Can the Surgery-to-Resident Ratio be Used to Determine the Ideal Number of Residents in a General Surgery Training Clinic? Single Center Experience.

OBJECTIVE: General surgery is a fundamental medical discipline that requires extensive training to develop competent surgeons. This study examines the impact of the number of residents on surgical training quality in a general surgery clinic and evaluates the usability of the Surgery-to-Resident Ratio (SRR) in determining the ideal number of residents. DESIGN: Retrospective analysis. SETTING: General Surgery Department, Gazi University Faculty of Medicine Hospital, Ankara, Turkey. PARTICIPANTS: Data from surgical residents at the General Surgery Department, collected from 2012 to 2023. METHODS: The study analyzed the number of surgeries performed and the total number of residents in 3-month periods. The Surgery-Resident Ratio (SRR) was calculated by dividing the total number of surgical procedures by the total number of residents. The educational impact of the SRR was assessed to identify the optimal number of residents. RESULTS: In the 48 periods analyzed, the number of residents in our clinic varied between 12 and 26, with an average of 18.69. An increase in the number of residents led to a decrease in the total number of surgical cases per resident, particularly during the COVID-19 pandemic, which caused a significant drop in elective surgeries. Excluding the COVID-19 periods, the SRR decreased significantly with more than 19 residents, suggesting that the ideal number of residents is 18 to maintain training quality. DISCUSSION: The study indicates that an optimal number of residents is essential for ensuring adequate case exposure and workload distribution, which are crucial for developing surgical competence. The SRR can serve as a useful guide for clinics in determining the ideal number of residents to maintain high training standards. Our findings suggest that while the number 18 is specific to our clinic, the SRR method can be adapted to other settings to ensure effective surgical education. CONCLUSION: The SRR method provides a systematic approach to determining the optimal number of residents in a surgical training program. Ensuring an adequate number of surgeries per resident is vital for their educational development and proficiency in surgical techniques.

Preserving Essential Skills: The Future of Vaginal Hysterectomy Training in Urogynaecology.

OBJECTIVES: This study aimed to evaluate the training and self-assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision-making, the surgical techniques employed, the training received, and the management of complications. DESIGN: A cross-sectional survey. SETTING: An electronic questionnaire. POPULATION: European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members. METHODS: A total of 33 questions evaluating surgeon preference regarding vaginal surgeries. MAIN OUTCOME MEASURES: Demographics, surgical selection, proficiency and technique, and training methods. RESULTS: There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two-thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10-30 cases were needed to achieve and maintain proficiency. CONCLUSION: Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine-sparing prolapse repairs, the decision-making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques.

Who Is Treating Periprosthetic Femur Fractures? An Analysis of the Periprosthetic Research Consortium.

Background: Periprosthetic femur fractures (PPFFs) following total hip arthroplasty (THA) have increased in the past decade as the demand for primary surgery continues to grow. Although there is now more evidence to describe the treatment of Vancouver B fractures, there is still limited knowledge regarding factors that cause surgeons to perform either an open reduction and internal fixation (ORIF) or revision THA (rTHA). The purpose of this study was to determine what type of surgeons treat Vancouver B PPFFs at 11 major academic institutions and if there are trends in treatment decision-making regarding the use of ORIF or rTHA based on surgical training or patient factors. Methods: This multicenter retrospective study evaluated patients surgically treated for Vancouver B PPFF after THA between 2014 and 2019. Patients from 11 academic centers located in the United States were included in this study. Surgical outcomes and patient demographics were evaluated based on surgeon training, surgical treatment type, and institution. Results: Presence of Vancouver B2 (odds ratio [OR]: 0.02, P < .001) or B3 (OR: 0.04, P < .001) fractures were independent risk factors for treatment with rTHA. Treatment by a trauma (OR: 12.49, P < .001) or other-specified surgeon (OR: 13.63, P < .001) were independent risk factors for ORIF repair of Vancouver B fractures. There were no differences in outcomes based on surgeon subspecialty training. Conclusions: This study showed the trends in surgeons who surgically manage Vancouver B fractures at 11 major academic institutions and highlighted that regardless of surgical training or surgical treatment type, postoperative outcomes following management of PPFF were similar.

Breast Modular Resection (BMR) in Nipple-Sparing Mastectomy (NSM) With Intraoperative Laser Speckle Contrast Imaging (LSCI) Monitoring Improved Surgical Training Outcome Among Fellows.

BACKGROUND: Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR). METHODS: The records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared. RESULTS: Surgical training outcomes of BMR group (N = 52) were insignificantly improved compared to CPR group (N = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (P = .011) and surgery time (P < .001) was significantly reduced in BMR group (N = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (P < .001). The absolute PU values were significantly higher in BMR group (P = .002). CONCLUSION: Compared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.

European Quality Markers in Oral and Maxillofacial Surgery Specialty Training: Defining Standards.

According to the European Union (EU) Directive 2005/36, the medical specialty of oral and maxillofacial surgery (OMFS) exists with two possible formats: dual degree OMFS called Dental, Oral and Maxillofacial Surgery (DOMFS) - basic medical and basic dental training and single medical degree Maxillofacial Surgery (MFS). Within the EU and across all of Europe, differences in the nature and quality of OMFS training coexist. By implementing the highest possible standards of training, patient care can be improved. To establish quality metrics for an ideal OMFS training programme, the European OMFS Trainee Forum of the Union Européenne des Médecins Spécialistes (UEMS) conducted a Delphi consensus protocol from November 2023 to January 2024. Facilitated by the OMFS Section of UEMS, 56 trainees from 32 countries participated. The process involved the definition of three quality levels using the red, amber, and green (RAG) rating system. Following the Delphi process, 46 domains were identified, including features within training programmes/rotations, teaching and education programmes, training placements, recording of training progression and activity, and external assessment of training programmes. The results were aligned with the UEMS OMFS European Training Requirement (ETR). With the introduction of a RAG rating, trainees and trainers can review their training programmes with the aim of improving them by moving domains from Red to Green. Raising the standard of training will benefit our patients. This initiative could mark a significant step towards the harmonisation of OMFS training, improving quality and ensuring consistent, high-level care throughout Europe.

Robotic donor hepatectomy for living donor liver transplantation.

Robotic donor hepatectomy introduces a new era in living donor liver transplantation (LDLT), combining advancements in minimally invasive surgery with superior precision and ergonomics. The beginning of LDLT in 1989 aimed to address the scarcity of deceased donor livers, a situation intensified by the technical and ethical challenges associated with this procedure. The integration of robotic systems since 2010s has broadened the scope and impact of liver transplantation, enhancing outcomes significantly for both donors and recipients. This review discusses the significant advancements in robotic surgery, the ongoing challenges such as cost and training needs, and the future toward global standardization and the integration of artificial intelligence. As this technology continues to evolve, it holds the potential to become the new global standard, ensuring safer procedures and enhanced outcomes for patients worldwide.

Evaluating the Validity of National Multiassessment System in Postgraduate Surgical Training: A Retrospective Cohort Study.

OBJECTIVE: The objective of this study was to evaluate the validity evidence supporting the use and interpretation of a multifaceted assessment system in the early years of surgical training. DESIGN: This was a national retrospective cohort study analyzing the validity and reliability of an assessment process for surgical residents over a 2-year period. Data from all elements of the assessment process was evaluated using Messick's unified validity framework. Assessments were categorized as Workplace-based, Structured assessment performed in the academic center and Multiple Mini Interview. SETTING: Our Institution is a health sciences university and the body responsible for the training and certification of all surgeons in our national program. Residents on the Core Surgical Training program undergo multiple assessments over the first 2 years of postgraduate training, both in the workplace and the academic training center, which inform their progression into higher surgical training in their chosen specialty. PARTICIPANTS: Data was collected from 2 cohorts of the entire population of postgraduate trainees nationally (N = 114). RESULTS: Best practice standards for educational testing aligned with the results supporting the use of this assessment process. Findings indicate a robust assessment system, demonstrating validity evidence in content, response process, internal structure, relations to other variables, and consequences. Composite score reliability of the assessment was 0.89 which demonstrates a highly reliable process. Correlation between workplace-based assessments and standardized tests performed in the simulation setting was also very high (0.93). CONCLUSIONS: The Core Training Assessment System (CTAS) provides a psychometrically rigorous system to measure trainee competence during the initial years of training. Residency programs of all sizes can replicate the methods described here to demonstrate the validity of their assessment processes, thereby being able to stand over decisions on surgical competency.

An Analysis of 1000 Patients With the "Big 5" Orthopaedic Surgery Procedures and the Impact of Residents on Outcome.

BACKGROUND: The study is intended to show that the operative quality of a resident in orthopedic trauma surgery is comparable to that of a senior physician in the most common orthopaedic trauma surgeries (Plate osteosynthesis in ankle fractures and distal radius fractures, ESIN in pediatric forearm fractures, implantation of a proximal femoral nail in pertrochanteric femur fractures and hemiarthroplasty in femoral neck fractures) with appropriate supervision by a senior physician. With only minimal deviations in the operating time, which is becoming increasingly relevant in everyday clinical practice, surgical training of residents could be supported. MATERIAL AND METHODS: 200 patients of the above-mentioned fracture patterns each, who were treated surgically between January 1, 2016 and December 31, 2020, were detected and categorized. In particular, a qualitative characteristic was determined for each fracture on the basis of the standard pre and postoperative X-rays taken during surgery and statistically evaluated with the surgery time, the fracture classification and the training status of the anonymized surgeon. Anonymized x-rays were evaluated by 2 senior physicians and 2 residents. RESULTS: Operations were performed by residents in 33.5 % of the cases (ankle fractures 42.0%; distal radius fractures 30.5%; pediatric forearm fractures 30.5%; pertrochanteric femur fractures 50.5%; femoral neck fractures 14.0%). Surgical complication rate was 4.8% in the resident group and 9.0% in the attending surgeon group. Revision surgeries were performed in 2.1% of resident cases, and in 4.1% of attending surgeon cases. In the resident group, time of surgery was 7.4 min longer for ankle fractures, 4.4 min for distal radius fractures, 2.8 min for forearm fractures, 2.3 min longer in proximal femur fractures 8.2 min longer for femoral neck fractures. No statistically significant difference in radiological outcome was observed in any of the groups after evaluation of the x-rays. CONCLUSION: This study shows that only slightly more than one third of all mentioned operations are performed by residents, although there is no statistical difference in quality. The operating time is extended on average by only 5 minutes. The surgical complication rate as well as the revision rate is higher in the group of senior physicians, whereby the more complicated fractures were treated by them. Resident involvement in trauma surgery is therefore not associated with increased morbidity or mortality of patients.

Modified colored three-dimensional posterior and temporal cranial fossa model with mobility of the joint between C1 and occipital condyle.

BACKGROUND: Skull base surgery requires anatomical knowledge and appropriate surgical technique in bone drilling. We developed a newly modified three-dimensional (3D) model of the posterior cranial fossa as a learning tool that improves knowledge of skull base anatomy and surgical approaches, including skull base drilling techniques. METHODS: This bone model of the posterior cranial fossa was created based on computed tomography data using a 3D printer, and incorporates artificial cranial nerves, cerebral vessels, bony structures, dura mater, and cerebellar tentorial dura. These anatomical components are differentiated with various colors. In addition, the atlanto-occipital junction can be mobilized to fully expose the surface of the cartilage between the C1 condyle and occipital condyle to allow drilling to open the hypoglossal canal under a wide surgical field. The usefulness of the model for practicing skull base surgical approaches was evaluated. RESULTS: Experience of bone drilling, dural dissection, and 3D positioning of important structures, including cranial nerves and blood vessels, was identical to that in actual surgery. CONCLUSIONS: This model is designed to facilitate teaching anatomical knowledge and essential epidural procedure-related skills, and is useful for teaching the essential elements of posterior skull base surgery.

Neuromechanisms of simulation-based arthroscopic skills assessment: a fNIRS study.

BACKGROUND: The neural mechanisms underlying differences in the performance of simulated arthroscopic skills across various skill levels remain unclear. Our primary objective is to investigate the learning mechanisms of simulated arthroscopic skills using functional near-infrared spectroscopy (fNIRS). METHODS: We recruited 27 participants, divided into three groups: novices (n = 9), intermediates (n = 9), and experts (n = 9). Participants completed seven arthroscopic tasks on a simulator, including diagnostic navigation, triangulation, grasping stars, diagnostic exploration, meniscectomy, synovial membrane cleaning, and loose body removal. All tasks were videotaped and assessed via the simulator system and the Arthroscopic Surgical Skill Evaluation Tool (ASSET), while cortical activation data were collected using fNIRS. Simulator scores and ASSET scores were analyzed to identify different level of performance of all participants. Brain region activation and functional connectivity (FC) of different types of participants were analyzed from fNIRS data. RESULTS: Both the expert and intermediate groups scored significantly higher than the novice group (p < 0.001). There were significant differences in ASSET scores between experts and intermediates, experts and novices, and intermediates and novices (p = 0.0047, p < 0.0001, p < 0.0001), with the trend being experts > intermediates > novices. The intermediate group exhibited significantly greater activation in the left primary motor cortex (LPMC) and left prefrontal cortex (LPFC) compared to the novice group (p = 0.0152, p = 0.0021). Compared to experts, the intermediate group demonstrated significantly increased FC between the presupplementary motor area (preSMA) and the right prefrontal cortex (RPFC; p < 0.001). Additionally, the intermediate group showed significantly increased FC between the preSMA and LPFC, RPFC and LPFC, and LPMC and LPFC compared to novices (p = 0.0077, p = 0.0285, p = 0.0446). CONCLUSION: Cortical activation and functional connectivity reveal varying levels of activation intensity in the PFC, PMC, and preSMA among novices, intermediates, and experts. The intermediate group exhibited the highest activation intensity.

Application of transformer architectures in generative video modeling for neurosurgical education.

PURPOSE: This article explores the potential impact of OpenAI's Sora, a generative video modeling technology, on neurosurgical training. It evaluates how such technology could revolutionize the field by providing realistic surgical simulations, thereby enhancing the learning experience and proficiency in complex procedures for neurosurgical trainees. METHODS: The study examines the incorporation of this technology into neurosurgical education by leveraging transformer architecture and processing of video and image data. It involves compiling a neurosurgical procedure dataset for model training, aiming to create accurate, high-fidelity simulations. RESULTS: Our findings indicate significant potential applications in neurosurgical training, including immersive simulations for skill development and exposure to diverse surgical scenarios. The technology also promises to transform assessment and feedback, introducing a standardized, objective way to measure and improve trainee competencies. CONCLUSION: Integrating generative video modeling technology into neurosurgical education marks a progressive step toward enhancing training methodologies. Despite challenges in technical, ethical, and practical domains, continuous development and evaluation could lead to substantial advancements in surgical education, preparing neurosurgeons more effectively for their demanding roles.

Blood Harmonisation of Endoscopic Transsphenoidal Surgical Video Frames on Phantom Models.

Physical phantom models have been integral to surgical training, yet they lack realism and are unable to replicate the presence of blood resulting from surgical actions. Existing domain transfer methods aim to enhance realism, but none facilitate blood simulation. This study investigates the overlay of blood on images acquired during endoscopic transsphenoidal pituitary surgery on phantom models. The process involves employing manual techniques using the GIMP image manipulation application and automated methods using pythons Blend Modes module. We then approach this as an image harmonisation task to assess its practicality and feasibility. Our evaluation uses Structural Similarity Index Measure and Laplacian metrics. The results we obtained emphasize the significance of image harmonisation, offering substantial insights within the surgical field. Our work is a step towards investigating data-driven models that can simulate blood for increased realism during surgical training on phantom models.

Development and assessment of case-specific physical and augmented reality simulators for intracranial aneurysm clipping.

BACKGROUND: Microsurgical clipping is a delicate neurosurgical procedure used to treat complex Unruptured Intracranial Aneurysms (UIAs) whose outcome is dependent on surgeon's experience. Simulations are emerging as excellent complements to standard training, but their adoption is limited by the realism they provide. The aim of this study was to develop and validate a microsurgical clipping simulator platform. METHODS: Physical and holographic simulators of UIA clipping have been developed. The physical phantom consisted of a 3D printed hard skull and five (n = 5) rapidly interchangeable, perfused and fluorescence compatible 3D printed aneurysm silicone phantoms. The holographic clipping simulation included a real-time finite-element-model of the aneurysm sac, allowing interaction with a virtual clip and its occlusion. Validity, usability, usefulness and applications of the simulators have been assessed through clinical scores for aneurysm occlusion and a questionnaire study involving 14 neurosurgical residents (R) and specialists (S) for both the physical (p) and holographic (h) simulators by scores going from 1 (very poor) to 5 (excellent). RESULTS: The physical simulator allowed to replicate successfully and accurately the patient-specific anatomy. UIA phantoms were manufactured with an average dimensional deviation from design of 0.096 mm and a dome thickness of 0.41 ± 0.11 mm. The holographic simulation executed at 25-50 fps allowing to gain unique insights on the anatomy and testing of the application of several clips without manufacturing costs. Aneurysm closure in the physical model evaluated by fluorescence simulation and post-operative CT revealed Raymond 1 (full) occlusion respectively in 68.89% and 73.33% of the cases. For both the simulators content validity, construct validity, usability and usefulness have been observed, with the highest scores observed in clip selection usefulness Rp=4.78, Sp=5.00 and Rh=4.00, Sh=5.00 for the printed and holographic simulators. CONCLUSIONS: Both the physical and the holographic simulators were validated and resulted usable and useful in selecting valid clips and discarding unsuitable ones. Thus, they represent ideal platforms for realistic patient-specific simulation-based training of neurosurgical residents and hold the potential for further applications in preoperative planning.

The current application of 3D printing simulator in surgical training.

In the rapidly evolving field of medical education, the integration of innovative technologies has become paramount to enhance the training and proficiency of future surgeons. Among these advancements, the application of 3D printing technology stands out as a useful tool in surgical training. The advantages of the 3D printing model include customization, re-usability and low-cost. The average cost of the 3D printing simulators was between $100-1000. However, there were extremely high potential labor cost during the 3D printing that hadn't been calculated into. Additionally, in the current stage, the 3D printing simulator still have specific limitations. The most mentioned limitation was poor haptic feedback of the simulators, which was very important during the surgical training, since it is the key element for junior doctors to master practical procedures. Also, some simulators didn't possess the integrated and elaborate structure as the human tissue, hence not the whole surgical procedures can be practiced by the trainees, and further improvement should be made. Although there are shortages, many studies have proved that 3D printing simulator can effectively reduce learning curves and is useful to enhance the trainees' surgical skills.

Usability, Ergonomics, and Educational Value of a Novel Telestration Tool for Surgical Coaching: Usability Study.

BACKGROUND: Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. OBJECTIVE: This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. METHODS: A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. RESULTS: In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90% and neutral 0, 0%), video feed navigation (SA/A 8, 80% and neutral 1, 10%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60% and neutral 3, 30%). Regarding ergonomics, 40% (4) of participants agreed or strongly agreed (neutral 4, 40%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device's size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device's perceived educational value, particularly for postoperative coaching (agree 6, 60%, strongly agree 4, 40%). CONCLUSIONS: This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training.

An Integrated Electroencephalography and Eye-Tracking Analysis Using eXtreme Gradient Boosting for Mental Workload Evaluation in Surgery.

OBJECTIVE: We aimed to develop advanced machine learning models using electroencephalogram (EEG) and eye-tracking data to predict the mental workload associated with engaging in various surgical tasks. BACKGROUND: Traditional methods of evaluating mental workload often involve self-report scales, which are subject to individual biases. Due to the multidimensional nature of mental workload, there is a pressing need to identify factors that contribute to mental workload across different surgical tasks. METHOD: EEG and eye-tracking data from 26 participants performing Matchboard and Ring Walk tasks from the da Vinci simulator and the pattern cut and suturing tasks from the Fundamentals of Laparoscopic Surgery (FLS) program were used to develop an eXtreme Gradient Boosting (XGBoost) model for mental workload evaluation. RESULTS: The developed XGBoost models demonstrated strong predictive performance with R2 values of 0.82, 0.81, 0.82, and 0.83 for the Matchboard, Ring Walk, pattern cut, and suturing tasks, respectively. Key features for predicting mental workload included task average pupil diameter, complexity level, average functional connectivity strength at the temporal lobe, and the total trajectory length of the nondominant eye's pupil. Integrating features from both EEG and eye-tracking data significantly enhanced the performance of mental workload evaluation models, as evidenced by repeated-measures t-tests yielding p-values less than 0.05. However, this enhancement was not observed in the Pattern Cut task (repeated-measures t-tests; p > 0.05). CONCLUSION: The findings underscore the potential for machine learning and multidimensional feature integration to predict mental workload and thereby improve task design and surgical training. APPLICATION: The advanced mental workload prediction models could serve as instrumental tools to enhance our understanding of surgeons' cognitive demands and significantly improve the effectiveness of surgical training programs.

Current status, challenges, and future directions of laparoscopic training in young surgeons: a nationwide survey in China.

BACKGROUND: With the rapid advancement of technology, minimally invasive surgery, particularly laparoscopic surgery, has made significant progress in the field of surgery. Despite the advantages of laparoscopic surgery, a systematic training system for laparoscopic procedures is lacking in Chinese postgraduate medical education. Our study aims to explore the prevalence of laparoscopic training among resident and attending physicians in China and to assess the current state of training programs. METHODS: A 10-item questionnaire was distributed to 1,750 resident and attending physicians specializing in surgery across China, with 1,324 valid responses (75.7% response rate). The survey focused on demographics, training curriculum content, and feedback on training effectiveness. Data analysis was conducted using Microsoft Excel and IBM SPSS. RESULTS: Among the 1,324 respondents, 30.7% reported receiving laparoscopic training, primarily at the attending physician stage. Only 4% of resident physicians and 14% of attending physicians could independently perform complex laparoscopic surgeries. Most respondents (76.6%) could only assist in surgeries. The majority expressed a desire for more frequent and longer training sessions, with suture training being identified as the most beneficial. CONCLUSIONS: This study underscores the critical need for comprehensive laparoscopic training in China. Early, frequent, and structured training programs are essential for developing proficient laparoscopic surgeons. Future initiatives should focus on expanding access to training at all levels of medical education, ensuring continuous skill development and improved surgical care quality.

"A clean slate": Insights for improving remediation from the perspectives of underperforming surgical trainees.

BACKGROUND: Remediation frameworks have centered around perspectives of educators. The aim of this study is to explore the insights proposed by surgical trainees to improve remediation processes. METHODS: This qualitative study used semi-structured interviews with 11 doctors who have experienced formal remediation as a surgical trainee. We used reflexive thematic analysis on transcribed interviews. RESULTS: Trainees recommended creating environments that safeguarded their well-being. Examples include trainee-led peer support groups and external mentors. Feedback conversations and remediation plans were flagged as needing improvement. Opportunities for forward planning for successful remediation were suggested including learning plans, program evaluation and aligning training program structure with expectations. CONCLUSIONS: These findings about trainees' insights on improving remediation highlighted the need for further emotional support for trainees. Supervisors need further support with feedback conversations and remediation plans. Actively seeking out trainee perspectives and integrating their recommendations when designing remediation processes should improve outcomes.

Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery?

Objective: To correlate the utility of the Fundamentals of Laparoscopic Surgery (FLS) manual skills program with the Objective Structured Assessment of Technical Skills (OSATS) global rating scale in evaluating operative performance. Methods: The Asian Urological Surgery Training and Educational Group (AUSTEG) Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training. Delegates' basic laparoscopic skills were assessed using three different training models (peg transfer, precision cutting, and intra-corporeal suturing). They also performed live porcine laparoscopic surgery at the same workshop. Live surgery skills were assessed by blinded faculty using the OSATS rating scale. Results: From March 2016 to March 2019, a total of 81 certified urologists participated in the course, with a median of 5 years of post-residency experience. Although differences in task time did not reach statistical significance, those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks. However, they took longer to complete the precision cutting task than participants with less experience. Overall OSATS scores correlated weakly with all three FLS tasks (peg transfer time: r=-0.331, r 2=0.110; precision cutting time: r=-0.240, r 2=0.058; suturing with intra-corporeal knot time: r=-0.451, r 2=0.203). Conclusion: FLS task parameters did not correlate strongly with OSATS globing rating scale performance. Although FLS task models demonstrated strong validity, it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence, as evaluated by FLS and OSATS, respectively.

Surgical training; destination unknown?

Background A surgical fellowship allows both additional training as well as maintenance of surgical skills while searching for a steady job. As the presence of fellows usually does not results in a measurably higher productivity, fellowshipsmay be considered a form of disguised unemployment. The aim of this study is to evaluate the career flow of a surgical trainee to a staff position and to determine the number of surgeons working on temporary basis within the general surgery workforce in Flanders.Methods All surgeons graduated in Flanders between 2000 and 2022 were invited to fill out a web-based survey concerning their current and past employment. Reminders were sent out after 2 and 4 weeks. Statistical analysis was performed with SPSS version 27.0 (IBM Inc., Chicago, IL, USA.)Results Response rate was 64% (292/457) with 76% of respondents currently working as surgeons, 14% (38) as fellows and 10% working outside the surgical domain. Eighty-two percent of current fellows graduated in 2019 or later. Thirty-one percent of surgeons graduated in 2019 are still working as fellows. For surgeons graduated in 2020, 2021 and 2022 this is 45%, 80% and 90% respectively. Compared to staff surgeons the number of additional training years (2,8 ± 1,0 vs 2,2 ± 1,3; p = 0,009). and the number of applications (6,6 ± 5 vs 3,3 ± 3; p < 0,001) is significantly higher for current fellowsConclusion This study shows that disguised unemployment is present in the general surgical community in Flanders. The status of "fellow" should be incorporated in calculations concerning future needs of the surgical workforce in order to prevent open unemployment.