When the first try fails: re-implementation of SIMPL in a general surgery residency.

BACKGROUND: Workplace-based assessment (WBA) can facilitate evaluation of operative performance; however, implementation of WBA is sometimes unsuccessful. The American Board of Surgery Entrustable Professional Activities WBA project was launched in July 2023. Some programs will face the challenge of re-implementation of a WBA following previous failures. It is unknown what interventions are most effective for WBA re-implementation. Our goal is to identify barriers and facilitators to re-implementing SIMPL, an operative performance WBA. METHODS: The System for Improving and Measuring Procedural Learning (SIMPL) was implemented at our residency in 2018, but usage rates were low. We interviewed residents and faculty to identify barriers to usage and opportunities for improvement. Residents reported that SIMPL usage declined because of several factors, including a low faculty response rate, while some faculty reported not responding because they were unable to login to the app and because usage was not mandated. We then re-implemented SIMPL using a plan based on Kotter's Model of Change. To evaluate impact, we analyzed rates of SIMPL usage when it was first implemented, as well as before and after the date of re-implementation. RESULTS: In September 2022, we re-implemented SIMPL at our program with measures addressing the identified barriers. We found that, in the six months after re-implementation, an average of 145.8 evaluations were submitted by residents per month, compared with 47 evaluations per month at the start of the original implementation and 5.8 evaluations per month just prior to re-implementation. Faculty completed 60.6% of evaluations and dictated feedback for 59.1% of these evaluations, compared with 69.1% at implementation (44% dictated) and 43% prior to re-implementation (53% dictated). CONCLUSIONS: After identifying barriers to implementation of a WBA, we re-implemented it with significantly higher usage by faculty and residents. Future opportunities exist to implement or re-implement assessment tools within general surgery programs. These opportunities may have a significant impact in the setting of national standardization of workplace-based assessment among general surgery residencies.

Expanding horizons in burn care: a new paradigm for General Surgeons in Brazil.

The role of the burn surgeon in Burn Treatment Centers (BTCs) is crucial for complementing the multidisciplinary approach in the treatment of burn patients. Globally, the areas of General Surgery and Plastic Surgery are the primary surgical specialties dedicated to this function. The structuring of the Burn Patient Care Line in Minas Gerais highlighted the need to expand the "Burn Care" Field of Expertise, extending it to General Surgery. With the inevitable expansion of the Care Line, pioneered by the state of Minas Gerais, to the federal level, the need for specialized surgical training encompasses both the state context and anticipates the national scenario in the short term. Therefore, the expansion of the "Burn Care" Field of Expertise is fundamental to meeting specific demands and improving the quality of care offered to burn patients, in accordance with international standarts.

[Surgical pedagogy: towards a humanistic education perspective]. / Pedagogía quirúrgica: hacia una perspectiva de la educación humanista.

No Abstract available.

The legacy of a surgeon - in memoriam Dr. Ismail Demir.

In this perspective article, we highlighted some special aspects of being a surgeon that are typically not taught in medical training. Departing from a real and personal story, the present manuscript is intended to communicate how surgery imbues us doctors with an unparalleled degree of satisfaction, gratification, meaning and fulfilment, like no other field of medicine.

Romanian Surgery between Tradition and Innovation: The Priorities of the 2024-2028 Mandate at the Romanian Society of Surgery.

img src="/images/viorel_scripcariu.jpg" alt="Viorel Scripcariu" style="float: right;max-width: 30%;"/ Assuming the leadership of the Romanian Society of Surgery for the next four years is for me a moment of deep significance and responsibility. With a tradition of almost 130 years, this organization is at the foundation of the Romanian surgeon community, and my role is to continue this legacy and open new paths for the future of Romanian surgery. I would like to share the priorities I have set for this mandate, given our shared commitment to promote excellence in surgical practice and to respond to contemporary challenges. An essential aspect of my mandate is to respect the rich tradition and history of Romanian surgery. The Romanian Society of Surgery was founded at the end of the 19th century in Bucharest, with the surgeon Constantin Severeanu at its head. At the meeting on January 27, 1899, the society constituted its first board, with Thoma Ionescu as president, together with other founding members such as Dr. Leonte, Dr. Racoviceanu-Pitesti, Dr. Duma and Dr. Staicovici. Over the years, numerous meetings were organized at the Institute of Topographic Anatomy in Bucharest, where clinical cases, new surgical methods and lectures by medical personalities from abroad were presented. Over the years, the society has continued to promote international collaboration, organizing congresses and inviting renowned surgeons from abroad to lecture and perform innovative surgery in Romania. This rich history and respect for traditional values are fundamental to preserving and enhancing the standards of excellence we have inherited. We will continue our efforts to honor our mentors and their achievements, ensuring that their legacy will continue to inspire and guide new generations of Romanian surgeons. [ a href="https://revistachirurgia.ro/pdfs/2024-4-357.pdf" read more /a ].

How well do faculty do in providing general surgery EPA feedback?

INTRODUCTION: Entrustable Professional Activities (EPAs) provide a framework for competency-based assessment in surgery. EPA descriptions include observable behaviors by trainees at progressive levels of autonomy. The American Board of Surgery (ABS) required all General Surgery (GS) residency programs to implement assessment of 18 EPAs at the beginning of academic year 2023-2024. Microassessments provide formative self-reflection by the resident and feedback by faculty upon completion of the EPA. These frequent assessments culminate in a resident performance profile utilized by the trainee for formative growth and the clinical competency committee for summative feedback. Assessor free text comments are an opportunity to provide meaningful, constructive feedback to residents. Our aim was to analyze comments provided by faculty to residents in terms of their alignment with EPA descriptors and provision of actionable feedback. METHODS: A total of 540 â€‹GS EPA assessments for inguinal hernia, gallbladder disease, appendicitis, trauma, and surgical consultation were evaluated from 6/2021-12/2022. We assessed free text EPA comments from faculty compared to EPA behavior descriptions for alignment with the selected EPA level of entrustment. The comments were judged on a binary scale of "Align" vs "Not Align" by two independent evaluators, with a third evaluator to address discordance. Comments were then evaluated for resident behavioral descriptions, suggestions for improvement, and positive or negative feedback. RESULTS: Approximately 77 â€‹% of EPA microassessments had alignment between level of autonomy and free text feedback. A common example of feedback discordant with level of autonomy was rating a trainee at an intraoperative level 4 (independent practice) with comments such as "required some guidance with retrocecal case and upsizing port." Based on behavior descriptions this would be a level 3 (indirect supervision). Approximately 88 â€‹% of feedback contained positive comments with minimal negative feedback (e.g., "this did not go well."). Actionable feedback including "work on optimization of retracting hand" or "continue to work clamp/tie technique and square off each knot" was present in 28.3 â€‹% of feedback. CONCLUSIONS: The majority of faculty provide feedback that is aligned with the behavioral anchors of the EPAs assessed, but frequently did not provide actionable feedback to the resident regarding how to advance to the next level of entrustment. EPA entrustment behaviors provide a framework for the development of practice-ready behaviors, and if assessors anchor their feedback in the behaviors for a given entrustment level and project how a resident could proceed to the next level, they can provide a clear trajectory for skill development. Faculty development should focus on improving the frequency of actionable free text feedback, outlining how residents can advance in the future.

Tumor de colision uterino: Reporte de un caso / Uterine collision tumor: Case report

La presencia de dos o más tipos de tumores en la misma zona del cuerpo es poco frecuente. El tumor compuesto o tumor de colisión presenta distintos subtipos histológicos en la misma región, con características clínicas, evolución y pronóstico diferente, diagnosticándose de forma incidental durante el estudio del otro. Se presenta un caso de una paciente quién fue diagnosticada con carcinoma epidermoide de cuello uterino estadio clínico IB1, tratada con cirugía (histerectomía radical Tipo III) que en el análisis histopatológico arroja dos subtipos histológicos, seguimiento con 4 años libres de enfermedad(AU)

The presence of two or more types of tumors in the same anatomic area is very strange. The compound tumor or coalition tumor presents different histological subtypes in the same region, with distinct clinical characteristics, evolution, and prognosis, being diagnosed incidentally during the study of the other. A case is presented of a patient who was diagnosed with squamous cell carcinoma of the cervix clinical stage IB1, treatedwith surgery (Type III radical hysterectomy) that in the histopathological analysis showed two histological subtypes, follow-up with 4 years free of disease(AU)

Leiomioma intraligamentario degenerado como simulador de patología maligna de ovario. Reporte de un caso / Degenerated intraligamentary leiomioma as a simulator of malignant ovarian pathology. Report of a case

Los leiomiomas son tumores mesenquimatosos benignos que se presentan como la neoplasia uterina más común en mujeres en edad reproductiva. Según su crecimiento, se puede ver comprometido su aporte sanguíneo, ocurriendo cambios degenerativos por la carencia de oxígeno, lo cual le confiere un aspecto atípico que puede generar confusión con el diagnostico. Se describe caso de paciente de 47 años de edad, quien consulta por aumento progresivo de volumen de circunferencia abdominal de 7 meses de evolución, referida a la consulta de ginecología oncológica por gran masa tumoral retrouterina de probable origen ovárico con elevado riesgo de malignidad. Luego de realizar estudios preoperatorios es llevada a quirófano, obteniéndose como diagnóstico definitivo, leiomioma con degeneración hialina e hidrópica focal. Los leiomiomas con cambios degenerativos pueden simular tumores malignos de ovario, por lo cual deben ser considerados como un diagnóstico diferencial antes de intervenciones quirúrgicas por tumores abdominopélvicos de gran tamaño(AU)

Leiomyomas are benign mesenchymal tumors that occur as the most common uterine neoplasm in women of reproductive age. Depending on its growth, its blood supply may be compromised, causing degenerative changes due to lack of oxygen, which gives it an atypical appearance that may cause confusion with the diagnosis. The case of a 47-year-old patient is described, who consults for a progressive increase in the volume of abdominal circumference of 7 months of evolution, referred to the gynecology oncology consultation due to a large retrouterine tumor mass of probable ovarian origin with a high risk of malignancy. After performing preoperative studies, she was taken to the operating room, obtaining as a definitive diagnosis, leiomyoma with hyaline and focal hydropic degeneration. Leiomyomas with degenerative changes can simulate malignant ovarian tumors, which is why they should be considered as a differential diagnosis before surgical interventions for large abdominopelvic tumors(AU)

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

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

Clinical applications of handheld robotic devices in general surgery: A mini-review.

Laparoscopy has evolved the surgical field around the world. Although this has defined minimally invasive surgery, there are limitations. Lack of articulating instrument tips restricts their use in difficult cases. Ergonomic challenges risk occupational injury. Although there is now an increasing use of robotics, these platforms have significant costs. Articulating laparoscopic instruments, termed handheld robotic devices, pose a potential solution to this problem. We aimed to perform a mini-review the clinical applications of handheld robotic devices in general surgery. A limited literature search of the MEDLINE, EMBASE, and Cochrane databases were performed to identify handheld robotic devices with clinical trial data. Primary outcomes were operative time, complication rate, and conversion to laparoscopy or open surgery. Three devices were identified. Noninferiority was demonstrated with respect to laparoscopic instruments in terms of operative time and postoperative complications. This is despite the devices being in their relative infancy with learning curves. Subgroup analysis in a comparative trial with robotics for inguinal hernia repair revealed no significant difference in operative duration during unilateral flap closure. There were no cases requiring conversion. The need for cost-effective robotic devices is clear. Handheld robotic devices have been engineered to provide articulating instrument tips while using existing laparoscopic equipment. They have been demonstrated to be safe and effective. The amalgamation of precision-enhancing robotic instruments with the fiscal advantages of laparoscopic tools has the potential to fundamentally alter the field of minimally invasive surgery.

The usefulness and effectiveness of interactive telemedicine in surgery classes - a survey of Polish medical students.

<b>Introduction:</b> Computer-based interactive techniques are becoming an important tool in medical education. One of the important benefits of the use of telemedicine in surgical training is the reduction of the number of people in the operating room. As shown in the studies, this can lead i.a. to the reduction in the risk of surgical site infections.<b>Aim:</b> The aim of this survey as held among fifth-year medical students at three academic centers was to assess the usefulness and effectiveness of telemedicine as a surgery-teaching tool.<b>Material and methods:</b> A transmission of a surgical procedure was carried out by each of the three participating centers according to a previously prepared schedule. Each transmission was preceded by the diagnostics, indications, and the course of the surgical procedure being discussed by the facilitator physician who also coordinated the transmission throughout the procedure. After the class, students received anonymous surveys consisting of fourteen questions as per the attached protocol so as to evaluate the class using the rating scale of 1 (the lowest rating) through 5 (the highest rating). The survey assessed the educational value (the knowledge acquired from the class), the form (interactivity, facilitator complicity), and the usefulness of the class for overall surgical education.<b>Results:</b> The survey was completed by 232 students, with 95% of respondents rating the usefulness of telemedicine classes in surgical education as very good or good. As many as 97% of students declared that the transmission had been a good or a very good tool in terms of delivery or adding to their knowledge of topographical anatomy and basic aspects of surgical technique. Higher ratings were given to the usefulness of comments and remarks by the facilitating physician (96% of very good or good ratings) who had been watching the procedure along with the students as compared to those provided by the operating physician (81%).<b>Discussion:</b> The use of telemedicine-based teaching models in surgical education facilitates a better view of the operating field for the students, greater accessibility of educational content delivered simultaneously to multiple groups of students, increased safety of the surgical procedure by reducing the number of people in the operating room as well as reduced burden on the operating physician (thanks to the introduction of class facilitator).<b>Conclusions:</b> In our opinion, the advantages of the presented teaching model are: better view (particularly in case of open procedures), ability to pinpoint surgical field structures (on the participants' and operator's monitors), absence of additional people (students) in the operating room (increasing the safety of the procedure and reducing the risk of surgical site infections) and the ability to go back to recorded operations and perform various types of educational analyses.

Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models.

Importance: Artificial intelligence (AI) has permeated academia, especially OpenAI Chat Generative Pretrained Transformer (ChatGPT), a large language model. However, little has been reported on its use in medical research. Objective: To assess a chatbot's capability to generate and grade medical research abstracts. Design, Setting, and Participants: In this cross-sectional study, ChatGPT versions 3.5 and 4.0 (referred to as chatbot 1 and chatbot 2) were coached to generate 10 abstracts by providing background literature, prompts, analyzed data for each topic, and 10 previously presented, unassociated abstracts to serve as models. The study was conducted between August 2023 and February 2024 (including data analysis). Exposure: Abstract versions utilizing the same topic and data were written by a surgical trainee or a senior physician or generated by chatbot 1 and chatbot 2 for comparison. The 10 training abstracts were written by 8 surgical residents or fellows, edited by the same senior surgeon, at a high-volume hospital in the Southeastern US with an emphasis on outcomes-based research. Abstract comparison was then based on 10 abstracts written by 5 surgical trainees within the first 6 months of their research year, edited by the same senior author. Main Outcomes and Measures: The primary outcome measurements were the abstract grades using 10- and 20-point scales and ranks (first to fourth). Abstract versions by chatbot 1, chatbot 2, junior residents, and the senior author were compared and judged by blinded surgeon-reviewers as well as both chatbot models. Five academic attending surgeons from Denmark, the UK, and the US, with extensive experience in surgical organizations, research, and abstract evaluation served as reviewers. Results: Surgeon-reviewers were unable to differentiate between abstract versions. Each reviewer ranked an AI-generated version first at least once. Abstracts demonstrated no difference in their median (IQR) 10-point scores (resident, 7.0 [6.0-8.0]; senior author, 7.0 [6.0-8.0]; chatbot 1, 7.0 [6.0-8.0]; chatbot 2, 7.0 [6.0-8.0]; P = .61), 20-point scores (resident, 14.0 [12.0-7.0]; senior author, 15.0 [13.0-17.0]; chatbot 1, 14.0 [12.0-16.0]; chatbot 2, 14.0 [13.0-16.0]; P = .50), or rank (resident, 3.0 [1.0-4.0]; senior author, 2.0 [1.0-4.0]; chatbot 1, 3.0 [2.0-4.0]; chatbot 2, 2.0 [1.0-3.0]; P = .14). The abstract grades given by chatbot 1 were comparable to the surgeon-reviewers' grades. However, chatbot 2 graded more favorably than the surgeon-reviewers and chatbot 1. Median (IQR) chatbot 2-reviewer grades were higher than surgeon-reviewer grades of all 4 abstract versions (resident, 14.0 [12.0-17.0] vs 16.9 [16.0-17.5]; P = .02; senior author, 15.0 [13.0-17.0] vs 17.0 [16.5-18.0]; P = .03; chatbot 1, 14.0 [12.0-16.0] vs 17.8 [17.5-18.5]; P = .002; chatbot 2, 14.0 [13.0-16.0] vs 16.8 [14.5-18.0]; P = .04). When comparing the grades of the 2 chatbots, chatbot 2 gave higher median (IQR) grades for abstracts than chatbot 1 (resident, 14.0 [13.0-15.0] vs 16.9 [16.0-17.5]; P = .003; senior author, 13.5 [13.0-15.5] vs 17.0 [16.5-18.0]; P = .004; chatbot 1, 14.5 [13.0-15.0] vs 17.8 [17.5-18.5]; P = .003; chatbot 2, 14.0 [13.0-15.0] vs 16.8 [14.5-18.0]; P = .01). Conclusions and Relevance: In this cross-sectional study, trained chatbots generated convincing medical abstracts, undifferentiable from resident or senior author drafts. Chatbot 1 graded abstracts similarly to surgeon-reviewers, while chatbot 2 was less stringent. These findings may assist surgeon-scientists in successfully implementing AI in medical research.

Needs Assessment for the Development of a Sustainability Curriculum for Surgical Residents.

INTRODUCTION: The healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions, of which one-third comes from operating rooms (ORs). As a result, there is great interest in decarbonizing the OR and surgical care. However, surgical residents are not routinely educated on the negative environmental impact of surgery or how to reduce it. In this paper, we present a formal needs assessment for a sustainability curriculum geared towards surgical residents. METHODS: Using Kern's Six-Step Framework for curriculum development, we conducted focus groups with surgical residents to perform a targeted needs assessment on 3 main topics: 1) the current state of surgical sustainability curricula; 2) resident knowledge regarding the environmental impact of surgery and barriers to sustainable practice; and 3) preferred educational methods and topics within sustainability education. We audio-recorded all focus groups and performed thematic analysis using anonymized transcripts. RESULTS: Fourteen residents participated in 3 focus groups, from which a qualitative analysis revealed 4 themes. First, surgery residents receive limited formal teaching on the negative environmental impact of surgical care or how to reduce this impact. Second, surgery residents have variable levels of prior education about and interest in sustainability in surgery. Third, several barriers prevent the implementation of sustainable changes in surgical practice, including a lack of institutional initiative, cultural inertia, concerns about workflow efficiency, and limited formal education. Finally, residents prefer to learn about practical ways to reduce waste, specifically through interactive approaches such as quality improvement initiatives. CONCLUSIONS: Given the increasing importance of sustainability in surgery, there is an urgent need for formal resident education on this topic. This needs assessment provides a valuable foundation for future sustainability curriculum development.

Teaching With the GlobalSurgBox: Trainer Perceptions of a Portable Surgical Simulator.

OBJECTIVES: Evaluate the utility of a low cost, portable surgical simulator (GlobalSurgBox) for surgical teaching and its ability to dismantle barriers faced by trainers when attempting to use surgical simulation. DESIGN: An anonymous survey was administered to surgical trainers who were involved in leading simulation events using the GlobalSurgBox in the past 2 years. The survey was designed to understand current barriers to using simulation as a trainer, and the utility of the GlobalSurgBox in overcoming these barriers. SETTING: Academic medical training centers or conferences in the United States, Rwanda and Kenya. PARTICIPANTS: 10 practicing surgeons, 3 practicing physicians, 11 surgical residents, 15 medical students and 1 anesthesia resident. RESULTS: The top 3 barriers for effective teaching were lack of convenient access to the simulator (50%), lack of trainer time (43%) and cost (28%). After using the GlobalSurgBox, 100% and 98% of respondents felt that it encourages more practice and offers significant advantages over current simulators in their program. About 90%, 88% and 70% of respondents believed that the GlobalSurgBox makes surgical simulation more convenient, affordable, and compatible with trainer time limitations, respectively. 83% of trainers agreed that it is a good replica of the operating room experience, and 85% practicing physicians were more likely to give autonomy to trainees after demonstrating competence on the GlobalSurgBox. CONCLUSION: The GlobalSurgBox mitigates several barriers surgical educators experience when practicing surgical skills with trainees. The convenience of the GlobalSurgBox can help facilitate the development of foundational surgical skills outside of the operating room.

Evaluating Operative Exposure for Medical Students in the Era of Virtual Learning: A Single-Institution Experience.

INTRODUCTION: Training at a tertiary center offers clerkship students the opportunity to rotate through a wide range of surgical specialties that may not be otherwise available. At our institution, students rotate through general surgery for 3 out of 9 weeks, with the remainder offering electives. As a result, students may have limited experience with core general surgery cases which are necessary to complete by the end of the clerkship to demonstrate competency. In efforts to standardize clinical training, students must log 11 core general surgery cases either in the operating room or modules via Wise-MD. Wise-MD is used in place of participating in the operating room when students do not have the opportunity to see certain cases during their surgical rotation. The purpose of the study is to ascertain what proportion of third year medical students experience core general surgery cases in the operating room versus Wise-MD, providing insight into ways to improve the surgical clerkship. METHODS: Clerkship students recorded whether surgical cases are completed via Wise-MD or experienced in the operating room. Forms submitted by students who completed surgical clerkship between January 2018 to September 2022 were analyzed. For each core surgical case (anorectal, appendicitis, bowel obstruction, breast cancer, cholecystitis, colon cancer, diverticulitis, inguinal hernia, lung cancer, skin cancer, and trauma) students were stratified based on their reported experience. The proportion of Wise-MD versus operating room cases was calculated. RESULTS: Between January 2018 and September 2022 a total of 411 students submitted completed case logs. Among all surgical cases, 60% were experienced by students in the operating room. The surgical cases with the highest proportion of operating room experience included appendicitis (78%), cholecystitis (85%), inguinal hernia (79%), and trauma (76%). The surgical cases with the lowest proportion of operating room experience included lung cancer (34%) and skin cancer (44%). CONCLUSION: Despite enforcing a general surgery block, about 40% of students are not experiencing most "bread and butter" surgical cases. Clerkship directors should be mindful about the distribution of medical students among surgical teams as this may affect which cases are observed. Moreover, the opportunity for surgical electives may influence general surgery exposure.

Framing our Expectations: Variability in Entrustable Professional Activity Assessments.

OBJECTIVE: To determine the ability of surgical trainees and faculty to correctly interpret entrustability of a resident learner in a modeled patient care scenario. DESIGN: Prospective study utilizing a web-based survey including 4 previously-recorded short videos of resident learners targeted to specific levels of the American Board of Surgery's (ABS) Entrustment Scale. Respondents were asked to choose the entrustment level that best corresponded to their observations of the learner in the video. Responses were subcategorized by low and high entrustment. SETTING: Online, utilizing the Qualtrics survey platform. PARTICIPANTS: Survey targeting US surgical trainees and surgical faculty via email and social media. We received 31 complete responses and 2 responses which completed > 1 video assessment question without demographic information (n = 33). Respondents included 10 trainees (32%) and 21 attending surgeons (68%). RESULTS: Neither faculty nor trainees readily identified the targeted entrustment level for Question 1 (preoperative care of a patient with acute appendicitis with high entrustment, 36% correct), though evaluations of the remaining questions (2 through 4) demonstrated more accuracy (70, 84, and 75% correct, respectively). Faculty were more readily able than trainees to identify low entrustment (level Limited Participation) in intraoperative inguinal hernia repair (95% vs 60%, p = 0.03). After subcategorization to high and low entrustment, both residents and faculty were able to accurately identify entrustment 95% overall. CONCLUSIONS: Both trainees and attending surgeons were able to identify high- and low-performing residents on short video demonstrations using the ABS EPA entrustment scale. This provides additional evidence in support of the need for frequent observations of EPAs to account for the variability in raters' perceptions in addition to complexity of clinical scenarios. Frame-of-reference training via a video-based platform may also be beneficial for both residents and faculty as an ongoing EPA implementation strategy.