BACKGROUND: The Royal Australasian College of Surgeons (RACS) recently instituted cultural safety and cultural competency as its 10th competency with formalized cultural safety training yet to be instituted. Wānanga are Indigenous Māori teaching institutions that can be used contemporarily for cultural safety training.
METHODS: In 2022, surgical registrars based at Taranaki Base Hospital (TBH) held in-hospital wānanga ranging from 1 to 3 h focussed on cultural safety, professionalism and wellbeing. This study explores the perspectives of these registrars who attended wānanga using a Kaupapa Māori aligned methodological stance and interpretive phenomenological analysis.
RESULTS: Twenty-six wānanga were held from March 22nd 2022 to January 30th 2023. Six registrars provided their perspectives with four major themes emerging from their stories including: cultural safety; unity; time, place and person; and a new era. Registrars valued the wānanga which was scheduled for Friday afternoons after daily clinical duties. Wānanga facilitated unity and understanding with registrars being able to reflect on the context within which they are practicing - describing it as a new era of surgical training. \'Time\' was the biggest barrier to attend wānanga however, the number of wānanga held was testament to the commitment of the registrars.
CONCLUSIONS: Regular wānanga set up by, and for, surgical registrars cultural safety development is feasible and well subscribed in a rural or provincial NZ setting. We present one coalface method of regular cultural safety training and development for surgical registrars and trainees in NZ.

OBJECTIVE: To develop the use of Thiel soft embalmed human cadavers (TeC) in open radical cystectomy (ORC) training for the first time, to investigate the effect of cadaveric training on surgical trainees\' technical skills/performance and to determine how trainees perceive the use of cadaveric workshops.
METHODS: A 3-day hands-on workshop was organised. Ten trainees performed ORC on five TeC, supervised by five experts. Feedback from trainees and mentors was evaluated on a five-point Likert scale. All procedures were completed in a fully equipped surgical environment and complied with the principles outlined in the Declaration of Helsinki.
RESULTS: The workshop participants evaluated the anatomical and manipulation characteristics of the TeC as similar to real-life conditions. The colour and consistency of the urethra and ureter differed little from those in live patients. The trainees stated that the TeC were beneficial for learning the stages of ORC and urinary diversion (UD), while their self-confidence increased. In terms of realism, all steps of radical cystectomy (RC) were rated 4 out of 5 or higher on the Likert scale by both trainees and faculty.
CONCLUSIONS: The use of TeC for RC und UD was perceived as favourable by trainees and faculty. The TeC demonstrated a surprising ability to mimic real-life anatomy and represent a new and effective surgical training tool.

We know of few studies in the international scientific literature that specifically address the evaluation of surgical and clinical progress among physicians undergoing specialist training in maxillofacial surgery. Identifying a reliable tool to accurately assess both theoretical knowledge and surgical skills of trainees is essential. The primary aim of this study therefore was to design a comprehensive assessment tool that is capable of evaluating both the theoretical and practical skills of physicians undergoing specialist training in maxillofacial surgery. The methodology employed aims to ensure fairness and effectiveness in skills development, thereby optimising training activities. To meet this need, an evaluation and self-assessment test was developed for maxillofacial surgery trainees at the Ospedali Riuniti of Ancona. Data collection involved digitally administered evaluations and self-assessment tests focused on maxillofacial traumatology, based on AO trauma surgery references. Data were processed into graphs which revealed a progressive learning trend following an initial adjustment phase, leading to optimal outcomes in both clinical and surgical domains. The evaluation and self-assessment test proved to be a valuable learning tool with which to gauge advancements in clinical and surgical skills among maxillofacial surgery residents.

OBJECTIVE: To compare characteristics of Urogynecology training and number of \"Incontinence and Pelvic Floor\" cases logged between OB/GYN residencies affiliated and those not affiliated with Urogynecology fellowships.
METHODS: A retrospective descriptive analysis was performed of OB/GYN residency programs, their Urogynecology training, and association with Urogynecology fellowship programs during the 2023-2024 academic year. Program websites for ACGME-accredited OB/GYN residency programs were reviewed to determine availability, timing, and length of Urogynecology training. ACGME data for \"Incontinence and Pelvic Floor\" cases were analyzed by training year and association with Urogynecology fellowship programs from the 2012-2013 to 2022-2023 academic year. Data was analyzed using SPSS.
METHODS: This research was conducted at Harbor-UCLA Medical Center.
METHODS: None.
METHODS: None RESULTS: Information was obtained for 85.9% of programs. Nearly all (97.0%) had dedicated Urogynecology rotations, and 64.4% had rotations in > 1 year of training. Association with Urogynecology fellowship did not affect the availability of Urogynecology training overall nor the overall number of rotations. Urogynecology rotations occurred most often in the third (PGY3) year of residency, though 43.6% of programs had training for junior (PGY1, PGY2) residents. Residencies with associated Urogynecology fellowships were more likely to have a rotation for PGY2 residents and for junior residents overall. From 2012-2023, the number of \"Incontinence and Pelvic Floor\" cases declined by 36.3%, with trainees at residencies not affiliated with Urogynecology fellowships logging more cases than those at a fellowship-affiliated residency.
CONCLUSIONS: While the majority of OB/GYN residencies have dedicated Urogynecology training, most rotations are for senior residents. Training programs associated with Urogynecology fellowships are more likely to expose junior residents to the field, but their trainees log fewer \"Incontinence and Pelvic Floor\" cases overall. Earlier exposure may enrich surgical training and help residents prepare for their career, whether in Urogynecology or as a generalist.

BACKGROUND: Traditional surgical training and further education has historically involved long working hours and hands-on experience within the framework of a teacher-apprentice relationship; however, changes in regulatory policy in the USA and subsequently in Switzerland and the European Union from 2003, led to restrictions in the working hours of medical residents. As a result the traditional method of surgical training \"see one, do one, teach one\" has come under scrutiny, prompting a search for alternative training methods beyond the confines of the operating theater.
OBJECTIVE: This publication highlights the possibilities and limitations associated with the use of virtual reality (VR) and gamification in surgical training and further education. It examines the ability of these technological resources to enhance the effectiveness and engagement of medical residents and the feasibility of incorporating them into the surgical training curriculum.
METHODS: The study was based on a literature search for current developments in surgical training, VR and gamification. Furthermore, various studies and projects that investigated the use of VR and gamification in medical training and further education were analyzed.
CONCLUSIONS: In this investigation it could be shown that the use of VR reduces the perioperative risks and improves the training environment and learning. The use of gamification also increases the motivation and engagement of the medical residents. As a result the quality of medical education can be improved by the fusion of VR and gamification.
UNASSIGNED: HINTERGRUND: Die traditionelle chirurgische Aus- und Weiterbildung war durch lange Arbeitszeiten und eine praktische Ausbildung im Rahmen eines Lehrer-Lehrling-Verhältnisses gekennzeichnet. Gesetzesänderungen in den Vereinigten Staaten und der Europäischen Union führten ab 2003 zu einer Reduzierung der Arbeitszeiten für Assistenzärztinnen und Assistenzärzte. In der Folge wurde der konventionelle Ausbildungsansatz „see one, do one, teach one“ aus Zeitgründen infrage gestellt und nach alternativen Ausbildungsstrategien jenseits des Operationssaals gesucht.
UNASSIGNED: Die vorliegende Arbeit stellt Möglichkeiten und Grenzen des Einsatzes von Virtual Reality (VR) und Gamification in der chirurgischen Aus- und Weiterbildung dar. Im Fokus steht die Frage, inwiefern der Einsatz solcher Technologien die Effizienz und die Motivation von Assistenzärztinnen und Assistenzärzten steigert und inwiefern eine Integration in den chirurgischen Lehrplan möglich ist.
METHODS: Die Arbeit basiert auf einer Literaturrecherche zu aktuellen Entwicklungen in der chirurgischen Aus- und Weiterbildung sowie zu VR und Gamification. Darüber hinaus werden verschiedene Studien und Projekte analysiert, welche den Einsatz von VR und Gamification in der medizinischen Aus- und Weiterbildung untersuchen.
UNASSIGNED: Im Rahmen dieser Untersuchung konnte nachgewiesen werden, dass der Einsatz von VR perioperative Risiken reduziert und die Trainingsumgebung sowie das Lernen verbessert. Der Einsatz von Gamification steigert wiederum die Motivation und das Engagement der Assistenzärztinnen und Assistenzärzte. Folglich lässt sich die Qualität der medizinischen Aus- und Weiterbildung sowohl durch den Einsatz von VR als auch durch Gamification steigern.

UNASSIGNED: To correlate the utility of the Fundamentals of Laparoscopic Surgery (FLS) manual skills program with the Objective Structured Assessment of Technical Skills (OSATS) global rating scale in evaluating operative performance.
UNASSIGNED: The Asian Urological Surgery Training and Educational Group (AUSTEG) Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training. Delegates\' basic laparoscopic skills were assessed using three different training models (peg transfer, precision cutting, and intra-corporeal suturing). They also performed live porcine laparoscopic surgery at the same workshop. Live surgery skills were assessed by blinded faculty using the OSATS rating scale.
UNASSIGNED: From March 2016 to March 2019, a total of 81 certified urologists participated in the course, with a median of 5 years of post-residency experience. Although differences in task time did not reach statistical significance, those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks. However, they took longer to complete the precision cutting task than participants with less experience. Overall OSATS scores correlated weakly with all three FLS tasks (peg transfer time: r=-0.331, r 2=0.110; precision cutting time: r=-0.240, r 2=0.058; suturing with intra-corporeal knot time: r=-0.451, r 2=0.203).
UNASSIGNED: FLS task parameters did not correlate strongly with OSATS globing rating scale performance. Although FLS task models demonstrated strong validity, it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence, as evaluated by FLS and OSATS, respectively.

Endoscopic submucosal dissection (ESD) requires skills that the vast majority of endoscopists do not possess. ESD be broken down into component skills and at least three of the necessary skill sets can be taught separately. In the United States most trainees initially participate in half- or full-day courses that utilize ex vivo and in vivo animal models and the great majority learn these advanced skills in the clinical setting. We describe a comprehensive training over a well-defined period using ex vivo porcine or bovine large bowel models. There are five components or modules that make up the training program: (1) bowel wall injections in ex vivo tissue, (2) inanimate figure tracing model to teach scope control, (3) ESD in plastic tube with window cutout over which square of ex vivo tissue is placed, (4) ESD in ex vivo porcine or bovine large bowel, and (5) mucosal wound closure. The authors are in the midst of training a group of residents, fellows, and young attendings using this approach. This approach has not been vetted yet; however, the preliminary results are promising.

Background A surgical fellowship allows both additional training as well as maintenance of surgical skills while searching for a steady job. As the presence of fellows usually does not results in a measurably higher productivity, fellowshipsmay be considered a form of disguised unemployment. The aim of this study is to evaluate the career flow of a surgical trainee to a staff position and to determine the number of surgeons working on temporary basis within the general surgery workforce in Flanders.Methods All surgeons graduated in Flanders between 2000 and 2022 were invited to fill out a web-based survey concerning their current and past employment. Reminders were sent out after 2 and 4 weeks. Statistical analysis was performed with SPSS version 27.0 (IBM Inc., Chicago, IL, USA.)Results Response rate was 64% (292/457) with 76% of respondents currently working as surgeons, 14% (38) as fellows and 10% working outside the surgical domain. Eighty-two percent of current fellows graduated in 2019 or later. Thirty-one percent of surgeons graduated in 2019 are still working as fellows. For surgeons graduated in 2020, 2021 and 2022 this is 45%, 80% and 90% respectively. Compared to staff surgeons the number of additional training years (2,8 ± 1,0 vs 2,2 ± 1,3; p = 0,009). and the number of applications (6,6 ± 5 vs 3,3 ± 3; p < 0,001) is significantly higher for current fellowsConclusion This study shows that disguised unemployment is present in the general surgical community in Flanders. The status of \"fellow\" should be incorporated in calculations concerning future needs of the surgical workforce in order to prevent open unemployment.

UNASSIGNED: While many studies have explored surgeons\' personal and professional identities separately, our study is the first to examine intersecting female surgical identities. We explore intersecting surgical identities constructed by self and others (colleagues and patients) within two healthcare systems and their perceived impacts answering the research question: How do female surgeons\' constructed identities intersect, and what influences do those intersections have on their surgical lives?
UNASSIGNED: We employed qualitative methodology drawing on semi-structured biographical narrative interviews underpinned by social constructionism. We employed intersectionality theory as an analytical lens. We adopted maximum variation sampling to identify diverse participants, including 38 surgeons (29 female; 9 male), 9 non-surgical colleagues (8 female, 1 male), and 13 patients of female surgeons (7 female, 6 male). Our 29 female surgeons also included six who had transitioned out of surgery. We analyzed the dataset using a five-step Framework Analysis approach. We captured talk about identities, as well as identity talk (constructions of identity through participants\' talk).
UNASSIGNED: Multiple intersecting personal (not just gender) and professional identities were constructed and reported to have multiple impacts on female surgeons\' lives (including their education, training, and success). We present intersecting identities and their impacts relating to gender through four primary intersections: (a) gender + ethnic identities; (b) gender + parenthood identities; (c) gender + age identities; and (d) gender + professional identities (namely carer, competent, mentor/mentee, role model and leader). Our findings particularly highlight the challenges experienced by female surgeons of color, who are mothers, who are younger and/or who are leaders, illustrating diversity in women\'s experiences beyond that of gender alone. Finally, we found unexpected insights into male surgeons and fatherhood.
UNASSIGNED: Intersectionality theory offered a novel analytical lens to extend existing knowledge on female surgical identities. Further research is warranted exploring intersecting identities of female surgeons of color, younger female surgeons, and male surgeons who are fathers, as well as identities unexplored in this study (e.g., diverse sexualities). We need to raise awareness of intersecting identities and their impacts in surgery, as well as providing training, allyship, and policy revision that is sensitive to intersectionality.

BACKGROUND: . Mitral transcatheter edge-to-edge repair (m-TEER) is a minimally invasive procedure for treating mitral regurgitation (MR). m-TEER is a highly technical procedure, and a steep learning curve needs to be overcome for operators to ensure optimal patient outcomes and minimise procedural complications. Training via online simulation and observation of procedures is not sufficient to establish operator confidence; thus, advanced hands-on training modalities need to be explored and developed.
METHODS: . In this study, a novel anatomical simulator for m-TEER training was evaluated in comparison to a standard model. The proposed simulator resembled the anatomical features of the right and left atrium, left ventricle and mitral valve apparatus. Participants in the questionnaire (n = 18) were recruited across 4 centres in London with (n = 8) and without (n = 10) prior experience in m-TEER. Participants were asked to simulate procedures on both an idealised, routinely used simulator and the newly proposed anatomical model. The questionnaire was designed to assess (i) participants\' confidence before and after training and (ii) the realism of the model in the context of the m-TEER procedure. The results of the questionnaires were collected, and statistical analysis (t-test) was performed.
RESULTS: . Both models were equally beneficial in increasing operator confidence before and after the simulation of the intervention (P = 0.43). However, increased confidence after training with the anatomical model was recorded (P = 0.02). Participants with prior experience with m-TEER therapy were significantly more confident about the procedure after training with the anatomical model than participants who had no prior experience (P = 0.002). On average, all participants thought that the anatomical model was effective as a training simulator (P = 0.013) and should be integrated into routine training (P = 0.015)). Participants with experience thought that the anatomical model was more effective at reproducing the m-TEER procedure than the idealised model (P = 0.03).
CONCLUSIONS: . This study showed how a more realistic simulator can be used to improve the effectiveness of m-TEER procedural training. Such pilot results suggest planning future and large investigations to evaluate improvements in clinical practice.