Surgery open science最新文献

{"title":"Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and International Clinical Guidelines (CoSMIC-G)","authors":"Anthony K.C. Chan PhD FRCS,&nbsp;Ajith K. Siriwardena MD FRCS","doi":"10.1016/j.sopen.2024.10.009","DOIUrl":"10.1016/j.sopen.2024.10.009","url":null,"abstract":"<div><h3>Introduction</h3><div>The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. This study appraises the recommendations made by national/international guidelines for the diagnosis and management of patients with synchronous liver metastases from colorectal cancer.</div></div><div><h3>Methods</h3><div>A systematic review of national and international guidelines published between 2011 and 2024 was carried out using PubMed, OvidSP and Guidelines International Network databases. The quality of guidelines was evaluated using the Appraisal of Guidelines for Research &amp; Evaluation II (AGREE II) instrument. Guidelines were assessed for the quality of advice for specific scenarios. The protocol was registered with PROSPERO (CRD42021243744).</div></div><div><h3>Results</h3><div>The search strategy returned ninety unique articles with 11 guidelines eligible for inclusion. Of these, one (9 %) guideline defined ‘synchronous disease’ at outset, eight (73 %) recommended neoadjuvant chemotherapy as first intervention. Seven (64 %) guidelines supported synchronous hepatic resection with colectomy. One (9 %) recommended against synchronous surgery.</div></div><div><h3>Conclusions</h3><div>This study demonstrates important variations between international clinical guidelines on diagnostic workup and management of synchronous liver metastases in colorectal cancer. [167 words].</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 61-66"},"PeriodicalIF":1.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary delayed gastric emptying after pylorus-resecting pancreatoduodenectomy: A matched-pair comparison of Roux-en-Y vs. Billroth-II reconstruction","authors":"Felix O. Hofmann ,&nbsp;Victoria S. Engelstädter ,&nbsp;Ughur Aghamaliyev ,&nbsp;Mathilda M. Knoblauch ,&nbsp;Elise Pretzsch ,&nbsp;Maximilian Weniger ,&nbsp;Jan G. D'Haese ,&nbsp;Bernhard W. Renz ,&nbsp;Jens Werner ,&nbsp;Matthias Ilmer","doi":"10.1016/j.sopen.2024.10.005","DOIUrl":"10.1016/j.sopen.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>After pylorus-resecting pancreatoduodenectomy (PrPD), delayed gastric emptying (DGE) might partially be attributed to biliary reflux. We investigated whether the incidence of primary DGE is reduced after Roux-en-Y instead of Billroth-II reconstruction.</div></div><div><h3>Methods</h3><div>Patients undergoing PrPD from 2016 to 2019 at a high-volume center were identified. Excluding causes of secondary DGE, we matched patients with Roux-en-Y and Billroth-II reconstruction in a 1:2 ratio and compared primary DGE.</div></div><div><h3>Results</h3><div>In 24 vs. 48 (Roux-en-Y vs. Billroth-II) patients, DGE (grade B/C) incidence (20.8 % vs. 18.8 %; <em>P</em> = 1.000), nasogastric tube requirement (median 2 vs. 2 days; <em>P</em> = 0.844) and time to solid food intake (7 vs. 7 days; <em>P</em> = 0.933) were comparable. Univariable logistic regression showed no association between DGE and Roux-en-Y reconstruction (OR 1.47; <em>P</em> = 0.524), in contrast to age (1.08; <em>P</em> = 0.030) and pancreatic biochemical leak (4.98; <em>P</em> = 0.007).</div></div><div><h3>Conclusions</h3><div>Primary DGE did not differ between Roux-en-Y and Billroth-II reconstruction after PrPD. Instead, age and postoperative pancreatic biochemical leak were associated with higher DGE risk.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 46-52"},"PeriodicalIF":1.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immersive collaborative virtual reality for case-based graduate student teaching in thoracic surgery: A piloting study","authors":"Philipp Feodorovici ,&nbsp;Nils Sommer ,&nbsp;Philipp Bergedieck ,&nbsp;Philipp Lingohr ,&nbsp;Jörg C. Kalff ,&nbsp;Joachim Schmidt ,&nbsp;Jan C. Arensmeyer","doi":"10.1016/j.sopen.2024.10.008","DOIUrl":"10.1016/j.sopen.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>In medical education various non-digital teaching methods are established. However, studies have proven that the immersive character of virtual reality (VR) applications positively impact the understanding of spatial relationships.</div><div>This study outlines the development and pilot testing of a novel system for collaborative, case-based VR teaching, utilizing real-time volume rendered computed tomography (CT) data of thoracic cases among graduate students.</div></div><div><h3>Methods</h3><div>A system was configured and deployed to provide real-time volume rendered CT data in a collaborative, multiuser VR environment. A thoracic surgery VR course was implemented into the surgical graduate curriculum, which has subsequently been evaluated with questionnaires.</div></div><div><h3>Results</h3><div>Seventy students assessed the curriculum through a questionnaire. Usability was rated intuitive (77.14 %) while few students (5.71 %) reported cyber sickness.</div><div>A vast majority (98.57 %) agreed VR improved their understanding of anatomy compared to traditional methods and most students found learning more effective. (88.57 %) and joy during participation was rated high (97,14 %). A majority of the students (61.43 %) believed VR could partly replace traditional methods. They supported integrating VR into preclinical (81.43 %) and clinical teaching (94.29 %) as well as taking VR courses from home (78.57 %). Most participants (90,72 %) encouraged the expansion of VR infrastructure.</div></div><div><h3>Conclusion</h3><div>The concept of a collaborative real-time VR-based educational program in medical graduate teaching has proven its technical feasibility and positive acceptance with a desire for more VR integration in surgical curricula. A two-armed study will be conducted to evaluate the objective impact as the expansion of VR environments for teaching continues.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 40-45"},"PeriodicalIF":1.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engagement and learning approaches among medical students in an online surgical teaching programme: A cross-sectional study","authors":"Sumayyah Ebrahim MMED Surgery (UKZN), MSc Epidemiology (Columbia University) ,&nbsp;Jacqueline Marina Van Wyk PhD (UKZN)","doi":"10.1016/j.sopen.2024.10.010","DOIUrl":"10.1016/j.sopen.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic prompted the transition of all teaching and learning of final-year General Surgery students to an online platform. Despite the utility of online methods, challenges exist such as a sense of impersonal learning, and poor student engagement. Student engagement with course content is important for deep learning. An Online Student Engagement Scale (OSE) and a revised Biggs Two-Factor Study Process Questionnaire (R-SPQ-2F) were used to evaluate student engagement and learning approaches respectively.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in 2021 at a South African university. The OSE and R-SPQ-2F online survey tools were administered to all final-year students (<em>n</em> = 325) enrolled in the surgical online module. Quantitative data was collected, and the data was analysed statistically using R-Statistical computing software. Results are presented in the form of descriptive and inferential statistics. The reliability of the tools was evaluated by Cronbach's alpha.</div></div><div><h3>Results</h3><div>The survey response rate was 35.4 % (115/325). Students were engaged at a high level, and the median (IQR) scores of the OSE tool were 71.0 (63.0–78.0). Overall, students adopted a deep approach (DA) to learning, with median (IQR) scores of 34.0 (30.0–39.0) on the R-SPQ-2F tool. There was a moderate positive correlation between the total OSE score and DA (0.53, <em>p</em> &lt; 0.001). Both the OSE and R-SPQ-2F tools showed an acceptable level of internal consistency of 0.893 and 0.806 respectively.</div></div><div><h3>Conclusions</h3><div>Student engagement was associated with deep learning approaches. The OSE and R-SPQ-2F tools were reliable tools to measure student engagement and learning approaches among medical students.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 53-60"},"PeriodicalIF":1.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender and age specific dynamics of health-related postoperative outcome measures following the laparoscopic sleeve gastrectomy","authors":"Sevak Shahbazyan ,&nbsp;Mushegh Mirijanyan ,&nbsp;Zhorzheta Badalova ,&nbsp;Zareh Ter-Avetikyan","doi":"10.1016/j.sopen.2024.10.007","DOIUrl":"10.1016/j.sopen.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>A variety of bariatric surgical techniques have been implemented to manage obesity, including the laparoscopic sleeve gastrectomy (LSG).</div><div>The aim of the study was to compare the pre and postoperative features of patients undergoing LSG, analyze the dynamics of BMI and BAROS indices and to assess the impact of body appearance concern on the postoperative outcomes.</div></div><div><h3>Methods</h3><div>A total of 591 participants were divided into 3 age groups (20–39, 40–59 and over 60 years of age). The Charlson Comorbidity Index was used to assess comorbidity in patient groups. The rate of complications, assessment of psychological well-being and number of hospital days for patients were used to compare the features of postoperative recovery in different age groups.</div></div><div><h3>Results</h3><div>In the young and middle-aged groups, the BMI reduction speed was similar, and significantly higher than in the elder group with a faster rate of BMI reduction in female participants. Higher scores of BAROS were revealed in the young and middle-aged groups for the 0–1 and 1–6 month periods. The 12-month assessment revealed much higher BAROS scores for male subgroups, compared to female participants. The BAROS scores decreased gradually in female groups within the assessment periods and was the lowest in the third assessment.</div></div><div><h3>Conclusions</h3><div>The pattern of BAROS reduction can be the result of lower psychological and social well-being scores in female participants who reported significant weight reduction in 6–12 month period with paradoxically decreased quality of life scores explained by the impact of body appearance concern on the postoperative outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 67-73"},"PeriodicalIF":1.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid liver graft implantation in canine: A preliminary study","authors":"Jie Hao ,&nbsp;Jia-Wei Yu ,&nbsp;Jing-Wen Xiao ,&nbsp;Lin-Biao Xiang ,&nbsp;Rong Peng ,&nbsp;Jia-Qi Quan ,&nbsp;Ya-Xu Dong ,&nbsp;En-Hui Li ,&nbsp;Juan-Juan Wang ,&nbsp;Lu Ren ,&nbsp;Yong Wan ,&nbsp;Hong-Ke Zhang ,&nbsp;Yi Lv ,&nbsp;Qiang Lu","doi":"10.1016/j.sopen.2024.10.006","DOIUrl":"10.1016/j.sopen.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>The current method for liver graft implantation during the anhepatic phase is complex. Therefore, this study aimed to introduce a modified orthotopic liver transplantation (OLT) technique with major vascular reconstruction using cuff technique to simplify the process of liver graft implantation during the anhepatic phase.</div></div><div><h3>Methods</h3><div>Twenty-four canines were randomly assigned to two groups: the modified orthotopic liver transplantation group (M-OLT, <em>n</em> = 12) and the control group (n = 12). All animals were randomly assigned to the donor or recipient groups. The recipients received orthotopic liver transplantation using a modified technique in the M-OLT group, and OLT using traditional implantation technique without venovenous bypass was performed in the control group. The donor and recipient characteristics were compared between the two groups. Vascular anastomotic patency was evaluated using angiography immediately and one week after surgery.</div></div><div><h3>Results</h3><div>All recipients underwent successful liver transplantation. There were no significant differences between the two groups in terms of sex, body weight, or cold ischemia time of the donor liver. However, recipients in the M-OLT group had a shorter operation time, less intraoperative blood loss, shorter anhepatic phase, shorter vascular occlusion time, and shorter warm ischemia time than that in the control group (all <em>p</em> &lt; 0.05). No anastomotic leakage or stenosis was detected in either group after liver transplantation. One recipient in the M-OLT group and three in the control group died within one week of transplantation.</div></div><div><h3>Conclusions</h3><div>This modified technique is safe and feasible for canine liver transplantation and can significantly simplify liver graft implantation procedures during the anhepatic period.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 34-39"},"PeriodicalIF":1.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nomogram for cancer-specific survival of lung adenocarcinoma patients: A SEER based analysis","authors":"Hong Guo Doctor of Medicine (M.D.) ,&nbsp;Guole Nie Doctor of Medicine (M.D.) ,&nbsp;Xin Zhao Master of Medicine (M.M.) ,&nbsp;Jialu Liu Master of Medicine (M.M.) ,&nbsp;Kaihua Yu Master of Medicine (M.M.) ,&nbsp;Yulan Li Doctor of Medicine (M.D.)","doi":"10.1016/j.sopen.2024.10.003","DOIUrl":"10.1016/j.sopen.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Non-small cell lung cancer (NSCLC) accounts for 85 % of lung cancer cases. Among NSCLC subtypes, lung adenocarcinoma (LUAD) stands as the most prevalent. Regrettably, LUAD continues to exhibit a notably unfavorable overall prognosis. This study's primary aim was to develop and validate prognostic tools capable of predicting the likelihood of cancer-specific survival (CSS) in patients with LUAD.</div></div><div><h3>Methods</h3><div>We retrospectively collected 21,099 patients diagnosed with LUAD between 2010 and 2015, and 8290 patients diagnosed between 2004 and 2009 from SEER database. The cohort of 21,099 patients served as the prognostic group for the exploration of LUAD-related prognostic risk factors. The cohort of 8290 patients was designated for external validation. We created a training set and an internal validation set in the prognostic group for the development and internal validation of CSS nomograms. CSS predictors were identified through the least absolute shrinkage and selection operator (Lasso) regression analysis. Prognostic model was constructed via Cox hazard regression analysis, presented in the form of both static and dynamic network-based nomograms.</div></div><div><h3>Results</h3><div>Several independent prognostic factors were incorporated into the construction of nomogram. The nomogram accurately predicted CSS at 1, 3, and 5 years, with respective AUC values of 0.769, 0.761, and 0.748 for the training group, and 0.741, 0.752, and 0.740 for the testing group. The study demonstrated a strong agreement between anticipated and actual CSS values, supported by decision curve analysis (DCA) and time-dependent calibrated curves. High-risk patients based on the nomogram exhibiting significantly lower survival rates compared to their low-risk counterparts according to Kaplan-Meier (K-M) curves. The nomogram demonstrates excellent predictive power in the external validation cohort.</div></div><div><h3>Conclusions</h3><div>A dependable and user-friendly nomogram has been developed, available in both static and online dynamic calculator formats, to facilitate healthcare professionals in accurately estimating the likelihood of CSS for patients diagnosed LUAD.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 13-23"},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation and self-assessment of liver transplantation training physicians at Shanghai Renji Hospital: A preliminary study","authors":"Xiaochen Bo,&nbsp;Feng Xue,&nbsp;Qiang Xia,&nbsp;Kang He","doi":"10.1016/j.sopen.2024.10.004","DOIUrl":"10.1016/j.sopen.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Continuing medical education in liver transplantation is pivotal in enhancing the proficiency of liver surgeons. The goal of this study is to obtain information on all aspects of the training, enable us to pinpoint the training's strengths, and address any shortcomings or challenges.</div></div><div><h3>Method</h3><div>We conducted an online questionnaire survey, which was comprised of 33 questions, offering response options in the form of “yes/no”, single choice, or multiple choice.</div></div><div><h3>Results</h3><div>A total of 59 liver surgeons actively participated in the questionnaire survey. The majority of them exhibited a comprehensive understanding of the liver transplant training program, encompassing its structure, content, and assessment format. It is noteworthy that all respondents expressed keen interest in novel course components such as medical humanities, interpersonal communication, full-process patient management, and scientific research and academic activities. The overall satisfaction with the diverse specialized training courses was notably high. Furthermore, there was a significant improvement in self-confidence among participants for performing relevant clinical practices post-training, signifying the effectiveness of the program. Notably, key determinants influencing physicians' confidence levels before and after training included accumulated clinical practice time, basic operation cases, and educational background.</div></div><div><h3>Conclusion</h3><div>This survey reveals that trainees possess a commendable grasp of the program, maintain a positive outlook, and gain substantial benefits from the training. Importantly, it underscores the need to enhance the pedagogical skills of professional training instructors, continually refine the curriculum, and serve as a foundation for informed decisions in the ongoing training of liver transplant physicians.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 24-33"},"PeriodicalIF":1.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing the role of scrub nurses during robotic surgery console time","authors":"Kenro Chikazawa ,&nbsp;Hiroyoshi Ko ,&nbsp;Hiroshi Noda ,&nbsp;Ken Imai ,&nbsp;Tomoyuki Kuwata","doi":"10.1016/j.sopen.2024.10.001","DOIUrl":"10.1016/j.sopen.2024.10.001","url":null,"abstract":"<div><div>At our institution, scrub nurses leave the surgical field during the console time for robotic surgeries to attend to other duties. The first assistant then assumes their responsibilities, allowing for efficient use of staff time and resources. This practice improves teamwork and can be presented as a cost-saving measure for hospital administrations.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 1-2"},"PeriodicalIF":1.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Woman or surgeon – Not both: Perceptions of support, enablers and barriers in general surgery","authors":"Kelda M.O. Sheridan,&nbsp;Naomi D. Quinton","doi":"10.1016/j.sopen.2024.10.002","DOIUrl":"10.1016/j.sopen.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The General Surgery (GS) educational community of practice faces crisis. Recruitment is challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility (UK Shape of Training Steering Group, 2017; Kennedy, 2021) [<span><span>1</span></span>,<span><span>45</span></span>]. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum (Brown et al., 2019) [<span><span>26</span></span>]. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose.</div></div><div><h3>Methods</h3><div>Qualitative methodology within a constructivist research paradigm was utilised. Recruitment included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. Individual semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. ‘Data sets’ were transformed to a thematic map and key themes identified.</div></div><div><h3>Results and discussion</h3><div>Foundation, specialty doctors, core and higher surgical trainees were included (60 % men, 40 % women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency.</div></div><div><h3>Conclusions</h3><div>The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"22 ","pages":"Pages 3-12"},"PeriodicalIF":1.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}