Coe, Taylor M.

Background. Liver transplantation (LT) is the standard treatment for liver failure secondary to alcohol-associated liver disease, but limited literature and best practices exist for post-LT treatment of alcohol use disorder (AUD). This study explores current AUD management practices and providers’ perceived barriers to effective post-LT AUD management. Methods. A 45-item survey on post-LT AUD treatment practices was distributed to members of the American Society of Transplant Surgeons, the Association of Consult/Liaison Psychiatry Transplant Special Interest Group, and both the American Society of Transplantation’s Liver and Intestine Community of Practice and Psychosocial and Ethics Community of Practice discussion boards, between December 2021 and April 2022. Univariate analysis of categorical variables was performed using the chi-square test. Data were analyzed using center volume tertiles, country region, and provider professional activity. Results. Two hundred thirty-two respondents from 70 LT centers across all 11 United Network for Organ Sharing regions completed the survey. Half of the them were attending physicians and 16.4% were nurse coordinators. Most centers (84%) aimed for alcohol abstinence for all post-LT patients. Perceived barriers to AUD treatment efficacy included ongoing desire to drink (18%), denial about alcohol misuse (14.9%), and lack of posttransplant support (14%). Additionally, 62.1% of centers had no policy for prescribing medication-assisted therapy to treat AUD, and 32.7% of centers reported no center-level changes in AUD care. Providers identified primary needs as hiring additional mental health professionals (30.8%), dedicating specific staff to AUD care (24.7%), and standardizing psychiatric/psychological care in transplant clinics (17.2%). Conclusions. Despite the increasing volume of LT for alcohol-associated liver disease, significant perceived barriers to effective AUD treatment remain.

ABSTRACT General surgery is a dynamic and multifaceted field influenced by diverse factors, ranging from cultural norms to healthcare system structures and technological advancements. This review paper delves into a comparative exploration of the educational landscapes in Canada and India, unravelling the intricacies of training aspiring general surgeons. As two nations with distinct healthcare systems and educational frameworks, Canada and India offer unique perspectives on the journey from medical school to independent surgical practice. This article compares the residency application process, training structure, assessment methods, challenges faced during clinical training and the role of research in surgical programmes between the two nations. Through this comparative lens, we seek to provide valuable insights that may inform future developments in surgical education, fostering a global exchange of knowledge and practices to advance healthcare systems worldwide.

Objective: This study aims to define an effective senior resident and understand the process of leadership and nontechnical skill development in the transition from junior to senior surgery resident. Summary Background: General surgery residents are responsible for patient care, technically demanding operations, and diverse care team management. However, leadership skill development for the transition from junior to senior resident roles is often overlooked. Methods: We conducted 15 semi-structured focus groups with surgery residents from an urban, academic institution. Focus group transcripts were inductively coded. Using content analysis and constant comparative methodology, primary codes were refined into categories and organized into higher-level themes. Results: Thirty-three general surgery residents completed fifteen focus groups. Six themes were identified. Three themes describe the process of becoming an effective senior resident: how to define a senior resident's scope of practice, the transition process, and the importance of personal investment. Three themes were identified regarding effective seniors: ideal traits, teachable skills, and the team and patient impact. Conclusions: Surgery residents define an effective senior resident as the team member with the highest level of experience who manages the big picture of patient care. The transition is improved by personal engagement and acknowledgement of the transition. Ideal traits of effective seniors, including emotional intelligence and inherent personality traits, allow a resident to more naturally assume this role; however, teachable skills, such as communication, expectation setting and competence, can be taught to improve one's effectiveness. The actions of a senior resident impact the team and patient care, underscoring the importance of understanding this role.

11033 Background: Breast enhanced recovery after surgery (ERAS) protocols emphasize multimodal analgesia to decrease pain and expedite home recovery, but variability remains for same-day discharge and pain management. The purpose of this qualitative study is to examine how residents learn and apply breast surgery ERAS protocols, how they conceptualize pain management for breast surgery patients, and what influences their decision to discharge a patient home on the day of surgery. Methods: A semi-structured interview guide was adapted from existing instruments in the pain management qualitative literature. Surgical residents who rotated on the breast surgery service within the previous 12 months were interviewed by a single researcher. Interviews were recorded, transcribed, de-identified, and independently inductively coded by two researchers. A codebook was developed and refined using the constant comparative method until interrater reliability (Cohen’s kappa) reached greater than 0.9. Codes were grouped into coding categories and explored for thematic analysis. Results: Twelve interviews were completed with plastic and general surgery residents. Participants spanned post-graduate years 1-4. Preferred discharge narcotic regimens for mastectomy patients ranged from 5-30 tablets of 5mg oxycodone and participants rarely reported the same quantity. Ultimately, 365 primary codes were collapsed into 26 parent codes, with a Cohen’s kappa of 0.93. Six emerging themes were identified. Three themes describe how participants learned through a mixture of templated care, formal education, and informal experiential learning. Two themes delineate how residents would teach breast surgery ERAS protocols: by emphasizing buy-in and by connecting the impetus behind ERAS with the implementation in daily workflow. One theme illustrates the patient-centered culture and how that impacts postoperative management and same-day discharges. Conclusions: Residents learn breast surgery ERAS and postoperative pain management from imitating their seniors, observing patient encounters, completing templated orders, and translating concepts from other ERAS services, more so than from a formal lecture. When implementing new same-day discharge protocols for mastectomy patients, it is important to consider how informal learning and local culture influence postoperative pain management and discharge rates.