Scientific Abstract Presentations: Top Residents Abstract Session 5 (Hand, Research) Friday, October 27 Fri, Oct 27 8:00-9:05 a.m. CDT

Background In patients with end-stage renal disease requiring hemodialysis, arteriovenous fistulas allow for stable, repeated vascular access.1 For safe access, AVFs not only have to be of an appropriate caliber, but also have to be relatively superficial for successful cannulation.1,2 Traditionally, superficialization is carried about using direct lipectomy at a time remote from initial arteriovenous fistula creation. Recently literature has touted liposuction has a viable option with less morbidity compared to open technique.1,3 Here, we present liposuction under direct visualization with ultrasound as an option for superficialization of deep vascular accesses.

Methods A single institution, retrospective review was conducted to identify patients with end-stage renal disease on dialysis presenting for superficialization of arteriovenous fistulas from 2019 to 2021. One of four patients underwent direct lipectomy, while three of four patients underwent liposuction under ultrasound-guidance for superficialization. All procedures were performed by a single surgeon. The primary outcomes were desired depth of arteriovenous fistula with subcutaneous tissue measurement of 5 mm and timing to next stable vascular access.

Results All patients were able to achieve 5 mm thickness of soft tissue overlying their fistulas intraoperatively at the conclusion of the procedure. Postoperatively, all patients had successful maturation of their arteriovenous fistulas, and were able to achieve successful vascular access. Of the patients undergoing ultrasound-guided liposuction, one patient achieved successful cannulation within 6 weeks post-procedure, though all patients undergoing superficialization were able to have successful cannulation by 12 weeks. All patients were neurovascularly intact postoperatively and at their subsequent follow up visits. Patient undergoing liposuction were noted to have resolution of local edema and ecchymosis on exam within 3 weeks of procedure.

Conclusion Liposuction under ultrasound-guidance is a minimally invasive technique for superficialization of arteriovenous fistulas with the potential for improved patient outcomes with faster recovery and timing to successful vascular access.

References 1. Krochmal, D.J., et al., Superficialization of deep arteriovenous access procedures in obese patients using suction-assisted lipectomy: A novel approach. Can J Plast Surg, 2010. 18(1): p. 25-7. 2. Inkollu, S., et al., Successful use of minimal incision superficialization technique for arteriovenous fistula maturation. J Vasc Surg, 2016. 63(4): p. 1018-25. 3. Causey, M.W., et al., Superficialization of arteriovenous fistulae employing minimally invasive liposuction. J Vasc Surg, 2010. 52(5): p. 1397-400.

Since the adipose-derived stem cell (ADSC) discovery, adipose tissue has been described as an ideal stem cell source.1 Numerous methods were designed to isolate ADSC, divided into enzymatic and mechanical techniques.2 The enzymatic technique is expensive, time-consuming,3 risks altering cell phenotype and raises legislative issues.4 However, the mechanical technique was shown to have a relatively lower yield.5 This study describes the optimization of the mechanical technique for ADSC isolation followed by verification and quantification.

In this prospective cohort study, 28 samples from 19 patients were collected. Adipose tissue was sampled using tissue blocks or lipoaspirates. The samples were prepared using scalpel blades followed by centrifugation. The samples were evaluated for cell viability with trypan blue solution and quantified with a hemocytometer. The ADSC were cultured, and the surface antigens CD29, CD34, CD73, CD90, and CD105 were detected using a flow cytometer. The ADSC were then differentiated into adipocytes, chondrocytes and osteocytes, and their respective identities were verified with Oil Red O staining, Toluidin Blue staining and Alizarin Red staining.

The mean weight of samples was 13.653g (range 1.752 to 40.587g, SD ±12.16g). The mean number of ADSC isolated was 1.187x10^5 (SD ±1.461x10^5). The mean number of ADSC per gram was calculated as 1.831x10^4 (SD ±3.401x10^4). The ADSC expressed high levels of CD29, CD73, CD90, and CD105, with low levels of CD34. Differentiation to adipogenic, chondrogenic and osteogenic lineages was successful.

Our mechanical technique for ADSC isolation provides a simple alternative method that can be tailored for future research or clinical application.

References 1. Mazini L, Rochette L, Amine M, Malka G. Regenerative Capacity of Adipose Derived Stem Cells (ADSCs), Comparison with Mesenchymal Stem Cells (MSCs). Int J Mol Sci. 2019;20(10). doi:10.3390/IJMS20102523 2. Khazaei S, Keshavarz G, Bozorgi A, Nazari H, Khazaei M. Adipose tissue-derived stem cells: a comparative review on isolation, culture, and differentiation methods. Cell and Tissue Banking 2021 23:1. 2021;23(1):1-16. doi:10.1007/S10561-021-09905-Z 3. Raposio E, Caruana G, Bonomini S, Libondi G. A novel and effective strategy for the isolation of adipose-derived stem cells: minimally manipulated adipose-derived stem cells for more rapid and safe stem cell therapy. Plast Reconstr Surg. 2014;133(6):1406-1409. doi:10.1097/PRS.0000000000000170 4. Gentile P, Calabrese C, De Angelis B, Pizzicannella J, Kothari A, Garcovich S. Impact of the Different Preparation Methods to Obtain Human Adipose-Derived Stromal Vascular Fraction Cells (AD-SVFs) and Human Adipose-Derived Mesenchymal Stem Cells (AD-MSCs): Enzymatic Digestion Versus Mechanical Centrifugation. International Journal of Molecular Sciences 2019, Vol 20, Page 5471. 2019;20(21):5471. doi:10.3390/IJMS20215471 5. Raposio E, Simonacci F, Perrotta RE. Adipose-derived stem cells: Comparison between two methods of isolation for clinical applications. Annals of Medicine and Surgery. 2017;20:87-91. doi:10.1016/J.AMSU.2017.07.018

INTRODUCTION Keloid disorder is an abnormal fibroproliferative reaction that can occur on any area of skin, and it can impair the quality of life of affected individuals. To investigate the pathogenesis and develop a treatment strategy, a preclinical animal model of keloid disorder is needed. However, keloid disorder is unique to humans, and the development of an animal model of keloid disorder is highly problematic. In this study, we developed a humanized mouse model, and compared it to the traditional mouse xenograft model. MATERIALS and METHODS To establish the Patient-Derived Keloid Xenograft (PDKX) model, peripheral mononuclear cells from 10 keloid patients (KP) and 5 healthy volunteers (HV) injected into NOD/SCID/IL-2Rγnull mice (3 X 106/mouse), and their keloid lesions were grafted onto the back of mice after the engraftment of immune cells . Four weeks after surgery, the grafted keloid lesion was subjected to histologic evaluation. RESULTS In both models injected with cells from KP and HV, the CD4+ T cell were engrafted well. But the level of engrafted CD4+ T cells were significantly different in KP PBMC and HC PBMC groups (18.80% vs 7.26%). Compared to traditional model without the injection of mononuclear cells and humanized mouse model of HV, neo-tissue formed along the margin of the grafted skin, and lymphocyte infiltration and collagen synthesis were significantly elevated in the PDKX model. The neotissue sites in the PDKX model resembled perilesional areas of keloid in several respects. In detail, the levels of human Th17 cells, IL-17, HIF-1a, and chemokines (SDF-1, CCL2, CCL3, and CXCL9) were significantly elevated. Furthermore, the weight of keloid lesion was increased significantly in avatar model, which was due to the pro-inflammatory microenvironment along the keloid lesion. DISCUSSION In keloid tissue, the degree of inflammation and characteristics of fibroblasts can be different according to the lesion. For example, lymphocyte infiltration and proinflammatory cytokine (IL-17, IL-1beta, IL-6, and tumor necrosis factor-alpha) expression are increased in the perilesional area (growing margin) of keloid compared to the intralesional or extralesional areas (surrounding normal skin). We confirmed that our Patient-Derived Keloid Xenograft (PDKX) model mimics the keloid disorder by recapitulating the in vivo microenvironment. This model will contribute to investigation of cell mechanisms and therapy treatments for keloid disorder.

Reference) 1. Ud-Din, S. & Bayat, A. New insights on keloids, hypertrophic scars, and striae. Dermatol Clin 32, 193-209, doi:10.1016/j.det.2013.11.002 (2014). 2. Shetlar, M. R., Shetlar, C. L., Hendricks, L. & Kischer, C. W. The use of athymic nude mice for the study of human keloids. Proc Soc Exp Biol Med 179, 549-552, doi:10.3181/00379727-179-rc3 (1985).

Background: Fournier's gangrene(FG) is a rare and potentially life-threatening infection that affects the genitals and perineum. The management of this condition is complex and requires prompt diagnosis and aggressive treatment. Scoring systems have been developed to assess the severity of Fournier's gangrene and predict the likelihood of poor outcomes. This article provides an overview of the different scoring systems used to evaluate Fournier's gangrene and the independent predictors of poor outcomes.   Methods: We retrospectively reviewed the past three years medical records of Kaohsiung Veterans General Hospital for all patients with a diagnosis code of FG. Epidemiologic data was collected for patients and used to calculate Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI) or Laboratory Risk Indicator for Necrotizing Fasciitis(LRINEC) score. Patients were grouped as survivors (Group I), non-survivors (Group II), ICU-admission (Group III) and non-ICU-admission (Group IV).   Results: From January 2017 to August 2022, 43 patients treated for FG were included in this study. The mortality rate was 9.3% (4 patients). LRINEC was significantly higher in Group II (9.50±2.88 vs. 5.79±2.62, p=0.011). The ICU-admission rate wAS 27.9% (12 patients). FGSI and UFGSI were significantly higher in Group III (8.41±4.42 vs. 4.25±3.21, 10.75±4.39 vs. 6.19±3.57, respectively, p=0.001)

Conclusion: FGSI and UFGSI are useful for predicting ICU admission in FG while LRINEC is better predictor for mortality. Patient with a FGSI score above 6.5 or UFGSI score above 8.5 have a higher risk of ICU admission; patient with LRINEC score above 8.5 have a higher mortality rate and should be treated under the direct care of an experienced clinical team.

Purpose: Despite an increase in under-represented in medicine (UIM) medical school graduates and residency applicants, there has been a decline in UIM representation of integrated plastic surgery residents.1 Minority applicants face bias, socioeconomic barriers, and lower access to mentors that results in overall lower matriculation into plastic surgery. The inaugural PREPPED (Plastic Surgery Research, Education, and Preparation Promoting Equity and Diversity) course took place in 2022 with the purpose of supporting under-represented students with their transition to sub-interns and residency applicants. The short-term results of the PREPPED 2022 course have been described in a previous study.2 This study describes the long-term match outcomes of the PREPPED 2022 cohort.

Materials and Methods: The PREPPED 2022 course was a 2-day course hosted in San Diego, CA in 2022.. A post-match survey was sent to the PREPPED 2022 cohort in late March of 2023. Data analysis was performed using IBM SPSS.

Results: A total of 30 students responded to the PREPPED 2022 post-match survey (90.1% response rate). Of the respondents, 47% identified as Black, and 40% did not have a home program. Sixty percent of students decided to proceed into their 4th year of medical school. PREPPED 2022 students received interviews at 93.1% of the programs where they had completed a sub-internship. Students endorsed that PREPPED 2022 helped improve their performance in sub-internships (78%), increase their confidence on sub-internships (72%), and identify mentors (61%). Students endorsed that the most useful sessions included "Common Consults", "Operating Room Basics and Suture Lab", and the two panels regarding "Success in Sub-internships" and "Applying to Residency". A total of 17 PREPPED 2022 students applied to the 2023 match, of which 35% dual applied. On average, PREPPED 2022 students applied to 87 (SD 6.5) programs and received 14.5 (SD 8.4) interviews. A total of 13 PREPPED 2022 students matched into plastic surgery (77% match rate) as compared to the 74.9% match rate for U.S. seniors in the 2023 integrated plastic surgery match. Of the six students who dual applied, 5 matched into plastic surgery and one did not match. Students who matched did so at an average rank of 4.5 (SD 2.7) on their rank list. About 29% of PREPPED 2022 students who matched did so at an institution with which they had prolonged contact, including their home program, sub-internship, or research fellowship. Students endorsed that the networking opportunities at PREPPED helped them complete an away rotation (35%) or interview (53%) at an institution of a PREPPED instructor.

Conclusions: PREPPED is a promising venue to help recruitment of UIM students into plastic surgery by improving preparation for the sub-internship and application process. The strengths of PREPPED include mentorship, networking, acquisition of technical skills, and exposure to common consults. Further research is warranted to further examine the impact of annual iterations of PREPPED on the match rate and success.

1 Parmeshwar N, Stuart ER, Reid CM, Oviedo P, Gosman AA. Diversity in Plastic Surgery: Trends in Minority Representation among Applicants and Residents. Plast Reconstr Surg. 2019;143(3):940-949. doi:10.1097/PRS.0000000000005354

2 Reghunathan, Meera MD1; Blum, Jessica MS1; Davis, Greta L. MD2; Ayyala, Haripriya S. MD3; Leis, Amber MD4; Butler, Paris D. MD, MPH3; Gosman, Amanda MD1. 13. PREPPED: Plastic Surgery Research, Education, and Preparation Promoting Equity and Diversity. Plastic and Reconstructive Surgery - Global Open 11(2S):p 8-9, February 2023. | DOI: 10.1097/01.GOX.0000921600.59389.4f

3 Advance Data Tables 2023 Main Residency Match - Nrmp.org. https://www.nrmp.org/wp-content/uploads/2023/04/Advance-Data-Tables-2023_FINAL-2.pdf.

Introduction : Physician wellness has become an increasingly popular and important topic over the past several years in response to the high prevalence of burnout within medicine. Burnout can be defined as emotional and physical exhaustion, depersonalization, and a decreased sense of personal accomplishment caused by prolonged work-related stress. Burnout has a multitude of detrimental effects most fundamentally affecting one's mental health and wellbeing. It is often associated with increase substance abuse, disruptive behavior, absenteeism, attrition, strained personal relationships, divorce, depression, suicidal ideation, and suicide. Burnout is a serious problem for physicians and as a result, can adversely affect their support systems and patients. To combat burnout, wellness interventions have been a big focus in the literature. Wellness has been defined as a multidimensional construct that encompasses several dimensions, with the most consistent including: mental, physical, occupational, social, and intellectual domains. Although earlier reviews have evaluated factors affecting physician wellness and wellness interventions in the field of surgery, insight regarding specific wellness interventions, wellness domains, and outcome measures are limited.

Purpose: This scoping review aims to identify current wellness interventions for surgical residents and staff and recognize which wellness domains are represented within these interventions. Wellness interventions within plastic surgery will be an area of focus.

Methods: We conducted a scoping review following the PRISMA-ScR protocol. A literature search was carried out in Ovid Medline, Embase, and PsycINFO for articles on wellness interventions in all surgical specialties from 1806 to 2022. The interventions identified were categorized based on the wellness domains they aimed to address including physical, social, emotional, intellectual, and occupational.

Results: Our search resulted in 9979 articles. Following specific inclusion and exclusion criteria, 49 studies were included in the final analysis with publication dates between 2004-2022. Most studies took place in the United States (n=38) and at an academic center (n=41). Most studies also focused on resident wellness only (n=36). Six studies focused on staff wellness only, and 7 studies included both resident and staff wellness. General surgery was represented in most studies (n=24) while cardiac surgery was the least represented (n=3). Plastic surgery was included in 7 studies that also included other specialties, however there were no studies dedicated to wellness in plastic surgery only. Wellness interventions were either multidimensional wellness programs or single modalities focused on ergonomics, mindfulness, stress reduction, or work hours. Within these wellness interventions, most focused on physical and occupational domains until 2015. Since then, many wellness interventions have focused on emotional wellness (n=29). Specifically, interventions centered on mindfulness were shown to be the most effective when wellness was measured with a validated outcome measure (p < 0.05). The Maslach Burnout Inventory was used in 45% of studies (n=22), while the remainder used other scales and surveys.

Conclusions: Our study demonstrates a paucity of studies on wellness in surgery, and plastic surgery, specifically for surgical staff. Over the last 10 years, interventions have focused on emotional wellness stressing the importance of mental health for physician wellbeing. More wellness studies in different surgical specialties using standardized instruments are needed to identify successful wellness interventions that will help shift surgery away from a culture of isolation and sense of invulnerability towards one of shared organizational responsibility for physician well-being.

BACKGROUND: The deep inferior epigastric artery perforator (DIEP) flap is widely used in autologous breast reconstruction. However, the technique relies heavily on non-randomized observational research which has been found to have high risk of bias. "Spin" is described as techniques to inappropriately present study findings to exaggerate benefits or minimize harms, either intentionally or unintentionally. There has been a high prevalence of spin identified in plastic surgery literature including 73% of systematic reviews1 and 85% of randomized controlled trials with non-significant primary outcomes.2

PURPOSE: The primary objective was to assess the prevalence of spin in non-randomized observational studies on DIEP reconstruction. The secondary objectives were to determine the prevalence of each spin category and strategy.

METHODS: MEDLINE and Embase databases were searched from January 2015 to November 2022. Screening was performed in duplicate. Spin was assessed in abstracts and full-texts of included studies according to criteria proposed by Lazarus et al.3 Overall, the spin strategies were divided in three categories: misleading reporting, inadequate interpretation, and inadequate extrapolation. Study characteristics were extracted and assessed for association with the presence of spin.

RESULTS: There were 77 studies included for review. The overall prevalence of spin was 87.0%. Studies used a median of 2 spin strategies (interquartile range: 1-3). The most common strategies identified were causal language or claims (n=41/77, 53.2%), inadequate extrapolation to larger population, intervention, or outcome (n=27/77, 35.1%), inadequate implication for clinical practice (n=25/77, 32.5%), use of linguistic spin (n=22/77, 28.6%), and no consideration of the limitations (n=21/77, 27.3%). There were no significant associations between selected study characteristics (authors, journal, year of publication, impact factor, number of citations, country affiliation of corresponding author, sample size, significant primary outcome) and the presence of spin.

CONCLUSION: The prevalence of spin is high in non-randomized observational studies on DIEP reconstruction. Causal language or claims are the most common strategy. Registration of study protocols in prospective observational studies can improve transparency in reporting of results. Investigators, reviewers, and readers should familiarize themselves with spin strategies to avoid misinterpretation of research in DIEP reconstruction.

REFERENCES 1. Gallo L, Yuan M, Gallo M, et al. Evaluation of "Spin" in the Abstracts of Systematic Reviews and Meta-analyses of Therapeutic Interventions Published in High-Impact Plastic Surgery Journals: A Systematic Review. Aesthetic Surgery Journal. 2022. 2. Yuan M, Wu J, Li A, et al. Assessment of "Spin" in Published Plastic Surgery Randomized Controlled Trials with Statistically Non-significant Primary Outcomes–A Systematic Review. Plastic and Reconstructive Surgery. 2022:10.1097. 3. Lazarus C, Haneef R, Ravaud P, Boutron I. Classification and prevalence of spin in abstracts of non-randomized studies evaluating an intervention. BMC medical research methodology. 2015;15(1):1-8.

Background: Prior research has shown that low Non-Technical Skills (NTS) among surgical teams is linked to surgical adverse events, and formal training in NTS can significantly reduce these.1-3 To gauge the level of NTS knowledge and training among US academic plastic surgeons, we conducted a national survey study. We hypothesized that most respondents would not have received formal NTS training but would favor providing such training to residents. Methods: A 29-question survey was distributed to academic plastic surgeons via email with the support of the American Council of Academic Plastic Surgeons. The survey inquired about demographics, knowledge and training in NTS, NTS importance and assessment tools, and NTS training in plastic surgery residency programs. Outcomes were analyzed with descriptive statistics and for associations between co-variables (region, sex, years since completing residency/fellowship). Results: One-hundred ninety-three responses were obtained. Only 43.5% knew the definition of NTS. Most respondents (60.1%) thought a plastic surgery NTS assessment tool would lead to a lower rate of adverse surgical events in the operating room. Respondents that had received NTS training in the past (61.6%, p=0.003) and felt more experienced in NTS (60.6%, p=0.001) were significantly more likely to formally teach NTS. Professionalism was considered the most important NTS (42.0% ranked it highest). Leadership was considered the least important (69.1% ranked it lowest). Of the 74.1% of respondents that thought NTS teaching should be standardized nationally, most (55.5%) thought the format should be online lectures. Conclusions: NTS knowledge and training among academic plastic surgeons could be improved. There is a preference for increased training and assessment for residents. The development of formal training and/or assessment programs could improve surgeons' NTS with the potential to improve patient outcomes.

References 1. Suliburk JW, Buck QM, Pirko CJ, et al. Analysis of Human Performance Deficiencies Associated With Surgical Adverse Events. JAMA Netw open. 2019;2(7):e198067. doi:10.1001/jamanetworkopen.2019.8067 2. Zegers M, de Bruijne MC, de Keizer B, et al. The incidence, root-causes, and outcomes of adverse events in surgical units: Implication for potential prevention strategies. Patient Saf Surg. 2011;5(1):13. doi:10.1186/1754-9493-5-13 3. Hernandez-Boussard T, McDonald KM, Rhoads KF, Curtin CM. Patient Safety in Plastic Surgery: Identifying Areas for Quality Improvement Efforts. In: Annals of Plastic Surgery. Vol 74. Lippincott Williams and Wilkins; 2015:597-602. Doi: 1097/SAP.0b013e318297791e

Background Matching into an integrated plastic surgery residency program is highly competitive, with a limited number of available seats and a highly qualified applicant pool. Many medical students elect to complete research fellowships to increase their research productivity and strengthen their residency applications. This study aimed to understand the process of identifying opportunities, financial considerations, and overall satisfaction with research fellowships.

Methods A national survey was distributed to integrated plastic surgery residency applicants in the 2020-2021 and 2021-2022 application cycles. The survey elicited information regarding demographics, resources utilized in identifying positions, as well as motivators and deterrents for pursuing research fellowships. Questions related to the productiveness of the fellowship as well as perceived benefit of the experience were also included.

Results Five hundred thirty-four integrated plastic surgery applicants were identified from our institution's records and included in our study. Our preliminary results revealed that out of 52 respondents, 19 completed research fellowships (37%). The average fellowship length was 11.6 months, with most completing their research at another institution (63%) between the third and fourth year of medical school (84%). Respondents utilized mentors (83%), previous applicants (48%), and other medical students (35%) to help with the decision to pursue or forgo additional time for research. All respondents, whether they chose to complete a research fellowship or not, considered publications (88%), opportunities for letters of recommendation (63%) and networking (52%) as the top motivational factors. Conversely, aspects that adversely impacted applicants' decisions included an additional year of education (83%), funding concerns (63%), and a delay in generating income (40%).

The most common avenues to identify available research positions were from online listings (42%), word of mouth (37%), and suggestions from mentors (37%). Over half of research fellows received full funding (58%), with the remainder receiving partial (16%) or no funding (26%). The average salary for a research fellowship was $27,900 with the main sources of funding being the institution where the fellowship was completed. Productivity was assessed by the average number of accepted or published publications (11.8 papers), oral presentations (6 presentations), and poster presentations (2.9 presentations) produced during dedicated research time. Overall, most respondents who completed a research fellowship found that a fellowship was worthwhile (83%), made them a stronger applicant overall (94%), and would recommend this opportunity to prospective applicants (72%).

Conclusion As the applicant pool for plastic surgery continues to expand, many candidates have been motivated to pursue dedicated research fellowships in attempts to make their residency applications stand out. Overall, almost all who completed research fellowships found their experiences worthwhile and recommended them to future applicants. However, the majority of prospective trainees have concerns about funding these endeavors and, for many applicants, the drawbacks still outweigh the benefits.

Background: Microaggressions result in the unintentional discrimination of marginalized groups. Women and minority groups are underrepresented in surgery, thus, microaggressions are a salient topic for surgical education. This study aims to establish the perceived effect of microaggressions on surgical trainees to demonstrate the need for implementing microaggression training.

Methods: After IRB approval, an anonymous Likert scaled survey on perceptions of microaggressions was distributed to interns at our institution prior to starting surgical residency. Data was de-identified and analyzed using Likert analysis and paired t-test. Follow-up focus groups were lead and transcriptions analyzed using detailed thematic analysis.

Results: Forty-four of 50 interns responded (88%) to the survey, 18 (40.9%) were female. Overall, respondents believed they were likely to experience microaggressions with average Likert score of 4.07. Respondents also felt that experiencing microaggressions was unlikely to impact patient care, with an average Likert score of 2.84. There was a significant difference between male and female respondents on perceived likelihood of experiencing microaggressions (94% vs 52%, p<0.001). Female respondents also felt these experiences were more likely to impact their mental health (84% vs 20%, p<0.001). Subsequent focus groups of female surgical trainees at all levels of training demonstrated patterns consistent with previously validated themes on gender-based microaggressions including assumption of inferiority, traditional gender roles, and environmental invalidations at all levels of training.

Conclusions: New trainees experience anxiety and lack preparedness when confronted with the threat of microaggressions. Our data shows that surgical interns, particularly females, demonstrate a preconception that microaggressions may negatively impact their patient care and mental health. Focus group data also reveals that microaggressions are experienced by trainees of all levels. Thus, we postulate that surgical residents may benefit from instituting formal microaggression training prior to starting surgical residency.

References 1. 2021 Fall Applicant, Matriculant, and Enrollment Data Tables. Association of American Medical Colleges (Nov. 8, 2021). https://www.aamc.org/media/57761/download?attachment 2. AMA Physician Masterfile. American Medical Association (Dec. 31, 2021). https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-specialty-2021 3. National GME Census in GME Track® (Aug. 27, 2022). https://www.aamc.org/data-reports/workforce/interactive-data/acgme-residents-fellows-sex-and-specialty-2021 4. Hu Y-Y, Ellis RJ, Hewitt DB et al (2019) Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med 381:1741–1752. 5. Sprow HN, Hansen NF, Loeb HE, Wight CL, Patterson RH, Vervoort D, Kim EE, Greving R, Mazhiqi A, Wall K, Corley J, Anderson E, Chu K. Gender-Based Microaggressions in Surgery: A Scoping Review of the Global Literature. World J Surg. 2021 May;45(5):1409-1422.