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BACKGROUND Racial inequities are infused within American society and healthcare systems; notable events in 2020 highlighted an urgent need for change. Many organizations were inspired to examine the impacts of systemic racism. The impact of physician bias on patient experiences and outcomes has been well documented; biased patient behavior is now becoming more openly discussed. In response to the current climate and painful effects of discrimination on healthcare and providers, we aimed to provide training for our surgical residents to more comfortably respond to bias in the workplace. METHODS We designed and piloted a simulation-based communication module focused on managing bias with medical students. We incorporated feedback received from students, facilitators, faculty, and simulated patients (SPs) to create an anti-bias workshop for surgical residents. Additionally, we worked with the pediatric and emergency departments to develop training videos depicting bias incidents, standardize debriefing processes, and implement anti-bias workshops for their residencies. RESULTS Twenty students participated in the medical student pilot session. Student confidence increased in target skills; many noted this was their first exposure to the topic in a medical school course, and first opportunity to practice these skills. Sixteen surgical residents participated in an in-person module; learners self-identifying as “completely confident” increased in number significantly for “determining whether to respond” (p = 0.023), “knowing how to ensure follow up” (p = 0.041), and “self-care following an event” (p = 0.023). CONCLUSION Our low-cost, high-impact anti-bias module provided learners with tools and practice, suggesting that such an effort is feasible, affordable, and effective. Our interdepartmental trainings have inspired our institution to develop approved statements clinicians may use when responding to race-based discrimination; offering a uniform approach to race-based microaggression or abuse can create a shared mental model for all team members, especially for those vulnerable to biased comments.

OBJECTIVE The use of the da Vinci Robot has been fast growing in general surgery in the United States over the past decade. While the financial cost of robot-assisted procedures has been studied, there has been limited research on the educational cost of the robotic approach on general surgery trainees, and their surgical skills. DESIGN Analysis of anonymous educational survey responses collected from residents, in addition to case logs which were used as a retrospective review for the 5 years preceding the survey. SETTING One thousand bed, tertiary care hospital general surgery residency program. PARTICIPANTS Twenty-four enrolled general surgery residents in 2018. RESULTS There has been a rapid expansion in the use of robotics in general surgery. In 2017 the total number of general surgery cases using the da Vinci robot increased 6 fold over that in 2013 (23 cases in 2013, 136 in 2017), while both open and laparoscopic procedures have witnessed about a 33% drop in the case volume during those years. Almost all residents would prefer a residency program which offers the da Vinci robot for care and training (95%), however, 38% of general surgery residents reported that the presence of robotic-assisted surgery had a “detrimental” effect on their surgical training. Senior residents were more likely to report a “detrimental” effect (56% vs 27%). A third of the residents believe that robotic surgery is impeding their ability to learn open and laparoscopic surgical techniques, and only 25% denied a negative impact. Senior residents are more likely to report this negative impact (67% vs 13%). CONCLUSIONS Reforms in residency curricula need to be in place to accommodate the expansion of the use of the robotic platform in general surgery. A subjective survey of the residents suggests that robotic surgery can potentially impede the development of residents’ open and laparoscopic surgical skills.

To establish expert consensus regarding the domains and topics for senior surgery residents (PGY-4) to make critical decisions and assume senior-level responsibilities, and to develop the formative American College of Surgeons Senior Resident Readiness Assessment (ACS SRRA) Program.The American College of Surgeons (ACS) education leadership team conducted a focus group with surgical experts to identify the content for an assessment tool to evaluate senior residents' readiness for their increased levels of responsibility. After the focus group, national experts were recruited to develop consensus on the topics through three rounds of surveys using Delphi methodology. The Delphi participants rated topics using Likert-type scales and their comments were incorporated into subsequent rounds. Consensus was defined as ≥ 80% agreement with internal-consistency reliability (Cronbach's alpha) ≥ 0.8. In a stepwise fashion, topics that did not achieve consensus for inclusion were removed from subsequent survey rounds.The surveys were administered via an online questionnaire.Twelve program directors and assistant program directors made up the focus group. The 39 Delphi participants represented seven different surgical subspecialties and were from diverse practice settings. The median length of experience in general surgery resident education was 20 years (IQR 14.3-30.0) with 64% of the experts being either current or past general surgery residency program directors.The response rate was 100% and Cronbach's alpha was ≥ 0.9 for each round. The Delphi participants contributed a large number of comments. Of the 201 topics that were evaluated initially, 120 topics in 25 core clinical areas were included to create the final domains of ACS SRRA.National consensus on the domain of the ACS SRRA has been achieved via the modified Delphi method among expert surgeon educators. ACS SRRA will identify clinical topics and areas in which each senior resident needs improvement and provide data to residents and residency programs to develop individualized learning plans. This would help in preparing the senior residents to assume their responsibilities and support their readiness for future fellowship training or surgical practice.

Background Effective physician communication improves care, and many medical schools and residency programs have adopted communication focused curricula. The COVID-19 pandemic has shifted the doctor-patient communication paradigm with the rapid adoption of video-based medical appointments by the majority of the medical community. The pandemic has also necessitated a sweeping move to online learning, including teaching and facilitating the practice of communication skills remotely. We aimed to identify effective techniques for surgeons to build relationships during a video consult, and to design and pilot a class that increased student skill in communicating during a video consult. Methods Fourth-year medical students matched into a surgical internship attended a 2-hour class virtually. The class provided suggestions for building rapport and earning trust with patients and families by video, role play sessions with a simulated patient, and group debriefing and feedback. A group debriefing generated lessons learned and best practices for telemedicine communication in surgery. Results Students felt the class introduced new skills and reinforced current ones; most reported higher self-confidence in target communication skills following the module. Students were particularly appreciative of opportunity for direct observation of skills and immediate faculty feedback, noting that the intimate setting was unique and valuable. Several elements of virtual communications required increased focus to communicate empathy and concern. Proper lighting and positioning relative to the camera were particularly important and body movement required “narration” to minimize misinterpretation. A patient's distress was more difficult to interpret; asking direct questions was recommended to understand the patient's emotional state. Conclusions There is a need to teach video-conference communication skills to enable surgical teams to build rapport in this distinct form of consultation. Our training plan appears effective at engaging learners and improving skills and confidence, and identifies areas of focus when teaching virtual communication skills.