Journal of surgical education最新文献

Objective: To develop, implement, and evaluate the Mastery of Operative Suturing/Stapling in Intestinal Surgery (MOSIS) curriculum, a longitudinal, simulation-based educational program designed to enhance open intestinal surgery competency and military surgical readiness among general surgery residents.

Design: Curriculum development and assessment study using the ADDIE instructional design framework. Validity was established through expert consensus among trauma and colorectal surgeons and supported through standardized evaluator training and checklist anchoring. Resident performance was measured using binary task checklists and structured technical assessment rubrics. Statistical analyses compared performance across postgraduate year (PGY) levels.

Setting: A single tertiary academic military medical center.

Participants: Thirty-three general surgery residents (PGY-1, n = 11; PGY-2, n = 4; PGY-3, n = 10, PGY-5, n = 8) enrolled in the MOSIS curriculum.

Results: Performance on hand-sewn anastomoses demonstrated significant improvement with increasing training level. For single-layer end-to-end anastomosis, correct task completion increased from 78.6% (PGY-1) to 100% (PGY-5) (p = 0.002). For two-layer side-to-side anastomosis, performance improved from 83.3% (PGY-1) to 100% (PGY-5) (p = 0.001). In contrast, accuracy for stapled anastomoses was uniformly high across all PGY levels, with no statistically significant differences for side-to-side stapled (p = 0.255) or circular stapled configurations (p = 0.293).

Conclusions: The MOSIS curriculum provides a structured, mastery-based framework that effectively develops open intestinal surgery skills among military general surgery residents. Significant PGY-related gains in hand-sewn anastomotic performance highlight the curriculum's educational impact. High stapled performance across levels suggests that targeted emphasis should remain on hand-sewn techniques essential for expeditionary and resource-limited environments. The MOSIS model is feasible, reproducible, and broadly applicable across military surgical training programs as a core component of military-unique curriculum and readiness preparation.

Objective: Racial bias in medical education can affect objective assessment of medical students and residents, especially those who have been historically minoritized and underrepresented in medicine (URM). This scoping review examines the impact of racial bias in evaluation of trainees in Obstetrics and Gynecology (OB/GYN) by mapping the existing literature regarding both racial bias in evaluation and interventions aimed to decrease such bias.

Data sources: The review was registered and conducted with the Open Science Framework. Comprehensive search identified U.S. studies published through April 2025 that evaluated racial bias in the assessment of trainees in OB/GYN and interventions aimed at reducing bias. Databases searched included PubMed, CINAHL, Education Full Text, Embase, ERIC, and Scopus; references and citations of included studies were also reviewed.

Methods of study selection: References were included if they described racial bias in any form of clinical evaluation, assessment of medical knowledge or performance of OB/GYN medical students, residents or fellows, or if they explored strategies to eliminate such bias. References that were narrative, literature review, or contained no data were excluded.

Tabulation, integration and results: Of 1469 studies screened, fifty-nine underwent full-text review, and 16 met inclusion criteria. Three studies analyzed biased linguistic differences in recommendation letters and evaluations. Two studies examined clinical exposure, both finding that minoritized trainees had fewer procedures and hands-on experiences. Nine studies focused on clerkship/clinical grading and evaluations, with 8 reporting lower evaluations for URM students. One found no disparity in objective standardized clinical exam scores by race. Two studies found bias in application and matriculation to OB/GYN residency and fellowship. Fourteen studies proposed recommendations to address disparities; only 1 evaluated implementation, with the evaluated intervention not improving inequity.

Conclusion: Racial bias in assessment of OB/GYN medical students and residents consistently shows negative impacts on historically minoritized trainees. Current literature inadequately addresses effective strategies to mitigate this bias. Future research should prioritize developing and testing targeted interventions aimed at reducing disparities and creating evidence-based institutional policies to ensure equity.

Objective: Effective communication is integral to patient outcomes with communication failure cited as a major cause of medical errors. The comfort level of general surgery residents sharing concerns with supervising attendings and associated factors were investigated.

Design: A cross-sectional survey for general surgery residents with Likert scale, objective-response, and free-response questions was administered. Quantitative data were analyzed with multivariable ordinal logistic regression models.

Setting: General surgery residency programs in the United States.

Participants: A total of 162 general surgery residents from across the country responded.

Results: Of 162 respondents, 159 (98%) acknowledged concerns regarding attendings' decisions at least annually, with 120 (74%) perceiving patient harm from suboptimal decisions. While 161 (99%) supported the importance of escalating concerns, 85 (52%) were uncomfortable speaking up in the operating room. Factors identified as "very important" for speaking up included department culture, rapport with attending, self-perceived medical knowledge, and severity of potential harm to patient (all>50%). Forty-six (28%) respondents received formal communication training. Eighty (49%) respondents were uncertain that program leadership would support raising concerns. Factors associated with increased comfort in speaking up intraoperatively included prior communication training (OR: 2.2; 95% CI: 1.6-4.2, p < 0.01), increased postgraduate year (OR: 4.3, 95% CI: 2.3-8.1, p < 0.01), and male gender (OR: 2.7, 95% CI: 1.5-5.1, p < 0.01). Established escalation protocols and residency program details (location/institution type) were not (p > 0.05).

Conclusions: Not all general surgery residents are comfortable raising patient safety concerns. Resident communication training is associated with increased comfort, and widespread adoption of such curricula may be valuable. However, residency program culture and supervising attending behavior appear to contribute to communication hesitancy. These issues should be addressed with faculty as well as institutional and program leadership.

Objective: Intraoperative video recording (IVR) is a valuable data collection modality for health professions education (HPE) research, and certifying organizations are increasingly adopting video-based operative assessments. No guidelines exist for the collection and use of this data. This scoping review characterizes current use of IVR in HPE research, with a focus on strategic, ethical, and technological considerations, to provide recommendations for future use.

Methods: Two surgeons, 2 education specialists, a resident, and 1 medical student followed Arksey and O'Malley's scoping review approach. Assisted by a librarian, the team utilized a MeSH search strategy to identify abstracts for screening, covering articles between 1991 and 2025. Paired researchers screened abstracts for studies with IVR that took place in the operating room (OR), with learners present. The team then reviewed studies, extracting 29 data points with intermittent check-ins to prevent rater drift. Descriptive statistics summarized IVR use in HPE research.

Results: A total of 7475 abstracts were screened, 291 full-text articles reviewed, 163 met inclusion criteria. Topics addressed included Surgical Performance (61.3%), Assessment (41.7%), and Teaching (33.1%). A total of 31.3% included an educational intervention. Studies included quantitative (94.5%) and qualitative (25.8%) analyses, of oral (21.5%) and/or nonverbal (10.4%) communication. Field of view was most frequently endoscopic (54.6%); 65.0% of studies included no audio. A total of 73.8% of studies reported Institutional/Ethics Review Board (IRB) status (Exempt 13.5%, Full Review 19.6%, "Approved" 39.9%). Consent was variably obtained from study participants and patients.

Conclusions: Researchers relied heavily on laparoscopic video which cannot capture body position, team interactions, teaching, or equipment use. We recommend precise reporting on how IVR data are collected, including information about recording devices and their placement in the OR, for study quality and reproducibility. Consent and IRB processes should be fully detailed. IVR can be better leveraged to study research questions about intraoperative teaching or communication, nonverbal cues essential for learning through thoughtful choices about theoretical guidance.

Objective: Surgical training is demanding and can be isolating, placing residents at risk for burnout and attrition. A strong sense of belonging and supportive relationships with peers and faculty are protective, promoting well-being and retention. We implemented an Incoming Intern Grand Rounds Quick Talk session to foster belonging by allowing interns to introduce their personal identities to the Department of Surgery at the start of residency.

Design: Incoming general, plastic, and vascular surgery interns delivered brief introduction presentations highlighting their backgrounds, research, hobbies, and passions during Department of Surgery Grand Rounds. Interns received a template, sample presentations, and individualized practice sessions with feedback before the event. A one-month post-session survey assessed perceived impact on belonging, connections, and departmental culture.

Setting: Department of Surgery, University of California, San Francisco.

Participants: Twenty-one incoming surgery interns (16 general [8 categorical, 8 preliminary], 4 plastic, and 1 vascular).

Results: All interns reported that the session contributed positively to departmental culture, improved their transition into residency, helped them feel more connected to their co-interns, and should be continued for future cohorts. Most interns felt that their presence and story were valued, they were seen as more than just their role of intern, and the session provided a sense of belonging. Qualitative responses revealed recurring themes of appreciation for being known beyond clinical roles, strengthened cohort connection, gratitude that the Department learned about them as individuals, and a culture of welcome and value.

Conclusions: A structured introduction session at Grand Rounds was well-received by incoming interns and fostered a sense of belonging, connection, and value within the department. This simple, scalable intervention may help surgical programs build community, reduce isolation, and support resident well-being from the outset of training.

Background/objective: During general surgery residency, 32% to 64% of male residents have children. Despite this, the parental leave experience for the nonchildbearing general surgery resident parent is not understood. Concerns have been expressed that parental leave negatively impacts resident training and careers. However, multiple studies have shown that residents with children do not report fewer operative case numbers, lower board examination pass rates, lower in-service examination scores, differences in academic productivity, or pursuance of fellowship training. This study aims to describe educational and career impacts from parental leave and parenthood as perceived by the nonchildbearing resident parent.

Design/setting/participants: Zoom interviews (n = 20) were conducted (August 2021-March 2022) with current general surgery residents or fellows in the United States who had at least one child during residency as the nonchildbearing parent. Interviews explored participants' experiences with impacts on training/education, career paths, and career satisfaction. Interviews were transcribed verbatim and analyzed using thematic content analysis. Univariate analysis was used to analyze participant demographics.

Results: All twenty were males with female partners who gave birth. Participants felt taking parental leave did not negatively impact their education or training, regardless of when they had children (research or clinical time). However, fear of potential negative consequences influenced many to take a shorter duration of leave; only 25% were satisfied with their duration of leave while 45% took leave using vacation time. Impacts on career path and career satisfaction were variable among participants.

Conclusions: Overall nonchildbearing general surgery resident parents do not perceive a negative impact on their education due to parental leave or parenthood. The majority of residents were not satisfied with their duration of leave. Optimal duration of parental leave for residents to be satisfied without a negative impact on their education remains unknown.

Objective: The role of the surgical trainer is critical in the development and training of surgeons of the future. Despite this, the majority of research in this area focuses on the views of the trainees. There is very little, or in some cases no research, into which practices make good surgical training, or what good modern surgical training looks like according to the trainers. This research looked to fill this gap.

Design: A constructivist exploratory approach was used. Semi structured interviews were conducted. Interviews continued until it was felt that sufficient information power had been achieved. Reflective thematic analysis was then applied using Braun and Clarke's 6 step technique.

Setting: Ninety-minute interviews were conducted over Microsoft teams, over a 3-month period General Surgery Consultants who self-identified as trainers from Yorkshire and Humber School of Surgery were recruited on a voluntary basis.

Results: Four main themes were identified, "Trainees are responsible for their own training," "The best training happens in positive relationships," "Learning to operate is the easy bit" and "Trainers are not empowered to train."

Conclusion: Participants emphasized trainee responsibility for proactive learning whilst simultaneously describing structural constraints limiting their capacity to deliver desired training. This tension may reflect broader contradictions in how training responsibilities are understood within current systems. Participants identified resource limitations, particularly time and access to training funding, as barriers beyond their control. However, perceptions that training produces "reasonable" consultants may reduce urgency for systemic change. Findings suggest that meaningful improvement in surgical training may require both institutional changes-such as formal recognition and resourcing of training activities-and collective advocacy by trainers themselves to address structural barriers. Given this study's single-region focus, further research across multiple regions and specialties would strengthen understanding of whether these perspectives reflect wider patterns in UK surgical training.