Background The study aim was to evaluate validity evidence using idle time as a performance measure in open surgical skills assessment. Methods This pilot study tested psychomotor planning skills of surgical attendings (N=6), residents (N=4) and medical students (N=5) during suturing tasks of varying difficulty. Performance data were collected with a motion tracking system. Participants’ hand movements were analyzed for idle time, total operative time and path length. We hypothesized that there will be shorter idle times for more experienced individuals and on the easier tasks. Results A total of 365 idle periods were identified across all participants. Attendings had fewer idle periods during three specific procedure steps (p < .001). All participants had longer idle time on friable tissue (p < .005). Conclusion Using an experimental model, idle time was found to correlate with experience and motor planning when operating on increasingly difficult tissue types. Further work exploring idle time as a valid psychomotor measure is warranted.

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Introduction Surgery residents may take years away from clinical responsibilities for dedicated research time. As part of a longitudinal project, the study aim was to investigate residents’ perceptions of clinical skill reduction during dedicated research time. Our hypothesis was that residents would perceive a greater potential reduction in skill during research time for procedures they were less confident in performing. Materials and methods Surgical residents engaged in dedicated research training at multiple training programs participated in four simulated procedures: urinary catheterization, subclavian central line, bowel anastomosis and laparoscopic ventral hernia (LVH) repair. Using pre and post-procedure surveys, participants rated procedures for confidence and difficulty. Residents also indicated the perceived level of skills reduction for the four procedures as a result of time in the laboratory. Results Thirty-eight residents (55% female) completed the four clinical simulators. Participants had between 0–36 months in a laboratory (M=9.29 months, SD=9.38). Pre-procedure surveys noted lower confidence and higher perceived difficulty for performing the LVH repair followed by bowel anastomosis, central line insertion, and urinary catheterization (p<.05). Residents perceived the greatest reduction in bowel anastomosis and LVH repair skills compared to urinary catheterization and subclavian central line insertion (p<.001). Post-procedure surveys showed significant effects of the simulation scenarios on resident perception for urinary catheterization (p<.05) and LVH repair (p<.05). Conclusion Residents in this study expected greater skills decay for the procedures they had lower confidence performing and greater perceived difficulty. In addition, carefully adapted simulation scenarios had a significant effect on resident perception and may provide a mechanism for maintaining skills and keeping confidence grounded in experience.

Utility of adjuvant chemotherapy for stage II cancer remains a matter of debate. Clinical guidelines suggest adjuvant chemotherapy for stage II tumors with high-risk features, in particular T4 tumors. However, limited consensus exists regarding the importance of other high-risk features (lymphovascular or perineural invasion, microsatellite instability). Our study aimed to investigate the impact of adjuvant chemotherapy for stage IIA (T3N0) colon cancer patients. Patients who underwent colectomy for stage IIA colon adenocarcinoma (2010-2015) were identified in the National Cancer Database (NCDB) and divided in two groups based on receipt of adjuvant chemotherapy vs observation. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed to compare overall survival between the two groups. Subgroup analysis of patients with specific high-risk features LVI, PNI and MSI was performed. Among 46 688 surgical patients with stage IIA colon adenocarcinoma 5937 (12.7%) received adjuvant chemotherapy, while 40 751 (87.3%) were observed. Five-year IPTW-adjusted survival was higher in the adjuvant chemotherapy group (79.7% [95% CI 79.1, 80.2]) compared to the observation group (70.3% [95% CI 69.7, 70.9]). Patients with high-risk pathological features showed an estimated 5-year survival benefit of 11.3% (78.2% [95% CI 77.4, 79.1] vs 66.9% [95% CI 65.9, 67.8]) when treated with adjuvant chemotherapy. This NCDB analysis revealed a survival benefit for patients with stage IIA colon adenocarcinoma and high-risk features that were treated with adjuvant chemotherapy.

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