Critical appraisal of Genelyn soft embalming for cadaveric surgical skill training: A systematic review.

Genelyn is a proprietary embalming solution used for preserving cadavers for surgical skill training (SST) and undergraduate teaching. The aim of this review is to examine the Genelyn embalming method critically by analyzing scientific publications that have employed this method for SST and undergraduate education. The systematic review process involved searching for all relevant articles in PubMed, Google Scholar, and Embase using the keywords "Genelyn," Genelyn embalming," "Genelyn embalmed cadaver," and "surgical skill training. All studies on Genelyn embalming published up to August 14, 2024, in the English language were eligible for inclusion. The literature review yielded 92 studies, 43 of which met the inclusion criteria. The Anatomical Quality Assurance (AQUA) tool from the International Evidence-Based Anatomy (iEBA) working group was used to assess and analyze the risk of bias in all the selected full-text articles. The selected studies reported that Genelyn embalming provided life-like joint range of motion, tissue pliability, and color. Cadaveric studies assessing embalming solutions typically had smaller sample sizes, and few of them compared Genelyn embalmed cadavers (GECs) with the other soft embalming solutions. Unlike Theil's embalming, Genelyn embalming is cost-effective, with easy steps for the preparation and storage of the solution and convenient handling of cadavers. Therefore, GECs serve as an efficient tool for SSTs.

Advancing Cultural Competency and Equity in Surgical Specialties (ACCESS): A Model for a Combined Resident and Faculty DEI Initiative.

BACKGROUND: Committees dedicated to diversity, equity, and inclusion (DEI) are not commonplace within departments of surgery. Even rarer are joint initiatives for residents and faculty. We aim to describe the creation of a collaborative committee within a department of surgery to better foster and advance the ideals of DEI. METHODS: An informal needs-assessment was performed amongst the general surgery residency, advanced practice practitioners, and faculty. Other DEI groups throughout the institution were engaged for feedback and interdisciplinary collaboration. RESULTS: Gaps were identified in social support for those from diverse backgrounds, advocacy and recruitment, general DEI education, and research. Three pillars were formed: Social Support, Education and Advocacy, and Research. The overall group and each pillar are co-led by residents and faculty. In less than a year, the group has launched a cultural complications morbidity and mortality curriculum, hosted the first city-wide LGTBQ+ in surgery event, created a safe space for discussion and support, and advocated for recruitment DEI initiatives. So far, the group consists of 48 residents, faculty, advanced practice practitioners, and staff. CONCLUSIONS: An intentional, collaborative effort between residents and faculty in a department of surgery can successfully result in an effective partnership to advance DEI initiatives.

Sub-Internship Academy: Implementation and Evaluation of Single-Day Resident-Driven Focused Sub-Internship Preparation Course.

OBJECTIVE: Strong performance in neurosurgical sub-internships is a vital component of a successful residency application and requires adequate familiarity with clinical knowledge and technical skills that may not be covered in standard medical school curricula. Accordingly, a need exists for immersive and comprehensive sub-internship preparation programs that respect time and resource limitations, are optimized based on longitudinal student feedback, provide opportunities for mentorship, and foster enthusiasm for neurosurgery. Therefore, residents at a single institution designed and implemented a comprehensive curriculum for a one-day sub-internship academy. METHODS: Academy curriculum involved hands-on and discussion-based elements split into three workshops. Anonymous surveys were conducted immediately following the academy and upon completion of sub-internships to evaluate participant perceptions on the utility of the academy. RESULTS: Twelve medical students participated in the inaugural neurosurgery sub-internship academy. Nine responded to the immediate post-survey, which revealed the following ratings: the overall program was rated as having maximal impact on sub-internship readiness and enthusiasm for neurosurgery by eight (88.9%) and seven (77.8%) respondents, respectively. A largely positive impact on access to mentorship was observed. Six participants responded to a post-sub-internship survey, and all six indicated they agreed or strongly agreed that the academy prepared them to perform well. CONCLUSIONS: Student perceptions of the relevance and utility of the sub-internship academy were positive, and the program fostered enthusiasm for neurosurgery and provided opportunities for mentorship. The participants indicated the academy positively impacted their sub-internship performance, and areas for improvement to guide future iterations of the academy were identified.

Development of Machine Learning Copilot to Assist Novices in Learning Flexible Laryngoscopy.

OBJECTIVES: Here we describe the development and pilot testing of the first artificial intelligence (AI) software "copilot" to help train novices to competently perform flexible fiberoptic laryngoscopy (FFL) on a mannikin and improve their uptake of FFL skills. METHODS: Supervised machine learning was used to develop an image classifier model, dubbed the "anatomical region classifier," responsible for predicting the location of camera in the upper aerodigestive tract and an object detection model, dubbed the "anatomical structure detector," responsible for locating and identifying key anatomical structures in images. Training data were collected by performing FFL on an AirSim Combo Bronchi X mannikin (United Kingdom, TruCorp Ltd) using an Ambu aScope 4 RhinoLaryngo Slim connected to an Ambu® aView™ 2 Advance Displaying Unit (Ballerup, Ambu A/S). Medical students were prospectively recruited to try the FFL copilot and rate its ease of use and self-rate their skills with and without the copilot. RESULTS: This model classified anatomical regions with an overall accuracy of 91.9% on the validation set and 80.1% on the test set. The model detected anatomical structures with overall mean average precision of 0.642. Through various optimizations, we were able to run the AI copilot at approximately 28 frames per second (FPS), which is imperceptible from real time and nearly matches the video frame rate of 30 FPS. Sixty-four novice medical students were recruited for feedback on the copilot. Although 90.9% strongly agreed/agreed that the AI copilot was easy to use, their self-rating of FFL skills following use of the copilot were overall equivocal to their self-rating without the copilot. CONCLUSIONS: The AI copilot tracked successful capture of diagnosable views of key anatomical structures effectively guiding users through FFL to ensure all anatomical structures are sufficiently captured. This tool has the potential to assist novices in efficiently gaining competence in FFL. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Implementation of an Education Module to Improve Emergency Medical Service Provider Accuracy and Confidence in Trauma Triage.

INTRODUCTION: Prehospital triage is critical to ensure timely activation of trauma center resources. Undertriage (UT) results in higher morbidity and mortality. To minimize this risk, the American College of Surgeons Committee on Trauma recommends trauma centers aim for a UT rate below 5%. Our center has a 3-tiered triage system aimed at optimizing resource allocation. We hypothesized that a trauma triage criteria educational module (TCEM) would 1) improve emergency medical services (EMSs) provider confidence and accuracy in triage and 2) improve our UT rate. METHODS: From July to November 2022, the TCEM was presented to 8 local EMS agencies who transport patients to our Level 1 trauma center. Preclass and postclass surveys assessed EMS provider triage confidence using a Likert scale 1-5. Validated trauma scenario questions were used to measure triage accuracy. The UT rate was compared between January-May 2022 (pre-TCEM) to January-May 2023 (post-TCEM) using trauma registry data. Data were analyzed using paired Wilcoxon signed rank and t-tests. RESULTS: 72 prehospital providers participated in TCEM, most were Caucasian (65.3%), non-Hispanic (84.7%), males (77.8%) with emergency medical technician-basic certifications (90.3%). There was a significant increase in triage confidence from pre-TCEM to post-TCEM (2 versus 5; P < 0.001) and accuracy (23.2% versus 88.9%; P < 0.001). Regression analysis did not indicate a significant difference in confidence or accuracy based on years of experience, paid or volunteer provider status, or transport volume per week. The UT rate remained stable after TCEM initiation (2.3% versus 2.0%; P < 0.669). CONCLUSIONS: This novel community based educational program demonstrated improvements in EMS provider confidence and accuracy regarding prehospital trauma triage. Outreach programs like these are often well received by EMS, and implementation is highly reproducible at other centers.

Development and dissemination of a series of surgical skills and procedures video tutorials using a novel, low-cost, and sustainable simulation kit (GlobalSurgBox).

INTRODUCTION: Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator. METHODS: We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS). RESULTS: Videos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 â€‹± â€‹1.05 and GQS of 3.06 â€‹± â€‹0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty. CONCLUSIONS: This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility.

See one, do one, teach one - Trends in resident autonomy and teaching assistant cases during general surgery residency in the United States: A nationwide retrospective analysis.

INTRODUCTION: Autonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the 'teaching assistant (TA)' case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce. METHODS: A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume. RESULTS: Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 â€‹% increase; τ â€‹= â€‹0.610, p â€‹= â€‹0.001). There was a concurrent 72.7 â€‹% increase in TA cases from a median of 22-38 (τ â€‹= â€‹0.574, p â€‹= â€‹0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018-2019 and 2016-2017. The uptrend in TA cases was associated with the significant increase in colorectal (τ â€‹= â€‹0.559, p â€‹= â€‹0.001), general surgery-other (τ â€‹= â€‹0.404, p â€‹= â€‹0.018), and hepatopancreaticobiliary (HPB) (τ â€‹= â€‹0.596, p â€‹= â€‹0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ â€‹= â€‹0.956, p=<0.001), HPB (τ â€‹= â€‹0.713, p=<0.001) and colorectal (τ â€‹= â€‹0.522, p â€‹= â€‹0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ â€‹= â€‹-0.485, p â€‹= â€‹0.006) and vascular surgery (τ â€‹= â€‹0.603, p â€‹= â€‹0.001) dropped significantly. The procedural category with the highest chief and TA volume was 'colorectal tract - large intestine.' Most procedural categories (53.49 â€‹%) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023. CONCLUSIONS: Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.

Development and Assessment of a Deceased Donor Organ Recovery Workshop for Surgical Fellows.

OBJECTIVE: To assess the impact of a deceased donor organ procurement training workshop on the transplant fellow's confidence and proficiency in organ recovery. This pilot workshop was designed to address the current gap in the transplant fellow's training in North America. DESIGN: Participants' confidence and competence in deceased donor organ recovery were assessed pre- and postworkshop (immediate, 1- and 6-month) using a survey questionnaire. Participants' responses were compared using T-test and Wilcoxon tests before and after the workshop. PARTICIPANTS: The hepatopancreatobiliary-transplant fellows from the University of Toronto participated in the workshop. RESULTS: Seven fellows participated, with 57% reported very limited exposure to deceased donor operations in the past year. Fellows' confidence improved significantly immediately postworkshop (69% vs. 85%, p = <0.05), persisting at 1 month (86%, p = <0.05) and 6 months (91%, p = <0.05). Competence scores also demonstrated improvement postworkshop (88% vs. 78%, p = 0.3), remaining constant at 1 month (88%, p = 0.18), and further increasing at 6 months (92%, p = 0.19). CONCLUSION: This pilot study represents a notable step as the first workshop tailored for transplant fellows in Canada, demonstrating sustained improvement in both confidence and competence for deceased donor organ procurements. The study is limited by results from a single center and small sample size, impacting the generalizability of findings. However, the workshop addresses variability in transplant fellows' exposure and confidence levels, emphasizing the importance of structured training in organ procurement to enhance skills and readiness for real-time procedures.

Enhancing Hospital Reimbursement Through a Pediatric Surgery Resident Orientation Program: A Focus on Accurate Diagnosis Code Documentation for Acute Appendicitis.

BACKGROUND: The usage of specific ICD-10 diagnosis codes significantly influences hospital reimbursement compared to non-specific codes. This study hypothesized that a formal orientation program for pediatric surgery residents would enhance the selection of accurate and specific diagnosis codes for acute appendicitis such as K35.30 for "Acute appendicitis with localized peritonitis" rather than K35.80 for "Unspecified acute appendicitis," thereby improving hospital reimbursement. METHODS: We implemented a comprehensive orientation for pediatric surgery residents at our institution in late 2020, a component of which emphasized the importance of having specific ICD-10 diagnosis codes. We conducted a retrospective analysis of laparoscopic appendectomy billing data for pediatric patients, comparing the use of specific versus unspecified diagnosis codes and associated hospital reimbursement rates before (2020) and after (2022) the program's initiation. Patients without payment were excluded. Statistical significance was determined by a two-tailed p-value of ≤0.05. RESULTS: Analysis of 267 patient records showed a significant increase in the use of the specific diagnosis code (K35.30) from 3.6% in 2020 to 87.5% in 2022 (p < 0.0001). Adjusted for inflation and billing changes, mean hospital reimbursement per case increased by $661 (from $4414 to $5,075, p = 0.027), totaling an additional $84,616 in 2022, just for a single subset of appendicitis patients. CONCLUSIONS: A targeted resident orientation program significantly improves the use of specific ICD-10 codes for acute appendicitis, leading to increased hospital reimbursement. Such programs represent a valuable approach for enhancing the financial outcomes of pediatric surgical care while reinforcing the importance of accurate medical documentation. STUDY DESIGN: Retrospective. LEVEL OF EVIDENCE: III.

Augmented Reality-Guided Mastoidectomy Simulation: A Randomized Controlled Trial Assessing Surgical Proficiency.

OBJECTIVE: Mastoidectomy surgical training is challenging due to the complex nature of the anatomical structures involved. Traditional training methods based on direct patient care and cadaveric temporal bone training have practical shortcomings. 3D-printed temporal bone models and augmented reality (AR) have emerged as promising solutions, particularly for mastoidectomy surgery, which demands an understanding of intricate anatomical structures. Evidence is needed to explore the potential of AR technology in addressing these training challenges. METHODS: 21 medical students in their clinical clerkship were recruited for this prospective, randomized controlled trial assessing mastoidectomy skills. The participants were randomly assigned to the AR group, which received real-time guidance during drilling on 3D-printed temporal bone models, or to the control group, which received traditional training methods. Skills were assessed on a modified Welling scale and evaluated independently by two senior otologists. RESULTS: The AR group outperformed the control group, with a mean overall drilling score of 19.5 out of 25, compared with the control group's score of 12 (p < 0.01). The AR group was significantly better at defining mastoidectomy margins (p < 0.01), exposing the antrum, preserving the lateral semicircular canal (p < 0.05), sharpening the sinodural angle (p < 0.01), exposing the tegmen and attic, preserving the ossicles (p < 0.01), and thinning and preserving the external auditory canal (p < 0.05). CONCLUSION: AR simulation in mastoidectomy, even in a single session, improved the proficiency of novice surgeons compared with traditional methods. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Could virtual reality be a solution in surgical trainings in resource-restricted settings? A perspective.

Surgical conditions account for 11 % of the global burden of disease, with over 313 million surgical procedures performed worldwide each year. This underscores the critical need to train more surgeons, particularly in low- and middle-income countries (LMICs), where disparities in access to surgical services persist due to a limited number of trained professionals. However, in resource-restricted settings, surgical education is often hampered by ethical, logistical, and financial challenges associated with the use of cadavers, leading to significant skill gaps that can negatively impact patient outcomes and exacerbate healthcare disparities. The advent of advanced technologies, such as Virtual Reality (VR), offers a promising alternative for enhancing surgical training. This paper explores the potential of VR to revolutionize surgical education in resource-constrained environments and addresses key considerations for its effective implementation.

Adult obstetricians and gynecologists lack knowledge of anorectal malformations - a call for action: Gynecologists lack knowledge of anorectal malformations.

OBJECTIVE: Patients with anorectal malformations (ARMs) may have concurrent gynecologic abnormalities. As patients grow, they typically transition from pediatric subspeciality care and seek adult OB/GYN related services. We aimed to assess adult OB/GYN physicians' knowledge, competency, and comfort meeting the sexual and reproductive health care needs of patients with ARM. METHODS: We performed a cross-sectional observational survey-based study of graduates from a single academic OB/GYN residency program from 2013-2022. Physicians were surveyed on experience, comfort, and challenges caring for patients with ARMs and given a knowledge assessment. Descriptive and comparative statistics between those who did and did not complete a pediatric and adolescent gynecology (PAG) rotation were generated. RESULTS: There were 59 respondents (53.6%). Fewer than half (39.0%) report caring for a patient with ARM, an appendicovesicostomy (12.3%) or an appendicostomy (5.4%). Most felt uncomfortable (80.4%) or felt they lacked competence caring for these patients (81.8%). The majority (64.3%) felt ARMs should be discussed in residency. Only one physician (1.7%) answered all questions in the knowledge assessment correctly; 33.9% did not answer any question correctly. On subgroup analysis, more physicians completing a PAG rotation recalled learning about ARMs (83.3 vs 51.9%, p=0.03); however, there were no differences in experience, comfort, competence, or willingness to learn. CONCLUSION: OB/GYN providers report lack of knowledge and comfort in caring for patients with ARMs. Development of a standardized OB/GYN residency curriculum and education for practicing OB/GYN physicians is necessary to allow access to knowledgeable sexual and reproductive health for this patient population.

Determining the learning curve of minimally invasive antireflux surgery: systematic review, meta-analysis, and meta-regression.

The rapid uptake of minimally invasive antireflux surgery has led to interest in learning curves for this procedure. This study ascertains the learning curve in laparoscopic and robotic-assisted antireflux surgery. A systematic review of the literature pertaining to learning curves in minimally invasive fundoplication with or without hiatal hernia repair was performed using PubMed, Medline, Embase, Web of Science, and Cochrane Library databases. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase. Twenty-five studies met the eligibility criteria. A meta-regression analysis was performed to quantitatively investigate the trend of number of cases required to achieve surgical proficiency from 1996 to present day. Using a mixed-effects negative binomial regression model, the predicted learning curve for laparoscopic and robotic-assisted antireflux surgery was found to be 24.7 and 31.1 cases, respectively. The meta-analysis determined that surgeons in their learning phase may experience a moderately increased rate of conversion to open procedure (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.28, 4.64), as well as a slightly increased rate of intraoperative complications (OR 1.60; 95% CI 1.08, 2.38), postoperative complications (OR 1.98; 95% CI 1.36, 2.87), and needing reintervention (OR 1.64; 95% CI 1.16, 2.34). This study provides an insight into the expected caseload to be competent in performing antireflux surgery. The discrepancy between outcomes during and after the learning curve for antireflux surgery suggests a need for close proctorship for learning surgeons.

Unleashing surgical skills: Ultra-high fidelity trauma thoracotomy training on knowledge donor platform.

BACKGROUND: Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. METHODS: General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. RESULTS: Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 â€‹± â€‹1.7), followed by Live Patient only (4.3 â€‹± â€‹2.5), and KD only (2.6 â€‹± â€‹1.3). The mean confidence rating for residents with neither training opportunity was 1.4 â€‹± â€‹1.0. CONCLUSIONS: The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies.

Rural general surgical provision from the perspective of twenty-two rural general surgeons: a thematic analysis.

BACKGROUND: Australia continues to suffer from a geographical maldistribution of general surgical services with only 20% of general surgeons working rurally despite 29% of Australia's population residing outside major metropolitan centres. This qualitative study explored the impact of human capacity and infrastructure upon rural general surgery provision. METHODS: This qualitative study employed semi-structured interviews of rural general surgeons. Participants were recruited via the Royal Australasian College of Surgeons (RACS) Rural newsletter and purposive sampling. All interviews were conducted between January 2023 and April 2023. Transcripts were transcribed, de-identified, and thematically analysed. RESULTS: Two female and 20 male rural general surgeons were interviewed from seven of the eight Australian State or Territories. Four main themes were identified which reflected the impact of human capacity and infrastructure upon Australian rural general surgery provision: (1) small hospital syndrome - and the impact, (2) the rural general surgeon identity, (3) infrastructure and disempowerment and (4) over-reliance on visiting surgeons. CONCLUSION: Improving access to equitable general surgical care for rural Australians requires appropriate infrastructure and a well-trained, sustainable multidisciplinary surgical team (human capacity). A greater understanding of the issues may help drive rational, long-term supportive solutions.

Perspective or Spectacle? Teaching thoracic aortic anatomy in a mixed reality assisted educational approach- a two-armed randomized pilot study.

PURPOSE: Anatomical understanding is an important basis for medical teaching, especially in a surgical context. The interpretation of complex vascular structures via two-dimensional visualization can yet be difficult, particularly for students. The objective of this study was to investigate the feasibility of an MxR-assisted educational approach in vascular surgery undergraduate education, comparing an MxR-based teaching-intervention with CT-based material for learning and understanding the vascular morphology of the thoracic aorta. METHODS: In a prospective randomized controlled trial learning success and diagnostic skills following an MxR- vs. a CT-based intervention was investigated in 120 thoracic aortic visualizations. Secondary outcomes were motivation, system-usability as well as workload/satisfaction. Motivational factors and training-experience were also assessed. Twelve students (7 females; mean age: 23 years) were randomized into two groups undergoing educational intervention with MxR or CT. RESULTS: Evaluation of learning success showed a mean improvement of 1.17 points (max.score: 10; 95%CI: 0.36-1.97). The MxR-group has improved by a mean of 1.33 [95% CI: 0.16-2.51], against 1.0 points [95% CI: -0.71- 2.71] in the CT-group. Regarding diagnostic skills, both groups performed equally (CT-group: 58.25 ± 7.86 vs. MxR-group:58.5 ± 6.60; max. score 92.0). 11/12 participants were convinced that MxR facilitated learning of vascular morphologies. The usability of the MxR-system was rated positively, and the perceived workload was low. CONCLUSION: MxR-systems can be a valuable addition to vascular surgery education. Further evaluation of the technology in larger teaching situations are required. Especially regarding the acquisition of practical skills, the use of MxR-systems offers interesting application possibilities in surgical education.

Impact of Holistic Application Scoring on Interview Offers.

OBJECTIVE: We aimed to develop a holistic screening tool for surgical residency application processing to capture the diverse skills and attributes of the applicant, based on characteristics most commonly associated with success in our residency program. DESIGN: We developed an application-scoring rubric with 4 domains based on ACGME Holistic reviewing criteria: academic potential, experiences, personal attributes, and clinical competency. We scored academic potential based on a composite of Step 2 score, MSPE tier rank, surgery clerkship grade, college honors, publications, and presentations. An additional score accounted for personal adversity overcome or "distance travelled". This included previous homelessness, first-generation college student or immigrant status, noted socioeconomic hardship, disability overcome, or other stated personal experience of discrimination including underrepresented in medicine status. We sorted the list of top 200 candidates by adversity score, Step 2 score, academic potential score, and total overall score to compare the groups in terms of interview offers. SETTING: We are an academic surgical residency program housed within a private medical college in the Northeast region. PARTICIPANTS: All categorical applicants to our program were managed with our holistic screening approach. RESULTS: There were 29 students with the highest adversity score (AS) of 4 and 26 (90%) were selected to interview based on holistic overall score and reviewer comments. Fourteen students had an AS of 3, and 12 (86%) were selected to interview. Twenty-five students had an AS of 2, and 23 (92%) were selected to interview. If Step 2 score alone had been used to determine which applicants should be interviewed, only 11 students (38%) with an AS of 4 would have been interviewed. If the academic potential alone was used for screening, only 10 (35%) of students with an AS of 4 would have been interviewed. Taking all students with any adversity score into account (n = 70), when screened with only Step 2 scores, just 31(44%) would have been interviewed. When ranked by academic potential score, 35 (50%) would have been interviewed. When applying our holistic overall score alone, 56 (80%) would have been interviewed. CONCLUSIONS: Performing a holistic application review and ranking students not only by standardized exam scores, but also considering other history of academic achievement, personal attributes, experiences in leadership or service, and clinical competency can allow for mitigation of implicit bias. Allowance for an adversity score can help programs recognize students who have significantly longer "distance traveled" to make it through medical education and who have the potential to be fantastic residents.

How I Do It: Process Control in Medical Student Experiences of Surgery.

OBJECTIVE: Extreme variation exists in teaching and clinical exposure for medical students, both from specialty-to-specialty but also between universities. There is mounting literature highlighting the need to reform and standardize surgical education to allow for unified graduate competency. In line with the recommendations from the GMC and the Royal College of Surgeons England (RCSEng), Queens University Belfast (QUB) significantly revised their undergraduate medical programme. Within this new curriculum is the introduction of Specialty Focus week in Surgery. This report reviews the processes used in the introduction of this week. DESIGN: The initial week was formulated with a weekly timetable consisting of tutorials, bedside teaching and students following a peri-operative case. Run charts were populated with an alert when feedback dropped below a certain standard, which then triggered an intervention. PARTICIPANTS: Feedback was collected via a QR code from the first 200 surgical student. SETTINGS: Belfast City Hospital in association with QUB undergraduate curriculum. RESULTS: Run charts resulted in an alert when feedback dropped below 8/10. Following this we implemented smaller group bedside teaching. There was a significant improvement in feedback post intervention (p = 0.04) with no further alerts. Overall feedback had a nonsignificant feedback improvement post intervention (p = 0.07) with once again, no further alerts. CONCLUSION: This review has shown how we have provided some standardization of local surgical teaching, as well as having a process centered model of monitoring. This approach is easy to implement and could be reproduced elsewhere.

Serious Illness Communication Training for Surgical Critical Care Fellows: A Pilot Implementation Study.

OBJECTIVE: Effective communication about serious illness is pivotal in delivering surgical palliative care-a crucial component of comprehensive surgical critical care (SCC). However, limited educational strategies exist for fellow-level trainees, who are often directing clinical decision-making and building mutual trust with patients and families. This pilot study assess implications of a novel serious illness communication training opportunity tailored specifically for SCC fellows. DESIGN: Prospective implementation of a multimodal training session (1 hour-didactic lecture, 2 hours-live-action simulation), using pre- and postcourse surveys to assess self-perceived confidence. SETTING: University of Michigan in Ann Arbor, Michigan. PARTICIPANTS: Eleven ACGME-accredited SCC fellows during the 2023 to 2024 academic year participated and completed all 3 survey assessments. RESULTS: Following the course, 6 of 7 confidence domains showed improvement, with 2 reaching statistical significance-communication skills to discuss goals of care and/or code status (3.73 vs. 4.36, p = 0.018) and end-of-life care or transition to comfort-focused care (3.36 vs. 4.18, p = 0.023) with a patient or family member. At 6-month follow up, fellows reported further increases in all queried domains, though changes were nonsignificant. Greatest absolute increases were noted in delivering serious news (4.18 vs. 4.55, p = 0.143) and expressing nonverbal empathy (4.09 vs. 4.50, p = 0.197). The majority (91%) of respondents felt more comfortable having serious illness conversations with patients and families due to their training course experience. CONCLUSION: Implementation of a 3-hour training course tailored for SCC fellows significantly boosted both the immediate and long-term confidence in their serious illness communication skills and ability to manage complex care scenarios.

Perspectives of Surgical Research Residents on Improving Their Reentry Into Clinical Training.

OBJECTIVE: Concerns exist about clinical and operative skill decay in surgery residents when they dedicate time away from clinical training to pursue research. However, it remains undetermined how to best prevent these negative impacts. Our study evaluated the perspectives of surgical research residents on interventions to improve their reentry into clinical training. DESIGN, SETTING, AND PARTICIPANTS: An anonymous web-based survey was distributed between 5/01/2023 and 6/01/2023 to 102 current and former (within the previous 3 years) general surgery research residents from 4 academic medical centers in Boston, MA. RESULTS: Survey response rate was 35.3% (36/102 residents). About 22 of 36 residents (61.1%) felt that their clinical aptitude decreased during the research years, whereas 33 of 36 (91.7%) reported reduced surgical skills. When reflecting on their re-entry to residency, former research residents reported feeling anxious and less confident (3.84/5 on a 1-5 Likert scale) as well as being below the expected level of clinical performance (3.42/5). Most of them (12 of 17; 70.6%) reported that it took up to 6 months, whereas 5 of them (29.4%) up to 12 months to feel at the expected level. When compared to nonmoonlighting residents, those who moonlighted often and operated during moonlighting, denied a decrease in clinical and surgical skills, and reported less anxiety, higher confidence, and a quicker return to the expected level of performance. Interventions proposed for improving their clinical re-entry included individualized development plans for 3 months before returning to clinical training, established curriculum for clinical work throughout the research years, clinical preceptorships throughout the research years, and simulation curriculum throughout the research years. CONCLUSIONS: General surgery residents feel that their clinical and surgical skills decreased during the research years, leading to anxiety and lack of confidence when returning to residency. Therefore, comprehensive interventions are needed to improve the reentry of the research residents into clinical training.