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Background Lack of transparency and meaningful assessment in surgical residency has led to inconsistent intraoperative entrustment and highly variable trainee competence at graduation. The relationship between faculty entrustment and resident entrustability on clinical competency remains unclear. We sought to evaluate the dynamic between entrustment/entrustability and clinical competency in general surgery residency. Methods Intraoperative observations were conducted across a 22-month period at an academic tertiary center. Entrustment/entrustability were measured using OpTrust. Clinical competencies were appraised via ACGME Milestones and Objective Structured Assessment of Technical Skill (OSATS) scores. Mixed effects linear regression was used to investigate the relationship among overall ACGME Milestone scores, OSATS domain scores, and overall OpTrust scores. Results Overall OpTrust scores significantly correlated with overall Milestone scores and multiple OSATS score domains. Conclusions OpTrust demonstrated a positive association between ACGME general surgery Milestones and OSATS scores. Overall, OpTrust may help optimize intraoperative faculty entrustment and resident entrustability, facilitating surgical trainee success during residency.

Background There is limited data on deliberate teaching of residents in the clinic setting; we sought to investigate the clinic experience at our institution and improve education through creation of a novel “Resident-Optimized Clinic” (ROC). Methods An online survey was sent separately to residents and faculty. Based on the results of this survey a modified ROC was developed to try to improve the obstacles to learning in clinic. Results Qualitative analysis revealed the barriers in clinic were inconsistencies in expectations, lack of autonomy, time, and facility limitations. The modified ROC was rated positively with 100% of participants expressing they had sufficient time and autonomy; and 90% felt the environment was optimized for teaching. Conclusions Multiple themes have been identified as problematic for the clinic education experience. The ROC was rated positively by trainees suggesting thoughtful intervention to improve clinic results in a better clinic experience and more educational gain from the clinic environment.

Objective Feedback is critical to the development of medical students. To enhance feedback, we created a web application, the Minute Feedback System (MFS). This app allows students to request precise, timely, written feedback from residents and staff without the burden of vague, end-of-rotation surveys. In this study, we investigate variations in response rates and feedback fatigue based on sex and rank (resident/fellow vs. faculty). Design Data were collected from May 2015-October 2016. The MFS stores student requests for feedback along with faculty responses allowing for analysis of feedback response rate as well as sex and rank identification. Variation in response rate was analyzed using Chi-square and log-rank testing. Feedback fatigue was assessed using Cox regression modeling. Setting University Affiliated, Tertiary Care Center. Participants Medical Students, Residents and Faculty. Results About 98.6% of students (138 women, 140 men) used the MFS on their surgery clerkship. They requested feedback from 159 trainees (residents or fellows) and 114 surgical faculty. Feedback was requested more from faculty (26.3 requests per individual) compared to trainees (16.4 requests per individual). The overall evaluator response rate was 60%. Male students were 13% less likely to receive feedback than female students. There was a higher prevalence of feedback fatigue among female faculty (11% less likely to respond) and residents (23% less likely to respond). Regression analysis showed that the overall hazard of nonresponse over time was 1.05, indicative of overall feedback fatigue among all respondents. Conclusions The MFS is a novel tool for feedback used by nearly all M3 students during their surgery clerkship at our institution. Evaluation of response rates demonstrated feedback fatigue, especially among women faculty and residents. Feedback fatigue was more likely to affect male students, although the reason for this is unclear. Further analysis is necessary to understand this sex-associated response disparity and its effect on student feedback in the learning environment.

Background Medical students often report dissatisfaction with the feedback they receive on their clerkships. This study evaluates the performance of the Minute Feedback System (MFS), a web-based tool designed to facilitate medical student acquisition of same day written feedback from surgery residents and faculty. Methods System-generated data, targeted surveys, and end of clerkship questionnaires were used to evaluate MFS performance over a one-year period. Results 170 students made 3190 feedback requests and received 1978 responses (62% response rate). Students felt the system was easy to use (90%), provided useful feedback (74%), and allowed them to obtain more feedback than they would have in its absence (81%). Concerns were raised regarding the quality of electronic feedback and whether the data generated would be used for summative assessment. Conclusions The MFS encourages same-day assessment and increases documented medical student feedback. Further development is required to improve feedback quality, response rates, and feedback application.

Background The feedback medical students receive during clinical rotations, traditionally verbal and not formally captured, plays a critical role in student development. This study evaluates written daily feedback given to students through a novel web-based feedback system. Methods A Minute Feedback System was used to collect feedback given to medical students during their surgery clerkship from May 2015-April 2016. Using qualitative content analysis, feedback comments were categorized as: encouraging, corrective, specific, and nonspecific. Effective feedback was a combination of specific and either corrective or encouraging feedback; ineffective feedback contained only nonspecific comments; mediocre feedback contained elements of both effective and ineffective comments. Results 3191 feedback requests were sent by medical students and 2029 faculty/resident feedback responses were received. The overall response rate was 62%. Nonspecific feedback comprised 80% of faculty, 83% of senior resident, and 78% of junior resident comments. Specific feedback was given by only 35% of faculty, 17% of senior residents, and 26% of junior residents. Faculty provided Effective feedback in only 16% of comments, senior residents 8%, and junior residents 17%. Mediocre feedback comprised 13% of faculty, 9% of senior resident, and 7% of junior resident comments. Ineffective feedback comprised 67% of all feedback: 60% of faculty, 72% of senior resident, and 68% of junior resident feedback. Conclusions The majority of resident and faculty feedback to medical students using an electronic, email-based application during their surgery clerkship was nonspecific and encouraging and therefore of limited effectiveness. This presents an opportunity for resident/faculty development and education regarding optimal feedback techniques.

Background Medical students often report a lack of timely, useful feedback during clerkship rotations. The purpose of this study was to develop a novel Minute Feedback System and determine whether it would generate frequent, high quality, documented feedback for students during the third year surgery clerkship. Methods The Minute Feedback System was created using the Qualtrics © survey software platform and piloted with surgery clerkship students. These students were surveyed about the frequency and quality of feedback and their overall rating of the surgery clerkship and compared to students who did not use the feedback system. Results The initial pilot of the Minute Feedback System involved 6/34 M3 surgery clerkship students and generated a total of 70 unique comments from faculty and residents over 3 weeks. When the 6 pilot students were compared to the 28 students without access to the Minute Feedback System , they respectively rated the frequency of feedback 4.50 vs 2.83 (p The system was then made available to all students on the M3 surgery clerkship (n = 31) over the subsequent 2 month rotation. 354 unique feedback comments were generated from 399 student requests (89% response rate). Students using the Minute Feedback System (n = 31) compared to students in the previous academic year without (n = 170) rated the quality of feedback (3.76 vs 3.4, p Conclusion The novel Minute Feedback System allows for frequent, timely, useful and documented feedback to medical students.