Journal of Surgical Education最新文献

Objective

Negative stereotypes associated with surgery by medical students are well documented in literature. Many cite long hours, poor work-life balance, pessimism, mean personalities, and cynicism as pervasive among surgeons and operating room culture. If allowed to persist, these negative perceptions can deter otherwise interested students from pursuing surgical subspecialties.

Design

Incorporation of peer-teaching in the third-year clerkship to not only illuminate the hidden curriculum in surgery but adequately prepare students to participate in the operating room is paramount to taking steps to improve student perception as well as success as clerkship students.

Setting

An academic medical center.

Participants

Pre-clinical medical students.

RESULTS

One-hundred and forty-three third year clerkship students were surveyed with pre- and postinstruments. Students who participated in these pre clerkship peer-teaching sessions reported significant improvements in their ability to identify surgical anatomy (p < 0.001), an increased confidence in answering questions from attendings about anatomy and function as well as in identifying anatomical abnormalities (all p < 0.001). Students also reported significantly improved perceptions about surgeons as teachers and their willingness to support students pursuing surgery.

CONCLUSION

This study demonstrates that the incorporation of an immersive orientation prior to the start of the surgery clerkship has significantly positive impacts on the learning experience and confidence of medical students. Increased efforts should be made to introduce students to surgeons, surgical careers, and the operating room prior to the surgery clerkship, being sure to incorporate aspects of the hidden curriculum, to address the negative perceptions that continue to exist regarding surgical fields.

OBJECTIVE

Following the transition to virtual interviews in 2021, interviewees began receiving gifts as a recruitment strategy in lieu of the preinterview dinner. This study characterizes quantity, type, and frequency of gift receipt in relation to program perception and ranking.

DESIGN

An anonymous survey study was conducted. Variables included demographics, interview modality, gift type, frequency of gift receipt, monetary value, and changes in program perception and ranking. Descriptive analyses and Pearson's chi-square testing were performed.

SETTING

Single institution with a medium to large general surgery program size.

PARTICIPANTS

All general surgery residents at the single institution without exclusion.

RESULTS

About 25 residents responded (60% response). Two respondents (8%) participated in both in-person (IPIs) and virtual interviews (VIs). About 72% (n = 18) participated in VIs, 36% (n = 9) IPIs. About 68% matched in 2021 or later. Overall, 76% received a gift during interviews. 100% of IPIs received a gift, while 67% of VIs received a gift. 88.9% of IPIs received a meal. VIs received: meal shared (28.6%), meal not shared (14.3%), food-specific gift card (28.6%), other food items (21.4%), or other (7.1%). About 66.7% of IPIs (n = 6) reported 76% to100% of programs offered a meal, whereas no VIs reported 76% to 100% of programs offering (p = 0.0002). VIs were less likely to have a shared meal experience (p = 0.017). About 55.5% of IPIs and VIs received nonfood gifts. Residents’ perception of a program's interest, resources, and ranking of the program were not significantly different based on gifting.

CONCLUSION

Virtual interviews introduced heterogeneity in the receipt of gifts. The impact of a variable gifting experience is uncertain but raises concern for a potential new source of bias in the recruitment process.

OBJECTIVE

Our study investigated the effects of surgical training on residents’ personal relationships. It aimed to address the gaps in understanding of how the surgical training commitment can influence relationship stability, decision-making, and life planning within this unique professional group.

DESIGN

We used cross-sectional survey methodology to gather data on the intricacies of relationship dynamics amid the rigors of surgical training. The survey focused on marital status, relationship dynamics, personal life choices, the challenges and rewards of dual-healthcare relationships, and the support networks that individuals and couples rely on.

SETTING

All surgical departments at The Johns Hopkins Hospital.

PARTICIPANTS

The study comprised 111 participants, including residents, fellows, and attending surgeons. Of those reporting sex, 56/105 (53%) were female, and the predominant age category was 25 to 34 years, making up 61/104 (59%) of respondents.

RESULTS

The majority (73/105, 70%) of respondents were or had been married, and 50/96 (52%) had partners in the medical field. Among those in a dual-healthcare relationship, 38/46 (83%) reported that their relationship was strengthened through understanding and empathy, yet 37/46 (80%) acknowledged complications in work-life balance. However, women were significantly more likely than men to report at least one negative effect of a dual-healthcare relationship (84% [16/19] versus 22% [6/27], p = .003). Among those with partners outside medicine, 39/46 (85%) acknowledged that their partner had to adjust their lifestyle significantly. A considerable number (73/92, 79%) postponed life events such as starting a family, and 57/85 (67%) experienced relationship strain due to long working hours.

CONCLUSIONS

Residents in dual-healthcare couples derived support from their relationships, but surgical training placed a significant strain on residents’ personal relationships and often prompted residents to postpone major life events such as starting a family. Enhanced support systems and targeted interventions are needed to assist surgical professionals in navigating the complexities of balancing a demanding career with personal life.

The residency match process can be overwhelming. We are the Collaboration of Surgical Education Fellows (CoSEF), a multi-institutional group of surgical residents. Our perspectives represent our current experiences as residents at academic programs, but all authors recently underwent the general surgery resident interview and match process, during which they interviewed at programs of all kinds. Based on our collective experiences, we aim to highlight program attributes that applicants should consider to find their perfect match.

OBJECTIVE

The transition of Step 1 to pass/fail has generated concerns over selecting promising candidates. Holistic reviews integrate other proficiencies, including extracurriculars such as sports. Grit – defined as perseverance and passion for long-term goals – has been positively associated with competitive activities and is predictive of academic success. The prevalence and impact of sports participation and its relationship to grit in the general surgery resident population has not been described and was investigated in this study.

DESIGN

Surveys measuring sports participation and grit were distributed after the 2021 ABSITE. Grit was assessed through the short grit scale. Inferential statistics were performed.

SETTING/PARTICIPANTS

General surgery residents in all US training programs who completed the 2021 ABSITE.

RESULTS

Of 5468 respondents (response rate 59.6%), 2,548 (46.7%) were female, 917 (17.4%) URiM, 2171 (39.8%) married, and 1,069 (19.6%) parents. About 4284 (83.8%) residents reported being involved in competitive sports. Grit was higher in residents with a competitive sports history (3.67 ± 0.58 versus 3.60 ± 0.61, p = 0.0022). Greater time commitment and being part of a team was positively correlated to grit (both p < 0.0001). Individuals that self-identified as underrepresented in medicine (URiM) had higher grit (3.71 ± 0.59 versus 3.65 ± 0.58 for non-URiM, p < 0.0001) as did female (p = 0.0016), married residents (p < 0.0001), and parents (p < 0.0001). Being an athlete was associated with significantly higher grit for nearly all demographic subgroups, including URiM (p = 0.0068), married (p = 0.0175), and parents (p = 0.0487).

CONCLUSIONS

Higher grit was found in athletes and marginalized groups including females, URiM, and residents that were married or parents. Our data suggests that recruiting applicants of diverse backgrounds and experiences will result in a grittier cohort; a group potentially equipped to weather the arduous surgical residency training path. Recruiting residents with characteristics associated with higher grit can potentially impact diversity of the surgical workforce.

OBJECTIVE

Gossip—evaluative talk about an absent third party—exists in surgical residency programs. Attending surgeons may engage in gossip to provide residents with feedback on performance, which may contribute to bias. Nevertheless, the perspectives of attending surgeons on gossip has not been studied.

DESIGN

In this qualitative study, semi-structured interviews about gossip in surgical training were conducted with attending surgeons. We performed a reflexive thematic analysis of transcripts with a grounded theory approach to describe attendings’ perceptions of their role in gossip within surgical residency.

SETTING

Interviews were conducted from September 23, 2023, to November 27, 2023 via Zoom™.

PARTICIPANTS

Eighteen surgery attendings associated with 7 surgical training programs were interviewed.

RESULTS

Six themes were developed: 1) Attendings typically view gossip with a negative lens; thus, well-intended conversations about resident performance that meet the academic definition of gossip are not perceived as gossip; 2) Gossip can damage attendings’ reputations as surgeons and educators; 3) Mitigating the negative impacts of gossip by maintaining accurate and objective standards of honest communication is hard; 4) Attendings express concerns about hearing other attendings’ impressions of residents prior to formulating their own opinion; 5) The surgical hierarchy restricts the volume and content of gossip that reaches attendings, which may limit their knowledge of program culture; and 6) It is very difficult to mitigate gossip at the program level. Ultimately, attendings utilize gossip (e.g. triangulating their experience) with the goal of providing residents feedback.

CONCLUSIONS

Defining important conversations about resident performance as gossip should not discourage these critically important conversations but rather underscore the importance of combating harmful gossip through 3 behaviors: 1) committing to objective communication; 2) limiting or reframing information about resident performance that is shared with attendings who have yet to formulate their own opinions; and 3) regulating gossip in particular high-stakes microenvironments (e.g. the operating room).

Introduction

Training at a tertiary center offers clerkship students the opportunity to rotate through a wide range of surgical specialties that may not be otherwise available. At our institution, students rotate through general surgery for 3 out of 9 weeks, with the remainder offering electives. As a result, students may have limited experience with core general surgery cases which are necessary to complete by the end of the clerkship to demonstrate competency. In efforts to standardize clinical training, students must log 11 core general surgery cases either in the operating room or modules via Wise-MD. Wise-MD is used in place of participating in the operating room when students do not have the opportunity to see certain cases during their surgical rotation. The purpose of the study is to ascertain what proportion of third year medical students experience core general surgery cases in the operating room versus Wise-MD, providing insight into ways to improve the surgical clerkship.

Methods

Clerkship students recorded whether surgical cases are completed via Wise-MD or experienced in the operating room. Forms submitted by students who completed surgical clerkship between January 2018 to September 2022 were analyzed. For each core surgical case (anorectal, appendicitis, bowel obstruction, breast cancer, cholecystitis, colon cancer, diverticulitis, inguinal hernia, lung cancer, skin cancer, and trauma) students were stratified based on their reported experience. The proportion of Wise-MD versus operating room cases was calculated.

Results

Between January 2018 and September 2022 a total of 411 students submitted completed case logs. Among all surgical cases, 60% were experienced by students in the operating room. The surgical cases with the highest proportion of operating room experience included appendicitis (78%), cholecystitis (85%), inguinal hernia (79%), and trauma (76%). The surgical cases with the lowest proportion of operating room experience included lung cancer (34%) and skin cancer (44%).

Conclusion

Despite enforcing a general surgery block, about 40% of students are not experiencing most “bread and butter” surgical cases. Clerkship directors should be mindful about the distribution of medical students among surgical teams as this may affect which cases are observed. Moreover, the opportunity for surgical electives may influence general surgery exposure.

OBJECTIVE

To determine the ability of surgical trainees and faculty to correctly interpret entrustability of a resident learner in a modeled patient care scenario.

DESIGN

Prospective study utilizing a web-based survey including 4 previously-recorded short videos of resident learners targeted to specific levels of the American Board of Surgery's (ABS) Entrustment Scale. Respondents were asked to choose the entrustment level that best corresponded to their observations of the learner in the video. Responses were subcategorized by low and high entrustment.

SETTING

Online, utilizing the Qualtrics survey platform.

PARTICIPANTS

Survey targeting US surgical trainees and surgical faculty via email and social media. We received 31 complete responses and 2 responses which completed > 1 video assessment question without demographic information (n = 33). Respondents included 10 trainees (32%) and 21 attending surgeons (68%).

RESULTS

Neither faculty nor trainees readily identified the targeted entrustment level for Question 1 (preoperative care of a patient with acute appendicitis with high entrustment, 36% correct), though evaluations of the remaining questions (2 through 4) demonstrated more accuracy (70, 84, and 75% correct, respectively). Faculty were more readily able than trainees to identify low entrustment (level Limited Participation) in intraoperative inguinal hernia repair (95% vs 60%, p = 0.03). After subcategorization to high and low entrustment, both residents and faculty were able to accurately identify entrustment 95% overall.

CONCLUSIONS

Both trainees and attending surgeons were able to identify high- and low-performing residents on short video demonstrations using the ABS EPA entrustment scale. This provides additional evidence in support of the need for frequent observations of EPAs to account for the variability in raters’ perceptions in addition to complexity of clinical scenarios. Frame-of-reference training via a video-based platform may also be beneficial for both residents and faculty as an ongoing EPA implementation strategy.