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In this randomized trial comparing ACGME duty-hour policies with more flexible policies for surgical residents, the flexible policies resulted in noninferior patient outcomes and no significant difference in residents' satisfaction with overall well-being and education quality. In response to concerns about patient safety and resident well-being, the Accreditation Council for Graduate Medical Education (ACGME) introduced national regulations in 2003 that limited resident duty periods to 80 hours per week, capped overnight shift lengths, and mandated minimum time off between shifts. 1 , 2 Concerns persisted, 3 and in 2011, the ACGME implemented further restrictions to shorten maximum shift lengths for interns and increase time off after overnight on-call duty for residents. 1 , 4 , 5 Although most observers agree that some duty-hour regulation was necessary, critics cite a weak evidence base for the 2003 and 2011 reforms. 3 , 6 , 7 Several retrospective . . .

The landscape of general surgery education has undergone a significant transformation over the past few years, driven in large part by the advent of surgical simulation and training technologies. These innovative tools have revolutionized the way surgeons are trained, allowing for a more immersive, interactive, and effective learning experience. In this review, we will explore the impact of surgical simulation and training technologies on general surgery education, highlighting their benefits, challenges, and future directions. Enhancing the technical proficiency of surgical residents is one of the main benefits of surgical simulation and training technologies. By providing a realistic and controlled environment, With the use of simulations, residents may hone their surgical skills without compromising patient safety. Research has consistently demonstrated that training with simulations enhances surgical skills., reduces errors, and enhances overall performance. Furthermore, simulators can be programmed to mimic a wide range of surgical scenarios, enabling residents to cultivate the essential critical thinking and decision-making abilities required to manage intricate surgical cases. Another area of development is incorporating simulation-based training into the wider surgical curriculum. As simulation technologies become more widespread, they will need to be incorporated into the fabric of surgical education, rather than simply serving as an adjunct to traditional training methods. This will require a fundamental shift in the way surgical education is delivered, with a greater emphasis on simulation-based training and assessment. Highlights Surgical simulation and training technologies have revolutionized general surgery education, enhancing technical skills and critical thinking abilities of surgical residents. Integration of simulation-based training into the broader surgical curriculum is necessary for its widespread adoption and effectiveness. With the support of educational agendas led by national neurosurgical committees, industry and new technology, simulators will become readily available, translatable, affordable, and effective. As specialized, well-organized curricula are developed that integrate simulations into daily resident training, these simulated procedures will enhance the surgeon’s skills, lower hospital costs, and lead to better patient outcomes.

To better understand the emerging role of artificial intelligence (AI) in surgical training, efficacy of AI tutoring systems, such as the Virtual Operative Assistant (VOA), must be tested and compared with conventional approaches. To determine how VOA and remote expert instruction compare in learners' skill acquisition, affective, and cognitive outcomes during surgical simulation training. This instructor-blinded randomized clinical trial included medical students (undergraduate years 0-2) from 4 institutions in Canada during a single simulation training at McGill Neurosurgical Simulation and Artificial Intelligence Learning Centre, Montreal, Canada. Cross-sectional data were collected from January to April 2021. Analysis was conducted based on intention-to-treat. Data were analyzed from April to June 2021. The interventions included 5 feedback sessions, 5 minutes each, during a single 75-minute training, including 5 practice sessions followed by 1 realistic virtual reality brain tumor resection. The 3 intervention arms included 2 treatment groups, AI audiovisual metric-based feedback (VOA group) and synchronous verbal scripted debriefing and instruction from a remote expert (instructor group), and a control group that received no feedback. The coprimary outcomes were change in procedural performance, quantified as Expertise Score by a validated assessment algorithm (Intelligent Continuous Expertise Monitoring System [ICEMS]; range, -1.00 to 1.00) for each practice resection, and learning and retention, measured from performance in realistic resections by ICEMS and blinded Objective Structured Assessment of Technical Skills (OSATS; range 1-7). Secondary outcomes included strength of emotions before, during, and after the intervention and cognitive load after intervention, measured in self-reports. A total of 70 medical students (41 [59%] women and 29 [41%] men; mean [SD] age, 21.8 [2.3] years) from 4 institutions were randomized, including 23 students in the VOA group, 24 students in the instructor group, and 23 students in the control group. All participants were included in the final analysis. ICEMS assessed 350 practice resections, and ICEMS and OSATS evaluated 70 realistic resections. VOA significantly improved practice Expertise Scores by 0.66 (95% CI, 0.55 to 0.77) points compared with the instructor group and by 0.65 (95% CI, 0.54 to 0.77) points compared with the control group (P < .001). Realistic Expertise Scores were significantly higher for the VOA group compared with instructor (mean difference, 0.53 [95% CI, 0.40 to 0.67] points; P < .001) and control (mean difference. 0.49 [95% CI, 0.34 to 0.61] points; P < .001) groups. Mean global OSATS ratings were not statistically significant among the VOA (4.63 [95% CI, 4.06 to 5.20] points), instructor (4.40 [95% CI, 3.88-4.91] points), and control (3.86 [95% CI, 3.44 to 4.27] points) groups. However, on the OSATS subscores, VOA significantly enhanced the mean OSATS overall subscore compared with the control group (mean difference, 1.04 [95% CI, 0.13 to 1.96] points; P = .02), whereas expert instruction significantly improved OSATS subscores for instrument handling vs control (mean difference, 1.18 [95% CI, 0.22 to 2.14]; P = .01). No significant differences in cognitive load, positive activating, and negative emotions were found. In this randomized clinical trial, VOA feedback demonstrated superior performance outcome and skill transfer, with equivalent OSATS ratings and cognitive and emotional responses compared with remote expert instruction, indicating advantages for its use in simulation training. ClinicalTrials.gov Identifier: NCT04700384.

Preoperative warm-up regimens are increasingly utilised in the surgical field, however no consensus on benefits of priming across surgical experience has been realised. The aim of this study was to evaluate the impact of simulation preoperative priming on operative performance across levels of resident experience. A single-blinded randomised control trial was carried out in a regional surgical training centre. Volunteers were randomised to undergo simulated surgical warm-up procedure prior to their first case as primary operator or proceed directly to surgery. Performances of 147 operative procedures were collected over an 18 month period, experience ranging from PGY2-PGY 7. Senior participants consistently outperformed junior residents in unprimed operative cases (p = 0.005). In primed operative performances no significant difference in aggregate performance scores was found (p = 0.07). Priming confers a greater advantage to junior residents with particular regard to generic surgical skills. Senior residents demonstrate improved self-efficacy scores measured following priming. •Preoperative priming improves technical skill and performance in junior residents.•Senior residents reported higher self-efficacy scores following preoperative priming.•Generic and specific skills in open procedures improved following priming.

This study aimed to evaluate the efficacy and feasibility of a cognitive fitness training (CFT) program on the development of emotional intelligence and stress management skills in medical students during their 3rd year surgery clerkship. MS3s (n ​= ​80) were randomized into a training or control group. The training group received CFT during their clerkship, the control group received online access afterwards. A cognitive fitness (CF) assessment was administered before and after the clerkship. The training group demonstrated a significant improvement in cumulative assessment scores (126.4–146.5, p ​< ​0.0001) and most dimensions of CF assessment. Integration of the curriculum did not adversely impact performance on surgery NBME or surgery OSCE when compared to control (p ​> ​0.05). The CFT provided to MS3s resulted in significant improvements in CF, including most subcategories. The CFT also did not have an adverse impact on academic performance indicating its feasibility within medical education curricula. •Emotional intelligence (EI) ​+ ​stress management skills ​= ​Cognitive Fitness (CF).•Cognitive fitness training (CFT) improves EI in 3rd year Medical Students.•CFT does not adversely impact academic performance on standardized examinations.

Exploring the application of 5E teaching model combined with virtual endoscopic surgical simulation system in surgical teaching. Eighty-six students who received standardized residency training in the Department of General Surgery at the Second Hospital of Shanxi Medical University from September 2022 to June 2023 were selected as the research subjects. They were randomly divided into experimental and control groups, with 43 students in each group. The experimental group adopts the 5E teaching mode combined with a virtual endoscopic surgery simulation system for teaching. In contrast, the control group was taught using traditional teaching and a simple endoscopic simulation training box. A comparison was made between the evaluation results, self-evaluation, and teaching mode evaluation of the two groups. A -test was performed on two sets of measurement data using SPSS 26.0 software. The theoretical test scores (  = 17.240,  = 0.000) and skill test scores (  = 21.335,  = 0.000) of students in the experimental group were higher than those in the control group. Compared to the control group, the experimental group showed significant improvement in operational skills (  = 3.557,  = 0.001), knowledge application (  = 4.936,  = 0.000), and overall performance (  = 2.999,  = 0.003) after training. The attitudes of students in the experimental group toward ability training (  = 3.818,  = 0.000), class order (  = 3.189,  = 0.002), teaching mode (  = 2.955,  = 0.004), and teaching level evaluation (  = 6.238,  = 0.000) were significantly higher than those in the control group. The virtual endoscopic surgery simulation system combined with the 5E teaching mode can significantly improve the theoretical knowledge and clinical practice skills of resident physicians in standardized training. Suggest applying it to clinical teaching.

The purpose of this study was to find out whether 3-dimensional (3D)-printed models improved the learners' ability to identify liver segments. A total of 116 physicians from 3 disciplines were tested in a cross-over trial at baseline and after teaching with 3D models and 2-dimensional (2D) images. Adjusted multilevel-mixed models were used to compare scores at baseline and after 3D and 2D. Accuracy in identifying hepatic segments was higher with 3D first than 2D (77% vs 69%; P = 0.05) and not significantly improved by a combination of 3D and 2D. Increased confidence in segment identification was highest in trainees after 3D (P = 0.04). 3D-printed models facilitate learning hepatic segmental anatomy.

Studies of gender disparity in surgical training have yielded conflicting results. We hypothesize that there is no influence of gender on resident self-evaluation Milestone (SEM) scores and those assigned by the Clinical Competency Committee (CCC). 42 residents (25 male & 17 female) and faculty completed 300 Accreditation Council for Graduate Medical Education (ACGME) Milestone evaluations over a 4-year period. Two-way ANOVA, intraclass correlations coefficients, and general linear mixed models were used for analysis. CCC Milestone scores from 150 evaluations, 51 (34%) for female residents and 99 (66%) for male residents, were compared to corresponding SEM scores. There is a high interrater reliability (self vs. CCC). There was a significant increase in scores with advancing PGY levels (p < 0.001). No effect of gender on Milestones scores (p > 0.05) was noted. We found no significant differences in Milestones scores between male and female residents as determined by the CCC. Both scores improved significantly as residents progressed in training. •No differences in surgical resident self-assessed Milestones scores and Clinical Competency Committee evaluations when stratified by gender.•Milestone scores increased with experience as expected.•Providing new trainees with early mentoring and coaching is essential

Background During the worldwide COVID-19 pandemic, the quality of surgical education experiences sudden major restrictions. Students’ presence in the operating theater and on wards is reduced to a bare minimum and face-to-face teaching is diminished. Aim of this study was therefore to evaluate alternative but feasible educational concepts, such as an online-only-platform for undergraduates. Objective A new online platform for undergraduate surgical education was implemented. A virtual curriculum for online-only education was designed. Methods A video-based online platform was designed. Following this, a cohort of medical students participating in a (voluntary) surgical course was randomized into a test and control group. Prior to conducting a written exam, students in the test group prepared using the video platform. Students in the control group prepared with standard surgical text books. Results of the exam were used to compare educational means. Results Students in the test group preparing through the video-based online platform reached significantly higher scores in the written exams (p = 0.0001) than students of the control group. A trend towards reduced preparation time that did not reach statistical significance was detectable in the test group (p = 0.090). Scores of “perceived workload” and “desire to become a surgeon” offered no differences between the groups. (p = 0.474 and 1.000). Conclusions An online-only, virtual curriculum proved feasible for surgical education in undergraduates. While blended learning concepts were applied in both groups, only the test group had access to case-based videos of surgical procedures and scored significantly better in the written exams. Thus, video-based virtual education offers a realistic alternative to face-to-face teaching or conventional text books in times of restricted access to the operating theatre.

Background Previous studies have shown a correlation between previous video game experience and performance in minimally invasive surgical simulators. The hypothesis is that systematic video game training with high visual-spatial demands and visual similarity to endoscopy would show a transfer effect on performance in virtual reality endoscopic surgical simulation. Methods A prospective randomized study was performed. Thirty surgical novices were matched and randomized to five weeks of systematic video game training in either a first-person shooter game (Half Life) with high visual-spatial demands and visual similarities to endoscopy or a video game with mainly cognitive demands (Chessmaster). A matched control group ( n  = 10) performed no video game training during five weeks. Performance in two virtual reality endoscopic surgical simulators (MIST-VR and GI Mentor II) was measured pre- and post-training. Before simulator training we also controlled for students’ visual-spatial ability, visual working memory, age, and previous video game experience. Results The group training with Half Life showed significant improvement in two GI Mentor II variables and the MIST-VR task MD level medium. The group training with Chessmaster only showed an improvement in the MIST-VR task. No effect was observed in the control group. As recently shown in other studies, current and previous video game experience was important for simulator performance. Conclusions Systematic video game training improved surgical performance in advanced virtual reality endoscopic simulators. The transfer effect increased when increasing visual similarity. The performance in intense, visual-spatially challenging video games might be a predictive factor for the outcome in surgical simulation.