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This study aims to investigate whether a systematic digital training system can improve the learning efficiency of residents in the first-year orthognathic surgery training course and evaluate its effectiveness in teaching orthognathic surgery. A digital training system was applied, and a comparative research approach was adopted. 24 first-year orthognathic surgery residents participated in the experiment as part of their professional skill training. The Experimental group was required to use a digital training system, and the Control group was trained in lectures without digital technologies. Three indicators, including theoretical knowledge and clinical operation, were assessed in tests, and evaluations from instructors were analyzed to evaluate learning efficiency. The results showed that the scores in theoretical tests, practical operations, and teacher evaluations, the Experimental groups were all higher than the Control group (  = 0.002 for anatomy,  = 0.000 for operation theory) after using digital technology, except for the understanding of complications (  = 0.771). In addition, the questionnaire survey results showed that the study interest (  = 0.001), self-confidence (  = 0.001), satisfaction (  = 0.002), and academic performance (  = 0.001) of the residents of the Experimental group were higher than those of the Control group. The outcomes indicated that the digital training system could benefit orthognathic residents' learning efficiency, and learning interest and teaching satisfaction will also improve.

Massive open online courses (MOOCs) is a new teaching technology based on a network platform, which can provide more students with the possibility of systematic and repeated learning. Due to the complexity of transesophageal echocardiography (TEE), the wide range of knowledge involved, and many knowledge points being difficult to understand, it is difficult to meet the teaching needs of this content with the traditional teaching mode. This study aimed to discuss the application of lecture based learning (LBL) and problem based learning (PBL) in the training of perioperative TEE in the context of MOOCs. Sixty residents were randomly divided into two groups to participate in a 5-day perioperative TEE training program. The web-based PBL mode was used in the observation group and the LBL mode was used in the control group, with 30 residents in each group. The teaching effect of the web-based PBL mode was compared with the LBL mode by basic theory test, practice examination, image interpretation and questionnaire. The image interpretation score and the total test score were higher in the observation group than in the control group with statistically significant differences ( <0.001). The results of the questionnaire show that the residents were more satisfied with the web-based PBL mode than the LBL mode ( <0.001). The web-based PBL method has obvious advantages over the LBL mode in the training of perioperative TEE.

Lemmese Alwatban,1,2 Mai S Alageel,3 Lina A Alshehri,4 Norah Saud Alfehaid,5 Reem Abdullah Albahlal,6 Norah Hejji Almazrou,7 Raghad Almubarak7 1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2University Family Medicine Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Department of Family Medicine, King Fahad Medical City, Riyadh, Saudi Arabia; 4Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 5Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia; 6Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia; 7College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Lemmese Alwatban, Department of Family and Community Medicine, College of Medicine, King Saud University, P.O. Box 2925, Riyadh, 11461, Saudi Arabia, Email lalwatban@ksu.edu.saPurpose: Burnout is an occupational stress syndrome that gives rise to emotional exhaustion (EE) depersonalization (DP) and reduced personal accomplishment (PA). Increasing rates of burnout among health care professionals has been reported globally. Saudi Arabia appears to be among the highest in prevalence with reports of higher than 70%. Medical residents in training are the highest group at risk. The literature has repeatedly linked burnout among residents with poor academic performance on training exams, impaired quality of life, career choice regret and intentions to abandon medicine. In this study, we explore the factors that contribute to resident burnout, their experiences with burnout and how they choose to mitigate it.Methods: A qualitative design was used to conduct this study in the city of Riyadh, Saudi Arabia. A total of 14 residents from surgical and non-surgical programs were interviewed through in-depth interviews. Interpretive thematic analysis was used in coding and generated coding templates. Categories were repetitively reviewed and revised, expanding to include new data as it emerged and collapsing to remove redundant codes. Categories were organized into the final themes and sub-themes.Results: All participants demonstrated a shared thread of shame in reaching the level of burnout. Three main interlinked themes were identified: Burnout stigma cycle, amalgamated causes of burnout and self-coping with burnout. One of the concerning findings in our study is the participants’ pursuit of self-coping strategies and the avoidance of formal help, creating a cycle of suffering in silence.Conclusion: The literature has repeatedly reported high levels of burnout among residents in training. This study has added another dimension to those findings through the exploration of residents actual accounts and appears to link burnout with suboptimal training and working conditions. We have highlighted the pivotal role stigma and shame play in completely preventing residents from seeking professional help.Keywords: resident training, burnout, stigma, self-coping

Autonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the ‘teaching assistant (TA)’ case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce. A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume. Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 ​% increase; τ ​= ​0.610, p ​= ​0.001). There was a concurrent 72.7 ​% increase in TA cases from a median of 22–38 (τ ​= ​0.574, p ​= ​0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018–2019 and 2016–2017. The uptrend in TA cases was associated with the significant increase in colorectal (τ ​= ​0.559, p ​= ​0.001), general surgery-other (τ ​= ​0.404, p ​= ​0.018), and hepatopancreaticobiliary (HPB) (τ ​= ​0.596, p ​= ​0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ ​= ​0.956, p=<0.001), HPB (τ ​= ​0.713, p=<0.001) and colorectal (τ ​= ​0.522, p ​= ​0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ ​= ​−0.485, p ​= ​0.006) and vascular surgery (τ ​= ​0.603, p ​= ​0.001) dropped significantly. The procedural category with the highest chief and TA volume was ‘colorectal tract - large intestine.’ Most procedural categories (53.49 ​%) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023. Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely. •This 17-year study on surgical training trends reveals an overall rise in surgeon chief and teaching assistant cases.•Case volume peaked for both teaching assistant and surgeon cheif volume between the 2016 and 2019.•Further research must focus on strategies to improve resident autonomy to train surgeons safely.

BackgroundDue to its complexity and to existing treatment alternatives, exposure to intracranial aneurysm microsurgery at the time of neurosurgical residency is limited. The current state of the art includes training methods like assisting in surgeries, operating under supervision, and video training. These approaches are labor-intensive and difficult to fit into a timetable limited by the new work regulations. Existing virtual reality (VR)–based training modules lack patient-specific exercises and haptic properties and are thus inferior to hands-on training sessions and exposure to real surgical procedures.Materials and methodsWe developed a physical simulator able to reproduce the experience of clipping an intracranial aneurysm based on a patient-specific 3D-printed model of the skull, brain, and arteries. The simulator is made of materials that not only imitate tissue properties including arterial wall patency, thickness, and elasticity but also able to recreate a pulsatile blood flow. A sample group of 25 neurosurgeons and residents (n = 16: early residency with less than 4 years of neurosurgical exposure; n = 9: late residency and board-certified neurosurgeons, 4–15 years of neurosurgical exposure) took part to the study. Participants evaluated the simulator and were asked to answer questions about surgical simulation anatomy, realism, haptics, tactility, and general usage, scored on a 5-point Likert scale. In order to evaluate the feasibility of a future validation study on the role of the simulator in neurosurgical postgraduate training, an expert neurosurgeon assessed participants’ clipping performance and a comparison between groups was done.ResultsThe proposed simulator is reliable and potentially useful for training neurosurgical residents and board-certified neurosurgeons. A large majority of participants (84%) found it a better alternative than conventional neurosurgical training methods.ConclusionThe integration of a new surgical simulator including blood circulation and pulsatility should be considered as part of the future armamentarium of postgraduate education aimed to ensure high training standards for current and future generations of neurosurgeons involved in intracranial aneurysm surgery.

Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 ​± ​1.7), followed by Live Patient only (4.3 ​± ​2.5), and KD only (2.6 ​± ​1.3). The mean confidence rating for residents with neither training opportunity was 1.4 ​± ​1.0. The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies. •Knowledge Donor provides hyper realistic training nearly replicating a live patient.•A unique perfusion-based platform with high-fidelity whole-body donors is the basis.•Knowledge Donor can revolutionize procedural training for medical learners.•Can be applied across any medical specialty with procedural learning.

The integration of holographic imaging technology with virtual reality (VR) simulation represents a significant advancement in medical education, particularly in the training of obstetrics and gynecology residents. This review explored the background and importance of these cutting-edge technologies in enhancing clinical skill acquisition while addressing the critical issue of patient privacy protection. Studies have highlighted the foundational principles of holographic and VR technologies, as well as their evolving roles in medical training. Their combined application in obstetrics and gynecology possesses notable advantages, including improved surgical precision, enhanced clinical decision-making, and increased effectiveness in emergency response situations among resident physicians. Moreover, the review examined the potential of these technologies to safeguard patient privacy by creating secure virtual environments that minimize exposure to sensitive clinical data. Ethical considerations and data security challenges in VR platforms were also discussed, along with emerging solutions. Through a systematic review and integration of current literature, this review provides a comprehensive overview of how holographic imaging combined with VR simulation can optimize educational outcomes and privacy standards in resident training programs. The review concluded with recommendations for future technological enhancements and innovative teaching methodologies to further support the training of proficient and ethically responsible practitioners in the field of obstetrics and gynecology.

Canadian specialist residency programs are in the process of transitioning to a hybrid time and competence model, Competence by Design (CBD), developed by the Royal College of Physicians and Surgeons Canada. Although there is extensive literature around competency-based medical education (CBME), few studies have evaluated the experience of residents after CBME implementation. The purpose of this study was to obtain a rich perspective on the lived experience of residents. We designed a qualitative study with inductive thematic analysis of semistructured interview data. The study population was residents in CBD postgraduate training programs in anesthesiology, internal medicine, or surgery (including all surgical subspecialties) at Dalhousie University (Halifax, NS, Canada). Residents identified the following benefits of their programs and CBD: supportive peers and clinical supervisors, a roadmap for residency, formalized feedback opportunities, and program evolution. Resident-identified drawbacks of CBD included: a lack of transparency around CBD, CBD not as advertised, a lack of buy-in, increased administrative burden, difficulties obtaining evidence for entrustable professional activities (EPAs); the onus for CBD on residents, inconsistent feedback, cumbersome technology, and significant psychological burden. Resident-suggested improvements were reducing the number of EPAs, streamlining EPA requirements, increasing transparency and communication with competence committees, providing incentives and continuous education for clinical supervisors, improving on existing electronic interfaces, and developing technology better suited to the needs of CBD. This study highlights that the significant administrative and psychological burden of CBD detracts from clinical learning and enthusiasm for residency. Future research could explore whether overcoming the identified challenges will improve residents' experiences.

Resident satisfaction is a key performance metric for surgery programs; we studied factors influencing resident satisfaction in operative cases, and the concordance of faculty and resident perceptions on these factors. Resident and faculty were separately queried on satisfaction immediately following operative cases. Statistical significance of the associations between resident and faculty satisfaction and case-related factors were tested by Chi-square or Fisher's exact test. Residents and faculty were very satisfied in 56/87 (64%) and 36/87 (41%) of cases respectively. Resident satisfaction was associated with their perceived role as surgeon (p < 0.04), performing >50% of the case (p < 0.01), autonomy (p < 0.03), and PGY year 4–5(p < 0.02). Faculty taking over the case was associated with both resident and faculty dissatisfaction. Faculty satisfaction was associated with resident preparation (p < 0.01), faculty perception of resident autonomy (p < 0.01), and faculty familiarity with resident's skills (p < 0.01). Resident and faculty satisfaction are associated with the resident's competent performance of the case, suggesting interventions to optimize resident preparation for a case or faculty's ability to facilitate resident autonomy will improve satisfaction with OR experience.