OBJECTIVE To identify barriers to entrustable professional activity (EPA) microassessment completion among surgical faculty and residents and to examine whether those barriers converge across roles and institutional contexts. DESIGN Two-cohort qualitative study using semistructured interviews and focus groups. Faculty participants were identified through purposeful sampling of low-assessment-completion (LAC) attendings from a national EPA database (Firefly). Resident participants were recruited from 2 institutions using different EPA delivery platforms (Firefly and Society for Improving Medical Professional Learning [SIMPL]). Transcripts were analyzed using a constructivist-informed hybrid deductive-inductive thematic analysis framework with a structured codebook held open to emergent codes. Data saturation was confirmed using cumulative code analysis. Reporting follows the Consolidated Criteria for Reporting Qualitative Research (COREQ). SETTING Faculty were identified through a national EPA database and practiced across 5 surgical subspecialties at a single academic medical center and its affiliated Veterans Affairs hospital; residents were drawn from 2 academic general surgery residency programs using different EPA delivery platforms. PARTICIPANTS Five general surgery faculty and 10 PGY4 to 5 general surgery residents, including 2 maximum variation interviews with self-described high- and LAC EPA users. RESULTS Across both cohorts, faculty and residents described EPA microassessment completion as an administrative act disconnected from the educational interaction it is intended to represent. Four faculty themes were identified: structural workflow limitations, misaligned perceived value, cultural and motivational gaps, and training and conceptual ambiguity. Five resident themes were identified: lack of perceived value, institutional priorities and accountability, feedback modality dissatisfaction, lack of training standardization, and selective initiation. The conceptual core uniting both cohorts was the conflation of formative feedback with formal entrustment assessment: both groups treated EPAs as duplicative of feedback conversations that had already occurred. Residents reported being more likely to request assessments after strong performances and less likely after challenging ones, while faculty described reluctance to document poor performance in a permanent record, producing bidirectional pressure toward a positively skewed entrustment signal. Platform architecture shaped engagement culture, with resident-initiated patterns predominating on SIMPL and attending-initiated patterns on Firefly. CONCLUSIONS Low EPA microassessment completion rates among surgical faculty and residents reflect modifiable failures in workflow design, conceptual framing, and assessment culture rather than fundamental limitations of the EPA framework. The widespread conflation of formative feedback with formal entrustment assessment represents a conceptual gap that undermines the construct validity of EPA-generated data and must be addressed through targeted education before structural interventions can be fully effective. Electronic health record (EHR)-integrated assessment workflows, platform-agnostic sampling standards, and faculty and resident development focused on the distinct longitudinal function of EPA microassessments are needed to realize the construct validity and educational utility the framework is designed to provide.

Introduction The American Association for the Surgery of Trauma (AAST) Critical Care Committee develops clinical consensus documents to provide practical guidance on topics based on literature review, available evidence, and expert consensus.

Background: Historically, there have been perceptions that engagement with palliative care (PC) services may preclude potentially curative but high-risk operations. As such, we sought to investigate the relationship between specialty PC consultation and the care trajectory of surgical patients. We hypothesized that PC consultation would be associated with increased frequency of nonoperative treatments being chosen among surgical inpatients.Design: All general surgery and general surgery subspecialty patients receiving PC consultation at a single tertiary academic medical center from 2020 to 2021 were identified. Surgical operations were stratified as "elevated risk" in accordance with 2014 American Heart Association guidelines. Retrospective chart review was performed, and comparisons were made with univariable statistics.Results: We identified a total of 729 patients who received specialty PC consultation, 159 of whom were admitted to a surgical service. PC was actively involved in consultation for surgical decision making in 27% (43/159) of these encounters. PC assistance with surgical decision making was associated with a greater incidence of elevated-risk operative procedures during admission compared with patients without presurgical PC consultation (OR 3.29 [2.51, 7.16]). There was no association between PC involvement with surgical decision making and odds of discharge to hospice (OR 0.42 [0.18, 1.51]) nor death during admission (OR 0.66 [0.21, 2.10]).Conclusions: We found that specialty PC involvement in surgical decision making does not preclude the pursuit of disease-directed surgical treatment. Contrary to our hypothesis, our single institutional data demonstrate that early PC consultation can be synergistic with surgical disease management and does not preclude elevated-risk operative care.

Background Graduate medical educators interested in designing and conducting education research may seek foundational general overview articles on education research methods. Objective We aimed to identify the most useful foundational education research methods articles for medical educators. Methods We identified candidate articles through a 2020 Ovid MEDLINE literature search augmented by the authors' personal files and by cross-checking references of included articles. Articles that were primarily about general education research principles were included; articles were excluded if they were not focused on medical education research methods, were published prior to the year 2000, were written in a non-English language, or had no available abstracts. We conducted a modified Delphi study with 10 participants representing a range of specialties and education research experience to find consensus about the most useful articles. We planned 3 rounds of the Delphi process, the first to eliminate any articles not deemed useful for this audience, and the second and third rounds to include articles that at least 80% of the panel deemed "most useful" to education researchers. Results Of 25 relevant articles identified in the literature search: one was excluded in round 1, 7 met the a priori threshold of 80% agreement for inclusion in round 2, and an additional 2 met inclusion in round 3. These 9 foundational education research methods articles relevant to graduate medical educators are described, along with a capsule summary and specific use for education researchers. Conclusions Our modified Delphi study of foundational education research methods articles identified 9 articles deemed useful for graduate medical educators who are seeking methods resources.

Introduction Acute care surgeons are frequently consulted for tracheostomy placement in the intensive care unit (ICU). Tracheostomy may facilitate ventilator weaning and improve physical comfort. Short-term outcomes after tracheostomy are not well studied. We hypothesize that a high proportion of ICU patients who underwent tracheostomy died prior to discharge. These data will help guide clinical decision-making at a key pivot point in care.Methods We identified 177 mixed ICU patients who received a tracheostomy for respiratory failure between January 2013 and December 2018. We excluded patients with trauma. Patient information was collected and comparisons made with univariable and multivariable statistics.Results Of the 177 patients who underwent a tracheostomy for respiratory failure, 45% were women, median age was 63 (51–71) years. Of this group 18% died prior to discharge, 63% were discharged to a care facility and only 16% discharged home. Compared with survivors, patients with tracheostomies who died during their admission were older, age 69 (64–76) versus 61 (49–71) years (p<0.01) on univariable analysis. In this model, no single comorbid condition or length of stay (LOS) variable was predictive of death before discharge. A multivariable model controlling for covariation similarly identified age, as well as a longer ICU LOS of 34 (20–49) versus 23 (16–31) days (p=0.003) as factors associated with increased likelihood of death before discharge.Conclusions Tracheostomy placement in a mixed ICU population is associated with a nearly 20% inpatient mortality and the vast majority of surviving patients were discharged to a care facility. This suggests that the need for tracheostomy could be considered a trigger for re-evaluation of patient goals. The high risk of death due to underlying illness and high intensity care after their hospitalization emphasize the need for clear advanced care planning discussions around the time of tracheostomy placement.Level of Evidence Level IV, Retrospective cohort study.

Background Curriculum development is an essential domain for medical educators, yet specific training in this area is inconsistent. With competing demands for educators' time, a succinct resource for best practice is needed. Objective To create a curated list of the most essential articles on curriculum development to guide education scholars in graduate medical education. Methods We used a modified Delphi method, a systematic consensus strategy to increase content validity, to achieve consensus on the most essential curriculum development articles. We convened a panel of 8 experts from the United States in curricular development, with diverse career stages, institutions, gender, and specialty. We conducted a literature search across PubMed and Google Scholar with keywords, such as "curriculum development" and "curricular design," to identify relevant articles focusing on a general overview or approach to curriculum development. Articles were reviewed across 3 iterative Delphi rounds to narrow down those that should be included in a list of the most essential articles on curriculum development. Results Our literature search yielded 1708 articles, 90 of which were selected for full-text review, and 26 of which were identified as appropriate for the modified Delphi process. We had a 100% response rate for each Delphi round. The panelists narrowed the articles to a final list of 5 articles, with 4 focusing on the development of new curriculum and 1 on curriculum renewal. Conclusions We developed a curated list of 5 essential articles on curriculum development that is broadly applicable to graduate medical educators.

ImportancePatients with trauma exhibit a complex balance of coagulopathy manifested by both bleeding and thrombosis. Antithrombin III is a plasma protein that functions as an important regulator of coagulation. Previous studies have found a high incidence of antithrombin III deficiency among patients with trauma.ObjectiveTo assess whether changes in antithrombin III activity are associated with thrombohemorrhagic complications among patients with trauma.Design, Setting, and ParticipantsThis cohort study was conducted from December 2, 2015, to March 24, 2017, at a level I trauma center. A total of 292 patients with trauma were followed up from their arrival through 6 days from admission. Data, including quantification of antithrombin III activity, were collected for these patients. Thromboprophylaxis strategy; hemorrhage, deep vein thrombosis (DVT), and pulmonary embolism screenings; and follow-up evaluations were conducted per institutional protocols. Data analyses were performed from September 28, 2023, to June 4, 2024.Main Outcomes and MeasuresThe primary study outcome measurements were associations between antithrombin III levels and outcomes among patients with trauma, including ventilator-free days, hospital-free days, intensive care unit (ICU)–free days, hemorrhage, venous thromboembolic events, and mortality.ResultsThe 292 patients had a mean (SD) age of 54.4 (19.0) years and included 211 men (72.2%). Patients with an antithrombin III deficiency had fewer mean (SD) ventilator-free days (27.8 [5.1] vs 29.6 [1.4]; P = .0003), hospital-free days (20.3 [8.2] vs 24.0 [5.7]; P = 1.37 × 10−6), and ICU-free days (25.7 [4.9] vs 27.7 [2.3]; P = 9.38 × 10−6) compared with patients without a deficiency. Antithrombin III deficiency was also associated with greater rates of progressive intracranial hemorrhage (21.1% [28 of 133] vs 6.3% [10 of 159]; P = .0003) and thrombocytopenia (24.8% [33 of 133] vs 5.0% [8 of 159]; P = 1.94 × 10−6). Although antithrombin III deficiency was not significantly associated with DVT, patients who developed a DVT had a more precipitous decrease in antithrombin III levels that were significantly lower than patients who did not develop a DVT.Conclusions and RelevanceIn this cohort study of patients with trauma, antithrombin III deficiency was associated with greater injury severity, increased hemorrhage, and increased mortality, as well as fewer ventilator-free, hospital-free, and ICU-free days. Although this was an associative study, these data suggest that antithrombin III levels may be useful in the risk assessment of patients with trauma.

INTRODUCTION:Single-site studies have found variable associations between gender and entrustment-based interactions during surgical residency. We sought to assess the relationship between resident sex and intraoperative entrustment at multiple institutions. METHODS:Surgical cases were observed at four university-based training programs. Faculty entrustment and resident entrustability were rated using OpTrust. OpTrust is a validated intraoperative entrustment measurement tool which enables trained third-party raters to objectively score resident and faculty behaviors in the operating room. Independent sample t-tests and regression analysis with cluster adjusted standard errors were used. RESULTS:337 cases were observed which included 149 residents (54 ​% female) and 97 faculty members (30 ​% female). There was no difference in resident entrustability based on resident sex (p ​= ​0.30). Female residents were more likely to be involved in cases rated as more difficult (p ​= ​0.04). At a single site, male residents scored higher on resident entrustability (p ​= ​0.007) and faculty entrustment (p ​= ​0.022). CONCLUSION:Entrustment did not differ based on resident sex on a multi-institutional scale; however, at a single site, there was a difference; suggesting there are multi-factorial issues contributing to differences in training.

OBJECTIVEThis study aimed to identify what best practices facilitate implementation of Entrustable Professional Activities (EPAs) into surgical training programs.DESIGNThis is a mixed methods study utilizing both survey data as well as semi-structured interviews of faculty and residents involved in the American Board of Surgery (ABS) EPA pilot study.SETTINGFrom 2018 to 2020, the ABS conducted a pilot that introduced five EPAs across 28 general surgery training programs.PARTICIPANTSAll faculty members and residents at the 28 pilot programs were invited to participate in the study.RESULTSAbout 117 faculty members and 79 residents responded to the survey. The majority of faculty (81%) and residents (66%) felt that EPAs were useful and were a valuable addition to training. While neither group felt that EPAs were overly time consuming to complete, residents did report difficulty incorporating them into their daily workflow (44%). Semi-structured interviews found that programs that focused on faculty and resident -development and utilized frequent reminders about the importance and necessity of EPAs tended to perform better.CONCLUSIONSEPA implementation is feasible in general surgery training programs but requires significant effort and engagement from all levels of program personnel. As EPAs are implemented by the ABS nationally a focus on resident and faculty development will be critical to success.

INTRODUCTION:Digital education tools are a cornerstone in the evolution to CBME through EPAs. Successful implementation requires understanding the variable impacts of EHR-driven delivery of EPAs, flexible digital device access to EPAs, and user-behavior trends. METHODS:Through a HIPAA compliant, flexible-device accessible, surgical education platform, general surgery training programs at 21 institutions collected EPA from July 2023 to April 2024. At 5 EHR-integrated institutions (EHR+), EPA were created for clinical activities based on the OR schedule, automatically pushed to attendings and residents with built in completion reminders. At 16 institutions without EHR integration (EHR-), EPA were initiated manually. To improve user experience, care phases were bundled (cEPA). We compared the EHR+ and EHR- groups, computing descriptive statistics on the cEPAs completed and user behavior metrics. RESULTS:We collected 4187 cEPAs in total, with 82% at EHR+ institutions and 18% at EHR- institutions. Platform triggering dramatically drove cEPA completion for both faculty and residents, 88% and 81%, respectively. Only 3% were initiated by the faculty or resident. Faculty at EHR+ institutions strongly preferred the automated OR-triggered workflow to start their EPAs (Chi-squared test, p ≈ 0). Faculty completed all 3 care phases nearly 80% of the time. Time reminders specifically drive EPA completion for residents and faculty on weekdays and build habits on weekends. 71% of cEPAs completed were by computer, and 29% by phone. More comments were provided when computers were used. Residents reviewed feedback with a median lag of 1 hour and 29 min after results were available. CONCLUSIONS:EHR-driven delivery of EPA leads to a 4.6-fold increase in EPAs completed. EPA initiation is the most critical phase in the workflow and EHR-data driven alerts drive this action. These alerts are also effective drivers of habit formation. Flexible device access is important to increase EPAs completed and improve the usefulness through comments for residents.

BACKGROUND:Intraoperative resident autonomy has been compromised secondary to expectations for increased supervision without defined parameters for safe progressive independence, diffusion of training experience, and more to learn with less time. Surgical residents who are insufficiently entrusted during training attain less autonomy, confidence, and even clinical competency, potentially affecting future patient outcomes.OBJECTIVE:To determine if OpTrust, an educational intervention for increasing intraoperative faculty entrustment and resident entrustability, negatively impacts patient outcomes after general surgery procedures.METHODS:Surgical faculty and residents received OpTrust training and instruction to promote intraoperative faculty entrustment and resident entrustability. A post-intervention OpTrust cohort was compared to historical and pre-intervention OpTrust cohorts. Multivariable logistic and negative binomial regression was used to evaluate the impact of the OpTrust intervention and time on patient outcomes.SETTING:Single tertiary academic center.PARTICIPANTS:General surgery faculty and residents.MAIN OUTCOMES AND MEASURES:Thirty-day postoperative outcomes, including mortality, any complication, reoperation, readmission, and length of stay.RESULTS:A total of 8890 surgical procedures were included. After risk adjustment, overall patient outcomes were similar. Multivariable regression estimating the effect of the OpTrust intervention and time revealed similar patient outcomes with no increased risk (P > 0.05) of mortality {odds ratio (OR), 2.23 [95% confidence interval (CI), 0.87-5.6]}, any complication [OR, 0.98 (95% CI, 0.76-1.3)], reoperation [OR, 0.65 (95% CI, 0.42-1.0)], readmission [OR, 0.82 (95% CI, 0.57-1.2)], and length of stay [OR, 0.99 (95% CI, 0.86-1.1)] compared to the historic and pre-intervention OpTrust cohorts.CONCLUSIONS:OpTrust, an educational intervention to increase faculty entrustment and resident entrustability, does not compromise postoperative patient outcomes. Integrating faculty and resident development to further enhance entrustment and entrustability through OpTrust may help facilitate increased resident autonomy within the safety net of surgical training without negatively impacting clinical outcomes.

Formal primary surgical palliative care education in the United States is lacking. We aimed to assess curricula and surgical program directors’ (PDs) attitudes toward instituting formal educational programs. Results will be able to guide future efforts to create and standardize educational materials to meet the needs of surgical training programs. An anonymized 15-item survey was developed by the SPCS Education Committee and electronically distributed to PDs at 282 general surgery residency programs through the Association of Program Directors in Surgery (APDS) in June 2023. Forty-three PDs completed the questionnaire (15

While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries. The NTDB (2015–2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15. Complications included medical and surgical complications, as well as 30-day mortality. Multivariable logistic regression was used to investigate the association between days to procedure and complications after adjusting for demographic characteristics and comorbidities. 2325 patients met inclusion criteria. 532 (23.0

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4 week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.

The need to integrate palliative care (PC) training into surgical education has been increasingly recognized. Our aim is to describe a set of PC educational strategies, with a range of requisite resources, time, and prior expertise, to provide options that surgical educators can tailor for different programs. Each of these strategies has been successfully employed individually or in some combination at our institutions, and components can be generalized to other training programs. Asynchronous and individually paced PC training can be provided using existing resources published by the American College of Surgeons and upcoming SCORE curriculum modules. A multiyear PC curriculum, with didactic components of increasing complexity for more advanced residents, can be applied based on available time in the didactic schedule and local expertise. Simulation-based training in PC skills can be developed to provide objective competency-based training. Finally, a dedicated rotation on a surgical palliative care service can provide the most immersive experience with steps toward clinical entrustment of PC skills for trainees.

OBJECTIVE: National guidelines have suggested that quality surgical care should incorporate effective pallia-tive care (PC). Numerous barriers to surgeon participa-tion remain and the domains of optimal surgeon participation are unclear.DESIGN: Eight semi-structured and multi-professional focus groups with 34 total participants. Discussion was transcribed, and qualitative approaches were used to encode, identify, and categorize emergent themes.SETTING: Oregon Health & Science University, Portland Oregon. A tertiary care teaching hospital.PARTICIPANTS: 34 multi-disciplinary participants in eight focus groups, identified on a volunteer basis.RESULTS: Key themes defining domains of optimal sur-geon/palliative practice include: (1) "primary/secondary PC" which detailed conflict between the surgeon's desire to be part of palliative discussions and competing clinical/time demands. (2) "role/responsibility" described the tension surgeons feel around a desire to provide honest and goal concordant care (3) "teamwork/conflict" detailed the approach to disagree-ment among multidisciplinary teams.CONCLUSIONS: In this qualitative analysis, emergent themes suggest that surgeons want to be involved in the PC of their patients but are limited by available time and competing for ethical obligations. Tension between com-peting communication and care obligations and PC goals is common, and discord around patient goals remains an issue. This work highlights the need for a standardized cur-riculum to improve the PC of surgical patients. (J Surg Ed 80:110-118. (c) 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

BACKGROUND It is unknown how often the physician-to-physician trauma transfer conversation includes a discussion of patient goals of care (GOC). We hypothesized that physicians would rarely discuss GOC on transfer calls when faced with patients with catastrophic injuries. METHODS We completed a retrospective case series of trauma patients transferred to an ACS-verified Level I trauma center between 2018 and 2022 who died or were discharged to hospice without surgical intervention within 48 hours. Transfer call recordings were analyzed for GOC conversations. RESULTS A total of 5,562 patients were accepted as transfers and 82 (1.5%) met inclusion criteria. Eighty of the 82 patients had recorded transfer calls and were analyzed. The most common transfer reason was traumatic brain injury (TBI) and need for neurosurgical capabilities (53%) followed by complex multisystem trauma (23%). There was explicit discussion of code status prior to transfer in 20% and a more in depth GOC conversation for 10% of patients. Appropriateness of transfer was discussed in 21% and at least one physician expressed explicit concerns of futility for 14%, though all were subsequently transferred. Code status was changed immediately upon arrival for 15% for patients and 19% of patients transferred for neurosurgical expertise were deemed to have non-survivable injuries based on imaging and examination that were unchanged from the referring hospital. CONCLUSION Among a group of profoundly injured trauma patients at high risk of death, an explicit discussion of GOC occurred in just 10%. This suggests that even when the catastrophic nature of patient injury is understood, transfers still occur, and patients and their families are subjected to an expensive, disruptive, and displacing experience with little to no anticipated benefit. A discussion of GOC and therapeutic objectives should be considered in all severely injured trauma patients prior to transfer. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

Background: Methamphetamine (M) is a widely used, powerful sympathomimetic drug that produces significant CNS stimulation. Its use is associated with psychiatric disorders, abnormal brain chemistry, and cardiovascular disease. Pre-hospital M use is associated with increased intubation, intensive care unit admission, and hospital length of stay. The purpose of this study was to determine the influence of acute M use on analgesia and sedation requirements in mechanically ventilated trauma patients. Methods: This single center retrospective cohort study included injured adult patients (>= 16 years) admitted to the trauma intensive care unit (TICU) between 2016 and 2018 who were mechanically ventilated and had a urine drug screen (UDS) completed. The primary outcome was the median sedation and total analgesia administered during the first 48 hours of TICU admission, expressed as propofol, dexmedetomidine, lorazepam, and morphine equivalents. Secondary endpoints included the median Richmond Agitation Sedation Scale (RASS) score, median Critical Pain Observation Tool (CPOT) score, ventilator days, length of stay, in-hospital mortality, and discharge disposition. Results: A total of 245 patients were included in the final analysis (53 M+ and 192 M-). The patients were mostly men (78%) and sustained blunt trauma (89%) with a median age of 35 (IQR 26-52) years and median ISS of 11 (IQR 4-24). A M+ UDS was associated with increased morphine requirements, defined as greater than the cohort median of 1.91 mg/kg, during the first 12 hours of admission on the univariable analysis (OR 2.03; 95% CI, 1.07-3.82). There was no difference in median propofol (M+ 30 mcg/kg/min vs. M- 30 mcg/kg/min, p=0.58) or total morphine equivalents (M+ 5.42 mg/kg s. M- 3.89 mg/kg, p=0.30) over 48 hours between M+ and M- groups to achieve similar RASS and CPOT scores. Conclusion: To achieve the same level of pain control and depth of sedation, intubated TICU patients with a M+ UDS do not require more analgesia and sedation than patients with a M- UDS during the first 48 hours of admission. (C) 2021 Elsevier Ltd. All rights reserved.

Objective This article describes the implementation of trauma-informed care (TIC) didactic training, using a novel, interdisciplinary peer-to-peer teaching model to improve confidence surrounding trauma-informed practices in a surgical residency program. Methods Eight psychiatry residents and two medical students with a background in psychological trauma and TIC and an interest in medical education were recruited to participate in three 2-hour “train the trainer” sessions led by a national expert in TIC. Eight psychiatry residents and two medical students subsequently developed and delivered the initial TIC training to 29 surgical interns. Training included the neurobiology of psychological trauma, principles of trauma-informed care, and developing trauma-informed curricula. Results Surgical interns reported significantly improved understanding of the physiology of trauma, knowledge of TIC approaches, and confidence and comfort with TIC and practices. Among surgical interns, understanding of the physiology of the fear response increased from 3.36 to 3.85 ( p = 0.03). Knowledge of the neurobiology of trauma improved between pre- and post-training surveys (2.71 to 3.64, p = 0.006). Surgery interns also expressed an improved understanding of the connection between fear, trauma, and aggression (3.08 to 4.23, p = 0.002) from pre- to post-training surveys. Post-training knowledge of trauma-informed approaches increased from 2.57 to 4.71 ( p < 0.001) and confidence in delivering TIC on the wards increased from 2.79 to 4.64 ( p < 0.001). Conclusion This TIC curriculum delivered via a peer-to-peer training model presents an effective way to improve comfort and confidence surrounding TIC practices and approaches in a surgical residency training program.

Background: Primary palliative care (PPC) is provided by the primary team and is essential for high-quality surgical care. There is a recognized PPC clinical and research need but little work on the optimal way to teach PPC to general surgery residents. We sought to define important factors of PPC pedagogy (i.e. nature and practice of teaching). Methods: Eight semi-structured and multi-professional focus groups (n = 34) were performed. Discussion was transcribed, and de-identified. Qualitative approaches were used to encode, identify, and categorize emergent themes. Results: Emergent themes included: establishing a baseline knowledge, use of existing resources, simulation and debriefings, and emphasis on authentic clinical opportunities with graduated responsibility. A tension between resident entrustability and hesitancy of faculty to entrust was identified. Conclusions: PPC must be taught in surgical residency and the themes identified here will inform development and implementation of a PPC curriculum.