Journal of Surgical Education最新文献

{"title":"Incorporating Intraoperative Assessments of surgical Trainees Performing Open Surgery Into Summative Trainee Evaluations: A Scoping Review","authors":"Michelle J. Clarke MD, PhD ,&nbsp;Sarah Lund MD ,&nbsp;Bobbie Ann Adair White EdD ,&nbsp;Danielle Gerberi MLIS ,&nbsp;Roger A. Edwards ScD","doi":"10.1016/j.jsurg.2025.103546","DOIUrl":"10.1016/j.jsurg.2025.103546","url":null,"abstract":"<div><h3>Objective</h3><div>Real-world assessment of trainee surgical competence and autonomy must occur in the operative environment. It is unclear if or how workplace-based operative skills assessments are systematically incorporated into summative evaluations. In this study, intraoperative surgical skills assessment tools were reviewed for actual or proposed incorporation into summative evaluations.</div></div><div><h3>Design</h3><div>A scoping review was conducted. The Cochrane Central Registrar of Clinical Trials, Embase, Medline, and Web of Science were searched for articles published from January 2012 to December 2021. Articles describing an educational assessment paradigm of a post-graduate surgical trainee performing an open surgical procedure were selected. Using the PRISMA Extension Guidelines for Scoping Reviews, two independent reviewers completed data extraction including literature quality, assessment paradigm, assessment quality, incorporation into summative evaluations, and facilitators and barriers to implementation. Finally, a narrative synthesis of extracted data was completed.</div></div><div><h3>Results</h3><div>Twenty-two articles met inclusion criteria describing 11 different surgical assessments. All were cohort studies, of which 21 involved the evaluation of an assessment tool and one involved participant perceptions of the assessment tool. All studies discussed the possible use of their assessment to track progress over time, but no study explicitly outlined the incorporation of the tool into a summative review. Four types of assessments automatically integrated results, which reportedly were utilized at Clinical Competency Committee (CCC) meetings. Facilitators and barriers of surgical assessment integration into summative assessments was not described.</div></div><div><h3>Conclusions</h3><div>While proponents of formative intra-operative assessment have claimed that their potential use in supporting summative evaluation and tracking learning trajectories are major benefits, a systematic method of integrating workplace surgical assessments into summative resident evaluation has not been described or uniformly implemented.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 8","pages":"Article 103546"},"PeriodicalIF":2.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123609","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":"Biosensors, Biometrics and Capabilities in Practice (CiP): A WHOOP 4.0 Perspective","authors":"E. Barlow ,&nbsp;D. Robinson ,&nbsp;O. James ,&nbsp;O. Luton ,&nbsp;C. Eley ,&nbsp;C. Bowman ,&nbsp;M. Kearns ,&nbsp;A.G.M.T. Powell ,&nbsp;D. Hanratty ,&nbsp;J.D. Barry ,&nbsp;R.J. Egan ,&nbsp;W.G. Lewis","doi":"10.1016/j.jsurg.2025.103549","DOIUrl":"10.1016/j.jsurg.2025.103549","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to measure physiological stress response related to Capabilities in Practice (CiPs) using wearable technology.</div></div><div><h3>Design</h3><div>Surgical residents wore WHOOP4.0 sensors for 6-weeks with CiP event diaries and Abbreviated Maslach Burnout Inventory (AMBI) scores recorded.</div></div><div><h3>Setting</h3><div>A surgical training program serving a single UK (Wales) deanery.</div></div><div><h3>Participants</h3><div>23 Surgical residents participated (13 male, median age 30 [26-35] year).</div></div><div><h3>Results</h3><div>Median Heart Rate Variability (HRV) varied by resident grade (Core Surgical Training (CST) resident 58 vs. Higher Surgical Training (HST) resident 48 ms, p &lt; 0.001) and duty shift (HRV: Off Duty 51 milliseconds (ms), Normal Working Day (NWD) 48, On Call Day (OCD) 45, p = 0.009) and CiP (Inpatient work 48, Elective Operating 47, Emergency Operating 44, Emergency Day Shift 46, Emergency Night Shift 63 ms, p = 0.017). Emergency shifts were associated with adverse sleep profiles with median sleep performance varying from 74.0% (Night Shift) to 98.0% (Off Duty, p &lt; 0.001). On average, residents had 13.4% and 27.2% less sleep related to OCDs or Night Shifts respectively (p &lt; 0.001), and 20.2% less sleep related to Emergency Night Shifts when compared with Elective Day time CiPs (p &lt; 0.001). HRV was related to sleep efficiency (rho 0.38, p &lt; 0.001) and REM sleep (rho 0.211, p &lt; 0.001). AMBI score &gt;3 (consistent with burnout) was found in 71.4% CST vs. 30.1% HST (p &lt; 0.001) and 49.1% males vs. 60.9% females (p &lt; 0.001) and was inversely related to HRV and sleep efficiency (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Stress response varied by 20% (shift profile) and 30% (CiP) highlighting daily clinician physical demand. Adverse sleep profiles were seen related to emergency work, in particular night shifts, impacting sleep quantity and quality.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 8","pages":"Article 103549"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115115","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":"Caring for Future Patients: Education as an Ethical Obligation","authors":"Jonathan D. D'Angelo PhD, MAEd ,&nbsp;Sarah Lund MD, MHPE ,&nbsp;Anne-Lise D. D’Angelo MD, MSEd","doi":"10.1016/j.jsurg.2025.103541","DOIUrl":"10.1016/j.jsurg.2025.103541","url":null,"abstract":"<div><div>Academic surgeons face an often overwhelming load of daily responsibilities. Frequently, the teaching and assessing of residents can receive little attention given the press of clinical and administrative duties. While an array of incentives have been developed to increase faculty compliance in education, we argue that there is one fundamental fact concerning the education of a trainee that is often overlooked: education is an ethical obligation. Offering accurate, critical, and helpful feedback to trainees fulfills an ethical obligation surgeons have towards future patients.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 8","pages":"Article 103541"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115116","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":"Usability of a Novel 3D Printed Open Inguinal Hernia Repair Simulator","authors":"Kelsey Ogomori BA ,&nbsp;Riley Brian MD, MAEd ,&nbsp;Scott Drapeau MA ,&nbsp;Patricia O’Sullivan EdD, MS ,&nbsp;Matthew Lin MD","doi":"10.1016/j.jsurg.2025.103545","DOIUrl":"10.1016/j.jsurg.2025.103545","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the utility of a novel 3D printed open inguinal hernia repair (IHR) simulator compared to our institution’s porcine tissue training model.</div></div><div><h3>Design</h3><div>We iteratively developed a novel 3D printed inguinal hernia model and then designed a convergent mixed methods study to compare the model with a porcine model. Participants completed a rating form post use of the models and were subsequently interviewed.</div></div><div><h3>Setting</h3><div>We conducted this study at the surgical skills center of a single large urban academic medical center.</div></div><div><h3>Participants</h3><div>Individuals were eligible if they were a senior general surgery resident, defined as postgraduate year (PGY) 3 or higher, or attending surgeon with expertise in open inguinal hernia repair or surgical education. Participants were 6 residents and 7 general surgery faculty; all completed the rating form, and 12 were interviewed.</div></div><div><h3>Results</h3><div>The 3D printed simulator demonstrated medium (&gt;0.5) to large effect sizes (&gt;0.8) on 10 of 12 evaluative criteria when compared to the porcine model, with the greatest effect seen in pelvic anatomy and the lowest in mechanical properties and operating in small spaces. We identified 4 themes: (1) utility varies between trainees and faculty: trainees prioritized anatomy whereas faculty prioritized both anatomy and tissue fidelity, (2) anticipate less intraop cognitive load: the 3D printed simulator realistically simulated procedure steps and could decrease intraop cognitive load, (3) both models can increase confidence: both models allow residents to practice the repair in a pressure-free environment, allowing them to build confidence, and (4) need novel ways to understand complexity of the anatomy: current methods to understand anatomy are insufficient.</div></div><div><h3>Conclusions</h3><div>An anatomically accurate 3D printed model may contribute to effective training for IHR. Addition of 3D to a tissue model would allow further development of trainee knowledge and skills.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 8","pages":"Article 103545"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108140","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":"Promoting Longevity in Surgical Careers: A Narrative Review and Fitness Program to Reduce Occupational Pain","authors":"Alexandra Gleave BSc ,&nbsp;Aryan Shah BSc ,&nbsp;Alexandra Giff ,&nbsp;Gihan Christopher Perera MD, FRCPC ,&nbsp;Doron D. Sommer MD ,&nbsp;Margo Mountjoy MD ,&nbsp;Smriti Nayan MD","doi":"10.1016/j.jsurg.2025.103512","DOIUrl":"10.1016/j.jsurg.2025.103512","url":null,"abstract":"<div><h3>Importance</h3><div>Many surgeons experience work-related musculoskeletal disorders (MSD) throughout their career. Incorporating evidence-based strategies to prevent and manage MSDs would benefit both trainees and those in practice. The present narrative review seeks to evaluate the effectiveness of current strategies to manage and prevent musculoskeletal (MSK) occupational pain among surgeons and trainees.</div></div><div><h3>Observations</h3><div>Eleven studies were identified. Included studies covered 3 broad interventions: ergonomics (<em>n</em> = 5), intraoperative breaks/pauses (<em>n</em> = 7), and physical fitness (<em>n</em> = 1). Intraoperative breaks demonstrated improved pain, fatigue, stress, and a decrease in intraoperative errors without increasing overall surgical time. Residents that were specifically instructed in ergonomics exhibited better posture and decreased musculoskeletal (MSK) symptoms and recommended incorporating this information into their curriculum. In a program combining ergonomics, microbreaks, and stretching, 85% of residents experienced reduced discomfort, and 93% felt this training would help them “perform better in the operating room”. Overall, the surgical physical fitness programs reduced surgery/occupational-related pain and increased performance measures in the OR. The study participants also found the interventions valuable and were able to use learned principles in practice.</div></div><div><h3>Conclusions and Relevance</h3><div>The existing body of literature supports the positive impact of fitness programs in preventing and managing occupational-related pain. We propose the implementation of a comprehensive program that integrates education, intraoperative breaks, ergonomic adjustment, and physical fitness, with initiation during the first year of surgical residency. To facilitate practical integration, we propose a pilot program that may be integrated into the regular surgical work week, encompassing recommendations from the reviewed studies. Future research is recommended to explore aspects such as program effectiveness, feasibility, mental health impacts, and gender-specific differences.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 7","pages":"Article 103512"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083702","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":"Surgical Assessments: Current State, Ideal State, and Considerations for Implementation. A Qualitative Interview Study of Faculty and Trainees","authors":"Michelle J. Clarke MD, PhD ,&nbsp;Roger A. Edwards ScD ,&nbsp;Bobbie Ann Adair White EdD","doi":"10.1016/j.jsurg.2025.103534","DOIUrl":"10.1016/j.jsurg.2025.103534","url":null,"abstract":"<div><h3>Objective</h3><div>This qualitative study explored trainee and faculty perceptions of procedural and surgical assessment and feedback, including current state, aspirational future state, and the factors affecting implementation of a formal assessment systems.</div></div><div><h3>Methods</h3><div>Data were collected with semi-structured interviews of 10 surgical faculty and 10 surgical trainees. The in-depth, semi-structured interviews included open-ended questions with targeted follow-up probing around the following topics (1) the current surgical assessment and feedback process, (2) requirements for future surgical assessments, and (3) perceived barriers and facilitators to implementing a new surgical assessment and feedback system. Braun and Clarke’s iterative 6-stage thematic analysis was used to analyze the data.</div></div><div><h3>Results</h3><div>Seven themes were identified from participants’ perceptions of surgical assessments and feedback: (1) Purpose of evaluation and assessment, (2) Assessment in service of feedback, (3) Outcome of evaluation and assessment, (4) Interpersonal relationships trump technology, (5) Challenges of constructive feedback, (6) Development of assessment tool, and (7) Utility is critical to success. Key facilitators to adopting a formal assessment system included ease of use particularly surrounding cell phone-based apps, quality of actionable information, and participant buy-in. Barriers to use included work-flow disruption, and perception that the results would not outweigh the effort.</div></div><div><h3>Conclusions</h3><div>Participants felt there was value in improving surgical assessment and feedback paradigms to improve assessment accuracy and provide actionable feedback. Skepticism surrounding potential assessment and feedback systems will require thoughtful implementation to be successful.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 7","pages":"Article 103534"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083703","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":"Eye Movement Modeling Examples in Robotic Surgery Training—A Randomized Controlled Study","authors":"Andrea Storck ,&nbsp;Eva Schönefeld ,&nbsp;Michelle Bellstedt ,&nbsp;Martin Janssen ,&nbsp;Konstantin E. Seifert ,&nbsp;Dogus Darici","doi":"10.1016/j.jsurg.2025.103539","DOIUrl":"10.1016/j.jsurg.2025.103539","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>In robotic-assisted laparoscopic surgery, the perception and interpretation of the visual scene poses a huge challenge for medical trainees. However, their ability to assist effectively in surgical procedures depends heavily on mastering these visual skills. Research on multimedia learning suggests that seeing an expert's eye movements during task completion as a “worked-example” (i.e., eye movement modeling examples [EMME]) may guide learners’ attention to critical areas and improve learning outcomes. The effectiveness of EMMEs in robotic surgical training remains unclear.</div></div><div><h3>DESIGN</h3><div>A randomized controlled 2-group study was conducted in which participants viewed an audio-guided robotic prostatectomy video. The EMME group viewed the surgical video with an overlay showing an expert urologist's eye movements captured through eye-tracking technology, while the control group viewed the video without the overlay. Learning outcomes were assessed through anatomical landmark identification tasks in 14 laparoscopic images (reliability coefficient α = 0.684). Training engagement was measured through time spent with the learning material.</div></div><div><h3>SETTING</h3><div>The study was conducted within the medical education program at Charité Berlin in an affiliated secondary care geriatric hospital during 2024.</div></div><div><h3>PARTICIPANTS</h3><div>The study included 137 fourth-year medical students randomized into 2 groups: EMME group (<em>n</em> = 67; mean age 26 ± 4 years; 62.7% female) and control group (<em>n</em> = 70; mean age 26 ± 5 years; 62.9% female).</div></div><div><h3>RESULTS</h3><div>The EMME group engaged with the material significantly longer (<em>M</em> = 971 <em>s</em> ±  241 s) compared to the control (<em>M</em> = 881 <em>s</em>  ±  217 s), <em>t(</em>135) = 2.288, p = 0.012, <em>d</em> = 0.391, 95% CI [12.137; 167.066]. However, there was no significant difference in the ability to interpret anatomical landmarks in laparoscopic images between the EMME (<em>M</em> = 54.9% ± 19.4%) and the control group (<em>M</em> = 57.1% ± 18.7%), <em>t(</em>135) = 0.688, p = 0.493, 95% CI [−0.042; 0.087].</div></div><div><h3>CONCLUSIONS</h3><div>Contrary to literature, these findings suggest that although EMME may enhance attention to educational content, the increased engagement does not automatically translate into superior visual performances in laparoscopic surgery. We discuss these results in the broader context of multimedia learning.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 7","pages":"Article 103539"},"PeriodicalIF":2.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071436","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":"Personality Characteristics of Orthopedic Surgery Residents and Faculty: Cross-Sectional Study From the Profiling Orthopaedic Surgery Trainees (POST) Study Group","authors":"Ryann A. Davie MD ,&nbsp;Noah Harrison MD ,&nbsp;Rebecca N. Pool MA ,&nbsp;Patrick J. Rosopa PhD ,&nbsp;Stephanie L. Tanner MS ,&nbsp;Brian Scannell MD ,&nbsp;Brandi Hartley MD ,&nbsp;Alexander W. Aleem MD ,&nbsp;Gabriella E. Ode MD","doi":"10.1016/j.jsurg.2025.103538","DOIUrl":"10.1016/j.jsurg.2025.103538","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>There is growing interest in the assessments of noncognitive and affective domains in orthopedic trainees to aid in resident education, improve interpersonal relationships between residents and faculty, and improve physician leadership skills.<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span> The purpose of this study is to examine personality traits of orthopedic trainees and faculty using the Big Five personality dimensions.</div></div><div><h3>DESIGN</h3><div>The Big Five was administered to residents (<em>n</em> = 151) and faculty (<em>n</em> = 57) at 10 academic medical institutions. Descriptive statistics were analyzed including the means of each Big Five dimension among residents and faculty. Independent samples <em>t</em>-tests and chi-square analyses were performed.</div></div><div><h3>RESULTS</h3><div>Faculty were significantly greater on Conscientiousness compared to residents (<em>M</em> = 74.7 vs 69.8, <em>d</em> = 0.33) and significantly greater among seniors than juniors (<em>M</em> = 74.0 vs 68.0, <em>d</em> = 0.42). Juniors demonstrated greater Extraversion compared to faculty (<em>M</em> = 61.9 vs. 52.2, <em>d</em> = 0.30). Faculty demonstrated greater Agreeableness than seniors (<em>M</em> = 68.5 vs 63.0, <em>d</em> = 0.44).</div></div><div><h3>CONCLUSION</h3><div>There are significant differences in certain Big Five personality dimensions between orthopedic residents and faculty. Better understanding of how these differences could influence interpersonal communication during orthopedic training is critical to improving interconnection in residency programs.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 8","pages":"Article 103538"},"PeriodicalIF":2.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072088","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":"Is Signaling the Solution? Curbing Excess Volumes and Costs of Urology Residency Applications With Large-Volume Preference Signaling","authors":"Anessa N. Rafetto MD,&nbsp;Candace F. Granberg MD,&nbsp;Kevin Koo MD, MPH, MPhil","doi":"10.1016/j.jsurg.2025.103542","DOIUrl":"10.1016/j.jsurg.2025.103542","url":null,"abstract":"<div><h3>Introduction</h3><div>Rising annual volumes of urology residency applications have increased applicants’ expenses and program faculty’s time costs. A “large-volume” preference signaling initiative that was introduced in the 2024 residency match, in which applicants may “signal” their interest in up to 30 programs, has the potential to reduce excess application volumes. We aimed to characterize changes in urology residency application volumes and model the financial impact to residency applicants and programs following implementation of large-volume preference signaling.</div></div><div><h3>Methods</h3><div>Using public data from the Association of American Medical Colleges and American Urological Association, we analyzed urology residency application and interview volumes during 2013 to 2024 and modeled preinterview costs during 2017 to 2024. To model applicants’ costs, we calculated submission fees for the total applicant pool annually. For program costs, we assumed that submitted applications undergo 2 rounds of faculty screening and that large-volume preference signaling permits programs to halve the initial screening pool. All costs were adjusted for inflation.</div></div><div><h3>Results</h3><div>From 2013 to 2023, the average number of applications submitted per applicant increased by 66% (53 to 83 applications). In 2024, large-volume preference signaling decreased submitted applications by 25% to 66 per applicant, while average interviews given by programs and taken by applicants remained unchanged. In the cost model, large-volume preference signaling resulted in applicants’ average submission costs decreasing by 31% per applicant and programs’ review costs decreasing by 25% per program. The total cost of application submission and review decreased by 26% from $3.05 million to $2.25 million, corresponding to a per-vacancy cost of $5,836, the lowest cost observed during the study period.</div></div><div><h3>Conclusions</h3><div>Implementation of large-volume preference signaling resulted in markedly decreased urology residency application volumes and program review time, resulting in substantially lower total costs of the submission and review process.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 7","pages":"Article 103542"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069109","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 Guide to the Background, Purpose, and Scope of Critical Access Hospitals for the Surgical Trainee","authors":"Kimberly B. Golisch MD, MS ,&nbsp;Isolina R. Rossi MD ,&nbsp;Alfred Rossi MD ,&nbsp;Matthew B. Rossi MD","doi":"10.1016/j.jsurg.2025.103537","DOIUrl":"10.1016/j.jsurg.2025.103537","url":null,"abstract":"<div><div>This paper serves to highlight aspects of critical access hospitals (CAH) that all surgeons and trainees should understand, regardless of their current and future practice settings. Due to the unique patient population, coordination of care needs, and varied scope of practice it is vital to have knowledge of CAH inner workings from a surgical perspective. It is also useful to comprehend why CAH surgeons are integral to rural healthcare systems, especially in the setting of on-going economic strain in the postpandemic era. A general comprehension of the scope of CAH perioperative capabilities is paramount to optimizing patient care and enhancing effective communication between facilities.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 7","pages":"Article 103537"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948083","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}