Vascular Anastomoses and Dissection: A Six-Part Simulation Curriculum for Surgical Residents.

Introduction: As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models. Methods: We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants' technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form. Results: Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24-29) out of a possible score of 35, with highest scores on knowledge of instruments. Discussion: This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.

An At-Home Laparoscopic Curriculum for Junior Residents in Surgery, Obstetrics/Gynecology, and Urology.

Introduction: Laparoscopic surgery requires significant training, and prior studies have shown that surgical residents lack key laparoscopic skills. Many educators have implemented simulation curricula to improve laparoscopic training. Given limited time for dedicated, in-person simulation center practice, at-home training has emerged as a possible mechanism by which to expand training and promote practice. There remains a gap in published at-home laparoscopic curricula employing embedded feedback mechanisms. Methods: We developed a nine-task at-home laparoscopic curriculum and an end-of-curriculum assessment following Kern's six-step approach. We implemented the curriculum over 4 months with first- to third-year residents. Results: Of 47 invited residents from general surgery, obstetrics/gynecology, and urology, 37 (79%) participated in the at-home curriculum, and 25 (53%) participated in the end-of-curriculum assessment. Residents who participated in the at-home curriculum completed a median of six of nine tasks (interquartile range: 3-8). Twenty-two residents (47%) responded to a postcurriculum survey. Of these, 19 (86%) reported that their laparoscopic skills improved through completion of the curriculum, and the same 19 (86%) felt that the curriculum should be continued for future residents. Residents who completed more at-home curriculum tasks scored higher on the end-of-curriculum assessment (p = .009 with adjusted R 2 of .28) and performed assessment tasks in less time (p = .004 with adjusted R 2 of .28). Discussion: This learner-centered laparoscopic curriculum provides guiding examples, spaced practice, feedback, and graduated skill development to enable junior residents to improve their laparoscopic skills in a low-stakes, at-home environment.

Comparing Peer and Faculty Feedback for Asynchronous Laparoscopic Skill Acquisition.

OBJECTIVE: Traditionally, expert surgeons have provided surgical trainees with feedback about their simulation performance, including for asynchronous practice. Unfortunately, innumerable time demands may limit experts' ability to provide feedback. It is unknown whether and how peer feedback is an effective mechanism to help residents acquire laparoscopic skill in an asynchronous setting. As such, we aimed to assess the effect of peer feedback on laparoscopic performance and determine how residents perceive giving and receiving peer feedback. DESIGN: We conducted a convergent mixed methods study. In the quantitative component, we randomized residents to receive feedback on home laparoscopic tasks from peers or faculty. We then held an end-of-curriculum, in-person laparoscopic assessment with members from both groups and compared performance on the in-person assessment between the groups. In the qualitative component, we conducted interviews with resident participants to explore experiences with feedback and performance. Three authors coded and rigorously reviewed interview data using a directed content analysis. SETTING: We performed this study at a single tertiary academic institution: the University of California, San Francisco. PARTICIPANTS: We invited 47 junior residents in general surgery, obstetrics-gynecology, and urology to participate, of whom 37 (79%) participated in the home curriculum and 25 (53%) participated in the end-of-curriculum assessment. RESULTS: Residents in the peer feedback group scored similarly on the final assessment (mean 70.7%; SD 16.1%) as residents in the faculty feedback group (mean 71.8%; SD 11.9%) (p = 0.86). Through qualitative analysis of interviews with 13 residents, we identified key reasons for peer feedback's efficacy: shared mental models, the ability to brainstorm and appreciate new approaches, and a low-stakes learning environment. CONCLUSIONS: We found that peer and faculty feedback led to similar performance in basic laparoscopy and that residents engaged positively with peer feedback, suggesting that peer feedback can be used when residents learn basic laparoscopy.

Who should proof my paper?

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the challenges in proofreading a manuscript. Emerging researchers might think that someone in the production team will catch any errors. This may not always be the case. We emphasize the importance of guiding mentees to take the process of preparing a manuscript for submission seriously.

Beyond the Task: Developing a Tool to Measure Workplace Characteristics That Affect Cognitive Load and Learning.

PURPOSE: Educators lack tools to measure the workplace characteristics that learners perceive to affect learning. Without a tool that encompasses the social, organizational, and physical components of workplace learning environments (WLEs), it is challenging to identify and improve problematic workplace characteristics. Using echocardiography WLE, this study developed a tool to measure workplace characteristics that cardiology fellows perceive to affect learning. METHOD: The Workplace-Cognitive Load Tool (W-CLT) was developed, which encompasses 17 items to measure workplace characteristics that could affect perceived cognitive load and learning. Exploratory factor analysis was used to identify the most parsimonious structure. A total of 646 cardiology subspeciality fellows were recruited from 60 cardiology fellowship programs to complete the survey between November 2020 and February 2021. Validity evidence was collected, guided by the unified model of validity. RESULTS: A total of 308 fellows (response rate, 49%) participated in the survey. The most parsimonious structure included 4 factors: (1) workplace-task, (2) workplace-environment, (3) workplace-orientation, and (4) workplace-teaching and feedback. All factors had high reliability (Cronbach α = 0.92, 0.92, 0.96, and 0.94, respectively). Social, organizational, and physical components of WLEs were represented in the items. Workplace-teaching and feedback had moderate negative correlations with workplace-environment (r = -0.41, P < .001) and workplace-orientation (r = -0.36, P < .001). A moderate positive correlation was found between workplace-task and workplace-teaching and feedback (r = 0.42, P < .001). Workplace-task had weak negative correlations with workplace-environment (r = -0.22, P < .001) and workplace-orientation (r = -0.23, P < .001). CONCLUSIONS: The W-CLT measures workplace characteristics that cardiology fellows perceive to affect their learning. The presence of social, organizational, and physical components emphasizes how workplace characteristics can enhance or impede learning. The W-CLT provides a foundation to explore how learning can be optimized in other WLEs.

Preparing Institutions to Implement Harmonized Medicine and Nursing Curricula Through the Use of Cross-Institutional Faculty Developers.

Background: Effective implementation of new curricula requires faculty to be knowledgeable about curriculum goals and have the appropriate pedagogical skills to implement the curriculum, even more so if the new curriculum is being deployed at multiple institutions. In this paper, we describe the process of creating a common faculty development program to train cross-institutional faculty developers to support the implementation of national harmonized medicine and nursing curricula. Methods: A five-step approach was used, including a cross-institutional needs assessment survey for faculty development needs, the development of a generic faculty development program, the identification and training of cross-institutional faculty educators, and the implementation of cross-institutional faculty capacity-building workshops. Results: A list of common cross-cutting faculty development needs for teaching and learning was identified from the needs assessment survey and used to develop an accredited, cross-institutional faculty development program for competency-based learning and assessment. A total of 24 cross-institutional faculty developers were identified and trained in 8 core learning and assessment workshops. A total of 18 cross-institutional and 71 institutional workshops were conducted, of which 1292 faculty members and 412 residents were trained, and three cross-institutional educational research projects were implemented. Conclusion: The success attained in this study shows that the use of cross-institutional faculty developers is a viable model and sustainable resource that can be used to support the implementation of harmonized national curricula.

The Role of Faculty Development in Advancing Change at the Organizational Level.

ABSTRACT: Although the traditional goal of faculty development (FD) has been to enhance individual growth and development, this goal may no longer suffice to address the compelling challenges faculty members are facing, such as increasing workloads, emotional well-being, and institutional support for education. Addressing these challenges will require change at the organizational level. The purpose of this perspective is to articulate a vision for FD programming that describes ways in which FD leaders, together with other educational leaders, can bring about change at the organizational level to support excellence and innovation in health professions education. To impact the organization at large, the authors propose a model that includes 4 major goals: (1) promoting individual and group development, through educational and leadership development programs, coaching and mentoring, and advanced degrees; (2) advocating for infrastructure and resources, including academies of medical educators, educational scholarship units, educational awards, and intramural funding for educational innovation and scholarship; (3) influencing policies and procedures, by engaging educators on key committees, reviewing appointment and promotion criteria, defining educator roles and portfolios, and valuing diversity, equity, and inclusion; and (4) contributing to organization-wide initiatives, such as addressing "hot button" issues, identifying value factors that support investments in FD and medical education, and enhancing the visibility of educators. In this model, the 4 goals are dynamically interconnected and can impact the culture of the organization. For each goal, the authors offer evidence-informed actions that FD leaders, along with other educational leaders, can adopt to improve the organizational culture and inspire institutionally relevant actions. Because each institution is unique, the options are illustrative and not prescriptive. The intent is to provide examples of how FD leaders and programs can enhance the educational mission through broader engagement with their institutions.

Ergonomic Assessment of Septorhinoplasty Maneuvers During Simulated Pregnancy.

Objective: Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact of pregnancy on surgeon posture and ergonomics. We piloted the use of a pregnancy simulation suit (Empathy Belly) to assess the risk of ergonomic compromise when performing open septorhinoplasty. Study Design: Surgical simulation. Setting: Single session, training simulation lab at academic medical center. Methods: Medical students and surgical residents performed the initial steps of a rhinoplasty procedure without and with a pregnancy simulation suit and were filmed with an artificial intelligence-based video analysis app from Kinetica Labs that calculates joint angles and categorizes the ergonomic risk factors. Still images from videos were taken and analyzed using validated posture-based analysis rubrics. Participants were asked to complete a qualitative questionnaire after the session. Results: Twelve medical students and surgical residents participated in the study. Posture-based analysis indicated increased ergonomics risk factors among trainees when performing a rhinoplasty while wearing the pregnancy suit. Video analysis indicated trends of worsening back angle and shoulder postures. Trainees reported experiencing pain in the neck, suprapubic area, and lower back. They acknowledged the importance of ergonomics in otolaryngology and desired further education about workplace injury risk mitigation. Conclusion: Pregnancy impacts the ergonomics of performing septorhinoplasty and further investigation is required into interventions to reduce risk of WRMSDs.

Should I do a synthesis (i.e. literature review)?

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the question of whether one should conduct a literature review or knowledge synthesis, considering the why, when, and how, as well as its potential pitfalls. The goal is to guide supervisors and students who are considering whether to embark on a literature review in education research.

I'd like to use a questionnaire (sub-text: this will be an easy way to get data. Right?).

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the question of using questionnaires in education research, considering the why, when, and how, as well as its potential pitfalls. The goal is to guide supervisors and students who are considering whether to develop and use a questionnaire for research purposes.

Student challenges during third-year perioperative clerkships through the lens of faculty and residents: A qualitative study.

PURPOSE: Studies of medical students suggest they often find the transition from the pre-clinical curriculum to clinical rotations particularly challenging during perioperative clerkships. Educators could add a new perspective into students' clerkship experiences and potential interventions to improve them. The purpose of this study was to examine the educator perspective on students' experiences in perioperative clerkships. The findings could inform potential curricular interventions to facilitate student transition from a didactic environment into perioperative clerkships. METHODS: Semi-structured qualitative interviews were conducted with 16 faculty and residents in the departments of anaesthesia, obstetrics and gynaecology (OBGYN), and general surgery across multiple clinical teaching sites at one institution. Interview questions explored their perceptions of the challenges students face during their transition into perioperative clerkships and probed thoughts on curriculum interventions they believed would be the most beneficial. Interviews were recorded, transcribed and analysed thematically. FINDINGS: Three themes were identified. Faculty and residents perceive that student experiences on perioperative clerkships are shaped by (1) students' ability to adapt to the specialty and operating room norms on these clerkships, (2) students' understanding of how they can meaningfully contribute to the clinical team, and (3) dedicated teaching time constraints. Interventions were suggested to address educator expectations and student gaps, such as implementing a pre-clerkship orientation across anaesthesia, general surgery and OBGYN. CONCLUSIONS: To facilitate the medical student transition to perioperative clerkships, interventions should aid students in adapting to clerkship norms for these specialties and clarifying their role and expectations within the care team.

Recovery Rates of Diagnostic Cardiac Procedural Volume in Oceania 1 Year Into COVID-19: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID 2).

AIM: The aim of this study was to assess the recovery rates of diagnostic cardiac procedure volumes in the Oceania Region, midway through the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A survey was performed comparing procedure volumes between March 2019 (pre-pandemic), April 2020 (during first wave of COVID-19 pandemic), and April 2021 (1 year into the COVID-19 pandemic). A total of 31 health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, as well as teaching and non-teaching hospitals. A comparison was made with 549 centres in 96 countries in the rest of the world (RoW) outside of Oceania. The total number and median percentage change in procedure volume were measured between the three timepoints, compared by test type and by facility. RESULTS: A total of 11,902 cardiac diagnostic procedures were performed in Oceania in April 2021 as compared with 11,835 pre-pandemic in March 2019 and 5,986 in April 2020; whereas, in the RoW, 499,079 procedures were performed in April 2021 compared with 497,615 pre-pandemic in March 2019 and 179,014 in April 2020. There was no significant difference in the median recovery rates for total procedure volumes between Oceania (-6%) and the RoW (-3%) (p=0.81). While there was no statistically significant difference in percentage recovery been functional ischaemia testing and anatomical coronary testing in Oceania as compared with the RoW, there was, however, a suggestion of poorer recovery in anatomical coronary testing in Oceania as compared with the RoW (CT coronary angiography -16% in Oceania vs -1% in RoW, and invasive coronary angiography -20% in Oceania vs -9% in RoW). There was no statistically significant difference in recovery rates in procedure volume between metropolitan vs regional (p=0.44), public vs private (p=0.92), hospital vs outpatient (p=0.79), or teaching vs non-teaching centres (p=0.73). CONCLUSIONS: Total cardiology procedure volumes in Oceania normalised 1 year post-pandemic compared to pre-pandemic levels, with no significant difference compared with the RoW and between the different types of health care facilities.

Assessing supervisor versus trainee viewpoints of entrustment through cognitive and affective lenses: an artificial intelligence investigation of bias in feedback.

The entrustment framework redirects assessment from considering only trainees' competence to decision-making about their readiness to perform clinical tasks independently. Since trainees and supervisors both contribute to entrustment decisions, we examined the cognitive and affective factors that underly their negotiation of trust, and whether trainee demographic characteristics may bias them. Using a document analysis approach, we adapted large language models (LLMs) to examine feedback dialogs (N = 24,187, each with an associated entrustment rating) between medical student trainees and their clinical supervisors. We compared how trainees and supervisors differentially documented feedback dialogs about similar tasks by identifying qualitative themes and quantitatively assessing their correlation with entrustment ratings. Supervisors' themes predominantly reflected skills related to patient presentations, while trainees' themes were broader-including clinical performance and personal qualities. To examine affect, we trained an LLM to measure feedback sentiment. On average, trainees used more negative language (5.3% lower probability of positive sentiment, p < 0.05) compared to supervisors, while documenting higher entrustment ratings (+ 0.08 on a 1-4 scale, p < 0.05). We also found biases tied to demographic characteristics: trainees' documentation reflected more positive sentiment in the case of male trainees (+ 1.3%, p < 0.05) and of trainees underrepresented in medicine (UIM) (+ 1.3%, p < 0.05). Entrustment ratings did not appear to reflect these biases, neither when documented by trainee nor supervisor. As such, bias appeared to influence the emotive language trainees used to document entrustment more than the degree of entrustment they experienced. Mitigating these biases is nonetheless important because they may affect trainees' assimilation into their roles and formation of trusting relationships.

"It's Time to Do It, to Make It a Major Part of Medicine": Faculty Experience With a Shift Toward an Antioppressive Medical School Curriculum.

PURPOSE: Health inequities compel medical educators to transform curricula to prepare physicians to improve the health of diverse populations. This mandate requires curricular focus on antioppression, which is a change for faculty who learned and taught under a different paradigm. This study used the Concerns-Based Adoption Model (CBAM) to explore faculty perceptions of and experiences with a shift to a curriculum that prioritizes antioppressive content and process. METHOD: In this qualitative study, authors interviewed faculty course directors and teachers at the University of California, San Francisco School of Medicine from March 2021 to January 2022. Questions addressed faculty experience and understanding regarding the curriculum shift toward antioppression, perceptions of facilitators and barriers to change, and their interactions with colleagues and learners about this change. Using the CBAM components as sensitizing concepts, the authors conducted thematic analysis. RESULTS: Sixteen faculty participated. Their perceptions of their experience with the first year of an antioppression curriculum initiative were characterized by 3 broad themes: (1) impetus for change, (2) personal experience with antioppressive curricular topics, and (3) strategies necessary to accomplish the change. Faculty described 3 driving forces for the shift toward antioppressive curricula: moral imperative, response to national and local events, and evolving culture of medicine. Despite broad alignment with the change, faculty expressed uncertainties on 3 subthemes: uncertainty about what is an antioppressive curriculum, the scientific perspective, and fear. Faculty also reflected on primary facilitators and barriers to accomplishing the change. CONCLUSIONS: The shift to an antioppressive curriculum compels faculty to increase their knowledge and skills and adopt a critical, self-reflective lens on the interplay of medicine and oppression. This study's findings can inform faculty development efforts and highlight curricular leadership and resources needed to support faculty through this type of curricular change.

Stereotype Threat and Gender Bias in Internal Medicine Residency: It is Still Hard to be in Charge.

BACKGROUND: Despite similar numbers of women and men in internal medicine (IM) residency, women face unique challenges. Stereotype threat is hypothesized to contribute to underrepresentation of women in academic leadership, and exploring how it manifests in residency may provide insight into forces that perpetuate gender disparities. OBJECTIVE: To quantify the prevalence of stereotype threat in IM residency and explore experiences contributing to that stereotype threat. DESIGN: We used a mixed methods study design. First, we surveyed IM residents using the Stereotype Vulnerability Scale (SVS) to screen for stereotype threat. Second, we conducted focus groups with women who scored high on the SVS to understand experiences that led to stereotype threat. PARTICIPANTS: The survey was sent to all IM residents at University of California, San Francisco (UCSF), in September-November 2019. Focus groups were conducted at UCSF in Spring 2020. APPROACH: The survey included an adapted version of the SVS. For focus groups, we developed a focus group guide informed by literature on stereotype threat. We used a thematic approach to data analysis. The mixed methods design enabled us to draw metainferences by integrating the two data sources. KEY RESULTS: Survey response rate was 61% (110/181). Women were significantly more likely than men to have a score indicating stereotype threat vulnerability (77% vs 0%, p < 0.001). Four themes from focus groups characterized women's experiences of gender bias and stereotype threat: gender norm tension, microaggressions and sexual harassment, authority questioned, and support and allyship. CONCLUSIONS: Gender-based stereotype threat is highly prevalent among women IM residents. This phenomenon poses a threat to confidence and ability to execute patient care responsibilities, detracting from well-being and professional development. These findings indicate that, despite robust representation of women in IM training, further attention is needed to address gendered experiences and contributors to women's vulnerability to stereotype threat.

Validation of Endurance Model for Manual Tasks.

Physical fatigue in the workplace can lead to work-related musculoskeletal disorders (WMSDs), especially in occupations that require repetitive, mid-air movements, such as manufacturing and assembly tasks in industry settings. The current paper endeavors to validate an existing torque-based fatigue prediction model for lifting tasks. The model uses anthropometrics and the maximum torque of the individual to predict the time to fatigue. Twelve participants took part in the study which measured body composition parameters and the maximum force produced by the shoulder joint in flexion, followed by three lifting tasks for the shoulder in flexion, including isometric and dynamic tasks with one and two hands. Inertial measurements units (IMUs) were worn by participants to determine the torque at each instant to calculate the endurance time and CE, while a self-subjective questionnaire was utilized to assess physical exertion, the Borg Rate of Perceived Exertion (RPE) scale. The model was effective for static and two-handed tasks and produced errors in the range of [28.62 49.21] for the last task completed, indicating the previous workloads affect the endurance time, even though the individual perceives they are fully rested. The model was not effective for the one-handed dynamic task and differences were observed between males and females, which will be the focus of future work.An individualized, torque-based fatigue prediction model, such as the model presented, can be used to design worker-specific target levels and workloads, take inter and intra individual differences into account, and put fatigue mitigating interventions into place before fatigue occurs; resulting in potentially preventing WMSDs, aiding in worker wellbeing and benefitting the quality and efficiency of the work output.Clinical Relevance- This research provides the basis for an individualized, torque-based approach to the prediction of fatigue at the shoulder joint which can be used to assign worker tasks and rest breaks, design worker specific targets and reduce the prevalence of work-related musculoskeletal disorders in occupational settings.

How should I determine author order for this paper?

This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors conclude their short series of articles on academic authorship by addressing the question of how to determine author order, including taking into account power dynamics that may be at play.

Overlapping worlds of art and plastic surgery: developing a concept model and its implications in surgical education.

Purpose: Editorials speculate on the relationship between art and plastic surgery, and studies of limited art education in surgical training show intriguing benefits. Identifying the shared concepts and skills in art and plastic surgery could advance incorporating artistic skills and concepts into plastic surgery training and curriculum. Methods: Using a grounded theory approach, we interviewed plastic surgeons and formally trained or self-identified artists and then analyzed the transcripts. During the process, we used a constant comparison approach while coding along with data collection. The team developed the codebook from initial transcripts; 2 members coded each transcript. We reconciled codes and summarized codes into themes based on discussion among the team. Results: 15 plastic surgeons aged 36-80 years and 16 artists aged 19-62 years were interviewed. We then developed a concept model, "Ways of Making," to illustrate the shared aspects of the artistic and surgical process through their ways of doing, knowing, seeing, and thinking. Both plastic surgeons and artists recognized that strong technical foundational skills are key to developing competency. Both groups spoke about the Elements of Art and Principles of Design, though artists know this formally. Artists and plastic surgeons shared that awareness to one's surroundings or to human features facilitates identifying problems or ideas. They described how technical skills, manual dexterity, and three-dimensional thinking can be taught and nurtured. Both groups also recognized that creativity played a major role in their work. While creativity was seen as innate, participants can learn to be innovative through critical thinking. Conclusion: This study provides a model for how plastic surgery and art overlap using data from interviews. Though there are differences between the two fields, the ways of doing, knowing, seeing, and thinking are key components of the artistic and surgical processes. Identifying the shared concepts and skills in art and plastic surgery could help enhance curricula seeking to incorporate artistic skills and concepts into plastic surgery training.