105.17 Why Interested Surgeons Not Choose Rural Surgery: What can We Do Now?

Posted on January 31, 2019

N. Frohne1, M. Sarap1, A. Alseidi2, L. Buckingham1, P. P. Parikh1  1Wright State University,Department Of Surgery,Dayton, OH, USA 2Virginia Mason Medical Center,Seattle, WA, USA

Introduction: There is a growing deficit of rural general surgeons and preparation to meet this need is inadequate. Further, there is limited data focusing on the factors of rural general surgery training that surgeon’s use to decide on practijce location. More research into stratifying factors that specifically influence choice in rural versus urban practice is needed.

Methods:  Rural was defined as a population of less than 50,000 per the U.S Census Bureau. An IRB approved Qualtrics survey was distributed to general surgeons and surgery residents nationwide through the American College of Surgeons (ACS) and American College of Osteopathic Surgeons (ACOS). This completely voluntary survey included questions related to prior rural experience, reasons for selecting or not selecting rural practice, and factors that could increase rural retention.  Further, the respondents were requested to provide narrative comments on how to improve recruitment and retention of rural surgeons. The responses were   analyzed for themes using constant comparative method. 

Results: Out of total 416 respondents, 74% were male. Further, 287(69%) respondents had previous exposure to rural surgery (Fig1). Of those with prior rural experience, 71 (25%) chose or would not choose to not continue with a rural career due to lack of professional/hospital support and lifestyle of a rural surgeon. Other reasons such as job opportunities, specialty practice, and no opportunities for teaching or pursuing academic surgery also hindered their choice of considering rural surgery career.  A broad scope of practice was most important among rural surgeons (52%) who chose rural practice without any previous rural experience. Over 60% of respondents without prior rural experience agreed that improved lifestyle and financial advantages would attract them to rural practice. Thematic analysis suggests that more tie ups with academic institutions, more support from the rural hospitals, rural rotations earlier in training, more mentoring and rural surgeon as a role model would help increase the number of rural surgeons.

Conclusion: Our results help focus specific resources in the rural setting. Providing appropriate hospital support in these areas and promoting specific aspects of rural practice to those in training could help grow interest in rural surgery. Strong collaboration with academic institutions for teaching, learning and mentoring opportunities for rural surgeons could lead to higher satisfaction, security, and potentially higher retention rate. A rural surgeon mentor would further influence the choice of practice location. Improving rural economic factors can provide some of the larger urban center qualities in a rural setting that may appeal to urban leaning surgeons.

105.16 Design and evaluation of a synthetic tissue for suturing and knot tying in laparoscopy training

Posted on January 31, 2019

C. M. Echeverri1, L. Cuevas1  1Pontificia Universidad Javeriana – Hospital Universitario San Ignacio,General Surgery,Bogota, DC, Colombia

Introduction:  The acquisition of psychomotor skills within the training process of a surgical resident requires repeated exposure and previous practice in the patient. The skills to suture and tie knots in laparoscopy are part of these and usually, the first exposure to the process is achieved in simulation centers, where the practice improves the final performance of the residents. Finding a product in the market that simulates this practice, easy and affordable, is difficult in our environment, mainly due to the high cost. We developed a semi-synthetic tissue manufactured at home, low- cost, reusable, replicable, with similar texture to the intestine and easy to use in the laparoscopic simulation environment.

Methods:  A descriptive observational study was carried out with 25 laparoscopic surgeons who evaluated the mentioned tissue, through laparoscopic suturing and knot tying, by means of a semi-structured survey of likert type perception.

Results: The overall score of the experience had a median of 9 on a visual analog scale from 0 to 10; As for the specific characteristics of the tissue, the perception was that the tissue allowed to perform very easily a simple suture for 68% (n = 17), continuous suture for 52% (n = 13) and intracorporeal knot tying for the 76 % (n = 19) of the surgeons. The characteristics most frequently described as better by the surgeons were consistency and firmness, as well as a progression in the ease to perform the proposed tasks. The characteristics that limited or hindered the development of the practice named by the surgeons were occasional resistance, different consistency in some tissue areas, particles, and 4 of them found no unfavorable characteristics.

Conclusion: The proposed tissue fulfills the desired characteristics when performed and provides a useful simulation model to improve the learning of knots and sutures by laparoscopy.

 

105.15 Systematic Review: Incorporation of Simulation in Orthopedic Surgery

Posted on January 31, 2019

R. Gulhar1, D. S. Brar1, G. Athwal1, R. Gulhar1  1California Northstate University College of Medicine,Elk Grove, CA, USA

Introduction:
Simulation training has played an important role in the training of surgical residents. Several factors including limited hours, financial pressure and increasing required knowledge have led to limited hands-on experience.  Simulation allows for a controlled environment to train residents. While it is thought simulation benefits trainees it is not clear how simulation translates to actual procedures. There are a number of simulation techniques including manikin-based, standardized patient, virtual reality, and tissue-based simulation. In this review, we compare how different techniques of virtual simulation translate into real-world applications.

Methods:
We looked at studies from the last 17 years in order to analyze the use of various form of simulation including virtual reality, anatomical models, 3D printing, and virtual reality in orthopedic surgery. We evaluated them on the basis of reduction in surgery time, improvement in surgery quality, and overall increased performance.

Results:
The systematic review in 2016 showed that of the 31 studies conducted on the use of virtual reality, 16% showed improvement in the surgery quality and 26% showed an overall increase in successful skill acquisition for the knee and shoulder arthroscopy. Another study in 2018 compared performance of dynamic hip screw fixation of femur fractures in virtual reality simulation and operation theatre. There was no significant difference in performance outcome which was measured by tip apex distance.

A study conducted in 2018 looked at virtual simulation and 3D printing techniques for the surgical treatment of acetabular fractures with plate fixation. The study found that the 3D printing group had a shorter total surgical duration and less blood loss than those in the control group. The postoperative results were similar for both groups. However, the complication rate was lower in the 3D printing group.

In 2018 a study was done on the use of anatomical models in simulation. It looked at efficacy and validation of simulation-based compartment syndrome course. Results found that PGY1 residents demonstrated significant improvement and were comparable to PGY5 resident performance after one month of training.

Conclusion:
There is continued need to assess the use of different simulation techniques in orthopaedic surgery. Many studies show the use and effective incorporation of virtual simulation in orthopedics surgery. Although virtual simulation has become more widespread in orthopaedics it still lags behind other surgeries. Thus, development of new virtual reality training methods will allow for more accurate and cost-effective ways to train residents. Further research needs to be conducted in order to standardize the different forms of virtual reality across the spectrum of orthopedic surgery.

105.12 What Is Global Surgery? Identifying Misconceptions Among Medical Students and Health Care Professionals

Posted on January 31, 2019

M. N. Abraham2, P. J. Abraham1, H. Chen1, K. M. Hendershot1  1University Of Alabama at Birmingham,Department Of Surgery,Birmingham, AL, USA 2University Of Alabama at Birmingham,School Of Medicine,Birmingham, AL, USA

Introduction:  Over the last five years, global surgery has emerged as a new field within academic surgery. Global surgery has been defined as “an area for study, research, practice, and advocacy that places priority on improving health outcomes and achieving health equity for all people worldwide who are affected by surgical conditions or have a need for surgical care.” Despite such unifying attempts to provide a common definition, it is unclear whether health care professionals and medical students understand what is meant by the term “global surgery.” This study aims to characterize the understanding of global surgery and what it means to be an academic global surgeon.

Methods: One hundred medical students, residents, physicians, nurses, and allied health care professionals were interviewed on their perceptions of global surgery using a six-question qualitative survey. Respondents were categorized based on gender and apparent age <40 or >=40 years old. Survey responses were coded and analyzed for common themes by two reviewers independently. SPSS was utilized for statistical analysis.

Results: Of the 100 health care professionals surveyed, 61% did not know the meaning of global surgery. While there was no difference between men and women, participants under age 40 were significantly more likely to relay an accurate definition (51% vs 17%, p=0.001). Of participants with knowledge of global surgery, 44% had previous exposure to a global health field and 85% expressed interest in global health or global surgery. Respondents described components of academic global surgery as “research”, “teaching,” “practicing,” and using “evidence-based medicine.” An effective career in global surgery was most often categorized as “sustainable” and “impactful.”

Conclusion: Although often used in academic surgical settings, the term “global surgery” is not well-understood among health care professionals and medical students. Even among those who are familiar with the term, there is no clear consensus on what it means to be a global surgeon or what constitutes a successful career in global surgery.

 

105.11 Implementation of Hemorrhage-Control Training Into The Medical School Curriculum

Posted on January 31, 2019

J. T. Gowen1, J. D. Wolfe1, K. W. Sexton1, C. R. Thrush1, A. Privratsky1, W. C. Beck1, J. R. Taylor1, B. Davis1, M. K. Kimbrough1, R. D. Robertson1, A. Bhavaraju1  1University Of Arkansas for Medical Sciences,Department Of Surgery, Division Of Trauma And Acute Care Surgery,Little Rock, AR, USA

Introduction:  To comply with the ACS goal of zero preventable deaths from trauma, we incorporated hemorrhage-control training into the formal medical school curriculum. We predict this training will increase the comfort and confidence levels of medical students with controlling major hemorrhage, and they will find this a valuable skillset for physicians and other health care professionals to possess.

Methods:  After IRB and institutional approval was obtained, hemorrhage-control training was taught to all third-year medical students during their surgery clerkship, beginning in May 2018. The training was completed in accordance with the American College of Surgeons’ Stop the Bleed (STB) program, details of which can be found at www.bleedingcontrol.org. Using a prospective study design, all trainees completed pre- and post-training surveys to gauge their prior experiences and comfort levels with controlling major hemorrhage, and their confidence levels with the techniques taught during the program. A knowledge quiz was completed immediately following the training. JMP Pro V13 (SAS; Cary, NC) was used for statistical analysis with significance set at p = 0.05.

Results: 47 students were trained and completed surveys. 43 out of 47 students (91%) reported only minimal first aid training or no experience at all with hemorrhage control; 1 student reported prior training. Comfort level with hemorrhage control and confidence level with all basic hemorrhage-control techniques showed statistically significant increases after training, with 100% of students reporting feeling confident or very confident in the application of these techniques. There was a trend towards, but not a statistically significant difference in students’ perceptions of the importance of this training for physicians (p=0.06) and the need to include STB training in medical school curricula (p=0.59) before and after STB training, which we attribute to the high positive response rates on the pre-survey. The mean percent correct on the quiz was 97.1%.

Conclusion: Hemorrhage-control training can be easily and effectively incorporated into the formal medical school curriculum with minimal effort via a single 2-hour Stop The Bleed course, increasing students’ comfort level and confidence with controlling major traumatic bleeding. Students value this training and feel it is a beneficial addition to their education, and possibly that of other healthcare professionals. We believe this should be a standard part of undergraduate medical education. Further work needs to be done to determine retention of these skills over time and if this training can be similarly incorporated into the curricula of other allied health professional schools.

 

105.10 Training Global Surgery Advocates: Strengthening the Global Surgery Voice

Posted on January 31, 2019

D. Vervoort1, X. Ma2  1Harvard School Of Medicine,Program In Global Surgery And Social Change,Brookline, MA, USA 2Université de Montréal,Montréal, QUÉBEC, Canada

Introduction:  Five billion people worldwide lack access to safe surgery when needed, causing 17 million preventable deaths each year and responsible for one-third of the global burden of disease. Despite the increasing recognition as an indispensable part of healthcare, surgery remains perceived as a luxury, and difficulties of scaling up surgical care remain widespread. InciSioN – International Student Surgical Network – is the world’s leading trainee global surgery network comprising over 3,000 medical students, residents, and young doctors from over 70 countries. InciSioN provides a platform to foster the development of future generations of global surgeons, anaesthesiologists, and obstetricians around the world.

Methods:  To strengthen, unify, and escalate InciSioN’s voices around the world, Training Global Surgery Advocates (TGSA), a standardized three-day advocacy workshop, was created. The 27-hour workshop is built on traditional didactic lectures, role-play exercises, and small working group activities, as well as advocacy and diplomacy training to provide participants with the needed knowledge and skills to effectively advocate for global surgery. During the pilot program, participants performed a baseline elevator pitch advocating for global surgery on day 1 and a prepared elevator pitch at the end of day 3 to formally assess progress. A questionnaire on the perceived familiarity, knowledge and motivation regarding the workshop and its topics was filled by participants before the beginning of the workshop and immediately after the workshop. Assessment was done using a 5-point Likert scale (strongly disagree, disagree, neutral, agree, strongly agree) for 18 components.

Results: 25 participants were selected from a pool of 52 applicants, of which 14 medical students from 14 different countries (7 high-income countries, 7 low- and middle-income countries) were able to attend the workshop in Quebec City, Canada. 11 students were unable to participate due to restrictions by visa issues (9 people) or personal reasons (2 people). An average net increase of 1.73 points across all 18 components was observed among participants. Participants lauded the mix of theory and practical exercises to integrate knowledge into practice, the diversity of participants, and the focus on soft skills for advocacy and diplomacy. During the post-assessment, all participants agreed or strongly agreed (average of 4.64 points) on their motivation to train other medical students in their respective countries to become global surgery advocates.

Conclusion: TGSA significantly improved participants’ knowledge and advocacy skills in the field of global surgery. This type of mixed didactic and hands-on workshop appears to be feasible, enjoyable for participants, and effective in improving medical students involvement in the emerging field of global surgery.

 

105.09 In-person hemorrhage control training effectiveness and comprehension in low-resource rural Kenya

Posted on January 31, 2019

D. El-Gabri1, A. D. McDow1, S. A. Sullivan3, H. Jung2, K. L. Long1  3University Of Wisconsin,Department Of Surgery/ University Of Wisconsin School Of Medicine And Public Health,Madison, WI, USA 1University Of Wisconsin,Division Of Endocrine Surgery/ Division Of General Surgery/ Department Of Surgery/ University Of Wisconsin School Of Medicine And Public Health,Madison, WI, USA 2University Of Wisconsin,Division Of Trauma, Acute Care Surgery, Burn And Surgical Critical Care/ Division Of General Surgery/ Department Of Surgery/ University Of Wisconsin School Of Medicine And Public Health,Madison, WI, USA

Introduction:
The American College of Surgeons Committee on Trauma developed the Stop the Bleed (STB) program in 2015 as a mechanism to prepare the public for response to life-threatening bleeding or mass casualty incidents. Assessments of STB in the United States (US) have shown the training’s effectiveness in improving comfort and skill in aiding a trauma victim. While the program continues to spread throughout the US, to the best of our knowledge, it has not been conducted and evaluated in low or middle-income countries. Kenya has a high burden of injuries and violence accounting for 88.4 deaths per 100,000 people. Addressing this burden is a healthcare priority in the country. STB training represents a potential intervention that could reduce trauma morbidity and mortality in a country with limited healthcare resources. The purpose of this study was to assess the effectiveness and retention of STB training in Kenya as compared to implementation in the US, the population for which it was originally designed.  

Methods:
This quasi-experimental study assessed differences between a STB intervention post-test conducted in the US and in Kenya. The two samples consisted of volunteer participants with no medical background. The STB training was advertised, and any willing participants were recruited into the study. The population of interest was recruited in Migori Kenya (n=19), the comparison population in Wisconsin, United States (n=12). Each group received the same STB training course in July 2018 by physicians trained to give STB instruction from the same US institution. After completing the course, each group received the same 5-question post-test, designed to assess effectiveness and comprehension of the material. The quizzes were anonymous and taken voluntarily. The quiz scores between each group were compared using the Mann-Whitney U Test.

Results:
There is a statistically significant (p=0.04) difference in the quiz scores between the US (n=12) and Kenya samples (n=18). The Kenyan and US mean scores were 3.9 and 4.7 out of a possible 5, respectively. If one quiz question is excluded from analysis, there is no significant difference between the two group’s quiz scores (p=0.41). The individual question that significantly lowered the mean score in the Kenyan sample was: “What is the first step when approaching an injured, bleeding person?”, which may identify a difference in interpretation of the material.

Conclusion:
In general, both samples studied demonstrated good comprehension of the STB core concepts.  In detailed review of the post-test scores, only one question was significantly different in answers among the Kenya and US participants.  Additional studies to assess long-term retention of these concepts will be necessary in both populations.  Understanding the discrepancies between the assessments in differing populations may contribute to the validation and utility of this STB post-intervention evaluation.

105.08 EARLY ENGAGEMENT HAS A SUSTAINED POSITIVE IMPACT ON MEDICAL STUDENTS' PERCEPTIONS OF SURGICAL CAREERS

Posted on January 31, 2019

P. S. Virtanen1, L. Timsina1, T. Esposito2, G. Rozycki1, J. Hartwell1  2University of Illinois,Peoria, ILLINOIS, USA 1Indiana University School Of Medicine,General Surgery,Indianapolis, IN, USA

Introduction:
Prior studies have demonstrated that brief, early exposure of medical students to surgery  is effective, creates positive perceptions of surgical career options and helps overcome negative stereotypes medical students may have of surgery . Opportunities for preclinical medical student (MS1, MS2) exposure to surgical careers are not universally available nor are the long term effects of such engagement well understood. 

Methods:
Our institution’s Surgery Student Interest Group (SIG) created a trauma shadowing experience which included observation of rounds, trauma resuscitation, operative procedures and interactions with resident and attending staff. Students were recruited via a SIG website announcement and an on-line registration form. Follow-up electronic surveys were sent immediately after the experience to all participants (n=109). If one year had elapsed during the study period (December 2016-July 2018) since the shadowing experience, a 1-year follow up survey was sent (n=77). Data gathered included demographics, student perceptions about surgery, and the experience itself. Fisher’s exact tests and matched Wilcoxon signed-rank tests were performed.

Results:
Overall, 59 immediate surveys (54.1%) and 24 1-year follow up surveys (31.2%) were returned. Of the 59 immediate responses, 55.9% (n=33) were female, and 93.2% self-identified as MS1/MS2 (n=55). Of the immediate responses, 94.9% (n=56) would “definitely” or “somewhat” agree to recommend the experience to a peer. Significantly more immediate responders stated they were either “strongly considering” or “considering” a career in surgery after the experience compared to before the experience (69.5% vs 61.0%, p=0.012). This was particularly evident in female responders (72.7% vs 57.6%, p=0.0112). The experience was felt to be relevant to the career choice process by 94.9% of students immediately after and 92.2% at 1-year follow up (p=0.90). At immediate follow up, 96.6% (n=57) of students recalled a specific trauma team member who made a positive impression on them and this was sustained (87.5%, n=21) at 1-year follow up (p=0.142).  

Conclusions:
Student participants reported a positive impact on their perceptions of, and were significantly more likely to consider, a career in surgery after the shadowing experience. Student recall of the personal connection made to the trauma team is sustained over a 1-year period. Early, informal shadowing experiences may increase interest in surgical careers, particularly for female students, and this engagement appears to be sustained over time.

105.07 Assisting Youth Bystanders Become First-Responders To "Stop The Bleed"

Posted on January 31, 2019

B. J. Ringhouse1, R. Gonzalez1, H. Ton-That1, M. Anstadt1, D. Lavigne1, J. Justiniano1, P. Patel1  1Loyola Universtiy Medical Center,Surgery,Maywood, IL, USA

Introduction: Uncontrolled hemorrhage remains one of the leading causes of preventable traumatic death. The "Stop the Bleed" campaign teaches lay people how to control life-threatening bleeding allowing for earlier intervention and improving outcomes. This study aims to assess the impact of this course on participant preparedness and willingness to intervene when faced with life-threatening bleeding.

Methods: This survey-based study utilized a pre and post intervention questionnaire. The intervention consisted of an hour long "Stop the Bleed" didactic and interactive lesson focused on recognition of life-threatening bleeding and methods of bleeding control including direct pressure and tourniquet application. The survey focused on preparedness and willingness to assist in situations of life-threatening bleeding and barriers to providing assistance. Data was collected and analyzed to evaluate trends.

Results: 54 people participated in the course, of which 44 individuals submitted a pre and post questionnaire and were included in the study analysisi. Most were inner-city youth with median age of 17, mihnoritiues, and had no first-aid experience. After the "Stop the Bleed" course, willingness to assist increased to 100%. The reported comfort in using direct pressure techniques increased by 54% (pre 46%; post 100%) and in applying a tourniquet increased by 72% (pre 28%; post 100%). In addition, there was a reduction in barriers to intervening in life-threatening bleeding, specifically the fear of making a mistake or causing more harm.

Conclusion: This study demonstrates that after a 1-hour intervention, 100% of participants felt trained to use direct pressure and tourniquets to control bleeding and were willing to assist in the setting of life-threatening bleeding. Our results establish the "Stop the Bleed" campaign as a meaningful resource to train bystanders in an at-risk population and possibly reduce preventable deaths due to uncontrolled bleeding.

 

105.06 Stop The Bleed: Effective Training In Need Of Improvement

Posted on January 31, 2019

C. Villegas1, S. Liu1, J. Rosenberg1, R. Winchell1, M. Narayan1  1Weill Cornell Medical College,The Division Of Trauma, Burns, Critical And Acute Care Surgery,New York, NY, USA

Introduction:
The “Stop the Bleed” (StB) campaign was instituted to educate laypersons on how to perform bleeding control techniques in the event of mass casualty events that result in life-threatening hemorrhage.  Participants currently undergo a 90-min instructional and practice session, the latter incorporating a mannequin on which participants practice. We hypothesized participants would 1) increase content knowledge after StB participation: and 2) find that the training could be improved by a more life-like modification of the mannequin.

Methods:
From July 2017 to January 2018, hospital and community members from a major metropolitan area participated in StB training.  Participants provided demographic data regarding prior emergency training and experience and were asked pre- and post-test questions (5-point Likert scale) regarding likelihood of and confidence in responding to hemorrhage.  Individuals also evaluated the mannequin on whether it would improve their education if it were more life-like.  Scores were reported as medians with interquartile ranges (IQR).  Wilcoxon paired and unpaired tests were used as appropriate to evaluate differences with α=0.05 and subset analysis stratified by experience.

Results:
Of 402 participants, 310 had complete data on demographic and outcome data of interest.  On a composite, pre-test self-assessment of willingness and confidence to respond to hemorrhage in emergency situations, participants had a median score of 24 out of 30 points (IQR 19-27).  Post-testing demonstrated a statistically significant increase with a median score of 29 (IQR 26-30, p < 0.05).  Participants’ composite score on mannequin realism assessing compression, packing, and tourniquet application was 13 out of 15 (IQR 12-15), yet the participants reported that more realistic model would increase their confidence in technique (median 15, IQR 12-15).  Subset analysis of those individuals without prior training or experience in emergency response or hemorrhage control (n=117) demonstrated that they had the largest gains in pre- and post-test differentiation (median difference 8.5, IQR 4.3-12.0) compared to those with prior experience (n=193, median difference of 3.0, IQR 0.0-6.0, p <0.05).  Both subgroups reported that training would be enhanced if the mannequins were more realistic (median 15, IQR 12-15 for both groups).

Conclusion:
StB is an effective education program resulting in improved confidence in wound compression, packing, and tourniquet application. Those without prior experience or training in hemorrhage cessation demonstrated the most improvement.  Regardless of background, participants overwhelmingly reported that the training would be more effective if it were more realistic. Future work to design and develop cost-effective mannequins demonstrating cessation of hemorrhage is required to enable learners to actually “Stop the Bleed”. 
 

105.05 Effectiveness of Bleeding Control Training in Improving Confidence To Intervene

Posted on January 31, 2019

E. G. Andrade1, J. M. Hayes1, L. J. Punch1  1Washington University,Acute & Critical Care Surgery,St. Louis, MO, USA

Introduction: Injury is the leading cause of death for individuals aged 1-44 years old in the United States. More specifically, gun violence (GV) is the leading cause of death for black males aged 15-24, outweighing the nine following most common causes of death combined. Hemorrhage is the leading cause of preventable trauma death. Thus, bystander abillity to control life-threatening hemorrhage is an important area for intervention to decrease preventable trauma deaths. We sought to ascertain if the Bleeding Control (BC) 1.0 course from the American College of Surgeons (ACS) is effective in teaching hemorrhage control to community members (CM) and medical professionals (MP) and if the provision of BC kits influences participant willingness to intervene in the setting of life-threatening bleeding.

Methods: Faculty and volunteers from a level 1 trauma center held BC courses on location for CM and on site for medical students, surgical residents, and surgical staff. The course was taught in concordance with the standards set for BC 1.0 by the American College of Surgeons. Participants then assembled their own BC kits, which included personal protective equipment, a combat application tourniquet, hemostatic gauze, adhesive compression tape, a permanent marker, and trauma shears. Pre- and post-course surveys were administered to assess exposure to severe bleeding (SB), knowledge of BC technique, and willingness to intervene with and without the kit. Surveys were compared using Pearson's chi-squared.

Results: Eighty CM and sixty MP completed BC training. Personal exposure to SB varied greatly between groups; among CM, 54% had experienced SB in themselves, a relative or close friend, compared with 13.6% in MP. After BC training, confidence among MP to stop life-threatening bleeding improved from 25.9% to 83.6%(p< 0.01). For CM, confidence improved from 6.7% to 57%(p<0.01). With BC training and the BC kit, 88.3% of MP and 91% of CM reported there was no reason why they could not stop life-threatening bleeding. When asked to consider their ability to stop life-threatening bleeding after the course without a BC kit, 53.8% of MP were confident compared with 36.1% of CM.

Conclusion: Although participants with a medical background start at a higher level of confidence with bleeding control techniques, both groups had significant improvement in their level of confidence with stopping life threatening bleeding after taking the BC course. The importance of the bleeding control kit was more evident in the community group.

 

105.04 The Choices We Make: Ethical Dilemmas in Trauma

Posted on January 31, 2019

P. N. Chotai1, M. B. Patel1, B. M. Dennis1, O. D. Guillamondegui1, K. G. Meador2, K. A. Wallston3, A. B. Peetz1  1Vanderbilt University Medical Center,Division Of Trauma And Acute Care Surgery, Department Of General Surgery,Nashville, TN, USA 2Vanderbilt University Medical Center,Center For Biomedical Ethics And Society At Vanderbilt,Nashville, TN, USA 3Vanderbilt University Medical Center,Institute Of Medicine And Public Health,Nashville, TN, USA

Introduction:
Trauma surgeons may often encounter complex patient situations that can be considered ethical challenges. These may require unique decision-making skills. Current literature is scarce in describing and characterizing ethical issues encountered by practicing trauma surgeons. We hypothesize variable incidence and estimates of self-efficacy of trauma surgeons’ ability to manage ethical problems in clinical practice.

Methods:
We surveyed members of the Eastern Association for the Surgery of Trauma (EAST) from January 5 to February 7, 2018 to ascertain their opinions and readiness on handling ethically challenging scenarios in their clinical trauma practice using a web-accessible survey via e-mail. The survey instrument was developed using published ethics literature and informal cognitive interviews of small focus groups that included trauma surgeons, physicians, ethicists, and other practitioners. Domains covered included perceived frequency and ability to manage ethical situations that present problems in trauma surgery practice. Common situations were defined as those situations that respondents encountered monthly or weekly. The ethical problems were categorized within seven larger categories: General ethics, Autonomy, Communication, Justice, End of Life, Conflict, and Other. Quantitative and qualitative analyses of the data were performed.

Results:
The response rate for the survey was 30.6% (548 respondents from 1794 invites); 28% of the respondents were female. Most respondents were white (74.6%) and under 55 years old (72.6%). A majority (85.4%) of respondents had completed fellowship training in either surgical critical care or trauma/acute care surgery.  Most respondents (86.6%) reported clinical practice in an American College of Surgeons (ACS) verified level I or II trauma center. The most commonly encountered ethical categories were Generic Ethical and Communication (79% of respondents reported that these were common issues in their clinical practice). Issues involving Conflict were least frequent (only 21% of respondents encountered these conflict issues on a monthly or weekly basis). Respondents’ ability to handle ethical situations did not differ among race or gender groups, size or geographic location of city of practice, completion of a fellowship training in trauma surgery, or trauma center verification level. Surgeons who reported high ability to handle ethical situations were more likely to be older (p=0.003), had been in practice 15 years or longer (linear relationship, rho = 0.21, p<0.001), had previously served on an ethics committee (p=0.038), and more frequently experienced ethically challenging situations in their clinical practice (p<0.05). Table 1 summarizes commonly encountered ethical situations in trauma surgery practice.

Conclusion:
An overwhelming majority of trauma surgeons encounter a range of ethical challenges on a regular basis in their clinical practice. Compared to younger and early career trauma surgeons, older and advanced career trauma surgeons reported higher ability and self-efficacy to manage ethical issues in clinical practice. To our knowledge, this is the first study to describe some of the unique ethical challenges that trauma surgeons face. We also identify a gap in knowledge regarding how trauma surgeons develop in addressing these problems effectively.
 

105.03 The Effect Of Body Mass Index On Penetrating Trauma Severity: A National Trauma Data Bank Analysis

Posted on January 31, 2019

L. A. De Leon Castro1, E. A. Alore1, J. W. Suliburk1, C. T. Wilson1, M. A. Davis1, S. R. Todd1  1Baylor College Of Medicine,Surgery,Houston, TX, USA

Introduction: The effect of body mass index (BMI) on penetrating injuries is not well described. The aim of this study was to describe the effect of BMI on the severity of penetrating injuries by abbreviated injury score (AIS). We hypothesized that increasing BMI would be protective against higher injury severity in patients with penetrating mechanisms.

Methods:  This was a retrospective analysis of penetrating trauma patients ≥ 16 years old from the 2007-2015 National Trauma Data Bank (NTDB). Patients transferred, dead on arrival, or with isolated brain injury were excluded. Patients were classified by BMI category as underweight (<18.99kg/m2), normal (19-24.99kg/m2), overweight (25-29.99kg/m2), obese (30-39.99kg/m2), and morbidly obese (≥40kg/m2). AIS severity was defined as minor (AIS 1-3) or major (AIS 4-6). Univariate and multivariate analyses were performed to assess association with BMI (significance, p<0.05).

Results: 83,826 patients were evaluated. The median age was 30 (IQR 23-41); 87% were men. Median BMI was 25.9 kg/m2 (IQR 23-30). The mechanism of injury was stab wound in 43% and firearm in 57%. The median AIS by region was 2 (IQR 1-3) for the abdomen, 3 (IQR 1-3) for the thorax, and 1 (IQR 1-2) for the extremities. The median injury severity score (ISS) was 5 (IQR 1-11). Overall mortality was 5.3%. On univariate analysis by BMI category, AIS severity was not significant for the abdomen (p=0.316), thorax (p=0.267), or extremities (p=0.184). This lack of significance continued when analyzed by mechanism of injury: stab wound – abdomen (p=0.350), thorax (p=0.471), or extremities (p=0.074); firearm – abdomen (p=0.172), thorax (p=0.340), or extremities (p=0.318). On multivariate analysis, AIS severity was not associated with BMI category for the abdomen (p=0.729), thorax (p=0.226), or extremities (p=0.232). Variables significantly associated with AIS severity were systolic blood pressure (abdomen: OR=0.986, CI=0.984-0.987, p<0.001; thorax OR=0.984, CI=0.982-0.985, p<0.001; extremities OR=0.977, CI=0.973-0.980, p<0.001), heart rate (abdomen: OR=1.008, CI=1.006-1.010, p<0.001; thorax OR=1.004, CI=1.002-1.006, p<0.001; extremities OR=1.021, CI=1.017-1.025, p<0.001) and firearm mechanism of injury (abdomen: OR=7.548, CI=6.562-8.681, p<0.001; thorax OR=2.223, CI=2.006-2.463, p<0.001; extremities OR=13.873, CI=8.752-21.992, p<0.001). Mortality did not vary significantly (p=0.552) across BMI categories.

Conclusion: Increased BMI is not associated with protection from penetrating injuries. Mortality did not vary significantly across BMI categories.

 

105.02 Medical Malpractice and Trauma Surgery, What Pays Out

Posted on January 31, 2019

M. S. Sussman1, M. Mulder1, S. Carranco1, E. L. Ryon1, B. Sussman1, S. Madiraju1, V. Hart1, K. Proctor1  1University Of Miami,Trauma Surgery/critical Care,Miami, FL, USA

Introduction:  Medical malpractice litigation is a source of anxiety for many surgeons. Previous studies indicate that a general surgeon’s chance of being involved in a malpractice claim by age 65 approaches 99%. Although single site analysis has indicated no increased risk of lawsuit for trauma surgeons, a review of a large, national, legal database is lacking. The purpose of this study is to explore the malpractice environment surrounding trauma surgery and acute care surgery services.

Methods:  Lexis Nexis is a mode of legal research that uses databases of court opinions, statutes, court documents, and secondary material. We searched 1987-2017, of all state and federal cases using the Boolean search Terms: “trauma” AND “medical malpractice” AND “case summary” AND NOT copyright.  Pediatrics, obstetrics, ophthalmologic and incomplete cases were excluded.

Results: During a 30-year period 231 malpractice cases were identified. Several trauma subspecialties were implicated in the lawsuits. These included trauma surgeons, acute care general surgeons (ACS), trauma orthopedics (TO), trauma neurosurgery (TN), and trauma anesthesia (TA). A majority of the cases involved emergent surgery (148/231, 64%). Preoperative assessment was responsible for 82 suits (35%). A total of 62 cases (27%) resulted in death.  A total of 20 cases (9%) resulted in monetary award to the plaintiff (patient) for an average payout of $1.1M (range, $35K – $6.4M). Examining trauma surgeons as a separate cohort, 12 malpractice suits resulted in payouts, eight of these (66%) were a result of delayed/missed diagnosis. Technical error was sited in 15% and neglect in 8% of cases where a payout was awarded. Looking at the other subspecialties (ACS, TO, TN, TA) involved, 8 cases resulted in payout, 100% of these cases were as a result of technical error.

Conclusion: Only a small fraction of medical malpractice cases that are filed result in a payout.  The majority of suits brought against trauma surgeons arise from delayed/missed diagnosis, whereas all of the suits brought against other subspecialties arise from technical error.  This is likely due to the fact that trauma surgeons serve as the frontline diagnosticians and must make rapid assessments. This study highlights the importance of the trauma assessment and time to diagnosis as targets for education on litigation prevention. Further investigation is warranted to understand the underlying causes for malpractice suits between trauma surgeons and other trauma subspecialties.

 

104.20 Varsity Sports and Surgical Training Success

Posted on January 31, 2019

A. Tanious1, C. Jokisch2, H. McMullin2, L. T. Boitano1, P. A. Armstrong2, M. Harrington3, M. F. Conrad1, M. L. Shames2  1Massachusetts General Hospital,Vascular Surgery,Boston, MA, USA 2University Of South Florida College Of Medicine,Vascular Surgery,Tampa, FL, USA 3University Of South Florida College Of Medicine,Plastic Surgery,Tampa, FL, USA

Introduction:

Our goal was to understand if a correlation exists between participation in varsity level sports and positive experiences during one’s surgical clerkship or surgical residency.

Methods:

            Surveys were sent to the program directors of all surgical residencies, all surgical residents, as well as all third and fourth year medicals students at our institution. Data collected included level of training, participation in varsity sports, and the last level of competitive sports played.  Likert scales where used to assess the level of enjoyment of surgical education, teaching style (i.e. Socratic method), and surgical training.

Results:

            Seventy-eight of our surgical residents (48%), and 87 of our medical students participated in the study (26%).  Sixty-three percent of medical student responders and 82% of surgical resident responders participated in varsity level sports.  Significant correlations were found between participation in varsity level sports and enjoyment of teaching style during surgical residency (P = .04).  Individuals with higher levels of sports involvement (high school and collegiate level involvement) had significantly increased positive interactions with other trainees as well as level as significantly increased feelings of preparedness for surgical residency (P = .01 and P = .04 respectively).  Six of 10 program directors responded and showed no preference towards students who participated in varsity sports.

Conclusions:

            The opinions of trainees suggest that participation in varsity sports may aid in preparing one for surgical training. It may also improve interactions amongst trainees during residency. While program directors do not consider this an essential characteristic, it may help discern which applicants are better suited for the hardships faced by surgical training and its associated teaching methods.

104.19 Faculty mentoring: Early experience with a Formal Mentoring Committee

Posted on January 31, 2019

P. N. Redlich1, T. A. DeRoon-Cassini1, R. Treat1, R. Spellecy1, M. Zarka1, M. A. Zimmerman1, T. P. Webb1, B. D. Lewis1, D. M. Gourlay1, G. Lomberk1, K. R. Brown1, M. F. Otterson1, D. B. Evans1, T. S. Wang1  1Medical College Of Wisconsin,Surgery,Milwaukee, WI, USA

Introduction: Faculty represent the most important asset of academic departments. Effective faculty mentoring is the cornerstone of career success. Studies have demonstrated the importance of mentoring, yet only half of surgical departments have mentoring programs. Our department sought to enhance its mentoring program by establishing a formal Mentoring Committee (MC) in 2016 to supplement support by the Chair and Division Chiefs. The goals of this study were to obtain junior faculty perceptions on mentoring and their perceived value of the MC. In addition, senior faculty participation in the MC was tracked as a measure of interest in, and support of, junior faculty mentoring.

Methods:
The MC was constituted to have broad representation with 11 senior faculty members from 8 Divisions and one from another academic department. Concomitant with the formation of the MC, a questionnaire (Survey 1) was sent to all assistant and associate professors surveying demographics, perceived mentoring components, and past mentoring experiences. Assistant professors (both newly hired [NH] and those beyond their first year [BFY]) met individually with the MC. Attendance at meetings was recorded, including MC members and invited mentors of NH faculty. The MC reviewed the mentee’s current and planned clinical, academic and professional activities while providing detailed feedback, guidance, and support in a 45-60-minute session. Comprehensive minutes were provided within 2-3 weeks along with a post-meeting survey (Survey 2) to include invited feedback. Both surveys were constructed using a Likert scale from 1-5 (5=strongly agree; most important). Significance was determined by the Mann-Whitney U-test.

Results:
Survey 1 had a response rate of 44% (14/32). Highest rated items defining mentoring were: professional development advice (5.0 [median]), support in societies (5.0), support of scholarly projects (5.0), and assisting with research (4.0). Over 2 years, 10 BFY and 16 NH assistant professors met with the MC. Survey 2 had a response rate of 100% (26/26). The highest rated items included: information provided was valuable (5.0), meeting time allotted was sufficient (5.0), and post-meeting communications were helpful (5.0). “Pre-meeting materials were helpful” was rated higher by NH faculty (4.0 vs 3.5, p=0.011) whereas “meeting time allotted was sufficient” was rated higher by BFY faculty (5.0 vs 4.5, p=0.04). The mean number of senior faculty who attended meetings was 6.3 (SD=1.6; range 4-11).

Conclusion:
A formal MC was well-received by junior faculty and enthusiastically supported by senior faculty. A focused meeting of the MC devoted to an individual faculty member has created a visible symbol of the importance of career mentoring. Interest from other departments has provided impetus for enhanced mentoring across the institution. Long-term evaluation of specific outcomes of our MC is ongoing.
 

104.18 Integrating Provider-Level Practical Trauma Training into Undergraduate Medical Education

Posted on January 31, 2019

A. C. Sayce1, S. Rakhit1,2,3, S. C. Eastham1,2, C. S. Wilson2, L. B. Nanney1,4,5, M. B. Patel1,2,3,6,7  1Vanderbilt University,School Of Medicine,Nashville, TN, USA 2Vanderbilt University Medical Center,Division Of Trauma, Emergency General Surgery, And Surgical Critical Care, Department Of Surgery, Section Of Surgical Sciences,Nashville, TN, USA 3Vanderbilt Critical Illness, Brain Dysfunction, and Survivorship Center,Nashville, TN, USA 4Vanderbilt University Medical Center,Department Of Plastic Surgery, Section Of Surgical Sciences,Nashville, TN, USA 5Vanderbilt University,Department Of Cell And Developmental Biology,Nashville, TN, USA 6US Department of Veterans Affairs,Surgical Service, Nashville VA Medical Center, Tennessee Valley Healthcare System,Nashville, TN, USA 7Vanderbilt University Medical Center,Departments Of Neurosurgery And Hearing And Speech Sciences, Vanderbilt Brain Institute,Nashville, TN, USA

Introduction: The American College of Surgeons (ACS) has created trauma curricula for graduate and continuing medical education (i.e. residents, fellows, faculty), including Advanced Trauma Life Support (ATLS) and Advanced Surgical Skills for Exposure in Trauma (ASSET). We used ATLS and ASSET programs as cornerstones for an undergraduate medical education (i.e. medical student) integrated science course in trauma in order to understand attitudes and performance of less-experienced learners. We hypothesized that medical students would be satisfied with the course, possess sufficient knowledge for ATLS certification, and demonstrate knowledge of the theoretical concepts of ASSET training.

Methods: From 2015 to 2018, ATLS (9th and/or 10th editions) and ASSET curricula were embedded in a single institution, four-week, post-core clinical clerkship medical student course containing basic science didactics, laboratory, and clinical experiences across the spectrum of post-injury science. Medical students enrolled in ATLS and ASSET alongside resident, fellow, faculty, and/or allied health providers. Prospective survey data were collected on medical student course satisfaction and clinical performance evaluations including pre-test and post-test ATLS and ASSET scores. Paired survey data and test scores were analyzed by Pratt’s modified method of matched non-parametric rank-sign testing. Change in performance on multiple choice testing was analyzed by ANOVA for level of training.

Results: Fifty-six medical students enrolled in and completed the trauma course. All students were satisfied with the overall learning experience (5/56 satisfied; 51/56 very satisfied) and would recommend the trauma course to their peers (8/56 agree; 48/56 strongly agree). ATLS test scores improved amongst medical students by 6.34 points (95% CI [3.64, 9.04]) and residents by 4.20 points (95% CI [0.06, 8.33]) but not faculty (mean: 0.98; 95% CI [-2.84, 4.81]) or other providers (mean: 1.25; 95% CI [-7.40, 9.90]). Although ATLS pre-test scores differed among groups by level of training (p=0.029), post-test scores did not differ by group (p=0.129). All medical students passed ATLS. In addition, 90 percent (44/49) of medical students achieved a score of at least 70 percent on the ASSET post-course test.

Conclusion: A four-week trauma course based on ATLS and ASSET curricula was well received by medical students. Medical students demonstrated equivalent improvement to residents during ATLS with both groups achieving final performance equivalent to attending faculty. All medical students passed ATLS for official certification on graduation. Medical students also exhibited abilities to synthesize and apply the advanced surgical concepts taught in ASSET. These data demonstrate that medical students can successfully complete postgraduate-level ACS trauma curricula, and suggest a means for increasing the clinical readiness of future residents in care of the injured patient.

104.17 Low Cost Inanimate Models are Useful in Assessing Open and Laparoscopic Skills of GS Residents

Posted on January 31, 2019

Y. N. AlJamal1, N. Prabhakar1, H. Saleem1, M. Baloul1, D. R. Farley1  1Mayo Clinic,General Surgery,Rochester, MN, USA

Introduction: Surgical residents prefer to spend most of their training time doing operations on real patients. Little has been written about training and assessing senior surgical residents on low cost models for both open and laparoscopic surgery. While our simulation education efforts have concentrated on surgical interns, we do assess senior level residents biannually in our simulation center. The cost and educational utility of such an effort to assess open and laparoscopic skills has not been delineated. 

Methods: Surgical residents biannually participate in a 59 minute OSCE (Surgical X-Games) consisting of 6 stations.  Several stations involve open surgery low-cost task trainers (constructed from felt, yarn, cardboard, etc.) and laparoscopic task trainers (laparoscope, monitor, graspers, plastic box containing felt and cloth made to look like abdominal organs). Skills assessed were open inguinal hernia repair, small bowel anastomosis, and portal vein injury management, and laparoscopic abdominal exploration and enterotomy closure. Performance analysis utilized an objective checklist, and residents provided feedback (Likert Scale 1= negative through 5=positive) regarding the utility of the exercises.

Results: Forty-four GS residents (16 PGY-2s, 8 PGY-3, 10 PGY-4s and 10 PGY-5s) completed the assessment. Performance within and between PGY levels was variable, but PGY 5 trainees outperformed PGY-2s, 3s, and 4s (p<0.05). Although PGY-4 and 3 residents’ skills were comparable (p=NS), they outperformed PGY 2 residents (p<0.05). Material cost for constructing models (IH repair= $3, SB anastomosis=$1.10, PV injury=$1.05, lap abd exploration=$10.50, and lap enterotomy closure=$11.50) was reasonable. Medical student volunteers (free labor) required between 9 minutes (SB anastomosis) and 2 hours (Lap abdominal exploration) for model construction. Models were re-used. Resident feedback suggests the models and activities had utility (Likert scores: range of 3-5, mean=4.5);  PGY-5s unanimously disliked the lap enterotomy closure station.

Conclusions: Low cost inanimate models facilitated assessment of surgical residents’ open and laparoscopic surgical skills. Residents felt the models were useful and realistic, and staff found them inexpensive, easy to set up, and durable. We will plan to look for new ways to use this low cost option in our surgical curriculum and specifically find a lap enterotomy closure model that is not so taxing on PGY-5s.

104.15 Attributes of Medical School Curricula that Promote the Development of Self-Directed Learning Skills

Posted on January 31, 2019

S. Stauder1, N. Kugler1, T. Webb1  1Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA

Introduction:
Self-Directed Learning (SDL) is a critical component of medical education beginning in medical school and continuing throughout the career of physicians. Medical schools are now required to demonstrate evidence of medical student SDL within the curriculum. However, there is no consensus on what constitutes a self-directed learner, nor how medical schools or residencies may better provide SDL opportunities to learners. Our project aimed to develop a consensus on the attributes and behaviors of a self-directed learner and the components of medical education curricula that promote SDL skills in medical students.

Methods:
Surveys were distributed to members of the Society of Teaching Scholars at the Medical College of Wisconsin, which is comprised of 75 full time faculty who have been elected based on demonstrated excellence in educational scholarship and leadership. The initial phase consisted of a survey asking two open-ended questions: 1) What are the observable characteristics (behaviors) of a self-directed learner? 2) What specific components of a medical school course or clerkship do you believe promote self-directed learning? Based on open-ended survey results, a new survey consisting of SDL characteristics and curriculum components was sent to the STS following the Delphi method of surveying, ranking attributes on a Likert scale of 1-7. Using attributes which received a 4+ rating from ≥50% of respondents, a second and final Delphi round was performed, and a consensus of final attributes was compiled using those which received a 5+ rating from >70% of respondents. Afterward, all attributes were classified into core themes to provide an outline of self-directed learners and components of a curriculum that foster SDL skills.

Results:
30 STS members completed the open-ended survey, 37 completed the Delphi 1st round, and 25 completed the Delphi 2nd round. 44 SDL characteristics and 50 curriculum components were used in the Delphi surveys. Final survey results obtained 33 unique SDL characteristics and 36 curriculum components which received a 5+ rating from >70% of respondents. These attributes were subsequently classified into themes with similar attributes. In total, 8 core themes of SDL characteristics and 8 core themes of curriculum components that promote SDL skill development were identified.

Conclusion:
Attributes of SDL related to the learner and educational environment can be classified into core themes that may be used for further curriculum development and demonstration of promotion of SDL. Further studies should analyze validity and reliability of using these themes in student assessment and curricular evaluation.

104.14 BioInnovate: Medical Student Experiential Education in Technology Innovation and Entrepreneurship

Posted on January 31, 2019

B. R. Fogg3, J. T. Langell1,2,3,4  1University Of Utah,Department Of Surgery,Salt Lake City, UT, USA 2University Of Utah,Department Of Bioengineering,Salt Lake City, UT, USA 3University Of Utah,Center for Medical Innovation,Salt Lake City, UT, USA 4VA Salt Lake City Health Care System,Center of Innovation,Salt Lake City, UT, USA

 

Introduction: Joint M.D. programs are becoming increasingly popular as more medical students seek additional professional development training. These programs have direct costs (tuition and living expenses) and opportunity costs (delayed training and compensation). Potential benefits include enhancing future career opportunities and knowledge acquisition in additional fields to increase future professional impact.

 

Here we present our 6-year experience with BioInnovate, a combined degree program for medical students and residents focused on medical technology innovation and entrepreneurship. BioInnovate is an accelerated 1-year Master of Science track in bioengineering. Students in the program combine their healthcare background with engineering and business training to identify clinical problems and create technology solutions to improve healthcare delivery. The program focuses on experiential education and interdisciplinary teams composed of graduate students with backgrounds in medicine, engineering, business, design and law. The curriculum is based on the complete product development lifecycle including design inputs, design processes, technology verification and validation and the commercial translation process.

 

Methods: Background and outcomes data was gathered through our program database and an anonymous online survey to assess medical student participant characteristics and program impact, including student academic and entrepreneurial accomplishments. Additional data was collected to assess how the program impacted future career choices and opportunities. 

 

Results:69% of BioInnovate medical students had no previous experience with technology development and only 2 had minor experience with business start-ups. No student had experience with FDA regulations or medical technology reimbursement pathways. On average during their BioInnovate year, students filed 2 patents (range 0-3), raised $37.5k in funding (range $6k-$120k), completed 4 peer-reviewed publications or national academic presentations on their BioInnovate work (range 1-6) and all filed at least 1 IRB clinical trial applications. Additionally, 100% of BioInnovate students later matched in one of their top-3 residency choices (national average 78%), 69% are currently engaged in healthcare technology development, 90% plan to conduct medical technology innovation and development as part of their professional careers and 90% recommend this training for all medical students and residents.

 

Conclusions:The BioInnovate program has been effective in providing medical students with an experience in comprehensive medical technology innovation and commercialization. It has impacted students’ future career decisions and their academic and entrepreneurial success metrics. Over the first 6-years, the program has trained 13 medical students who developed 21 medical technologies, filed 22 patents and launched 14 startup companies.

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