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.

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Background The study aim was to evaluate recommendation patterns of different specialties for the work-up of a palpable breast mass using simulated scenarios and clinical breast examination (CBE) models. Methods Study participants were a convenience sample of physicians (n=318) attending annual surgical, family practice and obstetrics and gynecology (OB/GYN) conferences. Two different silicone-based breast models (superficial mass vs chest wall mass) were used to test CBE skills and recommendation patterns (imaging, tissue sampling, and follow-up). Results Participants were more likely to recommend mammography (p<.001) and core biopsy (p<.0001) and less likely to recommend needle aspiration (p<.043) and 1-month follow up (p<.001) for the chest wall mass compared to the superficial mass. Family practitioners were less likely to recommend ultrasound (p<.001) and OB/GYNs were less likely to recommend mammogram (p<.006) across models. Surgeons were more likely to recommend core biopsy and less likely to recommend needle aspiration across models (p<.001) Conclusions Recommendation patterns differed across the two models in line with existing practice guidelines. Additionally, differences in practice patterns between primary care and specialty providers may represent varying clinician capabilities, health care resources, and individual preferences. Our work shows that simulation may be used to track adherence to practice guidelines for breast masses.