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.

Instrument and Supply Variability: An Opportunity to Reduce the Carbon Footprint of the Operating Room.

INTRODUCTION: Reducing costs and carbon footprints are important, parallel priorities for the US health-care system. Within surgery, reducing the number of instruments that are sterilized and disposable supplies that are used for each operation may help achieve both goals. We wanted to measure the existing variability in surgical instrument and supply choices and assess whether standardization could have a meaningful cost and environmental impact. METHODS: We analyzed surgeon preference cards for common general surgery operations at our hospital to measure the number of sterilizable instrument trays and supplies used by each surgeon for each operation. From this data, we calculated supply costs, carbon footprint, and median operative time and studied the variability in each of these metrics. RESULTS: Among the ten operations studied, variability in sterilizable instrument trays requested on surgeon preference cards ranged from one to eight. Variability in disposable supplies requested ranged from 17 to 45. Variability in open supply costs ranged from $104 to $4184. Variability in carbon footprint ranged from 17 to 708 kg CO2e. If the highest-cost surgeon for each operation switched their preference card to that of the median-cost surgeon, $245,343 in open supply costs and 41,708 kg CO2e could be saved. CONCLUSIONS: There is significant variability in the instrument and supply choices of surgeons performing common general surgery operations. Standardizing this variability may lead to meaningful cost savings and carbon footprint reduction, especially if scaled across the entire health system.