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This paper is part 4 in a series of workshops that examine the properties of some simple models of vocabulary networks. This Workshop explores how the overall activity level of a vocabulary network can be altered by changing the connections in the network (i.e., by implementing relinking events). The Workshop is linked to an online practice room where readers can explore these processes for themselves.

Ellen M Janssen,1 Sydney M Dy,2 Alexa S Meara,3 Peter J Kneuertz,4 Carolyn J Presley,5 John FP Bridges6,7 1Center for Medical Technology Policy, Baltimore, MD, USA; 2Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Department of Internal Medicine Division Of Rheumatology, The Ohio State University, College of Medicine, Columbus, OH, USA; 4Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 5Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; 6Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA; 7Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USACorrespondence: Ellen M JanssenResearch Director, Center for Medical Technology Policy, 401 East Pratt Street, Suite 631, Baltimore, MD 21202, USATel +1 443-222-8775Email ellen.janssen@cmtpnet.orgObjective: Increased treatment options and longer survival for lung cancer have generated increased interest in patient preferences. Previous studies of patient preferences in lung cancer have not fully explored preference heterogeneity. We demonstrate a method to explore preference heterogeneity in the willingness of patients with lung cancer and caregivers to trade progression-free survival (PFS) with side effects.Patients and Methods: Patients and caregivers attending a national lung cancer meeting completed a discrete-choice experiment (DCE) designed through a collaboration with patients. Participants answered 13 choice tasks described across PFS, short-term side effects, and four long-term side effects. Side effects were coded as a one-level change in severity (none-mild, mild-moderate, or moderate-severe). A mixed logit model in willingness-to-pay space estimated preference heterogeneity in acceptable tradeoffs (time equivalents) between PFS and side effects. The study was reported following quality indicators from the United States Food and Drug Administration’s patient preference guidance.Results: A total of 87 patients and 24 caregivers participated in the DCE. Participants would trade 3.7 month PFS (95% CI (CI): 3.3– 4.1) for less severe functional long-term treatment side effects, 2.3 months for less severe physical long-term effects (CI: 1.9– 2.8) and cognitive long-term effects (CI: 1.8– 2.8), 0.9 months (CI: 0.4– 1.4) for less severe emotional long-term effects, and 1.8 months (CI: 1.4– 2.3) for less severe short-term side effects. Most participants (90%) would accept treatment with more severe functional long-term effects for 8.4 additional month PFS.Conclusion: Participants would trade PFS for changes in short-term side effects and long-term side effects, although preference heterogeneity existed. Lung cancer treatments that offer less PFS but also less severe side effects might be acceptable to some patients.Keywords: non-small cell lung cancer, patient preferences, discrete choice experiment, heterogeneity, long-term side effects

This paper is part 3 of a series of workshops that examine the properties of some simple models vocabulary networks. This Workshop focusses on how the vocabulary network responds when words become easier to activate. The Workshop is linked to an on-line practice room where readers can explore these processes for themselves.

This paper reports a bibliometric analysis of two small data sets: a set of 34 papers that make up "The Routledge handbook of vocabulary studies" (Webb, 2020) and a set of papers dealing with second language (L2) vocabulary research taken from a single journal "Frontiers in Psychology." Bibliometric maps based on author co-citations in these two data sets are presented and compared. Although the two data sets are comparable in terms of size, they appear to be very divergent. In particular, the significant sources identified in "The Handbook" map seem to play a relatively minor role in the "Frontiers" map. The obvious conclusion is that "The Handbook" is not as representative of L2 vocabulary research as its title might lead us to believe. The paper argues that micro-bibliometric studies like this one can sometimes highlight features that are lost in the more traditional large-scale bibliometric approach.

OBJECTIVES: To identify hospital capabilities associated with behavioral health (BH) processes in emergency departments (EDs). RESEARCH DESIGN: Six hundred two hospital responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2017 American Hospital Association Annual Survey data. Separate multivariable regressions estimated how hospital capabilities (the use of quality improvement methods, approaches to disseminate best patient-care practices, barriers to using care delivery innovations, and inpatient beds for psychiatric or substance use) were associated with each of 4 ED-based BH processes: mental health and substance use disorder screening, team-based approaches to BH, telepsychiatry, and direct referrals to community-based BH clinicians. Models controlled for hospital structural characteristics and area-level socioeconomic factors. RESULTS: Most hospitals screened for BH conditions and provided direct referrals to community-based BH clinicians. Approximately half of the hospitals used a team approach to BH. A minority had implemented telepsychiatry. Each additional process used to disseminate best patient-care practices was associated with more screening for BH conditions (an increase of 4.07 points on the screening index, P

BACKGROUND: Bispecific T-cell engagers (BTEs) are novel agents used to treat hematological malignancies. Early trials were underpowered to define cardiovascular adverse events (CVAE) and no large-scale studies systematically examined the CVAEs associated with BTEs. METHODS: Leveraging the US Food and Drug Administrations Adverse Event Reporting System-(FAERS), we identified the relative frequency of CVAEs after initiation of five BTE products approved by the Food and Drug Administration between 2014 and 2023 for the treatment of hematological malignancies. Adjusted reporting ORs (aROR) were used to identify disproportionate reporting of CVAEs with BTEs compared with background rates in the database. Fatality rates and risk ratios (RRs) for each adverse event (AE) were calculated. RESULTS: From 3668 BTE-related cases reported to FAERS, 747 (20.4%) involved CVAEs. BTEs as a class were associated with fatal CVAEs (aROR 1.29 (95% CI 1.12 to 1.50)), an association mainly driven by teclistamab (aROR 2.44 (95% CI 1.65 to 3.60)). Teclistamab was also associated with a disproportionate risk of myocarditis (aROR 25.70 (95% CI 9.54 to 69.23)) and shock (aROR 3.63 (95% CI 2.30 to 5.74)), whereas blinatumomab was associated with a disproportionate risk of disseminated intravascular coagulation (aROR 3.02 (95% CI 1.98 to 4.60)) and hypotension (aROR 1.59 (95% CI 1.25 to 2.03)). CVAEs were more fatal compared with non-CVAEs (31.1% vs 17.4%; RR 1.76 (95% CI 1.54 to 2.03)). Most CVAEs (83.3%) did not overlap with cytokine release syndrome. CONCLUSION: In the first postmarketing surveillance study of BTEs, CVAEs were involved in approximately one in five AE reports and carried a significant mortality risk.

Abstract Social network analysis and shared-patient physician networks have become effective ways of studying physician collaborations. Assortative mixing or “homophily” is the network phenomenon whereby the propensity for similar individuals to form ties is greater than for dissimilar individuals. Motivated by the public health concern of risky-prescribing among older patients in the United States, we develop network models and tests involving novel network measures to study whether there is evidence of homophily in prescribing and deprescribing in the specific shared-patient network of physicians linked to the US state of Ohio in 2014. Evidence of homophily in risky-prescribing would imply that prescribing behaviors help shape physician networks and would suggest strategies for interventions seeking to reduce risky-prescribing (e.g., strategies to directly reduce risky prescribing might be most effective if applied as group interventions to risky prescribing physicians connected through the network and the connections between these physicians could be targeted by tie dissolution interventions as an indirect way of reducing risky prescribing). Furthermore, if such effects varied depending on the structural features of a physician’s position in the network (e.g., by whether or not they are involved in cliques—groups of actors that are fully connected to each other—such as closed triangles in the case of three actors), this would further strengthen the case for targeting groups of physicians involved in risky prescribing and the network connections between them for interventions. Using accompanying Medicare Part D data, we converted patient longitudinal prescription receipts into novel measures of the intensity of each physician’s risky-prescribing. Exponential random graph models were used to simultaneously estimate the importance of homophily in prescribing and deprescribing in the network beyond the characteristics of physician specialty (or other metadata) and network-derived features. In addition, novel network measures were introduced to allow homophily to be characterized in relation to specific triadic (three-actor) structural configurations in the network with associated non-parametric randomization tests to evaluate their statistical significance in the network against the null hypothesis of no such phenomena. We found physician homophily in prescribing and deprescribing. We also found that physicians exhibited within-triad homophily in risky-prescribing, with the prevalence of homophilic triads significantly higher than expected by chance absent homophily. These results may explain why communities of prescribers emerge and evolve, helping to justify group-level prescriber interventions. The methodology may be applied, adapted or generalized to study homophily and its generalizations on other network and attribute combinations involving analogous shared-patient networks and more generally using other kinds of network data underlying other kinds of social phenomena.

Workshop 2 explores some larger vocabulary networks than those presented in Workshop 1 (1,000 words instead of 100), and introduces some additional ways of activating words in a network (e.g., by using new parameters in our models). The simulations will show that raising a network's activation level may not be as easy as we would have expected, and that different kinds of events may cause either temporary or permanent changes in the networks. Findings will be discussed in relation to the previous literature on passive and active vocabularies. Several implications for vocabulary learning and teaching will also be considered.

Functional communication training (FCT) is an evidence-based treatment for behavior targeted for reduction that often combines extinction for target responses and arranges functionally equivalent reinforcement for alternative behavior. Long-term effectiveness of FCT can become compromised when transitioning from clinic to nonclinic contexts or thinning reinforcement schedules for appropriate behavior. Such increases in targeted behavior have been conceptualized as renewal and resurgence, respectively. The relation between resurgence and renewal has yet to be reported. Therefore, the present report retrospectively analyzed the relation between renewal and resurgence in data collected when implementing FCT with children diagnosed with developmental disabilities. We found no relation when evaluating all 34 individuals assessed for resurgence and renewal or a subset of individuals exhibiting both resurgence and renewal. These findings suggest that one form of relapse may not be predictive of another form of relapse.

BACKGROUND: Many potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality. METHODS: A narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated. RESULTS: Outside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These neglected conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain. CONCLUSIONS: Delays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system.

Abstract Previous research suggests that sharing emotionally intense experiences with others, for example by undergoing dysphoric collective rituals together, can lead to “identity fusion,” a visceral feeling of oneness that predicts group cohesion and self-sacrifice for the group. In this pre-registered research, we provide the first quantitative investigation of identity fusion following participation in a national funeral, surveying 1632 members of the British public. As predicted, individuals reporting intense sadness during Queen Elizabeth II’s funeral exhibited higher levels of identity fusion and pro-group commitment, as evidenced by generosity pledges to a British Monarchist charity. Also consistent with our hypotheses, feelings of unity in grief and emotional sharedness during the event mediated the relationship between sadness intensity and pro-group commitment. These findings shed light on importance of collective rituals in fostering group cohesion, cooperation, and the dynamics of shared emotional experiences within communities.

The idea that a vocabulary is a network of words is one that has become a common theme of the second language (L2) vocabulary research literature. However, not many people have considered the wider implications of this powerful metaphor. This paper is the first in a series of workshops that examines some of these implications. In this first workshop, we introduce some very simple computational models which illustrate some basic properties of network structures. The workshop consists of a set of interactive programs that model a vocabulary as a "Cellular Automaton"--a minimally organized network where each word is linked to a small number of other words, and words change their activity status depending on the inputs they receive from other words. These networks exhibit some surprising "emergent properties" which have important implications for the way we understand and think about real vocabulary networks.

ABSTRACTWhile coaching has been employed as a success strategy in many areas such as athletics and business for decades, its use is relatively new in the medical field despite evidence of its benefits. Implementation and engagement regarding coaching in graduate medical education (GME) for residents and fellows is particularly scarce. We report our three-year experience of a GME success coaching program that aims to help trainees reach their full potential by addressing various areas of medical knowledge, clinical skills, efficiency, interpersonal skills and communication, professionalism, and mental health and well-being. The majority of participants (87%) were identified by themselves, their program director, and/or the GME coaches to have more than one area of need. The majority (79%) of referrals were identified by the coaches to have additional needs to the reasons for referral. We provide a framework for implementation of a GME coaching program and propose that coaching in GME may provide an additional safe environment for learners to reveal areas of concerns or difficulty that otherwise would not be disclosed and/or addressed.

BackgroundPatients with cancer and an underlying autoimmune disease who are considering immune checkpoint blockers (ICBs) need to know about the benefits and risks of severe immune-related adverse events and flares of the autoimmune condition. ObjectiveThis study aims to develop and alpha test an educational website for patients with cancer. MethodsLearning topics, images, and website architecture (including flow and requirements) were developed and iteratively reviewed by members of a community scientist program, a patient advisory group, and content experts. Alpha testing was performed, measuring the site’s usability using the Suitability Assessment of Materials and its acceptability using the Ottawa Acceptability Measure. ResultsThe website included a home page; general information about ICBs; comprehensive modules on the benefits and risks of ICBs for patients with cancer and preexisting autoimmune diseases; general wellness information; and features such as a quiz, additional resources, and a glossary. For the alpha testing, 9 users assessed the newly developed website. Patient reviewers (n=5) had rheumatoid arthritis, Crohn disease, Sjogren syndrome, or vasculitis. Health care provider reviewers (n=4) were medical oncologists or rheumatologists. The median Suitability Assessment of Materials rating was 75 (IQR 70-79; range 0-100) for patients versus 66 (IQR 57-72; range 0-100) for providers (scores ≥70 indicate no substantial changes needed). Recommendations for improvement, mostly involving navigation and accessibility, were addressed. All participants expressed that the website was acceptable and balanced in terms of discussion of benefits and harms. Because half (2/4, 50%) of the providers suggested we increase the amount of information, we extended the content on the impact of having an autoimmune disease when considering ICB treatment, the probability of flares, and the management of flares in this context. ConclusionsThe feedback led to minor revisions to enhance readability, navigation, and accessibility, ensuring the website’s suitability as a decision-making aid. The newly developed website could become a supporting tool to facilitate patient-physician discussion regarding ICBs.

2023 marked the 50th anniversary of the 1973 Eldfell eruption on the island of Heimaey, Iceland. The eruption began unexpectedly at 1:50 a.m. on the 23rd of January 1973, creating a need to evacuate all 5300 residents to the Icelandic mainland by fishing fleet. The eruption is synonymous with the islanders’ fight to save their town by spraying cold seawater onto the advancing lava flows. Previous research has focussed on the physical volcanology and igneous petrology of the eruption and the wider Vestmannaeyjar Volcanic System; however, very little research has focussed on the social impacts of the eruption. Fieldwork identified how the 1973 eruption is remembered and commemorated by the residents of Heimaey both in public and private settings. Over 50 memorials are discussed, including artworks, sculptures, museum exhibitions, in-person events, and online digital repositories that highlight connections to the eruption itself and to life before the eruption. Interviews and surveys with the local community draw attention to the ongoing impacts of the eruption—for example, traumatic responses to hazard events such as the Eyjafjallajökull eruption in 2010. A predominantly positive community narrative of the event has persisted for several decades. The narrative depends on the belief that no deaths were caused by the eruption, the successful rebuilding and recovery of the town, and the resilience of the residents. The last ten years, however, have seen a change in how the community discuss their experiences of the eruption, with a new focus on the loneliness, bullying, isolation, danger, and trauma experienced during the event. Ágrip Árið 2023 voru 50 ár liðin frá Eldfellsgosinu 1973 á Heimaey. Eldgosið hófst óvænt klukkan 01.50 þann 23. janúar 1973 og þurfti að flytja 5.300 íbúana til Íslands með fiskiskipaflota. Eldgosið er samheiti við baráttu eyjarskeggja við að bjarga bænum sínum með því að úða köldum sjó á hraunið. Fyrri rannsóknir hafa beinst að eðlisfræðilegri eldfjallafræði og bergfræði gossins og víðara eldfjallakerfi Vestmannaeyja, hins vegar hafa mjög litlar rannsóknir beinst að félagslegum áhrifum gossins. Vettvangsvinna leiddi í ljós hvernig eldgosið 1973 er minnst og minnst af íbúum Heimaeyjar bæði í opinberu umhverfi og einkaumhverfi. Fjallað er um yfir 50 minnisvarða, þar á meðal listaverk, skúlptúra, safnsýningar, persónulega viðburði og stafrænar geymslur á netinu sem draga fram tengingar við eldgosið sjálft og lífið fyrir gos. Í viðtölum og könnunum við nærsamfélagið er vakin athygli á viðvarandi áhrifum eldgossins, til dæmis áfallaviðbrögðum við hættulegum atburðum nútímans eins og Eyjafjallajökulsgosinu 2010. Aðallega jákvæð samfélagsfrásögn af atburðinum hefur verið viðvarandi í nokkra áratugi. Frásögnin byggist á þeirri trú að engin dauðsföll hafi orðið af völdum eldgossins, árangursríkri endurreisn og endurheimt bæjarins og seiglu íbúanna. Síðustu tíu ár hafa hins vegar orðið róttækar breytingar á því hvernig samfélagið fjallar um upplifun sína af eldgosinu, með nýrri áherslu á einmanaleika, einelti, einangrun, hættu og áföll sem urðu fyrir atburðinum.

Background Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum.Methods We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications.Findings Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36–0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients’ experience of pain during the procedure.Interpretation This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals.Trial registration number NCT04438811.

Immune checkpoint inhibitors (ICIs) have revolutionized oncology treatment. However, their success is mitigated by the recognition that ICI-induced immune-related adverse events (irAEs) pose considerable challenges to patients and clinicians. These autoimmune toxicities are heterogeneous, unpredictable, and reflect a disease state resulting from a change in the immune system of patients. This contrasts with the typical acute nature of toxicities from chemotherapy and molecularly targeted oncology therapies. Management is further complicated by the extended bioavailability of these agents in patients as well as the persistence of autoimmune pathology. Currently, irAE treatment remains suboptimal in many areas, as many expert guidelines remain vague on the optimal selection, dosing, and duration of steroids and the use of other immunosuppressive agents. This coupled with delays in diagnosis and difficulties for patients accessing effective irAE treatment results in barriers to effective irAE care. The latter is complicated by the lack of US Food and Drug Administration-approved irAE treatments that lead to insurance denials, as well as the high cost of biological immunosuppressant therapies. Fortunately, rheumatologists and other subspecialists with expertize in the management of chronic autoimmune conditions have become more involved in irAE diagnosis and management and may help navigate treatment. In this commentary, we discuss these issues and propose potential solutions to advance the field.

Abstract The stability of cellular phenotypes in developing organisms depends on error-free transmission of epigenetic and genetic information during mitosis. Methylation of cytosine residues in genomic DNA is a key epigenetic mark that modulates gene expression and prevents genome instability. Here, we report on a genetic test of the relationship between DNA replication and methylation in the context of the developing vertebrate organism instead of cell lines. Our analysis is based on the identification of hypomorphic alleles of dnmt1, encoding the DNA maintenance methylase Dnmt1, and pole1, encoding the catalytic subunit of leading-strand DNA polymerase epsilon holoenzyme (Pole). Homozygous dnmt1 mutants exhibit genome-wide DNA hypomethylation, whereas the pole1 mutation is associated with increased DNA methylation levels. In dnmt1/pole1 double-mutant zebrafish larvae, DNA methylation levels are restored to near normal values, associated with partial rescue of mutant-associated transcriptional changes and phenotypes. Hence, a balancing antagonism between DNA replication and maintenance methylation buffers against replicative errors contributing to the robustness of vertebrate development.

BackgroundSurgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life.MethodsEpidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries.ResultsAn estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year.ConclusionsImproving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.

Objective: Robotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents’ opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). Methods: General surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2–5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. Results: Resident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons’ perceived operative time pressure inversely affected resident ICT. Conclusions: This study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.