The Association for Surgical Education

Impacting Surgical Education Globally

 

 

Thinking Out of the Box Presentations

 

LEVERAGING TECHNOLOGY TO CREATE A TRAUMA SURGERY VIDEO ATLAS
Patrick Georgoff, MD, Duke University; Duke University

What problem in education is addressed by this work? Preparing for the surgical treatment of deadly traumatic injuries is challenging, and currently available resources are extremely limited. Video-based education is a potent medium for teaching the surgical approach to severely injured patients. However, high-quality footage of injured patients is difficult to obtain. Describe the intervention: The Behind the Knife Trauma Surgery Video atlas uses fresh, perfused cadavers and a variety of video techniques to recreate deadly injuries and record repairs. Video editing and post-production was performed by the surgical team using widely available software and newer AI-based media creation tools. The final product, which includes text and original illustrations in addition to video, was delivered using Behind the Knife's bespoke media builder for consumption on our website or app. Link to atlas: https://app.behindtheknife.org/premium/trauma-surgery-video-atlas Describe the improvement/outcome of the intervention. Thousands of students, trainees, and surgeons around the world now have access to a practical, engaging, and highly useful trauma surgery education tool. The resource is being used by residency programs and fellowships, to supplement human and animal trauma labs like ASSET and ATOM, and in high-need areas like Syria and Gaza. There are multiple ongoing projects assessing the effectiveness of this resource for trainee education. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. The Trauma Surgery Video Atlas is just one of many examples of innovative surgical education content being produced by the team at Behind the Knife using resources available to all surgeons. Any interested educator can create highly engaging and contemporary content by leveraging currently available technology. Specifically, video editors like Final Cut Pro, digital media creators like Canva, and social media like X and YouTube.

 

 

PORCINE ORGAN RECOVERY COLLABORATIVE (PORC): EX VIVO SIMULATION MODELS FROM NON-SURVIVAL PROCEDURES
Shannon Marie Barter, MD, Duke University; Duke University

What problem in education is addressed by this work? Porcine tissue is an excellent model for surgical simulation. Commercial companies offer explanted porcine tissue for simulation, which costs money and the life of an animal. We sought to procure porcine tissue for ex vivo models by collaborating with groups using swine in non-survival procedures. Describe the intervention: Surgical trainees were trained to procure models from swine used in non-survival procedures. After euthanasia, midline sternotomies and laparotomies were performed to procure: heart-lung bloc, liver with gallbladder and long-segment common bile duct, stomach from esophagus to D1, small bowel segments (20cm each), kidneys, splenic vein, aortic trifurcation (~2cm iliac artery), and abdominal wall. The organs were preserved using a vacuum sealer and frozen at -20°C. The organs were thawed and used for various simulations for which model satisfaction was tracked. Describe the improvement/outcome of the intervention. This initiative has resulted in many ex vivo models, including skin suturing techniques, bowel anastomosis (hand-sewn, stapled; open, laparoscopic and robotic), ostomy creation, kidney transplant anastomosis, gastrojejunostomy, cholecystectomy, hepaticojejunostomy, pancreaticojejunostomy, lung resection, coronary artery dissection, and valve replacement. For each of these labs, trainee satisfaction ratings on a 5-point scale averaged 4.6 (n= 63). As a result of these new models, there has been a reduction of porcine labs from 25 in 2023/24 to 14 in 2024/25, resulting in an estimated saving of ~25 animals and $6100. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. Procured porcine tissue is an affordable and efficient way to provide models customized to specific simulation needs. An institution conducting large animal research could utilize this solution to optimize the 3Rs (Replacement, Reduction, and Refinement) of animal usage. Aside from administrative permissions, programs must invest in a vacuum-sealing device and a freezer for storage. The trainees procuring these models gain valuable technical skills which is a bonus of this project.

 

 

BINGO: A NOVEL APPROACH TO TEACHING THIRD YEAR MEDICAL STUDENTS ON A GENERAL SURGERY CLERKSHIP
Caitlin Silvestri, MD, Columbia/New York Presbyterian Hospital; Columbia/New York Presbyterian Hospital

What problem in education is addressed by this work? Great variation still exists in the structure and administration of surgical clerkships. Not surprisingly, previous studies have shown that across surgical clerkships, there are substantial differences in both teaching and practical skills.This variation can lead to unclear expectations and a substandard learning experience. Within medical education, setting clear expectations and learning objectives plays a large role in creating a successful learning environment for the trainee. Specifically within undergraduate medical education (UME), clearly defining a medical student’s role and assigning specific responsibilities is key for developing a clinically competent medical student. Despite this, the literature shows a lack of clear and consistent learning expectations across all stakeholders. Discrepancies between medical student, resident, and faculty expectations have been shown in areas such as involvement on morning rounds, note writing, priority of skills learned on the clerkship, components of evaluation, practical skills, and most troubling, value to the team. This learner-teacher mismatch in expectations often leads to poor engagement, non-standardized experiences, and has been shown to be a negative contributor to the surgical learning environment. Describe the intervention: The intervention involves the use of a gamified BINGO card that contains both mandatory and optional clinical tasks mapped to our institution’s clerkship learning objectives as well as the AAMC's core Entrustable Professional Activities (EPAs). The card is distributed to third-year medical students during their general surgery clerkship, and students complete tasks as they progress through the rotation. Each task is correlated to a specific work-based assessment (WBA) that the evaluating resident or faculty will fill out before signing off on the task. Using gamification, students are motivated to achieve "BINGO" by completing rows of tasks, with an additional challenge to fill the entire card by the end of the clerkship. This structured, engaging approach encourages active participation, helping students gain a clearer understanding of their roles and responsibilities during the rotation. Describe the improvement/outcome of the intervention. The intervention aims to enhance student engagement, clarify expectations, and reduce the gap between learners and teachers. While official pre- and post-survey data is still being collected, anonymous end-of-rotation feedback has indicated that the BINGO card serves as a useful tool for clarifying expectations, improving feedback, and increasing awareness of learning opportunities during the clerkship. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. We have created a template BINGO card that can be customized by each institution and, if applicable, by each rotation site within an institution. While the core concept remains consistent, each institution can tailor the BINGO card to fit its specific clerkship objectives and learning opportunities. Barrier #1: Time investment required from faculty and residents to track and confirm students' completion of tasks. Solution: Offer resident/faculty development sessions to emphasize the educational benefits of the tool, and implement automated systems or check-ins to reduce the manual workload. Additionally, utilization of QR codes for completion, that are present on the BINGO card itself, allows for streamlined process. As this becomes incorporated in the clerkship, it should streamline overall teaching efforts of medical students on the clerkship Barrier #2: Limited time during clinical rotations for students to complete all tasks on the BINGO card. Solution: Adjust the number of mandatory tasks to ensure they are feasible within the clinical schedule, and clarify priorities during orientation to focus on high-impact learning activities. Barrier #3: Ensuring consistent task completion and usage across different faculty and resident members. Solution: Provide clear guidelines and standardized rubrics for evaluating tasks, and involve faculty in customizing the BINGO card to ensure buy-in and consistency. While this process may be time-intensive, especially for institutions without existing work-based assessments, it is crucial to prevent the BINGO card from becoming merely a "logbook." Instead, the goal is to provide standardized assessment and meaningful feedback on students’ performance of clinical tasks.

 

 

ENGAGING FUTURE CLINICIANS: HOLOPATIENT SIMULATIONS FOR BEDSIDE PROCEDURE EDUCATION
Jenny Bui, MD, MPH, University of Michigan, Section of Thoracic Surgery, Ann Arbor Michigan; University of Michigan, Section of Thoracic Surgery, Ann Arbor Michigan

What problem in education is addressed by this work? This work addresses a critical problem in medical education: the challenge of efficiently and effectively training clinicians in essential procedural skills amidst growing workforce shortages and evolving patient safety standards. Traditional training methods are often limited by the need for instructor-led sessions and live patient interactions, which can be resource-intensive and pose risks to patient safety. Describe the intervention: Utilizing eXtended Reality (XR) technology, we have developed a procedural training platform for teaching hands-on procedural skills for medical or surgical training. Leveraging Microsoft 365 Guides, bedside procedures, such as central venous catheter placement and extracorporeal membrane oxygenation, are being developed in modules for learners to develop proficiency and competency using the Microsoft HoloLens 2, an XR device which allows the user to interact with both the physical world and virtual holographic elements. The platform is designed to improve both technical precision and non-technical skills such as decision-making, situational awareness, and communication within a controlled environment. Describe the improvement/outcome of the intervention. Pilot testing of the curriculum indicated students using the Hololens2 device rated it as highly usable, engaging, and adoptable compared to the traditional lab setting. Following XR training, students passed the competency training with 100% accuracy and faculty time was reduced by 75%. By offering a standardized training experience that can be tailored to individual learning speeds and needs, this intervention addresses the variability often encountered in traditional apprenticeship-based medical education. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. To support broad dissemination, the application will be made freely available for download on the Microsoft App Store, allowing any interested institution to join a multi-institutional research protocol. Additional institutions will be recruited through NSF IUCRC’s Medical Innovations in eXtended Reality (MIXR) network to share protocols for XR procedural simulation, enabling further validation studies across various academic settings. Potential barriers, such as the initial financial investment in XR hardware and software and the need for faculty training, could be addressed through grants, institutional funding, and partnerships with XR developers to help reduce these costs.

 

 

YES, AND: FOSTERING WELLNESS AND PROFESSIONAL GROWTH THROUGH MEDICAL IMPROV
Minna Wieck, MD, UC Davis; UC Davis

What problem in education is addressed by this work? Physician wellness, personal growth, communication, and self-awareness are ACGME milestones with well-defined behavioral descriptions of mastery that we expect general surgery residents to achieve. Exactly how they are supposed to learn and develop these competencies is not well defined. Thus, we sought to use medical improv as a novel and engaging teaching method for general surgery residents to build listening and communication skills and learn to find comfort in the present moment – however uncomfortable or unexpected – while fostering community within our training program. Describe the intervention: . Twelve senior residents participated in a two hour medical improv session led by two faculty with a background in improv comedy. The agenda included a short introduction to the applied improv skills and learning objectives, active participation in exercises to practice those skills, and then a facilitated group discussion on the clinical/interprofessional application of the skills learned. Games focused on a variety of skills including active listening, collaborative conversations, team building, non-verbal communication, self-reflection, and gratitude. Describe the improvement/outcome of the intervention. Following the first session, 9/12 (75%) residents stated they were confident in their active listening skills. Eleven residents (92%) felt they had the skills to create collaborative conversation with others. Eight residents (66%) were comfortable adapting to uncertainty. Free text comments expressed appreciation for a chance to learn useful tips for leadership, a space to learn and grow, and the opportunity to practice listening deeply and thinking on one’s feet. What they enjoyed the most was doing something seemingly informal but meaningful with their co-residents. Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome. Medical Improv is a flexible, low cost, and approachable means of helping surgical residents develop essential non-technical skills while also building community and wellness. This format can easily be adapted to differences in learning environment and residents’ preferences. Although having facilitators comfortable with improv comedy can optimize the experience for trainees, the detailed curriculum can easily be implemented by novices as well. Finding an adequate block of protected time, especially if multiple sessions are planned, can also be a potential barrier. This can be mitigated by incorporating this short session into existing educational time or into a longer resident retreat. Individual games can also be used as a brief ice breaker in other settings to still provide benefit.