Shotgun injury: don't forget the wad.

While close-range shotgun injuries may clinically appear similar to gunshot wounds from rifles or handguns, they are important to differentiate as they require special consideration. We present a case of a male in his 20s who sustained a close-range shotgun wound to the right lower extremity and was subsequently found to have a retained, radiolucent shotgun wad deep within the wound bed. Identification and removal of shotgun wads are of paramount importance, as failure to do so may lead to downstream secondary infectious complications.

Multi-institutional study examining intraoperative entrustment and resident sex.

Introduction: Single-site studies have found variable associations between gender and entrustment-based interactions during surgical residency. We sought to assess the relationship between resident sex and intraoperative entrustment at multiple institutions.

Methods: Surgical cases were observed at four university-based training programs.

Best Case/Worst Case-ICU: protocol for a multisite, stepped-wedge, randomised clinical trial of scenario planning to improve communication in the ICU in US trauma centres for older adults with serious injury.

Introduction: Poor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU.

EHR-Driven Delivery of EPA Assessments Significantly Improves Participation.

Introduction: Digital education tools are a cornerstone in the evolution to CBME through EPAs. Successful implementation requires understanding the variable impacts of EHR-driven delivery of EPAs, flexible digital device access to EPAs, and user-behavior trends.

Methods: Through a HIPAA compliant, flexible-device accessible, surgical education platform, general surgery training programs at 21 institutions collected EPA from July 2023 to April 2024.

Key Issues in Surgical Residency Education: Recommendations of the Blue Ribbon II Committee Residency Education Subcommittee.

Background: In September 2022, a summit was convened by the American Board of Surgery (ABS) to discuss competency-based reform in surgical education. A key output of that summit was the recommendation that the prior work of the Blue Ribbon I Committee convened 20 years earlier be revived. With leadership from the American College of Surgeons (ACS) and the American Surgical Association (ASA), the Blue Ribbon Committee (BRC) II was subsequently convened.

Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities.

Importance: A competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs' clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet known.

Objective: To identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions.

Cultivating emotional intelligence in general surgery residents through a patient-centered experience.

Background: Emotional intelligence (EI) can decrease physician burnout. EI and burnout were assessed in surgical residents through participation in Patient-Centric Resident Conferences (PCRCs), which incorporated patients in resident education. We hypothesized PCRCs would improve EI and reduce burnout.

An executive summary of the National Trauma Research Action Plan.

The National Trauma Research Action Plan project successfully engaged multidisciplinary experts to define opportunities to advance trauma research and has fulfilled the recommendations related to trauma research from the National Academies of Sciences, Engineering and Medicine report. These panels identified more than 4,800 gaps in our knowledge regarding injury prevention and the optimal care of injured patients and laid out a priority framework and tools to support researchers to advance this field. Trauma research funding agencies and researchers can use this executive summary and supporting manuscripts to strategically address and close the highest priority research gaps.

Risk of motor vehicle collision associated with cannabis and alcohol use among patients presenting for emergency care.

Background: The objective of this study was to examine the relationship between cannabis and alcohol use and occurrence of motor vehicle collision (MVC) among patients in the emergency department (ED).

Methods: This was a cross-sectional study of visits to EDs in Denver, CO, Portland, OR, and Sacramento, CA by drivers who were involved in MVCs and presented with injuries (cases) and non-injured drivers (controls) who presented for medical care. We obtained blood samples and measured delta-9-THC and its metabolites.

Validity of Entrustable Professional Activities in a National Sample of General Surgery Residency Programs.

Background: The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees.

Faculty Entrustment and Resident Entrustability.

Importance: As the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs.

Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study.

Objective: The ongoing complexity of general surgery training has led to an increased focus on ensuring the competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, Accreditation Council for Graduate Medical Education (ACGME) Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country.

Pediatric emergency resuscitative thoracotomy: A Western Trauma Association, Pediatric Trauma Society, and Eastern Association for the Surgery of Trauma collaborative critical decisions algorithm.

Literature synthesis and expert opinion, Level V.

Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education.

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4 week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year.

How well do we understand our patients' perioperative experience? A qualitative analysis of themes derived from patient-centric resident conferences.

Background: Patient-centric resident conferences (PCRCs) provide meaningful time to connect with and learn from patients. This qualitative study explores themes of patients' perioperative experiences from PCRCs through patient and resident perspectives.

Methods: General Surgery residents participated in six PCRCs, which include condensed standard didactics to accommodate a patient panel regarding their perioperative experience.

Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons.

Objective: We tested the association of systems factors with the surgeon's likelihood of offering surgical intervention for older adults with life-limiting acute surgical conditions.

Background: Use of surgical treatments in the last year of life is frequent. Improved risk prediction and clinician communication are solutions proposed to improve serious illness care, yet systems factors may also drive receipt of nonbeneficial treatment.

Blunt pancreatic trauma: A Western Trauma Association critical decisions algorithm.

Background: The Western Trauma Association (WTA) has undertaken publication of best practice clinical practice guidelines on multiple trauma topics. These guidelines are based on scientific evidence, case reports, and best practices per expert opinion. Some of the topics covered by this consensus group do not have the ability to have randomized controlled studies completed because of complexity, ethical issues, financial considerations, or scarcity of experience and cases.

Increased identification of cannabis use among drivers involved in motor vehicle collisions using an expanded cannabis inventory.

Objectives: The objectives of this study were to implement and examine the potential capture rate of a novel instrument, the Expanded Cannabis Inventory, in a population of emergency department (ED) patients presenting after motor vehicle collisions (MVC).

Methods: Study participants who presented to the ED after MVC were recruited from three hospitals in cannabis-legal states (Denver, CO; Portland, OR; and Sacramento, CA). Research assistants (RAs) administered the Expanded Cannabis Inventory, which includes a wide variety of products that have become readily available in states where cannabis is legal, in addition to assessments related to patient demographic characteristics, general health, cannabis attitudes, and dependency measures.

What Should the Surgeons Do at the Family Meeting: A Multi-Disciplinary Qualitative Description of Surgeon Participation in Palliative Care Discussions.

Objective: National guidelines have suggested that quality surgical care should incorporate effective palliative care (PC). Numerous barriers to surgeon participation remain and the domains of optimal surgeon participation are unclear.

Design: Eight semi-structured and multi-professional focus groups with 34 total participants.

Developing a National Trauma Research Action Plan: Results from the long-term outcomes research gap Delphi survey.

Background: In the National Academies of Sciences, Engineering, and Medicine 2016 report on trauma care, the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research was recommended. To address this recommendation, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. We describe the gap analysis and high-priority research questions generated from the National Trauma Research Action Plan panel on long-term outcomes.

Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey.

Introduction: The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda.