75.10 Building TEAMs: Improving Trauma Management in Western Kenya

Posted on January 18, 2018

H. W. Li1, C. Donnelley3, M. Boeck2, C. Keung1  1Indiana University School Of Medicine,Indianapolis, IN, USA 2New York Presbyterian Hospital,New York, NY, USA 3Columbia University College Of Physicians And Surgeons,New York, NY, USA

Introduction: Ninety percent of trauma injuries, responsible for 10% of the world’s deaths, occur in low resource countries like Kenya. This surpasses the combined fatalities due to malaria, tuberculosis, and HIV/AIDS worldwide. Advanced Trauma Life Support (ATLS) is the gold standard for basic trauma training. However, ATLS is limited to training physicians only, and is not designed for medical students. Thus, the condensed Trauma Evaluation and Management (TEAM) course was developed in response. This study retrospectively assessed the effectiveness of incorporating TEAM into the Moi University School of Medicine (MUSM) curriculum in Eldoret, Kenya.

Methods:  The course took place over two afternoons in May 2017. Participants completed a baseline survey, an identical but scrambled 20 question pretest and posttest, and course evaluation. Test scores were analyzed using paired t-tests, and Wilcoxon signed rank test for confidence levels.

Results: N=34 participants met criteria for study inclusion, of which 61.8% (N=21) were male, and the median age was 23 years (IQR 22, 25). There were equal numbers of fourth and sixth year medical students (50.0% vs. 47.1%), and only 29.4% (N=10) reported previous trauma training. Overall mean test scores increased by 12.8% (51.1% vs. 64.0%, SD 12.1, p<0.001) from pre- to post-course. Subjective confidence to provide trauma care (0-5) significantly increased after course completion [median (IQR): pre 2 (1, 3); post 4 (4, 4); difference 2 (1,3); p<0.001].

Conclusion: TEAM was created as a systematic approach to trauma care teaching for medical students. For students in resource-limited areas, this can be their only exposure to formal trauma training. Early results show the course is effective at improving immediate trauma knowledge and subjective confidence levels, and due to its low demands for supplies and personnel, TEAM is a feasible tool that medical schools of all backgrounds can utilize, including those in low resource countries. Investigations into the application of learned knowledge to patient care via follow-up surveys, as well as trauma patient outcomes via a new trauma registry, will further elucidate the true impact of this course to improve trauma care in this region of Kenya. 

75.07 Utilizing Technology for Global Surgery: A Survey of the West African College of Surgeons

Posted on January 18, 2018

A. Ashok1, C. Stephens1, E. Ameh2, M. Swaroop3, E. Yang1, S. Krishnaswami1  3Northwestern University,Feinberg School Of Medicine,Chicago, IL, USA 1Oregon Health And Science University,Pediatric Surgery,Portland, OR, USA 2National Hospital,Abuja, FEDERAL CAPITAL TERRITORY, Nigeria

Introduction:

A previous AAS sponsored workshop demonstrated that high-income country (HIC) participants had strong interest in using Information and Communication Technology platforms (ICT) to facilitate global surgery collaborations. However, access, usage, and utility of ICT in Low-and Middle-Income Countries (LMIC) was unknown. We hypothesized that LMIC surgeons shared similiar interest in using ICT to facilitate international collaborations and education initiatives.

Methods:  

We conducted a survey of members of the West African College of Surgeons (WACS). Topics included computer and internet access/utilization, familiarity with ICT, such as social media (SM), virtual document sharing platforms (VDS), virtual meeting applications (VM), and learning management systems (LM), and interest in ICT adoption. English and French surveys were distributed through RedCap™ and in paper at the WACS and Pan African Pediatric Surgical Association conferences. Statistical analyses were done on STATA 14 using chi-squared tests, with Bonferroni corrections.

Results:

In total, 83 individuals began the survey, and 71% completed all sections. Respondents came from 9 countries (80% were faculty) and were equally split in years of practice (50% > 10 years). All respondents reported computer access, using laptops (91%), smartphones (82%) and tablets (62%). A significantly greater proportion (95%) of participants used SM compared to all other modalities (p<0.001). Commonly used SM platforms included Facebook, LinkedIn and WhatsApp, with 77% using them for professional reasons and 57% for education. VDS was used by 60% of participants, 73% of whom used it for education. The utilization of other ICTs was lower (VM 43%, LM 32%). Unreliable wifi hindered every ICT, less often SM (41%) and VDS (23%), and more commonly VM (64%) and LM (52%). Despite this, VM was typically used in international collaboration (79%), as compared to SM (42%, p=0.007), VDS (42%, p=0.007), or LM (32%, p=0.001, see figure). The vast majority of respondents (98%) expressed interest in using ICT to support local and international collaboration, with SM favored in medical education (85%) and VDS favored in collaborations (86%).

Conclusion:

ICT platforms have potential for supporting bidirectional education initiatives and international collaborations in resource limited areas, with surgeons in both HIC and LMIC expressing high levels of interest. Given the penetrance and reliability of SM and VDS, despite relative underusage and, at times, unreliable and limited wifi, there is significant potential for increased use of both platforms. Workshops providing instruction on ICT use are warranted to support the expansion of ICT use in global surgical collaborations. 

 

75.08 Can a Haptic Robotic Train New Interns to Place Central Venous Lines?

Posted on January 18, 2018

C. C. Sonntag1, M. A. Yovanoff3, D. F. Pepley2, R. S. Prabhu5, S. R. Miller4, J. Z. Moore2, D. C. Han1  1Penn State Hershey Medical Center,Department Of Surgery,Hershey, PA, USA 2Penn State University,Department Of Mechanical And Nuclear Engineerging,University Park, PA, USA 3Penn State University,Department Of Industrial Engineering,University Park, PA, USA 4Penn State University,Department Of Engineering Design And Industrial Engineering,University Park, PA, USA 5Penn State University,Department Of Engineering Design,University Park, PA, USA

Introduction: Ultrasound guided central venous catheterization (USCVC) training is typically performed using mannequin simulators that cannot simulate anatomic variations in vessel depth and position. Mannequin training also requires the presence of a preceptor to provide real time meaningful feedback to the learner. A virtual reality haptic robotic simulator that provides anatomic variation and immediate qualitative feedback has been previously validated. The goal of this study was to assess the effectiveness of the robotic simulator as a new intern training device using Verification of Proficiency (VOP) testing as the outcome measure.

Methods: Resident USCVC training curriculum currently consists of an introductory video, didactic instruction, procedure demonstration, and three simulation sessions prior to VOP testing.  New surgical interns were randomly assigned to either robotic (n=13) or mannequin (n=13) training, and all 26 interns performed a pretest USCVC on the same mannequin that was used for training. Both the first and second simulation sessions consisted of ten ultrasound guided venous aspirations on their assigned training modality. Feedback was provided by either the robotic simulator (robotic group) or an experienced preceptor (mannequin group).  The training mannequin was used in the third session by both groups. This session consisted of two USCVC with feedback by an experienced preceptor. VOP testing was performed on a mannequin with vessel depth and position that was dissimilar to the mannequin used for simulator training. A standardized rubric grading system was used by a single experienced educator to assess VOP performance. Two-way mixed ANOVA was used to evaluate results.

Results: Baseline demographics and pre-test time to insertion were not significantly different between groups. All robotic simulation residents (13 of 13) passed VOP testing on their first attempt, compared to 92% of residents trained on mannequin simulation. Reason for the exam failure in the mannequin group was unintentional arterial access. Average time to perform ultrasound guided venous aspiration for mannequin trained residents was 134 seconds, compared to 86 seconds for robotic trained residents training (p = 0.07).

Conclusion: The virtual reality haptic robotic simulator for USCVC demonstrated improved results compared to standard mannequin training with respect to first time pass rate on VOP testing. Interns who used the robotic simulator showed a faster time to perform USCVC compared to mannequin testing, although this did not quite reach statistical significance. In addition to the ability to simulate anatomic variations, another potential advantage of the robotic simulator for USCVC is the immediate

75.09 How Far Have We Come? A Survey of U.S. Institutions From the SUS Committee on Academic Global Surgery

Posted on January 18, 2018

M. Boulos2, C. Q. Stephens2, E. Ramly1, B. Nwomeh3, S. Orloff4, S. Krishnaswami2  1Oregon Health And Sciences University,Department Of Surgery,Portland, OR, USA 2Oregon Health And Sciences University,Division Of Pediatric Surgery,Portland, OR, USA 3Ohio State University,Department Of Pediatric Surgery,Columbus, OH, USA 4Oregon Health And Sciences University,Division Of Abdominal Organ Transplant Surgery,Portland, OR, USA

Introduction:

Global surgery has recently gained prominence within public health, and has growing interest among surgical trainees. Despite variable endorsement within academia, we hypothesized that overall Academic Global Surgery (AGS) work and institutional backing has increased over the last decade.

Methods:
We conducted a longitudinal study comparing two surveys of U.S. academic surgery department involvement in AGS. In 2009, a SUS and AAS survey explored AGS efforts, institutional support, perceived benefit to individuals and institutions, and next steps for field advancement. A follow-up survey was conducted in 2017 to evaluate interim change. Surveys were sent to program directors, chairpersons and faculty in global surgery using Survey Monkey©. Comparisons were analyzed by Chi-square and Fisher’s exact tests with significance at p≤0.05.

Results:

In 2017, 118 respondents initiated the survey compared to 117 in 2009. International partnerships increased significantly (60 vs 38%, p<.001), with programs spanning the globe and doubling in Africa (65 vs 30%, p=.001). Most AGS efforts remained structured as short-term clinical volunteerism (57 vs 47%, p=.41), with a notable rise in clinical research (57 vs 20%, p=.005) and new capacity building initiatives (49%). While trainee participation increased (44 vs 23%, p=.008), faculty involvement did not.

Significant changes in institutional support were reported, with increases in long-term time allowances and a 2-fold growth in internal funding (Table 1). Extramural funding also notably expanded. While credit toward academic promotion was more common, most institutions still had no structure to recognize faculty efforts. Significant increases were found in perception of individual professional enhancement and improvement of U.S. trainee education through AGS, but not in benefits to the institution. Perception of low and middle-income (LMIC) trainee benefit (74 vs 84%, p=.08) and provision of unavailable clinical care (64 vs 76%, p=.08) remained high. Priorities for future work included training of local workforces (94%) and validation of AGS through development of formal career tracks with contractual and financial support (84%).

Conclusion:
Over the past 8 years, AGS programs increased significantly and had provision of longer time allowances and internal funding. However, many departments remain without formal structure to facilitate longitudinal faculty efforts, despite acknowledged benefit to U.S. and LMIC trainee education. Further growth of AGS will require a clear delineation of the benefit to U.S. institutions, as ongoing institutional support will ensure sustained faculty involvement, thus enabling AGS to more closely focus on improving LMIC surgical capacity.

75.06 Evaluating Mobile Information Display System in Transfer of Care Scenarios

Posted on January 18, 2018

S. Ganapathy1, K. A. Berberich1, A. N. Kreiner2, M. McCarthy1  1Wright State University,Department Of Industrial And Human Factors Engineering; Department Of Trauma Care And Surgery,Dayton, OH, USA 2Air Force Research Lab,Human Performance Wing,DAyton, OH, USA

Introduction:
Transfer of care continuum is highly dynamic in nature and there are multiple complexities associated with man-man interaction and man-machine interaction. During transfer of patient care, adequate information related to the patient must be communicated very quickly and precisely. Providing the receiving emergency department with patient vitals and pre-hospital procedures that occurred during the EMT ride could allow for enhanced preparation and improved communication during the transfer process thereby being beneficial to the patient’s health. This paper focuses on designing and evaluating the usability of information presentation for a tablet device and the use of such device to improve efficiency during the transfer of care process. This could potentially help emergency department better prepare for the incoming patient.

Methods:
The experiment was conducted on a 7" Samsung tablet. The pool of participants was 16 nursing or medical students from WSU's nursing program and Boonshoft School of Medicine). A training period was provided to familiarize the participants with the display screens they would be seeing during the experimental scenarios. During the experimental phase, participants were asked to navigate through four different simulated transfer of care scenarios using a 7-inch tablet and create an action plan for when the patient would arrive.

Results:
Results indicated that basic information displays on the use of mobile devices for transfer of care could provide faster preparation response times in one and three patient-simulated scenarios. Results indicate that there were significant differences for simple and complex scenarios (p<0.0001) and for basic and advanced information displays (p=0.0474). An analysis of variance indicated there was a significant difference in the response time by situation (p<0.0001). Investigating the response times to create an action plan and SUS scores for display type, scenario, and type of medical personnel helped to identity the best information display design for patient vitals in a transfer of care.

Conclusion:
The fast paced, highly unpredictable environment of transfer of cares results in critical information being condensed down to be verbally conveyed as quickly as possible. Reducing patient information can result in errors, and even negative outcomes for the patient. Investigating the best information display resulted in the simpler displays having a faster response times compared to the advanced. Results also showed that the higher the usability score the quicker the response time suggesting future studies focus on high usability. This study can also help in training novice users the methods to prepare for complex scenarios during transfer of care.

75.04 The Malawi Trauma Score: A Model for Predicting Trauma-Associated Mortality in a Resource-Poor Setting

Posted on January 18, 2018

J. R. Gallaher1, M. Jefferson1, C. Varela2, B. Cairns1, A. Charles1,2  1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA 2Kamuzu Central Hospital,Surgery,Lilongwe, , Malawi

Introduction:
Globally, traumatic injury is a leading cause of morbidity and mortality in low-income countries. Current tools for predicting trauma-associated mortality are often not applicable in low-resource environments due to a lack of diagnostic adjuncts. This study sought to derive and validate a model for predicting mortality that requires only a history and physical exam. 

Methods:
We conducted a retrospective analysis of all patients recorded in the Kamuzu Central Hospital trauma surveillance registry in Lilongwe, Malawi from 2011 through 2014. Using statistical randomization, 80% of patients were used for derivation and 20% were used for validation. Logistic regression modeling was used to derive factors associated with mortality and the Malawi Trauma Score (MTS) was constructed. The model fitness was tested. 

Results:
62,425 patients were included. The MTS is tabulated based on initial mental status (alert, responds to voice, responds only to pain or worse), anatomical injury location, the presence or absence of a radial pulse, age, and sex, with a total possible score of 32. A mental status exam of only responding to pain or worse, head injury, the absence of a radial pulse, extremes of age, and male sex all conferred a higher probability of mortality. The ROC area under the curve for the derivation cohort and validation cohort were 0.83 and 0.84, respectively. A MTS of 25 confers a 50% probability of death (Figure 1).

Conclusion:
The MTS provides a reliable tool for trauma triage in sub-Saharan Africa and helps risk stratify patient populations. Unlike other models previously developed, its strength is its utility in virtually any environment, while reliably predicting injury- associated mortality. 
 

75.05 The Next Generation of Global Surgeons: Aligning Interest with Early Access to Global Surgery Education

Posted on January 18, 2018

E. M. Scott1, R. E. NeMoyer1, D. H. Blitzer3, J. S. Hanna1, Z. C. Sifri2, V. H. Gracias1, G. L. Peck1  1Robert Wood Johnson – UMDNJ,New Brunswick, NJ, USA 2New Jersey Medical School,Newark, NJ, USA 3MedStar Union Memorial Hospital,Baltimore, MARYLAND, USA

Introduction: While interest in global surgery appears to be increasing among medical students, little information is available regarding student perceptions of global surgery or level of interest in participation. In addition, limited data exists regarding availability and access to global surgery electives for students. This study investigates the influence of student demographics on interest in global surgery, the extent that global surgical burden education has been integrated into medical education curricula across the United States (US), and availability of global surgery electives.

Methods: An anonymous online survey was provided to the American Medical Student Association, who then distributed the survey via email and social media to current medical student members. Descriptive data was compiled regarding interest in and access to global surgery programs; demographic data was analyzed using chi-square testing for categorical variables.

Results: A total of 205 complete surveys were included in analysis. Over 85% of respondents were born in the US, however, 47% reported at least one parent born outside of the US. Respondents were predominantly located in the northeast (70%). A statistically significant association was identified between medical school year and reported interest in global surgery, with a higher proportion of those interested being in their pre-clinical years. A majority (61%) expressed interest in participating in global surgery programs, with top reasons reported as gaining an understanding of international health systems and sociocultural determinants of health. Collectively, 84% of respondents reported that global surgery issues are rarely or never addressed in their required medical school curriculum. Over half of respondents answered, “I don’t know,” when asked if their school offers a global surgery focus or electives within the global health department. Reported barriers to participating in global surgery programs included: funding (87%), scheduling constraints (65%), and language proficiency (51%).

Conclusion: Disparities in global surgery have emerged as an area of interest for medical students. This concern appears to extend beyond country of origin with a curiosity regarding the sociocultural determinants of health, suggesting a genuine commitment to social responsibility.  In addition, the data suggests that introduction to global surgery issues may be most effective during pre-clinical years so that students may incorporate potential interest with their clinical aspirations. The data also reveals that many students lack meaningful exposure to global surgery concepts, and are unaware of elective opportunities within their institution. Further study is needed to identify barriers to providing global surgery education either within core curriculum requirements or as electives. Early exposure to issues in global surgery is essential in engaging the next generation of surgeons to address these disparities.
 

75.03 Can They Stop the Bleed? Evaluation of Tourniquet Application by Laypersons with Reported Training

Posted on January 18, 2018

J. C. McCarty1, M. A. Chaudhary1, E. J. Caterson1,4, S. A. Goldberg2, M. L. McDonald1, C. Goolsby3, A. Haider1, E. Goralnick2  3Uniformed Services University Of The Health Sciences,Military & Emergency Medicine,Bethesda, MD, USA 4Brigham And Women’s Hospital,Division Of Plastic Surgery, Department Of Surgery, Harvard Medical School,Boston, MA, USA 1Brigham And Women’s Hospital,Center For Surgery And Public Health, Department Of Surgery, Harvard Medical School,Boston, MA, USA 2Brigham And Women’s Hospital,Department Of Emergency Medicine, Harvard Medical School,Boston, MA, USA

Introduction: Uncontrolled hemorrhage is an important cause of preventable death. With the increasing incidence of mass casualty events in western nations as a result of urban terrorism, several initiatives have been launched to empower laypersons to act as first responders and perform hemorrhage control (HC) including but not limited to the ACS “Stop the Bleed” campaign in the United States, Just-in-time point of care education, and web-based education. A central tenet of these is application of extremity tourniquets. This study assessed laypersons’, who self-reported prior training, ability to control bleeding with a tourniquet.

 

Methods: Employees of a major National Football League stadium participated in this study assessing ability to apply a Combat Application tourniquet (CAT) in an emergency. As a subgroup analysis of a larger study, participants who self-reported prior: 1) first aid (FA) training or 2) FA + HC training were included and presented an emergency scenario requiring tourniquet application on a mannequin. Correct application was assessed by time to application and appropriate tourniquet tightness. Prior to this, we obtained demographic data including open-ended questions on type of training participants had received and administered a survey to assess likelihood to help in a scenario requiring HC and comfort level in effectively controlling hemorrhage. The effect of FA training compared to FA + HC training was analyzed using Chi-square to compare correct tourniquet application and Mann-Whitney U test to compare reported likelihood to help and comfort level in HC.

 

Results: 206 participants were included. Overall, only 27% correctly applied a tourniquet. There was no difference in correct tourniquet application between those reporting just FA training and those reporting prior FA + HC training (table). However, the likelihood to help in an emergency and reported comfort level to effectively control bleeding of those participants with prior HC training was significantly higher than those with just FA training (table). Within the open-ended questions, no participants reported formal ACS “Stop the Bleed” training.

 

Conclusion: Despite self-reported prior training, a great majority of participants were unable to correctly apply a tourniquet. Prior reported HC training was associated with an increase in these laypersons intention to act to control bleeding, but it did not improve correct tourniquet application compared to those with just FA training. As work continues to identify the most effective method of layperson empowerment to act as effective first responders, these findings highlight the importance of high quality hemorrhage control training with proven long term retention.

75.01 Utilizing Nurse-focused Simulation Sessions to Decrease Patient Refusal of VTE Chemoprophylaxis

Posted on January 18, 2018

L. J. Kreutzer3, A. D. Yang2,3, D. B. Hewitt3,4, K. Y. Bilimoria2,3, J. K. Johnson2,3  2Feinberg School Of Medicine – Northwestern University,Center For Healthcare Studies In The Institute For Public Health And Medicine,Chicago, IL, USA 3Feinberg School Of Medicine – Northwestern University,Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 4Thomas Jefferson University,Surgery,Philadelphia, PA, USA

Introduction: Venous thromboembolism (VTE) is the leading cause of preventable inpatient death. VTE prophylaxis for moderate to high risk patients includes chemoprophylaxis; however, patients who refuse prophylaxis increase their VTE risk. Studies suggest that nurses can influence patient compliance with VTE prophylaxis. We previously conducted nursing focus groups at one hospital and found that they felt ill-equipped to handle patient refusals of VTE chemoprophylaxis. Our objective was to assess the effectiveness of a structured simulation session designed to equip nurses with skills to handle conversations with patients refusing VTE chemoprophylaxis.

Methods: Based on the findings from our qualitative study, we developed a 20-minute interactive in-person patient VTE chemoprophylaxis refusal simulation (Figure) as part of a larger VTE Prophylaxis Improvement Bundle. The simulation session goals were to 1) discuss the perspective of inpatients who refuse VTE chemoprophylaxis, 2) equip nurses with strategies to address patient refusals, 3) provide opportunities for nurses to learn from each other, and 4) to practice the nurse-patient conversation around VTE chemoprophylaxis refusal. After a brief brainstorming session discussing reasons why patients refuse VTE prophylaxis, nurse participants role-played as both the nurse and patient in a scenario where a patient refuses VTE chemoprophylaxis. The facilitators then debriefed the entire group of nurses to discuss effective strategies to respond to patient concerns. Participants then switched roles and repeated the role-play. Nurses received a reference sheet on effective strategies to respond to patients who decline VTE prophylaxis. We evaluated nurses’ perceptions of the utility and effectiveness of the experience with a post-session survey.

Results:We conducted 17 patient refusal simulation sessions including a total of 122 nurses from 4 inpatient units. After the simulation session, 98.4% of nurses felt ‘Quite a Bit’ or ‘A Great Deal’ able to speak with patients refusing VTE chemoprophylaxis compared to 76.2% pre-intervention (P<0.001). Furthermore, 94% of nurses intended to change their practice as a result of the session. Attendees translated lessons learned as they returned to their units: “After the session, I saw a lot more confidence when nurses were explaining the benefits of the medication to help prevent VTE.” – Unit Nurse Manager

Conclusion:A brief, focused interactive simulation session met an educational need and improved nurses’ ability to discuss VTE prophylaxis with patients. Future efforts will focus on expanding the initiative across our hospital system by integrating the sessions into the nursing education curriculum.

 

75.02 Eye-tracking in Educational Assessment: An Automated Procedure to Define Dynamic Areas of Interest

Posted on January 18, 2018

E. Fichtel1, J. Park2, S. Parker3, N. Lau1, S. D. Safford2  1Virginia Tech,Grado Department Of Industrial And Systems Engineering,Blacksburg, VA, USA 2Virginai Tech Carilion School Of Medicine,Surgery,Roanoke, VA, USA 3Virginia Tech Carilion Research Institute,Roanoke, VA, USA

Introduction:
Quality of assessment in medical education impacts training efficiency and patient outcomes. Eye tracking has demonstrated potential to provide unobtrusive and valid assessment of surgical skills by highlighting where experts and trainees focus during critical periods of surgical procedures. The locations of the expert eye-gazes can be used to define the Areas of Interest (AOIs) which can serve as evaluation criteria for where novices should focus. That is, eye-tracking provides a means to determine whether novices observe the same fields as the experts. However, when eye-gazes of experts are changing constantly over the course of a procedure, defining the AOIs can be time consuming and unnecessarily subjective because commercial software rely on the evaluator to specify the AOIs manually. To improve eye-tracking assessment, we developed a procedure that can be easily automated with common scripting language (e.g., R, Python) for defining dynamic AOIs for data analysis.

Methods:
The procedure for generating dynamic AOIs was developed with eye gaze samples collected from three expert surgeons viewing videos of laparoscopic cholecystectomy on a computer. Raw data on when (i.e., timestamps) and where (i.e., coordinates) expert gazes fell on the monitor was exported and using R statistics software the dynamic AOIs were defined. The R script removed invalid data (e.g., eye gaze outside of the monitor), and executed a loop to specify a circular-shaped AOI for every predefined time interval. The location and size of AOI center were based on the eye-gaze of an expert and 3 degrees of visual angle, respectively. The R script outputted a text file that was imported into a commercial software for quantitative eye-gaze analysis. At this exploratory analysis stage, we performed an ANOVA to test whether eye-gaze agreement between three expert surgeons would be lower for 10 videos with than 9 without adverse events.

Results:
This procedure created dynamic AOIs that closely resembled the heat map of expert eye gazes in the commercial eye-gaze analysis software (Figure 1), lending credibility to the validity of the procedure. Further, ANOVA indicated a significant decline in agreement between experts for videos with adverse events (F(1, 35)=10.02, p=.003), suggesting the dynamic AOIs were sensitive to change in complexity between surgeries.

Conclusion:
Our method of automatically generating dynamic AOIs can alleviate labor and subjectivity of the evaluators in manually defining AOIs for analysis. Future work will introduce dynamic AOI shapes to reflect complex environment in surgery. Our method should improve efficiency, sensitivity and reliability of analyzing eye-gaze in dynamic surgical environments. 
 

74.09 Illustrated Operative Reports are Superior to Conventional Dictations in Communicating Postop Anatomy

Posted on January 18, 2018

V. Vacharathit1, V. Vacharathit2, C. Tu3, G. Morris-Stiff1  1Cleveland Clinic,General Surgery,Cleveland, OH, USA 2Johns Hopkins,Molecular Microbiology And Immunology,Baltimore, MD, USA 3Cleveland Clinic,Biostatistics,Cleveland, OH, USA

Introduction:
Few documents are as important as operative reports (ORs) for physicians taking care of postsurgical patients, yet these documents are variable in quality, detail, and accuracy. This may result in decreased ability to plan medical and surgical care, thereby decreasing its quality. No studies to date have rigorously explored the effectiveness of using a customizable illustrated operative report (IOR) to bridge the communication gap that exists between surgeons and other providers. We propose that usage of IORs to supplement conventional ORs will enhance multidisciplinary communication and improve understanding of patient postoperative changes.

Methods:
To quantify the effectiveness of IORs vis a vis coventional dictated ORs, we conducted a randomized controlled trial with respondents (surgical residents wound care/ostomy nurses, nutritionists, and surgical nurses; n=174) blindly randomized to either the control (only dictated ORs; n=72) or experimental group (received the same ORs plus illustrations of the final anatomy; n=102). Respondents were asked interpretative questions based on three patients: 1) a routine Roux-en-y gastric bypass (denoted as “simple”) 2) a Whipple operation with prior Billroth II anatomy (“complex”) and 3) a trauma requiring sequential re-laparotomies and bowel resections (“sequential”). Accuracy and time needed to read and answer questions were quantified. Results were analyzed with the Chi-squared, Fisher’s exact and Wilcoxon rank sum tests. Two tailed comparisons were performed at a significance level of 0.05.

Results:
The control group was consistently less accurate in answering analytical questions even when adjusted for differing difficulty levels between operation types (allowed 1 incorrect response per section): 53% vs 71% answered accurately in simple operations (p=0.024), 24% vs 52% in complex operations (p<0.001), and 42% vs 60% in sequential operations (p=0.034). This trend was mirrored in the general surgery resident subpopulation but did not reach statistical significance (89% vs 97%; 51% vs 65%; and 67% vs 86% in simple, complex, and sequential operations, respectively). Time needed to read and interpret reports was also decreased with IORs: mean 377s vs 290s in simple (p=0.021); 354s vs 360s in complex (p=0.89), and 442s vs 327s in sequential operations (p=0.017). IORs increased confidence and overcame perceived hurdles in comprehending conventional ORs (jargon, too detailed, style of ORs) with 94% respondents recommending its usage overall and in resident (96%) and patient (97%) education.

Conclusion:
The use of customizable illustrations increased interpretative accuracy of ORs and decreased time needed for their interpretation. While effects were more pronounced for non-surgeons, subjective benefits were felt across the board. Creation and routine usage of IORs could improve communication between healthcare practitioners and serve as a teaching and learning tool for surgical trainees.
 

74.10 Utilizing Handoff Checklists Enhances Nurse-Physician Communication and May Prevent On-Call Fatigue

Posted on January 18, 2018

C. J. Hendrix1, A. E. Graham1, J. J. Lu1, S. W. Chen1, T. E. Ju1, L. Rivas1, I. N. Haskins1, K. Vaziri1  1George Washington University School Of Medicine And Health Sciences,Department Of Surgery,Washington, DC, USA

Introduction:
Frequent non-urgent paging between nurses and physicians can lead to interruptions in patient care, physician rest, and also result in pager fatigue for the on-call surgery resident. Overnight on-call residents are particularly vulnerable due to high patient volume and decreased staff availability for support. Studies have explored how to reduce non-urgent pages between nurses and providers using collaborative education and protocols to determine which calls may be labeled as “non-urgent” and thus be deferred until more staff are available or until morning rounds. Recently, the use of checklists within the healthcare system has proven to enhance patient care and outcomes, particularly for surgical safety. This study aims to investigate the utilization of checklists at evening sign out to improve communication between nurses and physicians, limit the incidence of non-urgent paging, and help minimize resident physician work burden.

Methods:
A survey was provided to the nursing staff and surgery resident physicians to determine the most common calls made to surgical interns on overnight shifts. A list was compiled based on these survey results. This list was then given to surgery interns to track calls or pages received overnight. The results were used to identify the five most common preventable, non-urgent overnight calls. A list of these items was provided to residents and daytime nursing staff to be utilized at time of evening handoffs. Both physicians and nurses were encouraged to address these items for each patient prior to start of night-shift. Calls and pages were again logged following this intervention to assess the frequency of non-urgent, preventable calls and pages. Calls and pages were recorded in the middle weeks of February and March only on weekdays (from 6pm to 6am) to avoid weekend coverage confounders. A T-test was used for data analysis.

Results:
Of the 270 calls recorded during the pre- and post-intervention data collection period, 173 calls were for common, non-urgent matters. Pre-intervention, residents received an average of 19 (0.55/patient) preventable calls overnight. After the checklist was instituted, residents received an average of 9 (0.26/patient) preventable calls overnight with a p-value of 0.016.

Conclusion:
Implementing a handoff checklist prior to night-shift to address the most common preventable issues necessitating overnight pages significantly decreased the number of calls made from the nurses to on-call resident physicians at night at our institution. This pilot study suggests that handoff checklists and multidisciplinary sign out can decrease non-urgent calls which may help prevent pager fatigue and improve resident physician work burden.

 

74.07 Geographic Variation in Scholarly Productivity among US Academic Surgeons

Posted on January 18, 2018

E. F. Garner1, N. P. Valsangkar2, L. G. Koniaris2, K. I. Bland1, H. Chen1  1University Of Alabama at Birmingham,Birmingham, Alabama, USA 2Indiana University School Of Medicine,Indianapolis, IN, USA

Introduction:
Academic productivity as measured by publications, citations, and extramural research funding is often an important factor in the promotion of academic surgeons.  The H-index accounts for the quantity and significance of an individual’s academic contributions. While previous studies have demonstrated regional differences in scholarly impact in other medical specialties, we describe the geographic distribution of academic productivity among US surgeons. 

Methods:
An established database of surgical department faculty from the top 50 NIH-funded universities was used for this study. Academic metrics were obtained using publically available data online from Scopus, Grantome, and NIH RePORTER. Physicians were categorized into four geographic regions: Northeast, Midwest, South, and West.  Two-sided Wilcoxon tests were used for comparisons.

Results:
4,078 surgical department faculty were included. Overall, 21.5% were female. There were 11.7% instructors, 32.0% assistant, 23.6% associate, and 32.6% full professors. Faculty in the West had a higher median H-index compared to the other regions (13 vs. 10; p <0.0001) with no other pairwise differences between the other regions. Faculty in the West also had significantly more citations in the past three years (p <0.001). Faculty in the Midwest were less likely to have NIH funding when compared to the other regions (Fig.1).

Conclusion:
Academic productivity of surgical faculty in the United States varies by geographic region. Surgical faculty in the West had higher research output with respect to citations over the past 3 years and H-index. Academic productivity may differ between regions in part due to variable emphasis on research, clinical and educational responsibilities. 
 

74.08 Post-Operative Surgical Trainee Opioid Prescribing Practices: A National Survey

Posted on January 18, 2018

P. Underwood1, J. Mira1, M. Hoffman2, D. Hall1, H. Keshava3, K. Olsen4, J. Hardaway5, K. Hawley6, A. Antony4, T. Vasilopoulos4, N. Mouawad7  1University Of Florida,Department Of Surgery,Gainesville, FL, USA 2University Of North Carolina,Department Of Surgery,Chapel Hill, NC, USA 3Cleveland Clinic,Department Of General Surgery,Cleveland, OH, USA 4University Of Florida,Department Of Anesthesiology,Gainseville, FL, USA 5Michigan State University,Department Of Surgery,Lansing, MI, USA 6MedStar Union Memorial Hospital,Department Of Surgery,Baltimore, MD, USA 7Mclaren Bay Region,Department Of Surgery,Bay City, MI, USA

Introduction:
Death from opioid overdoses continues to rise, prompting increased attention towards preventing opioid abuse. A significant portion of previously opioid naïve patients develop persistent opioid use after surgery. The impact of surgical trainees on the opioid epidemic is unclear. There is little data examining the association of surgical trainee education in pain management and opioid prescribing practices.
 

Methods:

An anonymous, online survey was created by a multidisciplinary team at six institutions. The survey was tested and is reliable based on statistical evaluation of a pilot survey. The survey was distributed to surgical trainee members of the Resident and Associate Society of the American College of Surgeons. The survey covered five themes: education and knowledge, prescribing practices, clinical case scenarios, policy, and beliefs and attitudes. Linear mixed models were used to evaluate the influence of respondent characteristics and case scenarios on reported morphine milligram equivalents (MME) prescribed for four common general surgery clinical scenarios.

Results:
Of the 427 survey respondents, 54% indicated receiving formal training in post-operative pain management during medical school and 66% received training during residency. Only 35% agreed that they had received adequate training in prescribing opioids. There was a significant association between undergoing formal pain management training in medical school and prescribing fewer MME for common outpatient general surgery scenarios (94±15.2 vs 108±15.0; p = 0.003; Figure).  Similarly, formal pain management training in residency was associated with prescribing fewer MME in the survey scenarios (92.6±15.2 vs 109±15.2; p = 0.002).

Conclusion:
Data informing general surgery programs on the utility of surgical trainee education in pain management is lacking. In this survey, nearly two-thirds of surgical residents felt that they were inadequately trained in opioid prescribing. Further, our data suggest that improving education may result in increased resident comfort with managing surgical pain and lead to more responsible opioid prescribing. Further studies are needed to inform residency programs on developing educational curricula for opioid prescribing best practices.
 

74.05 Impact of Medical School Experience on Attrition from General Surgery Residency

Posted on January 18, 2018

J. S. Abelson1, H. L. Yeo1,4, M. Symer1, N. Wong1, F. Michelassi1, R. Bell5, J. A. Sosa2  1Weill Cornell Medical College,Surgery,New York, NY, USA 2Duke University Medical Center,Surgery,Durham, NC, USA 3American Board Of Surgery, Inc,Philadelphia, PA, USA 4Weill Cornell Medical College,Healthcare Policy And Research,New York, NY, USA 5Temple University,Lewis Katz School Of Medicine,Philadelphia, PA, USA

Introduction: Medical school experience plays a role in the decision to pursue graduate surgical education.  However, no studies have examined the effect of medical school experiences on a resident’s likelihood of completing general surgery training.

Methods:  This is a national prospective longitudinal cohort study of all categorical general surgery (GS) interns who entered training in the 2007-2008 academic year. Interns were asked a series of questions related to their medical school experience and reasons for pursuing general surgery residency. Responses were linked with American Board of Surgery residency completion data. The primary outcome was completion of residency training. Multivariable Cox proportional hazards modeling was used to evaluate the association between medical school experiences and residency attrition. 

Results: 792/1043 (76%) GS interns had complete survey data; 287 (36%) were female, 252 (32%) non-White, and 70 (8.8%) Hispanic. The overall attrition rate was 20%. After multivariable adjustment for survey respondent gender, race/ethnicity and residency program type and size, two factors related to medical experience were found to be associated with completion of training. Residents who had medical school experiences with surgery attendings who were happy with their careers were more likely to complete training than those who did not (Hazard Ratio [HR] = 0.60; p=0.01). In addition, residents who matched at their first choice training program were more likely to complete their residency compared to those who did not match at their top choice (HR = 0.69; p = 0.04).  Having completed a sub-internship in surgery or having spent more time (0-8 wks vs. 9-12+ weeks) on surgical clerkships in the 3rd and 4th year were not associated with lower rates of attrition.

Conclusion: This is the first prospective national study to evaluate the potential association between medical school experiences and completion of general surgery residency.  These findings offer important insight into how exposure to surgery during medical school may impact a learner’s likelihood of finishing residency training and underlines the importance of positive role models and mentors for the development of trainees. 

 

74.06 Faculty responsiveness to students’ requests for feedback affects teaching evaluations

Posted on January 18, 2018

K. Heckman1, R. Kim1, A. Lee1, E. Chang2, N. Matusko3, R. Reddy3, D. Hughes3, G. Sandhu3,4  1University Of Michigan,University Of Michigan Medical School,Ann Arbor, MI, USA 2University Of Michigan,Ann Arbor, MI, USA 3University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 4University Of Michigan,Department Of Learning Health Sciences,Ann Arbor, MI, USA

Introduction: High quality teaching and feedback have both been identified as essential faculty skills in medical education. Medical student evaluations of faculty teaching are increasingly incorporated into promotion and tenure decisions, making it imperative to understand learner perceptions of high quality teaching better. Prior work has shown that faculty responsiveness to students has been linked with higher perception of teaching quality. However, while faculty perceive that they provide adequate feedback, students often cite an insufficiency. This mismatch in perception could negatively affect teaching evaluations.

The Minute Feedback System (MFS), developed at the University of Michigan Medical School (UMMS), uniquely offers a means to quantify how feedback responsiveness affects teaching quality scores. This novel electronic feedback tool enables medical students on their surgery clerkship to request feedback about their performance from faculty. This study assessed the relationship between MFS faculty feedback response rate and teaching evaluations.

Methods: This retrospective observational study compared student assessment of clinical instruction, as assessed by the “M3 Student Assessment of Clinical Instruction” survey, with feedback provided to students by faculty via the MFS. The data were generated from required surgical clerkship rotations for third-year medical students (M3s) at UMMS from May 2016 through June 2017. Average teaching quality scores from the survey were merged and compared with each faculty’s response rate (%) to student feedback requests. Weighted regression analysis (analytic weights) was used assess the relationship between average teaching quality scores and response rate while controlling for gender, average response time, and surgical service.

Results: The analysis included feedback requests (via MFS) from 237 M3s and teaching quality survey responses of 104 faculty. The mean feedback response rate by faculty was 55.78%. The mean teaching quality score was 4.27 on a scale of 1 to 5; however, no faculty scored lower than 3. Teaching quality score was significantly correlated with response rate (p<0.001). For every 10% increase in faculty response rate, an improvement of 0.074 was seen in average teaching quality score (Figure 1). Average teaching quality score was not significantly associated with response time (p=0.158), gender (p=0.407), or surgical service (p=0.498).

Conclusion: These results suggest that medical students consider adequate responses to feedback requests an important component of quality teaching. Further, faculty development focused on efficient and practical feedback strategies may have the added benefit of improving the quality of their teaching.

 

74.04 Caveat Emptor – Educating Surgeons About the Perilous Landscape of Solicitant Publishing

Posted on January 18, 2018

V. Nguyen1, R. A. Marmor1,2, S. L. Ramamoorthy1,3, T. W. Costantini1,4, J. M. Baumgartner1,5, J. Berumen1,6, G. R. Jacobsen1,7, J. K. Sicklick1,5  1University Of California – San Diego,School Of Medicine,San Diego, CA, USA 2University Of California – San Diego,Department Of Surgery,San Diego, CA, USA 3University Of California – San Diego,Division Of Colorectal Surgery, Department Of Surgery,San Diego, CA, USA 4University Of California – San Diego,Division Of Trauma, Surgical Critical Care, Burns And Acute Care Surgery, Department Of Surgery,San Diego, CA, USA 5University Of California – San Diego,Division Of Surgical Oncology, Department Of Surgery,San Diego, CA, USA 6University Of California – San Diego,Division Of Hepatobiliary Surgery And Abdominal Transplantation, Department Of Surgery,San Diego, CA, USA 7University Of California – San Diego,Division Of Minimally Invasive Surgery, Department Of Surgery,San Diego, CA, USA

Introduction:
Despite the exponential increase in open access surgical journals that actively solicit manuscripts via email, little is known about them. Because surgeons frequently review the literature for research and evidence-based practice, it is critical to understand how these journals compare to more traditional journals and who comprises their authorship. We hypothesized that U.S. academic surgeons do not publish in these journals. Thus, the primary objectives of this cross-sectional study are: (1) to characterize the practices of solicitant surgical journals; (2) to compare solicitant surgical journals to non-solicitant journals; and (3) to assess authorship by U.S. surgeons.

Methods:
We identified publishers who contacted the senior author and compared their surgical journals’ publication fees, PubMed indexing, and impact factors to 10 top-tier surgical journals and 10 top-tier open access medical journals. In a validation study, we tallied email solicitations received by 5 additional academic surgeons in various subspecialties. We then assessed the senior authorship of articles published by solicitant surgical journals from Jan-Mar 2017.

Results:
Over a 6-wk period, 1 surgeon received 110 email solicitations from 29 publishers distributing 113 surgical journals. Over a 2-wk period, 5 additional surgeons each received a mean of 3.0±1.4 emails/day, suggesting generalizability across subspecialties. The median year of journal inauguration was 2016. Only 12 journals (11%) were indexed in PubMed and 9 journals (8%) reported an impact factor (median: 0.24; range: 0.08-0.60). The median reported publication fee was $755. Google Maps satellite images revealed that 30% of these journals' U.S. editorial offices operated from personal residences. Compared to non-solicitant journals, solicitant journals were characterized by lower open access publication fees (p<0.001), but also lower PubMed indexing rates (p<0.001) and impact factors (p<0.001). We then assessed the 649 articles published by these 113 journals from Jan-Mar 2017. Contrary to our hypothesis, 23% of these articles’ senior authors were from U.S. institutions, of whom 78% were academic faculty. Over 3 months, academics published 117 articles in 36 journals with a median impact factor of 0.12 and 26% PubMed indexing rate, costing an estimated $82,560.

Conclusion:
This is the first report describing surgical journals who strategically utilize email solicitations to acquire academic contributions. Despite their sparse PubMed indexing and low impact factors, many academic surgeons in the U.S. publish their work in these journals. With the constant pressure to ‘publish or perish’ in academic surgery, this study highlights the importance for trainees and academic surgeons of all ranks to be cognizant of the quantity and quality of these journals when considering manuscript submissions or critical literature review for evidence-based clinical practice.

74.01 Surgical Trainee Attitudes Towards Safety Event Reporting

Posted on January 18, 2018

D. Vicente1, A. Loehrer1, S. Fisher1, J. Skibber1, E. Grubbs1, T. Aloia1  1University Of Texas MD Anderson Cancer Center,Houston, TX, USA

Introduction:  Patient Safety Event (PSE) reporting is an important element of quality improvement. While surgical trainees have frequent exposure to and involvement in PSEs, repeated studies have shown that they seldom report such events.  Herein, we describe surgical fellow’s attitudes towards PSE reporting at a tertiary cancer center.

Methods:  We reviewed the PSE reports for the entire institution to quantify the number of trainee reports per year compared to other PSE reporters.  After Institutional Quality Improvement Assessment Board approval, a 10-question survey regarding their perceptions of PSE reporting was administered to fellows in Complex General Surgical Oncology, Breast Surgical Oncology, Endocrine Surgery, Pediatric Surgery, and an International Fellow. 

Results:  Less than 1% of PSE reports between June 2016 and May 2017 were submitted by trainees institution-wide. 20 of 25 fellows completed the 10-question survey.  While 90% of fellows were aware of the PSE reporting system, only 25% had ever submitted a report.  While most trainees stated that anonymity did not influence their decision to report (35%), fellows were more likely to report support staff (70%), and nursing personnel (60%), and less likely to report either peers (5%) or physicians senior to them (0%).  Additional barriers to reporting included the time burden to submit a PSE report (85%) and a concern that the PSE would have a limited impact on the system (80%).  80% of fellows agreed that they would be more likely to report a PSE with either improved reporting efficiency or guaranteed feedback regarding the report and subsequent actions taken to improve the system.

Conclusion: Barriers to PSE reporting exist amongst surgical fellows, and may include a hierarchical reporting bias. The time burden required to file the PSE report and concern over lack of impact of individual reports contribute to a lack of enthusiasm regarding PSE reporting. More efficient submission processes and report feedback may improve trainee participation in PSE reporting.

 

74.02 Type of Surgical Rotation Does Not Affect Students’ Technical and Academic Development

Posted on January 18, 2018

P. Kandagatla1, R. Rinaldi1, Z. Al Adas1, E. Field1, C. Steffes1, H. Abdallah1, L. Kabbani1  1Henry Ford Health System,Detroit, MI, USA

Introduction:  During a surgical clerkship, medical students rotate through various specialties. There is little research on the effect of this diversity of rotations on students. Some programs allow students to select their rotations while others assign them in an attempt to provide a similar experience to everyone. The purpose of this study is to assess the effect of taking core rotations compared to specialty rotations on students’ technical and academic development.

Methods:  Students going through a surgical clerkship at our institution were given a suturing workshop at the beginning of their clerkship. A questionnaire was also given to students to record any prior interest in surgery or previous hands-on experience. Immediately after the workshop, they were asked to perform a simple and a complex suturing task. The tasks were repeated again at the end of the 2-month clerkship and a post clerkship questionnaire filled out. These tasks were videotaped, the times to completion were recorded, and the proficiency scored by a blinded attending surgeon. The times and scores were analyzed to assess for any improvement. The students were then divided into two groups depending on the number of core surgical rotations they rotated through. Groups were compared using uni-variate and multi-variate analyses and the variables compared included objective scores, time to complete tasks, and exam scores.

Results: Thirty-eight students were included in the study. By the end of the rotation there was a decrease in the average time to perform the simple task (5.1 vs 4.1 min, p<0.01) and the complex task (7.9 vs 6.3 min, p<0.01). There was also an increase in proficiency of the simple task (14.2 vs 16.4, p=0.035) and the complex task (12.9 vs 16.5, p<0.01). Using multi-variate analysis, we found that reported hours in the operating room per week and previous hands-on experience affected proficiency of the simple suturing task. 

Sixteen students had predominantly core surgical rotations. When compared to the 22 students with more subspecialty rotations, there was no difference in terms of age, hours logged in the operating room per week, amount of practice, previous interest in surgery, and previous hands-on experience. There was a difference in gender (more males in the core surgical rotations, 50% vs 87.5%, p=0.02). There was no significant difference in the completion times (p=0.964, 0.821), the proficiency scores (p=0.057, 0.198), the shelf exam scores (p=0.572), and oral exam pass rates (p=0.885) between the two groups.

Conclusion: After completion of a general surgery clerkship most students’ technical skills improved. This was not affected by the type of rotations (core vs subspecialty) they were assigned.  In this small study, it appears that neither their surgical skills development nor their knowledge is associated by their choice of rotation.

74.03 “Competencies and Areas for Improvement in Surgical Clerkship Instructors: A Qualitative Study”

Posted on January 18, 2018

D. M. Carmona Matos1, M. K. Mandabach1, A. W. Chang1, B. R. Herring1, V. Strickland1, H. Chen1, B. L. Corey1  1University Of Alabama at Birmingham,Surgery Department,Birmingham, Alabama, USA

Introduction: Medical students’ interest in surgical careers has declined progressively over the past few decades. Nevertheless, it is known that positive learning experiences can foster student interest in potential fields of study. In this project, we sought to identify the competencies and areas of improvement of surgical clerkship instructors as perceived by third year medical students.

 

Methods: Our medical school has a mandatory 8-week surgical clerkship for third-year medical students. At the end of their clerkship students are required to complete surveys on their surgical clerkship instructors. Surveys were collected during a period of 3 academic years (2012-2015) and individual summaries per instructor were generated. The analysis was limited to the open feedback sections: “What was done well?” and “Suggestions for improvement”. A survey content analysis was carried out using the qualitative data analysis software ATLAS.ti Scientific Software Development GmbH, Berlin (MAC version 1.6.0).

 

Results: A total of 533 survey summaries were analyzed. Instructors were sorted by rank: interns (12.4%), residents (49.1%), assistant professors (15.8%), associate professors (9.8%) and full professors (12.9%). Most instructors belonged to the general surgery, orthopedic surgery, vascular surgery and plastic surgery divisions. We found 89.5% of the summaries comprised feedback on competencies while 64.5% had suggestions for improvement. The most frequently used words were: teach/er/ing (n=1236), time (n=897), work/ing (n=834), surgeries/procedures (n=701), patients (n=629), questions (n=537). There were no significant differences in most common words based on instructor rank, gender or division. A quotation analysis showed that surgical instructors were most valued in terms of their teaching ability, enthusiasm, and availability. In addition, instructor work ethic, student hands on experiences and team based learning were highly regarded. In terms of improvements, students focused on issues such as providing clear expectations, allotting additional non-lecture instruction time, and improving student feedback.

Conclusion: These results suggest that, regardless of instructor rank, gender or division, students valued a set of common competencies. Students consistently described what surgical clerkship instructors did well as: making time for questions and education, showing enthusiasm for teaching, and allowing students to be involved with patients in clinics and the OR. Students desire clear expectations, increased non-lecture instruction time, and better feedback. This information can help reinforce and improve individual instructor’s skills and the   surgical clerkship experience.

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