James Lau, MD, MHPE, FACS is a general surgeon who specializes in minimally invasive and bariatric surgery. Clinically he specializes in the treatment of achalasia, esophageal reflux, gastroparesis, morbid obesity, and abdominal wall hernias. He performs surgeries through a myriad of techniques including: laparoscopic, robotic, open, and endoscopic platforms. He has been active in medical education at two different institutions since 2004 and has been at Stanford since 2009. He was the associate program director for the surgery residency and is the medical student surgery core clerkship director at the Stanford School of Medicine. He created a simulation center and program for the Department of Surgery at the University of Nevada School of Medicine 12 years ago from the ground up. Upon his arrival to Stanford, he positioned the Goodman Surgical Education Center and the Education Fellowship to new heights of curricular and research rigor. He serves as a mentor for the surgical education fellows and is the champion for many medical education initiatives for the Department of Surgery at Stanford. Since becoming the Assistant Dean for Clerkship Education for the Stanford School of Medicine, he has made improving the educational environment for medical students and coordinating support and guidance for the struggling student his mission. Dr. Lau’s research interests have culminated into the creation, deployment, and assessment of interdisciplinary in-situ simulations in the Operating Room environment to improve patient safety through teamwork and communication. James completed his Master’s Degree in 2016 in Health Professions Education from the University of Illinois Chicago in order to better serve as an educational mentor for faculty, fellows, residents, and medical students. His passion is to empower others to reach their potential through teaching and mentorship especially through innovation in any form it takes.

Clinical Focus

  • Surgical Procedures, Minimally Invasive
  • Esophageal Reflux - LINX
  • Achalasia - POEM - Endoscopic Approach
  • Bariatric Surgery
  • Inguinal Hernias - Robotic, Laparoscopic, and Open
  • Abdominal Hernias - Robotic, Laparoscopic, and Open
  • Gastric Pacemaker for Gastroparesis
  • General Surgery
  • Gastrointestinal Surgery, Endoscopic
  • Esophageal Reflux
  • Hernias, Paraesophageal Hiatal
  • Esophageal Achalasia
  • Abdominal Hernias
  • Single Incision Laparoscopic Surgery
  • Gastric Bypass
  • Sleeve Gastrectomy
  • Trauma Surgery

Academic Appointments

Administrative Appointments

  • Assistant Dean for Clerkship Education, Stanford School of Medicine (2015 - Present)
  • Director, Stanford Surgery ACS Education Institute/Goodman Surgical Education Center, Stanford Department of Surgery (2011 - Present)
  • Director, Surgical Education Fellowship, Stanford Department of Surgery (2011 - Present)
  • Director, Core Clerkship in Surgery, Stanford School of Medicine (2011 - Present)

Honors & Awards

  • Associate Member, Academy of Master Surgeon Educators, American College of Surgeons (2018)
  • Outstanding Community-Engaged Faculty Award - 17th Annual Stanford Community Health Symposium, Office of Community Engagement, Stanford School of Medicine (2019)
  • John Austin Collins, MD Memorial Teaching Award, Department of Surgery, Stanford School of Medicine (2018)
  • Award for Excellence in Promotion of Humanism, Stanford School of Medicine (2018)
  • Arthur L. Bloomfield Award in Recognition of Excellence in the Teaching of Clinical Medicine, Stanford School of Medicine (2018)
  • Membership in the Academy of Clerkship Directors in Surgery, Association for Surgical Education (2018)
  • 2016 Best Master's Health Professions Education Thesis, Department of Medical Education, University Of Illinois Chicago (2017)
  • The Alwin C. Rambar-James BD Mark Award for Excellence in Patient Care, Stanford School of Medicine (2017)
  • 2016 – Surgery Chief Residents’ Award, Department of Surgery, Stanford School of Medicine (2016)
  • Franklin G. Ebaugh, Jr. Award for Excellence in Advising Medical Students, Stanford School of Medicine (2016)
  • 2015 Phillip J. Wolfson Outstanding Teacher Award, Association for Surgical Education (2015)
  • Award for Excellence in the Promotion of the Learning Environment and Student Wellness, Stanford School of Medicine (2014)
  • Henry J. Kaiser Family Foundation Teaching Award for Clerkship Instruction, Stanford School of Medicine (2014)
  • John Austin Collins, MD Memorial Teaching Award, Department of Surgery, Stanford School of Medicine (2012)
  • John Austin Collins, MD Memorial Teaching Award, Department of Surgery, Stanford School of Medicine (2010)
  • Poster of Distinction, SAGES Annual Meeting at Las Vegas, Nevada (2007)
  • Faculty Teaching Award, Department of Surgery at University of Nevada School of Medicine, Las Vegas, Nevada (2006)
  • Special Recognition for Teaching, Department of Surgery at University of Nevada School of Medicine, Las Vegas, Nevada (2005)
  • Meritorious Service Medal, United States Air Force (2003)
  • Surgical Socrates Award, Department of Surgery Indiana University Medical Center Indianapolis, Indiana (2002)

Boards, Advisory Committees, Professional Organizations

  • Bariatric Surgery Training Committee, American Society of Bariatric and Metabolic Surgery (2014 - Present)
  • Associate Program Director Committee, Association for Program Directors in Surgery (2016 - Present)
  • Surgery Clerkship Committee, Association for Surgical Education (2012 - Present)
  • Curriculum Committee Member, American College of Surgeons Education Institutes (ACS-EI) (2012 - Present)

Professional Education

  • Master's Degree, University of Illinois Chicago, Health Professions Education (2016)
  • Fellowship: Stanford University Medical Center (2007) CA
  • Board Certification: General Surgery, American Board of Surgery (2003)
  • Residency: Indiana University Medical Center GME Verifications (2002) IN
  • Internship: Loyola University Medical Center (1996) IL
  • Medical Education: Loyola Univ Of Chicago Stritch (1995) IL
  • Bachelor's Degree, University of CA, San Diego, Bio-Engineering (1990)

Community and International Work

  • Healthy Connections Pre-Medical Student Volunteer Program, Webster House Health Center


    Clinical Exposure to Pre-Health Volunteers

    Partnering Organization(s)

    Webster House Health Center

    Populations Served

    Geriatric and Skilled Nursing Facility Residents


    Bay Area

    Ongoing Project


    Opportunities for Student Involvement


  • Healthy Options for Prevention and Education, Las Vegas, Nevada


    Childhood Obesity Prevention

    Partnering Organization(s)

    University of Nevada School of Medicine

    Populations Served

    Economically Disadvantaged/Hispanic

    Ongoing Project


    Opportunities for Student Involvement



  • Christopher Stevens Pell, Bryan J. Duggan, Hattie Zhi Chen Dong, Thomas Ruby, John Avi Roop, Jonathan B. Ticker, James N. Lau, Kevin Chao. "United States Patent 9861272 Apparatus, sustems, and methods for performing laparoscopic surgery", The Board of Trustess of the Leland Stanford Junior University, Jan 9, 2018

Current Research and Scholarly Interests

We live in an exciting time of new techniques in minimal surgical access. These techniques are being practiced in basic as well as more advanced general surgical procedures. Controlled studies of outcomes comparing standard approaches to these newer ones are the only way to validate these evolving and possibly less painful and less morbid open techniques.

The education of surgeons has been changing from a mentorship skills acquisition model towards a simulation first approach. The variety of methods to convey medical knowledge and technical prowess must be honed to provide the future surgeons with the most effective education in a world with more time constraints. Studies that explore new ways to improve standard education of surgical residents as well as novel approaches to teaching technical, team dynamics, and crisis management skills are essential toward the goal of producing a caring and skilled physician.

The educational environment for medical students and residents has changed. Because of this, a more comprehensive and systematic inter-disciplinary approach is essential to adapt to the learning styles of modern trainees. Programs of education must be innovative in scope and practice. Evaluation of novel programs qualitatively and quantitatively ensure these robust curricula accomplish the task of conveying knowledge and skills efficiently.

Teamwork and communication remain important, yet under emphasized, concepts in our complex clinical practices. Superior patient care as shown by improved outcomes are the result of interdisciplinary team training. Promoting this behavioral culture in large tertiary institutions require new educational methods. Simulation training, as part of a comprehensive large scale blended learning model cross disciplines can yield improved patient care outcomes. Studies to prove this are necessary in program implementation through maintenance.

Clinical Trials

  • Device to Assist With Abdominal Access During Laparoscopic Surgery Not Recruiting

    The purpose of this study is to assess the safety and ease of use of a trocar placement access device (TPAD) to assist with obtaining peritoneal access with a Veress needle, and for placing a primary trocar, during laparoscopic surgery.

    Stanford is currently not accepting patients for this trial. For more information, please contact Study Team, 650-736-2776.

    View full details


  • InterCEPT - Interprofessional Communicaion Education Project in Teamwork, Stanford Health Care

    Monthly interprofessional in-situ simulation and debriefs as team training in the Stanford main operating room and ambulatory surgery center as part of standard work. Patient Safety, quality improvement, and culture change.


    300 pasteur drive stanford ca

All Publications

  • Preclinical Surgical Preparatory Course and the NRMP Match: Early Exposure and Surgical Recruitment a 10-Year Follow-Up. Journal of surgical education Anderson, T. N., Shi, R., Schmiederer, I. S., Miller, S. E., Lee, E. W., Hasty, B. N., Lin, D. T., Lau, J. N. 2020


    OBJECTIVE: Many medical students mentally commit to specialties prior to entering clerkships. This is why early preclinical interactions with surgical specialties, through mentorship and/or interest groups, increases the opportunity to nurture enthusiasm for surgery. In 2007, a course providing preclinical medical students with introductory surgical skills training and preparation for the surgical environment ("SURG205") was established at our institution. The course underwent a major revision in 2016, increasing intraoperative mentorship by matching students to surgical attendings and requiring students to scrub into operative cases together. We anticipate that the positive surgical experiences created by the course will lead to further development and enhancement of student interest in surgical specialties-interest that we hypothesized would reflect in their National Resident Matching Program (NRMP) Match outcomes.DESIGN: NRMP results from 2010 to 2019 were cross-referenced with a database of students who participated in the SURG205 course from 2007 to 2016. With this, we examined the correlation between student participation in SURG205 and surgical specialty match. Descriptive statistics were used to review the trends of the NRMP results, and Pearson's correlation was used to determine the relationship and its significance.SETTING: This study was conducted in a single private medical school in California.PARTICIPANTS: Specialties considered "surgical" included: General Surgery, integrated programs-such as Plastic, Thoracic, or Vascular surgery, Obstetrics and Gynecology, Orthopedic Surgery, Otolaryngology, Neurosurgery, and Urology. All other specialties were considered nonsurgical. Students identified as having participated in SURG205 and who then also took part in the NRMP.RESULTS: Seven hundred eighty students underwent the Match process from 2010 to 2019. 144 (18.5%) of these students participated in SURG205 between 2007 and 2016. Each Match class ranged in size from 62 to 91 (median = 77.5, IQR = 14.5) students. (Table 1) Two-hundred and nineteen students (28.1%) matched into a surgical specialty, of which 34 (15.5%) selected general surgery. From 2010 to 2019 the rate of students who matched into surgical specialties averaged 28.1% per year with a slight nonstatistically significantly increasing trend over that time period R2 = 0.30 (p = 0.09; Fig. 1). There was a significant increase in trend in proportion of students who took the course and matched into any specialty between 2010 and 2019 (R2 = 0.85, p = 0.0002; Fig. 2). And, there was a statistically significant positive relationship between students taking the course and matching into a surgical specialty (R2 = 0.63, p = 0.01; Fig. 3).CONCLUSION: Our results highlight the increasing tendency of students who pursue surgical specialties having previously participated in this early exposure courses. Not only is student interest created and encouraged through positive mentorship experiences, but that interest may be associated with increases in application rates and eventual match into the specialty. General surgery training programs might consider these trends when designing courses to ease transitions into first-year residency positions-such as fourth-year surgical boot camps, surgical procedure-based anatomy courses, and mentorship frameworks. This information further justifies the cost and time commitment required to administer these programs for students.

    View details for DOI 10.1016/j.jsurg.2020.05.016

    View details for PubMedID 32522563

  • Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience. Surgical endoscopy Podboy, A. J., Hwang, J. H., Rivas, H., Azagury, D., Hawn, M., Lau, J., Kamal, A., Friedland, S., Triadafilopoulos, G., Zikos, T., Clarke, J. O. 2020


    INTRODUCTION: Many centers have reported excellent short-term efficacy of per-oral endoscopic myotomy (POEM) for the treatment of achalasia. However, long-term data are limited and there are few studies comparing the efficacy of POEM versus Heller Myotomy (HM).AIMS: To compare the long-term clinical efficacy of POEM versus HM.METHODS: Using a retrospective, parallel cohort design, all cases of POEM or HM for achalasia between 2010 and 2015 were assessed. Clinical failure was defined as (a) Eckardt Score>3 for at least 4weeks, (b) achalasia-related hospitalization, or (c) repeat intervention. All index manometries were classified via Chicago Classification v3. Pre-procedural clinical, manometric, radiographic data, and procedural data were reviewed.RESULTS: 98 patients were identified (55 POEM, 43 Heller) with mean follow-up of 3.94years, and 5.44years, respectively. 83.7% of HM patients underwent associated anti-reflux wrap (Toupet or Dor). Baseline clinical, demographic, radiographic, and manometric data were similar between the groups. There was no statistical difference in overall long-term success (POEM 72.7%, HM 65.1% p=0.417, although higher rates of success were seen in Type III Achalasia in POEM vs Heller (53.3% vs 44.4%, p<0.05). Type III Achalasia was the only variable associated with failure on a univariate COX analysis and no covariants were identified on a multivariate Cox regression. There was no statistical difference in GERD symptoms, esophagitis, or major procedural complications.CONCLUSION: POEM and HM have similar long-term (4-year) efficacy with similar adverse event and reflux rates. POEM was associated with greater efficacy in Type III Achalasia.

    View details for DOI 10.1007/s00464-020-07450-6

    View details for PubMedID 32157405

  • Paraesophageal Hernia Repair and Fundoplication. JAMA Baiu, I., Lau, J. 2019; 322 (24): 2450

    View details for DOI 10.1001/jama.2019.17390

    View details for PubMedID 31860048

  • What Is a Paraesophageal Hernia? JAMA Baiu, I., Lau, J. 2019; 322 (21): 2146

    View details for DOI 10.1001/jama.2019.17395

    View details for PubMedID 31794626

  • 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
  • Flipping the Boot Camp: A Multidisciplinary Curriculum for Incoming Interns Lee, E. W., Sapp, R. W., Mazer, L. M., Merrell, S., Lau, J. N., Lin, D. T. ELSEVIER SCIENCE INC. 2019: E184
  • Indolent In Situ B-Cell Neoplasms With MYC Rearrangements Show Somatic Mutations in MYC and TNFRSF14 by Next-generation Sequencing. The American journal of surgical pathology Kumar, J., Butzmann, A., Wu, S., Easly, S., Zehnder, J. L., Warnke, R. A., Bangs, C. D., Jangam, D., Cherry, A., Lau, J., Nybakken, G., Ohgami, R. S. 2019


    Systemic high-grade B-cell lymphomas (HGBCLs) with MYC gene rearrangements are clinically aggressive. In situ lesions with indolent behavior have not been described to date. We have identified 2 cases of in situ B-cell neoplasms with MYC rearrangements (IS-BCN, MYC) occurring, and focally confined to ≤4 lymphoid follicles in otherwise healthy individuals and without clinical progression despite minimal intervention (surgical only). Morphologically similar to systemic HGBCLs, the low power view of these lesions showed a starry sky pattern with numerous mitotic figures. High power imaging demonstrated these cells to be medium-large in size with irregular nuclear contours, immature chromatin, and prominent nucleoli. Immunophenotypically these cells were light chain restricted, positive for CD20, CD10, c-Myc, and dim or negative for BCL2 with a Ki67 proliferative index of >95%. By fluorescence in situ hybridization studies, we detected MYC translocations in these cells but no rearrangements in BCL2 or BCL6. Microdissection of neoplastic cells in these patients followed by targeted next-generation sequencing identified a mutation in MYC, D2N, and an indel in TNFRSF14. Mutations in ID3 or TCF3 were not identified. Although rare, these lesions should be separated from HGBCLs involving follicles but with systemic spread which has been previously described. Unlike systemic lymphomas with MYC gene rearrangements, these in situ B-cell neoplasms with MYC rearrangements did not require systemic therapy and no progression has been seen in either patient beyond 1 year (29 and 16mo). Our work offers pathologic and biologic insight into the early process of B-cell neoplasia.

    View details for DOI 10.1097/PAS.0000000000001338

    View details for PubMedID 31368914

  • Validity Evidence for a Knowledge Assessment Tool for a Mastery Learning Scrub Training Curriculum. Academic medicine : journal of the Association of American Medical Colleges Hasty, B. N., Lau, J. N., Tekian, A., Miller, S. E., Shipper, E. S., Bereknyei Merrell, S., Lee, E. W., Park, Y. S. 2019


    To examine the validity evidence for a scrub training knowledge assessment tool to demonstrate the utility and robustness of a multimodal, entrustable professional activity (EPA)-aligned, mastery learning scrub training curriculum.Validity evidence was collected for the knowledge assessment used in the scrub training curriculum at Stanford University School of Medicine from April 2017-June 2018. The knowledge assessment had 25 selected response items that mapped to curricular objectives, EPAs, and operating room policies. A mastery passing standard was established using the Mastery Angoff and Patient-Safety approaches. Learners were assessed pre-curriculum, post-curriculum, and 6 months after the curriculum.From April 2017-June 2018, 220 medical and physician assistant students participated in the scrub training curriculum. The mean pre- and post-curriculum knowledge scores were 74.4% (SD = 15.6) and 90.1% (SD = 8.3), respectively, yielding a Cohen's d = 1.10, P <.001. The internal reliability of the assessment was 0.71. Students with previous scrub training performed significantly better on the pre-curriculum knowledge assessment than those without previous training (81.9% [SD = 12.6] vs. 67.0% [SD = 14.9]; P <.001). The mean item difficulty was 0.74, and the mean item discrimination index was 0.35. The Mastery Angoff overall cut score was 92.0%.This study describes the administration of and provides validity evidence for a knowledge assessment tool for a multimodal, EPA-aligned, mastery-based curriculum for scrub training. The authors support the use of scores derived from this test for assessing scrub training knowledge among medical and physician assistant students.

    View details for DOI 10.1097/ACM.0000000000003007

    View details for PubMedID 31577588

  • Perception and confidence of medical students in informed consent: A core EPA. Surgery Anderson, T. N., Aalami, L. R., Lee, E. W., Merrell, S. B., Sgroi, M. D., Lin, D. T., Lau, J. N. 2019


    Informed consent discussions have been identified as a core entrustable professional activity for medical students by the Association of American Medical Colleges. Medical students, however, rarely receive formal instruction on how to appropriately conduct informed consent discussions before residency, resulting in inconsistent levels of experience and deficiencies in performance. This study explores medical students' understanding of the elements of informed consent discussions and their readiness to perform a comprehensive informed consent discussion.Using expert consensus, cognitive interviews, and piloting, we iteratively developed a 15-item survey aligned with entrustable professional activity guidelines concerning informed consent discussions consisting of multiple choice, free text, and 5-point Likert-type questions. The instrument covered domains of experience, confidence, medical-legal knowledge, and recall of informed consent discussion elements. The full survey was distributed anonymously to undergraduate medical students at our institution. An abbreviated survey was administered to postgraduate students who were new interns at our institution. Responses were analyzed quantitatively using descriptive statistics. The free text data were coded for inclusion in this analysis.A total of 75 undergraduate medical students across all years responded (response rate [RR] = 86%), and 34 (RR = 77%) of the postgraduate students who were new interns participated. A total of 45 (75%) undergraduate medical students reported no training on informed consent discussions, and 9 (15%) undergraduate medical students had never witnessed an informed consent discussion. The undergraduate medical students agreed that informed consent discussions could be legally performed by residents and advance practice providers but were unsure whether the same applied to medical students. On a 5-point scale (anchored to "Not at all," "Somewhat," and "Extremely"), they were "somewhat confident" in their ability to perform an informed consent discussion. When asked to list the 7 elements of an informed consent discussion, 2 undergraduate medical students (3%) were able to identify all the elements. Although 3 undergraduate medical students (9%) had experience leading an informed consent discussion and 11 (32%) reported formal instruction in informed consent, the ability (3.7 ± 0.9 standard deviation [SD]) of the postgraduate students who were new interns to recall the 7 elements was similar to that of the undergraduate medical students (3.4 ± 1.2 SD); P = .31.These findings suggest that undergraduate medical students and postgraduate students who are new interns are not confident or competent in their ability to perform an appropriate informed consent discussion. Our study findings support the creation of a needs-based, entrustable professional activity-aligned informed consent discussion teaching program and the need for an ongoing evaluation of the success of such a program.

    View details for DOI 10.1016/j.surg.2019.11.012

    View details for PubMedID 31879088

  • Service through surgery: A quasi-experimental comparison study on the impact of a preclinical seminar course on diverse mentorship and attitudes towards the underserved. American journal of surgery Steinberg, J. R., Bryant, T. S., Carroll, A. L., Marin-Nevarez, P., Lee, E. W., Anderson, T. N., Merrell, S. B., Lau, J. N. 2019


    Increased surgical workforce diversity diminishes health disparities.Researchers recruited and nonrandomly enrolled participants into intervention and comparison groups for a quasi-experimental study of the impact of a seminar course on student exposure to diverse mentorship and service through surgery. All metrics were analyzed with chi-squared and paired t-tests.109 students participated (34 intervention, 75 comparison). There were significant differences in the percentage of participants that newly met a surgeon of their race (intervention, comparison: 100%, 25%), their race and gender (80%, 21%), their religion (23%, 9%), and who completed health disparities research (90%, 45%, p-value for all <0.05). There was a nonsignificant change in participants' attitudes towards underserved populations in intervention and comparison groups.This preclinical surgery seminar course increased exposure of underrepresented students to surgeons from diverse backgrounds and may impact student attitudes towards the underserved. This class represents a replicable model for increasing mentorship.

    View details for DOI 10.1016/j.amjsurg.2019.07.031

    View details for PubMedID 31376950

  • Introductory Surgical Skills Course: Technical Training and Preparation for the Surgical Environment. MedEdPORTAL : the journal of teaching and learning resources Miller, S., Shipper, E., Hasty, B., Bereknyei Merrell, S., Lee, E. W., Lin, D., Lau, J. N. 2018; 14: 10775


    Introduction: Early exposure to surgery in a positive learning environment can contribute to increased student interest. The primary objectives of this study included developing increased comfort in the operating room (OR) environment, confidence in surgical skills, and mentorship for students interested in surgery.Methods: The course comprised seven 2-hour sessions covering both nontechnical and technical skills facilitated by attending and resident surgeons. Sessions included nontechnical skills training, basic knot tying and suturing, laparoscopic surgical skills, and high-fidelity operative simulations on animal and cadaver models. The curriculum also matched students with faculty mentors in order to scrub into operative cases. Surveys assessing self-reported comfort in the OR, confidence levels in surgical skills, and whether students had mentors in surgery were distributed before and after the course.Results: Thirty preclinical medical students were enrolled in the course in 2016 and an additional 41 students in 2017. Results showed increased confidence in all skills and in comfort in the OR, as well as increased surgeon mentorship. Thirty-two students who completed the course entered clinical rotations in 2018 and, when surveyed, reported increased confidence in the aforementioned domains and in their preparedness for their surgery clerkship, compared to 49 peers who had not completed the course.Discussion: The course successfully increased comfort in the OR, increased confidence in performing surgical skills, and provided students with mentors in surgery, all of which will hopefully foster positive experiences during their surgery clerkship and ultimately increase their consideration of surgery as a career.

    View details for PubMedID 30800975

  • Psychologist-Facilitated Group Sessions for Residents: A Worthwhile Investment? Lin, D. T., Qiu, W., Lai, C., Post, L. I., Merrell, S., Lau, J. N., Salles, A., Mueller, C. M. ELSEVIER SCIENCE INC. 2018: E53–E54
  • Medical Student Mistreatment: Coping Strategies and Resilience on the Surgery Clerkship Hasty, B. N., Merrell, S., Brandford, E. C., Lee, E. W., Lau, J. N. ELSEVIER SCIENCE INC. 2018: E207–E208
  • Emotional Intelligence as a Possible Safeguard to Surgeon Wellness Lee, E. W., Hasty, B. N., Lau, J. N., Merrell, S., Hawn, M. T., Shanafelt, T., Salles, A., Lin, D. T. ELSEVIER SCIENCE INC. 2018: S145
  • Surgeon Emotional Intelligence Is Strongly Correlated with Patient Satisfaction Lee, E. W., Hasty, B. N., Lau, J. N., Merrell, S., Hawn, M. T., Shanafelt, T., Salles, A., Lin, D. T. ELSEVIER SCIENCE INC. 2018: S164–S165
  • Social Belonging as a Predictor of Surgical Resident Well-being and Attrition. Journal of surgical education Salles, A., Wright, R. C., Milam, L., Panni, R. Z., Liebert, C. A., Lau, J. N., Lin, D. T., Mueller, C. M. 2018


    OBJECTIVE: In light of the predicted shortage of surgeons, attrition from surgical residency is a significant problem. Prior data have shown that those who are happier are more productive, and those who are less well have higher rates of absenteeism. This study sought to identify the role of social belonging and its relationship to well-being and risk of attrition.DESIGN: Surgical residents were invited to participate in an online survey containing measures of social belonging (a 10-item scale adapted from previous studies), well-being (the Dupuy Psychological General Well-Being Scale, Beck Depression Inventory Short Form, and Maslach Burnout Inventory), and risk of attrition (indicated by frequency of thoughts of leaving the program).SETTING: We surveyed residents at 2 tertiary care centers, Stanford Health Care (2010, 2011, and 2015) and Washington University in St. Louis (2017).PARTICIPANTS: Categorical general surgery residents, designated preliminary residents going into 7 surgical subspecialties, and nondesignated preliminary residents were included.RESULTS: One hundred sixty-nine residents responded to the survey for a response rate of 66%. Belonging was positively correlated with general psychological well-being (r = 0.56, p < 0.0001) and negatively correlated with depression (r = -0.57, p < 0.0001), emotional exhaustion (r = -0.58, p < 0.0001), and depersonalization (r = -0.36, p < 0.0001). Further, belonging was negatively correlated with frequency of thoughts of leaving residency (r = -0.45, p < 0.0001). In regression analysis controlling for demographic variables, belonging was a significant positive predictor of psychological well-being (B = 0.95, t = 8.18, p < 0.0001) and a significant negative predictor of thoughts of leaving (B = -1.04, t = -5.44, p < 0.0001).CONCLUSIONS: Social belonging has a significant positive correlation with well-being and negative correlation with thoughts of leaving surgical training. Lack of social belonging appears to be a significant predictor of risk of attrition in surgical residency. Efforts to enhance social belonging may protect against resident attrition.ACGME COMPETENCY: Interpersonal and Communication Skills.

    View details for DOI 10.1016/j.jsurg.2018.08.022

    View details for PubMedID 30243929

  • Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees JAMA NETWORK OPEN Mazer, L. M., Merrell, S., Hasty, B. N., Stave, C., Lau, J. N. 2018; 1 (3)
  • Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees. JAMA network open Mazer, L. M., Bereknyei Merrell, S., Hasty, B. N., Stave, C., Lau, J. N. 2018; 1 (3): e180870


    Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care.To document the published programmatic and curricular attempts to decrease the incidence of mistreatment.PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched. Comprehensive searches were run on "mistreatment" and "abuse of medical trainees" on all peer-reviewed publications until November 1, 2017.Citations were reviewed for descriptions of programs to decrease the incidence of mistreatment in a medical school or hospital with program evaluation data. A mistreatment program was defined as an educational effort to reduce the abuse, mistreatment, harassment, or discrimination of trainees. Studies of the incidence of mistreatment without description of a program, references to a mistreatment program without outcome data, or a program that has never been implemented were excluded.Authors independently reviewed all retrieved citations. Articles that any author found to meet inclusion criteria were included in a full-text review. The data extraction form was developed based on the guidelines for Best Evidence in Medical Education. An assessment of the study quality was conducted using a conceptual framework of 6 elements essential to the reporting of experimental studies in medical education.A descriptive review of the interventions and outcomes is presented along with an analysis of the methodological quality of the studies. A separate review of the MedEdPORTAL mistreatment curricula was conducted.Of 3347 citations identified, 10 studies met inclusion criteria. Of the programs included in the 10 studies, all were implemented in academic medical centers. Seven programs were in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The most common format was a combination of lectures, workshops, and seminars over a variable time period. Overall, quality of included studies was low and only 1 study included a conceptual framework. Outcomes were most often limited to participant survey data. The program outcome evaluations consisted primarily of surveys and reports of mistreatment. All of the included studies evaluated participant satisfaction, which was mostly qualitative. Seven studies also included the frequency of mistreatment reports; either surveys to assess perception of the frequency of mistreatment or the frequency of reports via official reporting channels. Five mistreatment program curricula from MedEdPORTAL were also identified; of these, only 2 presented outcome data.There are very few published programs attempting to address mistreatment of medical trainees. This review identifies a gap in the literature and provides advice for reporting on mistreatment programs.

    View details for PubMedID 30646041

  • A Call for Mixed Methods in Competency-Based Medical Education: How We Can Prevent the Overfitting of Curriculum and Assessment. Academic medicine : journal of the Association of American Medical Colleges Hoang, N. S., Lau, J. N. 2018


    Competency-based medical education (CBME) has been the subject of heated debate since its inception in medical education. Despite the many challenges and pitfalls of CBME that have been recognized by the medical education community, CBME is now seeing widespread implementation. However, the biggest problems with CBME still have not been solved. Two of these problems, reductionism and loss of authenticity, present major challenges when developing curricula and assessment tools.The authors address these problems by making a call for flexibility in competency definitions and for the use of mixed methods in CBME. First, they present the issue of reductionism and a similar concept from the field of data science, overfitting. Then they outline several solutions, both conceptual and concrete, to prevent undue reductionist tendencies in both competency definitions and in tools of assessment. Finally, they propose the re-introduction of qualitative methods to balance the historically quantitative emphasis of assessment in medical education.The authors maintain that mixed-methods assessment with multiple assessors in differing contexts can yield a more accurate representation of a medical trainee's skills and abilities, deter the loss of authenticity, and increase the willingness of medical educators to adopt a feasible form of CBME. Finally, they propose the deployment of dedicated faculty assessors and physician coaches (which will reduce training requirements for other faculty), as well as the use of formal qualitative tools of assessment alongside established quantitative tools, to encourage a truly mixed-method approach to assessment.

    View details for DOI 10.1097/ACM.0000000000002205

    View details for PubMedID 29517532

  • Determining the educational value of a technical and nontechnical skills medical student curriculum. The Journal of surgical research Shipper, E. S., Miller, S. E., Hasty, B. N., De La Cruz, M. M., Merrell, S. B., Lin, D. T., Lau, J. N. 2018; 225: 157–65


    Residency application rates to general surgery remain low. The purpose of this study is to describe the educational value of a curriculum designed to increase preclinical medical student interest in surgical careers to better understand the process by which medical students decide to pursue a career in surgery.We used qualitative methodology to describe the educational value of a technical and nontechnical skills curriculum offered to preclinical medical students at our institution. We conducted semistructured interviews of students and instructors who completed the curriculum in 2016. The interviews were recorded, transcribed, and inductively coded. The data were analyzed for emergent themes.A total of eight students and five instructors were interviewed. After analysis of 13 transcripts, four themes emerged: (1) The course provides a safe environment for learning, (2) acquisition and synthesis of basic technical skills increases preclinical student comfort in the operating room, (3) developing relationships with surgeons creates opportunities for extracurricular learning and scholarship, and (4) operative experiences can inspire students to explore a future career in surgery.These factors can help inform the design of future interventions to increase student interest, with the ultimate goal of increasing the number of students who apply to surgical residency programs.

    View details for PubMedID 29605027

  • Medical student perceptions of a mistreatment program during the surgery clerkship. American journal of surgery Hasty, B. N., Miller, S. E., Bereknyei Merrell, S., Lin, D. T., Shipper, E. S., Lau, J. N. 2018


    Medical student mistreatment remains a concern, particularly in the surgery clerkship. This is a single academic institution's report of medical student perceptions of a mistreatment program embedded in the surgery clerkship.Students who completed the surgery clerkship and the mistreatment program volunteered to be interviewed individually or in focus groups. The interviews were transcribed and qualitatively analyzed.Twenty-four medical students were interviewed and nine transcripts were obtained. Codes were identified independently then nested into four codes: Student Growth, Faculty Champion and Team, Student Perspectives on Surgical Culture, and Program Methods. Rank orders were then calculated for each major code.Our mistreatment program has shown that providing students with an opportunity to define mistreatment, a safe environment for them to debrief, and staff to support and advocate for them empowers them with the knowledge and skillset to confront what is too often considered part of the hidden curriculum.

    View details for PubMedID 29395030

  • Evaluating the Impact of Blinded vs Non-Blinded Interviews on the General Surgery Resident Selection Process Shipper, E. S., Forrester, J., Lau, J. N., Melcher, M. L. ELSEVIER SCIENCE INC. 2017: S174–S175
  • A Multi-Institutional, Qualitative Interview Study Investigating Attrition and Retention Resident Experiences Affecting the Decision to Complete General Surgery Training Shipper, E. S., Braverman, G., Brandford, E. C., Hasty, B., Mazer, L. M., Lin, D. T., Choi, J. N., Kissane-Lee, N. A., Baynosa, J., Lau, J. N. ELSEVIER SCIENCE INC. 2017: S170
  • Prevalence and predictors of depression among general surgery residents. American journal of surgery Lin, D. T., Liebert, C. A., Esquivel, M. M., Tran, J., Lau, J. N., Greco, R. S., Mueller, C. M., Salles, A. 2017; 213 (2): 313-317


    Recent resident suicides have highlighted the need to address depression among medical trainees. This study sought to identify the prevalence and predictors of depression among surgical residents.Surgical residents at a single institution were surveyed. Depression and personal traits were assessed using validated measures; participant demographics were also obtained.73 residents completed the survey (response rate 63%). 36% met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. In multivariate linear regression analyses controlling for demographic factors, trait emotional intelligence alone was a significant inverse predictor of depression (β = -0.60, p < 0.001).Depression is prevalent among general surgery residents. Identifying protective factors and at-risk populations may allow for effective initiatives to be developed to address depression, and optimize the mental health of trainees.The aim of this study is to identify the prevalence and predictors of depression among surgical trainees. Over one third of respondents met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. Among demographic and personal trait variables, emotional intelligence emerged as a significant inverse predictor of depression.

    View details for DOI 10.1016/j.amjsurg.2016.10.017

    View details for PubMedID 28017297

  • Grit as a predictor of risk of attrition in surgical residency. American journal of surgery Salles, A., Lin, D., Liebert, C., Esquivel, M., Lau, J. N., Greco, R. S., Mueller, C. 2017; 213 (2): 288-291


    Grit, a measure of perseverance, has been shown to predict resident well-being. In this study we assess the relationship between grit and attrition.We collected survey data from residents in a single institution over two consecutive years. All residents in general surgery were invited to participate (N = 115). Grit and psychological well-being were assessed using validated measures. Risk of attrition was measured using survey items.73 residents participated (63% response rate). Grit was positively correlated with general psychological well-being (r = 0.30, p < 0.05) and inversely correlated with depression (r = -0.25, p < 0.05) and risk of attrition (r = -0.37, p < 0.01). In regression analyses, grit was positively predictive of well-being (B = 0.77, t = 2.96, p < 0.01) and negatively predictive of depression (B = -0.28 t = -2.74, p < 0.01) and attrition (B = -0.99, t = -2.53, p < 0.05).Attrition is a costly and disruptive problem in residency. Grit is a quick, reliable measure which appears to be predictive of attrition risk in this single-institution study.

    View details for DOI 10.1016/j.amjsurg.2016.10.012

    View details for PubMedID 27932088

  • A Mixed-Methods Analysis of a Novel Mistreatment Program for the Surgery Core Clerkship. Academic medicine Lau, J. N., Mazer, L. M., Liebert, C. A., Merrell, S. B., Lin, D. T., Harris, I. 2017


    To review mistreatment reports from before and after implementation of a mistreatment program, and student ratings of and qualitative responses to the program to evaluate the short-term impact on students.In January 2014, a video- and discussion-based mistreatment program was implemented for the surgery clerkship at the Stanford University School of Medicine. The program aims to help students establish expectations for the learning environment; create a shared and personal definition of mistreatment; and promote advocacy and empowerment to address mistreatment. Counts and types of mistreatment were compared from a year before (January-December 2013) and two years after (January 2014-December 2015) implementation. Students' end-of-clerkship ratings and responses to open-ended questions were analyzed.From March 2014-December 2015, 141/164 (86%) students completed ratings, and all 47 (100%) students enrolled from January-August 2014 provided qualitative program evaluations. Most students rated the initial (108/141 [77%]) and final (120/141 [85%]) sessions as excellent or outstanding. In the qualitative analysis, students valued that the program helped establish expectations; allowed for sharing experiences; provided formal resources; and provided a supportive environment. Students felt the learning environment and culture were improved and reported increased interest in surgery. There were 14 mistreatment reports the year before the program, 9 in the program's first year, and 4 in the second year.The authors found a rotation-specific mistreatment program, focused on creating shared understanding about mistreatment, was well received among surgery clerkship students, and the number of mistreatment reports decreased each year following implementation.

    View details for DOI 10.1097/ACM.0000000000001575

    View details for PubMedID 28121657

  • Pilot evaluation of the Computer-Based Assessment for Sampling Personal Characteristics test. The Journal of surgical research Shipper, E. S., Mazer, L. M., Merrell, S. B., Lin, D. T., Lau, J. N., Melcher, M. L. 2017; 215: 211–18


    High attrition rates hint at deficiencies in the resident selection process. The evaluation of personal characteristics representative of success is difficult. Here, we evaluate a novel tool for assessing personal characteristics.To evaluate feasibility, we used an anonymous voluntary survey questionnaire offered to study participants before and after contact with the CASPer test. To evaluate the CASPer test as a predictor of success, we compared CASPer test assessments of personal characteristics versus traditional faculty assessment of personal characteristics with applicant rank list position.All applicants (n = 77) attending an in-person interview for general surgery residency, and all faculty interviewers (n = 34) who reviewed these applications were invited to participate. Among applicants, 84.4% of respondents (65 of 77) reported that a requirement to complete the CASPer test would have no bearing or would make them more likely to apply to the program (mean = 3.30, standard deviation = 0.96). Among the faculty, 62.5% respondents (10 of 16) reported that the same condition would have no bearing or would make applicants more likely to apply to the program (mean = 3.19, standard deviation = 1.33). The Spearman's rank-order correlation coefficients for the relationships between traditional faculty assessment of personal characteristics and applicant rank list position, and novel CASPer assessment of personal characteristics and applicant rank list position, were -0.45 (P = 0.033) and -0.41 (P = 0.055), respectively.The CASPer test may be feasibly implemented as component of the resident selection process, with the potential to predict applicant rank list position and improve the general surgery resident selection process.

    View details for PubMedID 28688650

  • Underlying mechanisms of mistreatment in the surgical learning environment: A thematic analysis of medical student perceptions. American journal of surgery Brandford, E., Hasty, B., Bruce, J. S., Bereknyei Merrell, S., Shipper, E. S., Lin, D. T., Lau, J. N. 2017


    Medical students experience more psychological distress than the general population. One contributing factor is mistreatment. This study aims to understand the mechanisms of mistreatment as perceived by medical students.Students completed anonymous surveys during the first and last didactic session of their surgery clerkship in which they defined and gave examples of mistreatment. Team-based thematic analysis was performed on responses.Between January 2014 and June 2016, 240 students participated in the surgery clerkship. Eighty-nine percent of students completed a survey. Themes observed included (1) Obstruction of Students' Learning, (2) Exploitation of Student Vulnerability, (3) Exclusion from the Medical Team, and (4) Contextual Amplifiers of Mistreatment Severity.The themes observed in this study improve our understanding of the students' perspective on mistreatment as it relates to their role in the clinical learning context, which can serve as a starting point for interventions that ultimately improve students' experiences in the clinical setting.

    View details for PubMedID 29167023

  • Evaluation of a technical and nontechnical skills curriculum for students entering surgery. The Journal of surgical research Shipper, E. S., Miller, S. E., Hasty, B. N., Merrell, S. B., Lin, D. T., Lau, J. N. 2017; 219: 92–97


    Prior interventions to address declining interest in surgical careers have focused on creating early exposure and fostering mentorship at the preclinical medical student level. Navigating the surgical environment can be challenging, however, and preclinical students may be more likely to pursue a surgical career if they are given the tools to function optimally.We designed a 10-wk technical and nontechnical skills curriculum to provide preclinical students with knowledge and skills necessary to successfully navigate the surgical learning environment, followed by placement in high-fidelity surgical simulations and scrubbing in on operative cases with attending surgeons. We administered pre-post surveys to assess student confidence levels in operative skills, self-perceptions of having a mentor, overall course efficacy, and interest in a career in surgery.The overall response rates presurvey and postsurvey were 100% (30 of 30) and 93.3% (28 of 30), respectively. Confidence levels across all operative skills increased significantly after completing the course. Faculty mentorship increased significantly from 30.0% before to 61.5% after the course. Overall effectiveness of the course was 4.00 of 5 (4 = "very effective"), and although insignificant, overall interest in a career in surgery increased at the completion of the course from 3.77 (standard deviation = 1.01) to 4.17 (standard deviation = 0.94).Our curriculum was effective in teaching the skills necessary to enjoy positive experiences in planned early exposure and mentorship activities. Further study is warranted to determine if this intervention leads to an increase in students who formally commit to a career in surgery.

    View details for PubMedID 29078916

  • Leaders by example: Best practices and advice on establishing a state-of-the art surgical simulation center that optimizes available resources. American journal of surgery Gardner, A. K., Ritter, E. M., Dunkin, B. J., Smink, D. S., Lau, J. N., Paige, J. T., Phitayakorn, R., Acton, R. D., Stefanidis, D., Gee, D. W. 2017


    The role of simulation-based education continues to expand exponentially. To excel in this environment as a surgical simulation leader requires unique knowledge, skills, and abilities that are different from those used in traditional clinically-based education.Leaders in surgical simulation were invited to participate as discussants in a pre-conference course offered by the Association for Surgical Education. Highlights from their discussions were recorded.Recommendations were provided on topics such as building a simulation team, preparing for accreditation requirements, what to ask for during early stages of development, identifying tools and resources needed to meet educational goals, expanding surgical simulation programming, and building educational curricula.These recommendations provide new leaders in simulation with a unique combination of up-to-date best practices in simulation-based education, as well as valuable advice gained from lessons learned from the personal experiences of national leaders in the field of surgical simulation and education.

    View details for DOI 10.1016/j.amjsurg.2017.11.007

    View details for PubMedID 29174772

  • Student perceptions of a simulation-based flipped classroom for the surgery clerkship: A mixed-methods study. Surgery Liebert, C. A., Mazer, L., Bereknyei Merrell, S., Lin, D. T., Lau, J. N. 2016; 160 (3): 591-598


    The flipped classroom, a blended learning paradigm that uses pre-session online videos reinforced with interactive sessions, has been proposed as an alternative to traditional lectures. This article investigates medical students' perceptions of a simulation-based, flipped classroom for the surgery clerkship and suggests best practices for implementation in this setting.A prospective cohort of students (n = 89), who were enrolled in the surgery clerkship during a 1-year period, was taught via a simulation-based, flipped classroom approach. Students completed an anonymous, end-of-clerkship survey regarding their perceptions of the curriculum. Quantitative analysis of Likert responses and qualitative analysis of narrative responses were performed.Students' perceptions of the curriculum were positive, with 90% rating it excellent or outstanding. The majority reported the curriculum should be continued (95%) and applied to other clerkships (84%). The component received most favorably by the students was the simulation-based skill sessions. Students rated the effectiveness of the Khan Academy-style videos the highest compared with other video formats (P < .001). Qualitative analysis identified 21 subthemes in 4 domains: general positive feedback, educational content, learning environment, and specific benefits to medical students. The students reported that the learning environment fostered accountability and self-directed learning. Specific perceived benefits included preparation for the clinical rotation and the National Board of Medical Examiners shelf exam, decreased class time, socialization with peers, and faculty interaction.Medical students' perceptions of a simulation-based, flipped classroom in the surgery clerkship were overwhelmingly positive. The flipped classroom approach can be applied successfully in a surgery clerkship setting and may offer additional benefits compared with traditional lecture-based curricula.

    View details for DOI 10.1016/j.surg.2016.03.034

    View details for PubMedID 27262534

  • Emotional Intelligence as a Predictor of Resident Well-Being. Journal of the American College of Surgeons Lin, D. T., Liebert, C. A., Tran, J., Lau, J. N., Salles, A. 2016; 223 (2): 352-358


    There is increasing recognition that physician wellness is critical; it not only benefits the provider, but also influences quality and patient care outcomes. Despite this, resident physicians suffer from a high rate of burnout and personal distress. Individuals with higher emotional intelligence (EI) are thought to perceive, process, and regulate emotions more effectively, which can lead to enhanced well-being and less emotional disturbance. This study sought to understand the relationship between EI and wellness among surgical residents.Residents in a single general surgery residency program were surveyed on a voluntary basis. Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire-Short Form. Resident wellness was assessed with the Dupuy Psychological General Well-Being Index, Maslach Burnout Inventory, and Beck Depression Inventory-Short Form. Emotional intelligence and wellness parameters were correlated using Pearson coefficients. Multivariate analysis was performed to identify factors predictive of well-being.Seventy-three residents participated in the survey (response rate 63%). Emotional intelligence scores correlated positively with psychological well-being (r = 0.74; p < 0.001) and inversely with depression (r = -0.69, p < 0.001) and 2 burnout parameters, emotional exhaustion (r = -0.69; p < 0.001) and depersonalization (r = -0.59; p < 0.001). In regression analyses controlling for demographic factors such as sex, age, and relationship status, EI was strongly predictive of well-being (β = 0.76; p < 0.001), emotional exhaustion (β = -0.63; p < 0.001), depersonalization (β = -0.48; p = 0.002), and depression (β = -0.60; p < 0.001).Emotional intelligence is a strong predictor of resident well-being. Prospectively measuring EI can identify those who are most likely to thrive in surgical residency. Interventions to increase EI can be effective at optimizing the wellness of residents.

    View details for DOI 10.1016/j.jamcollsurg.2016.04.044

    View details for PubMedID 27182037

  • Novel Use of Google Glass for Procedural Wireless Vital Sign Monitoring. Surgical innovation Liebert, C. A., Zayed, M. A., Aalami, O., Tran, J., Lau, J. N. 2016; 23 (4): 366-373


    This study investigates the feasibility and potential utility of head-mounted displays for real-time wireless vital sign monitoring during surgical procedures.In this randomized controlled pilot study, surgery residents (n = 14) performed simulated bedside procedures with traditional vital sign monitors and were randomized to addition of vital sign streaming to Google Glass. Time to recognition of preprogrammed vital sign deterioration and frequency of traditional monitor use was recorded. User feedback was collected by electronic survey.The experimental group spent 90% less time looking away from the procedural field to view traditional monitors during bronchoscopy (P = .003), and recognized critical desaturation 8.8 seconds earlier; the experimental group spent 71% (P = .01) less time looking away from the procedural field during thoracostomy, and recognized hypotension 10.5 seconds earlier. Trends toward earlier recognition of deterioration did not reach statistical significance. The majority of participants agreed that Google Glass increases situational awareness (64%), is helpful in monitoring vitals (86%), is easy to use (93%), and has potential to improve patient safety (85%).In this early feasibility study, use of streaming to Google Glass significantly decreased time looking away from procedural fields and resulted in a nonsignificant trend toward earlier recognition of vital sign deterioration. Vital sign streaming with Google Glass or similar platforms is feasible and may enhance procedural situational awareness.

    View details for DOI 10.1177/1553350616630142

    View details for PubMedID 26848138

  • Effectiveness of the Surgery Core Clerkship Flipped Classroom: a prospective cohort trial AMERICAN JOURNAL OF SURGERY Liebert, C. A., Lin, D. T., Mazer, L. M., Bereknyei, S., Lau, J. N. 2016; 211 (2): 451-U214


    The flipped classroom has been proposed as an alternative curricular approach to traditional didactic lectures but has not been previously applied to a surgery clerkship.A 1-year prospective cohort of students (n = 89) enrolled in the surgery clerkship was taught using a flipped classroom approach. A historical cohort of students (n = 92) taught with a traditional lecture curriculum was used for comparison. Pretest and post-test performance, end-of-clerkship surveys, and National Board of Medical Examiners (NBME) scores were analyzed to assess effectiveness.Mean pretest and post-test scores increased across all modules (P < .001). There was no difference between mean NBME examination score in the prospective and historical cohorts (74.75 vs 75.74, P = .28). Mean ratings of career interest in surgery increased after curriculum completion (4.75 to 6.50, P < .001), with 90% reporting that the flipped classroom contributed to this increase.Implementation of a flipped classroom in the surgery clerkship is feasible and results in high learner satisfaction, effective knowledge acquisition, and increased career interest in surgery with noninferior NBME performance.

    View details for DOI 10.1016/j.amjsurg.2015.10.004

    View details for Web of Science ID 000368344800023

  • Emotional Intelligence as a Predictor of Resident Wellness Lin, D. T., Liebert, C. A., Lau, J. N., Salles, A. ELSEVIER SCIENCE INC. 2015: S52
  • Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial. Surgical endoscopy Rosas, U., Ahmed, S., Leva, N., Garg, T., Rivas, H., Lau, J., Russo, M., Morton, J. M. 2015; 29 (9): 2486-2490


    Internal herniation is a potential complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). Previous studies have shown that closure of mesenteric defects after LRYGB may reduce the incidence of internal herniation. However, controversy remains as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after LRYGB. This study aims to determine if jejeunal mesenteric defect closure reduces incidence of internal hernias and other complications in patients undergoing LRYGB.105 patients undergoing laparoscopic antecolic RYGB were randomized into two groups: closed mesenteric defect (n = 50) or open mesenteric defect (n = 55). Complication rates were obtained from the medical record. Patients were followed up to 3 years post-operatively. Patients also completed the gastrointestinal quality of life index (GI QoL) pre-operatively and 12 months post-operatively. Outcome measures included: incidence of internal hernias, complications, readmissions, reoperations, GI QoL scores, and percent excess weight loss (%EWL).Pre-operatively, there were no significant differences between the two groups. The closed group had a longer operative time (closed-153 min, open-138 min, p = 0.073). There was one internal hernia in the open group. There was no significant difference at 12 months for decrease in BMI (closed-15.9, open-16.3 kg/m(2), p = 0.288) or %EWL (closed-75.3%, open-69.0%, p = 0.134). There was no significant difference between the groups in incidence of internal hernias and general complications post-operatively. Both groups showed significantly improved GI QoL index scores from baseline to 12 months post-surgery, but there were no significant differences at 12 months between groups in total GI QoL (closed-108, open-112, p = 0.440).In this study, closure or non-closure of the jejeunal mesenteric defect following LRYGB appears to result in equivalent internal hernia and complication rates. High index of suspicion should be maintained whenever internal hernia is expected after LRYGB.

    View details for DOI 10.1007/s00464-014-3970-3

    View details for PubMedID 25480607

  • Validity evidence for Surgical Improvement of Clinical Knowledge Ops: a novel gaming platform to assess surgical decision making AMERICAN JOURNAL OF SURGERY Lin, D. T., Park, J., Liebert, C. A., Lau, J. N. 2015; 209 (1): 79-85


    Current surgical education curricula focus mainly on the acquisition of technical skill rather than clinical and operative judgment. SICKO (Surgical Improvement of Clinical Knowledge Ops) is a novel gaming platform developed to address this critical need. A pilot study was performed to collect validity evidence for SICKO as an assessment for surgical decision making.Forty-nine subjects stratified into 4 levels of expertise were recruited to play SICKO. Later, players were surveyed regarding the realism of the gaming platform as well as the clinical competencies required of them while playing SICKO.Each group of increasing expertise outperformed the less experienced groups. Mean total game scores for the novice, junior resident, senior resident, and expert groups were 5,461, 8,519, 11,404, and 13,913, respectively (P = .001). Survey results revealed high scores for realism and content.SICKO holds the potential to be not only an engaging and immersive educational tool, but also a valid assessment in the armamentarium of surgical educators.

    View details for DOI 10.1016/j.amjsurg.2014.08.033

    View details for PubMedID 25454955

  • What is the future of training in surgery? Needs assessment of national stakeholders SURGERY Kim, S., Dunkin, B. J., Paige, J. T., Eggerstedt, J. M., Nicholas, C., Vassilliou, M. C., Spight, D. H., Pliego, J. F., Rush, R. M., Lau, J. N., Carpenter, R. O., Scott, D. J. 2014; 156 (3): 707-717


    The Curriculum Committee of the American College of Surgeons-Accredited Educational Institutes conducted a need assessment to (1) identify gaps between ideal and actual practices in areas of surgical care, (2) explore educational solutions for addressing these gaps, and (3) shape a vision to advance the future of training in surgery.National stakeholders were recruited from the committee members' professional network and interviewed via telephone. Interview questions targeted areas for improving surgical patient care, optimal educational solutions for training in surgery including simulation roles, and entities that should primarily bear training costs. We performed an iterative, qualitative analysis including member checking to identify key themes.Twenty-two interviewees included state/national board representatives, risk managers, multispecialty faculty/program directors, nurses, trainees, an industry representative, and a patient. Surgeons' communication with patients, families, and team members was raised consistently by stakeholders as a way to establish clear expectations regarding pre-, peri-, and postoperative care. Other comments highlighted the surgeon's development and demonstration and maintenance of cognitive and technical skills, including surgical judgment. Stakeholders also reiterated the critical need for surgeons to engage in on-going self-assessment and professional development to identify and remediate recognized limitations. Recommended learning modalities for meeting surgeons' needs included active learning (deliberate practice, diverse patient experiences), experiential learning (simulation), and peer and mentored learning (preceptorship).This first formal needs assessment of education for surgeons points to opportunities for educational programs in patient-centered communication, learning models that match preferences of new generations of trainees, and training in interprofessional/interdisciplinary team communication and teamwork.

    View details for DOI 10.1016/j.surg.2014.04.047

    View details for PubMedID 25175505

  • PREDICT: Instituting an Educational Time Out in the Operating Room. Journal of graduate medical education Yang, R. L., Esquivel, M., Erdrich, J., Lau, J., Melcher, M. L., Wapnir, I. L. 2014; 6 (2): 382-383

    View details for DOI 10.4300/JGME-D-14-00086.1

    View details for PubMedID 24949168

  • Comparison of robotic and laparoendoscopic single-site surgery systems in a suturing and knot tying task SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Eisenberg, D., Vidovszky, T. J., Lau, J., Guiroy, B., Rivas, H. 2013; 27 (9): 3182-3186


    BACKGROUND: Laparoendoscopic single-site (LESS) surgery has been established for various procedures. Shortcomings of LESS surgery include loss of triangulation, instrument collisions, and poor ergonomics, making advanced laparoscopic tasks especially challenging. We compared a LESS system with a robotic single-site surgery platform in performance of a suturing and knot-tying task under clinically simulated conditions. METHODS: Each of five volunteer minimally invasive surgeons was tasked with suturing a 5 cm longitudinal enterotomy in porcine small intestine with square knots at either end, using a laparoendoscopic or da Vinci robotic single-site surgery platform, within a 20 min time limit. A saline leak test was then performed. Each surgeon performed the task twice using each system. The time to completion of the task and presence of a leak were noted. Fisher's exact test was used to compare the overall completion rate within the defined time limit, and a Wilcoxon rank test was used to compare the specific times to complete the task. A p value of <0.05 was considered significant. RESULTS: All surgeons were able to complete the task on the first try within 20 min using the robot system; 60 % of surgeons were able to complete it after two attempts using the LESS surgery system. Time to completion using the robot system was significantly shorter than the time using the standard LESS system (p < 0.0001). There were no leaks after closure with the robot system; the leak rate following the standard LESS system was 90 %. CONCLUSIONS: Surgeons demonstrated significantly better suturing and knot-tying capabilities using the robot single-site system compared to a standard LESS system. The robotic system has the potential to expand single-site surgery to more complex tasks.

    View details for DOI 10.1007/s00464-013-2874-y

    View details for Web of Science ID 000323621500016

    View details for PubMedID 23443484

  • The assessment of emotional intelligence among candidates interviewing for general surgery residency. Journal of surgical education Lin, D. T., Kannappan, A., Lau, J. N. 2013; 70 (4): 514-521


    There is an increasing demand for physicians to possess strong personal and social qualities embodied in the concept of emotional intelligence (EI). However, the residency selection process emphasizes mainly academic accomplishments. In this system, the faculty interview is the primary means of evaluating the nontangible, nonacademic attributes of a candidate.To determine whether the impressions derived from faculty interviews correlate with an applicant's actual EI as measured by a validated objective instrument.Participating applicants interviewing for a surgical residency position at Stanford completed an EI inventory Trait Emotional Intelligence Questionnaire (TEIQue). Faculty estimated the EI of the applicants they interviewed using a corresponding 360° evaluation form. Multivariate linear regression was performed to identify demographic and academic factors predictive of EI. Applicant TEIQue scores and faculty 360° impressions were correlated using Pearson coefficients.Mean EI of the cohort was higher than that of the average population (5.43 vs 4.89, p<0.001). Age was the only demographic variable that significantly informed EI (B = 0.07, p = 0.005). Among the academic factors considered, United States Medical Licensing Examination Step 1 score was a slight negative predictor of EI (B =-0.007, p = 0.04). Applicant global EI scores did not correlate with faculty impressions of overall EI (r = 0.27, p = 0.06). Of the 4 domains that comprise global EI, sociability and emotionality demonstrated a moderate correlation between applicant and faculty scores (r = 0.31, p = 0.03 and r = 0.27, p = 0.05, respectively). None of the fifteen individual facets of EI demonstrated any correlation between applicant and faculty ratings (r =-0.12 to 0.26, p = 0.06-0.91). No association was found between applicant TEIQue and traditional faculty interview evaluations (r = 0.18, p = 0.19).Applicant EI correlated poorly with academic parameters and was not accurately assessed by faculty interviews. Methods that better capture this dimension should be incorporated into the residency selection process.

    View details for DOI 10.1016/j.jsurg.2013.03.010

    View details for PubMedID 23725940

  • Hemobilia from Transjugular Liver Biopsy Resulting in Gallbladder Rupture DIGESTIVE DISEASES AND SCIENCES Plerhoples, T. A., Lau, J. N. 2013; 58 (3): 630-633

    View details for DOI 10.1007/s10620-012-2254-9

    View details for Web of Science ID 000317076700010

    View details for PubMedID 22678461

  • Recurrent abdominal liposarcoma: Analysis of 19 cases and prognostic factors. World journal of gastroenterology : WJG Lu, W., Lau, J., Xu, M. D., Zhang, Y., Jiang, Y., Tong, H. X., Zhu, J., Lu, W. Q., Qin, X. Y. 2013; 19 (25): 4045–52


    To evaluate the clinical outcome of re-operation for recurrent abdominal liposarcoma following multidisciplinary team cooperation.Nineteen consecutive patients who had recurrent abdominal liposarcoma underwent re-operation by the retroperitoneal sarcoma team at our institution from May 2009 to January 2012. Patient demographic and clinical data were reviewed retrospectively. Multidisciplinary team discussions were held prior to treatment, and re-operation was deemed the best treatment. The categories of the extent of resection were as follows: gross total resection (GTR), palliative resection and partial resection. Surgical techniques were divided into discrete lesion resection and combined contiguous multivisceral resection (CMR). Tumor size was determined as the largest diameter of the specimen. Patients were followed up at approximately 3-monthly intervals. For survival analysis, a univariate analysis was performed using the Kaplan-Meier method, and a multivariate analysis was performed using the Cox proportional hazards model.Nineteen patients with recurrent abdominal liposarcoma (RAL) underwent 32 re-operations at our institute. A total of 51 operations were reviewed with a total follow-up time ranging from 4 to 120 (47.4 ± 34.2) mo. The GTR rate in the CMR group was higher than that in the non-CMR group (P = 0.034). CMR was positively correlated with intra-operative bleeding (correlation coefficient = 0.514, P = 0.010). Six cases with severe postoperative complications were recorded. Patients with tumor sizes greater than 20 cm carried a significant risk of profuse intra-operative bleeding (P = 0.009). The ratio of a highly malignant subtype (dedifferentiated or pleomorphic) in recurrent cases was higher compared to primary cases (P = 0.027). Both single-factor survival using the Kaplan-Meier model and multivariate analysis using the Cox proportional hazards model showed that overall survival was correlated with resection extent and pathological subtype (P < 0.001 and P = 0.02), however, relapse-free interval (RFI) was only correlated with resection extent (P = 0.002).Close follow-up should be conducted in patients with RAL. Early re-operation for relapse is preferred and gross resection most likely prolongs the RFI.

    View details for DOI 10.3748/wjg.v19.i25.4045

    View details for PubMedID 23840151

  • The Effect of Positive and Negative Verbal Feedback on Surgical Skills Performance and Motivation Annual Spring Meeting of the Association-for-Program-Directors-in-Surgery (APDS) Kannappan, A., Yip, D. T., Lodhia, N. A., Morton, J., Lau, J. N. ELSEVIER SCIENCE INC. 2012: 798–801


    There is considerable effort and time invested in providing feedback to medical students and residents during their time in training. However, little effort has been made to measure the effects of positive and negative verbal feedback on skills performance and motivation to learn and practice. To probe these questions, first-year medical students (n = 25) were recruited to perform a peg transfer task on Fundamentals of Laparoscopic Surgery box trainers. Time to completion and number of errors were recorded. The students were then randomized to receive either positive or negative verbal feedback from an expert in the field of laparoscopic surgery. After this delivery of feedback, the students repeated the peg transfer task. Differences in performance pre- and post-feedback and also between the groups who received positive feedback (PF) vs negative feedback (NF) were analyzed. A survey was then completed by all the participants. Baseline task times were similar between groups (PF 209.3 seconds; NF 203 seconds, p = 0.58). The PF group averaged 1.83 first-time errors while the NF group 1 (p = 0.84). Post-feedback task times were significantly decreased for both groups (PF 159.75 seconds, p = 0.05; NF 132.08 seconds, p = 0.002). While the NF group demonstrated a greater improvement in mean time than the PF group, this was not statistically significant. Both groups also made fewer errors (PF 0.33 errors, p = 0.04; NF 0.38 errors, p = 0.23). When surveyed about their responses to standardized feedback scenarios, the students stated that both positive and negative verbal feedback could be potent stimulants for improved performance and motivation. Further research is required to better understand the effects of feedback on learner motivation and the interpersonal dynamic between mentors and their trainees.

    View details for DOI 10.1016/j.jsurg.2012.05.012

    View details for PubMedID 23111049

  • Informed Consent SAGES MANNUAL OF QUALITY, OUTCOMES AND PATIENT SAFETY Plerhoples, T. A., Lau, J. N., Tichansky, D. S., Morton, J., Jones, D. B. 2012: 521–28
  • Potential Nutritional Conflicts in Bariatric and Renal Transplant Patients OBESITY SURGERY Lightner, A. L., Lau, J., Obayashi, P., Birge, K., Melcher, M. L. 2011; 21 (12): 1965-1970


    An increasing number of morbidly obese patients with end stage renal disease (ESRD) are sequentially undergoing bariatric surgery followed by renal transplantation. Discrepancies between the nutritional recommendations for obesity and chronic kidney disease (CKD) are often confusing for the obese patient in renal failure. However, when recommendations are structured according to stage and treatment of disease, a consistent plan can be clearly communicated to the patient. Therefore, to optimize patient and graft outcomes we present nutritional recommendations tailored to three patient populations: obese patients with ESRD, patients post Roux-en-Y gastric bypass (RYGBP) with ESRD, and patients post RYGBP and post renal transplantation.

    View details for DOI 10.1007/s11695-011-0423-0

    View details for PubMedID 21526378

  • Another Use of the Mobile Device: Warm-up for Laparoscopic Surgery JOURNAL OF SURGICAL RESEARCH Plerhoples, T. A., Zak, Y., Hernandez-Boussard, T., Lau, J. 2011; 170 (2): 185-188


    An important facet of laparoscopic surgery is its psychomotor component. As this aspect of surgery gains attention, lessons from other psychomotor-intense fields such as athletics have led to an investigation of the benefits of "warming up" prior to entering the operating room. Practical implementation of established methods of warm-up is hampered by a reliance on special equipment and instrumentations that are not readily available. In light of emerging evidence of translatability between video-game play and operative performance, we sought to find if laparoscopic task performance improved after warming up on a mobile device balance game.Laparoscopic novices were randomized into either the intervention group (n = 20) or the control group (n = 20). The intervention group played a mobile device balance game for 10 min while the control group did no warm-up whatsoever. Assessment was performed using two tasks on the ProMIS laparoscopic simulation system: "object positioning" (where small beads are transferred between four cups) and "tissue manipulation" (where pieces of plastic are stretched over pegs). Metrics measured were time to task completion, path length, smoothness, hand dominance, and errors.The intervention group made fewer errors: object positioning task 0.20 versus 0.70, P = 0.01, tissue manipulation task 0.15 versus 0.55, P = 0.05, total errors 0.35 versus 1.25, P = 0.002. The two groups performed similarly on the other metrics.Warm-up using a mobile device balance game decreases errors on basic tasks performed on a laparoscopic surgery simulator, suggesting a practical way to warm-up prior to cases in the operating room.

    View details for DOI 10.1016/j.jss.2011.03.015

    View details for Web of Science ID 000295128600013

    View details for PubMedID 21529831

  • The role of functional endoscopic sinus surgery in asthmatic patients JOURNAL OF OTOLARYNGOLOGY Park, A. H., Lau, J., Stankiewicz, J., Chow, J. 1998; 27 (5): 275-280


    This study was conducted to determine the efficacy of FESS (functional endoscopic sinus surgery) on sinus and asthma symptoms.Seventy-nine patients with asthma and medically unresponsive sinusitis were evaluated. Maximal medical therapy was attempted to relieve both sinus and asthma symptoms. The surgical procedures involved standard FESS techniques. Fifty-six percent of patients had undergone a sinus procedure prior to the FESS. Nasal polyposis was noted in 73% of the group. The majority of patients had pansinusitis.Eighty-six percent of patients stated that FESS improved their sinusitis. Nine of 11 sinus symptoms recorded preoperatively diminished significantly (p < .05) following surgery. Eighty percent of patients noted improvement of their asthma following FESS. The factors associated with treatment failure and the unique characteristics of this disease process were evaluated.FESS is a viable option in the treatment of asthma when medical therapy fails.

    View details for Web of Science ID 000076536200006

    View details for PubMedID 9800626