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Abstract Background Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees’ stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees’ stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. Methods We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants’ stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. Results Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P

Background: Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees' stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees' stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. Methods: We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants' stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. Results: Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05). Conclusion: Trainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees' stress response during simulation-based skills training courses. [ABSTRACT FROM AUTHOR]

Objective: As trainees rotate through thoracic subspecialties within their curricula, a crucial portion of their robotic training consists of actual console operating time. The more time spent on the surgeon console, the greater the development will be through the course of their training. Implementing a physician assistant at the bedside may increase the operative console time for the trainee and develop robotic skills in a more expeditious rate. The objective was to evaluate the impact a designated robotic physician assistant can have on trainee console learning opportunity. Methods: Operating room data collected consisted of all robotic general thoracic surgical cases that trainees participated in with and without a physician assistant present. Metrics regarding case efficiency included anesthesia ready-to-incision, incision-to-console, and raw resident console times. By using PRISM software, a nonparametric t test was used to analyze each averaged data group compared between when a physician assistant was present and not present. Results: The mean resident console time without and with a physician assistant assist was 45.8 minutes and 80.9 minutes, respectively (P

ObjectiveThe COVID-19 pandemic has drastically transformed the healthcare community and medical education across the United States. The aim of this study was to evaluate the impact of COVID-19 on the surgical resident training experience, assess possible sources of stress or anxiety among surgery residents, and examine how patterns of anxiety vary by resident rank.DesignWe developed and disseminated a survey, which included the Generalized Anxiety Disorder 7-Item Scale (GAD-7), to all general and integrated plastic surgery residents in their clinical years of training at the University of California, San Francisco. Statistical analysis of the survey responses was performed using the Kruskal-Wallis or Wilcoxon rank sum test. Post-hoc analysis was performed using the Bonferroni-corrected Dunn test. Survey data were combined with aggregated duty hour information and operative case numbers from select hospitals for March and April of 2019 (historical baseline) and 2020.ResultsThe overall survey response rate was 73.7% (n = 73). With an estimated operative volume reduction of 63.3% for general surgery cases, over 90% of residents expressed concern about the decline in operative exposure. While the senior residents tended to work more shifts, they were not more likely to have higher risk perception scores for contracting COVID-19 nor higher anxiety levels about the possibility of contracting COVID-19. They were, however, significantly more likely to have high GAD-7 scores (≥ 10) when compared to interns (z = -2.82, p-adj = 0.014). Overall, residents were more concerned about the general health of loved ones than about their own risk of contracting COVID-19 (U = 3897.5, p < 0.01).ConclusionsWhile the work-related experiences of residents varied across a number of factors during the pandemic, residents tended to report similar sources of anxiety. Moving forward, surgical residency training programs will need to develop ways to optimize available surgical experiences and address the unique resident anxieties that an infectious pandemic presents.

Purpose: Concerns persist that trainee participation in surgical procedures may compromise patient care and potentiate adverse events and costs. We aimed to analyse the potential impact and consequences of surgical trainee involvement in total hip arthroplasty (THA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. Methods: We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in October 2021. Eligible studies reported a direct comparison between THA cases performed with and without trainee involvement. Results: Eighteen publications met our eligibility criteria and were included in our study. The included studies reported on 142,450 THAs completed on 142,417 patients. Specifically, 48,155 and 94,295 surgeries were completed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 5,662) and without (n = 14,763) trainee involvement were 106.20 and 91.41 min, respectively. Mean overall complication rates were 6.43% and 5.93% for THAs performed with (n = 4842) and without (n = 12,731) trainees. Lastly, the mean Harris Hip Scores (HHS) for THAs performed with (n = 442) and without (n = 750) trainee participation were 89.61 and 86.97, respectively. Conclusion: Our systematic review confirmed previous studies' reports of increased operative time for THA cases with trainee involvement. However, based on the overall similar complication rates and functional hip scores obtained, patients should be reassured concerning the relative safety of trainee involvement in THA. Future prospective studies with higher levels of evidence are still needed to reinforce the existing evidence. [ABSTRACT FROM AUTHOR]

Aim: The reversal of diverting loop ileostomy (DLI) is one of surgical trainees’ first procedures. Complications of DLI reversal can cause life-threatening complications and increase patient morbidity. This study compared DLI reversals performed by surgical trainees with those by attending surgeons. Method: This retrospective cohort study was performed at a single primary care center on 300 patients undergoing DLI reversal. The primary outcome was morbidity, according to the Clavien-Dindo classification (CDC), with special attention paid to the surgeon’s level of training. The secondary endpoint was postoperative intestinal motility dysfunction. Results: Surgical trainees had significantly longer operation times (p < 0.001) than attending surgeons. Univariate analyses revealed no influence on the level of training for postoperative morbidity. First bowel movement later than 3 days after surgery was a significant risk factor for CDC ≥ 3 (OR, 4.348; 96% CI, 1670–11.321; p = 0.003). Independent risk factors for surgical site infections (SSIs) were an elevated BMI (OR, 1.162; 95% CI, 1.043–1.1294; p = 0.007) and a delayed bowel movement (OR, 3.973; 95% CI, 1.300–12.138; p = 0.015). For postoperative intestinal motility dysfunction, an independent risk factor was a primary malignant disease (OR, 1.980; 95% CI, 1.120–3.500; p = 0.019), and side-to-side stapled anastomosis was a protective factor (OR, 0.337; 95% CI 0.155–0.733; p = 0.006). Conclusion: Even though surgical trainees needed significantly more time to perform the surgery, the level of surgical training was not a risk factor for increased postoperative morbidity. Instead, delayed first bowel movement was predictive of SSI. [ABSTRACT FROM AUTHOR]

Purpose: Trainee involvement in patient care has raised concerns about the potential risk of adverse outcomes and harming patients. We sought to analyze the impact and potential consequence of surgical trainee involvement in total knee arthroplasty (TKA) procedures in terms of surgical efficacy, patient safety, and functional outcomes. Methods: We systematically reviewed Medline/PubMed, EMBASE, the Cochrane library, and Scopus databases in April 2021. Eligible studies reported on the impact of trainee participation in TKA procedures performed with and without such involvement. Results: Twenty-three publications met our eligibility criteria and were included in our study. These studies reported on 132,624 surgeries completed on 132,416 patients. Specifically, 23,988 and 108,636 TKAs were performed with and without trainee involvement, respectively. The mean operative times for procedures with (n = 19,573) and without (n = 94,581) trainee involvement were 99.77 and 85.05 min, respectively. Both studies that reported data on cost of TKAs indicated a significant increase (p < 0.001) associated with procedures completed by teaching hospitals compared to private practices. Mean overall complication rates were 7.20% and 7.36% for TKAs performed with (n = 9,386) and without (n = 31,406) trainees. Lastly, the mean Knee Society Scale (KSS) knee scores for TKAs with (n = 478) and without (n = 806) trainee involvement were similar; 82.81 and 82.71, respectively. Conclusion: Our systematic review concurred with previous studies that reported trainee involvement during TKAs increases the mean operative time. However, the overall complication rates and functional outcomes were similar. Larger studies with a better methodology and higher level of evidence are still needed for a resolute conclusion. [ABSTRACT FROM AUTHOR]

Background: Prejudice towards Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) people continues to decline. Despite this, LGBTQ surgeons still experience discrimination from colleagues, staff, and patients at an alarming rate. The Association of Out Surgeons and Allies (AOSA) was established to address this issue by fostering a more equitable and inclusive surgical environment.Aosa: AOSA is a national surgical organization of LGBTQ students, trainees, faculty, and allies committed to enhancing equity in surgery through education, outreach, mentorship, and sponsorship. AOSA works in collaboration with national efforts and institutional initiatives to promote the inclusion and acceptance of LGBTQ surgeons.Future Directions: Achieving these goals will require a community effort of LGBTQ surgeons and allies in addition to the support of prominent academic institutions and national surgical organizations.Conclusion: Lesbian, Gay, Bisexual, Transgender, and Queer surgeons continue to face workplace discrimination. This new surgical society will help foster a supportive environment through visibility, mentorship, education, and community. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendicectomy has advantages over open surgery in terms of complications, postoperative pain and the length of hospital stay. It is considered as a preferred basic laparoscopic procedure for surgical trainees based on the studies performed at teaching hospitals. Objective: The aim of this study was to determine whether laparoscopic appendicectomy can safely be carried out by surgical trainees in peripheral hospitals. Methods: A retrospective analysis was conducted at a base hospital in Uva province of Sri Lanka including all laparoscopic appendicectomies performed from July 2018 to December 2018. Duration of procedure, complications, postoperative pain, and duration of hospital stay were compared between the surgeries performed by surgeon (group A) and by a supervised trainee (group B). Results: 53 laparoscopic appendicectomies, 15 (28.3%) were included in group A and 38 (71.7%) were included in group B. Demographics including age, intraoperative findings and histology were comparable between two groups. There were no significant differences observed between group A and B for the duration of procedure (34.67 min vs. 41.18 min, p = 0.30), deep surgical site infections (0 vs. 2.6%, p = 1.0), median postoperative pain score (1 vs 1, p = 0.23) and duration of hospital stay (2.27 days vs. 2.58 days, p = 0.11). However, group B had a higher conversion rate to open surgery compared to group A (5% vs. 0). Conclusion: Laparoscopic appendicectomy is a safe procedure for supervised trainees to perform in peripheral hospital setting.

Brent Bauman,1 Peter Kernahan,1,2 Anthony Weinhaus,2 Michael J Walker,2 Eric Irwin,1 Andrew Sundin,1 Derek Yerxa,3 Victor Vakayil,1 James V Harmon1,2 1Department of Surgery, University of Minnesota, Minneapolis, MN, USA; 2Program in Human Anatomy, University of Minnesota, Minneapolis, MN, USA; 3College of Biological Sciences, University of Minnesota, Minneapolis, MN, USACorrespondence: James V Harmon 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USATel +1 612-625-7911Email harm0031@umn.eduPurpose: Senior medical students are variably prepared to begin surgical training; and a national curriculum was established through the American College of Surgeons to better prepare senior medical students for surgical training. The purpose of our course is to prepare senior medical students to more effectively enter surgical training programs. We recently enhanced our independently developed surgical training preparation course by increasing exposure to surgical anatomy, medical physiology, surgical skills, and point-of-care ultrasound. We evaluated the impact of our interprofessional training course to increase confidence and readiness among senior medical students entering surgical training.Methods: The course focused on pre- and post-operative patient care, surgical anatomy, human physiology, and bedside ultrasound. Didactic lectures in anatomy, human physiology, and bedside ultrasound were provided prior to all hands-on simulated patient care sessions and mock surgical procedures. To evaluate our interprofessional curriculum, we administered pre- and post-course surveys, pre- and post-course knowledge tests, and a final surgical anatomy laboratory practical examination to 22 senior medical students who were enrolled in the course. All students created a final surgical anatomy presentation.Results: The students demonstrated a 100% pass rate in surgical anatomy. The knowledge test, which included assessment of knowledge on perioperative surgical decision making, human physiology, and bedside ultrasound, demonstrated an average improvement of 10%. Statistically significant improvements in median confidence values were identified in 10 of 32 surveyed categories, including surgical skills (p < 0.05); 84% of student goals for the course were achieved. The medical students’ surveys confirmed increased confidence related to the use of point-of-care ultrasound, teamwork experience, and basic surgical skills through small group interactive seminars and surgical simulation exercises.Conclusion: Our preparation for surgical training course resulted in high student satisfaction and demonstrated an increased sense of confidence to begin surgical training. The 10% improvement in medical student knowledge, as evaluated by a written examination, and the significant improvement in confidence level self-assessment scores confirms this surgery preparation course for senior medical students successfully achieved the desired goals of the course.Keywords: surgical trainee, simulation-based training, clinical anatomy, medical student education

BACKGROUND: While burnout has been identified in half of practicing physicians, no validated questionnaires have assessed burnout among minimally invasive gynecologic surgery fellows. OBJECTIVE: This study aimed to assess factors associated with burnout among minimally invasive gynecologic surgery fellows. STUDY DESIGN: Cross-sectional online survey including the validated Copenhagen Burnout Inventory: 100 minimally invasive gynecologic surgery fellows in the United States were invited, including the classes of 2021 and 2022. Of the 100 fellows invited, 60 fellows completed the Copenhagen Burnout Inventory survey. Descriptive statistics were used to report the demographic variables, the mean Copenhagen Burnout Inventory score, and the responses to the survey questions. Logistic and linear regression models were created to assess relationships between fellow characteristics and Copenhagen Burnout Inventory scores. RESULTS: Of the 60 fellows with complete Copenhagen Burnout Inventory survey data, 73% were female, 50% were first-year, and 50% were second-year fellows. The mean Copenhagen Burnout Inventory score was 39.2 (standard deviation, 14.4), indicating moderate burnout, and 21.7% of fellows had scores >50, indicating high burnout. Personal and work-related burnout were highest, with Copenhagen Burnout Inventory scores of 47.9 (standard deviation, 16.8) and 45.1 (standard deviation, 17.6), respectively. Patient-related burnout scores were the lowest at 23.5 (standard deviation, 16.5).Factors associated with overall burnout included career choice dissatisfaction (beta, 5.6; 95% confidence interval, 0.9–10.3; P=.02) and absence of a positive and respectful work environment (beta, 5.9; 95% confidence interval, 1.0–10.9; P=.02). Fellows who were somewhat satisfied with their career choice scored 11.2 points higher than those who were highly satisfied. Fellows whose work environment was almost never positive and respectful scored 17.8 points higher than those whose work environment was always positive and respectful. Female fellows were significantly less likely to have a low Copenhagen Burnout Inventory score than male fellows (odds ratio, 0.05; 95% confidence interval, 0.004–0.3; P=.004).Only one-third of fellows reported regular individual wellness behaviors: mindfulness (23%), exercise (35%), 7 to 8 hours of sleep (37%), and recreation (27%); however, these factors were not associated with lower burnout scores. CONCLUSION: Fellows had moderate to high personal and work-related burnout, whereas patient-related burnout was low. Factors associated with burnout were negative work culture, lack of control over work schedule, and decreased career satisfaction. Individual wellness behaviors were not associated with burnout, highlighting the need to look beyond individual behavior in the fight against physician burnout.

Background: In surgical training, a mentor is a more senior and experienced surgeon who guides a surgical trainee to meet personal, professional, and educational goals. Although mentorship is widely assumed to positively affect surgical residents' professional development, a more nuanced understanding of mentorship's impact is lacking and urgently needed as burnout rates among residents increase. This study aims to summarize the current literature on the effects of mentorship on surgical residents' burnout and well-being., Methods: A comprehensive literature review was performed with key terms related to "surgical resident" and "mentor" using Pubmed, Embase, and ProQuest databases for primary studies published in the United States or Canada from January 1, 2010 to December 9, 2022 that measured outcomes related to burnout and well-being. Multiple reviewers screened titles and abstracts for relevance, then full-text articles for eligibility., Results: Initial search resulted in 1,468 unique articles, and 19 articles were included after review. Only one article was a randomized controlled trial. Twelve studies described a decrease in burnout rates or in outcomes related to burnout. In contrast, 4 studies identified negative outcomes related to burnout. Six studies showed improved well-being or related outcomes. One study was not able to show a change in self-valuation between coached and noncoached residents., Conclusion: High quality mentorship can be associated with improved well-being and decreased burnout in surgical residents, but the key elements of effective and helpful mentorship remain poorly characterized. This summary highlights the importance of making mentorship accessible to surgical residents, and training faculty to be effective mentors., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Unilateral cleft lip repair is a common procedure in plastic and reconstructive surgery to restore both function and aesthetics. The long-term outcomes of these surgeries can be influenced by various factors, including the experience and position of the surgeon performing the procedure. This study aims to investigate whether there is a significant difference in long-term secondary deformities based on whether the surgery was performed by a specialist or a trainee., Methods and Materials: This is a retrospective cross-sectional study among unilateral cleft lip patients based on their data records. The study aims to assess the long-term secondary deformity in relation to the position of the surgeon (specialist or trainee) in patients who underwent unilateral cleft lip repair surgery at the Reconstructive Sciences Unit at Hospital Universiti Sains Malaysia (HUSM)., Results: Of the 50 patients, the majority (74%) were operated on by a specialist with more than five years of experience. Only 13 patients (26%) were operated on by trainees in the plastic and reconstructive surgery training program. Long-term secondary deformity had no significant relationship with the surgeon's position (chi-squared (χ 2 )(1) = 5.89, p = 0.08)., Conclusion: Long-term secondary deformities were less likely following unilateral cleft lip repair performed by a specialist or senior surgeon. However, the relationship between these secondary deformities and the surgeon's position (specialist or trainee) was statistically insignificant. Therefore, this study urges trainees to be more involved in simple cleft surgeries to enhance their surgical skills and achieve the best outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Review Board of Universiti Sains Malaysia issued approval USM/JEPeM/21120775. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Chalabi et al.)

Objective: To obtain insights into the effects of surgical training on the well-being of support persons. Summary Background Data: Surgical trainee wellness is a critical priority among surgical educators and leaders. The impact of surgical training on the wellness of loved ones who support trainees has not been previously studied. Methods: This qualitative study employs semi-structured interviews of 32 support persons of surgical trainees at a single tertiary care center with multiple surgical specialty training programs. Interviews focused on perceptions about supporting a surgical trainee. Transcripts underwent thematic analysis with semantic and conceptual coding. Key themes regarding the effects that caring for a trainee has on support persons are reported. Results: Three key themes were identified: (1) Sacrifices—support persons report significant tangible and intangible sacrifices, (2) Delaying life—life is placed on hold to prioritize training, and (3) A disconnect—there is a disconnect and a lack of recognition of support person needs that require greater awareness and targeted interventions. Conclusions: The impact of surgical training can extend beyond trainees and can affect the wellness of their support persons who endure the effects of training alongside trainees. Programs should be aware of these effects and develop meaningful strategies to aid trainees and their support persons. [ABSTRACT FROM AUTHOR]

Summary: Background: Burnout in physicians affects personal life, health, commitment to work, and finally patient care. Surgeons in training have been shown to be prone to burnout. The aim of the present study is to characterize the prevalence of burnout among Swiss and Australian surgery residents, as well as to identify individual and system-related predispositions for burnout. Methods: All Swiss and Australian surgery residents were contacted to complete an online questionnaire between April and December 2017. Personal and system-related issues were assessed, and the abbreviated version of the Maslach Burnout Inventory, the Brief Resilience Scale, and a shortened version of the Interpersonal Support Evaluation List were included. Results: In Switzerland 237 of 700 (34%) and in Australia 175 of 428 (41%) general surgery residents completed the online questionnaire. Australian residents were older, more experienced, and rather had family. While documented training programs are fewer, regulated weekly work hours are more common in Switzerland. Factors mostly associated with risk of burnout were "barely" or no free time activities and increased working hours per week. Factors inversely correlated with burnout were having children, salary satisfaction, and regulated weekly working hours. Factors not associated with burnout were country, age, gender, work experience, relationship, religion, hospital type, and a documented training program. Conclusion: Reduced free time activities and augmented working hours increase the risk of burnout, whereas having children, salary satisfaction, and regulated weekly working hours decrease the risk of burnout. [ABSTRACT FROM AUTHOR]

Objective: Mental health distress and suicidal ideation are leading contributors to the silent epidemic of physician suicide leading to approximately 300 to 400 physician deaths per year. The Second Trial has illuminated the alarming fact that several of our residents have experienced suicidal thoughts within the last year. Unfortunately, our institution is not an outlier. Suicidal ideation and under- or untreated mental health disorders are increasingly prevalent in the surgical trainee population. Given the major concern for our residents' well-being, our department consulted a licensed mental health professional familiar with resident training and the GME to develop a program to provide access to a mental health professional that is free of cost for trainees, safe and confidential., Design: Implementation of a 30 minute opt-out resident check-in program with a licensed mental health professional and a post-session survey that provided retrospective survey data for analysis., Setting: This program was implemented at the University of Virginia Health System in Charlottesville, VA., Participants: General surgery categorical and preliminary residents participated in this program., Results: Thirty residents participated in the program and an overwhelming majority would like to continue this program at regular intervals. Sessions were 25 minutes on average and 27.7% of participants requested additional sessions., Conclusions: Implementation of this program for our surgical trainees was favorably perceived with request for continuation of the program and provided access to a safe space with a familiar provider., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The parathyroidectomy approach has shifted over the last few decades from routine bilateral to more commonly focused exploration. The purpose of this study is to assess the operative experience in parathyroidectomy for surgical trainees as well as overall parathyroidectomy trends., Methods: Data from the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) were analyzed between 2014 and 2019., Results: The overall distribution of focused versus bilateral parathyroidectomy remained stable (2014: 54 % focused and 46 % bilateral approach; 2019: 55 % focused and 45 % bilateral). Ninety three percent of procedures involved a trainee (fellow or resident) in 2014, this dropped to 74 % in 2019 (P < 0.005). Fellow involvement decreased significantly from 31 % to 17 % (P < 0.05) over the six-year period., Conclusions: Resident exposure to parathyroidectomies mirrored that of practicing endocrine surgeons. This works highlights the opportunities to capture more information regarding the surgical trainee experience in endocrine surgeries., Competing Interests: Declaration of competing interest The authors have no conflicts of interest or funding sources to disclose. CESQIP and the hospitals participating in CESQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The conclusions, findings, and opinions expressed by the authors do not necessarily reflect the official position of the AAES or CESQIP. Use of CESQIP data does not imply endorsement by any of the groups named above., (Copyright © 2023. Published by Elsevier Inc.)

Open appendicectomy is the traditional standard treatment for appendicitis. Laparoscopic appendicectomy is perceived as a procedure with greater potential for complications and longer operative times. This paper examines the hypothesis that unsupervised laparoscopic appendicectomy by surgical trainees is a safe and time-effective valid alternative. Methods: Medical records, operating theatre records and histopathology reports of all patients under-going laparoscopic and open appendicectomy over a 15-month period in two hospitals within an area health service were retrospectively reviewed. Data were analysed to compare patient features, pathology findings, operative times, complications, readmissions and mortality between laparoscopic and open groups and between unsupervised surgical trainee operators versus consultant surgeon operators. Results: A total of 143 laparoscopic and 222 open appendicectomies were reviewed. Unsupervised trainees performed 64% of the laparoscopic appendicectomies and 55% of the open appendicectomies. There were no significant differences in complication rates, readmissions, mortality and length of stay between laparoscopic and open appendicectomy groups or between trainee and consultant surgeon operators. Conversion rates (laparoscopic to open approach) were similar for trainees and consultants. Unsupervised senior surgical trainees did not take significantly longer to perform laparoscopic appendicectomy when compared to unsupervised trainee-performed open appendicectomy. Conclusion: Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

Purpose: The efficacy of the Mindful Self-Compassion (MSC) for Healthcare Communities program has not been verified. This study aims to evaluate the feasibility and efficacy of the online MSC for Healthcare Communities program on burnout, stress-related health, and resilience among surgical trainees., Methods: A single-arm pilot study was conducted at a tertiary referral academic hospital in Korea. Surgical trainees were recruited through flyer postings; therefore, a volunteer sample was used. Thus, 15 participants participated, among whom 9 were women and 11 were doctor-residents. The Self-Compassion for Healthcare Communities (SCHC) program was conducted from September to October 2021 via weekly online meetings (1 hour) for 6 weeks. The efficacy of the program was evaluated using validated scales for burnout, stress, anxiety, depression, self-compassion, and resilience before and after the intervention and 1 month later., Results: The results showed significantly reduced burnout, anxiety, and stress scores. After the program, high emotional exhaustion and depersonalization rates decreased, and personal accomplishment increased. Eight participants showed reduced anxiety postintervention, and 9 showed reduced stress. Improvements were observed between pre- and postintervention in resilience, life satisfaction, and common humanity. Changes in self-compassion predicted higher gains in resilience and greater reductions in burnout and stress., Conclusion: The SCHC is a feasible and effective program to improve resilience, self-compassion, and life satisfaction and reduce stress, anxiety, depression, and burnout in surgical trainees. This study highlights the need to include specific mental health programs in surgical training to improve trainees' well-being., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2023, the Korean Surgical Society.)

Background: The ACGME has required that a skills lab be incorporated into the surgical residency curriculum. While the value of warm-up is generally accepted in other areas requiring complex motor skills, there is little evidence to support the benefits of warm-up prior to performing surgery. We are conducting this study in an attempt to identify whether a warm-up period prior to operating impacts operative technique. Methods: All general surgery residents and MIS fellows were included in this IRB-approved randomized study. Participants were randomized to either warm-up or no warm-up groups. Participants randomized to the warm-up group completed a 10 min practice session in the simulation lab within 1 h of starting the case, using an FLS training box. At the conclusion of the operation, the participant was evaluated by the attending surgeon using the validated global rating scales of Reznick and Vassiliou. The attending surgeons were blinded to the use of pre-procedure warm-up. The results of the questionnaire were analyzed using student's t test with p < 0.05 for significance. Results: Pilot data were obtained after completing 40 cases that were randomized to warm-up (19) or no warm-up (21). There was a statistically significant improvement in depth perception ( p = 0.02), bimanual dexterity ( p = 0.01), and efficiency of movements ( p = 0.03) for those randomized to warm-up. There was statistical improvement when we preformed a composite scoring of the attending evaluations for each of the Reznick ( p = 0.008) and the Vassiliou ( p = 0.01) global rating scales. Conclusions: Preoperative warm-up significantly improves depth perception, bimanual dexterity, and efficiency of movements, as well as improvement in composite scores as judged by the attending surgeon. The lack of self-perceived improvement by the residents may be a reflection of the high standards and intense self-critique that is common among surgical trainees. We believe that our findings, while preliminary, reflect that surgical performance can be enhanced through structured warm-up activities. [ABSTRACT FROM AUTHOR]

Objective: To determine the knowledge, attitudes and practices of general surgical trainees regarding safe use of diathermy. Methodology: In this cross-sectional Survey, 47 surgical trainees of the Civil Hospital Karachi, comprising PGY 1 through 4, were interviewed by questionnaires made up of five close-ended and three open-ended items. Results: Majority of the trainees belonged to the first two years of training. More than 80% had no formal training in diathermy use. Most of them were found lacking in core knowledge and evidence-based practice of electrosurgery. Conclusion: There was a high level of ignorance regarding current and established principles of diathermy use among surgical trainees at the Civil Hospital Karachi. [ABSTRACT FROM AUTHOR]

Background An operative note (op note) is a vital medical record of remarkable clinical, medico-legal and academic relevance. The Royal College of Surgeons (RCS) has set out a guideline to standardise op notes. This closed-loop audit assessed the compliance of op notes completed in our local hospital against the guidance set by RCS with the view to identify deficiencies and improve practice. Methods A retrospective review of general surgery operative notes was carried out to access their various characteristics against RCS guidance. Two additional parameters were assessed, namely, 'cadre of the surgeon that completed the op note' and 'use of abbreviations'. To improve compliance with RCS guidelines, an electronic proforma (EP) that included all the 18 characteristics listed in good surgical practice was implemented and a re-audit was undertaken six months afterwards. Results A total of 200 op notes were reviewed, 98 during the initial audit cycle and 102 at the re-audit. Seventy-eight per cent (78%) of the op notes were written by trainees. At the initial audit, seven parameters performed poorly, with compliance ranging between 5.1% and 76.5%. The re-audit demonstrated improved adherence to guidelines following the implementation of the EP, as well as a reduction in the use of abbreviations. The overall compliance improved from roughly 80% to >95%. Conclusion A sustainable change was achieved through the implementation of EP with improvement demonstrated in content and structure. The need to provide teaching to trainees who are responsible for writing a vast majority of op notes was identified., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Oladeji et al.)

Background: In the regional setting, general practitioners often refer complicated skin excisions to general surgery, whereas in larger centres this is the domain of plastic surgery. General surgical trainees often do not have adequate exposure to complex skin excisions prior to placement in regional centres. Objective: To explore what factors affected positive margin rates in surgical registrars in a regional setting. Design: Retrospective audit. Setting: Large teaching hospital (referral centre). Participants: All skin lesions excised under local anaesthetic by registrars at a single referral centre over a 30‐month period from 2007 to mid 2009, of these only basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) were analysed. Results: Registrars excised a total of 703 skin lesions, 314 (43.4%) were BCC or SCC, and of these 50 (15.9%) had positive margins. Repeated measures multivariable logistic regression was performed on relevant data. Surgical registrars had significantly higher positive margin rates when operating unsupervised (P = 0.014). Although not significant, there was a tendency for BCC excisions to have positive margins (P = 0.059). There was no statistical difference when comparing lesions excised on the head compared to body, use of a graft/flap or registrar training level. Conclusion: This study's positive margin rate of 15.9% falls within the range reported in the literature (0.7% to 20.7%); however, this has the potential to be further reduced. Surgical registrars excising skin lesions in regional centres, regardless of level of training, should have closer supervision. Regular surgical audit should be done so registrars can have early feedback on performance. [ABSTRACT FROM AUTHOR]

This study compares the mechanical properties of locking Kessler and four-strand flexor tendon repairs and examines for difficulties related to technical ability. Two trainee surgeons each carried out 10 locking Kessler and 10 four-strand single-cross flexor tendon repairs on an in vitro porcine model. Outcome measures included gap formation and ultimate forces, operative time and repair bulk. Ultimate force was 81% greater for the four-strand repair compared to the Kessler (52N, SD 5, versus 29N, SD 6). Operating times were similar between the two techniques (Kessler 10.0minutes, four strand 10.1minutes). Rupture force and operating times improved slightly during the study for the Kessler repairs, but in the four strand repairs results remained stable throughout the study. We conclude that the single-cross four-strand repair tolerates superior loads yet is no more technically demanding than the modified Kessler, and can be reliably performed without additional operating time. [Copyright &y& Elsevier]

Objective: Few studies examine the impact of surgical trainee involvement on tumor-free margins in breast conserving surgery (BCS). Our objective was to investigate the impact of resident and fellow involvement on positive margins rates following BCS for invasive breast cancer (BC)., Design: We identified female patients who had BCS for BC between January 2005 to December 2015., Setting: Tertiary care hospital., Participants: Around 1089 patients were identified from a prospectively maintained database., Results: Of 1089 patients, mean age was 63 (range 43-99) years. Around 768 patients (70.1%) required preoperative localization, and 328 patients (29.9%) had a palpable cancer. Nonpalpable cancers had a smaller volume of specimen tissue excised (p = 0.0005) compared to palpable cancers, and no significant difference was observed in the positive margin rate between the nonpalpable group compared to the palpable group (24.7% nonpalpable vs. 25.3% palpable, p = 0.88). Nonpalpable cancer positive margin rates were 23.9% (n = 102/427) for cases performed by an attending surgeon, 25.0% (n = 15/60) with a junior resident (PGY 2-3), 28.6% (n = 8/28) with a senior resident (PGY 4-5), and 25.7% (n = 65/253) with a fellow, which were not statistically significant (p = 0.89). Palpable cancer positive margin rates were 27.6% (n = 47/170) for cases performed by an attending, 13.9% (n = 5/36) with an intern (PGY-1), 40.9% (n = 9/22) with a junior resident, 0% (n = 0/8) with a senior resident, and 23.9% (n = 22/92) with a fellow, which were also not significantly different (p = 0.07)., Conclusion: Resident and fellow participation in BCS for BC does not appear to impact the rate of positive margins., (Copyright © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: There is a recognized need to develop high-stakes technical skills assessments for decisions of certification and resident promotion. High-stakes examinations requires a rigorous approach in accruing validity evidence throughout the developmental process. One of the first steps in development is the creation of a blueprint which outlines the potential content of examination. The purpose of this validation study was to develop an examination blueprint for a Canadian General Surgery assessment of technical skill certifying examination., Methods: A Delphi methodology was used to gain consensus amongst Canadian General Surgery program directors as to the content (tasks or procedures) that could be included in a certifying Canadian General Surgery examination. Consensus was defined a priori as a Cronbach's α ≥ 0.70. All procedures or tasks reaching a positive consensus (defined as ≥80% of program directors rated items as ≥4 on the 5-point Likert scale) were then included in the final examination blueprint., Results: Two Delphi rounds were needed to reach consensus. Of the 17 General Surgery Program directors across the country, 14 (82.4%) and 10 (58.8%) program directors responded to the first and second round, respectively. A total of 59 items and procedures reached positive consensus and were included in the final examination blueprint., Conclusions: The present study has outlined the development of an examination blueprint for a General Surgery certifying examination using a consensus-based methodology. This validation study will serve as the foundational work from which simulated model will be developed, pilot tested and evaluated., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Poor mental health in junior clinicians is prevalent and may lead to poor productivity and significant medical errors. We aimed to provide contemporary data on the mental health of surgical trainees and identify risk factors relating to poorer mental health outcomes., Methods: A detailed questionnaire was developed comprising questions based on the 36-item short-form health survey (SF-36) and Physical Activity Questionnaire. Each of the questionnaires has proven validity and reliability in the clinical context. Ethics approval was obtained from the Royal Australasian College of Surgeons. The questionnaire was aimed at surgical registrars. We used Physical Activity Questionnaire, SF-36 scores and linear regression to evaluate the effect of putative predictors on mental health., Result: A total of 83 responses were collected during the study period, of which 49 (59%) were from men and 34 (41%) were from women. The mean Mental Component Summary (MCS) score for both sexes was significantly lower than the population mean at ages 25-34 (p < 0.001). Poor satisfaction with one's work culture and a feeling of a lack of support at work were extremely strong predictors of a lower MCS score (p < 0.001). Hours of overtime worked, particularly unpaid overtime, were also strong predictors of a poorer score., Conclusions: Australian surgical trainees reported lower MCS scores from the SF-36 questionnaire compared to the general population. Increasing working hours, unpaid overtime, poor job security, and job satisfaction were associated with poorer scores among trainees. Interventions providing improved working conditions need to be considered by professional training bodies and employers., (Copyright © 2018 Association of Program Directors in Surgery. All rights reserved.)