Career Advancement for Surgeon-Educators:Findings from a Modified Delphi Process.

Objectives: Reward and recognition of surgical education as an academic activity remains a highly variable process between institutions. The goal of this study is to provide expert consensus definition of an academic surgical educator, with focus on criteria for academic promotion.

Study Design And Setting: Following IRB approval, a Web-based modified Delphi process was used to generate prioritized academic promotion criteria for surgical educators.

A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents' Operative Performance and Decreases Skill Variability: Cohort Study.

Objective: To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill.

Summary Of Background Data: Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition.

Trainee Autonomy in Minimally Invasive General Surgery in the United States: Establishing a National Benchmark.

Objective: Minimally invasive surgery (MIS) is an integral component of General Surgery training and practice. Yet, little is known about how much autonomy General Surgery residents achieve in MIS procedures, and whether that amount is sufficient. This study aims to establish a contemporary benchmark for trainee autonomy in MIS procedures.

A Proposed Blueprint for Operative Performance Training, Assessment, and Certification.

Objective: The aim of this study was to propose an evidence-based blueprint for training, assessment, and certification of operative performance for surgical trainees.

Summary Background Data: Operative skill is a critical aspect of surgical performance. High-quality assessment of operative skill therefore has profound implications for training, accreditation, certification, and the public trust of the profession.

Are surgeons behind the scientific eight ball: Delayed acquisition of the NIH K08 mentored career development award.

Background: Surgery residents complete their research training early in residency. Non-surgical trainees typically have research incorporated toward the last two years of their fellowship, conferring an advantage to apply for grants with recent research experience and preliminary data.

Methods: The NIH RePORTER database was queried for K08 awardees trained in medicine, pediatrics, and surgery from 2013 to 2017.

The effect of gender on operative autonomy in general surgery residents.

Background: Despite an increasing number of women in the field of surgery, bias regarding cognitive or technical ability may continue to affect the experience of female trainees differently than their male counterparts. This study examines the differences in the degree of operative autonomy given to female compared with male general surgery trainees.

Methods: A smartphone app was used to collect evaluations of operative autonomy measured using the 4-point Zwisch scale, which describes defined steps in the progression from novice ("show and tell") to autonomous surgeon ("supervision only").

"Show Me the Data": A Recipe for Quality Improvement Success in an Academic Surgical Department.

Background: Surgeons in academic medical centers have traditionally taken a siloed approach to reducing postoperative complications. We initiated a project focusing on transparency and sharing of data to engage surgeons in collaborative quality improvement. Its key features were the development of a comprehensive department quality dashboard and the creation of the Clinical Operations Council that oversaw quality.

The business of educating the next generation of surgeons.

Surgical education community needs to be informed about how education is funded and how it is threatened. In order to explore these issues the Association of Surgical Education convened a panel with significant experience in managing surgery departments to discuss the business of surgical education. They specifically addressed methods to recognize and reward faculty, educate residents on safety, quality and cost, and increase departmental revenue.

Is the operative autonomy granted to a resident consistent with operative performance quality.

Background: We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality.

Methods: Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as "practice ready performance/meaningfully autonomous" or "not practice ready/not meaningfully autonomous.

High-speed Intraoperative Assessment of Breast Tumor Margins by Multimodal Ultrasound and Photoacoustic Tomography.

Conventional methods for breast tumor margins assessment need a long turnaround time, which may lead to re-operation for patients undergoing lumpectomy surgeries. Photoacoustic tomography (PAT) has been shown to visualize adipose tissue in small animals and human breast. Here, we demonstrate a customized multimodal ultrasound and PAT system for intraoperative breast tumor margins assessment using fresh lumpectomy specimens from 66 patients.

Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents.

Background: Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements.

Methods: Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.

How Many Observations are Needed to Assess a Surgical Trainee's State of Operative Competency?

Objective: To establish the number of operative performance observations needed for reproducible assessments of operative competency.

Background: Surgical training is transitioning from a time-based to a competency-based approach, but the number of assessments needed to reliably establish operative competency remains unknown.

Methods: Using a smart phone based operative evaluation application (SIMPL), residents from 13 general surgery training programs were evaluated performing common surgical procedures.

What factors influence attending surgeon decisions about resident autonomy in the operating room?

Background: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents.

Methods: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs.

Readiness of US General Surgery Residents for Independent Practice.

Objective: This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy.

Background: The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate.

The Feasibility of Real-Time Intraoperative Performance Assessment With SIMPL (System for Improving and Measuring Procedural Learning): Early Experience From a Multi-institutional Trial.

Purpose: Intraoperative performance assessment of residents is of growing interest to trainees, faculty, and accreditors. Current approaches to collect such assessments are limited by low participation rates and long delays between procedure and evaluation. We deployed an innovative, smartphone-based tool, SIMPL (System for Improving and Measuring Procedural Learning), to make real-time intraoperative performance assessment feasible for every case in which surgical trainees participate, and hypothesized that SIMPL could be feasibly integrated into surgical training programs.

A problem-oriented approach to resident performance ratings.

Background: Global, end-of-rotation evaluations are often difficult to interpret due to their high level of abstraction (eg, excellent, good, poor) and the bias toward high ratings. This study documents the utility of and measurement characteristics of serious problem items, an alternative item format.

Methods: This report is based on 4,234 faculty performance ratings for 105 general surgery residents.

Practice Guidelines for Operative Performance Assessments.

Objective: To provide recommended practice guidelines for assessing single operative performances and for combining results of operative performance assessments into estimates of overall operative performance ability.

Summary Background Data: Operative performance is one defining characteristic of surgeons. Assessment of operative performance is needed to provide feedback with learning benefits to surgical residents in training and to assist in making progress decisions for residents.

Is a Single-Item Operative Performance Rating Sufficient?

Objective: A valid measure of resident operative performance ability requires direct observation and accurate rating of multiple resident performances under the normal range of operating conditions. The challenge is to create an operative performance rating (OPR) system that: is easy to use, encourages completion of many ratings immediately after performances and minimally disrupts supervising surgeons' work days. The purpose of this study was to determine whether a score based on a single-item overall OPR provides a valid and stable appraisal of resident operative performances.

Identification of behaviors and techniques for promoting autonomy in the operating room.

Background: To further understand how faculty promote resident autonomy in the operating room (OR), we explored their perceptions, and those of senior residents, on the behaviors and techniques they employ to foster independence.

Methods: Twenty postgraduate year PGY4 and PGY5 residents were asked to list 3 general surgery faculty who give the most and least autonomy to residents in the OR. Two focus groups were conducted with residents to identify behaviors and techniques for promoting autonomy from the resident perspective.

Determining the Drivers of Academic Success in Surgery: An Analysis of 3,850 Faculty.

Objective: Determine drivers of academic productivity within U.S. departments of surgery.

Ranking Surgical Residency Programs: Reputation Survey or Outcomes Measures?

Objective: The release of general surgery residency program rankings by Doximity and U.S. News & World Report accentuates the need to define and establish measurable standards of program quality.

Placing constraints on the use of the ACGME milestones: a commentary on the limitations of global performance ratings.

As part of the outcomes-based accreditation process, the Accreditation Council for Graduate Medical Education (ACGME) now requires that medical specialties formulate and use educational milestones to assess residents' performance. These milestones are specialty-specific achievements that residents are expected to demonstrate at established intervals in their training. In this Commentary, the authors argue that the pressure to efficiently use program directors' and faculty members' time, particularly in the increasingly clinical-revenue-dependent model of the academic medical center, will lead program directors to meet these new accreditation expectations solely by adding items that assess these competencies to global end-of-rotation rating forms.