Journal of Surgical Education最新文献

{"title":"Benchmarking Vision Capabilities of Large Language Models in Surgical Examination Questions","authors":"Jean-Paul Bereuter MD ,&nbsp;Mark Enrik Geissler MS ,&nbsp;Anna Klimova PhD ,&nbsp;Robert-Patrick Steiner MD ,&nbsp;Kevin Pfeiffer ,&nbsp;Fiona R. Kolbinger MD ,&nbsp;Isabella C. Wiest MD ,&nbsp;Hannah Sophie Muti MD ,&nbsp;Jakob Nikolas Kather MD","doi":"10.1016/j.jsurg.2025.103442","DOIUrl":"10.1016/j.jsurg.2025.103442","url":null,"abstract":"<div><h3>Objective</h3><div>Recent studies investigated the potential of large language models (LLMs) for clinical decision making and answering exam questions based on text input. Recent developments of LLMs have extended these models with vision capabilities. These image processing LLMs are called vision-language models (VLMs). However, there is limited investigation on the applicability of VLMs and their capabilities of answering exam questions with image content. Therefore, the aim of this study was to examine the performance of publicly accessible LLMs in 2 different surgical question sets consisting of text and image questions.</div></div><div><h3>Design</h3><div>Original text and image exam questions from 2 different surgical question subsets from the German Medical Licensing Examination (GMLE) and United States Medical Licensing Examination (USMLE) were collected and answered by publicly available LLMs (GPT-4, Claude-3 Sonnet, Gemini-1.5). LLM outputs were benchmarked for their accuracy in answering text and image questions. Additionally, the LLMs’ performance was compared to students’ performance based on their average historical performance (AHP) in these exams. Moreover, variations of LLM performance were analyzed in relation to question difficulty and respective image type.</div></div><div><h3>Results</h3><div>Overall, all LLMs achieved scores equivalent to passing grades (≥60%) on surgical text questions across both datasets. On image-based questions, only GPT-4 exceeded the score required to pass, significantly outperforming Claude-3 and Gemini-1.5 (GPT: 78% vs. Claude-3: 58% vs. Gemini-1.5: 57.3%; p &lt; 0.001). Additionally, GPT-4 outperformed students on both text (GPT: 83.7% vs. AHP students: 67.8%; p &lt; 0.001) and image questions (GPT: 78% vs. AHP students: 67.4%; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>GPT-4 demonstrated substantial capabilities in answering surgical text and image exam questions. Therefore, it holds considerable potential for the use in surgical decision making and education of students and trainee surgeons.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103442"},"PeriodicalIF":2.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Reality Simulation as a Tool for ENT Training: An Autoethnographic Study","authors":"Thomas W. Binnersley MBChB ,&nbsp;Emma Richards MRCS (ENT) ,&nbsp;Joshua D. Whittaker MRCS (ENT) ,&nbsp;C. Lucy Dalton FRCS (ORL-HNS)","doi":"10.1016/j.jsurg.2025.103439","DOIUrl":"10.1016/j.jsurg.2025.103439","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To investigate the factors influencing a novice trainee's surgical skill acquisition using virtual reality (VR) temporal bone (TB) drilling simulation as a training tool. This study is the first application of autoethnography in the surgical simulation literature.</div></div><div><h3>DESIGN</h3><div>This study uses autoethnography to examine the factors underpinning simulated surgical skill acquisition using VR TB drilling (ethnography) through systematically documenting and analyzing the researcher's reflections over a prolonged period of time (autobiography). The primary researcher undertook 16 3-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) simulator over 8 months. Data collected comprised qualitative field notes and reflective journal logs, and quantitative scores from formative assessments. Data were coded using NVivo12 and analyzed using inductive thematic analysis.</div></div><div><h3>SETTING</h3><div>University Hospitals Birmingham ENT Simulation Dry Lab, Queen Elizabeth Hospital, Birmingham, United Kingdom.</div></div><div><h3>PARTICIPANTS</h3><div>The primary researcher, a surgical novice, was responsible for the study design and execution, with supervision from a consultant ENT surgeon and 2 simulation fellows.</div></div><div><h3>RESULTS</h3><div>The study yielded 6 themes: About 3 themes highlight new insights: 1) VMT as a surgical learning tool, 2) overcoming technological issues, 3) and physical impacts of simulated surgery; About 3 themes support existing evidence relating to surgical skill acquisition: 4) rushing leading to inaccuracy, 5) reflections and feedback, and 6) overcoming demotivation.</div></div><div><h3>CONCLUSION</h3><div>The application of autoethnography to the study of surgical skill acquisition is new. Our results enable a deeper insight into surgical skill acquisition using VR TB simulation, with 6 specific themes identified as impacting learning with this tool. An understanding of these factors will facilitate future research in this area, and enable constructive adjustments to the learning experience, ultimately improving training program delivery and outcomes going forward.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103439"},"PeriodicalIF":2.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143338085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey Assessment of Psychological Safety in Colon and Rectal Surgery Residents and Comparison to General Surgery Residents","authors":"Saher-Zahra Khan MD ,&nbsp;Alexander Loftus MD ,&nbsp;John B. Ammori MD ,&nbsp;Michael Valente DO ,&nbsp;Ronald Charles MD ,&nbsp;Jennifer L. Miller-Ocuin MD ,&nbsp;Emily Steinhagen MD","doi":"10.1016/j.jsurg.2025.103448","DOIUrl":"10.1016/j.jsurg.2025.103448","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Psychological safety (PS) is the shared belief that the team is safe for interpersonal risk-taking. Although some research has been conducted regarding PS in healthcare settings, there is minimal research in surgical training programs. Our objective was to study PS levels in colorectal surgery (CRS) residents.</div></div><div><h3>DESIGN</h3><div>Our survey was adapted from Amy Edmonson's psychological safety scale and the Maslach Burnout Inventory for the surgical work environment. Questions regarding interactions with attending surgeons (AS) and program directors (PD) and regarding burnout were asked. Each question was scored on a 1-9 Likert Scale. Total PS scores for questions targeting AS or PD ranged from 3 (low) to 126 (high) and the overall PS score ranged from 6 (low) to 252 (high). Burnout scores ranged from 0 (low) to 32 (high). Descriptive statistics including medians and interquartile ranges (IQR) are used to present the data.</div></div><div><h3>SETTING</h3><div>The survey was distributed to CRS residents in-person at the 2023 Colorectal Career Course in November, 2023.</div></div><div><h3>PARTICIPANTS</h3><div>Of the 87 CRS residents in attendance, 50 completed the survey (57%).</div></div><div><h3>RESULTS</h3><div>CRS residents had overall high psychological safety overall (median score 228, IQR 198-247) with 92% of CRS residents having PS scores in the top third of the range. CRS residents had low burnout scores (median score 6, IQR 3-11) with 80% having burnout scores in the lowest third of the range.</div></div><div><h3>CONCLUSION</h3><div>CRS residents generally have high PS levels and low burnout levels. This high level of PS could stem from the consistency of working with the same attendings, the shared interest in 1 subspecialty, and/or more frequent high-quality feedback. Further research to determine the mediators of high PS in surgical residency and CRS can be used to foster PS in other healthcare fields.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103448"},"PeriodicalIF":2.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143338081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Pediatric Ambulatory Surgical Center on Surgery Resident Education","authors":"Parker Evans MD ,&nbsp;Sameer Sundrani BS ,&nbsp;Christina Bailey MD ,&nbsp;Jamie Robinson MD, PhD ,&nbsp;Jeffrey Upperman MD ,&nbsp;Harold Lovvorn III MD","doi":"10.1016/j.jsurg.2025.103444","DOIUrl":"10.1016/j.jsurg.2025.103444","url":null,"abstract":"<div><h3>Objective</h3><div>Most operative education for surgery trainees occurs in primary academic hospitals. The impact of ambulatory surgery centers (ASCs) on resident operative experience with adult procedures is variable but has not been reported regarding pediatric cases. We hypothesized that the introduction of a pediatric ASC in our health system led to decreased opportunities for surgery residents to participate in ACGME-required cases.</div></div><div><h3>Design</h3><div>We performed a retrospective analysis of operative data from the electronic health record (EHR) and resident-reported case logs for procedures performed at an academic children's hospital (CH) and its pediatric ASC from 2018 to 2023. Pediatric surgery first performed operations at the ASC in May 2020. Operative cases analyzed were those performed at both the ASC and the CH. The presence of trainees in overlapping case types was analyzed, and descriptive statistics were performed.</div></div><div><h3>Setting</h3><div>Vanderbilt University Medical Center, General Surgery training program and Vanderbilt Children's Hospital, both quaternary care centers.</div></div><div><h3>Participants</h3><div>General surgery residents rotating on the Pediatric Surgery service between 2018 and 2023.</div></div><div><h3>Results</h3><div>Overlapping cases included inguinal, umbilical, and epigastric herniorrhaphies, as well as subcutaneous lesion excisions. Of 17,012 cases performed by pediatric surgeons during the study period, 5,413 (31.8%) were overlapping cases, and 599 (3.5%) were performed at the ASC. Retrospective review of the EHR demonstrated resident presence in 82.9% of CH cases before the ASC and 81.8% afterwards. Resident presence in ASC cases was minimal (<em>n</em> = 9). Categorical General Surgery and Pediatric Surgery residents had no decrease in case volume after ASC initiation based on EHR data or case logs.</div></div><div><h3>Conclusions</h3><div>The introduction of a pediatric ASC did not reduce resident operative experience but represents a missed educational opportunity in the ambulatory setting.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103444"},"PeriodicalIF":2.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143338082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internalized Shame Experiences and Burnout in General Surgery Residents","authors":"Sophia M. Smith MD, MS ,&nbsp;Anna Kobzeva-Herzog MD ,&nbsp;Patrick McGillen MD, MS ,&nbsp;Myriam Castagne-Charlotin MD ,&nbsp;Joshua Davies MD ,&nbsp;Sabrina E. Sanchez MD, MPH ,&nbsp;Tracey Dechert MD, FACS ,&nbsp;Tejal S. Brahmbhatt MD, FACS ,&nbsp;Sheina Theodore MD","doi":"10.1016/j.jsurg.2025.103447","DOIUrl":"10.1016/j.jsurg.2025.103447","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>General surgery residents have high rates of professional burnout, characterized by depersonalization, emotional exhaustion, and reduced sense of personal accomplishment. While shame experiences in surgical residency have been sparsely studied, there are no studies evaluating internalized shame states in surgical residents. This study quantifies internalized shame in surgical residents and its association with burnout. We hypothesized that higher levels of internalized shame would be associated with higher odds of burnout.</div></div><div><h3>DESIGN</h3><div>This cross-sectional study was conducted via an anonymous survey consisting of demographic information, the Maslach Burnout Inventory (MBI), and the Experience of Shame Scale (ESS), both validated measures. Multivariable logistic regression was used to determine the association between ESS and MBI scores, controlling for age, sex, relationship and parental status, and resident seniority level.</div></div><div><h3>SETTING</h3><div>The survey was distributed among United States general surgery residency programs via email through the Association of Program Directors in Surgery.</div></div><div><h3>PARTICIPANTS</h3><div>Categorical general surgery residents were invited to participate.</div></div><div><h3>RESULTS</h3><div>122 general surgery residents responded to the survey. Respondents were 61.48% female (<em>n</em> = 75), with a median age of 31 (IQR 29-32) and distributed across postgraduate years. On multivariable logistic regression, increased ESS scores were significantly associated with higher odds of burnout (OR 1.11, 95% CI 1.06-1.16, p &lt; 0.001).</div></div><div><h3>CONCLUSIONS</h3><div>General surgery residents experience high rates of internalized shame (median ESS score 54.5, IQR 43-69), and shame states are significantly associated with increased odds of experiencing burnout. Interventions to minimize internalized shame experiences may help mitigate the high rates of burnout found in general surgery residents.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103447"},"PeriodicalIF":2.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143360441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional Experience Modulates the Effect of Impulsiveness on Laparoscopic Simulator Performance","authors":"Bas Kengen MD, PhD,&nbsp;Harry van Goor MD, PhD,&nbsp;Jan-Maarten Luursema PhD","doi":"10.1016/j.jsurg.2025.103443","DOIUrl":"10.1016/j.jsurg.2025.103443","url":null,"abstract":"<div><h3>Objective</h3><div>High impulsiveness is associated with adverse outcomes, such as dangerous driving leading to traffic accidents and decreased job performance in general. In surgical training, high impulsiveness is associated with increased damage during simulated laparoscopic tasks. The objective of this study is to investigate the impact of professional experience on the relation between impulsiveness and simulated laparoscopy.</div></div><div><h3>Methods</h3><div>In this single institution study, a total of 120 participants, of whom 78 inexperienced medical students and residents (≤ 10 laparoscopic procedures as primary surgeon), and 42 residents and attending surgeons experienced in laparoscopy (&gt; 10 laparoscopic procedures as primary surgeon), performed 4 different, standardized laparoscopic tasks on the LapSim Virtual Reality trainer. Based on the UPPSP impulsive behavior scale, a scale to measure impulsiveness, we divided participants into equal sized high- and low impulsiveness groups for both experience groups. We used Mann–Whitney U tests to compare task duration and damage parameters between the low and high impulsiveness group, separately for inexperienced and experienced participants. Spearman's rank correlation tests were used to investigate the correlation of different facets of impulsiveness (positive and negative urgency, premeditation, perseverance and sensation seeking) on performance.</div></div><div><h3>Results</h3><div>Inexperienced participants with high impulsiveness demonstrated significantly faster task completion (<em>z</em> = 2.74, p &lt; 0.01). Inexperienced participants of very high-impulsiveness (upper quartile) also caused significantly more tissue damage (<em>z</em> = 2.27, p = 0.02). Conversely, experienced surgeons exhibited no discernible performance variations based on impulsiveness for time (<em>z</em> = 1.42, p = 0.16) or tissue damage (<em>z</em> = −0.19, p = 0.85). For inexperienced participants the impulsiveness facets (lack of) premeditation and sensation seeking correlated with shorter task duration, while negative urgency, positive urgency, and (lack of) perseverance were associated with increased tissue damage. For the experienced participants no significant correlations were found between impulsiveness facets and simulator outcomes.</div></div><div><h3>Conclusion</h3><div>High impulsiveness results in shorter task duration but tend to increase tissue damage for laparoscopic simulator performance of inexperienced trainees. The performance of experienced surgeons remained unaffected by impulsiveness, indicating that professional experience may play a role in mitigating its influence.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103443"},"PeriodicalIF":2.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143360442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Medical School Experiences in Global Surgery on Perceptions and Career Plans Among U.S. Medical Students","authors":"Lydia Kersh MS, MPH ,&nbsp;Paul Serrato MS ,&nbsp;Cassandra Anderson MD ,&nbsp;Vanitha Raguveer MD ,&nbsp;Connor Peck MD ,&nbsp;Syeda Akila Ally MD ,&nbsp;Isha Gondi BS ,&nbsp;Shivani Subhedar DO ,&nbsp;Allison Rollins MD ,&nbsp;Blake Hauser MD ,&nbsp;Anusha Jayaram MD ,&nbsp;Sarah Hill MD ,&nbsp;Bathsheba Wariso MD ,&nbsp;Shahyan Rehman MD ,&nbsp;Global Surgery Student Alliance,&nbsp;James Clune MD","doi":"10.1016/j.jsurg.2025.103441","DOIUrl":"10.1016/j.jsurg.2025.103441","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>There is a growing interest among medical students to learn about global surgery and how they can incorporate it into their further training in residency. This study addresses US-based medical student perceptions of global surgery, medical school experiences, and career plans.</div></div><div><h3>METHODS</h3><div>A cross-sectional survey study of US-based medical students was performed. Univariate and multivariable regression models were constructed to assess the impact of student experiences during medical school and mentor experiences on global surgery perceptions and career plans. Career plans for international surgical mission trips and for global surgery advocacy/research were further evaluated.</div></div><div><h3>RESULTS</h3><div>Of the 708 responses, 251 (34.6%) students indicated interest in global surgery. Global surgery curricular experiences during medical school were associated with increased odds of believing that global surgery topics should be included in medical school curricula (OR = 2.42, p = 0.021) and having career plans for global surgery research or advocacy (OR = 3.72, p = 0.002). Students with mentors with global surgery research experience were more likely to have career plans for global surgery research or advocacy (OR = 4.36, p = 0.019). Student participation in global health research was associated with lower odds of having career plans for international surgical mission trips (OR = 0.22, p &lt; 0.001).</div></div><div><h3>CONCLUSION</h3><div>Students with more experience in global surgery view it more favorably, and have greater odds of participating in global surgery in their future careers. There is a desire among the respondent medical students for more global surgery education and mentoring among medical institutions. Therefore, medical schools may benefit by offering more global surgery opportunities at their institutions.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103441"},"PeriodicalIF":2.6,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serve Coffee, Hold Clamps, Do Not Complain: Student Perceptions and Experiences Regarding Surgery","authors":"Begum Pekbay MD ,&nbsp;Sjoerd M. Lagarde MD, PhD ,&nbsp;Claudia M. Keyzer-Dekker MD, PhD ,&nbsp;Frouke C. de Vries MSc ,&nbsp;Jeroen de Jonge MD, PhD ,&nbsp;Johanna M. Hendriks MD, PhD","doi":"10.1016/j.jsurg.2024.103394","DOIUrl":"10.1016/j.jsurg.2024.103394","url":null,"abstract":"<div><h3>Objective</h3><div>To explore medical students’ perceptions and experiences regarding the surgery clerkship and surgeons.</div></div><div><h3>Design</h3><div>Between November 2021 and February 2022, an anonymous prepost survey study was performed among 2 consecutive cohorts of medical students. The survey was taken 6 weeks prior to the surgery clerkship and repeated shortly after the surgery clerkship.</div></div><div><h3>Setting</h3><div>Single-center prepost survey study.</div></div><div><h3>Participants</h3><div>Medical students studying at Erasmus Medical Center entering a 6-week surgery education block directly followed by a ten-week surgery clerkship.</div></div><div><h3>Results</h3><div>The preclerkship response rate was 100% (n=145). One out of 5 students considered a surgical career (21%). Half of the students expected to be negatively treated (55%), mainly in terms of hierarchy and offensive language. The postclerkship response rate was 70% (n=101). Interest in a surgical career increased significantly from 21% to 50% (p&lt;0.001). Thirteen students (13%) reported being negatively treated during their surgery clerkship, mainly in terms of poor supervision of their learning process and nonconstructive feedback.</div></div><div><h3>Conclusions and Relevance</h3><div>Stereotypes of surgeons and the surgical clerkship are strongly prevalent among medical students. Half of the students enter the surgery clerkship with negative perceptions. Fortunately, the surgery clerkship debunked prejudices and increased interest in surgery. Poor supervision and feedback during the surgery clerkship were experienced as negative treatment, emphasizing the importance of cultivating a safe learning climate.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 2","pages":"Article 103394"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Table of Contents & Bacode","authors":"","doi":"10.1016/S1931-7204(25)00004-2","DOIUrl":"10.1016/S1931-7204(25)00004-2","url":null,"abstract":"","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 2","pages":"Article 103423"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urology Resident Autonomy in the Veterans Affairs Healthcare System","authors":"Anh Thuy Nguyen ,&nbsp;Joseph B. Oliver ,&nbsp;Kunj Jain ,&nbsp;Janmejay Hingu ,&nbsp;Anastasia Kunac ,&nbsp;Hossein Sadeghi-Nejad ,&nbsp;Devashish Anjaria MD, FACS","doi":"10.1016/j.jsurg.2024.103370","DOIUrl":"10.1016/j.jsurg.2024.103370","url":null,"abstract":"<div><h3>Purpose</h3><div>Surgical resident autonomy in procedures has been eroding over time, due to multiple factors that include duty hour restrictions, focus on operating time, complication rate, and trust among supervising physicians. This study examines whether urology residents at the Veterans Affairs hospitals (VA) have experienced decreased surgical autonomy and contributing factors.</div></div><div><h3>Methods</h3><div>The national VA Surgical Quality Improvement Program (VASQIP) was queried for the most common urologic procedures between 2004 to 2019 with resident involvement. The most frequent surgeries were transurethral resection of prostate (TURP); transurethral resection of small, medium, or large tumor (TURBT); photo vaporization of prostate, scrotal surgery, and ureteral stent placement. The cases were stratified by resident involvement: attending as primary (AP), attending and resident (AR), resident as primary (RP).</div></div><div><h3>Results</h3><div>93,756 urology cases were selected from 2004 to 2019. The above procedures accounted for 76.5% of all urologic cases. The percentage of RP cases decreased from 44.4% of cases in 2004 to 25.1% in 2019. Reduction in RP cases was seen in all of the 7 examined urology cases. Cases with resident involvement had patients with more medical comorbidities. Mean operative times were not significantly different. The 30-day composite complications and 30-day return to operating room were greatest for AR. Postoperative morbidity and all-cause mortality were not significantly different.</div></div><div><h3>Conclusions</h3><div>Urology resident autonomy has decreased within the VA healthcare system over the past 15 years. Mean operative times and postoperative complications are not significantly different in cases with residents as primary surgeon.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 2","pages":"Article 103370"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}