Anesthetic considerations for the management of the surgical patient with COVID-19 / Consideraciones anestésicas para el abordaje del paciente quirúrgico con COVID-19

Resumen Introducción: La situación actual causada por el COVID-19 demanda la implementación de nuevas técnicas en el manejo anestésico y los riesgos preexistentes en los servicios quirúrgicos. Objetivo: Identificar las consideraciones anestésicas para pacientes con COVID-19 con el fin de sugerir intervenciones en el área quirúrgica. Metodología: Revisión integrativa de alcance descriptivo en conjunto con el cumplimiento de los pasos metodológicos de Whittemore-Knafl y los parámetros PRISMA. Se realizó la búsqueda en las bases de datos: PubMed, BVS, Coronavirus Research Database, SCOPUS, Elsevier y SAGE. Se obtuvieron 953 artículos que, junto a un análisis crítico por CASPe, cumplieron los criterios establecidos de inclusión y exclusión. Resultados: Se seleccionaron 27 artículos clasificados en: criterios de selección de técnica anestésica; anestesia general y el uso de medicamentos específicos para el manejo anestésico que disminuyan la tos y prevengan la liberación de aerosoles; manejo de la vía aérea encaminada a evitar intubaciones fallidas; anestesia regional y consideraciones de enfermería sobre la preparación de elementos y dispositivos de manera previa al ingreso del paciente al quirófano; identificación y monitorización de pacientes sintomáticos y asintomáticos durante el proceso perioperatorio. Conclusión: Con respecto a la técnica anestésica, es importante priorizar el uso, en cuanto sea posible, de la anestesia regional guiada con ultrasonido. En caso de requerirse la anestesia general, es recomendable mantener las precauciones para prevenir el contagio con el virus. Para enfermería, es destacable el rol en la preparación de un entorno quirúrgico seguro, del conocimiento sobre la técnica anestésica empleada y los cuidados individualizados según las necesidades requeridas.

Abstract Introduction: The current situation caused by COVID-19 demands the implementation of new techniques in anesthetic management and pre-existing risks in surgical services. Objective: to identify the anesthetic considerations for patients with COVID-19 to suggest interventions in the surgical area. Methodology: Integrative review of descriptive scope in conjunction with compliance with the methodological steps of Whittemore-Knafl and the PRISMA parameters. The search was performed in the following databases: PubMed, VHL, Coronavirus Research Database, SCOPUS, Elsevier, and SAGE. A total of 953 articles were obtained, which together with a critical analysis by CASPe, met the established inclusion and exclusion criteria. Results: Twenty-seven articles classified as: selection criteria for anesthetic techniques; general anesthesia and the use of specific medications for anesthetic management that reduce cough and prevent the release of aerosols; airway management to avoid failed intubations; regional anesthesia and nursing considerations in the preparation of elements and devices prior to the patient's admission to the operating room; identification and follow-up of symptomatic and asymptomatic patients during the perioperative process. Conclusion: Regarding the anesthetic technique, it is important to prioritize the use, as far as possible, of ultrasound-guided regional anesthesia. If general anesthesia is required, it is advisable to maintain precautions to prevent infection with the virus. For nursing, the role in preparing a safe surgical environment, knowledge of the anesthetic technique used and individualized care according to the required needs stand out.

Operative autonomy and supervision of the surgical resident: A look at the COVID-19 pandemic / Autonomía y supervisión operatorias del residente de cirugía: Una mirada en la pandemia por COVID-19

Introducción. Al declararse la pandemia por SARS-CoV-2, se establecieron múltiples cambios en los sistemas de salud y en las instituciones hospitalarias, influyendo en la actividad quirúrgica global. El objetivo de este estudio fue evaluar el impacto de la pandemia en los niveles de autonomía y supervisión operatorias de los residentes de cirugía. Métodos. Estudio analítico cuasi-experimental, que incluyó los procedimientos quirúrgicos registrados por residentes de cirugía general de la Universidad de La Sabana, de febrero de 2019 a agosto de 2021. Se analizaron la autonomía y la supervisión mediante la escala Zwisch en los periodos prepandemia y pandemia. Resultados. Se recolectaron datos de 10.618 procedimientos en el periodo establecido, la mayoría realizados con abordaje abierto (57,4 %) y en rotaciones tronculares de cirugía general (65 %). Los procedimientos realizados más frecuentes fueron apendicectomía (18,6 %), colecistectomía (18,4 %) y herniorrafías (8,6 %). Se encontró una disminución estadísticamente significativa en los niveles globales de autonomía y supervisión entre los periodos analizados de 2, 4/4, 0 a 2, 2/4, 0 (p<0,001). Discusión. La disminución en la autonomía percibida por los residentes podría corresponder al impacto negativo en la motivación intrínseca de los individuos, en la disminución objetiva en el logro de las competencias esperadas en su proceso de formación quirúrgica y a la pérdida del relacionamiento colectivo propiciado por los aislamientos y limitaciones vividos. Conclusión. La pandemia por COVID-19 impactó negativamente en la autonomía y supervisión operatoria de los residentes de cirugía general de la Universidad de La Sabana, Chía, Colombia.

Introduction. Changes in health systems and hospital institutions due to the coronavirus pandemic influenced global surgical activity. The objective of this study was to evaluate the impact of the pandemic on the levels of autonomy and supervision in general surgery residents. Methods. Quasi-experimental analytical study. It included the surgical procedures recorded by general surgery residents of the University of La Sabana from February 2019 to August 2021. Autonomy and supervision were analyzed using the Zwisch scale in the pre-pandemic and pandemic periods. Results. 10,618 procedures were collected in the established period. Most surgeries were performed with an open approach (57,4%), in rotations of general surgery (65%). The most frequent procedures performed were appendectomy (18,6%), and cholecystectomy (18,4%), and herniorrhaphy (8,6%). There was a decrease in levels of autonomy and supervision compared between the analyzed periods from 2, 4/4, 0 to 2, 2/4, 0 (p<0.001). Discussion. The decrease in the autonomy perceived by the residents could correspond to the negative impact on the intrinsic motivation of the individuals, a decrease in the achievement of the competencies expected in their surgical training process, and the loss of the collective relationship produced by the isolation and limitations experienced. Conclusion. The COVID-19 pandemic had a negative impact on autonomy and supervision in general surgery residents of the University of La Sabana, Chia, Colombia

Coronavirus Disease 2019 and the Yale Response: A Semistructured Interview Study on Plastic Surgery Resident Education and Departmental Adaptation to the Lockdown.

BACKGROUND: Sooner-than-expected progression to statewide lockdown at the height of the coronavirus disease 2019 pandemic left minimal time for medical specialty boards, including The American Board of Plastic Surgery, to issue guidance for their respective programs. As a result, programs were tasked with developing creative alternatives to their standard resident curricula and department schedules. OBJECTIVE: To capture attending and resident experience of the coronavirus disease 2019 lockdown in narrative form and to understand what specific changes enacted to maintain adequate education should be considered for continuation after the pandemic's conclusion. METHODS: Qualitative, semistructured interviews of residents, fellows, and faculty of the Section of Plastic and Reconstructive Surgery during 2019 to 2020 academic year were conducted on the following topics: (1) general reflection on lockdown, (2) resident maintenance of daily logs, (3) multi-institutional collaborative lectures, (4) modified didactic curriculum, (5) virtual 3-dimensional craniofacial planning sessions, (6) maintenance of department camaraderie, and (7) effect on preparation to become a surgeon. RESULTS: Twenty interviews (response rate 77%) were conducted between October 2020 and February 2021. Of residents, 100% felt observing the craniofacial planning sessions was beneficial, with many explicitly noting it provided a unique perspective into the surgeon's thought process behind planned manipulations, to which they usually are not privy. Of residents, 100% felt confident at the time of the interview that the lockdown would have no lasting effects on their preparation to become a surgeon. CONCLUSIONS: Rapid changes enacted at Yale enabled resident training to advance, and documentation of the success of these changes can inform future curriculum design.

Teaching to transform surgical culture: an educational programme and thematic analysis in a general surgery department.

INTRODUCTION: General surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department. METHODS: Twelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery. DISCUSSION: Teaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the 'community of practice' was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum. CONCLUSION: Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future.

COVID-19 Did Not Stop the Rising Tide: Trends in Case Volume Logged by Surgical Residents.

INTRODUCTION: The coronavirus pandemic has profoundly impacted all facets of surgical care, including surgical residency training. The objective of this study was to assess the operative experience and overall case volume of surgery residents before and during the pandemic. METHODS: Using data from the Accreditation Council for Graduate Medical Education annual operative log reports, operative volume for 2015 to 2021 graduates of Accreditation Council for Graduate Medical Education -accredited general, orthopedic, neuro- and plastic surgery residency programs was analyzed using nonparametric Kendall-tau correlation analysis. The period before the pandemic was defined as AY14-15 to AY18-19, and the pandemic period was defined as AY19-20 to AY20-21. RESULTS: Operative data for 8556 general, 5113 orthopedic, 736 plastic, and 1278 neurosurgery residency graduates were included. Between 2015 and 2021, total case volume increased significantly for general surgery graduates (Kendall's tau-b: 0.905, p = 0.007), orthopedic surgery graduates (Kendall's tau-b: 1.000, p = 0.003), neurosurgery graduates (Kendall's tau-b: 0.905, p = 0.007), and plastic surgery graduates (Kendall's tau-b: 0.810, p = 0.016). Across all specialties, the mean total number of cases performed by residents graduating during the pandemic was higher than among residents graduating before the pandemic, though no formal significance testing was performed. Among general surgery residents, the number of cases performed as surgeon chief among residents graduating in AY19-20 decreased for the first time in 5 years, though the overall volume remained higher than the prior year, and returned to prepandemic trends in AY20-21. CONCLUSIONS: Over the past 7 years, the case volume of surgical residents steadily increased. Surgical trainees who graduated during the coronavirus pandemic have equal or greater total operative experience compared to trainees who graduated prior to the pandemic.

Virtual Mentoring: A Novel Approach to Facilitate Medical Student Applications to General Surgery Residency.

OBJECTIVE: The COVID-19 pandemic rapidly altered the landscape of medical education, particularly disrupting the residency application process and highlighting the need for structured mentorship programs. This prompted our institution to develop a virtual mentoring program to provide tailored, one-on-one mentoring to medical students applying to general surgery residency. The aim of this study was to examine general surgery applicant perception of a pilot virtual mentoring curriculum. DESIGN: The mentorship program included student-tailored mentoring and advising in 5 domains: resume editing, personal statement composition, requesting letters of recommendation, interview skills, and residency program ranking. Electronic surveys were administered following ERAS application submission to participating applicants. The surveys were distributed and collected via a REDCap database. RESULTS: Eighteen out of 19 participants completed the survey. Confidence in a competitive resume (p = 0.006), interview skills (p < 0.001), obtaining letters of recommendation (p = 0.002), personal statement drafting (p < 0.001), and ranking residency programs (p < 0.001) were all significantly improved following completion of the program. Overall utility of the curriculum and likelihood to participate again and recommend the program to others was rated a median 5/5 on the Likert scale (5 [IQR 4-5]). Confidence in the matching carried a premedian 66.5 (50-65) and a postmedian 84 (75-91) (p = 0.004). CONCLUSION: Following the completion of the virtual mentoring program, participants were found to be more confident in all 5 targeted domains. In addition, they were more confident in their overall ability to match. General Surgery applicants find tailored virtual mentoring programs to be a useful tool allowing for continued program development and expansion.

Mortality and pulmonary complications in emergency general surgery patients with COVID-19: A large international multicenter study.

OBJECTIVES: The outcomes of emergency general surgery (EGS) patients with concomitant COVID-19 infection remain unknown. With a multicenter study in 361 hospitals from 52 countries, we sought to study the mortality and pulmonary complications of COVID-19 patients undergoing EGS. METHODS: All patients 17 years or older and diagnosed preoperatively with COVID-19 between February and July 2020 were included. Emergency general surgery was defined as the urgent/emergent performance of appendectomy, cholecystectomy, or laparotomy. The main outcomes were 30-day mortality and 30-day pulmonary complications (a composite of acute respiratory distress syndrome, unexpected mechanical ventilation, or pneumonia). Planned subgroup analyses were performed based on presence of preoperative COVID-related respiratory findings (e.g., cough, dyspnea, need for oxygen therapy, chest radiology abnormality). RESULTS: A total of 1,045 patients were included, of which 40.1% were female and 50.0% were older than 50 years; 461 (44.1%), 145 (13.9%), and 439 (42.0%) underwent appendectomy, cholecystectomy, and laparotomy, respectively. The overall mortality rate was 15.1% (158 of 1,045 patients), and the overall pulmonary complication rate was 32.9% (344 of 1,045 patients); in the subgroup of laparotomy patients, the rates were 30.6% (134 of 438 patients) and 59.2% (260 of 439 patients), respectively. Subgroup analyses found mortality and pulmonary complication risk to be especially increased in patients with preoperative respiratory findings. CONCLUSION: COVID-19 patients undergoing EGS have significantly high rates of mortality and pulmonary complications, but the risk is most pronounced in those with preoperative respiratory findings. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.

Are Simulators Paving a New Way for Continuing Education?

Simulated learning has been practiced for decades and was a key element in remote learning during the midst of the COVID-19 pandemic. Continuing healthcare education courses for clinicians have incorporated surgical simulators to enable relief from the time constraints encountered in the operating room and provide a more relaxed environment in which to practice complex surgical procedures. Educational research studies show that the implementation of such applications in pedagogy have improved knowledge retention, increased clinician confidence, provided easier access to educational materials, and reduced levels of anxiety about learning. This review highlights the benefits and limitations of surgical simulators. Based on the evidence and current trends, simulated learning signifies a fundamental shift in higher education that is transforming healthcare academic institutions and offering significant potential for continuing dental education.

Initiation of the Virtual Interview: A 5-Y Evaluation of General Surgery Residency Match Results.

INTRODUCTION: The virtual residency application season posed numerous challenges for the 2021 residency match process. Many residency programs are exploring relationships between this novel format and the match process. The purpose of this study was to compare one of the largest general surgery residency program's applications and match data from preCOVID years to the 2021 virtual cycle. MATERIALS AND METHODS: A retrospective review was performed of applicants to a single general surgery residency program from 2017 to 2021. The primary outcome was the number of locally matched applicants. The secondary outcomes were the total number of applications, change in applicant demographics, and variability of the geographic spread during this study period. Chi-square tests of independence, Fisher's exact tests, and negative binomial regression were performed. RESULTS: 6819 applicants were included in the study. In 2021, an increase in applications was observed. The distribution of 2021 applications was statistically different from previous years regarding gender and race (P < 0.0001). The 2021 application cycle had a greater proportion of applicants from the United States (P < 0.0001) and southern US medical schools (P = 0.008). While the 2021 cycle had significantly more interviews (P = 0.013), there were no significant differences in the demographic composition of interviewees. During the 2021 application year, all 11 matches were from southern medical schools and there was a trend to more matched female applicants compared to previous years. CONCLUSIONS: During the 2021 COVID-19 virtual match cycle, an increase in both the number of applications and number of interviews for general surgery residency was identified. The characteristics of applicants who interviewed and matched were not different when compared to previous years. As virtual interviews may become more commonplace, it is important to assess all factors that may be involved in the dynamic residency application process.

Shared Decision-Making in General Surgery: Prospective Comparison of Telemedicine vs In-Person Visits.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has accelerated a shift toward virtual telemedicine appointments with surgeons. While this form of healthcare delivery has potential benefits for both patients and surgeons, the quality of these interactions remains largely unstudied. We hypothesize that telemedicine visits are associated with lower quality of shared decision-making. STUDY DESIGN: We performed a mixed-methods, prospective, observational cohort trial. All patients presenting for a first-time visit at general surgery clinics between May 2021 and June 2022 were included. Patients were categorized by type of visit: in-person vs telemedicine. The primary outcome was the level of shared decision-making as captured by top box scores of the CollaboRATE measure. Secondary outcomes included quality of shared decision-making as captured by the 9-item Shared Decision-Making Questionnaire and satisfaction with consultation survey. An adjusted analysis was performed accounting for potential confounders. A qualitative analysis of open-ended questions for both patients and practitioners was performed. RESULTS: During a 13-month study period, 387 patients were enrolled, of which 301 (77.8%) underwent in-person visits and 86 (22.2%) underwent telemedicine visits. The groups were similar in age, sex, employment, education, and generic quality-of-life scores. In an adjusted analysis, a visit type of telemedicine was not associated with either the CollaboRATE top box score (odds ratio 1.27; 95% CI 0.74 to 2.20) or 9-item Shared Decision-Making Questionnaire (ß -0.60; p = 0.76). Similarly, there was no difference in other outcomes. Themes from qualitative patient and surgeon responses included physical presence, time investment, appropriateness for visit purpose, technical difficulties, and communication quality. CONCLUSIONS: In this large, prospective study, there does not appear to be a difference in quality of shared decision making in patients undergoing in-person vs telemedicine appointments.

Impact of COVID-19 on the surgical volume of general surgery residents as main surgeons in a National Training Program in Costa Rica: A cross-sectional study.

ABSTRACT: To quantify the impact of coronavirus disease 19 (COVID-19) on the surgical volume of residents' medical practice in Costa Rica's General Surgery Residency Program.The COVID-19 pandemic has caused a significant disruption in people's lives. Health systems worldwide have been forced to adapt to the new normal, which has posed a challenge for medical residency programs, especially in the surgical field.This transversal study includes the surgical records of all residents of the General Surgery program who worked as main surgeons at the Mexico Hospital of the Costa Rican Social Security between December 23, 2019, and June 25, 2020.As main surgeons, a total of 10 residents performed 291 pre-pandemic surgeries and 241 pandemic surgeries.When comparing the distribution of procedures performed by residency levels, it is observed that the postgraduate year -2 increased the number of procedures performed during the pandemic period (pre-pandemic 19% vs pandemic 27%, P = .028). There was no statistically significant difference between the pre-pandemic and pandemic periods in the remaining levels.When comparing the procedures by unit, a statistically significant decrease was observed in the Endocrine-Abdominal Wall Unit (pre-pandemic 18.3% vs pandemic 5.4%, P < .001). Conversely, a statistically significant increase was identified in Surgical Emergencies Unit procedures (40.0% vs post 51.7%, P = .007). No statistically significant differences were observed in the remaining the Units.The COVID-19 pandemic had no statistically significant effect on surgeries performed by residents of the General Surgery Residency Program as main surgeons in a national training center in Costa Rica. The Department's timely measures and pro-resident attitude were the key reasons for the above results.

COVID-19 Elective Surgery Shutdown and Operative Experience for Graduating Plastic Surgery Independent Residents.

INTRODUCTION: The initial wave of the COVID-19 pandemic led to a temporary shutdown of elective procedures. The purpose of this study is to evaluate how the elective surgery shutdown impacted case log numbers for graduating plastic surgery independent residents. METHODS: The Accreditation Council of Graduate Medical Education graduate self-reported case logs were retrospectively compiled for graduating independent track plastic surgery residents for the year before the pandemic (2019), 4 months into the pandemic (2020) and 16 months into the pandemic (2021). Procedures were grouped into resident review committee area and totals for each area were used for analysis. Average number of cases and standard deviations were compiled. Percent change was calculated comparing each year to the prepandemic baseline. Statistical significance was determined with Student t tests comparing average number of cases. Coefficients of variation were calculated to assess for changes in interprogram variation. Average case numbers were then compared with minimum case requirements necessary for graduation. RESULTS: The Accreditation Council of Graduate Medical Education graduation case log statistics were available for 238 independent residents. There were no statistically significant differences in average case number for graduating independent residents for total reconstructive breast, trunk, hand and upper extremity, or total reconstructive procedures between graduation years. The average case number of total lower extremity reconstruction increased from 2019 to 2020 (average = 83-97.4, P = 0.02). The average total number of breast aesthetic cases increased between all years (average = 92, 98, 114), with the average increase from 2019 to 2021 being statistically significant ( P = 0.02). Differences in head and neck aesthetic deformities and trunk and extremity deformities between years were not statistically significant. The average case number for all graduating plastic surgery independent residents exceeded the minimum case log requirements. CONCLUSIONS: The temporary hold on elective procedures during the pandemic decreased the opportunity for plastic surgery trainees to meet minimum case log requirements. Case log data for graduating plastic surgery independent residents demonstrate that despite the temporary suspension, the pandemic did not greatly impact the average resident case numbers.

A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program.

BACKGROUND: Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents' exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. METHODS: A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high definition and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training. RESULTS: Statistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations. CONCLUSION: An OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self-confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in residency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be beneficial when future surgeons face extremely severe trauma scenarios.

Faculty Scoring of General Surgery Residency Interviewees: A Comparison of In-Person and Virtual Interview Formats.

OBJECTIVE: With new rules regarding social distancing and non-essential travel bans, we sought to determine if faculty scoring of general surgery applicants would differ between the in-person interview (IPI) and virtual interview (VI) platforms. DESIGN: A single institution, retrospective review comparing faculty evaluation scores of applicant interviewees in the 2019 and 2020 MATCH® application cycles (IPIs) and the 2021 and 2022 application cycle (VIs) was conducted. Faculty scored applicants using a 5-point Likert scale in 7 areas of assessment and assigned each student to 1 of 4 tiers (tier 1 highest). A composite score for the 7 assessments (maximum score 35) was calculated. Mean and composite scores and tiers were compared between VI and IPI cycles and adjusted for within-interviewer correlations. The variance of the 2 groups were also compared. SETTING: Harbor-UCLA Medical Center, an academic, tertiary care hospital. PARTICIPANTS: General Surgery applicants for the 2019 to 2022 MATCH® application cycles. RESULTS: Four hundred forty-one faculty IPI ratings of General Surgery applicants were compared to 531VI ratings. No difference in mean composite scores, individual assessments, or tier ranking. Less variance was identified in the VI group for academic credentials (0.6 vs 0.6, p = 0.01), strength of letters (0.7 vs 0.4, p = 0.005), communication skills (0.4 vs 0.6, p = 0.01), personal qualities (0.2 vs 0.5, p = 0.02), overall sense of fit for program (0.6 vs 0.9, p = 0.01), and tier ranking (0.3 vs 0.4, p = 0.004). CONCLUSIONS: Faculty ratings of General Surgery applicants in the VI format appear to be similar to IPI. However, faculty ratings of VI applicants demonstrated less variability in scores in most assessments. This finding is potentially concerning, as it may suggest an inability of VI to detect subtle differences between applicants as comparted to IPI.

Global Surgery Opportunities for General Surgery Residents: Are We Making Progress?

INTRODUCTION: Global surgery efforts have significantly expanded in the last decade. While an increasing number of general surgery residents are incorporating global surgery experiences and research into their training, few resources are available for residency applicants to evaluate opportunities at programs to which they are applying. MATERIALS AND METHODS: A 17-question survey of all general surgery residency program directors (PDs) was conducted by the Global Surgery Student Alliance through emails to the Association of Program Directors in Surgery listserv. PDs indicated if they wished to remain anonymous or include program information in an upcoming online database. RESULTS: Two hundred fifty eight general surgery PDs were emailed the survey and 45 (17%) responses were recorded. Twenty eight (62%) programs offered formal global surgery experiences for residents, including clinical rotations, research, and advocacy opportunities. Thirty one (69%) programs were developing a global health center. Forty two (93%) respondents indicated that global surgery education was an important aspect of surgical training. Barriers to global surgery participation included a lack of funding, time constraints, low faculty participation, and minimal institutional interest. CONCLUSIONS: While most respondents felt that global surgery was important, less than two-thirds offered formal experiences. Despite the significant increase in public awareness and participation in global surgery, these numbers remain low. While this study is limited by a 17% response rate, it demonstrates that more efforts are needed to bolster training, research, and advocacy opportunities for surgical trainees and promote a global perspective on healthcare.

Improving the financial wellness of general surgery residents: A nationwide survey.

BACKGROUND: Our study evaluated general surgery resident indebtedness and perspectives on financial compensation. METHODS: In May 2020, a survey was distributed nationwide by general surgery program directors in the Association of Program Directors in Surgery on a voluntary basis to their residents. RESULTS: The survey was completed by 419 general surgery residents. Median salary was $60-65 K and median medical educational debt was $200-250 K. Approximately 61% of residents reported that their financial needs were not met by their income. Most residents (76%) believe that for a fair compensation, their salaries should be 30-50% higher. Proposed interventions for improvement in resident compensation included: overtime payment, redirection of GME funds to the residency programs, and compensating residents for billable services. CONCLUSIONS: Residents enter training with significant medical educational debt and feel unfairly compensated for their work. Therefore, comprehensive interventions with input from residents are needed to improve their financial well-being.

Optimizing surgical education through the implementation of a feedback curriculum.

BACKGROUND: While the advent of work-hour restrictions contributes to increased resident well-being, new interventions are needed to ensure that surgical residents continue to be adequately trained. Our study aims to take the evidence supportive of enhanced feedback and apply it in the real world by creating a feedback training curriculum within a surgical residency. METHODS: A large academic general surgery residency program consisting of 42 residents was sequentially surveyed using the Kirkpatrick model to assess baseline attitudes towards feedback and the efficacy of a feedback training program for faculty and residents. RESULTS: After feedback training, the number of residents that believed their faculty were providing feedback effectively increased from 23% to 54%. Although limited by small sample size, improvements were likely seen in constructive feedback overall and quality feedback from senior residents. CONCLUSIONS: Formal feedback training should be incorporated into efforts to enhance educational skills among surgical faculty.