James R. Korndorffer, Jr. MD MHPE FACS is Associate Professor and Vice Chair of Education in the Department of Surgery at Stanford University. Previously he served as Vice chair of Surgery at Tulane University Health Sciences Center in New Orleans. While at Tulane he also was the Surgery Residency Program Director, the assistant dean for Graduate medical education and the Medical Director of the Tulane Center for Advanced Medical Simulation and Team Training. He received his undergraduate degree in Biomedical Engineering from Tulane University, his Medical Degree from the University of South Florida College of Medicine and his Masters in Health Professions Education from the University of Illinois Chicago. His general surgery residency was completed at The Carolinas Medical Center in Charlotte, North Carolina and his Advanced Laparoscopic Fellowship was completed at Tulane University.

He is actively involved in numerous national societies including the American College of Surgeons, the Society for Gastrointestinal and Endoscopic Surgeons, the Association for Surgical Education, and the Association for Program Directors in Surgery. He serves on the American College of Surgeons Committee on Validation of Surgical Knowledge and Skills, SAGES Fundamentals of Laparoscopic Surgery and Development Committees and also serves as the APDS research committee vice chair.

Dr. Korndorffer has published over 60 papers in peer reviewed journals, 5 book chapters and has presented at over 100 national meetings. Dr. Korndorffer’s clinical interests include minimally invasive surgery for gastrointestinal disorders and hernias. His research interests include surgical education, surgical simulation, patient safety, and patient care quality.

Clinical Focus

  • General Surgery

Academic Appointments

Administrative Appointments

  • Vice Chair of Education, Department of Surgery (2017 - Present)

Honors & Awards

  • Best Doctors, New Orleans (2017-2018)
  • Teaching Scholar, Tulane University School of Medicine (2012)
  • ACS Young Surgeon Representative, ACS Louisiana Chapter (2005)
  • Best Surgical Resident Teacher, Carolinas Medical Center (1995)
  • Distinguished Service Award, University of South Florida COM (1990)

Boards, Advisory Committees, Professional Organizations

  • Member, Southern Surgical Association (2016 - Present)
  • Member, Editorial Board, Surgical Council on Resident Education (2014 - Present)
  • Recorder, American College of Surgeons Accredited Education Institutes (2018 - Present)
  • Chair, Program Committee, American College of Surgeons Accredited Education Institute (2015 - 2016)
  • Member, Program Committee, American College of Surgeons – Accredited Education Institutes (2013 - Present)
  • Co-Chair, Research and Development Committee, American College of Surgeons – Accredited Education Institutes (2013 - 2015)
  • Chair, Graduate Surgical Education Committee, Association for Surgical Education (2011 - 2013)
  • Member, Graduate Surgical Education Committee, Association for Surgical Education (2008 - Present)
  • Member, Board of Directors, Association for Surgical Education (2011 - 2013)
  • VIce Chair, Research and Development Committee , Association of Program Directors in Surgery (2016 - Present)
  • Co-Chair, Curriculum Task Force Society of American Gastrointestinal and Endoscopic Surgeons (2015 - Present)
  • Member, Fundamentals of Endoscopic Surgery Committee, Society of American Gastrointestinal and Endoscopic Surgeons (2011 - Present)
  • Member, Committee on Validation of Surgical Knowledge and Skills, American College of Surgeons (2013 - Present)
  • Member, Development Committee, Society of American Gastrointestinal and Endoscopic Surgeons (2016 - Present)

Professional Education

  • Medical Education: University of South Florida Morsani College of Medicine (1990) FL
  • Fellowship: Tulane University School of Medicine Registrar (2005) LA
  • Board Certification: American Board of Surgery, General Surgery (1996)
  • Fellowship, Tulane University School of Medicine, Minimally invasive Surgery (2005)
  • Residency: Carolinas Medical Center General Surgery Residency (1995) NC
  • Residency, Carolinas Medical Center, Chalotte NC, Surgery (1995)
  • MHPE, University of Illinois, Chicago, Masters of Health Professions Education (2011)
  • MD, University of South Florida College of Medicine (1990)


  • James Korndorffer. "United States Patent 7,802,990 Laparoscopic Camera Navigation Trainer", Sep 28, 2010

Stanford Advisees

All Publications

  • Tips for developing a coaching program in medical education. Medical education online Miller-Kuhlmann, R., Sasnal, M., Gold, C. A., Nassar, A. K., Korndorffer, J. R., Van Schaik, S., Marmor, A., Williams, S., Blankenburg, R., Rassbach, C. E. 2024; 29 (1): 2289262


    This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.

    View details for DOI 10.1080/10872981.2023.2289262

    View details for PubMedID 38051864

  • Perception Is Not Reality: Examining the Quality of Endof-Rotation Evaluations Anand, A., Jensen, R., Liebert, C., Korndorffer, J. R. LIPPINCOTT WILLIAMS & WILKINS. 2023: S445
  • The Role of Non-Technical Skills in the Development of Operative Self-Efficacy Jensen, R. M., Kearse, L., Anand, A., Dent, D. L., Korndorffer, J. R. LIPPINCOTT WILLIAMS & WILKINS. 2023: S432
  • More is not better: A scoping review of simulation in transition to residency programs. Surgery Anand, A., Jensen, R., Korndorffer, J. R. 2023


    Transition to residency programs frequently use simulation to promote clinical skills but place limited emphasis on non-clinical skills. We conducted a scoping review to determine how simulation is being used in transition to residency programs and the key non-clinical skills addressed by simulation activities and tools in these programs.We searched PubMed, Scopus, and Embase to identify articles addressing transition to residency, simulation, and non-clinical skills/attributes. Two authors independently screened all abstracts and full-text articles and identified non-clinical attributes elicited in each study. Using descriptive statistics, we characterized the simulation activities and tools and the number and type of non-clinical attributes captured in the programs. Using analysis of variance, we compared the number of non-clinical attributes elicited based on the number of simulation activities used and compared the number of non-clinical attributes elicited based on the number of simulation tools used.We identified 38 articles that met the study criteria. We characterized simulation activities as mock paging (37%), case-based scenarios (74%), and/or procedural skills training (39%). We found that the most common simulation tools were standardized patients (64.8%), and the most elicited non-clinical attributes were communication skills, critical thinking, and teamwork. Using more simulation activity categories or simulation tools did not increase the number of non-clinical skills elicited.Simulation is used broadly in transition to residency programs but provides training in a few of the non-clinical skills required for a successful transition. Incorporating more simulation activities or tools does not increase the number of non-clinical attributes elicited, illustrating the importance of developing more targeted simulation activities to promote non-clinical skills more effectively.

    View details for DOI 10.1016/j.surg.2023.08.030

    View details for PubMedID 37852830

  • Usability of ENTRUST as an Assessment Tool for Entrustable Professional Activities (EPAs): A Mixed Methods Analysis. Journal of surgical education Lee, M. C., Melcer, E. F., Merrell, S. B., Wong, L. Y., Shields, S., Eddington, H., Trickey, A. W., Tsai, J., Korndorffer, J. R., Lin, D. T., Liebert, C. A. 2023


    As the American Board of Surgery transitions to a competency-based model of surgical education centered upon entrustable professional activities (EPAs), there is a growing need for objective tools to determine readiness for entrustment. This study evaluates the usability of ENTRUST, an innovative virtual patient simulation platform to assess surgical trainees' decision-making skills in preoperative, intra-operative, and post-operative settings.This is a mixed-methods analysis of the usability of the ENTRUST platform. Quantitative data was collected using the system usability scale (SUS) and Likert responses. Analysis was performed with descriptive statistics, bivariate analysis, and multivariable linear regression. Qualitative analysis of open-ended responses was performed using the Nielsen-Shneiderman Heuristics framework.This study was conducted at an academic institution in a proctored exam setting.The analysis includes n = 47 (PGY 1-5) surgical residents who completed an online usability survey following the ENTRUST Inguinal Hernia EPA Assessment.The ENTRUST platform had a median SUS score of 82.5. On bivariate and multivariate analyses, there were no significant differences between usability based on demographic characteristics (all p > 0.05), and SUS score was independent of ENTRUST performance (r = 0.198, p = 0.18). Most participants agreed that the clinical workup of the patient was engaging (91.5%) and felt realistic (85.1%). The most frequent heuristics represented in the qualitative analysis included feedback, visibility, match, and control. Additional themes of educational value, enjoyment, and ease-of-use highlighted participants' perspectives on the usability of ENTRUST.ENTRUST demonstrates high usability in this population. Usability was independent of ENTRUST score performance and there were no differences in usability identified in this analysis based on demographic subgroups. Qualitative analysis highlighted the acceptability of ENTRUST and will inform ongoing development of the platform. The ENTRUST platform holds potential as a tool for the assessment of EPAs in surgical residency programs.

    View details for DOI 10.1016/j.jsurg.2023.09.001

    View details for PubMedID 37821350

  • The domino effect: the impact of gender on operative self-efficacy. Surgical endoscopy Jensen, R. M., Anand, A., Kearse, L. E., Korndorffer, J. R. 2023


    Studies suggest that there are key differences in operative experience based on a trainee's gender. A large-scale self-efficacy (SE) survey, distributed to general surgery residents after the American Board of Surgery In-Training Examination in 2020, found that female gender was associated with decreased SE in graduating PGY5 residents for all 4 laparoscopic procedures included on the survey (cholecystectomy, appendectomy, right hemicolectomy, and diagnostic laparoscopy). We sought to determine whether these differences were reflected at the case level when considering operative performance and supervision using an operative assessment tool (SIMPL OR).Supervision and performance data reported through the SIMPL OR platform for the same 4 laparoscopic procedures included in the SE survey were aggregated for residents who were PGY5s in 2020. Independent t-tests and multiple linear regression were used to determine the relationship between trainee gender and supervision/performance ratings.For laparoscopic cases in aggregate (n = 2708), male residents rated their performance higher than females (3.57 vs. 3.26, p < 0.001, 1 = critical deficiency, 5 = exceptional performance) and reported less supervision (3.15 vs. 2.85, p < 0.001, 1 = show and tell, 4 = supervision only); similar findings were seen when looking at attending reports of resident supervision and performance. A multiple linear regression model showed that attending gender did not significantly predict resident-reported supervision or performance levels, while case complexity and trainee gender significantly affected both supervision and performance (p < 0.001).Female residents perceive themselves to be less self-efficacious at core laparoscopic procedures compared to their male colleagues. Comparison to more case-specific data confirm that female residents receive more supervision and lower performance ratings. This may create a domino effect in which female residents receive less operative independence, preventing the opportunity to establish SE. Further research should identify opportunities to break this cycle and consider gender identity beyond the male/female construct.

    View details for DOI 10.1007/s00464-023-10378-2

    View details for PubMedID 37697120

    View details for PubMedCentralID 7450402

  • An Open-Source Curriculum to Teach Practical Academic Research Skills. Annals of surgery open : perspectives of surgical history, education, and clinical approaches Lee, J. J., Korndorffer, J. R., Knowlton, L. M., Choi, J. 2023; 4 (3): e329


    Academic productivity is important for career advancement, yet not all trainees have access to structured research programs. Without formal teaching, acquiring practical skills for research can be challenging. A comprehensive research course that teaches practical skills to translate ideas into publications could accelerate trainees' productivity and liberate faculty mentors' time. We share our experience designing and teaching "A Practical Introduction to Academic Research", a course that teaches practical skills including building productive habits, recognizing common statistical pitfalls, writing cover letters, succinct manuscripts, responding to reviewers, and delivering effective presentations. We share open-source educational material used during the Winter 2022 iteration to facilitate curriculum adoption at peer institutions.

    View details for DOI 10.1097/AS9.0000000000000329

    View details for PubMedID 37746596

    View details for PubMedCentralID PMC10513130

  • We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency. Journal of surgical education Anand, A., Jensen, R., Korndorffer, J. R. 2023


    Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation.A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score.A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8).Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.

    View details for DOI 10.1016/j.jsurg.2023.07.009

    View details for PubMedID 37541937

  • What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey. Surgical endoscopy Seymour, N. E., Nepomnayshy, D., De, S., Banks, E., Breitkopf, D. M., Campagna, R., Gomez-Garibello, C., Green, I., Jacobsen, G., Korndorffer, J. R., Minasi, J., Okrainec, A., Matthew Ritter, E., Sankaranarayanan, G., Schwaitzberg, S., Soper, N. J., Vassiliou, M., Wagner, M., Zevin, B. 2023


    INTRODUCTION: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests.METHODS: A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform.RESULTS: Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks.CONCLUSIONS: This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.

    View details for DOI 10.1007/s00464-023-10238-z

    View details for PubMedID 37517042

  • Correlation of Performance on ENTRUST and Traditional Oral Objective Structured Clinical Examination for High-Stakes Assessment in the College of Surgeons of East, Central, and Southern Africa. Journal of the American College of Surgeons Liebert, C. A., Melcer, E. F., Eddington, H., Trickey, A., Shields, S., Lee, M., Korndorffer, J. R., Bekele, A., Wren, S. M., Lin, D. T. 2023


    To address the global need for accessible evidence-based tools for competency-based education, we developed ENTRUST, an innovative online virtual patient simulation platform to author and securely deploy case scenarios to assess surgical decision-making competence.In partnership with COSECSA, ENTRUST was piloted during the Membership of the College of Surgeons (MCS) 2021 examination. Examinees (n=110) completed the traditional 11-station oral OSCE, followed by three ENTRUST cases, authored to query similar clinical content of three corresponding OSCE cases. ENTRUST scores were analyzed for associations with MCS Exam outcome using independent sample t-tests. Correlation of ENTRUST scores to MCS Exam Percentage and OSCE Station Scores were calculated with Pearson correlations. Bivariate and multivariate analyses were performed to evaluate predictors of performance.ENTRUST performance was significantly higher in examinees who passed the MCS Exam compared to those who failed (p<0.001). ENTRUST score was positively correlated with MCS Exam Percentage (p<0.001) and combined OSCE Station Scores (p<0.001). On multivariate analysis, there was a strong association between MCS Exam Percentage and ENTRUST Grand Total Score (p<0.001), Simulation Total Score (p=0.018), and Question Total Score (p<0.001). Age was a negative predictor for ENTRUST Grand Total and Simulation Total Score, but not for Question Total Score. Sex, native language status, and intended specialty were not associated with performance on ENTRUST.This study demonstrates feasibility and initial validity evidence for the use of ENTRUST in a high-stakes examination context for assessment of surgical decision-making. ENTRUST holds potential as an accessible learning and assessment platform for surgical trainees worldwide.

    View details for DOI 10.1097/XCS.0000000000000740

    View details for PubMedID 37144790

  • Changing Guidelines And Its Impact On Resident Operative Experiences: Evaluating Trends In Prostatectomy Case Logs Kearse, L., Zeineddin, A., Stewart, S., Jensen, R., Korndorffer, J., Metwalli, A. R. LIPPINCOTT WILLIAMS & WILKINS. 2023: S142
  • ENTRUST: A Serious Game-Based Virtual Patient Platform to Assess Entrustable Professional Activities in Graduate Medical Education. Journal of graduate medical education Lin, D. T., Melcer, E. F., Keehl, O., Eddington, H., Trickey, A. W., Tsai, J., Camacho, F., Merrell, S. B., Korndorffer, J., Liebert, C. A. 2023; 15 (2): 228-236


    As entrustable professional activities (EPAs) are implemented in graduate medical education, there is a great need for tools to efficiently and objectively evaluate clinical competence. Readiness for entrustment in surgery requires not only assessment of technical ability, but also the critical skill of clinical decision-making.We report the development of ENTRUST, a serious game-based, virtual patient case creation and simulation platform to assess trainees' decision-making competence. A case scenario and corresponding scoring algorithm for the Inguinal Hernia EPA was iteratively developed and aligned with the description and essential functions outlined by the American Board of Surgery. In this study we report preliminary feasibility data and validity evidence.In January 2021, the case scenario was deployed and piloted on ENTRUST with 19 participants of varying surgical expertise levels to demonstrate proof of concept and initial validity evidence. Total score, preoperative sub-score, and intraoperative sub-score were analyzed by training level and years of medical experience using Spearman rank correlations. Participants completed a Likert scale user acceptance survey (1=strongly agree to 7=strongly disagree).Median total score and intraoperative mode sub-score were higher with each progressive level of training (rho=0.79, P<.001 and rho=0.69, P=.001, respectively). There were significant correlations between performance and years of medical experience for total score (rho=0.82, P<.001) and intraoperative sub-scores (rho=0.70, P<.001). Participants reported high levels of platform engagement (mean 2.06) and ease of use (mean 1.88).Our study demonstrates feasibility and early validity evidence for ENTRUST as an assessment platform for clinical decision-making.

    View details for DOI 10.4300/JGME-D-22-00518.1

    View details for PubMedID 37139206

    View details for PubMedCentralID PMC10150817

  • Developing an Inpatient Relationship Centered Communication Curriculum (I-RCCC) rounding framework for surgical teams. BMC medical education Nassar, A. K., Weimer-Elder, B., Yang, R., Kline, M., Dang, B. K., Spain, D. A., Knowlton, L. M., Valdez, A. B., Korndorffer, J. R., Johnson, T. 2023; 23 (1): 137


    Morning rounds by an acute care surgery (ACS) service at a level one trauma center are uniquely demanding, given the fast pace, high acuity, and increased patient volume. These demands notwithstanding, communication remains integral to the success of surgical teams. Yet there are limited published curricula that address trauma inpatient communication needs. Observations at our institution confirmed that the surgical team lacked a shared mental model for communication. We hypothesized that creating a relationship-centered rounding conceptual framework model would enhance the provider-patient experience.A mixed-methods approach was used for this study. A multi-pronged needs assessment was conducted. Provider communion items for Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to measure patients' expressed needs. Faculty with experience in relationship-centered communication observed morning rounds and documented demonstrated behaviors. A five-hour workshop was designed based on the identified needs. A pre-and post-course Assessment and course evaluation were conducted. Provider-related patient satisfaction items were measured six months before the course and six months after the workshop.Needs assessment revealed a lack of a shared communication framework and a lack of leadership skills for senior trauma residents. Barriers included: time constraints, patient load, and interruptions during rounds. The curriculum was very well received. The self-reflected behaviors that demonstrated the most dramatic change between the pre and post-workshop surveys were: I listened without interrupting; I spoke clearly and at a moderate pace; I repeated key points; and I checked that the patient understood. All these changed from being performed by 50% of respondents "about half of the time" to 100% of them "always". Press Ganey top box likelihood to recommend (LTR) and provider-related top box items showed a trend towards improvement after implementing the training with a percentage difference of up to 20%.The Inpatient Relationship Centered Communication Curriculum (I-RCCC) targeting senior residents and Nurse Practitioners (NP) was feasible, practical, and well-received by participants. There was a trend of an increase in LTRs and provider-specific patient satisfaction items. This curriculum will be refined based on the study results and potentially scalable to other surgical specialties.

    View details for DOI 10.1186/s12909-023-04105-7

    View details for PubMedID 36859253

  • The Program Director Perspective: Perceptions of PGY5 Residents' Operative Self-Efficacy and Entrustment AMERICAN SURGEON Jensen, R. M., Kearse, L. E., Anand, A., Dent, D. L., Korndorffer, J. R. 2023: 31348231157862


    A 2020 survey of post-graduate year 5 (PGY5) general surgery residents linked to the American Board of Surgery In-Training Examination (ABSITE) revealed significant deficits in self-efficacy (SE), or personal judgment of one's ability to complete a task, for 10 commonly performed operations. Identifying whether this deficit is similarly perceived by program directors (PDs) has not been well established. We hypothesized that PDs would perceive higher levels of operative SE compared to PGY5s.A survey was distributed through the Association of Program Directors in Surgery listserv; PDs were queried about their PGY5 residents' ability to perform the same 10 operations independently and their accuracy of patient assessments and operative plans for components of several core entrustable professional activities (EPAs). Results of this survey were compared to PGY5 residents' perception of their SE and entrustment based on the 2020 post-ABSITE survey. Chi-squared tests were used for statistical analysis.108 responses were received, representing ∼32% (108/342) of general surgery programs. Perceptions from PDs of PGY5 residents' operative SE were highly concordant with resident perceptions; no significant differences were observed for 9 of 10 procedures. Both PGY5 residents and PDs perceived adequate levels of entrustment; no significant differences were observed for 6 of 8 EPA components.These findings show concordance between PDs and PGY5 residents in their perceptions of operative SE and entrustment. Though both groups perceive adequate levels of entrustment, PDs corroborate the previously described operative SE deficit, illustrating the importance of improved preparation for independent practice.

    View details for DOI 10.1177/00031348231157862

    View details for Web of Science ID 000935997000001

    View details for PubMedID 36802912

  • The fundamentals of laparoscopic surgery in general surgery residency: fundamental for junior residents' self-efficacy. Surgical endoscopy Schmiederer, I. S., Kearse, L. E., Jensen, R. M., Anderson, T. N., Dent, D. L., Payne, D. H., Korndorffer, J. R. 2022


    BACKGROUND: Implementation of the Fundamentals of Laparoscopic Surgery (FLS) by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has served a need for educational structure for laparoscopic skill within General Surgery training since 2004. This study looks at how FLS affects resident self-efficacy (SE) with laparoscopic procedures.METHODS: We conducted a national survey, linked to the 2020 American Board of Surgery In-Training Examination (ABSITE), in which 9275 residents from 325 US General Surgery Training Programs participated. The online survey included multimodal questions that analyzed whether participants felt they could perform the most commonly-logged laparoscopic operationsamong residents [Laparoscopic Appendectomy (LA), Laparoscopic Cholecystectomy (LC), Laparoscopic Right Hemicolectomy (LRH), Diagnostic Laparoscopy (DL)] without faculty assistance. This used a 5-point scaled assessment, ranging from "not able to" to "definitely able to." Multivariate analyses determined if completion of FLS made a difference for resident self-efficacy, stratified by post-graduate year (PGY).RESULTS: At the time of the survey, 2300 reported completion of FLS. The percentage of FLS completion increased from PGY1 to PGY5 (4.2% n=59 vs 85.8% n=893). PGY1 residents who completed FLS, from 48 diverse institutions, demonstrated the most significant increases in SE (p<0.05) with significantly higher perceived self-efficacy in LA (p=0.001) and LRH (p=0.012). PGY2 and PGY3 residents indicated increased SE in DL (p=0.037, p=0.015, respectively), based on FLS completion. These FLS effects were less evident in the more senior classes.CONCLUSIONS: Completion of FLS arguably has the greatest benefits for more junior residents, as it establishes a foundation of laparoscopic knowledge and skill, upon which further residency training can build. Successful completion of the curriculum and assessment offered by the Fundamentals of Laparoscopic Surgery leads to greater sense of ability in early trainees.

    View details for DOI 10.1007/s00464-022-09443-z

    View details for PubMedID 36109359

  • Validity Evidence for ENTRUST as an Assessment of Surgical Decision-Making for the Inguinal Hernia Entrustable Professional Activity (EPA). Journal of surgical education Liebert, C. A., Melcer, E. F., Keehl, O., Eddington, H., Trickey, A. W., Lee, M., Tsai, J., Camacho, F., Merrell, S. B., Korndorffer, J. R., Lin, D. T. 2022


    OBJECTIVE: As the American Board of Surgery (ABS) moves toward implementation of Entrustable Professional Activities (EPAs), there is a growing need for objective evaluation of readiness for entrustment of residents. This requires not only assessment of technical skills and knowledge, but also surgical decision-making in preoperative, intraoperative, and postoperative settings. We developed and piloted an Inguinal Hernia EPA Assessment on ENTRUST, a serious game-based online virtual patient simulation platform to assess trainees' decision-making competence.DESIGN: This is a prospective analysis of resident performance on the ENTRUST Inguinal Hernia EPA Assessment using bivariate analyses.SETTING: This study was conducted at an academic institution in a proctored exam setting.PARTICIPANTS: Forty-three surgical residents completed the ENTRUST Inguinal Hernia EPA Assessment.RESULTS: Four case scenarios for the Inguinal Hernia EPA and corresponding scoring algorithms were iteratively developed by expert consensus aligned with ABS EPA descriptions and functions. ENTRUST Inguinal Hernia Grand Total Score was positively correlated with PGY-level (p < 0.0001). Preoperative, Intraoperative, and Postoperative Total Scores were also positively correlated with PGY-level (p = 0.001, p = 0.006, and p = 0.038, respectively). Total Case Scores were positively correlated with PGY-level for cases representing elective unilateral inguinal hernia (p = 0.0004), strangulated inguinal hernia (p < 0.0001), and elective bilateral inguinal hernia (p = 0.0003). Preoperative Sub-Scores were positively correlated with PGY-level for all cases (p < 0.01). Intraoperative Sub-Scores were positively correlated with PGY-level for strangulated inguinal hernia and bilateral inguinal hernia (p = 0.0007 and p = 0.0002, respectively). Grand Total Score and Intraoperative Sub-Score were correlated with prior operative experience (p < 0.0001). Prior video game experience did not correlate with performance on ENTRUST (p = 0.56).CONCLUSIONS: Performance on the ENTRUST Inguinal Hernia EPA Assessment was positively correlated to PGY-level and prior inguinal hernia operative performance, providing initial validity evidence for its use as an objective assessment for surgical decision-making. The ENTRUST platform holds potential as tool for assessment of ABS EPAs in surgical residency programs.

    View details for DOI 10.1016/j.jsurg.2022.07.008

    View details for PubMedID 35909070

  • Do Individual Surgeon Preferences Affect Procedural Outcomes? Annals of surgery Mohamadipanah, H., Perumalla, C. A., Kearse, L. E., Yang, S., Wise, B. J., Goll, C. K., Witt, A. K., Korndorffer, J. R., Pugh, C. M. 2022


    OBJECTIVES: Surgeon preferences such as instrument and suture selection and idiosyncratic approaches to individual procedure steps have been largely viewed as minor differences in the surgical workflow. We hypothesized that idiosyncratic approaches could be quantified and shown to have measurable effects on procedural outcomes.METHODS: At the ACS Clinical Congress, experienced surgeons volunteered to wear motion tracking sensors and be videotaped while evaluating a loop of porcine intestines to identify and repair two pre-configured, standardized enterotomies. Video annotation was used to identify individual surgeon preferences and motion data was used to quantify surgical actions. Chi-square analysis was used to determine whether surgical preferences were associated with procedure outcomes (bowel leak).RESULTS: Surgeons' (N=255) preferences were categorized into four technical decisions. Three out of the four technical decisions (repaired injuries together, double layer closure, corner-stitches versus no corner-stitches) played a significant role in outcomes, P<0.05. Running versus interrupted did not affect outcomes. Motion analysis revealed significant differences in average operative times (leak-6.67 min vs. no leak-8.88 min, P=0.0004) and work effort (leak-path length=36.86cm vs. no leak-path length=49.99cm, P=0.001). Surgeons who took the riskiest path but did not leak had better bimanual dexterity (leak=0.21/1.0 vs. no leak=0.33/1.0, P=0.047) and placed more sutures during the repair (leak=4.69 sutures vs. no leak=6.09 sutures, P=0.03).CONCLUSION: Our results show that individual preferences affect technical decisions and play a significant role in procedural outcomes. Future analysis in more complex procedures may make major contributions to our understanding of contributors to procedure outcomes.

    View details for DOI 10.1097/SLA.0000000000005595

    View details for PubMedID 35861074

  • EQIP's First Year: A Step Closer to Higher Quality in Surgical Education. Journal of surgical education Joshi, A. R., Nfonsam, V., Relles, D. M., Murphy, S., Ciolkosz, J., Fise, T., Klingensmith, M. E., Hickey, M., Brunsvold, M. E., Korndorffer, J. R., Jarman, B. T., Smink, D. S., Terhune, K., Kmiec, K., Harrington, D. T. 2022


    To describe the first year of the Educational Quality Improvement Program (EQIP) DESIGN: The Educational Quality Improvement Program (EQIP) was formed by the Association of Program Directors in Surgery (APDS) in 2018 as a continuous educational quality improvement program. Over 18 months, thirteen discrete goals for the establishment of EQIP were refined and executed through a collaborative effort involving leaders in surgical education. Alpha and beta pilots were conducted to refine the data queries and collection processes. A highly-secure, doubly-deidentified database was created for the ingestion of resident and program data.36 surgical training programs with 1264 trainees and 1500 faculty members were included in the dataset. 51,516 ERAS applications to programs were also included. Uni- and multi-variable analysis was then conducted.EQIP was successfully deployed within the timeline described in 2020. Data from the ACGME, ABS, and ERAS were merged with manually entered data by programs and successfully ingested into the EQIP database. Interactive dashboards have been constructed for use by programs to compare to the national cohort. Risk-adjusted multivariable analysis suggests that increased time in a technical skills lab was associated with increased success on the ABS's Qualifying Examination, alone. Increased time in a technical skills lab and the presence of a formal teaching curriculum were associated with increased success on both the ABS's Qualifying and Certifying Examination. Program type may be of some consequence in predicting success on the Qualifying Examination.The APDS has proved the concept that a highly secure database for the purpose of continuous risk-adjusted quality improvement in surgical education can be successfully deployed. EQIP will continue to improve and hopes to include an increasing number of programs as the barriers to participation are overcome.

    View details for DOI 10.1016/j.jsurg.2022.05.018

    View details for PubMedID 35842405

  • Developing a multi-departmental residency communication coaching program. Education for health (Abingdon, England) Nassar, A. K., Sasnal, M., Miller-Kuhlmann, R. K., Jensen, R. M., Blankenburg, R. L., Rassbach, C. E., Smith-Bentley, M., Vyas, A., Korndorffer, J. R., Gold, C. A. 2022; 35 (3): 98-104


    Local needs assessments in our institution's surgery and neurology residency programs identified barriers to effective communication, such as no shared communication framework and limited feedback on nontechnical clinical skills. Residents identified faculty-led coaching as a desired educational intervention to improve communication skills. Three university departments (Surgery, Neurology, and Pediatrics) and health-care system leaders collaborated closely to develop an innovative communication coaching initiative generalizable to other residency programs.Coaching program development involved several layers of collaboration between health-care system leaders, faculty educators, and departmental communication champions. The efforts included: (1) creating and delivering communication skills training to faculty and residents; (2) hosting frequent meetings among various stakeholders to develop program strategy, discuss opportunities and learnings, and engage other medical educators interested in coaching; (3) obtaining funding to implement the coaching initiative; (4) selecting coaches and providing salary and training support.A multi-phased mixed-methods study utilized online surveys and virtual semi-structured interviews to assess the program's quality and impact on the communication culture and the satisfaction and communication skills of residents. Quantitative and qualitative data have been integrated during data collection and analysis using embedding, building, and merging strategies.Establishing a multi-departmental coaching program may be feasible and can be adapted by other programs if similar resources and focus are present. We found that stakeholders' buy-in, financial support, protected faculty time, flexible approach, and rigorous evaluation are crucial factors in successfully implementing and sustaining such an initiative.

    View details for DOI 10.4103/efh.efh_357_22

    View details for PubMedID 37313890

  • Artificial intelligence in surgery: A research team perspective. Current problems in surgery Mohamadipanah, H., Perumalla, C., Yang, S., Wise, B., Kearse, L., Goll, C., Witt, A., Korndorffer, J. R., Pugh, C. 2022; 59 (6): 101125

    View details for DOI 10.1016/j.cpsurg.2022.101125

    View details for PubMedID 35690434

  • In Brief. Current problems in surgery Mohamadipanah, H., Perumalla, C., Yang, S., Wise, B., Kearse, L., Goll, C., Witt, A., Korndorffer, J. R., Pugh, C. 2022; 59 (6): 101127

    View details for DOI 10.1016/j.cpsurg.2022.101127

    View details for PubMedID 35690433

  • The APDS General Surgery Education Quality Improvement Program (EQIP). Journal of surgical education Brunsvold, M. E., Fise, T. F., Hickey, M., Jarman, B. T., Joshi, A. R., Klingensmith, M. E., Korndorffer, J. R., Nfonsam, V. N., Relles, D. M., Smink, D. S., Harrington, D. T. 2022


    BACKGROUND: Although the ACGME has called for outcomes-based evaluation of residency programs, few metrics or benchmarks exist connecting educational processes with resident educational outcomes. To address this deficiency, a national Education Quality Improvement Program (EQIP) for General Surgery training is proposed.METHODS: We describe the initial efforts to create this platform. In addition, a national survey was administered to 330 Program Directors to assess their interest in and concerns about a continuous educational quality improvement project.RESULTS: We demonstrate that through a collaborative process and the support of the Association of Program Directors in Surgery (APDS), we were able to develop the groundwork for a national surgical educational improvement project, now called EQIP. The survey response rate was 45.8% (152 of 332 programs) representing a mix of university (55.3%), university-affiliated (18.4%), independent (24.3%), and military (2.0%) programs. Most respondents (66.2%) had not previously heard of EQIP. Most respondents (69.7%) believe that educational outcomes can be measured. The majority of respondents indicated they believed EQIP could be successful (57%). Only 2.3% thought EQIP would not be successful. Almost all programs (98.7%) expressed a willingness to participate, although 19.1% did not believe that they had adequate resources to participate.CONCLUSION: The APDS EQIP platform holds promise as a useful and achievable method to obtain educational outcomes data. These data can be used as a basis for continuous surgical educational quality improvement. General Surgery Program Directors have expressed enthusiasm for EQIP and are willing to participate in the program examining outcomes of General Surgery training programs, with an ultimate goal of improving overall residency training.

    View details for DOI 10.1016/j.jsurg.2022.02.010

    View details for PubMedID 35365435

  • Diversity, equity, and inclusion in presidential leadership of academic medical and surgical societies. American journal of surgery Kearse, L. E., Goll, C. K., Jensen, R. M., Wise, B. J., Witt, A. K., Huemer, K., Korndorffer, J. R., Pugh, C. M. 2022


    BACKGROUND: Our aim was to identify gender and racial disparities in presidential leadership for national medical and surgical organizations.METHODS: We located publicly sourced information on national medical organizations. Years between or since the first diverse presidents were analyzed using descriptive statistics and Mann Whitney U tests.RESULTS: Sixty-seven national medical and surgical organizations were surveyed. 70.8% (n=34) diversified via gender first (White-female), whereas 26.1% (n=14) had racial diversity first. Organizations with gender diversity first followed with an African American male president sooner than organizations who first diversified by race (14.7±11.8 v. 27.6±11.3 years, p=0.018). No significant difference was observed for the third tier of diversification.CONCLUSIONS: Significant gender and racial leadership disparities in national medical organizations are still present. It is notable that organizations with female leaders had a shorter timeline to racial diversity. These findings help to inform strategies to promote and increase diversity, equity, and inclusion in national leadership.

    View details for DOI 10.1016/j.amjsurg.2022.03.028

    View details for PubMedID 35369971

  • Surgical endoscopy education research: how are we doing? Surgical endoscopy Anderson, T. N., Kearse, L. E., Shi, R., Kaba, A., Schmiederer, I. S., Huffman, E. M., Ritter, E. M., Korndorffer, J. R. 2022


    BACKGROUND: Surgical endoscopy (SE), the official journal of the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association for Endoscopic Surgery, is an important source of new evidence pertaining to surgical education in the field. However, qualitative deficiencies in medical education research have prompted medical education leaders to advocate for increased methodological rigor. The purpose of this study is to review the quality of education-focused research published through SE.METHODS: A PubMed search examining all SE articles categorized as education-related research from 2010 to 2019 was conducted; studies not meeting inclusion criteria were excluded. Remaining publications were independently reviewed, classified, and scored by 7 raters using the medical education research study quality instrument (MERSQI). Intraclass correlation was calculated and data were examined with descriptive statistics.RESULTS: A total of 227 studies met inclusion criteria. There was no significant difference in number of publications by year (average 25.88 [SD 5.6]); 60% were conducted outside of the United States, and 47% (n=106) were funded. The average MERSQI was 12.5 (SD 2). Most studies used two-group non-random (42%, n=96) or post/cross-sectional designs (29%, n=65). Thirty-six (16%) were randomized controlled trials. Multi-institutional studies comprised 24% (n=54). Of the manuscripts, 96% (n=217) reported at least one measure of validity evidence and 28% (n=67) described three levels of validity evidence. Studies primarily reported changes in skills or knowledge (45%, n=103) or satisfaction or general facts (44%, n=99), while patient-related outcomes encompassed 3% (n=6) of studies. ICC between raters was 0.93 (CI 0.90-0.93, p<0.001).CONCLUSIONS: Based on publications to date, this journal's peer review process appears to facilitate the dissemination of education-related studies of moderate to good quality. However, there were uncovered deficits, ranging from validity evidence to study designs and level of outcomes. This journal's breadth of viewership offers a potential venue to advance education-related research.

    View details for DOI 10.1007/s00464-022-09104-1

    View details for PubMedID 35194666

  • Developing a longitudinal database of surgical skills performance for practicing surgeons: A formal feasibility and acceptance inquiry. American journal of surgery Applewhite, M. K., Kearse, L. E., Mohamadipanah, H., Witt, A., Goll, C., Wise, B., Korndorffer, J. R., Pugh, C. M. 1800


    BACKGROUND: We explored the feasibility and surgeons' perceptions of the utility of a longitudinal skills performance database.METHODS: A 10-station surgical skills assessment center was established at a national scientific meeting. Skills assessment volunteers (n=189) completed a survey including opinions on practicing surgeons' skills evaluation, ethics, and interest in a longitudinal database. A subset (n=23) participated in a survey-related interview.RESULTS: Nearly all participants reported interest in a longitudinal database and most believed there is an ethical obligation for such assessments to protect the public. Several interviewees specified a critical role for both formal and informal evaluation is to first create a safe and supportive environment.CONCLUSIONS: Participants support the construction of longitudinal skills databases that allow information sharing and establishment of professional standards. In a constructive environment, structured peer feedback was deemed acceptable to enhance and diversify surgeon skills. Large scale skills testing is feasible and scientific meetings may be the ideal location.

    View details for DOI 10.1016/j.amjsurg.2021.12.035

    View details for PubMedID 34998521

  • Individual and Institutional Factors Associated with PGY5 General Surgery Resident Self-Efficacy: A National Survey. Journal of the American College of Surgeons Kearse, L. E., Schmiederer, I. S., Dent, D. L., Anderson, T. N., Payne, D. H., Jensen, R., Trickey, A. W., Ding, Q., Korndorffer, J. R. 2022; 234 (4): 514-520


    Variability in post-graduate year 5 (PGY5) residents' operative self-efficacy exists; yet the causes of variability have not been explored. Our study aims to determine resident-related and program-dependent factors associated with residents' perceptions of self-efficacy.Following the 2020 American Board of Surgery In-Training Examination, a national survey of self-efficacy in 10 of the most commonly performed Accreditation Council for Graduate Medical Education case-log procedures was completed.A total of 1,145 PGY5 residents completed the survey (response rate 83.8%), representing 296 surgical residency programs. Female sex (odds ratio [OR] 0.46 to 0.67; 95% CI 0.30 to 0.95; p < 0.05) was associated with decreased self-efficacy for 6 procedures. Residents from institutions with emphasis on autonomy were more likely to report higher self-efficacy for 8 of 10 procedures (OR 1.39 to 3.03; 95% CI 1.03 to 4.51; p < 0.05). In addition, increased socialization among residents and faculty also correlated with increased self-efficacy in 3 of 10 procedures (OR 1.41 to 2.37; 95% CI 1.03 to 4.69; p < 0.05). Procedures performed with higher levels of resident responsibility, based on Graduated Levels of Resident Responsibility (GLRR) and Teaching Assistant (TA) scores, were correlated with higher self-efficacy (p < 0.001).Ensuring that residents receive ample opportunities for GLRR and TA experiences, while implementing programmatic support for resident-dependent factors, may be crucial for building self-efficacy in PGY5 residents. Institutional support of resident "autonomy" and increasing methods of socialization may provide a means of building trust and improving perceptions of self-efficacy. In addition, reevaluating institutional policies that limit opportunities for graduated levels of responsibility, while maintaining patient safety, may lead to increased self-efficacy.

    View details for DOI 10.1097/XCS.0000000000000090

    View details for PubMedID 35290270

  • Response to the Comments on "Situating Artificial Intelligence in Surgery, a Focus on Disease Severity'' Reply ANNALS OF SURGERY Pugh, C. M., Wolf, T., Korndorffer, J. R. 2021; 274 (6): E892-E893
  • Diversity, Equity, and Inclusion: A Current Analysis of General Surgery Residency Programs. The American surgeon Kearse, L. E., Jensen, R. M., Schmiederer, I. S., Zeineddin, A., Anderson, T. N., Dent, D. L., Payne, D. H., Korndorffer, J. R. 2021: 31348211048824


    BACKGROUND: Local, regional, and national diversity, equity, and inclusion (DEI) initiatives have been established to combat barriers to entry and promote retention in surgery residency programs. Our study evaluates changes in diversity in general surgery residency programs. We hypothesize that diversity trends have remained stable nationally and regionally.MATERIALS AND METHODS: General surgery residents in all postgraduate years were queried regarding their self-reported sex, race, and ethnicity following the 2020 ABSITE. Residents were then grouped into geographic regions. Data were analyzed utilizing descriptive statistics, Kruskal-Wallis test, and chi-square analyses.RESULTS: A total of 9276 residents responded. Nationally, increases in female residents were noted from 38.0 to 46.0% (P < .001) and in Hispanic or Latinx residents from 7.3 to 8.3% (P = .031). Across geographic regions, a significant increase in female residents was noted in the Northwest (51.9 to 58.3%, P = .039), Midwest (36.9 to 43.3%, P = .006), and Southwest (35.8 to 47.5%, P = .027). A significant increase in black residents was only noted in the Northwest (0 to 15.8%, P = .031). The proportion of white residents decreased nationally by 8.9% and in the Mid-Atlantic, Southeast, and Southwest between 5.5 and 15.9% (P < .05).DISCUSSION: In an increasingly diverse society, expanding the numbers of underrepresented surgeons in training, and ultimately in practice, is a necessity. This study shows that there are region-specific increases in diversity, despite minimal change on a national level. This finding may suggest the need for region-specific DEI strategies and initiatives. Future studies will seek to evaluate individual programs with DEI plans and determine if there is a correlation to changing demographics.

    View details for DOI 10.1177/00031348211048824

    View details for PubMedID 34730421

  • ENTRUST: A Serious Game-Based Virtual Patient Platform to Assess Entrustable Professional Activities in Surgical Education Liebert, C. A., Lin, D. T., Melcer, E. F., Keehl, O. G., Trickey, A., Eddington, H., Merrell, S., Korndorffer, J. R. ELSEVIER SCIENCE INC. 2021: S224
  • American Board of Surgery Entrustable Professional Activities (EPAs): Assessing Graduating Residents' Perception of Preoperative Entrustment. Journal of surgical education Kearse, L. E., Schmiederer, I. S., Anderson, T. N., Dent, D. L., Payne, D. H., Korndorffer, J. R. 2021


    OBJECTIVE: To determine if graduating surgical residents are achieving entrustment of surgical entrustable professional activities (EPAs). We hypothesize that postgraduate year 5 (PGY5) residents are achieving evaluation and management entrustment in the selected EPAs.DESIGN: In January 2020, surgical residents completed a survey following the American Board of Surgery In-Training Examination (ABSITE) to measure their levels of entrustment in 4 of the 5 ABS-selected EPAs. A Resident Entrustability Index (REI) score was developed to ascertain PGY5 residents' levels of entrustment (range 1-5). Residents indicated how often their assessments and operative plans were modified in the prior 6 months for each EPA (1=Always, 2=Frequently, 3=Occasionally, 4=Rarely, 5=Never). An independent clinical decision-making score (ICDM) was developed with subsequent evaluation of its relationships to intrinsic, resident-related and extrinsic, program-dependent factors.SETTING: A national post-ABSITE survey.PARTICIPANTS: All general surgery residents participating in ABSITE were invited to participate. Of the 1367 PGY5 residents that completed the survey, 1049 residents (76.7%) responded to the surgical EPA items.RESULTS: Residents achieved an average REI of 4, indicating rare modification of assessments and operative plans for the 4 EPAs assessed. Complete entrustment was reported for inguinal hernias and penetrating abdominal trauma (Median REI = 5, IQR 4, 5) indicating assessments and operative plans were never modified. Lack of entrustment (REI ≤3) was reported by a minority of residents (ranging from 8.6% for operative plan of right lower quadrant pathology to 12.8% for operative plan of blunt abdominal trauma). Significant resident-related and program-dependent factors associated with achievement of expected ICDM was socializing with a co-resident (p = 0.001), while training in one's hometown (p < 0.001) and policies that mandate attendings be scrubbed in (p = 0.022) were associated with decreased achievement of expected ICDM. Overall, 89.2% and 90.3% of PGY5 residents are attaining appropriate levels of entrustment and ICDM abilities, respectively, within 6 months of graduating.CONCLUSIONS: Of the EPAs evaluated, PGY5 residents are achieving appropriate levels of entrustment in evaluation and management. Although this is the case for a vast majority of PGY5 residents, there is still work to be done to ensure that all PGY5 residents are attaining entrustment prior to graduation. Our study also provides content validity for the surgical EPAs in assessing levels of entrustment in PGY5 residents.

    View details for DOI 10.1016/j.jsurg.2021.09.004

    View details for PubMedID 34602378

  • Validity Evidence for Vascular Skills Assessment: The Feasibility of Fundamentals of Vascular Surgery in General Surgery Residency. Journal of surgical education Schmiederer, I. S., Kearse, L. E., Korndorffer, J. R., Lee, E., Sgroi, M. D., Lee, J. T. 2021


    OBJECTIVE: As the Fundamentals of Laparoscopic Surgery (FLS) and Fundamentals of Endoscopic Surgery (FES) have been used for general surgery assessment, the Fundamentals of Vascular Surgery (FVS) has recently been developed to evaluate core operative skills for vascular trainees. This study examines the 3 year implementation of FVS for general surgery residents and it gathers validity evidence using Messick's framework. We hypothesized that the curriculum and assessment tool enhance general surgery resident training and assessment.DESIGN: This is a retrospective review of FVS assessments of residents using descriptive and multivariate analyses.SETTING: This study was conducted at an academic institution, where simulation-based teaching sessions occur in coordination between the general surgery and the integrated vascular surgery residency programs.PARTICIPANTS: Seventeen general surgery residents were assessed in FVS skills by an expert rater from 2018 to 2020.RESULTS: Overall, 86 assessments were completed.CONTENT: Assessment focuses on 3 open vascular skills (End-to-Side Anastomosis, Patch Angioplasty and Clockface Suturing). Response Process: 7 items comprise a graded rating for a skills score. Additionally, a global summary score is designated. Internal Structure: The assessment tool has a Cronbach's alpha of 0.87, demonstrating good internal consistency. Addition of the second rater correlated with Cohen's kappa -0.69 (p < 0.001), indicating poor interrater reliability. Relationships to other variables: The most significant improvement occurred in total scores between PGY2s (17.4 ± 2.37) and PGY4s (23.2 ± 3.00), p < 0.001, indicating adequate level discernment.CONCLUSIONS: The validity evidence of FVS assessment in this study supports its use in general surgery residency at a time when opportunities for open vascular skills assessment may be decreasing due to case availability and shifting paradigms. Further study into quality rater training is needed to optimize national implementation of FVS and ensure consistency in grading.

    View details for DOI 10.1016/j.jsurg.2021.07.009

    View details for PubMedID 34446383

  • Defining the need for faculty development in assessment. American journal of surgery Steinemann, S., Korndorffer, J. J., Dent, D., Rucinski, J., Newman, R. W., Blair, P., Lupi, L. K., Sachdeva, A. K. 2021


    BACKGROUND: High-quality workplace-based assessments are essential for competency-based surgical education. We explored education leaders' perceptions regarding faculty competence in assessment.METHODS: Surgical education leaders were surveyed regarding which areas faculty needed improvement, and knowledge of assessment tools. Respondents were queried on specific skills regarding (a)importance in resident/medical student education (b)competence of faculty in assessment and feedback.RESULTS: Surveys (n=636) were emailed, 103 responded most faculty needed improvement in: verbal (86%) and written (83%) feedback, assessing operative skill (49%) and preparation for procedures (50%). Cholecystectomy, trauma laparotomy, inguinal herniorrhaphy were "very-extremely important" in resident education (99%), but 21-24% thought faculty "moderately to not-at-all" competent in assessment. This gap was larger for non-technical skills. Regarding assessment tools, 56% used OSATS, 49% Zwisch; most were unfamiliar with all non-technical tools.SUMMARY: These data demonstrate a significant perceived gap in competence of faculty in assessment and feedback, and unfamiliarity with assessment tools. This can inform faculty development to support competency-based surgical education.

    View details for DOI 10.1016/j.amjsurg.2021.06.010

    View details for PubMedID 34226039

  • A 20-year review of surgical training case logs: Is general surgery still general? Surgery Kearse, L. E., Zeineddin, A., Schmiederer, I. S., Korndorffer, J. R., Lau, J. N. 2021


    BACKGROUND: Surgical training has undergone many facets of restructuring over the most recent decades, with critiques of the quality and variability of training as well as the competency of recent graduates. This study examines the changes in surgical training in operative volume and breadth in the past 2 decades.METHODS: The Accreditation Council for Graduate Medical Education Case Log Statistics Reports from 1999 to 2019 were reviewed. Case logs were grouped into defined case categories and group levels of postgraduate training. Descriptive analyses and multiple linear regressions were performed.RESULTS: General surgery residents are graduating with 10.7% more cases, owing to increases in mostly junior year cases (P < .001). The breadth of specialty cases has decreased, while there was an increase in alimentary and abdominal cases to 58.4% from 47.2% 20 years ago. A decrease in vascular surgery cases from 19.9% to 10.7% of all cases was noted. Analysis of the distribution of defined categories showed right skewness in many categories with mode being much lower than reported mean.CONCLUSION: Evaluation of trends, despite residents graduating with higher case volume than the minimum required, shows that the breadth and variety of cases has narrowed significantly in the past 20 years, providing a case for general surgery training restructuring.

    View details for DOI 10.1016/j.surg.2021.03.062

    View details for PubMedID 33975730

  • Peer Assessment in Medical Student Education: A Study of Feasibility, Benefit, and Worth. The American surgeon DuCoin, C., Zuercher, H., McChesney, S. L., Korndorffer, J. R. 2021: 31348211011096


    BACKGROUND: Direct experience with medical procedures is an important component of medical school training, yet opportunities for medical students have dwindled for various reasons. To offset this, simulated procedures are being integrated into training. However, this comes with additional time commitments required of teaching surgeons regarding assessment of simulation. A solution to this could be peer assessment. We hypothesize that there will be no significant difference between peer assessment when compared to that of a teaching surgeon.METHODS: Third-year medical students were shown 3 simulated procedures by teaching surgeon and provided a grading rubric. Student performances were independently graded by peer assessment and by teaching surgeons. All peer assessment grades and surgeon grades were compared.RESULTS: Four hundred fifty-nine medical students completed the simulation procedures. Comparisons between the teaching surgeons and peer assessment evaluations demonstrated a 99% interobserver agreement for pass-fail designation and 98% agreement for individual data points (kappa = .78). Survey results demonstrated a significant increase in confidence in performing the tested items and comfort with peer assessment.DISCUSSION: This analysis demonstrates that the inclusion of peer assessment within medical school is highly comparable to teaching surgeon assessments.

    View details for DOI 10.1177/00031348211011096

    View details for PubMedID 33870753

  • From Listening to Action: Academic Surgcial Departmental Response to Social Injustice Through Curricular Development. Annals of surgery Korndorffer, J. R., Wren, S. M., Pugh, C. M., Hawn, M. T. 2021


    OBJECTIVES: To describe the development and evaluation of a structured department wide cultural competency curriculum.SUMMARY BACKGROUND DATA: Despite numerous organizational policies and statements, social injustice and bias still exists. Our department committed to assist individuals of the entire department to develop foundational knowledge and skills to combat implicit bias and systemic racism through the creation of a cultural competency curriculum. The purpose of this manuscript is to detail our curriculum and the evaluation of its effectiveness.METHODS: Using a well-established curriculum development framework, a cultural competency curriculum was developed focusing on knowledge, skills and attitudes at the individual level, for all members of the department. The curriculum was implemented through six, hour-long sessions over a nine-week period. Effectiveness was assessed through a post curriculum survey.RESULTS: 20% of the respondents had experienced bias based on race, ethnicity or sexual orientation in the past 12 months while 30% had experienced bias based on gender. 71% independently explored related topics. The curriculum was overall well received and generally achieved the goals and objectives.CONCLUSIONS: Using a standard curriculum development framework, an effective department-wide cultural competency curriculum can be developed and implemented.

    View details for DOI 10.1097/SLA.0000000000004891

    View details for PubMedID 33856378

  • Defining the Deficit in US Surgical Training: The Trainee?s Perspective JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Anderson, T. N., Payne, D. H., Dent, D. L., Kearse, L. E., Schmiederer, I. S., Korndorffer, J. R. 2021; 232 (4): 623–27
  • Response to: Comments on "Situating Artificial Intelligence in Surgery, a Focus on Disease Severity". Annals of surgery Pugh, C. M., Wolf, T., Korndorffer, J. R. 2021

    View details for DOI 10.1097/SLA.0000000000004820

    View details for PubMedID 33630431

  • Isolating steps instead of learners: Use of deliberate practice and validity evidence in coronavirus disease (COVID)-era procedural assessment. Surgery Schmiederer, I. S., Kearse, L. E., Lin, D. T., Anderson, T. N., Lau, J. N., Korndorffer, J. R. 2021


    In surgical training, assessment tools based on strong validity evidence allow for standardized evaluation despite changing external circumstances. At a large academic institution, surgical interns undergo a multimodal curriculum for central line placement that uses a 31-item binary assessment at the start of each academic year. This study evaluated this practice within increased in-person learning restrictions. We hypothesized that external constraints would not affect resident performance nor assessment due to a robust curriculum and assessment checklist.From 2018 to 2020, 81 residents completed central line training and assessment. In 2020, this curriculum was modified to conform to in-person restrictions and social distancing guidelines. Resident score reports were analyzed using multivariate analyses to compare performance, objective scoring parameters, and subjective assessments among "precoronavirus disease" years (2018 and 2019) and 2020.There were no significant differences in average scores or objective pass rates over 3 years. Significant differences between 2020 and precoronavirus disease years occurred in subjective pass rates and in first-time success for 4 checklist items: patient positioning, draping, sterile ultrasound probe cover placement, and needle positioning before venipuncture.Modifications to procedural training within current restrictions did not adversely affect residents' overall performance. However, our data suggest that in 2020, expert trainers may not have ensured learner acquisition of automated procedural steps. Additionally, although 2020 raters could have been influenced by logistical barriers leading to more lenient grading, the assessment tool ensured training and assessment integrity.

    View details for DOI 10.1016/j.surg.2021.06.010

    View details for PubMedID 34272045

  • Impact of COVID-19 on presentation, management, and outcomes of acute care surgery for gallbladder disease and acute appendicitis. World journal of gastrointestinal surgery Farber, O. N., Gomez, G. I., Titan, A. L., Fisher, A. T., Puntasecca, C. J., Arana, V. T., Kempinsky, A., Wise, C. E., Bessoff, K. E., Hawn, M. T., Korndorffer, J. R., Forrester, J. D., Esquivel, M. M. 2021; 13 (8): 859-870


    The ongoing coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted both elective and acute medical care. Data from the early months suggest that acute care patient populations deferred presenting to the emergency department (ED), portending more severe disease at the time of presentation. Additionally, care for this patient population trended towards initial non-operative management.To examine the presentation, management, and outcomes of patients who developed gallbladder disease or appendicitis during the pandemic.A retrospective chart review of patients diagnosed with acute cholecystitis, symptomatic cholelithiasis, or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June, 2020 and in the same months of 2019. Patients were selected through a research repository using international classification of diseases (ICD)-9 and ICD-10 codes. Across both years, 313 patients were identified with either type of gallbladder disease, while 361 patients were identified with acute appendicitis. The primary outcome was overall incidence of disease. Secondary outcomes included presentation, management, complications, and 30-d re-presentation rates. Relationships between different variables were explored using Pearson's r correlation coefficient. Variables were compared using the Welch's t-Test, Chi-squared tests, and Fisher's exact test as appropriate.Patients with gallbladder disease and appendicitis both had more severe presentations in 2020. With respect to gallbladder disease, more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort [50% (80) vs 35% (53); P = 0.01]. Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores [mean (SD) 1.39 (0.56) vs 1.16 (0.44); P = 0.02]. With respect to appendicitis, more patients were diagnosed with a perforated appendix at presentation in 2020 [20% (36) vs 16% (29); P = 0.02] and a greater percentage were classified as emergent cases using the emergency severity index [63% (112) vs 13% (23); P < 0.001]. While a greater percentage of patients were admitted to the hospital for gallbladder disease in 2020 [65% (104) vs 50% (76); P = 0.02], no significant differences were observed in hospital admissions for patients with appendicitis. No significant differences were observed in length of hospital stay or operative rate for either group. However, for patients with appendicitis, 30-d re-presentation rates were significantly higher in 2020 [13% (23) vs 4% (8); P = 0.01].During the COVID-19 pandemic, patients presented with more severe gallbladder disease and appendicitis. These findings suggest that the pandemic has affected patients with acute surgical conditions.

    View details for DOI 10.4240/wjgs.v13.i8.859

    View details for PubMedID 34512909

    View details for PubMedCentralID PMC8394376

  • Editorial. Journal of surgical education Brasel, K. J., Korndorffer, J. R., Webb, T. P., Tseng, J., Smink, D. S. 2020

    View details for DOI 10.1016/j.jsurg.2020.08.032

    View details for PubMedID 33172800

  • Situating Artificial Intelligence in Surgery A Focus on Disease Severity ANNALS OF SURGERY Korndorffer, J. R., Hawn, M. T., Spain, D. A., Knowlton, L. M., Azagury, D. E., Nassar, A. K., Lau, J. N., Arnow, K. D., Trickey, A. W., Pugh, C. M. 2020; 272 (3): 523–28
  • The what? How? And who? Of video based assessment. American journal of surgery Pugh, C. M., Hashimoto, D. A., Korndorffer, J. R. 2020


    BACKGROUND: Currently, there is significant variability in the development, implementation and overarching goals of video review for assessment of surgical performance.METHODS: This paper evaluates the current methods in which video review is used for evaluation of surgical performance and identifies which processes are critical for successful, widespread implementation of video-based assessment.RESULTS: Despite the advances in video capture technology and growing interest in video-based assessment, there is a notable gap in the implementation and longitudinal use of formative and summative assessment using video.CONCLUSION: Validity, scalability and discoverability are current but removable barriers to video-based assessment.

    View details for DOI 10.1016/j.amjsurg.2020.06.027

    View details for PubMedID 32665080

  • Defining the Deficit in US Surgical Training: The Trainee's Perspective. Journal of the American College of Surgeons Anderson, T. N., Payne, D. H., Dent, D. L., Kearse, L. E., Schmiederer, I. S., Korndorffer, J. R. 2020


    Self-efficacy (SE) is the personal judgement of how well one can successfully complete a task. The goal of this study is to assess SE of PGY5 residents for common general surgery operations. We hypothesize there are deficits in SE of PGY5 residents, and SE of a given operation correlates with 1) experience performing the operation without attending assistance (independently) and/or 2) teaching the operation start-to-finish.A survey was linked to the 2020 ABSITE. From the ACGME case log's 15 most commonly performed surgeon-chief operations and AHRQ's 15 most common operations, 10 operations were selected. Residents evaluated their ability to perform these operations independently using a 5-point SE scale. Residents were asked if they had experience performing these operations independently and/or teaching the operation start-to-finish. Descriptive statistics and Pearson correlation were used to examine the relationship between SE and operative experience.1145 of 1367 (84%) PGY5 residents responded. Highest SE was in performing wide-local excision (90.24%) and the lowest in performing open thyroidectomy (19.58%) (Table 1). Eighty-eight (7.7%) reported SE in all procedures. Statistically significant positive correlations were identified between experience and SE for cases performed without assistance (r = 0.98, p<0.01) and cases taught (r = 0.91, p<0.01).With 5 months left in training, 92.3% of residents report deficits in preparation for practice as defined by SE to complete common procedures independently. Resident SE increased in direct relation to performed cases and cases taught.

    View details for DOI 10.1016/j.jamcollsurg.2020.11.029

    View details for PubMedID 33385569

  • Developing an Inpatient Relationship-Centered Communication Curriculum for Surgical Teams: Pilot Study Nassar, A., Weimer-Elder, B., Kline, M., Minthorn, C., Staudenmayer, K. L., Yang, R., Spain, D. A., Maggio, P., Korndorffer, J. R., Johnson, T. ELSEVIER SCIENCE INC. 2019: E48
  • Laparoscopic Parenchymal Sparing Hepatectomy: Feasibility, Efficacy, and Cumulative Sum Control Chart (CUSUM) Analysis of Laparoscopic Right Posterior Resection (LRP) to Laparoscopic Right Lobectomy (LRL) Raju, S., Flaris, A., Korndorffer, J. R., Buell, J. F., Slakey, D. P. ELSEVIER SCIENCE INC. 2019: E148
  • Decade in Surgical Education and Simulation Fellowship: A New Pathway for the Surgical Education Leader Anderson, T. N., Lee, E. W., Korndorffer, J. R., Hawn, M. T., Lau, J. N. ELSEVIER SCIENCE INC. 2019: S237–S238
  • A Surgical Team Simulation to Improve Teamwork and Communication across Two Continents: ViSIOT Proof-of-Concept Study JOURNAL OF SURGICAL EDUCATION Weldon, S., Korkiakangas, T., Calzada, J., Korndorffer, J. R., Kneebone, R. L. 2019; 76 (5): 1413–24
  • Tracking Surgical Education Survey Research Through the APDS Listserv. Journal of surgical education Anderson, T. N., Lee, E. W., Merrell, S. B., Korndorffer, J. R. 2019


    OBJECTIVE: Survey-based studies are cornerstones in medical education research. The Association of Program Directors in Surgery (APDS) listserv offers a method to contact program directors (PD) and residents for such research. To facilitate research beneficial to the APDS, improve the quality of survey-based research and minimize survey fatigue, the APDS research committee (ARC) developed a survey review process to grant access to the listserv for research. This study was conducted to determine the impact of the review process on the quality of survey-based research and eventual publication.DESIGN: This log was systematically reviewed identifying publications resulting from accepted surveys. Publications were categorically analyzed to determine the components of their survey tool methodology, response rate (RR), and medical education research study quality instrument (MERSQI) score.SETTING: The ARC used a 2-reviewer peer-review process for survey distribution requests. The request was either accepted, rejected, or returned for revision. Accepted surveys were distributed through the listserv with an ARC attestation of approval.PARTICIPANTS: A log of all survey requests maintained from 2014 to 2017 and subsequent publications.RESULTS: Thirty-five requests were accepted (40%), 30 were reviewed discovering 10 surveys that led to 12 publications (publication rate of 33%). The average RR was 60% (SD = 29%). Detailed explanations of survey development strategies were reported in 5 (42%), consisting of methods building validity evidence such as expert consensus, modified Delphi method, and pilot group sampling. Half of study participants were PD (50%). MERSQI scores averaged 10 (SD = 1.6).CONCLUSION: Based on those survey research published to date, the ARC survey peer-review process has enabled most accepted surveys to achieve adequate RR. Although the pool of accepted requests is small, it does highlight areas of improvement. With further refinement of the process, including questioning the survey development methods, the process and listserv can be a powerful tool for further research.

    View details for DOI 10.1016/j.jsurg.2019.07.006

    View details for PubMedID 31383613

  • A Surgeon Led Clinically Focused Anatomy Course Increases Student Selection of General Surgery As a Career JOURNAL OF SURGICAL EDUCATION Santini, A. G., Korndorffer, M. L., Barraza, M., Johnson, H. R., Kaplan, J. L., DuCoin, C. G., Satchell, E. K., Korndorffer Jr, J. R. 2019; 76 (3): 694–99
  • Best Practice for Implementation of the SCORE Portal in General Surgery Residency Training Programs. Journal of surgical education Joshi, A. R., Klingensmith, M. E., Malangoni, M. A., Delman, K. A., Korndorffer, J. R., Smink, D. S., Barrett, K. B., Hickey, M. 2018; 75 (6): e11-e16


    The Surgical Council on Resident Education (SCORE) has presented a workshop annually at the annual meeting of the Association of Program Directors (APDS) to discuss the evolution of the SCORE portal and best practices for implementation within residency training programs.A review of the literature was undertaken, along with a summation of discussion at these several workshops. A history of the SCORE project and a summary of its organizational framework and content are presented. In addition, best practices for use of SCORE within programs are described.The SCORE portal is now a decade old, and is used ubiquitously in US surgical training programs. With this experience, there is data to show the utility of SCORE to support trainee learning and programmatic didactics.

    View details for DOI 10.1016/j.jsurg.2018.04.014

    View details for PubMedID 29793808

  • How Much Are We Spending on Resident Selection? Journal of surgical education Gardner, A. K., Smink, D. S., Scott, B. G., Korndorffer, J. R., Harrington, D., Ritter, E. M. 2018


    INTRODUCTION: Rigorous selection processes are required to identify applicants who will be the best fit for training programs. This study provides a national snapshot of selection practices used within surgical residency programs and their associated financial costs.METHODS: A 17-item online survey was distributed to General Surgery Program Directors (PDs) via the Association of Program Directors in Surgery listserv. The survey examined program characteristics, applicant pool size, and interview day components of the prior match year. PD/coordinator teams also provided hard costs associated with interview day components, as well as time and effort estimations among program faculty, residents, and staff during the past interview season. Effort estimates were translated to dollar values via national salary data reports of hourly wages for faculty and annual wages for administrative staff and residents. Descriptive statistics and one-way analysis of variance via SPSS 24.0 were used to examine the data.RESULTS: One-hundred and twenty-eight responses were received, reflecting 48% (128/267) of programs in the 2017 match. Average hard costs (±SD) were $8053 ± 6467, covering food ($3753 ± 4042), social sessions ($3175 ± 3749), supplies ($329 ± 866), hotel ($328 ± 1381), room reservations ($120 ± 658), shuttle fees ($84 ± 403), tour guide fees ($50 ± 379), and other ($146 + 824). Costs for personnel effort was $77,601 ± 62,413 for faculty, $12,393 ± 33,518 for residents, $6447 ± 11,107 for coordinators, and $1294 ± 1943 for staff. Total average cost associated with the interview process (hard + effort) was $100,438±87,919, with university-based programs ($128,686 ± 101,565) spending significantly more than independent-university affiliated ($61,162 ± 33,945), independent ($74,793 ± 73,261), and military ($62,495 ± 38,532) programs (p < 0.01). Average cost for each residency program per position being filled was $18,648 ± 13,383, and average cost per interviewee was $1221 ± 894.CONCLUSIONS: In an era of declining resources for medical education, PDs must understand the time and effort associated with resident selection. These data reveal that residency programs are spending significant time and resources on the current selection process. Program leaders can use these data to assess their current selection strategies, review faculty and staff time allocation, and identify opportunities for making the process more efficient.

    View details for PubMedID 30366686

  • A Surgeon Led Clinically Focused Anatomy Course Increases Student Selection of General Surgery As a Career. Journal of surgical education Santini, A. G., Korndorffer, M. L., Barraza, M. J., Johnson, H. R., Kaplan, J. L., DuCoin, C. G., Satchell, E. K., Korndorffer, J. R. 2018


    OBJECTIVE: This study aims to identify program-specific critical factors in a student's path to general surgery and how different factors contribute to our high rate of matriculation.DESIGN: Semi-structured interviews were conducted focusing on critical factors in student's decision processes to pursue general surgery. Three investigators independently evaluated the transcripts and identified recurring themes based on phenomenological qualitative methods until saturation was achieved. Inter-rater reliability was determined.SETTING: The study took place at Tulane University School of Medicine, an academic medical center in New Orleans, Louisiana.PARTICIPANTS: Current fourth-year students from our medical school, applying into general surgery, were interviewed for the study.RESULTS: Twelve of 21 students were interviewed. The most common factor cited was the positive effect of clinically based anatomy and of having surgeons in anatomy (81%). Other factors mentioned included interest before medical school, clerkship experience, and mentor interactions; Kappa was 0.76 or higher for each theme.CONCLUSIONS: A clinically focused anatomy course led by surgeons at our institution has a significant impact on a general surgery career choice. With the constant evolution of the medical field, understanding what guides students toward a career in general surgery will better assist medical education planners in providing resources that will positively impact future classes.

    View details for PubMedID 30318298

  • The Change in Surgical Case Diversity Over the Past 15 Years and the Influence on the Pursuit of Surgical Fellowship Ducoin, C., Hahn, A., Baimas-George, M., Slakey, D. P., Korndorffer, J. R. SOUTHEASTERN SURGICAL CONGRESS. 2018: 1476–79


    The surgical community has expressed concern that residents do not receive the same caliber training as their predecessors and the increase in fellowships have been described as secondary to perceived lack of preparation. Yet, data show no change in total cases even after implementation of the 80-hour workweek. It is hypothesized that the increasing subspecialization of general surgery may decrease in certain resident case numbers. Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) General Surgery Case Logs National Data Report (1999-2014) of mean number of procedures per resident for 19 surgical categories. Statistical analysis was performed with analysis of variance over three time periods between 1999 and 2014. The number of total cases performed by residents has not changed significantly. There was a statistically significant difference observed in the variety of cases: vascular, esophageal, breast, and trauma cases decreased (P < 0.01), whereas major intestinal, hernia, liver, pancreatic, and biliary cases increased (P < 0.01). There are many reasons to pursue additional training after residency. The demonstrated change in case variability, presumably secondary to increasing fellowships, may play a significant role on training and preparation. Close monitoring of curriculums is essential to ensure a comprehensive general surgical education.

    View details for Web of Science ID 000445896600053

    View details for PubMedID 30268179

  • Preparing for the American Board of Surgery Flexible Endoscopy Curriculum: Development of multi-institutional proficiency-based training standards and pilot testing of a simulation-based mastery learning curriculum for the Endoscopy Training System AMERICAN JOURNAL OF SURGERY Franklin, B. R., Placek, S. B., Gardner, A. K., Korndorffer, J. R., Wagner, M. D., Pearl, J. P., Ritter, E. 2018; 216 (1): 167–73


    The Fundamentals of Endoscopic Surgery (FES) exam is required for American Board of Surgery certification. The purpose of this study was to develop performance standards for a simulation-based mastery learning (SBML) curriculum for the FES performance exam using the Endoscopy Training System (ETS).Experienced endoscopists from multiple institutions and specialties performed each ETS task (scope manipulation (SM), tool targeting (TT), retroflexion (RF), loop management (LM), and mucosal inspection (MI)) with scores used to develop performance standards for a SBML training curriculum. Trainees completed the curriculum to determine feasibility, and effect on FES performance.Task specific training standards were determined (SM-121sec, TT-243sec, RF-159sec, LM-261sec, MI-180-480sec, 7 polyps). Trainees required 29.5 ± 3.7 training trials over 2.75 ± 0.5 training sessions to complete the SBML curriculum. Despite high baseline FES performance, scores improved (pre 73.4 ± 7, post 78.1 ± 5.2; effect size = 0.76, p > 0.1), but this was not statistically discernable.This SBML curriculum was feasible and improved FES scores in a group of high performers. This curriculum should be applied to novice endoscopists to determine effectiveness for FES exam preparation.

    View details for PubMedID 28974312

  • The Economics of Private Practice versus Academia in Surgery. Journal of surgical education Baimas-George, M., Fleischer, B., Korndorffer, J. R., Slakey, D., DuCoin, C. 2018


    OBJECTIVE: Residents often make career decisions regarding future practice without adequate knowledge to the realities of professional life. Currently there is a paucity of data regarding economic differences between practice models. This study seeks to illuminate the financial differences of surgical subspecialties between academic and private practice.DESIGN: Data were collected from the Association of American Medical College (AAMC) and the Medical Group Management Association's (MGMA) 2015 reports of average annual salaries. Salaries were analyzed for general surgery and 7 subspecialties. Fixed time of practice was set at 30 years. Assumptions included 5 years as assistant professor, 10 years as associate professor, and 15 years as full professor. Formula used: (average yearly salary) * [years of practice (30 yrs - fellowship/research yrs)] + ($50,000 * yrs of fellowship/research) = total adjusted lifetime revenue.RESULTS: As a full professor, academic surgeons in all subspecialties make significantly less than their private practice counterparts. The largest discrepancy is in vascular and cardiothoracic surgery, with full professors earning 16% and 14% less than private practitioners. Plastic surgery and general surgery are the only 2 disciplines that have similar lifetime revenues to private practitioners, earning 2% and 6% less than their counterparts' lifetime revenue.CONCLUSIONS: Academic surgeons in all surgical subspecialties examined earn less lifetime revenue compared to those in private practice. This difference in earnings decreases but remains substantial as an academic surgeon advances. With limited exposure to the diversity of professional arenas, residents must be aware of this discrepancy.

    View details for PubMedID 29674107

  • Time crunch: increasing the efficiency of assessment of technical surgical skill via brief video clips Sawyer, J., Anton, N. E., Korndorffer, J. R., DuCoin, C. G., Stefanidis, D. MOSBY-ELSEVIER. 2018: 933–37


    Video review for assessment of surgical performance is gaining popularity but is time consuming for busy expert reviewers, making review delays inevitable. Decreasing review time and including nonexpert reviewers may facilitate more timely reviews. We hypothesized that a shorter duration video clip would not affect the quality of expert ratings compared with full-length review. A secondary aim was to examine the reliability between expert and novice raters and how it was affected by video clip duration.Videos of laparoscopic suturing performed on a live porcine model by premedical students, surgery residents, and fully trained surgeons were edited into 3 different durations: full, part, and 30-second versions. Video clips (n = 36) were reviewed by experienced surgeons (n = 3) and novice volunteers (n = 4) using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) assessment. Videos were assigned randomly during 3 review cycles held 1 week apart. Each cycle included 1 iteration of the 12 performance videos. We assessed the impact of the duration of the video on reviewer scores and inter-rater reliability.Variance in scores for 2 of 4 GOALS domains was dependent on the duration of the video clip (P < .05). Total GOALS scores were greater for part and 30-second clips compared with full clips (P < .05). Inter-rater reliability was greatest for full clips (intraclass correlation = 0.68) and decreased significantly for shorter clips.Our hypothesis was rejected as shorter video durations for surgical performance assessment led to inflated reviewer ratings both for expert and novice reviewers. Shortening duration of the video cannot be recommended for accurate performance assessment.

    View details for PubMedID 29373170

  • Learning preferences of surgery residents: a multi-institutional study Kim, R. H., Viscusi, R. K., Collier, A. N., Hunsinger, M. A., Shabahang, M. M., Fuhrman, G. M., Korndorffer, J. R. MOSBY-ELSEVIER. 2018: 901–5


    The VARK model categorizes learners by preferences for 4 modalities: visual, aural, read/write, and kinesthetic. Previous single-institution studies found that VARK preferences are associated with academic performance. This multi-institutional study was conducted to test the hypothesis that the VARK learning preferences of residents differ from the general population and that they are associated with performance on the American Board of Surgery In-Training Examination (ABSITE).The VARK inventory was administered to residents at 5 general surgery programs. The distribution of the VARK preferences of residents was compared with the general population. ABSITE results were analyzed for associations with VARK preferences. χ2, Analysis of variance, and multiple linear regression were used for statistical analysis.A total of 132 residents completed the VARK inventory. The distribution of the VARK preferences of residents was different than the general population (P < .001). The number of aural responses on the VARK inventory was an independent predictor of ABSITE percentile rank (P = .03), percent of questions correct (P = .01), and standard score (P = .01).This study represents the first multi-institutional study to examine VARK preferences among surgery residents. The distribution of preferences among residents was different than that of the general population. Residents with a greater number of aural responses on VARK had greater ABSITE scores. The VARK model may have potential to improve learning efficiency among residents.

    View details for PubMedID 29395237

  • The Economics of Academic Advancement Within Surgery JOURNAL OF SURGICAL EDUCATION Baimas-George, M., Fleischer, B., Korndorffer, J. R., Slakey, D., DuCoin, C. 2018; 75 (2): 299–303


    The success of an academic surgeon's career is often viewed as directly related to academic appointment; therefore, the sequence of promotion is a demanding, rigorous process. This paper seeks to define the financial implication of academic advancement across different surgical subspecialties.Data was collected from the Association of American Medical College's 2015 report of average annual salaries. Assumptions included 30 years of practice, 5 years as assistant professor, and 10 years as associate professor before advancement. The base formula used was: (average annual salary) × (years of practice [30 years - fellowship/research years]) + ($50,000 × years of fellowship/research) = total adjusted lifetime salary income.There was a significant increase in lifetime salary income with advancement from assistant to associate professor in all subspecialties when compared to an increase from associate to full professor. The greatest increase in income from assistant to associate professor was seen in transplant and cardiothoracic surgery (35% and 27%, respectively). Trauma surgery and surgical oncology had the smallest increases of 8% and 9%, respectively. With advancement to full professor, the increase in lifetime salary income was significantly less across all subspecialties, ranging from 1% in plastic surgery to 8% in pediatric surgery.When analyzing the economics of career advancement in academic surgery, there is a substantial financial benefit in lifetime income to becoming an associate professor in all fields; whereas, advancement to full professor is associated with a drastically reduced economic benefit.

    View details for PubMedID 28870711

  • Developing a robust suturing assessment: validity evidence for the intracorporeal suturing assessment tool Anton, N. E., Sawyer, J. M., Korndorffer, J. R., DuCoin, C. G., McRary, G., Timsina, L. R., Stefanidis, D. MOSBY-ELSEVIER. 2018: 560–64


    Assessment tools specific to intracorporeal suturing are lacking. The purpose of this study was to validate a novel Intracorporeal Suturing Assessment Tool (ISAT) by comparing it with existing measures that have been reported to have validity evidence.Videos of laparoscopic suturing were assessed by 3 blinded laparoscopic experts using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) scale and the ISAT. Correlations between these instruments were calculated, and sensitivity analyses compared both tools with objective suturing scores. A factor analysis was also performed.The ISAT and GOALS ratings were significantly correlated with the objective suturing score (r = 0.58 and 0.61, respectively; P < .0001), and with each other (r = 0.92, P < .0001). A weighted κ test indicated significantly higher agreement than expected between these instruments (P < .0001). All ISAT items had a factor loading approaching or greater than 0.50.The ISAT accurately assessed laparoscopic suturing skill related to other instruments. ISAT was highly correlated with GOALS, which is often used for laparoscopic performance assessment. Unlike the generic GOALS, ISAT includes specific information that can provide feedback on trainee suturing ability and targeted performance improvements. ISAT may provide a better alternative for intracorporeal suturing assessment.

    View details for PubMedID 29274941

  • Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam Ritter, E., Taylor, Z. A., Wolf, K. R., Franklin, B. R., Placek, S. B., Korndorffer, J. R., Gardner, A. K. SPRINGER. 2018: 413–20


    The fundamentals of endoscopic surgery (FES) program has considerable validity evidence for its use in measuring the knowledge, skills, and abilities required for competency in endoscopy. Beginning in 2018, the American Board of Surgery will require all candidates to have taken and passed the written and performance exams in the FES program. Recent work has shown that the current ACGME/ABS required case volume may not be enough to ensure trainees pass the FES skills exam. The aim of this study was to investigate the feasibility of a simulation-based mastery-learning curriculum delivered on a novel physical simulation platform to prepare trainees to pass the FES manual skills exam.The newly developed endoscopy training system (ETS) was used as the training platform. Seventeen PGY 1 (10) and PGY 2 (7) general surgery residents completed a pre-training assessment consisting of all 5 FES tasks on the GI Mentor II. Subjects then trained to previously determined expert performance benchmarks on each of 5 ETS tasks. Once training benchmarks were reached for all tasks, a post-training assessment was performed with all 5 FES tasks.Two subjects were lost to follow-up and never returned for training or post-training assessment. One additional subject failed to complete any portion of the curriculum, but did return for post-training assessment. The group had minimal endoscopy experience (median 0, range 0-67) and minimal prior simulation experience. Three trainees (17.6%) achieved a passing score on the pre-training FES assessment. Training consisted of an average of 48 ± 26 repetitions on the ETS platform distributed over 5.1 ± 2 training sessions. Seventy-one percent achieved proficiency on all 5 ETS tasks. There was dramatic improvement demonstrated on the mean post-training FES assessment when compared to pre-training (74.0 ± 8 vs. 50.4 ± 16, p < 0.0001, effect size = 2.4). The number of ETS tasks trained to proficiency correlated moderately with the score on the post-training assessment (r = 0.57, p = 0.028). Fourteen (100%) subjects who trained to proficiency on at least one ETS task passed the post-training FES manual skills exam.This simulation-based mastery learning curriculum using the ETS is feasible for training novices and allows for the acquisition of the technical skills required to pass the FES manual skills exam. This curriculum should be strongly considered by programs wishing to ensure that trainees are prepared for the FES exam.

    View details for PubMedID 28698900

  • SAGES University MASTERS Program: a structured curriculum for deliberate, lifelong learning (vol 31, pg 3061, 2017) SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Jones, D. B., Stefanidis, D., Korndorffer, J. R., Dimick, J. B., Jacob, B. P., Schultz, L., Scott, D. J. 2017; 31 (11): 4863

    View details for PubMedID 28799074

  • Is the Title worth the Cost? Economic Nuances of Academic Surgery Baimas-George, M. R., Fleischer, B., Korndorffer, J. R., Slakey, D. P., DuCoin, C. ELSEVIER SCIENCE INC. 2017: E89
  • Using Simulation to Improve Systems-Based Practices JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY Gardner, A. K., Johnston, M., Korndorffer, J. R., Haque, I., Paige, J. T. 2017; 43 (9): 484–91


    Ensuring the safe, effective management of patients requires efficient processes of care within a smoothly operating system in which highly reliable teams of talented, skilled health care providers are able to use the vast array of high-technology resources and intensive care techniques available. Simulation can play a unique role in exploring and improving the complex perioperative system by proactively identifying latent safety threats and mitigating their damage to ensure that all those who work in this critical health care environment can provide optimal levels of patient care.A panel of five experts from a wide range of institutions was brought together to discuss the added value of simulation-based training for improving systems-based aspects of the perioperative service line. Panelists shared the way in which simulation was demonstrated at their institutions. The themes discussed by each panel member were delineated into four avenues through which simulation-based techniques have been used.Simulation-based techniques are being used in (1) testing new clinical workspaces and facilities before they open to identify potential latent conditions; (2) practicing how to identify the deteriorating patient and escalate care in an effective manner; (3) performing prospective root cause analyses to address system weaknesses leading to sentinel events; and (4) evaluating the efficiency and effectiveness of the electronic health record in the perioperative setting.This focused review of simulation-based interventions to test and improve components of the perioperative microsystem, which includes literature that has emerged since the panel's presentation, highlights the broad-based utility of simulation-based technologies in health care.

    View details for DOI 10.1016/j.jcjq.2017.05.006

    View details for Web of Science ID 000424164800007

    View details for PubMedID 28844234

  • SAGES University MASTERS Program: a structured curriculum for deliberate, lifelong learning SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Jones, D. B., Stefanidis, D., Korndorffer, J. R., Dimick, J. B., Jacob, B. P., Schultz, L., Scott, D. J. 2017; 31 (8): 3061–71


    Postgraduate training has been haphazard to date. Surgeons have relied on attendance to annual meetings and multiple choice study guides to demonstrate maintenance of certification and continuing medical education.SAGES held a retreat to develop the concept and scope of the Masters Program. Surveys were sent to SAGES members to guide curriculum development and selection of anchoring operations.SAGES has developed an educational curriculum across eight domains (Acute Care, Biliary, Bariatric, Colorectal, Hernia, Foregut, Flex Endoscopy, and Robotic Surgery) incorporating SAGES educational materials and guidelines, social media, coaching and mentoring.Deliberate, lifelong learning should be a better way to teach and learn.

    View details for PubMedID 28634631

  • Is it All About the Money? Not All Surgical Subspecialization Leads to Higher Lifetime Revenue when Compared to General Surgery. Journal of surgical education Baimas-George, M., Fleischer, B., Slakey, D., Kandil, E., Korndorffer, J. R., DuCoin, C. 2017


    OBJECTIVE: It is believed that spending additional years gaining expertise in surgical subspecialization leads to higher lifetime revenue. Literature shows that more surgeons are pursuing fellowship training and dedicated research years; however, there are no data looking at the aggregate economic impact when training time is accounted for. It is hypothesized that there will be a discrepancy in lifetime income when delay to practice is considered.DESIGN: Data were collected from the Medical Group Management Association's 2015 report of average annual salaries. Fixed time of practice was set at 30 years, and total adjusted revenue was calculated based on variable years spent in research and fellowship. All total revenue outcomes were compared to general surgery and calculated in US dollars.PARTICIPANTS: The financial data on general surgeons and 9 surgical specialties (vascular, pediatric, plastic, breast, surgical oncology, cardiothoracic, thoracic primary, transplant, and trauma) were examined.RESULTS: With fellowship and no research, breast and surgical oncology made significantly less than general surgery (-$1,561,441, -$1,704,958), with a difference in opportunity cost equivalent to approximately 4 years of work. Pediatric and cardiothoracic surgeons made significantly more than general surgeons, with an increase of opportunity cost equivalent to $5,301,985 and $3,718,632, respectively. With 1 research year, trauma surgeons ended up netting less than a general surgeon by $325,665. With 2 research years, plastic and transplant surgeons had total lifetime revenues approximately equivalent to that of a general surgeon.CONCLUSIONS: Significant disparities exist in lifetime total revenue between surgical subspecialties and in comparison, to general surgery. Although most specialists do gross more than general surgeons, breast and surgical oncologists end up netting significantly less over their lifetime as well as trauma surgeons if they do 1 year of research. Thus, the economic advantage of completing additional training is dependent on surgical field and duration of research.

    View details for PubMedID 28705484

  • Choosing Surgery: Identifying Factors Leading to Increased General Surgery Matriculation Rate AMERICAN SURGEON Pointer, D. T., Freeman, M. D., Korndorffer, J. R., Meade, P. C., Jaffe, B. M., Slakey, D. P. 2017; 83 (3): 290–95


    Tulane graduates have, over the past six years, chosen general surgical residency at a rate above the national average (mean 9.6% vs 6.6%). With much of the recent career choice research focusing on disincentives and declining general surgery applicants, we sought to identify factors that positively influenced our students' decision to pursue general surgery. A 50-question survey was developed and distributed to graduates who matched into a general surgery between the years 2006 and 2014. The survey evaluated demographics, exposure to surgery, and factors affecting interest in a surgical career. We achieved a 54 per cent (61/112) response rate. Only 43 per cent considered a surgical career before medical school matriculation. Fifty-nine per cent had strongly considered a career other than surgery. Sixty-two per cent chose to pursue surgery during or immediately after their surgery clerkship. The most important factors cited for choosing general surgery were perceived career enjoyment of residents and faculty, resident/faculty relationship, and mentorship. Surgery residents and faculty were viewed as role models by 72 and 77 per cent of responders, respectively. This study demonstrated almost half of those choosing a surgical career did so as a direct result of the core rotation experience. We believe that structuring the medical student education experience to optimize the interaction of students, residents, and faculty produces a positive environment encouraging students to choose a general surgery career.

    View details for Web of Science ID 000397998900025

    View details for PubMedID 28316314

  • Muscle-Cooling Intervention to Reduce Fatigue and Fatigue-Induced Tremor in Novice and Experienced Surgeons: A Preliminary Investigation SURGERY JOURNAL-NEW YORK Jensen, L., Dancisak, M., Korndorffer, J. 2016; 2 (4): E126–E130


    A localized, intermittent muscle-cooling protocol was implemented to determine cooling garment efficacy in reducing upper extremity muscular fatigue and tremor in novice ( n  = 10) and experienced surgeons ( n  = 9). Subjects wore a muscle-cooling garment while performing multiple trials of a forearm exercise and paired suturing task to induce muscular fatigue and exercise-induced tremor. A reduction in tremor amplitude and an extension in time to fatigue were expected with muscle cooling as compared with control trials. Each subject completed an intervention session (5°C cooling condition) and a control session (32°C or thermal neutral condition). A paired samples t test indicated that tremor amplitude was significantly reduced ( t [8] = 1.89458; p  < 0.05) in experienced surgeons in two dimensions (up and down, and back and forth). Tremor amplitude was reduced in novice surgeons but the effect was not significant. Time to fatigue and suture time improved in both cohorts with muscle cooling, but the effect did not reach significance. Results from the pilot work suggest muscle cooling as an intervention for reduction of fatigue and tremor is very promising, warranting further investigation. Surgical specialties that require prolonged procedures might benefit more from this intervention.

    View details for PubMedID 28825005

  • Simulation-based summative assessments in surgery Szasz, P., Grantcharov, T. P., Sweet, R. M., Korndorffer, J. R., Pedowitz, R. A., Roberts, P. L., Sachdeva, A. K. MOSBY-ELSEVIER. 2016: 528–35


    The American College of Surgeons-Accredited Education Institutes (ACS-AEI) Consortium aims to enhance patient safety and advance surgical education through the use of cutting-edge simulation-based training and assessment methods. The annual ACS-AEI Consortium meeting provides a forum to discuss the latest simulation-based training and assessment methods and includes special panel presentations on key topics.During the 8th annual Consortium, there was a panel presentation on simulation-based summative assessments, during which experiences from across surgical disciplines were presented. The formal presentations were followed by a robust discussion between the conference attendees and the panelists.This report summarizes the panelists' presentations and their ensuing discussion with attendees.The focus of this report is on the basis for and advances in simulation-based summative assessments, the current practices employed across various surgical disciplines, and future directions that may be pursued by the ACS-AEI Consortium.

    View details for PubMedID 27206332

  • The value proposition of simulation Gardner, A. K., Nepomnayshy, D., Reickert, C., Gee, D. W., Brydges, R., Korndorffer, J. R., Scott, D. J., Sachdeva, A. K. MOSBY-ELSEVIER. 2016: 546–51


    Simulation has been shown to improve trainee performance at the bedside and in the operating room. As the use of simulation-based training is expanded to address a host of health care challenges, its added value needs to be clearly demonstrated. Demonstrable improvements will support the expansion of infrastructure, staff, and programs within existing simulation facilities as well as the establishment of new facilities to meet growing needs and demands. Thus, organizational and institutional leaders, faculty members, and other stakeholders can be assured of the best use of existing resources and can be persuaded to make greater investments in simulation-based training for the future.A multidisciplinary panel was convened during the 8th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes (Simulation Centers) in March 2015 to discuss the added value of simulation-based training. Panelists shared the ways in which the value of simulation was demonstrated at their institutions.The value of simulation-based training was considered and described in terms of educational impact, patient care outcomes, and costs.

    View details for PubMedID 27206331

  • Using simulation for disaster preparedness Gardner, A. K., DeMoya, M. A., Tinkoff, G. H., Brown, K. M., Garcia, G. D., Miller, G. T., Zaidel, B. W., Korndorffer, J. R., Scott, D. J., Sachdeva, A. K. MOSBY-ELSEVIER. 2016: 565–70


    As it addresses both technical and nontechnical skills, simulation-based training is playing an increasingly important role in surgery. In addition to the focus on skill acquisition, it is also important to ensure that surgeons are able to perform a variety of tasks in unique and challenging situations. These situations include responding to mass casualties, dealing with disease outbreaks, and preparing for wartime missions. Simulation-based training can be a valuable training modality in these situations, as it allows opportunities to practice and prepare for high-risk and often low-frequency events.During the 8th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes in March 2015, a multidisciplinary panel was assembled to discuss how simulation can be used to prepare the surgical community for such high-risk events.An overview of how simulation has been used to address needs in each of these situations is presented.

    View details for PubMedID 27206335

  • Validation evidence of the paediatric Objective Structured Assessment of Debriefing (OSAD) tool. BMJ simulation & technology enhanced learning Runnacles, J., Thomas, L., Korndorffer, J., Arora, S., Sevdalis, N. 2016; 2 (3): 61-67


    Debriefing is essential to maximise the simulation-based learning experience, but until recently, there was little guidance on an effective paediatric debriefing. A debriefing assessment tool, Objective Structured Assessment of Debriefing (OSAD), has been developed to measure the quality of feedback in paediatric simulation debriefings. This study gathers and evaluates the validity evidence of OSAD with reference to the contemporary hypothesis-driven approach to validity.Expert input on the paediatric OSAD tool from 10 paediatric simulation facilitators provided validity evidence based on content and feasibility (phase 1). Evidence for internal structure validity was sought by examining reliability of scores from video ratings of 35 postsimulation debriefings; and evidence for validity based on relationship to other variables was sought by comparing results with trainee ratings of the same debriefings (phase 2).Simulation experts' scores were significantly positive regarding the content of OSAD and its instructions. OSAD's feasibility was demonstrated with positive comments regarding clarity and application. Inter-rater reliability was demonstrated with intraclass correlations above 0.45 for 6 of the 7 dimensions of OSAD. The internal consistency of OSAD (Cronbach α) was 0.78. Pearson correlation of trainee total score with OSAD total score was 0.82 (p<0.001) demonstrating validity evidence based on relationships to other variables.The paediatric OSAD tool provides a structured approach to debriefing, which is evidence-based, has multiple sources of validity evidence and is relevant to end-users. OSAD may be used to improve the quality of debriefing after paediatric simulations.

    View details for DOI 10.1136/bmjstel-2015-000017

    View details for PubMedID 35519431

    View details for PubMedCentralID PMC8936622

  • Force feedback vessel ligation simulator in knot-tying proficiency training AMERICAN JOURNAL OF SURGERY Hsu, J. L., Korndorffer, J. R., Brown, K. M. 2016; 211 (2): 411–15


    Tying gentle secure knots is an important skill. We have developed a force feedback simulator that measures force exerted during knot tying. This pilot study examines the benefits of this simulator in a deliberate practice curriculum.The simulator consists of silastic tubing with a force sensor. Knot quality was assessed using digital caliper measurement. Participants performed 10 vessel ligations as a pretest, then were shown force readings and tied knots until reaching proficiency targets. Average peak forces precurriculum and postcurriculum were compared using Student t test.Participants exerted significantly less force after completing the curriculum (.61 N ± .22 vs 1.42 N ± .53, P < .001), and had fewer air knots (10% vs 27%). The curriculum was completed in an average of 19.4 ± 6.27 minutes and required an average of 11.7 ± 4.03 knots to reach proficiency.This study demonstrates the feasibility of real-time feedback in learning to tie delicate knots. The curriculum can be completed in a reasonable amount of time, and may also work as a warm-up exercise before a surgical case.

    View details for PubMedID 26723838

  • Pre-Operative Antisepsis Protocol Compliance and the Effect on Bacterial Load Reduction SURGICAL INFECTIONS Lundberg, P. W., Smith, A. A., Heaney, J. B., Wimley, W. C., Hauch, A. T., Nichols, R. L., Korndorffer, J. R. 2016; 17 (1): 32–37


    Adequate skin preparation is essential to preventing surgical site infection. Many products are available, each with specific manufacturers' directions. This lack of standardization may lead to incorrect use of the agents and affect the bacterial load reduction. We hypothesize that a lack of adherence to utilization protocols for surgical skin antiseptics affects bacterial load reduction.Thirty subjects who routinely perform surgical skin preparation were recruited from four hospitals. Participants completed a questionnaire of both demographics and familiarity with two of the most common skin prep formulas: Chlorhexidine gluconate-isopropyl alcohol (CHG-IPA) and povidone-iodine (PVI) scrub and paint. Randomly selecting one formula, subjects performed skin preparation for ankle surgery on a healthy standardized patient. This was repeated using the second formula on the opposite ankle. Performance was recorded and reviewed by two independent evaluators using standardized dichotomous checklists created against the manufacturer's recommended application. Swabs of the patients' first interweb space and medial malleolus were obtained before, 1 min after, and 30 min after prep, and plated on Luria Bertani agar. Bacterial loads were measured in colony forming units (CFUs) for each anatomical site. Data was analyzed using a univariate linear regression.Subjects had an average of 12.7 ± 2.2 y operating room experience and 8.8 ± 1.5 y of skin prep experience. Despite this, no participant performed 100% of the manufacturers' steps correctly. All essential formula-specific steps were performed 90% of the time for CHG-IPA and 33.3% for PVI (p = 0.0001). No correlation was found between experience or familiarity and number of correct steps for either formula. Average reduction in CFUs was not different between CHG-IPA and PVI at 30 min for all anatomical sites (75.2 ± 5.4% vs. 73.7 ± 4.5%, p = 0.7662). Bacterial reductions at 30 min following skin prep were not substantially correlated with operator experience, protocol compliance, or total prep time for either formula.This study demonstrates existing problems with infection prevention as those tasked with pre-operative skin preparation do so with tremendous incongruence according to manufacturer guidelines. No effect on bacterial load was identified, however with a larger sample size this may be noted. Standardization of the prep solutions as well as simplification and education of the correct techniques may enhance protocol compliance.

    View details for PubMedID 26431266

  • Effectiveness of systems changes suggested by simulation of adverse surgical outcomes. BMJ simulation & technology enhanced learning Garstka, M. E., Slakey, D. P., Martin, C. A., Simms, E. R., Korndorffer, J. R. 2015; 1 (3): 83-86


    Simulation of adverse outcomes (SAO) has been described as a technique to improve effectiveness of root cause analysis (RCA) in healthcare. We hypothesise that SAO can effectively identify unsuspected root causes amenable to systems changes.Systems changes were developed and tested for effectiveness in a modified simulation, which was performed eight times, recorded and analysed.In seven of eight simulations, systems changes were effectively utilised by participants, who contacted anaesthesia using the number list and telephone provided to express concern. In six of seven simulations where anaesthesia was contacted, they provided care that avoided the adverse event. In two simulations, the adverse event transpired despite implemented systems changes, but for different reasons than originally identified. In one case, appropriate personnel were contacted but did not provide the direction necessary to avoid the adverse event, and in one case, the telephone malfunctioned.Systems changes suggested by SAO can effectively correct deficiencies and help improve outcomes, although adverse events can occur despite implementation. Further study of systems concepts may provide suggestions for changes that function more reliably in complex healthcare systems. The information gathered from these simulations can be used to identify potential deficiencies, prevent future errors and improve patient safety.

    View details for DOI 10.1136/bmjstel-2015-000055

    View details for PubMedID 35515203

    View details for PubMedCentralID PMC8990181

  • Effect of Visuospatial Training on Surgical Skill Acquisition Wright, M., Drake, C. B., Alsaleh, N., Korndorffer, J. R. ELSEVIER SCIENCE INC. 2015: S50–S51
  • Choosing surgery: identifying factors leading to increased general surgery matriculation rate Pointer, D. T., Slakey, D. P., Freeman, M., Meade, P. C., Jaffe, B. M., Korndorffer, J. R. ELSEVIER SCIENCE INC. 2015: E72
  • Design of vessel ligation simulator for deliberate practice JOURNAL OF SURGICAL RESEARCH Hsu, J. L., Korndorffer, J. R., Brown, K. M. 2015; 197 (2): 231–35


    Surgical residents develop technical skills at variable rates, often based on random chance of cases encountered. One such skill is tying secure knots without exerting excessive force. This study describes the design of a simulator using a force sensor to measure instantaneous forces exerted on a blood vessel analog during vessel ligation and the development of expert-derived performance goals.Vessel ligations were performed on Silastic tubing at an offset from a Vernier Force Sensor. Nine experts (surgical faculty and senior residents) and 10 novices (junior residents) were recruited to each perform 10 vessel ligations (two square knots each) with two-handed and one-handed techniques. Internal consistency for the series of vessel ligations was tested with Cronbach alpha. Maximum forces exerted by novices and experts were compared using Student t-test.Internal consistency across the 10 ligations on the simulator was excellent (Cronbach alpha = 0.91). The expert group on average exerted a significantly lower maximum force when compared with novices while performing two-handed (0.76 ± 0.39 N versus 1.12 ± 0.49 N, P < 0.01) and one-handed (0.84 ± 0.32 N versus 1.36 ± 0.44 N, P < 0.01) vessel ligations.Although the expert group performed vessel ligations with significantly lower peak force than the novice group, there were novices who performed at the expert level. This is consistent with the conceptual framework of milestones and suggests that the skill of gentle knot-tying can be measured and develops at different chronologic levels of training in different individuals. This simulator can be used as part of a deliberate practice curriculum with instantaneous visual feedback.

    View details for PubMedID 25840488

  • Using Simulation to Improve Systems SURGICAL CLINICS OF NORTH AMERICA Lundberg, P. W., Korndorffer, J. R. 2015; 95 (4): 885-+


    Simulation technology provides an important opportunity to prospectively identify systemic problems with minimal risk to patient safety and quality. Health care systems are implementing simulation-based exercises on a more regular basis, especially in high-risk settings such as the emergency department and operating room. The adoption of simulation-based and other system-oriented improvement strategies by the health care industry, especially regarding quality and safety, was preceded by its development in the manufacturing and aviation sectors.

    View details for PubMedID 26210978

  • Camera navigation and cannulation: validity evidence for new educational tasks to complement the Fundamentals of Laparoscopic Surgery Program Watanabe, Y., Ritter, E., Schwaitzberg, S. D., Korndorffer, J. R., Scott, D. J., Okrainec, A., Bilgic, E., Kaneva, P. A., O'Donnell, M. T., Feldman, L. S., Fried, G. M., Vassiliou, M. C. SPRINGER. 2015: 552–57


    Experts identified camera navigation and cannulation as important skills that are not assessed by the Fundamentals of Laparoscopic Surgery (FLS) hands-on examination. The purpose of this study was to create metrics for and evaluate the validity for two new tasks: camera navigation (N) and cannulation (C), and to explore the potential value of adding these tasks to the FLS program.Participants were assessed by two raters during performance of N and C in addition to the five standard FLS tasks. They also completed a questionnaire regarding the educational value of the new tasks. Validity evidence was assessed by comparing performance between Novice (PGY 1 and 2) and Experienced (PGY 3 and higher) participants, and by correlating new task scores with standard FLS scores. The ability to predict level of training using scores was evaluated by regression analysis.Sixty subjects participated from five North American centers. Inter-rater reliabilities for both tasks were 0.99. Novice and Experienced participants scored 74 ± 17.8 versus 85 ± 8.3 (p < 0.01) and 21 ± 17.3 versus 39 ± 20.1 (p < 0.01) on N and C tasks, respectively. Correlations with total FLS scores for N and C were 0.39 and 0.53, respectively. Prediction of training level using the combination of all seven tasks was 52.6 % (R (2) = 0.526, p < 0.01), adding an additional 2.2 % to the five FLS tasks. Of 55 participants with laparoscopic experience, 51 % reported N to be similar in difficulty to reality. Of 28 participants who perform intraoperative cholangiograms, 43 % found C to be more difficult than reality. Most (70 %) participants thought the new tasks added value to FLS.This study provides preliminary validity evidence for the metrics of these new tasks. The value of adding these tasks to the FLS manual skills assessment is marginal in terms of predicting level of training.

    View details for DOI 10.1007/s00464-014-3721-5

    View details for Web of Science ID 000349296400010

    View details for PubMedID 25034381

  • Multicenter longitudinal assessment of resident technical skills AMERICAN JOURNAL OF SURGERY Stefanidis, D., Gardner, C., Paige, J. T., Korndorffer, J. R., Nepomnayshy, D., Chapman, D. 2015; 209 (1): 120–25


    Our aim was to report the longitudinal assessment of technical performance of general surgery residents on select tasks from multiple programs over a 2-year period.An institutional review board-approved, multi-institutional collaborative study was undertaken with yearly resident performance assessments over a 3-year period. General surgery residents (postgraduate year [PGY] 1 to 5) were tested on 3 laparoscopic and 5 open simulated surgical tasks. Resident performance was compared individually over time and among interns and more senior residents.Forty-one residents from 4 residency programs were evaluated. Scores increased in all tasks with each assessment, plateauing at a lower PGY level for open tasks compared with laparoscopic tasks. Change in performance scores between assessments were higher for interns compared with more senior residents (P < .003).Resident performance on basic open and laparoscopic tasks assessed over time improved the most between the PGY 1 and 2 levels and was dependent on task difficulty. This documented skill evolution may allow tailoring of skills curricula to both meet existing needs and minimize performance variability.

    View details for PubMedID 25466766

  • Establishing technical performance norms for general surgery residents SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Stefanidis, D., Grewal, H., Paige, J. T., Korndorffer, J. R., Scott, D. J., Nepomnayshy, D., Edelman, D. A., Sievers, C. 2014; 28 (11): 3179–85


    Surgery residents are required to achieve performance milestones to advance in their residency. Level-specific, technical performance norms that could be used as milestones, however, do not currently exist. Our aim was to develop level-specific, technical performance norms for general surgery residents on select simulated tasks across multiple institutions.An IRB-approved, prospective, multi-institutional collaborative study with voluntary participation of residents was undertaken at the start of the 2011-2012 academic year. General surgery residents (PGY I-V) from seven institutions were tested on three laparoscopic and five open simulated surgical tasks, and their performance was assessed based on task time and errors. Means and standard deviations of performance for each resident level were calculated and compared. Residents with performance 1 standard deviation below the mean were considered outliers.A total of 147 residents were evaluated. Mean resident age was 28 ± 3 years; 42 % were female; and they had attended 74 different medical schools. Senior residents (PGY III-V) had more clinical and simulator experience than junior residents (PGY I-II) (p < 0.001). Resident performance scores progressively increased in all tasks reaching a plateau at a lower PGY level for open tasks. Depending on the task, 0-18 % of residents were outliers. When surveyed, 66 % of residents agreed that national performance norms for residents should exist.Performance norms were established for select tasks in a representative sample of US surgery residents. Such performance norms allow a more informed assessment of resident skill through comparison to national data and enable the identification of outliers who may benefit from additional training.

    View details for DOI 10.1007/s00464-014-3582-y

    View details for Web of Science ID 000344168200020

    View details for PubMedID 24939154

  • Using simulation to improve root cause analysis of adverse surgical outcomes INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE Slakey, D. P., Simms, E. R., Rennie, K. V., Garstka, M. E., Korndorffer, J. R. 2014; 26 (2): 144–50


    The purpose of this study was to develop and test a simulation method of conducting investigation of the causality of adverse surgical outcomes.Six hundred and thirty-one closed claims of a major medical malpractice insurance company were reviewed. Each case had undergone conventional root cause analysis (RCA). Claims were categorized by comparing the predominant underlying cause documented in the case files. Three cases were selected for simulation.All records (medical and legal) were analyzed. Simulation scenarios were developed by abstracting data from the records and then developing paper and electronic medical records, choosing appropriateincluding test subjects and confederates, scripting the simulation and choosing the appropriate simulated environment.In a simulation center, each case simulation was run 6-7 times and recorded, with participants debriefed at the conclusion.Sources of error identified during simulation were compared with those noted in the closed claims. Test subject decision-making was assessed qualitatively.Simulation of adverse outcomes (SAOs) identified more system errors and revealed the way complex decisions were made by test subjects. Compared with conventional RCA, SAO identified root causes less focused on errors by individuals and more on systems-based error.The use of simulation for investigation of adverse surgical outcomes is feasible and identifies causes that may be more amenable to effective systems changes than conventional RCA. The information that SAO provides may facilitate the implementation of corrective measures, decreasing the risk of recurrence and improving patient safety.

    View details for PubMedID 24521702

  • Fundamentals of endoscopic surgery: creation and validation of the hands-on test SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Vassiliou, M. C., Dunkin, B. J., Fried, G. M., Mellinger, J. D., Trus, T., Kaneva, P., Lyons, C., Korndorffer, J. R., Ujiki, M., Velanovich, V., Kochman, M. L., Tsuda, S., Martinez, J., Scott, D. J., Korus, G., Park, A., Marks, J. M. 2014; 28 (3): 704–11


    The Fundamentals of Endoscopic Surgery™ (FES) program consists of online materials and didactic and skills-based tests. All components were designed to measure the skills and knowledge required to perform safe flexible endoscopy. The purpose of this multicenter study was to evaluate the reliability and validity of the hands-on component of the FES examination, and to establish the pass score.Expert endoscopists identified the critical skill set required for flexible endoscopy. They were then modeled in a virtual reality simulator (GI Mentor™ II, Simbionix™ Ltd., Airport City, Israel) to create five tasks and metrics. Scores were designed to measure both speed and precision. Validity evidence was assessed by correlating performance with self-reported endoscopic experience (surgeons and gastroenterologists [GIs]). Internal consistency of each test task was assessed using Cronbach's alpha. Test-retest reliability was determined by having the same participant perform the test a second time and comparing their scores. Passing scores were determined by a contrasting groups methodology and use of receiver operating characteristic curves.A total of 160 participants (17 % GIs) performed the simulator test. Scores on the five tasks showed good internal consistency reliability and all had significant correlations with endoscopic experience. Total FES scores correlated 0.73, with participants' level of endoscopic experience providing evidence of their validity, and their internal consistency reliability (Cronbach's alpha) was 0.82. Test-retest reliability was assessed in 11 participants, and the intraclass correlation was 0.85. The passing score was determined and is estimated to have a sensitivity (true positive rate) of 0.81 and a 1-specificity (false positive rate) of 0.21.The FES hands-on skills test examines the basic procedural components required to perform safe flexible endoscopy. It meets rigorous standards of reliability and validity required for high-stakes examinations, and, together with the knowledge component, may help contribute to the definition and determination of competence in endoscopy.

    View details for DOI 10.1007/s00464-013-3298-4

    View details for Web of Science ID 000331961500002

    View details for PubMedID 24253562

  • Fundamentals of Endoscopic Surgery cognitive examination: development and validity evidence SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Poulose, B. K., Vassiliou, M. C., Dunkin, B. J., Mellinger, J. D., Fanelli, R. D., Martinez, J. M., Hazey, J. W., Sillin, L. F., Delaney, C. P., Velanovich, V., Fried, G. M., Korndorffer, J. R., Marks, J. M. 2014; 28 (2): 631–38


    Flexible endoscopy is an integral part of surgical care. Exposure to endoscopic procedures varies greatly in surgical training. The Society of American Gastrointestinal and Endoscopic Surgeons has developed the Fundamentals of Endoscopic Surgery (FES), which serves to teach and assess the fundamental knowledge and skills required to practice flexible endoscopy of the gastrointestinal tract. This report describes the validity evidence in the development of the FES cognitive examination.Core areas in the practice of gastrointestinal endoscopy were identified through facilitated expert focus groups to establish validity evidence for the test content. Test items then were developed based on the content areas. Prospective enrollment of participants at various levels of training and experience was used for beta testing. Two FES cognitive test versions then were developed based on beta testing data. The Angoff and contrasting group methods were used to determine the passing score. Validity evidence was established through correlation of experience level with examination score.A total of 220 test items were developed in accordance with the defined test blueprint and formulated into two versions of 120 questions each. The versions were administered randomly to 363 participants. The correlation between test scores and training level was high (r = 0.69), with similar results noted for contrasting groups based on endoscopic rotation and endoscopic procedural experience. Items then were selected for two test forms of 75 items each, and a passing score was established.The FES cognitive examination is the first test with validity evidence to assess the basic knowledge needed to perform flexible endoscopy. Combined with the hands-on skills examination, this assessment tool is a key component for FES certification.

    View details for DOI 10.1007/s00464-013-3220-0

    View details for Web of Science ID 000331961100033

    View details for PubMedID 24100859

  • Development and Verification of a Taxonomy of Assessment Metrics for Surgical Technical Skills ACADEMIC MEDICINE Schmitz, C. C., DaRosa, D., Sullivan, M. E., Meyerson, S., Yoshida, K., Korndorffer, J. R. 2014; 89 (1): 153–61


    To create and empirically verify a taxonomy of metrics for assessing surgical technical skills, and to determine which types of metrics, skills, settings, learners, models, and instruments were most commonly reported in the technical skills assessment literature.In 2011-2012, the authors used a rational analysis of existing and emerging metrics to create the taxonomy, and used PubMed to conduct a systematic literature review (2001-2011) to test the taxonomy's comprehensiveness and verifiability. Using 202 articles identified from the review, the authors classified metrics according to the taxonomy and coded data concerning their context and use. Frequencies (counts, percentages) were calculated for all variables.The taxonomy contained 12 objective and 4 subjective categories. Of 567 metrics identified in the literature, 520 (92%) were classified using the new taxonomy. Process metrics outnumbered outcome metrics by 8:1. The most frequent metrics were "time," "manual techniques" (objective and subjective), "errors," and "procedural steps." Only one new metric, "learning curve," emerged. Assessments of basic motor skills and skills germane to laparoscopic surgery dominated the literature. Novices, beginners, and intermediate learners were the most frequent subjects, and box trainers and virtual reality simulators were the most frequent models used for assessing performance.Metrics convey what is valued in human performance. This taxonomy provides a common nomenclature. It may help educators and researchers in procedurally oriented disciplines to use metrics more precisely and consistently. Future assessments should focus more on bedside tasks and open surgical procedures and should include more outcome metrics.

    View details for PubMedID 24280844

  • The American College of Surgeons/Association of Program Directors in Surgery National Skills Curriculum: Adoption rate, challenges and strategies for effective implementation into surgical residency programs Korndorffer, J. R., Arora, S., Sevdalis, N., Paige, J., McClusky, D. A., Stefanidis, D., PEGASUS Res Grp MOSBY-ELSEVIER. 2013: 13–20


    The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers.A web-based survey was developed by an international expert panel of surgical educators (5 surgeons and 1 psychologist). After piloting, the survey was sent to all general surgery program directors via email link. Descriptive statistics were used to determine the residency program characteristics and perceptions of the curriculum. Implementation rates for each phase and module were calculated. Adoption barriers were identified quantitatively and qualitatively using free text responses. Standardized qualitative methodology of emergent theme analysis was used to identify strategies for success and details of support required for implementation.Of the 238 program directors approached, 117 (49%) responded to the survey. Twenty-one percent (25/117) were unaware of the ACS/APDS curriculum. Implementation rates for were 36% for phase I, 19% for phase II, and 16% for phase III. The most common modules adopted were the suturing, knot-tying, and chest tube modules of phase I. Over 50% of respondents identified lack of faculty protected time, limited personnel, significant costs, and resident work-hour restrictions as major obstacles to implementation. Strategies for effective uptake included faculty incentives, adequate funding, administrative support, and dedicated time and resources.Despite the availability of a comprehensive curriculum, its diffusion into general surgery residency programs remains low. Obstacles related to successful implementation include personnel, learner, and administrative issues. Addressing these issues may improve the adoption rate of the curriculum.

    View details for PubMedID 23809479

  • Does the Incorporation of Motion Metrics Into the Existing FLS Metrics Lead to Improved Skill Acquisition on Simulators? A Single Blinded, Randomized Controlled Trial ANNALS OF SURGERY Stefanidis, D., Yonce, T. C., Korndorffer, J. R., Phillips, R., Coker, A. 2013; 258 (1): 46–52


    We hypothesized that training to expert-derived levels of speed and motion will lead to improved learning and will translate to better operating room (OR) performance of novices than training to goals of speed or motion alone.Motion tracking has been suggested to be a more sensitive performance metric than time and errors for the assessment of surgical performance.An institutional review board-approved, single blinded, randomized controlled trial was conducted at our level-I American College of Surgeons accredited Education Institute. Forty-two novices trained to proficiency in laparoscopic suturing after being randomized into 3 groups: The speed group (n = 14) had to achieve expert levels of speed, the motion group (n = 15) expert levels of motion (path length and smoothness), and the speed and motion group (n = 13) both levels. To achieve proficiency, all groups also had to demonstrate error-free performance. The FLS suture module (task 5) was used for training inside the ProMIS simulator that tracks instrument motion. All groups participated in transfer and retention tests in the OR. OR performance was assessed by a blinded expert rater using Global Operative Assessment of Laparoscopic Skills, speed, accuracy, and inadvertent injuries.Thirty (71%) participants achieved proficiency and participated in the transfer and retention tests. The speed group achieved simulator proficiency significantly faster than the other groups (P < 0.001). With the exception of a higher injury rate during the transfer test for the speed group (that reversed during the retention test), there were no significant performance differences among the groups on all assessed parameters.The incorporation of motion metrics into the time/accuracy goals of the FLS laparoscopic suturing curriculum had limited impact on participant skill transfer to the OR. Given the increased training requirements for such a curriculum, further study is needed before the addition of motion metrics to the current FLS metrics can be recommended.

    View details for DOI 10.1097/SLA.0b013e318285f531

    View details for Web of Science ID 000330460400016

    View details for PubMedID 23470570

  • The Modern Surgery Department Chairman The Job Description as Identified by Chairmen JAMA SURGERY Slakey, D. P., Korndorffer, J. R., Long, K. N., Clark, T., Hidalgo, M. 2013; 148 (6): 511–15


    The role of the chairman of a surgery department is critical in academic surgery. However, little is known about the variability of job responsibilities.To evaluate chairmen's responsibilities, methods of support, determinants of job performance success, and concerns.Internet-based survey.Electronic survey system.Seventy-two chairmen.Survey data on job responsibilities, methods of support, determinants of job performance success, and concerns.Of 168 chairmen who received the survey, 72 (43%) responded. The mean age of chairmen was 57 years (range, 44-78 years). Of 72 chairmen who responded, 69 (96%) were men, 67 (93%) were white, 65 (90%) were professors, 11 (15%) held a previous chair, 35 (49%) have advanced degrees, and 19 (26%) are program directors. Respondents are responsible for an average of 8.7 divisions, 60 (83%) spent 1 to 10 hours per week in the clinic, 45 (63%) performed surgery 1 to 10 hours per week, 54 (75%) took less than 6 call days per month, 44 (61%) published 1 to 6 papers per year and attended a mean (SD) of 4.3 (1.7) essential meetings per year, and 48 (67%) took 1 to 3 weeks of vacation annually. Chair salary support includes (from least to most) faculty tax, grants, endowment, school, and hospital. Compensation correlates with age, additional degree, specialty, location, contract, and tenure but not clinical hours. Reported compensation was consistent with data from the Association of American Medical Colleges, but 24 (33%) felt undercompensated. Incentives for job performance were given for clinical productivity (34 chairmen [47%]), department performance (50 [70%]), institutional performance (27 [38%]), and personal accomplishment (14 [19%]). Of 72 chairmen, 30 (42%) were concerned about personal liability related to the job, 15 (21%) had purchased personal liability insurance, and 20 (28%) have defended a lawsuit related to nonclinical responsibilities.Academic surgery department chairmen have a wide array of responsibilities that have changed from historic standards. Success in the role of chairman may improve by appreciating the responsibilities, time allocation, methods of support, and concerns of other chairmen.

    View details for PubMedID 23754568

  • The Ethics of Conducting Graduate Medical Education Research on Residents ACADEMIC MEDICINE Keune, J. D., Brunsvold, M. E., Hohmann, E., Korndorffer, J. R., Weinstein, D. F., Smink, D. S. 2013; 88 (4): 449–53


    The field of graduate medical education (GME) research is attracting increased attention and broader participation. The authors review the special ethical and methodological considerations pertaining to medical education research. Because residents are at once a convenient and captive study population, a risk of coercion exists, making the provision of consent important. The role of the institutional review board (IRB) is often difficult to discern because GME activities can have multiple simultaneous purposes, educational activities may go forward with or without a research component, and the subjects of educational research studies are not patients. The authors provide a road map for researchers with regard to research oversight by the IRB and also address issues related to research quality. The matters of whether educational research studies should have educational value for the study subject and whether to use individual information obtained when residents participate as research subjects are explored.

    View details for DOI 10.1097/ACM.0b013e3182854bef

    View details for Web of Science ID 000316853100011

    View details for PubMedID 23425981

  • Can simulation improve the traditional method of root cause analysis: A preliminary investigation SURGERY Simms, E. R., Slakey, D. P., Garstka, M. E., Tersigni, S. A., Korndorffer, J. R. 2012; 152 (3): 489–97


    The Joint Commission on Accreditation of Healthcare Organizations recommendations for conducting root cause analysis (RCA) include identifying "root causes" and "common-cause variation" rather than "proximate causes" and "special-cause variation" to create interventions. Simulation for health care RCA is a novel technique but has not been compared with traditional RCA methods.All of the RCAs of adverse events conducted at Tulane Hospital between September 2010 and September 2011 were reviewed. A case of missed postprocedural, preoperative hemorrhage resulting in death was chosen. Hospital records were analyzed to identify the presumed root causes. A simulation of the event was developed and conducted. Six test subjects (preoperative and postanesthesia care unit nurses) participated in the simulation. Root causes identified by simulation analysis were compared with those identified by traditional RCA.In 2 of 6 simulations, the adverse event was duplicated. The root cause identified by standard RCA technique was inattention to signs of bleeding in the patient/ lack of appropriate monitoring of the patient by nursing staff ("special-cause variation"). Simulation-based RCA revealed that the root cause was not only inadequate monitoring, but also the lack of physical presence of physicians in the care environment ("common-cause variation"). Simulation-based RCA identified root causes more amenable to intervention.This study demonstrates that simulation-based RCA can identify additional root causes amenable to making health care interventions when compared with traditional RCA.

    View details for DOI 10.1016/j.surg.2012.07.029

    View details for Web of Science ID 000308623500025

    View details for PubMedID 22938908

  • Effective home laparoscopic simulation training: a preliminary evaluation of an improved training paradigm Korndorffer, J. R., Bellows, C. F., Tekian, A., Harris, I. B., Downing, S. M. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2012: 1–7


    Laparoscopic simulation training has proven to be effective in developing skills but requires expensive equipment, is a challenge to integrate into a work-hour restricted surgical residency, and may use nonoptimal practice schedules. The purpose of this study was to evaluate the efficacy of laparoscopic skills training at home using inexpensive trainer boxes.Residents (n = 20, postgraduate years 1-5) enrolled in an institutional review board-approved laparoscopic skills training protocol. An instructional video was reviewed, and baseline testing was performed using the fundamentals of laparoscopic surgery (FLS) peg transfer and suturing tasks. Participants were randomized to home training with inexpensive, self-contained trainer boxes or to simulation center training using standard video trainers. Discretionary, goal-directed training of at least 1 hour per week was encouraged. A posttest and retention test were performed. Intragroup and intergroup comparisons as well as the relationship between the suture score and the total training sessions, the time in training, and attempts were studied.Intragroup comparisons showed significant improvement from baseline to the posttest and the retention test. No differences were shown between the groups. The home-trained group practiced more, and the number of sessions correlated with suture retention score (r(2) = .54, P < .039).Home training results in laparoscopic skill acquisition and retention. Training is performed in a more distributed manner and trends toward improved skill retention.

    View details for PubMedID 22172481

  • Research Regarding Methods of Assessing Learning Outcomes SIMULATION IN HEALTHCARE Boulet, J. R., Jeffries, P. R., Hatala, R. A., Korndorffer, J. R., Feinstein, D. M., Roche, J. P. 2011; 6: S48–S51


    As the use of simulation-based assessment expands for healthcare workers, there is a growing need for research to quantify the psychometric properties of the associated process and outcome measures.

    View details for DOI 10.1097/SIH.0b013e31822237d0

    View details for Web of Science ID 000294209700008

    View details for PubMedID 21705967

  • Effect of Structuring Clinical Services Based on Resident Educational Objectives Korndorffer, J. R., Slakey, D. P. ELSEVIER SCIENCE INC. 2011: 696–701


    Traditionally, surgical rotations are established based on attending surgeon clinical specialty and department/section organizational structure. Consequently, resident clinical rotations are forced to adopt an underlying structure that may not align with resident educational needs. An option is to realign clinical services based on resident educational objectives.We performed a comprehensive reorganization of the clinical service lines by emphasizing resident educational objectives. Effects on resident education were evaluated qualitatively and using a semistructured interview. Effects on clinical referral patterns and patient volumes for individual faculty and sections were also evaluated.New rotations and services (clarifying faculty roles and appointments) were designed. Examples of new rotations include hepatobiliary/transplant, acute care surgery, elective surgery, cardiac/vascular, and minimally invasive surgery. Clinical case mix was evaluated by using Residency Review Committees-defined categories for general surgery and used as a component of clinical service reorganization. Since the reorganization, all residents completed the minimum case number requirements before beginning postgraduate year 5. Program quality improved in key measurable areas, including American Board of Surgery In-Training Examination mean and median and total resident operative cases performed. Individual faculty clinical volume increased during the same time period. Evaluation of faculty volumes reveals that the new clinical services lines allowed for coordination of clinical services into centers with a multidisciplinary focus.If carefully performed, reorganization of clinical rotations based on resident goals and objectives can result in measurable improvements in resident education without disrupting faculty practices. Unanticipated benefits for faculty include new collaborative opportunities that cross traditional section/department barriers. The process allows for rapid change focused on educational effectiveness, not simply revision of existing paradigms, but it requires faculty cooperation and willingness to change traditional clinical service organization.

    View details for PubMedID 21463815

  • Simulation training for vascular access interventions JOURNAL OF VASCULAR ACCESS Davidson, I. A., Yoo, M. C., Biasucci, D. G., Browne, P., Dees, C., Dolmatch, B., Gallieni, M., La Greca, A., Korndorffer, J. R., Nolen, B., O'Rear, S., Peden, E., Pittiruti, M., Reed, G., Scott, D., Slakey, D. 2010; 11 (3): 181–90


    Training and learning in the field of access for dialysis, including peritoneal and hemodialysis and access for oncologic patients, is well suited for the use of simulators, simulated case learning, and root cause analysis of adverse outcomes and team training. Simulators range over a wide spectrum from simple suture learning devices, inexpensive systems for venous puncture simulation, such as a turkey breast or leg with a pressurized tunneled rubber or graft conduit, to sophisticated computer designed simulators to teach interventional procedures such as vascular access angiogram, balloon angioplasty and stent placing. Team training capitalizes on the principles used in aviation, known as Crew Resource Management (CRM) or Human Factor (HF). The objectives of team training are to improve communication and leadership skills, to use checklists to prevent errors, to promote a change in the attitudes towards vascular access from learning through mistakes in a non-punitive environment, to impacting positively the employee performance and to increase staff retention by making the workplace safer, more efficient and user-friendly.

    View details for Web of Science ID 000287465200001

    View details for PubMedID 21240863

  • SAGES guideline for laparoscopic appendectomy SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Korndorffer, J. R., Fellinger, E., Reed, W. 2010; 24 (4): 757–61

    View details for PubMedID 19787402

  • Initial Laparoscopic Basic Skills Training Shortens the Learning Curve of Laparoscopic Suturing and Is Cost-Effective JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Stefanidis, D., Hope, W. W., Korndorffer, J. R., Markley, S., Scott, D. J. 2010; 210 (4): 436–40


    Laparoscopic suturing is an advanced skill that is difficult to acquire. Simulator-based skills curricula have been developed that have been shown to transfer to the operating room. Currently available skills curricula need to be optimized. We hypothesized that mastering basic laparoscopic skills first would shorten the learning curve of a more complex laparoscopic task and reduce resource requirements for the Fundamentals of Laparoscopic Surgery suturing curriculum.Medical students (n = 20) with no previous simulator experience were enrolled in an IRB-approved protocol, pretested on the Fundamentals of Laparoscopic Surgery suturing model, and randomized into 2 groups. Group I (n = 10) trained (unsupervised) until proficiency levels were achieved on 5 basic tasks; Group II (n = 10) received no basic training. Both groups then trained (supervised) on the Fundamentals of Laparoscopic Surgery suturing model until previously reported proficiency levels were achieved. Two weeks later, they were retested to evaluate their retention scores, training parameters, instruction requirements, and cost between groups using t-test.Baseline characteristics and performance were similar for both groups, and 9 of 10 subjects in each group achieved the proficiency levels. The initial performance on the simulator was better for Group I after basic skills training, and their suturing learning curve was shorter compared with Group II. In addition, Group I required less active instruction. Overall time required to finish the curriculum was similar for both groups; but the Group I training strategy cost less, with a savings of $148 per trainee.Teaching novices basic laparoscopic skills before a more complex laparoscopic task produces substantial cost savings. Additional studies are needed to assess the impact of such integrated curricula on ultimate educational benefit.

    View details for DOI 10.1016/j.jamcollsurg.2009.12.015

    View details for Web of Science ID 000276563800007

    View details for PubMedID 20347735

  • Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Stefanidis, D., Wang, F., Korndorffer, J. R., Dunne, J., Scott, D. J. 2010; 24 (2): 377–82


    Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room.Medical students (n = 34), without prior laparoscopic suturing experience, were enrolled in an Institutional Review Board-approved, randomized protocol. After viewing an instructional video, subjects were tested in intracorporeal suturing on two identical, live, porcine Nissen fundoplication models; they placed three gastro-gastric sutures using conventional laparoscopic instruments in one model and using robotic assistance (da Vinci) in the other, in random order. Each knot was objectively scored based on time, accuracy, and security. Injuries to surrounding structures were recorded. Workload was assessed using the validated National Aeronautics and Space Administration (NASA) task load index (TLX) questionnaire, which measures the subjects' self-reported performance, effort, frustration, and mental, physical, and temporal demands of the task. Analysis was by paired t-test; p < 0.05 was considered significant.Compared with laparoscopy, robotic assistance enabled subjects to suture faster (595 +/- 22 s versus 459 +/- 137 s, respectively; p < 0.001), achieve higher overall scores (0 +/- 1 versus 95 +/- 128, respectively; p < 0.001), and commit fewer errors per knot (1.15 +/- 1.35 versus 0.05 +/- 0.26, respectively; p < 0.001). Subjects' overall score did not improve between the first and third attempt for laparoscopic suturing (0 +/- 0 versus 0 +/- 0; p = NS) but improved significantly for robotic suturing (49 +/- 100 versus 141 +/- 152; p < 0.001). Moreover, subjects indicated on the NASA-TLX scale that the task was more difficult to perform with laparoscopic instruments compared with robotic assistance (99 +/- 15 versus 57 +/- 23; p < 0.001).Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing performance and safety of novices in the operating room while decreasing their workload. Moreover, the robot significantly shortened the learning curve of this difficult task. Further study is needed to assess the value of robotic assistance for experienced surgeons, and validated robotic training curricula need to be developed.

    View details for DOI 10.1007/s00464-009-0578-0

    View details for Web of Science ID 000274141400016

    View details for PubMedID 19536599

  • A call for the utilization of consensus standards in the surgical education literature Korndorffer, J. R., Kasten, S. J., Downing, S. M. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2010: 99–104


    Assessment methods and theory continue to evolve in the general education literature. Nowhere is this more evident than in the framework of validity methods and concepts. The consensus standards of the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education have changed from "types of validity" (criterion, construct, and content) and "valid instruments," last used in 1974, to a concept of identifying evidence for the validity of results and the use of those results. The purpose of this study was to evaluate the surgical education literature for the adoption of the current consensus standards.As a representative sample of the surgical educational literature, the validation effort in laparoscopic simulator education was chosen. A MEDLINE search using the terms and laparoscop$.tw between 1996 and 2008 (September week 1) yielded 192 citations. All titles and abstracts were reviewed, resulting in 47 studies appropriate for in-depth analysis.Validation studies have evaluated 21 different simulators. Twenty-three percent of the studies adhere, in part, to the new consensus standards for validity. One hundred percent use the old framework of types of validity including 75% using construct validity, 38% using face validity, and 11% using content.The widespread use of the currently (after 1999) accepted framework for validity is lacking in the surgical education literature. Surgical educators must remain current and begin to investigate our assessments within the contemporary framework of validity to avoid improper judgments of performance.

    View details for PubMedID 20103073

  • Do Metrics Matter? Time Versus Motion Tracking for Performance Assessment of Proficiency-Based Laparoscopic Skills Training SIMULATION IN HEALTHCARE Stefanidis, D., Scott, D. J., Korndorffer, J. R. 2009; 4 (2): 104–8


    The purpose of this study was to compare the added value of motion metrics in determining training completion during a proficiency-based simulator curriculum compared with traditional metrics (time).Novices (n=16) practiced on a basic laparoscopic task of a hybrid simulator until expert-derived proficiency levels for time, path length, and smoothness were achieved on two consecutive attempts. The order by which proficiency in each metric was achieved was recorded and correlated to baseline characteristics. Motion metrics were considered valuable if their incorporation led to extension of training duration.Compared with baseline participant performance improved at training completion according to all metrics (time 67+/-17 to 20+/-6 seconds; P<0.001, pathlength 5326+/-1444 to 2339+/-545 cm; P<0.001, and smoothness from 529+/-185 to 133+/-59; P<0.001). Pathlength was the easiest metric to reach the proficiency level and time the most difficult. Four (33%) participants benefited from the motion metrics as their training was prolonged by an average of 50% compared with using time alone. Baseline characteristics did not correlate to the order of achievement of these metrics.Time may be superior to motion tracking metrics for performance assessment during proficiency-based simulator training. Nevertheless, in this study one third of trainees benefited from motion analysis metrics by having their training duration extended. Further study is needed to establish the value of motion metrics during simulator training and their impact on operating room performance improvement.

    View details for DOI 10.1097/SIH.0b013e31819171ec

    View details for Web of Science ID 000277049900007

    View details for PubMedID 19444048

  • Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention. Journal of the American College of Surgeons Stefanidis, D., Korndorffer, J. R., Markley, S., Sierra, R., Scott, D. J. 2006; 202 (4): 599-603


    Proficiency-based training in laparoscopic suturing and knot tying translates to the operating room, but little is known about the durability of acquired skill. The purpose of this study was to determine the effect of maintenance training on skill retention after demonstration of proficiency.Medical students (n=18) with no previous laparoscopic or simulator experience were enrolled in an IRB-approved randomized controlled trial. All subjects trained to proficiency (score of 512, based on time and errors) on a previously validated suturing model (Fundamentals of Laparoscopic Surgery videotrainer). Subjects were then randomized to a control group, which received no additional training, and an ongoing training group, which trained again to proficiency at 1 and 3 months (immediately after testing). Simulator testing was repeated at 2 weeks, 1 month, 3 months, and 6 months after initial training. No subject had interval operative experience.Both groups demonstrated excellent skill retention during followup; performance scores, reported as means+/-SD, were 488+/-57 versus 482+/-55 at 2 weeks (p=ns), 483+/-81 versus 491+/-64 at 1 month (p=ns), 467+/-75 versus 470+/-67 at 3 months (p=ns), and 462+/-62 versus 492+/-43 at 6 months (p=0.02) for the control versus ongoing training groups, respectively. At 6 months, the ongoing training group showed better skill retention (95% versus 90%; p=0.02) and a trend for achieving the proficiency level (33% versus 18%; p=0.2) more often than the control group.Although proficiency-based training results in excellent skill retention, ongoing training substantially enhances performance and minimizes skill loss. Curricula should incorporate training that fosters maintenance of proficiency.

    View details for DOI 10.1016/j.jamcollsurg.2005.12.018

    View details for PubMedID 16571429

  • Intensive continuing medical education course training on simulators results in proficiency for laparoscopic suturing. American journal of surgery Stefanidis, D., Sierra, R., Korndorffer, J. R., Dunne, J. B., Markley, S., Touchard, C. L., Scott, D. J. 2006; 191 (1): 23-7


    The purpose of this study was to determine the feasibility and effectiveness of implementing a validated suturing curriculum as a free-standing continuing medical education (CME) course.Eighteen participants (9 practicing surgeons, 9 surgery residents) attended a 4-hour laparoscopic suturing CME course. After viewing an instructional videotape all participants had their baseline performance measured on a fundamentals of laparoscopic surgery-type videotrainer suture model. Participants then practiced on the model with active instruction from 6 proctors until a previously reported proficiency level was achieved or until the course ended. Performance was scored objectively based on time and errors. Precourse and postcourse questionnaires were collected.Participants trained for 2.6 +/- .8 hours and performed 37 +/- 11 repetitions. Although no participant was proficient at baseline, 72% achieved the proficiency level by the end of the course. Participants showed 44% improvement in objective scores and 34% improvement according to subjective self-rating.Although 4 hours may be insufficient for some trainees, an intensive half-day CME course is feasible and effective in significantly improving performance and allowing the majority of participants to achieve proficiency.

    View details for DOI 10.1016/j.amjsurg.2005.06.046

    View details for PubMedID 16399101

  • Multicenter construct validity for southwestern laparoscopic videotrainer stations. The Journal of surgical research Korndorffer, J. R., Clayton, J. L., Tesfay, S. T., Brunner, W. C., Sierra, R., Dunne, J. B., Jones, D. B., Rege, R. V., Touchard, C. L., Scott, D. J. 2005; 128 (1): 114-9


    The "Southwestern" videotrainer stations have demonstrated concurrent validity (transferability to the operating room). The purpose of this study was to evaluate the Southwestern stations for construct validity (the ability to discriminate between subjects at different levels of experience).From two surgical training programs, Institutional Review Board approved protocol data were collected from 142 subjects, including novice (medical students and R1, n = 66), intermediate (R2-R4, n = 67), and advanced (R5 and expert surgeons, n = 9) groups. All participants performed three repetitions on each of five stations. Completion time was scored for each task. Laparoscopic experience was determined from residency case log databases and from expert surgeon personal case logs. Results for the three groups were compared using one-way ANOVA, including relevant pair-wise comparisons. Correlations between number of laparoscopic cases performed and task scores were determined by Pearson's and Spearman's rho-correlation coefficients.The mean number of laparoscopic cases performed prior to completing the five tasks was 0 for novices, 9 for intermediates, and 431 for the advanced group. Significant differences (P < 0.001) were noted between groups for all five tasks and composite score. Task scores and composite scores significantly correlated with laparoscopic experience (P < 0.01).These data suggest that differences in laparoscopic ability are detected by performance on the videotrainer; thus, construct validity is demonstrated. Moreover, scores accurately reflect laparoscopic experience. Further validation may allow such simulators to be used for testing and credentialing purposes.

    View details for DOI 10.1016/j.jss.2005.03.014

    View details for PubMedID 15916767

  • Skill retention following proficiency-based laparoscopic simulator training. Surgery Stefanidis, D., Korndorffer, J. R., Sierra, R., Touchard, C., Dunne, J. B., Scott, D. J. 2005; 138 (2): 165-70


    Proficiency-based curricula using both virtual reality (VR) and videotrainer (VT) simulators have proven to be efficient and maximally effective, but little is known about the retention of acquired skills. The purpose of this study was to assess skill retention after completion of a validated laparoscopic skills curriculum.Surgery residents (n=14) with no previous VR or VT experience were enrolled in an Institutional Review Board-approved protocol and sequentially practiced 12 Minimally Invasive Surgical Trainer-VR and 5 VT tasks until proficiency levels were achieved. One VR (manipulate diathermy) and 1 VT (bean drop) tasks were selected for assessment at baseline, after training completion (posttest), and at retention.All residents completed the curriculum. Posttest assessment occurred at 13.2 +/- 11.8 days and retention assessment at 7.0 +/- 4.0 months. After an early performance decrement at posttest (17%-45%), the acquired skill was maintained up to the end of the follow-up period. For VR, scores were 81.5 +/- 23.5 at baseline, 33.3 +/- 1.8 at proficiency, 48.4 +/- 9.2 at posttest, and 48.4 +/- 11.8 at retention. For VT, scores were 49.4 +/- 12.5 at baseline, 22.0 +/- 1.4 at proficiency, 25.6 +/- 3.6 at posttest, and 26.4 +/- 4.2 at retention. Skill retention was better for VT, compared with VR (P < .02). The extent of skill deterioration did not correlate with training duration or resident level.Although residents do not retain all acquired skills (more so for VR than for VT) according to simulator assessment, proficiency-based training on simulators results in durable skills. Additional studies are warranted to further optimize curriculum design, investigate simulator differences, and establish training methods that improve skill retention.

    View details for DOI 10.1016/j.surg.2005.06.002

    View details for PubMedID 16153423

  • Simulator training for laparoscopic suturing using performance goals translates to the operating room. Journal of the American College of Surgeons Korndorffer, J. R., Dunne, J. B., Sierra, R., Stefanidis, D., Touchard, C. L., Scott, D. J. 2005; 201 (1): 23-9


    The purpose of this study was to develop a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness (transferability) of the curriculum.Surgical residents (PGY1 to PGY5, n = 17) proficient in basic skills, but with minimal laparoscopic suturing experience, were enrolled in an IRB-approved, randomized controlled protocol. Subjects viewed an instructional video and were pretested on a live porcine laparoscopic Nissen fundoplication model by placing three gastrogastric sutures tied in an intracorporeal fashion. A blinded rater objectively scored each knot based on a previously published formula (600 minus completion time [sec] minus penalties for accuracy and knot integrity errors). Subjects were stratified according to pretest scores and randomized. The trained group practiced on a videotrainer suturing model until an expert-derived proficiency score (512) was achieved on 12 attempts. The control group received no training. Both the trained and control groups were posttested on the porcine Nissen model.For the training group, mean time to demonstrate simulator proficiency was 151 minutes (range 107 to 224 minutes) and mean number of attempts was 37 (range 24 to 51 attempts). Both the trained and control groups demonstrated significant improvement in overall score from baseline. But the trained group performed significantly better than the control group at posttesting (389 +/- 70 versus 217 +/- 140, p < 0.001), confirming curriculum effectiveness.These data suggest that training to a predetermined expert level on a videotrainer suture model provides trainees with skills that translate into improved operative performance. Such curricula should be further developed and implemented as a means of ensuring proficiency.

    View details for DOI 10.1016/j.jamcollsurg.2005.02.021

    View details for PubMedID 15978440

  • Robotic Laparoscopic Fundoplication. Current treatment options in gastroenterology Stefanidis, D., Korndorffer, J. R., Scott, D. J. 2005; 8 (1): 71-83


    Gastroesophageal reflux disease is a very common disorder, and both medical and surgical treatments have shown outstanding results. Whereas proton pump inhibitors are the mainstay of treatment, laparoscopic fundoplication has become a very attractive alternative due to its efficacy and low morbidity. There are defined patient categories that may benefit more from laparoscopy than medical therapy, but a conclusive comparison between the two is lacking. Robotic laparoscopic fundoplication can be performed safely without increased morbidity. Potential advantages include enhanced precision, improved dexterity, and remote telesurgical applications. Disadvantages include increased cost and prolonged operative times. Further studies and more long-term outcome data are needed to fully evaluate the procedure. Robotic surgery is currently in its infancy and not cost effective but has a very promising future. With further development of automatization and miniaturization features, robotic surgery may prove more efficient than conventional laparoscopy.

    View details for PubMedID 15625036

  • Development and transferability of a cost-effective laparoscopic camera navigation simulator. Surgical endoscopy Korndorffer, J. R., Hayes, D. J., Dunne, J. B., Sierra, R., Touchard, C. L., Markert, R. J., Scott, D. J. 2005; 19 (2): 161-7


    Laparoscopic camera navigation (LCN) is vital for the successful performance of laparoscopic operations, yet little time is spent on training. This study aimed to develop an inexpensive LCN simulator, to design a structured curriculum, and to determine the transferability of skills acquired.In this study, 0 degrees and 30 degrees LCN simulators were developed for use on a videotrainer platform. Transferability was tested by enrolling 20 medical students in an institutional review board-approved, randomized, controlled, blinded protocol. Subjects viewed a video tutorial and were pretested in LCN on a porcine Nissen model. Procedures were videotaped and the LCN performance was scored by a blinded rater according to the number of standardized verbal cues required and the percentage of time an optimal surgical view (%OSV) was obtained. Procedure time also was recorded. Subjects were stratified and randomized. The trained group practiced on the LCN simulator until competency was demonstrated. The control group received no training. Both groups were posttested on the porcine Nissen model.The constructed simulators required 35 man hours for development, cost $25 per board for materials, and proved to be durable. The trained group demonstrated significant improvement in verbal cues (p = 0.001), %OSV (p < 0.001), and procedure time (p = 0.001), whereas the control group showed improvement only in verbal cues (p < 0.02). At posttesting, the training group demonstrated significantly better scores for verbal cues (2.1 vs 8.0; p = 0.02) and %OSV (64% vs 45% p = 0.01) than the control group.These data suggest that the LCN simulator is cost effective and provides trainees with skills that translate to the operating room.

    View details for DOI 10.1007/s00464-004-8901-2

    View details for PubMedID 15624054

  • Determining standards for laparoscopic proficiency using virtual reality. The American surgeon Brunner, W. C., Korndorffer, J. R., Sierra, R., Dunne, J. B., Yau, C. L., Corsetti, R. L., Slakey, D. P., Townsend, M. C., Scott, D. J. 2005; 71 (1): 29-35


    Laparoscopic training using virtual reality has proven effective, but rates of skill acquisition vary widely. We hypothesize that training to predetermined expert levels may more efficiently establish proficiency. Our purpose was to determine expert levels for performance-based training. Four surgeons established as laparoscopic experts performed 11 repetitions of 12 tasks. One surgeon (EXP-1) had extensive Minimally Invasive Surgical Trainer-Virtual Reality (MIST VR) exposure and formal laparoscopic fellowship training. Trimmed mean scores for each were determined as expert levels. A composite score (EXP-C) was defined as the average of all four expert levels. Thirty-seven surgery residents without prior MIST VR exposure and two research residents with extensive MIST VR exposure completed three repetitions of each task to determine baseline performance. Scores for EXP-1 and EXP-C were plotted against the best score of each participant. On average, the EXP-C level was reached or exceeded by 7 of the 37 (19%) residents. In contrast, the EXP-1 level was reached or exceeded by 1 of 37 (3%) residents and both research residents on all tasks. These data suggest the EXP-C level may be too lenient, whereas the EXP-1 level is more challenging and should result in adequate skill acquisition. Such standards should be further developed and integrated into surgical education.

    View details for PubMedID 15757053

  • Developing and testing competency levels for laparoscopic skills training. Archives of surgery (Chicago, Ill. : 1960) Korndorffer, J. R., Scott, D. J., Sierra, R., Brunner, W. C., Dunne, J. B., Slakey, D. P., Townsend, M. C., Hewitt, R. L. 2005; 140 (1): 80-4


    Expert levels can be developed for use as training end points for a basic video-trainer skills curriculum, and the levels developed will be suitable for training.Fifty subjects with minimal prior simulator exposure were enrolled using an institutional review board-approved protocol. As a measure of baseline performance, medical students (n = 11) and surgery residents (n = 39) completed 3 trials on each of 5 validated video-trainer tasks. Four board-certified surgeons established as laparoscopic experts (with more than 250 basic and more than 50 advanced cases) performed 11 trials on each of the 5 tasks. The mean score was determined and outliers (>2 SDs) were trimmed; the trimmed mean was used as the competency level. Baseline performance of each subject was compared with the competency level for each task.All research was performed in a laparoscopic skills training and simulation laboratory.Medical students, surgical residents, and board-certified surgeons.Expert scores based on completion time and the number of subjects achieving these scores at baseline testing.For all tasks combined, the competency level was reached by 6% of subjects by the third trial; 73% of these subjects were chief residents, and none were medical students.These data suggest that the competency level is suitably challenging for novices but is achievable for subjects with more experience. Implementation of this performance criterion may allow trainees to reliably achieve maximal benefit while minimizing unnecessary training.

    View details for DOI 10.1001/archsurg.140.1.80

    View details for PubMedID 15655210

  • Laparoscopic virtual reality training: are 30 repetitions enough? The Journal of surgical research Brunner, W. C., Korndorffer, J. R., Sierra, R., Massarweh, N. N., Dunne, J. B., Yau, C. L., Scott, D. J. 2004; 122 (2): 150-6


    Current literature suggests that novices reach a plateau after two to seven trials when training on the MIST VR laparoscopic virtual reality system. We hypothesize that significant benefit may be gained through additional training.Second-year medical students (n = 12) voluntarily enrolled under an IRB-approved protocol for MIST VR training. All subjects completed pre- and posttraining questionnaires and performed 30 repetitions of 12 tasks. Performance data were automatically recorded for each trial. Learning curves for each task were generated by fitting spline curves to the mean overall scores for each repetition. Scores were assessed for plateaus by repeated measures, slope, and best score.On average, subjects completed training in 7.1 h. (range, 5.9-9.2). Two to seven performance plateaus were identified for each of the 12 MIST VR tasks. Initial plateaus were found for all tasks by the 8th repetition; however, ultimate plateaus were not reached until 21-29 repetitions. Overall best score was reached between 20 and 30 repetitions and occurred beyond the ultimate plateau for 9 tasks.These data indicate that a lengthy learning curve exists for novices and may be seen throughout 30 repetitions and possibly beyond. Performance plateaus may not reliably determine training endpoints. We conclude that a significant and variable amount of training may be required to achieve maximal benefit. Neither a predetermined training duration nor an arbitrary number of repetitions may be adequate to ensure laparoscopic proficiency following simulator training. Standards which define performance-based endpoints should be established.

    View details for DOI 10.1016/j.jss.2004.08.006

    View details for PubMedID 15555611