OBJECTIVE:To develop a group of "Junior Key Indicator Procedures" (JKIPs) for junior residents to facilitate tracking and development of basic skills necessary for success in more advanced procedures. DESIGN:ACGME case logs for Oto-HNS residents at the University of Wisconsin were reviewed between 6/24/2016 and 6/23/2023. Procedures logged as "Resident Surgeon" or "Resident Supervisor" were included, analyzed using the procedure "Type" category, and compared by post graduate year (PGY). Quantitatively, procedure types were assessed by comparison of mean and variance of operative experience trajectory (time to 50% of case experience) against KIPs. Growth curves of operative experience were constructed for each proposed Junior Key Indicator Procedure (JKIP). SETTING:University of Wisconsin-Madison, a tertiary care center with an Otolaryngology-Head & Neck Surgery Residency training program. PARTICIPANTS:The case log data of 18 residents over 7 years was retrospectively reviewed. RESULTS:Case logs of 18 residents (29,457 case entries) were analyzed. Analysis resulted in nine JKIPs with adequate volume, reliability, sub-specialty representation, and linkage with KIPs: tracheostomy, tympanoplasty without ossicular chain reconstruction (OCR), myringotomy/tympanostomy, resection skin lesion & primary closure, repair complex laceration, endoscopic sinus surgery, tonsillectomy and adenoidectomy, septoplasty, and rigid laryngoscopy w/wo biopsy. CONCLUSIONS:Oto-HNS residents complete most KIPs in PGY 4-5. A subset of procedures that are commonly completed by junior residents (PGY 1-3) has been identified for use as JKIPs. A set of models were developed to evaluate junior resident experience with the JKIPs.
Objective To evaluate general surgery resident competence in adrenalectomy using national case log data and qualitative resident feedback to identify actionable training gaps. Design A mixed-methods analysis of Society for Improving Medical and Professional Learning (SIMPL) national case evaluations and semistructured interviews with general surgery residents. SIMPL data included faculty- and resident-reported assessments of performance, autonomy, and case complexity for laparoscopic and open adrenalectomies. Logistic regression modeled predictors of competent performance and meaningful autonomy. Interview transcripts were coded using content analysis to identify themes related to perioperative knowledge and skill gaps. Setting SIMPL data for quantitative analysis came from a national database, and semistructured interviews took place at a single academic center. Participants For quantitative analysis of SIMPL evaluations, participants included general surgery residents across all residency programs participating in the SIMPL system from 2015 to 2023. For qualitative analysis of semistructured interviews, participants included postgraduate year (PGY)-3 to PGY5 residents. Results A total of 317 adrenalectomy cases (265 laparoscopic, 52 open) were analyzed, including 225 residents who completed an average of 1.4 adrenalectomies each (SD = 0.84). Competent performance was observed in 41.7% of laparoscopic and 32.6% of open cases, while meaningful autonomy occurred in 37.4% and 13.5%, respectively. PGY5 residents demonstrated a 47.2% predicted probability of competent performance and 45.9% probability of meaningful autonomy. Agreement between resident and faculty ratings occurred in 45.9% of competency and 58.2% of autonomy assessments, with residents underestimating their performance in 44.1% of cases. Fourteen resident interviews revealed limited exposure to adrenal surgery, variability in intraoperative autonomy, and persistent knowledge gaps in postoperative management—particularly steroid replacement and long-term surveillance. Conclusions General surgery residents infrequently achieve competence or autonomy in adrenalectomy by graduation and often underestimate their abilities relative to faculty assessments. Resident-reported data highlight insufficient longitudinal exposure and perioperative management knowledge gaps. These findings underscore the need for resident-informed training interventions and support the role of fellowship training for surgeons intending to perform adrenal surgery independently.
OBJECTIVE:Adverse events are inevitable in neurosurgical practice and may have significant emotional and professional implications for surgeons. While second victim experiences have been increasingly recognized, the role of professional grief remains insufficiently characterized within the field of neurosurgery. This study aimed to examine professional grief as a component of the second victim experience and its associations with distress, support dimensions, educational needs, and professional sustainability. METHODS:We conducted an international, cross-sectional, anonymous web-based survey among neurosurgeons and neurosurgical trainees. Professional grief related to a personally impactful adverse event was assessed retrospectively using the Professional Bereavement Scale-Short-term Bereavement Reactions Subscale (PBS-Acute); scores therefore reflect retrospectively recalled acute grief responses rather than contemporaneously measured reactions. Second victim dimensions were evaluated with the Second Victim Experience and Support Tool-Revised (SVEST-R). Associations among grief severity, second victim dimensions, and professional sustainability indicators were analyzed using correlation and multivariable regression. RESULTS:Of 465 respondents from 49 countries, 314 completed the survey and were included in the analysis. A total of 240 participants (76.4%) reported a personally impactful adverse event. Professional grief severity was substantial among respondents (PBS-Acute mean 37.9 ± 13.8) and was strongly correlated with psychological distress (ρ = 0.71, p < 0.001). Higher grief severity was independently associated with increased turnover intention (β = 0.026, p < 0.001). Perceived preventability and primary surgeon role were associated with higher grief severity, while event timing and seniority were not. Supervisor support was inversely associated with grief severity. Participants reported substantial unmet educational needs related to medicolegal processes, communication with patient families, and grief coping skills. CONCLUSIONS:Among surveyed neurosurgeons who described a personally impactful adverse event, professional grief was frequently reported. Professional grief in this sample was associated with second victim experiences, psychological distress, and indicators of professional vulnerability. These cross-sectional associations suggest that professional grief may warrant consideration in structured educational models and tiered support systems within neurosurgical training and institutional practice. Prospective work is needed to clarify the direction and durability of these relationships and their implications for professional sustainability.
OBJECTIVE:Due to the coronavirus disease 2019 (COVID-19) pandemic, the Association of American Medical Colleges (AAMC) required that residency interviews be conducted virtually, instead of the traditional in-person format. Previous survey studies have indicated that vascular surgery (VS) residency applicants favor remote interviews, noting sufficient exposure to the program, location and residents, with minimal travel-related cost and time burden. However, the overall impact of the virtual interview on objective measures of VS residency match have not been examined. DESIGN:Residency application and match-related data were collected from National Resident Matching Program (NRMP) Main Residency Match reports. In-person interview cycles (2010-2019) were compared with virtual interview cycles (2020-2024). Metrics of VS specialty popularity included total applicants per position and position fill rate. Metrics of VS competitiveness included overall match rate, first-choice match rate, and proportion of unmatched applicants. SETTING:NRMP interview cycles from 2010 to 2024. PARTICIPANTS:All VS residency applicants from 2010 to 2024. RESULTS:The total number of VS programs (68.8 ± 7.9 vs 42.3 ± 11.2), positions (86.2 ± 10.2 vs 48.8 ± 14.3), and applicants (164.8 ± 10.6 vs 96.3 ± 18.3) were significantly higher during the virtual interview cycles (p < 0.001 each). Similar increases were noted in total ACGME-accredited programs, positions, and applicants (p < 0.001 each). Measures of VS specialty popularity, including applicants per position (1.9 ± 0.3 vs 2.1 ± 0.5, p = 0.54) and position fill rate (99.1% ± 1.1% vs 97.2% ± 2.9%, p = 0.20), remained unchanged when comparing in-person and virtual interview cycles. In comparison, the proportion of applicants per position (1.8 ± 0.0 vs 1.9 ± 0.1) and position fill rate (93.9% ± 0.8% vs 95.9% ± 0.5%) across all ACGME-accredited programs were both significantly lower during the virtual interview years (p < 0.001 each). At the same time, the percentage of overall applicants applying into VS increased from 0.18% (±0.03%) to 0.26% (±0.02%) in the virtual era (p < 0.001). Three metrics for specialty competitiveness were also examined. For VS residency programs, overall match rate (52.0% ± 7.1% vs 48.7% ± 10.2%, p = 0.53) and percentage of unmatched applicants (48.0% ± 7.1% vs 51.3% ± 10.2%, p = 0.53) remained unchanged, whereas the proportion of applicants matching at their first choice (41.5% ± 2.9% vs 59.2% ± 13.5%, p = 0.01) was lower during the virtual interview cycles. In comparison, overall match rate was greater (53.2% ± 0.8% vs 49.3 ± 2.1%) and the proportion of unmatched applicants were lower (46.8% ± 0.8% vs 50.7% ± 2.1%, p = 0.001) across all ACGME-accredited programs during the virtual interview years. CONCLUSIONS:The study period of virtual recruitment saw no change in VS popularity, suggesting that this approach does not detract interested applicants. However, VS did become a more competitive residency, with fewer applicants matching at their first choice. Potential hybrid approaches, such as the protocol described within the VISIT trial, may offer viable alternatives that capitalize on the strengths of both virtual recruitment and face-to-face engagement.
OBJECTIVE Self-regulated learning (SRL) enables learners to take ownership of their development. While prior studies have described SRL in surgical training through theoretical frameworks, how senior residents enact SRL in everyday clinical practice remains underexplored. This qualitative study examines how surgical residents operationalize SRL within the perioperative clinical environment. DESIGN We conducted a qualitative study using semistructured interviews and a supplementary survey assessing the frequency of SRL strategy use. Directed content analysis was applied to transcripts to map strategies across the 3 phases defined by Zimmerman’s framework of SRL: forethought, performance, and self-reflection. SETTING The study was performed at a single academic quaternary medical center. PARTICIPANTS Fourteen senior surgical residents representing 6 specialties participated. They included residents within 1 to 2 years of graduation and those in dedicated research time, all of whom have completed at least 3 years of clinical training. RESULTS Residents described employing a range of SRL strategies across the forethought, performance, and self-reflection phases. Forethought strategies included case preparation, mental rehearsal, and goal setting. During the performance phase, residents engaged in active inquiry, observational learning, and real-time self-monitoring in the operating room. In the self-reflection phase, residents utilized written, verbal, and mental reflection, attributed causes to errors and complications, and adapted their future practice accordingly. Time constraints shaped how residents engaged in SRL, often favoring efficient, opportunistic strategies embedded within clinical workflow. CONCLUSIONS Surgical residents engage in SRL across the perioperative period, though these processes are often variably recognized as SRL. Establishing a shared understanding of SRL and addressing structural barriers, such as time constraints, may support more deliberate and consistent learning in surgical training.
BACKGROUND:International Medical Graduates (IMGs) comprise approximately a quarter of the U.S. physician workforce and play a critical role in healthcare delivery. Despite their contributions, IMGs often face unique challenges when transitioning into residency. These include adapting to new healthcare systems, clinical workflows, and cultural environments. Few studies, however, have investigated the challenges of this transition or proposed actionable strategies to mitigate the stress. METHODS:We conducted a single-center, cross-sectional needs assessment at a large academic medical center. Surveys were distributed to 2 groups: current residents, and faculty. Participants were asked to identify their primary concern regarding the IMG transition and to identify the top 3 challenges for IMGs across domains including professional/system-based factors, social/cultural adaptation, and personal wellbeing. Responses were analyzed descriptively, with subgroup comparisons between IMGs, American Medical Graduates (AMGs) and faculty. RESULTS:A total of 75 current residents (12 IMGs, 63 AMGs) completed or partially completed the survey. IMGs more frequently identified challenges related to adapting to the U.S. healthcare system, electronic medical record (EMR) use, and cultural differences within the team. In contrast, AMGs concerns more commonly related to work-life balance and specialty-specific knowledge. A total of 27 faculty members responded; their perspectives aligned with sentiments of the IMGs and emphasized the need for structured onboarding, targeted training, and longitudinal mentorship. CONCLUSIONS:IMGs experience distinct and multifactorial challenges during the transition to residency which span professional, social, and personal domains. Institutional recognition of these stressors is essential, as generalized onboarding programs alone appear insufficient to address IMG-specific needs. Tailored orientation programs, early systems-based training, and structured mentorship may help bridge this gap and improve both trainee experience and clinical integration.
OBJECTIVE:To address high burnout and professional challenges among general surgery residents, attendings, and advanced practice providers (APPs) by implementing a sustainable, departmentally funded performance coaching framework designed to foster leadership, emotional regulation, and work-life integration. DESIGN:A four-year retrospective programmatic evaluation (academic years 2020-2021 through 2023-2024). The framework utilized core 1:1 confidential coaching sessions, all-resident group workshops (e.g., Executive Presence, Bailout Planning, Self Advocacy), departmental grand rounds (Change Management, Healthy Compartmentalization), and PGY-specific sessions (PGY-1 transitions, Leadership Lab). Participation was voluntary and promoted via announcements. Engagement metrics were tracked prospectively via session logs, and anonymized participant feedback was evaluated iteratively to refine curricular content. SETTING:Department of Surgery at a single large academic medical center located in the Northeast United States. PARTICIPANTS:General surgery residents (PGY 1-5), attending surgeons, and surgical APPs. The eligible departmental pool expanded from 49 residents in Year 1 to 50 residents, 53 attendings, and 56 APPs in Year 4. RESULTS:From 2020-2024, allocated 1:1 coaching hours increased 47% (85 to 125), and total encounters grew from 41 (all residents) to 130 (59 resident sessions, 54 attending sessions, and 17 APP sessions). Qualitative themes revealed evolving role-specific needs: residents focused on strategies for task prioritization, difficult conversations, and expectation-reality gaps, showing increased self-awareness and proactive support-seeking over time; attendings addressed "golden handcuffs" (feeling constrained by career success), institutional change navigation, and professionalism, with growing openness to wellness; and APPs emphasized leadership development, burnout prevention ("burning the candle at both ends"), and role ambiguity, reporting actionable behavioral changes post-coaching. Strengths include an infused culture of wellness and the ability to promote coaching as added value to incoming trainees. CONCLUSIONS:This four-year experience establishes a scalable performance coaching framework that enhances engagement and supports work-life integration across all departmental roles. The model begins with core 1:1 coaching and group workshops, uses monthly qualitative feedback to tailor content dynamically to emerging stressors, and expands organically through sustained participant buy-in. Academic institutions can adopt this blueprint to support retention, morale, and professional behaviors in surgical education, with year-over-year utilization growth serving as a primary marker of program value and cultural acceptability.
OBJECTIVE:In recent years, the general surgery residency match has experienced "application inflation"; applicants are submitting more applications, burdening applicants and program directors. To address this, preference signaling was introduced, allowing applicants to express targeted interest in a select number of programs. While preference signaling has been implemented in other specialties, its impact on general surgery applicants' experiences, perceptions, and Match outcomes is underexplored. This study surveyed general surgery residency applicants to evaluate their experience with preference signaling in the 2024 to 2025 match cycle. DESIGN:We distributed a cross-sectional, anonymous survey to general surgery residency applicants who applied to a cohort of 12 New England programs. Survey responses captured demographics, signaling use, mentorship, and satisfaction with preference signaling. Quantitative data were analyzed using descriptive and inferential statistics. Qualitative responses underwent inductive coding followed by thematic analysis. SETTING:12 New England general surgery residency programs. PARTICIPANTS:General surgery residency applicants. RESULTS:Of 107 respondents: 57.9% were female, 41.1% were underrepresented in medicine (URiM), and 34.9% were international medical graduates (IMGs). The median number of signals used was 15 (maximum). U.S. MDs averaged 13.7 interviews while IMGs averaged 4.5 (p < 0.001). Overall, 52.3% matched to a signaled program. Less than half (44.9%) believed that signaling helped secure interviews, and 59.8% wished they had signaled different programs. Furthermore, 63.6% regretted some of the signals they sent. While 57.9% found the 15-signal limit to be adequate, the process carried an emotional toll, with 43.0% reporting increased stress. Regarding equity, perceptions were split; URiM and non-URiM applicants perceived equity benefits at similar rates (27.3% vs. 25.9%), while IMGs perceived lower equity overall. Qualitative themes included unclear strategy, inconsistent mentorship, and calls for greater transparency regarding how individual programs incorporate signals into their review process. CONCLUSION:Applicant perspectives on preference signaling were mixed to negative; many found it highly stressful, only moderately effective, and laden with postmatch regret. Perceived equity varied significantly among applicant types. These findings suggest a pressing need for clarity, stronger mentorship, and potential adjustments in how programs value and communicate signals to reduce applicant burden.
OBJECTIVES:To determine faculty perceptions of feedback delivery, EPA completion, and narrative feedback provision. To evaluate barriers to EPA completion and narrative feedback, as well as potential solutions to these barriers. DESIGN:A survey was sent to surgical faculty that asked about feedback delivery, EPA completion, and barriers to completion of EPAs or narrative feedback. Both free response and multiple-choice questions regarding barriers were included. Faculty responses were analyzed for perception of feedback completion verbally and through EPAs. Inductive thematic analysis was performed for free response questions regarding barriers to EPA completion and possible solutions. SETTING:Two large, academic general surgery residency programs. PARTICIPANTS:Faculty at two academic institutions who work with general surgery residents and complete EPA evaluations. RESULTS:Survey response rate was 57.9%. Most surgeons participating were male (68.8%) and had been in practice at least 20 years (37.1%). Faculty reported providing verbal intraoperative feedback a median of 91.5%, but only completing EPAs a median of 25% of the time. They reported providing EPA narrative feedback a median of 50% of the time. The greatest barriers to EPA completion were reported as lack of resident requests for EPAs and completion not being within their normal workflow. Barriers to providing narrative feedback within the EPA were time and lack of clear benefit to the feedback. Possible solutions to combat these barriers were improvements to the EPA evaluation app to include a better user interface, reminders, or incorporating prior verbal intraoperative feedback and encouraging residents to take ownership of EPA requests. CONCLUSIONS:Faculty report frequently providing verbal intraoperative feedback, but report completing EPAs and narrative feedback much less often. Implementation should focus on enhancing EPA evaluation apps to improve functionality and providing incentives to make EPA completion a habit and worthwhile use of faculty time.
OBJECTIVE:To develop and evaluate a suturing simulator using Artificial intelligence (AI)-driven computer vision for objective, high-resolution assessment of technical performance in cardiothoracic surgery, applied to a novel 3D-printed simulator across different levels of surgical expertise. DESIGN:Prospective study using a novel 3D-printed suturing simulator with targets positioned at multiple depths and angles relevant to cardiothoracic surgery. Participants performed standardized running baseball sutures on 2 planes while procedural videos and post-completion images were recorded. Supervised machine learning-based video tracking (MediaPipe) and classical image processing were used to derive temporal metrics, hand path length, acceleration variability, movement irregularity, and suture uniformity. These metrics were then compared between attending surgeons and trainees. SETTING:Brigham and Women's Hospital, an academic tertiary care center in Boston, Massachusetts. PARTICIPANTS:Ten attending cardiac surgeons and 10 surgical trainees. RESULTS:AI-assisted video analysis differentiated experts from trainees with high precision. Attending cardiac surgeons performed significantly faster than trainees in needle loading (1.9 seconds vs. 2.5 seconds, p < 0.01) and stitch execution (4.6 seconds vs. 6.4 seconds, p < 0.01), resulting in shorter ring completion times (252 seconds vs. 312 seconds, p < 0.02). Attending surgeons also demonstrated superior motion efficiency and less irregular movements during key maneuvers, characterized by reduced overall path length (6,714 vs. 10,154 mm, p = 0.01), lower average acceleration (20 vs. 25 mm/s2, p = 0.01) and reduced vibrational motion patterns (26,786,414 vs. 56,008,703 mm2/s4, p = 0.01). Image analysis confirmed that attending surgeons produced significantly more uniform sutures with lower variability in inter-stitch distances (standard deviation [SD] 1.72 vs. 2.14 mm, p = 0.02; uniformity 68.9% vs. 63.1%, p = 0.03). CONCLUSIONS:AI-based assessment on an anatomically relevant simulator distinguished experts from novices using granular and mechanistic metrics of suturing skill across AI-segmented motion phases. Experts demonstrated more deliberate, controlled, and smoother movements while completing tasks in less time.
Objective A career in surgery is physically demanding and often leads to musculoskeletal (MSK) discomfort and disease. Optimization of ergonomics in the operating room (OR) can mitigate these risks, but there is a lack of formal education on the matter in surgical training. This Quality Improvement initiative aimed to identify baseline practices and knowledge of ergonomics amongst a cohort of surgical residents and provide targeted education to prevent work-related MSK injuries. Design In this quality improvement study (QI), a pre-education survey gathered demographic information, presence of physical symptoms, and prior knowledge and implementation of ergonomic principles. Participants then received a 30-minute didactic lecture on ergonomics in the OR. A posteducation survey evaluated the lecture’s impact on ergonomic knowledge, intention to incorporate learnings into practice, and barriers to implementation. Setting This study was conducted at the Schulich School of Medicine & Dentistry in London, ON, Canada. Participants All surgical residents at our institution were invited to participate. Seventy-seven residents attended ergonomics teaching, with 56 and 27 responding to pre- and posteducation surveys respectively. Results The pre-education surveys revealed that most residents experienced negative physical symptoms attributed to surgical training, had limited knowledge of operative ergonomic principles, and were hesitant to make adjustments in the OR. Posteducation surveys indicated improved awareness of MSK injury risks and prevention methods. Despite awareness, barriers such as hierarchical dynamics and discomfort speaking up in the OR persisted. While the sessions were deemed practical and valuable, only about half of respondents anticipated implementing changes into their daily practice. Conclusion This work emphasizes the importance of integrating ergonomics education into surgical training to enhance resident well-being and mitigate workplace injuries. Effective communication and collaboration among surgical teams are crucial for promoting ergonomic practices.
OBJECTIVE:Recent changes have substantially impacted the assessment of medical students, including adjustments in clerkship grading and the transition of Step 1 to a pass/fail grading system in 2022. This study examines factors influencing students' decisions to take a gap year and the potential impact of assessment changes on the landscape of these decisions. DESIGN:This qualitative study used semi-structured interviews of medical students applying to surgical specialties to gather in-depth perspectives regarding their decision-making processes around taking or not taking a gap year. SETTING:We conducted virtual interviews with students from 5 U.S. medical schools located in the West, Midwest, Mid-Atlantic, and South. PARTICIPANTS:Interviewees comprised 25 senior medical students pursuing surgical specialties including general surgery, orthopedic surgery, neurosurgery, plastic surgery, and otolaryngology-head and neck surgery. RESULTS:We identified 5 main themes related to students' gap year decisions. Local institutional and specialty cultures set background expectations around gap years. Within these contexts, 3 dominant and often interrelated reasons motivated gap year decisions: the anticipated potential of a gap year to affect residency application competitiveness; personal, nonacademic circumstances; and the desire for professional growth. Regardless of students' gap year wishes, logistics ultimately dictated decisions for many students. CONCLUSIONS:In the context of evolving assessment systems, residency application competitiveness emerged as a primary factor influencing students' decisions to take a gap year. Students described that the transition of Step 1 to pass/fail led to fewer objective application metrics, with an ensuing focus on increased research productivity as a perceived differentiating factor amongst applicants. Personal and professional growth motivations remained present, but often played secondary roles in decision-making. For both gap year and traditional students, concerns regarding research years included variable access to funding, financial and temporal costs, and implications for delayed career and family timelines.
OBJECTIVE:To evaluate the feasibility and impact of a gamified, low-fidelity simulation activity for pediatric pelvic sheet binding, focused on improving trainee procedural speed, technical proficiency, and self-efficacy through deliberate practice and mastery learning. DESIGN:This was a prospective educational pilot study utilizing a pretest/posttest design and a low-fidelity simulation mannequin with haptic feedback. The intervention was developed using Kern's 6-Step Framework and designed to address American Board of Surgery (ABS) Entrustable Professional Activities (EPAs). The activity followed a structured progression to track performance across assessment phases and 2 successive attempts separated by a structured educational session (debriefing with focused feedback, video demonstration, and live demonstration) to evaluate short-term skill acquisition. SETTING:The study was conducted at a quaternary academic children's hospital during a protected surgical education block in the 2025 to 2026 academic year. PARTICIPANTS:A convenience sample of 8 surgical trainees and medical students (PGY2-PGY10 and MS3) participated. Seven completed the presurvey and 6 completed the postsurvey. Participation was voluntary across all stages. RESULTS:Time to successful binder application significantly decreased from an average of 239 seconds to 102 seconds (p = 0.012). Technique quality remained high for positioning of the binder around the greater trochanter, maintenance of full spine precautions using the log roll technique, and utilization of clamps to secure the binder. Participant confidence significantly improved from an average of 2.2 to 3.8 on a 5-point Likert scale (p = 0.026), with 83.3% feeling "moderately confident" following the simulation compared to 14.3% at baseline. CONCLUSIONS:A gamified, low-fidelity simulation using haptic feedback is a feasible and effective method for teaching the rare but critical skill of pediatric pelvic sheet binding. The curriculum successfully utilized deliberate practice to enhance procedural speed and trainee confidence without compromising technical accuracy. This model provides a reproducible framework for addressing core entrustable professional activities in pediatric trauma education.
OBJECTIVE:The evolved Orthopedic Surgery Milestones 2.0 set was introduced in July 2021 by the ACGME. The purpose of this study was to understand the new version's utility and any challenges. DESIGN, SETTING, PARTICIPANTS:Study recruitment began in 2024 and included an email invitation to orthopedic surgery program directors (PDs) and associate program directors (APDs) from 197 ACGME-accredited programs. Participants were self-selected; survey data was anonymous. Interviews were scheduled and conducted by ACGME employees not associated with the accreditation process. Survey questions measured the utility of and satisfaction with Orthopedic Surgery Milestones 2.0. Relationships among survey items were examined using a prespecified conceptual framework and chi-square test with Bonferroni correction. Template analysis was used to code and analyze the interviews. RESULTS:The online survey response rate was 24%, representing 85 PDs and APDs. Survey respondents reported Milestones 2.0 effectively assessed residents' competency levels and valued structural changes including reorganization of patient care and medical knowledge content. One-on-one interviews were conducted with PDs (17) or APDs (2) from 19 programs. Qualitative analysis highlighted reduced burden, preference for subspecialty-based organization over the previous format of grouping by conditions, and better consistency across rotations, highlighting the range of surgical components. The number of Milestones decreased but PDs reported concern about "box-checking" rather than thoughtful, individualized assessment of resident performance and requested resources to support Milestones implementation. CONCLUSIONS:Survey and interview results reported Orthopedic Surgery Milestones 2.0 to be more representative and less burdensome. However, the shorter, cleaner design did not consistently translate to improved ease of use. More resources are needed for faculty development to support implementation into the clinical environment.
OBJECTIVE:Describe the post-match pathways of OB/GYN applicants who did not match in their initial application cycle, as well as factors associated with a subsequent successful match attempt. DESIGN:IRB-exempt observational cohort study of OB/GYN reapplicants from 2 academic institutions between 2017 and 2024. SETTING:Two large, tertiary academic medical centers in the Midwest and Southeast. PARTICIPANTS:Any applicants who applied to the residency programs at the institutions in 2 consecutive years, indicating an unsuccessful match and reapplication. RESULTS:Among 287 reapplicants, 17 (6%) repeated a fourth year (most commonly for research), 234 (82%) entered the Supplemental Offer and Acceptance Program (SOAP), and 27 (9%) pursued nonclinical work. Overall, 71% (173/245) ultimately re-matched into OB/GYN. Among those repeating a fourth year, 76% (13/17) matched OB/GYN. Among SOAP participants, OB/GYN preliminary residents had the highest success with OB/GYN residency placement, with two-thirds obtaining an OB/GYN PGY-2 position. General surgery preliminary residents had a 75% OB/GYN re-match rate, followed by OB/GYN preliminaries who re-entered the Match; nonsurgical preliminary positions had lower success. Re-applicants matched in nearly equal numbers to academic and community-based programs. Among SOAP participants who had a second unsuccessful cycle, failure of course work or medical board exams (OR = 0.07, p = 0.02) and completion of a nonsurgical SOAP program (OR = 0.42, p = 0.02) was associated with lower odds of matching. CONCLUSIONS:Overall, these results provide reassurance to applicants who do not initially match into OB/GYN and offer evidence-based guidance for advisors. When feasible, surgical preliminary pathways-particularly OB/GYN and general surgery-may optimize reapplication outcomes, while structured academic support may enhance competitiveness.
BACKGROUND:Mastering basic surgical skills is essential for medical students transitioning from theoretical learning to clinical practice. However, novice learners often require repeated practice to achieve consistent procedural performance. Guided by Cognitive Load Theory (CLT), this study aimed to evaluate the effects of a standardized checklist-based instructional model on learning efficiency, procedural performance, and cognitive load during wound dressing and suture removal training. METHODS:In this prospective randomized controlled trial, 70 fifth-year undergraduate clinical medical students undergoing their initial clinical internship training were enrolled to either the Checklist Group (n = 35) or the Control Group (n = 35). Both groups received standardized instructional videos before practice. The Checklist Group used a structured four-dimension checklist covering pre-procedural preparation, aseptic technique, procedural steps, and post-procedural care, whereas the Control Group followed traditional textbook-based instructions. The primary outcome was learning efficiency, defined as the number of practice attempts required to achieve proficiency, which was defined as three consecutive successful performances with a modified Global Rating Scale (GRS) ≥ 18/30 and no major aseptic technique violations. Secondary outcomes included immediate and two-week delayed procedural performance assessed using the GRS, and cognitive load measured using the modified NASA Task Load Index (NASA-TLX). RESULTS:The Checklist Group required significantly fewer practice attempts to reach the predefined proficiency criterion compared with the Control Group (wound dressing: median [IQR], 4 [3.5-5] vs. 6 [5-7.5], p < 0.001; suture removal: 5 [4-6] vs. 8 [7-9], p < 0.001). The Checklist Group also achieved higher GRS scores in both immediate and two-week delayed assessments (all p < 0.001). In addition, NASA-TLX scores demonstrated significantly lower total cognitive load in the Checklist Group for both wound dressing and suture removal tasks (p = 0.0027 and p < 0.001, respectively). CONCLUSIONS:Checklist-based instruction was associated with fewer practice attempts required to reach the predefined proficiency criterion, improved procedural performance, and reduced cognitive load during basic surgical skills training. The maintained performance observed in the two-week delayed assessment suggests that checklist-based instruction may support sustained procedural performance at two weeks after training. These findings support the potential value of checklist-based approaches as a structured instructional strategy for basic clinical skills education.
OBJECTIVE:To describe trends in general surgery (GS) program director (PD) tenure and attrition over time. DESIGN:Retrospective analysis of PD term duration and reasons for attrition based on a report generated by the Accreditation Council for Graduate Medical Education. We then conducted a Cox proportional hazards regression with PD term duration as the outcome of interest, accounting for institution. Content analysis was performed with regard to the inclusive list of reasons for PD turnover via independent review and coding into distinct categories by 2 separate authors. SETTING:365 US-based GS programs in existence between 1990 and 2025. PARTICIPANTS:A total of 1112 distinct PDs across 365 programs. RESULTS:The average GS PD term duration in the 1990s was 13.6 years, compared to 6.4 years in the 2000s, and 5.0 years in the 2010s. PD turnover was significantly lower in the 1990s than since the 2000s (p < 0.0001), with no significant differences in PD turnover between the 2000s, 2010s, and 2020s. Programs in the South had significantly more PD turnover (hazard ratio [HR]=1.4 compared to West, 95% confidence interval [CI] = [1.1, 1.9], p = 0.04). Additionally, community-based (HR = 0.7, 95% CI = [0.5, 0.9]) and community-based/university-affiliated programs (HR = 0.7, CI = [0.6, 0.9]) had significantly lower PD turnover rates compared to university programs (p = 0.0002). Formal resignation and/or departure from the institution entirely was the most commonly stated reason for PD turnover (42.6%, n = 120). CONCLUSIONS:We demonstrate significantly more GS PD turnover since the 1990s, with increased turnover appearing stable since 2000. While attrition is not continuing to increase, short PD terms over the past 20 years are concerning for a lack of continuity in leadership for GS trainees nationwide.
OBJECTIVE To develop and evaluate a department-level urology intern bootcamp designed to improve early residency preparedness. Hypothesis that a structured, locally delivered curriculum would enhance foundational knowledge, procedural familiarity, and performance on the American Urological Association In-Service Examination (ISE). DESIGN Prospective educational intervention with post-curriculum survey assessment and comparison to historical controls. The study was non-randomized and unblinded. Outcomes included subjective participant feedback and objective ISE performance. SETTING Single academic, tertiary-care urology residency program PARTICIPANTS Eight urology interns over two academic years participated in the bootcamp. All eligible interns entering the program were included, and all completed the curriculum and post-intervention assessments. RESULTS Participants reported improved understanding of core urologic topics, increased familiarity with common procedures, and greater confidence in early clinical responsibilities. All interns rated the curriculum as good or excellent preparation for the ISE. Median ISE performance improved to the 90th to 93rd percentile compared with a historical program median of 53%. One year after completing the bootcamp, the initial cohort’s ISE percentile rank as R2s (mean 78.5 percentile) remained above the program’s 5- and 10-year historical average for R2s (50.8 and 56.7 percentile, respectively). Simulation-based and hands-on sessions were rated as the most valuable components. CONCLUSIONS A department-level urology intern bootcamp is a feasible and effective educational intervention that improves perceived preparedness, and early data suggest the observed gains in relative ISE performance persist into the second year of training. This model offers a practical, low-cost approach to enhancing early residency training with minimal disruption to clinical workflow.
OBJECTIVE Cognitive task analysis (CTA) has emerged as a structured approach to enhance surgical training by organizing procedural knowledge and decision-making. This study aimed to update the evidence on the effectiveness of CTA-based and other structured cognitive training interventions in surgical education, as well as to conduct a meta-analysis. DESIGN Systematic review and meta-analysis conducted in accordance with PRISMA guidelines. Randomized controlled trials evaluating CTA-based or other structured cognitive interventions in surgical training were included. Primary outcomes were procedural knowledge and technical performance. Subgroup analyses were performed according to training level and intervention type. SETTING Surgical and procedural training programs in academic and simulation-based settings. PARTICIPANTS Fifteen randomized controlled trials were identified; 9 were included in the quantitative synthesis, and 6 were analyzed qualitatively due to insufficient or noncomparable data. Participants were surgical trainees and medical students. RESULTS CTA-based training significantly improved procedural knowledge among surgical trainees (standardized mean difference [SMD] 2.08, 95% CI 1.46-2.71), with no significant effect among medical students. Overall, cognitive training interventions were associated with improved procedural knowledge (SMD 1.79, 95% CI 1.45-2.14) and technical performance (SMD 1.73, 95% CI 0.82-2.64). Sensitivity analyses demonstrated a consistent direction of effect across studies, supporting the overall stability of the findings. CONCLUSIONS CTA-based cognitive training improves procedural knowledge and technical performance in surgical education, particularly among surgical trainees, supporting its integration into modern surgical curricula.
OBJECTIVE:To examine the association between perceived trainee technical skill proficiency and supervising surgeons' intraoperative stress using both subjective assessments and heart rate variability (HRV)-based physiological indicators and to explore whether this association differs according to the supervisor's operative role. DESIGN:Prospective observational study. After each procedure, supervisors completed structured questionnaires assessing subjective intraoperative stress and mood states. Trainee technical proficiency was evaluated by supervisors using a 10-item scale developed for breast surgery training. HRV was continuously recorded, and 2 indices were calculated: LF/HF↑% (percentage of operative time with LF/HF ratios exceeding the intraoperative mean) and RR↓% (percentage of RR intervals shorter than the preoperative baseline). Correlations were analyzed separately for each group. SETTING:Single academic institution. PARTICIPANTS:Supervising surgeons served either as primary surgeon (Group 1) or 1st assistant (Group 2) during breast surgeries involving trainees. RESULTS:A total of 123 procedures were analyzed (Group 1: n = 52, Group 2: n = 71). Trainee technical skill scores showed significant negative correlations with supervising surgeons' subjective stress scores in both groups (Group 1: ρ = -0.592, p < 0.001; Group 2: ρ = -0.706, p < 0.001). In contrast, no significant associations in either group were observed between trainee skill scores and HRV-derived indices. CONCLUSIONS:Supervising surgeons' perceptions of trainee technical proficiency were associated with self-perceived intraoperative stress in both primary and assistant roles, while HRV-based physiological markers showed no such associations. Subjective stress ratings may capture supervisory cognitive load and educational burden more sensitively than HRV metrics alone.
