as conversion, morbidity, and mortality associated with robotic surgery in Africa, necessitated this study. This is the first study examining the status and outcomes of robotic surgery in Africa. A thorough scoping search was performed in PubMed, Google Scholar, Web of Science, and African Journals Online. Of the 1,266 studies identified, 16 studies across 3 countries met the inclusion criteria. A meta-analysis conducted using R statistical software estimated the pooled prevalences with the 95% confidence interval (CI) of conversion, morbidity, and mortality. Surgical robots are reportedly in use in South Africa, Egypt, and Tunisia. Across four specialties, 1,328 procedures were performed using da Vinci (Intuitive Surgical), Versius (CMR Surgical), and Senhance (Asensus Surgical) surgical robotic platforms. Urological procedures (90.1%) were the major procedures performed, with robotic prostatectomy (49.3%) being the most common procedure. The pooled rate of conversion and prevalence of morbidity from the meta-analysis was 0.21% (95% CI, 0%-0.54%) and 21.15% (95% CI, 7.45%-34.85%), respectively. There was no reported case of mortality. The outcomes highlight successful implementation and the potential for wider adoption. Based on our findings, we advocate for multidisciplinary and multinational collaboration, investment in surgical training programs, and policy initiatives aimed at addressing barriers to the widespread adoption of robotic surgery in Africa.

SP7.10 - Awareness and Knowledge of Medical Coding Education Amongst Vascular Surgeons: A National Survey

Abstract Aims Accurate medical coding plays a critical role in optimising healthcare delivery, facilitating appropriate reimbursement, supporting research and data analysis, and providing a foundation for public healthcare databases and policies. This survey aims to explore the familiarity and comprehension of medical coding among vascular surgeons. Methods Ninety-five responses were gathered from participants across diverse levels of vascular surgery. A notable 77.7% (n=73) of respondents indicated a lack of formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons advocated for including medical coding within surgical training programs. Regarding assessing medical coding proficiency, 61.1% (n=55) correctly identified ‘BSS’ as an example of non-medical coding classification. Moreover, 67.7% (n=63) accurately recognised ‘OPCS-4’ as the classification system employed by the NHS for coding surgical procedures. Results Ninety-five questionnaire responses were collected from participants working in vascular surgery of various levels. A notable 77.7% (n=73) of the participants reported receiving no formal training in medical coding. Additionally, 70.5% (n=67) of vascular surgeons expressed that medical coding should be included in surgical training. Regarding assessing medical coding knowledge, 61.1% (n=55) of respondents correctly identified ‘BSS’ as the non-example of medical coding classification. When asked about the classification system used by the NHS to code surgical procedures, 67.7% (n=63) correctly identified ‘OPCS-4.’ Conclusion The study's findings reveal the need for more awareness, knowledge, and formal training in medical coding. Augmented education and training in medical coding, potentially through concise courses, are imperative for ensuring equitable reimbursement for healthcare services, facilitating data analysis for research and quality enhancement endeavours, and fostering effective inter-professional communication within the healthcare domain.

ThP7.8 - What is the gap in operative trauma surgical skills needed for humanitarian and military deployment? A systematic narrative review of surgeons in high-income countries

Abstract Aims The incidence of armed conflict, terrorist attacks and environmental disaster is increasing and death from traumatic injury remains a leading cause of mortality globally, posing complex challenges in surgical care. Despite advancements in trauma systems development, practice in high-income countries (HICs) is characterised by low trauma volumes, evolving non-operative strategies and increasing sub-specialisation, raising concerns about surgical preparedness for managing diverse injuries. This systematic review aims to assess the operative trauma skills of surgeons in HICs mapped against core military and humanitarian procedures. Examination of the breadth of skills acquired and identification of areas where further experience is required will inform the development of more comprehensive and adaptable surgical training programs. Methods A systematic literature review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE and EMBASE. Inclusion criteria targeted general and trauma surgery consultants or trainees in HICs, analysing quantitative and qualitative data on operative workload and skills acquisition. Results Twelve studies from the USA, UK, Netherlands, Ireland, Australia, and New Zealand were included. Trainees demonstrated experience in general surgical trauma but lack exposure to critical skills in orthopaedic, vascular and obstetric and gynaecological surgery. Conclusion This review highlights a gap in the operative trauma surgical skills of surgeons in HICs and the need for re-evaluation of surgical training curricula to address the dynamic challenges posed by contemporary trauma care. Emphasising a versatile skillset and exploring avenues for enhanced exposure through didactic courses and global surgery partnerships might prove crucial for better preparing surgeons for the diverse and demanding scenarios in the field of trauma care

Training the Next Generation of Transplant Surgeons With a 3-Dimensional Trainer: A Pilot Study.

In the United States, no published guidelines promote exposure to technical variants (ie, living donor or split liver) during transplant fellowship. Simulation with hands-on liver models may improve training in transplantation. This pilot study addressed 3 overall goals (material and model creation tools, recruitment rates and assessment of workload, and protocol adherence). A patient-specific hands-on liver model was constructed from clinical imaging, and it needed to be resilient and realistic. Multiple types of materials were tested between January 2020 and August 2022. Participants were recruited stepwise. A left lateral segmentectomy simulation was conducted between August 2022 and December 2022 to assess protocol adherence. Digital anatomy 3-dimensional printing was considered the best option for the hands-on liver model. The recruitment rate was 100% and 47% for junior attendings and surgical residents, respectively. Ten participants were included and completed all the required surveys. Seven (70%) and 6 (60%) participants "agreed" that the overall quality of the model and the material were acceptable for surgical simulation. Five participants (50%) "agreed" that the training improved their surgical skills. Nine participants (90%) "strongly agreed" that similar sessions should be included in surgical training programs. Three-dimensional hands-on liver models have the advantage of tactile feedback and were rated favorably as a potential training tool. Study enrollment for further studies is possible with the support of leadership. Rigorous multicenter designs should be developed to measure the actual impact of 3-dimensional hands-on liver models on surgical training.

Upper gastrointestinal training in the UK and Ireland: a Roux Group Study.

Surgical training programmes in the United Kingdom and Ireland (UK&I) are in a state of flux. This study aims to report the contemporary opinions of trainee and consultant surgeons on the current upper gastrointestinal (UGI) training model in the UK&I. A questionnaire was developed and distributed via national UGI societies. Questions pertained to demographics, current training evaluation, perceived requirements and availability. A total of 241 responses were received with representation from all UK&I postgraduate training regions. The biggest discrepancies between rotation demand and national availability related to advanced/therapeutic endoscopy and robotic surgery, with 91.7% of respondents stating they would welcome greater geographical flexibility in training. The median suggested academic targets were 3-5 publications (trainee vs consultant <3 vs 3-5, p<0.001); <3 presentations (<3 vs 3-5, p=0.002); and 3-5 audits/quality improvement projects (<3 vs 3-5, p<0.001). Current operative requirements were considered achievable (87.6%) but inadequate for day one consultant practice (74.7%). Reassuringly, 76.3% deemed there was role for on-the-job operative training following consultant appointment. Proficiency in diagnostic endoscopy was considered a minimum requirement for Certificate of Completion of Training (CCT) yet the majority regarded therapeutic endoscopy competency as non-essential. The median numbers of index UGI operations suggested were comparable with the current curriculum requirements. Post-CCT fellowships were not considered necessary; however, the majority (73.6%) recognised their advantage. Current CCT requirements are largely consistent with the opinions of the UGI community. Areas for improvement include flexibility in geographical working and increasing national provisions for high-quality endoscopy training.

Ergonomics in the operating room and surgical training: a survey on the Italian scenario.

Surgical-related injuries are frequent, in fact the reported percentage of musculoskeletal disorders in surgeons is between 47% and 87%. These conditions are caused by long periods of standing, incorrect postures, repeated movements, little rest between operations, the lack of integrated operator rooms, the correct number and arrangement of monitors and the use of non-ergonomic instruments. This survey aims to assess the Italian overview both highlighting how prevalent surgical-related injury is in our surgeons and whether there is an operating room ergonomics education program in Italian surgical specialty schools. An anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of 3 different sections concerning the general characteristics of the participants, their surgical background and any training performed, and any injuries or ailments related to the surgical activity. The survey was carried out in the period 1th of December 2022 and the 6th of February 2023. At the close of our survey, 300 responses were collected. Among the participants, the two most represented specialties were Gynecology and Obstetrics (42.3%) and General Surgery (39.7%) and surgeons were mainly employed in the Northern regions of Italy (54.8%). Analyzing the participants' background, 61.7% of the respondents had laparoscopic training during their training and only 53.1% had a pelvic trainer during their residency. In accordance with 98.7% of the respondents, during surgery we have the feeling of being in an uncomfortable position that causes discomfort or muscle pain, and regarding the frequency of these discomforts, the majority of our study population experiences these problems monthly (46.2%), while in 29.6% it is experienced weekly, 12.1% annually and finally 12.1% daily. The surgical approach that is most correlated with these disorders is laparoscopy (62.7%) while the one that causes the least discomfort is robotic surgery (1.4%). These discomforts cause 43.9% of our population to take a break or do short exercises to reduce pain during surgery, and the body areas most affected are the back (61.6%), neck (40.6%) and shoulders (37.8%). Despite this, our survey allows us to highlight some now-known gaps present in the surgical training program of our schools and the lack of protection toward our surgeons during their long career.

Current status of resident simulation training curricula: pearls and pitfalls.

Residency programs are required to incorporate simulation into their training program. Ideally, simulation provides a safe environment for a trainee to be exposed to both common and challenging clinical scenarios. The purpose of this review is to detail the current state of the most commonly used laparoscopic, endoscopic, and robotic surgery simulation programs in general surgery residency education, including resources required for successful implementation and benchmarks for evaluation. Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Resident and Fellow Task Force (RAFT) Committee performed a literature review using PubMed and training websites. Information regarding the components of the most commonly used laparoscopic, endoscopic, and/or robotic simulation curriculum, including both formal and informal benchmarks for evaluating training competence, were collected. Laparoscopic simulation revolves around the Fundamentals of Laparoscopic Surgery (FLS). Proficiency-based as well as virtual simulation have been utilized for FLS training curricula. Challenges include less direct translation to the technical complexities that can arise in laparoscopic surgery. Endoscopic simulation focuses on the Fundamentals of Endoscopic Surgery. There are virtual reality simulation platforms that can be used for skills assessment and training. Challenges include simulator types and access, as well as structured mentoring and feedback. Robotic simulation training curricula have not been standardized. Simulation includes one primary technology, which can be prohibitive based on cost and requirements for onboarding. While surgical simulation seems to be a fundamental and integrated part of surgical training, it requires a significant number of resources, which can be daunting for residency training programs. Regardless of the barriers outlined, the need for surgical simulation in laparoscopy, endoscopy, and robotics at surgical education training programs is clear.

Co-Existing Vascular Surgery Integrated Residencies are Associated with Increased General Surgery Resident Proficiency and Autonomy in Vascular Cases

Integrated vascular surgery residency positions have doubled more than the last decade. Studies have investigated the impact of co-existing subspecialty surgical training programs on case volume of general surgery residents (GSRs). However, no studies have explored the impact of subspecialty training on GSR operative competency. The aim of this study is to understand the impact of integrated residencies on operative performance and autonomy of GSR performing vascular procedures. Autonomy and performance ratings of GSR participating in vascular surgery cases were collected from all institutions participating in the Society for Improving Medical Professional Learning application database from 2015 to 2023. Faculty and self-assessments of autonomy and performance on vascular cases performed by GSRs at programs with co-existing vascular integrated residency (VIR), vascular surgery fellowship (VSF), or no subspecialty vascular training (VX) were compared using Fisher's exact tests with Bonferroni corrections across training levels and case complexity. Eleven thousand one hundred seventy five assessments (26% at institutions with VIR, 46% VSF, and 28% VX) were submitted by 920 GSRs and 343 faculty. Senior GSRs at programs with VSF achieved lower autonomy than those with VIR (P=0.049) or VX (P=0.042) based on faculty assessment. GSRs achieved a level of "practice ready" at significantly higher rates when training at programs with VIR, and at the lowest rates with VSF (P<0.001). However, self-perception of autonomy and performance was highest among GSRs at programs with VX compared with VIR and VSF (P<0.001). The presence of VIR was associated with higher achievement of "practice ready" competency and higher levels of operative autonomy among senior GSRs performing vascular procedures. Shared-learning among peers and faculty expertise in teaching resident-level trainees may contribute to this finding.

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

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

Surgical outreach for the Americas: a self-sustainable model for partnership and education.

It is estimated that up to 28% of global disease burden is surgical with hernias representing a unique challenge as the only definitive treatment is surgery. Surgical Outreach for the Americas (SOfA) is a nongovernmental organization focused primarily on alleviating the disease burden of inguinal and umbilical hernias in Central America. We present the experience of SOfA, a model focused on partnership and education. SOfA was established in 2009 to help individuals recover from ailments that are obstacles to working and independent living. Over the past 15years, SOfA has partnered with local healthcare providers in the Dominican Republic, El Salvador, Honduras, and Belize. The SOfA team consists of surgeons, surgery residents, triage physicians, an anesthesiologist, anesthetists, operating room nurses, recovery nurses, a pediatric critical care physician, sterile processing technicians, interpreters, and a team coordinator. Critical partnerships required include the CMO, internal medicine, general surgery, nursing, rural health coordinators and surgical training programs at public hospitals. SOfA has completed 24 trips, performing 2074 procedures on 1792 patients. 71.4% of procedures were hernia repairs. To enhance sustainability of healthcare delivery, SOfA has partnered with the local facilities through capital improvements to include OR tables, OR lights, anesthesia machines, monitors, hospital beds, stretchers, sterilizers, air conditioning units, and electrosurgical generators. A lecture series and curriculum on perioperative care, anesthesia, anatomy, and operative technique is delivered. Local surgery residents and medical students participated in patient care, learning alongside SOfA teammates. Recently, SOfA has partnered with SAGES Global Affairs Committee to implement a virtual Global Laparoscopic Advancement Program, a simulation-based laparoscopic training curriculum for surgeons in El Salvador. A sustainable partnership to facilitate surgical care in low resource settings requires longitudinal, collaborative relationships, and investments in capital improvements, education, and partnership with local healthcare providers, institutions, and training programs.

807 Reliability of Simulation-Based Assessment of Surgical Technical Skills

Abstract Aim To examine the reliability of surgical trainees’ assessment data from a structured simulation training and assessment programme. Method The General Surgical Skills Programme is a simulation-based surgical training programme integrated within the clinical training pathway for surgical trainees across London. It is tailored to each trainee’s level of training and subspecialty. The ‘Junior’ pathway involves nine training sessions and one assessment session performing three procedures (Inguinal hernia [IH], laparoscopic cholecystectomy [LC] and small bowel anastomoses [SBA]). Within the scope of the Programme, skills assessment data collection was initiated in 2012. Data collected includes demographics and training data (grade/subspecialty/case numbers). Each procedure is assessed by two consultant surgeons using two procedure specific assessment tools, a visual analogue scale (VAS) and competency assessment tool (CAT). Reliability analyses were performed using SPSS for ‘Junior’ data over a four-year period. Results In total, 355 surgical trainees (Male = 199, Female = 154, Missing = 2) were assessed from 2014 to 2017 (2014 n=105; 2015 n=92; 2016 n=89; 2017 n=69). Both assessment tools showed satisfactory inter-item reliability (IH-CAT α=.794-.903, LC-CAT α=.837–910, IH-VAS α=.851-.991, LC-VAS α=.831-.986, SBA-VAS α=.778-.984). Inter-rater reliability, ICC (1,2), was good to poor across all tools. (IH-CAT .345-.510, IH-VAS .243-.600, LC-CAT .271-.766, LC-VAS .157-.678, SBA-VAS .225-.278). Conclusions The assessment tools used within the Programme both demonstrate satisfactory inter-item reliability. Inter-rater reliability is variable, highlighting a potential utility for assessor training within the Programme.