This is the first report of cross-institutional surgical coaching for the continuous professional development of practicing surgeons, demonstrating perceived value among participants, as well as logistical challenges for implementing this evidence-based program. Future research is necessary to evaluate the impact of coaching on practice change and patient outcomes.

Peer-nominated surgical coaches were provided with training on abstract concepts that underlie effective coaching practices in other fields. By identifying the strategies used by peer surgical coaches to operationalize these concepts, empirically based strategies to inform other surgical coaching programs are provided.

Introduction Increasing emphasis is being placed on appropriateness of care and avoidance of over- and under-treatment. Indeterminate thyroid nodules (ITN), present a particular risk for this problem because cancer found via diagnostic lobectomy (DL) often requires a completion thyroidectomy (CT). However, initial total thyroidectomy (TT) for benign ITN results in lifelong thyroid hormone replacement. We sought to measure the accuracy and factors associated with the extent of initial thyroidectomy for ITN. Methods We queried a single institution thyroid surgery database for all adult patients undergoing an initial operation for ITN. Multivariate logistic regression identified factors associated with either oncologic under- or over-treatment at initial operation. Results There were 639 patients with ITN. The median age was 52 (range 18 – 93), 78.4% were female, and final pathology revealed a cancer > 1 cm in 24.7%. The most common cytology was follicular neoplasm (45.1%) followed by Hurthle cell neoplasm (20.2%). CT or initial oncologic under-treatment was required in 58 patients (9.3%). Excluding those with goiters, 19.0% were treated with total thyroidectomy for benign final pathology. Multivariate analysis failed to identify any factor that independently predicted the need for CT. Female gender was associated with total thyroidectomy in benign disease (OR 2.1, 95% C.I. 1.0 – 4.5, p = 0.05). Age >45 predicted correct initial use of DL (OR 2.6, 95% C.I. 1.2 – 5.7, p = 0.02). Suspicious for PTC (OR 5.7, 95% C.I. 2.1 – 15.3, p<0.01) and frozen section (OR 9.7, 95% C.I. 2.5 – 38.6, p<0.01) were associated with oncologically appropriate initial TT. The highest frequency of CT occurred in patients with follicular lesion of undetermined significance (11.6%). Total thyroidectomy for benign final pathology occurred most frequently in patients with a Hurthle cell neoplasm (24.8%). Conclusions In patients with ITN, nearly 30% received an inappropriate extent of initial thyroidectomy from an oncologic standpoint. Tools to preoperatively identify both benign and malignant disease can assist in the complex decision-making to gauge the proper extent of initial surgery for ITN.

The resulting toolkit provides guidance on essential engagement activities relevant to researchers in a variety of settings. Conclusion: Investigators wishing to engage the veteran community may benefit from the experience and lessons summarized in this veteran-informed toolkit, in addition to resources directed at informing community engagement more generally.

Introduction Preoperative nasal decolonization of surgical patients with nasal povidone-iodine (PI) has potential to eliminate pathogenic organisms responsible for surgical site infections. However, data on implementation of PI for quality improvement in clinical practice is limited. The purpose of this study was to evaluate the implementation feasibility, fidelity and acceptability of intranasal PI solution application by surgical nurses using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) conceptual framework. Materials and methods Using the i-PARIHS framework to frame questions and guide interview content areas, we conducted 15 semi-structured interviews of pre- and post-operative care nurses in two facilities. We analyzed the data using deductive content analysis to evaluate nurses’ experience and perceptions on preoperative intranasal PI solution decolonization implementation. Open coding was used to analyze the data to ensure all relevant information was captured. Results Each facility adopted a different quality improvement implementation strategy. The mode of facilitation, training, and educational materials provided to the nurses varied by facility. Barriers identified included lack of effective communication, insufficient information and lack of systematic implementation protocol. Action taken to mitigate some of the barriers included a collaboration between the study team and nurses to develop a systematic written protocol. The training assisted nurses to systematically follow the implementation protocol smoothly to ensure PI administration compliance, and to meet the goal of the facilities. Nurses’ observations and feedback showed that PI did not cause any adverse effects on patients. Conclusions We found that PI implementation was feasible and acceptable by nurses and could be extended to other facilities. However further studies are required to ensure standardization of PI application.