Journal of Surgical Education最新文献

{"title":"Cultivating Rural Surgeons: An Analysis of the Current Rural Surgery Graduate Medical Education Landscape and a Roadmap to Program Creation","authors":"Mustafa Abid MD ,&nbsp;Lori Rodefeld MS ,&nbsp;Mukesh Adhikari MPH ,&nbsp;Benjamin Jarman MD, FACS ,&nbsp;Laney McDougal MS-HSM ,&nbsp;Ann P. O'Rourke MD, MPH, FACS ,&nbsp;Farzad Amiri MD, FACS ,&nbsp;Emily M. Hawes PharmD","doi":"10.1016/j.jsurg.2025.103446","DOIUrl":"10.1016/j.jsurg.2025.103446","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of the study is to provide current data on the composition and prevalence of rural general surgery residency programs and describe new mechanisms and resources facilitating the creation of such programs.</div></div><div><h3>Design</h3><div>Training site and program data for general surgery residencies for the academic year 2022 to 2023 from the Accreditation Council for Graduate Medical Education (ACGME) were geocoded and analyzed. A literature search and iterative consensus process with graduate medical education (GME) experts was used to synthesize and describe new mechanisms and resources to grow rural general surgery training.</div></div><div><h3>Setting</h3><div>Programs were designated as either having a rural rotation or the majority of training in a rural location (i.e. greater than 50% of training). Two definitions of rural were incorporated: nonmetropolitan Core-Based Statistical Area (CBSA) counties and Federal Office of Rural Health Policy area (FORHP) rural counties or census tracts.</div></div><div><h3>Participants</h3><div>All listed general surgery residency programs reporting data to the ACGME.</div></div><div><h3>Results</h3><div>Less than 2% of ACGME-accredited general surgery programs spend the majority of their training in rural areas. Nearly 10% (<em>n</em> = 36) of programs have training sites in nonmetropolitan counties, and 13.30% (<em>n</em> = 48) of programs have sites in FORHP rural areas. Recent changes to GME funding policies and regulations have opened opportunities to expand rural GME programs. For example, existing residencies that increase their complement and establish a new rural site are eligible for Medicare GME funding.</div></div><div><h3>Conclusions</h3><div>Despite new funding opportunities for rural GME, program development remains low among existing or new general surgery programs. Rural general surgery residency training could play an important role in addressing current and future general surgeon workforce shortages. Recent state and federal financing and assistance can be accessed to bolster rural rotations and residencies.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103446"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421229","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":"Nontechnical Coaching in Academic Surgical Practice–Where Do We Stand and What's Next?","authors":"Krishna Unadkat MS ,&nbsp;Patti M. Thorn PhD ,&nbsp;Mary Ann Djonne Med ,&nbsp;Shelley S. Noland MD","doi":"10.1016/j.jsurg.2025.103469","DOIUrl":"10.1016/j.jsurg.2025.103469","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the potential of nontechnical coaching (NC) as an intervention to enhance professional development, reduce burnout, and improve patient outcomes among attending academic surgeons (AS) in high-pressure surgical environments.</div></div><div><h3>Design</h3><div>A narrative review was performed using PubMed to identify and assess studies focused on NC in academic surgery. We evaluated articles addressing the impact, benefits, risks, and barriers associated with NC, with particular attention to coaching frameworks, training programs, and participant feedback.</div></div><div><h3>SETTING</h3><div>The review encompasses research conducted in various academic surgical settings.</div></div><div><h3>PARTICIPANTS</h3><div>Studies primarily involved attending academic surgeons across diverse surgical specialties, especially those experiencing high levels of burnout and decreased job satisfaction.</div></div><div><h3>Results</h3><div>Findings indicate that NC offers several benefits for AS. Pilot studies and qualitative surveys suggest that NC can reduce burnout, enhance intraoperative decision-making, and improve patient engagement. Surgeons who participated in NC reported better stress management, increased self-awareness, and improved leadership skills. Moreover, NC appears to foster enhanced team dynamics and, in some cases, may yield fiscal benefits by reducing surgical errors and increasing operational efficiency. However, significant barriers to NC adoption remain, including cultural resistance within surgical departments, time constraints, and concerns regarding the efficacy of NC compared to traditional technical coaching. Additionally, the current evidence is limited by small sample sizes, selection bias, and a lack of standardized, quantitative measures.</div></div><div><h3>Conclusion</h3><div>Preliminary evidence supports NC as a promising intervention for enhancing surgeon well-being and patient outcomes. Future research should focus on establishing standardized guidelines for coach training, addressing misconceptions about NC, and designing larger, methodologically robust studies using validated outcomes. Expanding NC could foster a more resilient surgical workforce, ultimately benefiting both surgeons and patients through improved engagement, satisfaction, and quality of care.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 5","pages":"Article 103469"},"PeriodicalIF":2.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403337","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":"Opportunities to Overcome Barriers to Lactation—Recommendations for Best Practices","authors":"Rida Mitha MD ,&nbsp;Rohit Prem Kumar BA ,&nbsp;Nitin Agarwal MD ,&nbsp;Peter C. Gerszten MD, MPH ,&nbsp;D. Kojo Hamilton MD ,&nbsp;Robert M. Friedlander MD ,&nbsp;Roberta Sefcik MD, MSCR","doi":"10.1016/j.jsurg.2025.103445","DOIUrl":"10.1016/j.jsurg.2025.103445","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Women represent over 50% of graduating medical students in the United States and approximately 20% of current neurosurgical residents in training. An increase in female representation requires an increase in advocacy efforts related to pregnancy. Although there is extensive literature on pregnancy in neurosurgical residents, the postpartum period, sometimes referred to as the “fourth trimester”, is frequently overlooked. This study was performed in order to characterize the lactation experiences of female neurosurgeons and neurosurgical trainees and compare their experiences to their peers in other medical specialties.</div></div><div><h3>METHODS</h3><div>A 62-question survey examining lactation experiences was developed and electronically disseminated to members of Women In Neurosurgery, the social media group Dr. MILK, and to neurosurgical residency Program Directors throughout the United States.</div></div><div><h3>RESULTS</h3><div>Seventy-eight responses were received (neurosurgery: 10, other surgical specialty: 19, nonsurgical specialty: 49). When asked if respondents met their goal for lactation duration, 26 nonsurgical, 13 other surgical, and 8 neurosurgery respondents responded affirmatively (p = 0.059). A significantly greater proportion of neurosurgery respondents reported that expression of breastmilk at work caused anxiety compared to nonsurgical respondents (p = 0.02). Overall, 59% of respondents felt that they did not have adequate time to express breastmilk at work, and 69% had to stop expressing breastmilk at work prior to completely emptying. Fifty-three percent of respondents were fearful of being unable to feed their baby secondary to the inability to express breastmilk. Twenty percent reported never being able to consume sufficient liquid at work, and 17% reported never being able to consume sufficient calories at work. Additional cited barriers included limited mentorship (68%), inconvenient lactation spaces (58%), perceived discrimination (32%), and breast pump malfunction (28%).</div></div><div><h3>CONCLUSION</h3><div>Women residents across medical specialties face significant barriers to successful lactation experiences. With limited mentorship in lactation across medical specialties, advocacy efforts and lactation support are vitally needed for the protection of the health of physician mother and baby.</div></div>","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103445"},"PeriodicalIF":2.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394598","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":"Essential Competencies for the Success of International Medical Graduates in Surgical Training: A Comparative Study of Trainee and Faculty Perspectives","authors":"Carolina Torres Perez-Iglesias MD ,&nbsp;Fleming Mathew MBBS ,&nbsp;Brendha Cacao Coimbra MD ,&nbsp;Gopika SenthilKumar PhD ,&nbsp;Raunak Goyal MBBS ,&nbsp;Sidharta P. Gangadharan MD","doi":"10.1016/j.jsurg.2024.103419","DOIUrl":"10.1016/j.jsurg.2024.103419","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;International Medical Graduates (IMGs) occupy a third of all non-designated preliminary general surgery training positions in the United States, but fewer than half complete surgical training. Previous research has shown discrepancies between evaluators and trainees on various aspects of medical training, impacting educational outcomes. Understanding any potential divergence in perceptions between faculty and trainees on essential competencies could help trainees improve their clinical performance and their chances of obtaining categorical training positions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;To assess differences in perceptions between IMGs and evaluators on essential competencies during general surgery training.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;DESIGN&lt;/h3&gt;&lt;div&gt;Cross-sectional, survey-based using a nonvalidated electronic survey instrument, with 13 questions aimed to assess the competencies considered essential for IMGs in preliminary PGY-1 or PGY-2 training positions to succeed in general surgery residency. Responses were collected using a snowball sampling method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;SETTING&lt;/h3&gt;&lt;div&gt;The survey was distributed via X (formerly known as Twitter), WhatsApp, the American College of Surgeon Online Communities, and email between June and August 2023. Responses were captured in RedCap.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PARTICIPANTS&lt;/h3&gt;&lt;div&gt;The first group (“the evaluatees\") comprises IMGs and medical students applying for general surgery residency positions in the U.S. and IMGs in PGY-1 and PGY-2 preliminary general surgery training positions in the U.S. The second group (“the evaluators”) included faculty in general surgery programs in the U.S. and senior general surgery residents in the U.S.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;There were 196 respondents, including 70 “evaluators” and 126 “evaluatees”. Most evaluators identified as male (78.5%), whereas 65.1% of evaluatees identified as female. Ethnic diversity varied widely between groups. Evaluators identified mainly as white (67.1%), while evaluatees were mostly Asian/South Asian (46%) or Hispanic/Latino (30.1%). Most evaluators worked at university-affiliated hospitals (61.4%). Both groups ranked “Knowledge Application/Critical Thinking Skills” as the most essential competency for preliminary IMG residents to do well in training. “Research Skills” followed by “Technical Skills” were rated as the least essential. The highest concordance (&gt;80%) between groups for mandatory competencies was found for “Interpersonal and Communication Skills”, “Professionalism,” and “Learning, Teaching, and Teamwork”. Significant differences were found between the groups' perceptions of clinical, research, and technical skills (p &lt; 0.01).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;The value of nontechnical skills in surgical training transcends cultural and educational backgrounds. IMGs place greater importance on clinical and technical skills. Future educational initiatives must bridge ","PeriodicalId":50033,"journal":{"name":"Journal of Surgical Education","volume":"82 4","pages":"Article 103419"},"PeriodicalIF":2.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387365","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":"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}