Surgical Trainee Performance and Alignment With Surgical Program Director Expectations.

OBJECTIVE: To examine the alignment between graduating surgical trainee operative performance and a prior survey of surgical program director expectations. BACKGROUND: Surgical trainee operative training is expected to prepare residents to independently perform clinically important surgical procedures. METHODS: We conducted a cross-sectional observational study of US general surgery residents' rated operative performance for Core general surgery procedures. Residents' expected performance on those procedures at the time of graduation was compared to the current list of Core general surgery procedures ranked by their importance for clinical practice, as assessed via a previous national survey of general surgery program directors. We also examined the frequency of individual procedures logged by residents over the course of their training. RESULTS: Operative performance ratings for 29,885 procedures performed by 1861 surgical residents in 54 general surgery programs were analyzed. For each Core general surgery procedure, adjusted mean probability of a graduating resident being deemed practice-ready ranged from 0.59 to 0.99 (mean 0.90, standard deviation 0.08). There was weak correlation between the readiness of trainees to independently perform a procedure at the time of graduation and that procedure's historical importance to clinical practice ( p = 0.22, 95% confidence interval 0.01-0.41, P = 0.06). Residents also continue to have limited opportunities to learn many procedures that are important for clinical practice. CONCLUSION: The operative performance of graduating general surgery residents may not be well aligned with surgical program director expectations.

Measuring Competence in Surgical Training through Assessment of Surgical Entrustable Professional Activities.

OBJECTIVE: To assess competency in surgical residents with bundled assessments using a surgical entrustable professional activity (SEPA) framework. DESIGN: A pilot study was conducted using a combination of validated assessment tools (multiple choice exam (MCE) questions from the Surgical Council on Resident Education [SCORE], the Clinical Assessment and Management Examination - Outpatient (CAMEO) form, the Virtual Surgical Patient (VSP) website, and a procedure-specific Operative Performance Rating System [OPRS]) to determine competency in surgical residents in the treatment of breast cancer and gallbladder disease, respectively. SETTING: A large academic institution with a surgical training program in the Mid West of the United States. PARTICIPANTS: A total of 10 categorical surgical residents were invited to participate. Five completed the breast surgical EPA (SEPA) and 5 different residents completed the gallbladder SEPA. RESULTS: In terms of performance on the assessments, for the breast SEPA, scores did not appear to be related to PGY level, and residents' performance in general was the least strong on the MCE and the VSP case. The gallbladder SEPA showed a more expected pattern, distinguishing between junior and senior residents. As expected, all junior residents were required to remediate the OPRS assessment, while the senior residents passed. For the OPRS, senior level residents consistently were rated as "excellent" in terms of operative flow (5/5), while junior residents were all given a score of "good" (3/5). CONCLUSIONS: Assessing competence among surgical residents has been a discussion for several years. Varying methods of assessing competence have been proposed, but surgical competence is presently defined in a very general way through both the ACGME and American Board of Surgery (ABS). Using a SEPA format, as proposed, we could ensure specific understanding of each graduating resident's ability. These results show that the SEPA may be a valid tool for defining and capturing multiple areas of competence that are associated with different disease processes.

Life events during surgical residency have different effects on women and men over time.

BACKGROUND: Women represent half of medical school graduates in the United States. Our aim was to characterize the effects of marriage and childbirth on the experiences of surgery residents. METHODS: This was a prospective, longitudinal study of categorical general surgery residents between 2008 and 2010. Outcomes included changes in faculty and peer relationships, work-life balance, financial security, and career goals over time. RESULTS: We included 4,028 residents. Compared with men, women in postgraduate years (PGYs) 1 through 5 were less likely to be married (28.2% to 47.3% vs 49.6% to 67.6%) or have children (4.6% to 18.0% vs 19.0% to 45.8%) (P < .001). Women who married during PGY1 to PGY3 became worried about performing in front of senior residents (P = .005); men who married were more likely to be happy at work (P = .005). Women who had a first child during PGY1 to PGY3 were more likely to feel overwhelmed (P = .008) and worry about financial security (P = .03) than other women. Men who had a child were more likely to feel supported by faculty (P = .004), but they experienced more family strain (P = .008) compared to childless men. CONCLUSION: Marriage and childbirth are associated with divergent changes in career experiences for women and men. Women lag behind their male peers in these life events from start to finish of residency.

Striving for work-life balance: effect of marriage and children on the experience of 4402 US general surgery residents.

OBJECTIVE: To determine how marital status and having children impact US general surgical residents' attitudes toward training and personal life. BACKGROUND: There is a paucity of research describing how family and children affect the experience of general surgery residents. METHODS: Cross-sectional survey involving all US categorical general surgery residents. Responses were evaluated by resident/program characteristics. Statistical analysis included the χ test and hierarchical logistic regression modeling. RESULTS: A total of 4402 residents were included (82.4% response rate) and categorized as married, single, or other (separated/divorced/widowed). Men were more likely to be married (57.8% vs 37.9%, P < 0.001) and have children (31.5% vs 12.0%, P < 0.001). Married residents were most likely to look forward to work (P < 0.001), and report happiness at work (P < 0.001) and a good program fit (P < 0.001). "Other" residents most frequently felt that work hours caused strain on family life (P < 0.001). Residents with children more frequently looked forward to work (P = 0.001), were happy at work (P = 0.001), and reported a good program fit (P = 0.034), but had strain on family life (P < 0.001), and worried about future finances (P = 0.005). On hierarchical logistic regression modeling, having children was predictive of a resident looking forward to work [odds ratio (OR): 1.22, P = 0.035], yet feeling that work caused family strain (OR: 1.66, P < 0.001); being single was associated with less strain (OR: 0.72, P < 0.001). The female gender was negatively associated with looking forward to work (OR: 0.81, P = 0.007). CONCLUSIONS: Residents who were married or parents reported greater satisfaction and work-life conflict. The complex effects of family on surgical residents should inform programs to target support mechanisms for their trainees.

Race and surgical residency: results from a national survey of 4339 US general surgery residents.

OBJECTIVE: To determine how race influences US general surgery residents' experiences during residency training. BACKGROUND: Minorities are underrepresented in medicine, particularly surgery, with no large-scale studies investigating their training experiences. METHODS: Cross-sectional national survey administered after the 2008 American Board of Surgery In-Training Examination to all categorical general surgery residents. Demographic characteristics and survey responses with respect to race were evaluated using the χ test and hierarchical logistic regression modeling. RESULTS: A total of 4339 residents were included: 61.9% whites, 18.5% Asians, 8.5% Hispanics, 5.3% Blacks, and 5.8% Others. Minorities differed from whites in sex proportion, marital status, number of children, geographic location, type of residency program, and 24 survey items (all Ps < 0.05). Compared with white residents, Black, Asian, and Other residents were less likely to feel they fit in at their programs (86.2% vs 73.9%, 83.3%, and 81.2%, respectively; P < 0.001). Black and Asian residents were more likely to report that attendings would think worse of them if they asked for help (13.5% vs 20.4% and 18.4%, respectively; P = 0.002), and Black residents were less likely to feel they could count on their peers for help (85.2% vs 77.2%; P = 0.017). On hierarchical logistic regression modeling, Blacks were least likely to fit in at their programs (odds ratio = 0.6; P = 0.004), and all minorities were more likely to feel that there was a need for additional specialty training (odds ratio = 1.4 Blacks and Hispanics, 1.9 Asians, and 2.1 Others; all Ps ≤ 0.05). CONCLUSIONS: Minority residents report less positively on program fit and relationships with faculty and peers. Future studies should focus on examining residency interventions to improve support and integration of minority residents.

Surgical residency and attrition: defining the individual and programmatic factors predictive of trainee losses.

BACKGROUND: Voluntary resident attrition remains problematic despite recent changes in postgraduate general surgery training, including reduction of work hours. STUDY DESIGN: We conducted a prospective study of all postgraduate year (PGY)-1 and -2 trainees on the 2008 American Board of Surgery resident roster (ABS-RR) who completed the National Study of Expectations and Attitudes of Residents in Surgery (NEARS) survey after the American Board of Surgery In-Training Examination (ABSITE) in 2008 or 2009. RESULTS: Among 2,222 PGY-1 and -2 residents on the 2008 ABS-RR, 2,033 completed the NEARS survey in 2008 or 2009 (91.5%). The only demographic or programmatic variables associated with voluntary attrition on univariate analysis were PGY-1 status (9.4% risk vs 4.5% risk for PGY-2, p < 0.001) and program location (p = 0.03). Response differences (p < 0.01) were noted in 23 survey items. In multivariate modeling, PGY-2 status was protective against voluntary attrition (p < 0.001, hazard ratio [HR] 0.41), while programs located outside of the South (Northeast: p = 0.006, HR 2.39; Midwest: p = 0.01, HR 2.37; West: p = 0.10, HR 1.76) were associated with higher attrition. The attrition group more frequently reported that they had considered leaving training (p < 0.001, HR 2.59), that the personal cost of training was too great (p < 0.001, HR 2.89), that they were dissatisfied with their operative experience (p = 0.002, HR 1.89), and that they were not committed to completing their training (p < 0.001, HR 3.96). Using the estimated regression coefficient for each variable in the multivariate models, we calculated a risk score for individual residents; these scores were used to construct covariate-adjusted survivorship functions. CONCLUSIONS: Resident attitudes, PGY-1 status, and program location are most frequently associated with voluntary attrition. Our risk score calculation represents a novel potential tool for programs to quantify deficiencies in the training experience of residents, and develop targeted strategies to limit disaffection and improve resident retention.

Discrepancies in training satisfaction and program completion among 2662 categorical and preliminary general surgery residents.

OBJECTIVE: To compare training experiences of postgraduate year (PGY)-1 and PGY-2 categorical and nondesignated preliminary (NDP) residents and examine NDP educational outcomes. BACKGROUND: There is a paucity of research describing the professional attitudes of NDP surgical trainees. METHODS: Analysis of the 2009 National Study of Expectations and Attitudes of Residents in Surgery survey and American Board of Surgery 2009 to 2011 Resident Rosters. Chi-square and hierarchical logistic regression modeling were employed. RESULTS: A total of 1428 PGY-1s (528 NDPs) and 1234 PGY-2s (189 NDPs) were included. Among PGY-1s, NDPs reported lower program satisfaction than categorical residents (84.2% vs 89.2%, P = .007), and less collegiality with coresidents (P = 0.001). NDPs were less satisfied with their operative experience (P = 0.002) and less frequently enjoyed operating (P < 0.001). NDPs more frequently reported that "the personal cost of surgical training is not worth it" (11.2% vs 3.7%, P < 0.001) and were less frequently committed to completing their surgical training (P < 0.001). Among PGY-2s, NDPs expressed a lower program fit (P = 0.008) and commitment to program completion (P = 0.037). Of 1102 NDP PGY-1s and PGY-2s on the 2009 American Board of Surgery Resident Roster, 347 achieved categorical status by 2011 (31.5%), including 237 National Study of Expectations and Attitudes of Residents in Surgery respondents (34.3%). Marked response differences were found between NDPs who ultimately did and did not achieve categorical status. In hierarchical logistic regression modeling, older age [30-34 years, odds ratio (OR): 0.54; ≥35 years, OR: 0.28), and race/ethnicity (black, OR: 0.28; Hispanic, OR: 0.50) were negatively associated with an NDP attaining categorical status. CONCLUSIONS: The residency experience for NDPs appears less rewarding than for categorical residents. NDPs report less robust operative experience and overall support. Ultimately, only one third of NDPs become categorical surgery residents.

"Join the club": effect of resident and attending social interactions on overall satisfaction among 4390 general surgery residents.

OBJECTIVES: To investigate which residents develop successful collegial relationships with attending physicians and to determine how social interactions affect residency satisfaction. DESIGN: Cross-sectional National Study of Expectations and Attitudes of Residents in Surgery survey. Demographics and level of agreement regarding training experiences were collected from the survey responses and related to overall satisfaction with the residency program. We performed χ2 testing and hierarchical logistic regression modeling. SETTING: Two hundred forty-eight residency programs. PARTICIPANTS: All US categorical general surgery residents. MAIN OUTCOME MEASURES: Answers to "How often do you do things with your attendings socially?" and "I can turn to members of the faculty when I have difficulties." RESULTS: Of 4402 returned surveys (response rate, 82.4%), we included 4390. Residents who were older (P = .01), in a higher postgraduate year (PGY) (P < .001), men (P = .003), married (P = .02), and parents (P = .001) were most likely to socialize with attendings. In hierarchical logistic regression modeling, PGY-5 status was independently associated with socializing; PGY-1 and PGY-2 status and female sex were negatively associated. Residents who were men (P < .001), married (P < .001), and parents (P = .001) were most likely to feel they could turn to attendings with problems. In hierarchical logistic regression modeling, PGY-1, PGY-4, and PGY-5 status and being married were positively associated with this statement; female sex was negatively correlated. Residents not socializing with attendings expressed 3 times more program dissatisfaction (18.9% vs 6.2% [P < .001]); those unable to turn to attendings expressed 5 times more dissatisfaction (34.7% vs 7.0% [P < .001]). CONCLUSIONS: Collegial interactions between residents and attendings are important because they are associated with residency satisfaction. Efforts should be made to expand such interactions to junior and female residents.

Effect of program type on the training experiences of 248 university, community, and US military-based general surgery residencies.

BACKGROUND: There is a paucity of research comparing resident training experiences of university, community, and military-affiliated surgical programs. STUDY DESIGN: We reviewed a cross-sectional national survey (NEARS) involving all US categorical general surgery residents (248 programs). Demographics and level of agreement regarding training experiences were collected. Statistical analysis included chi-square, ANOVA, and hierarchical logistic regression modeling (HLRM). RESULTS: There were 4,282 residents included (82.4% response rate). The majority (69%) trained in university programs. Types of programs differed by sex mix (p < 0.001), racial makeup (p = 0.005), marital status profile (p = 0.002), and parental status profile (p < 0.001). Community residents were most satisfied with their operative experience (community 84.5%, university 73.4%, military 62.4%; p < 0.001), most likely to feel their opinions are important (76.0% vs 69.4% vs 67.9%, respectively; p < 0.001), and least likely to believe attendings will think worse of them if residents asked for help with patient management (12.6% vs 15.9% vs 14.7%, respectively; p = 0.025). Military residents were least likely to report that surgical training is too long (military 7.4%, community 14.0%, university 23.8%; p < 0.001). On HLRM, community programs were independently associated with residents feeling their opinions are important (odds ratio [OR] 1.91; p < 0.001), and reporting satisfactory operative experience (OR 4.73; p < 0.001). Residents training at military programs (OR 0.23; p = 0.002) or community programs (OR 0.31; p < 0.001) were less likely to feel that surgical training is too long, or that attendings will think worse of them if asked for help with patient care (community OR 0.19; p < 0.001; military OR 0.27; p = 0.004). CONCLUSIONS: Residents at university, community, and military programs report distinct training experiences. These findings may inform programs of potential targeted strategies for enhanced support.

Our trainees' confidence: results from a national survey of 4136 US general surgery residents.

OBJECTIVES: To characterize factors shaping surgery resident confidence and determine whether confidence is associated with future specialty training. DESIGN: Cross-sectional study. SETTING: Survey administered at the 2008 American Board of Surgery In-Service Training Examination. PARTICIPANTS: All categorical general surgery residents. INTERVENTIONS: National Study of Expectations and Attitudes of Residents in Surgery survey. PARTICIPANTS: reported demographics and level of agreement for 46 items regarding confidence, training, and professional plans. MAIN OUTCOMES MEASURES: Survey items "My operating skill level is appropriate" and "I may not feel confident enough to perform procedures independently before training completion." We compared demographics and responses among residents who did/not feel confident. RESULTS: Response rate was 77.4%. Residents who were female, single, or without children and at a lower postgraduate year had less confidence in their operating skill, as did residents at larger, university-based programs, in the northeastern United States. Residents worried about competence were more likely to believe specialty training was needed (71.2% vs 60.2%; P < .001). After adjustment, residents dissatisfied with training were less likely to believe their skills were level appropriate (odds ratio, 0.13; P < .001) as were residents not comfortable asking for help (odds ratio, 0.48; P < .001). After adjustment, women were twice more likely than men to worry about competence after training; single residents were 1.36 times more likely than married residents to believe their skills were not level appropriate. Program location, type, and size remained associated with confidence, as did satisfaction and comfort asking for help. Residents worried about skills were more likely to plan for fellowship. CONCLUSIONS: Sex, marital status, children, and postgraduate year are predictors of confidence, as are program location, type, and size. Residency programs may target modifiable factors contributing to low surgical confidence.

How to teach uncommon and highly complex operations.

The Surgical Council on Resident Education (SCORE) was officially formed by six surgical organizations in 2006 with the goal of improving general surgery residency training through the development of an explicit curriculum. As a result, SCORE has identified a group of "essential" operations which believes that residents should be competent to perform by the end of training. Other "complex" operations require additional training beyond residency. Currently, operative data submitted by residents suggest that there are significant gaps between ideal and actual operative experience. A particularly difficult challenge is to train residents to perform procedures that are rarely encountered.

National curricula, certification and credentialing.

The education, certification, and credentialing of surgeons is undergoing change brought about by public expectations and by reform within the profession. In the United States, there is a clear trend towards standardization of education, as exemplified by the Surgical Council on Resident Education (SCORE) curriculum. There is an emerging effort to tie certification closely to the national curriculum. Finally, there is clarity emerging from the curriculum development process about the expected operative skills of graduating surgical trainees, and this will ultimately drive the process by which surgeons are credentialed by their hospitals or surgical centers. This period of change is being accompanied by a demand for more assessment of trainees and for outcomes-based training and residency program accreditation.

The vulnerable stage of dedicated research years of general surgery residency: results of a national survey.

OBJECTIVE: To characterize the demographics and attitudes of US general surgery residents performing full-time research. DESIGN: Cross-sectional national survey administered after the 2008 American Board of Surgery In-Service Training Examination. SETTING: Two hundred forty-eight residency programs. PARTICIPANTS: General surgery residents. INTERVENTION: Survey administration. MAIN OUTCOMES MEASURES: A third of categorical general surgery residents interrupt residency to pursue full-time research. To our knowledge, there exist no comprehensive reports on the attitudes of such residents. RESULTS: Four hundred fifty residents performing full-time research and 864 postgraduate year 3 (PGY-3) clinical residents completed the survey. Thirty-eight percent of research residents were female, 53% were married, 30% had children, and their mean age was 31 years. Residency programs that were academic, large, and affiliated with fellowships had proportionally more research residents compared with other programs. Research and PGY-3 residents differed (P < .05) on 10 survey items. Compared with PGY-3 residents, research residents were less likely to feel they fit well in their program (86% vs 79%, respectively), that their program had support structures if they struggled (72% vs 64%), or that they could turn to faculty (71% vs 65%). They were more likely to feel training was too long (21% vs 30%) and that surgeons must be specialty trained (55% vs 63%). In multivariate analyses, research residents believed surgical training was too long (odds ratio, 1.36) and they fit in less well at their programs (odds ratio, 0.71) (P < .05). CONCLUSIONS: Compared with PGY-3 residents, research residents report less satisfaction with important aspects of training, suggesting this is a vulnerable stage. Interventions could be targeted to facilitate support and better integration into the mainstream of surgical education.

A national study of attrition in general surgery training: which residents leave and where do they go?

OBJECTIVE(S): Implementation of the 80-hour mandate was expected to reduce attrition from general surgery (GS) residency. This is the first quantitative report from a national prospective study of resident/program characteristics associated with attrition. METHODS: Analysis included all categorical GS residents entered on American Board of Surgery residency rosters in 2007 to 2008. Cases of attrition were identified by program report, individually confirmed, and linked to demographic data from the National Study of Expectations and Attitudes of Residents in Surgery administered January 2008. RESULTS: All surgical categorical GS residents active on the 2007-2008 resident rosters (N = 6,303) were analyzed for attrition. Complete National Study of Expectations and Attitudes of Residents in Surgery demographic information was available for 3959; the total and survey groups were similar with regard to important characteristics. About 3% of US categorical residents resigned in 2007 to 2008, and 0.4% had contracts terminated. Across all years (including research), there was a 19.5% cumulative risk of resignation. Attrition was highest in PGY-1 (5.9%), PGY-2 (4.3%), and research year(s) (3.9%). Women were no more likely to leave programs than men (2.1% vs. 1.9%). Of several program/resident variables examined, postgraduate year-level was the only independent predictor of attrition in multivariate analysis. Residents who left GS whose plans were known most often pursued nonsurgical residencies (62%), particularly anesthesiology (21%) and radiology (11%). Only 13% left for surgical specialties. CONCLUSIONS: Attrition rates are high despite mandated work hour reductions; 1 in 5 GS categorical residents resigns, and most pursue nonsurgical careers. Demographic factors, aside from postgraduate year do not appear predictive. Residents are at risk for attrition early in training and during research, and this could afford educators a target for intervention.

Impact of family and gender on career goals: results of a national survey of 4586 surgery residents.

OBJECTIVE: To determine how marriage, children, and gender influence US categorical general surgery residents' perceptions of their profession and motivations for specialty training. DESIGN: Cross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination. SETTING: Two hundred forty-eight US general surgery residency programs. PARTICIPANTS: All US categorical general surgery residents. INTERVENTIONS: We evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed. MAIN OUTCOME MEASURES: Perceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle. RESULTS: The survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P < .001; 57.0% with no children vs 50.1% with children, P < .001). In our multivariate analyses, male gender was an independent predictor of worry that general surgery is becoming obsolete (P = .003). Female residents who were single or had no children tended to identify lifestyle rather than income as a motivator for specialty training. CONCLUSION: Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.

Residents' self-reported learning needs for intraoperative knowledge: are we missing the bar?

BACKGROUND: The purpose of this study was to compare the intraoperative learning needs and educational resource use of junior and senior residents. Our goal was to gain a better understanding of the progression of learning needs in surgical training. METHODS: Residents (n = 125) completed a previously validated, 27-item survey indicating the following: (1) the extent to which traditional learning resources are used when preparing for cases in the operating room, and (2) which intraoperative management topics in which they believed they were deficient despite preoperative preparation. RESULTS: On a scale of 1 to 5, with 5 indicating frequent use, postgraduate year (PGY)-5 residents (n = 39) indicated surgical atlases (4.15; SD, .90) and surgical texts (4.15; SD, .90) were their most frequently used resources when preparing for a case in the operating room. In contrast, PGY-1 residents (n = 32) indicated anatomy atlases (3.97; SD, .93) and advice from colleagues (3.64; SD, .90) were their most frequently used resources when preparing for a case in the operating room. Despite the differences in how the PGY-5 group and the PGY-1 group prepared for a case, of 12 intraoperative management topics both groups believed they were the least prepared for instrument use/selection and suture selection. CONCLUSIONS: Today's residents represent a heterogeneous group of individuals with different learning needs based on level of experience, knowledge, and learning style. Our study highlights unexpected but critical learning needs for senior-level residents that can and should be readily addressed.

Anti-pancreatic cancer effects of a polar extract from the edible sea cucumber, Cucumaria frondosa.

OBJECTIVES: To investigate the effects and mechanism of Frondanol-A5P, a polar extract from Cucumaria frondosa, on growth inhibition and apoptosis in S2013 and AsPC-1 human pancreatic cancer cells. METHODS: The effects of Frondanol-A5P on proliferation, cell cycle, expression of cell cycle proteins and p21, phosphorylation of MAP kinases, annexin V binding, and caspase-3 activation were examined. RESULTS: Frondanol-A5P inhibited proliferation and induced G2/M phase cell cycle arrest in both cell lines with decreased expression of cyclin A, cyclin B, and cdc25c. Frondanol-A5P induced phosphorylation of stress-activated protein kinase and Janus kinase (SAPK/JAK) and p38 mitogen-activated protein kinase (MAP) within 5 minutes. Frondanol-A5P markedly increased expression of p21 messenger RNA and protein at 3 hours in both cell lines. This effect was reduced by the p38 kinase inhibitor, SB203580. Frondanol-A5P markedly increased annexin V binding and activated caspase-3. CONCLUSIONS: Frondanol-A5 causes cell cycle arrest and apoptosis in human pancreatic cancer cells. These changes are associated with decreased expression of cyclin A, cyclin B, and cdc25c and increased expression of p21 that, at least in part, is mediated by a p38 kinase-dependent mechanism. Because Frondanol-A5P is derived from an edible, nontoxic, sea cucumber, it may be valuable for nutritional therapy or prevention of pancreatic cancer.