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Introduction: Traditionally, surgical outcomes have been attributed to individual surgeon factors such as experience, training, and gender, as well as contextual elements like case volume and complexity. More recently, the importance of nontechnical skills such as situational awareness, teamwork, and decision-making has been increasingly recognized. Although factors like cognitive load and time pressure1 have been studied, the specific cognitive processes that underlie and connect these elements—how surgeons synthesize information, weigh risks, and adapt in real time—remain poorly defined. A deeper understanding of these mental mechanisms is essential to advancing surgical care. This scoping review synthesizes existing cognitive frameworks in surgical decision-making to inform interventions aimed at improving surgical education and intraoperative performance.

Methods: This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews guidelines.

Objectives: Recent studies have shown gender-based disparities in surgical outcomes, with women physicians achieving better postoperative results. However, the mechanisms underlying these differences remain poorly understood. This complex, underexplored phenomenon lacks perspectives from key stakeholders such as patients, staff, and surgeons. Surgical residents inhabit a unique position, balancing the roles of learners and healthcare providers and offering valuable insights into these disparities. Our objective was to explore resident surgeons' perceptions of the mechanisms underlying the differences observed in postoperative outcomes through interviews.

Methods: We conducted a qualitative study using semi-structured interviews with men and women residents, analyzed through qualitative content analysis. Participants included 17 surgical residents from 10 ACGME-accredited orthopedic and general surgery programs across four U.S. regions.

Results: Key findings were: (1) Women surgical residents experienced gender biases during training; (2) Men and women surgeons differed in their approaches to patient care and surgical practice. Residents of both genders noted that women surgeons encounter biases stemming from prevailing norms, beliefs, and expectations related to gender. These biases manifest as double standards and pressure to conform to men-dominated environments. The absence of comparable pressure on men surgeons to adapt to interactions with women colleagues or patients may lead to challenges in meeting the expectations of women patients. Participants of both genders reported that women surgeons tend to adopt a more holistic approach to patient care.

Conclusions: Our findings suggest that the unique challenges faced by women surgeons may contribute to the development of refined interpersonal and surgical skills, which could be associated with improved postoperative outcomes. Raising awareness of gender-based differences in surgical practice is essential to addressing the disparities observed in postoperative results.

Practical Implications: Residency programs may benefit from incorporating gender-aware training to address implicit biases, foster equitable learning environments, and optimize skill development for all trainees.

The successful teaching of communication skills (CS)—a key competency in medical education—depends on teachers’ expertise. Focusing on the experiences of CS teachers in Sweden, this study aims to explore the challenges they identify in teaching CS and how they adapt their practice accordingly. Individual interviews were conducted with 16 CS teachers, guided by a semi-structured interview guide. Data collection and analysis were iterative, aligning with constructivist Grounded Theory methodology. The teachers experienced a conflict between an idealized view of patient-centered communication taught during CS courses and the actual communication practiced in the clinical context, as well as students’ attitudes. This conflict permeated participants’ perceptions of their teaching goals, the challenges they faced, and the teaching strategies they employed. The teachers’ goals were to convey the purpose of CS, aiming for progress rather than expecting students to reach fixed goals and to promote student ownership in classroom practice. Challenges included students’ negative attitudes towards CS courses, their focus on succeeding rather than developing, and having to teach and examine simultaneously. Strategies focused on supporting learning by transforming negative attitudes towards CS teaching, providing a safe group climate, and offering constructive feedback to reduce defensiveness. This study highlights the need to bridge the gap between idealized CS teaching and clinical practice through institutional support, including curriculum integration, clear assessment frameworks, and recognition of emotional demands on CS teachers.

Background:The selection of a medical specialty is influenced by multiple factors, with personality traits potentially shaping career preferences. This study examines the personality traits and their impact on interest in surgical specialty among Swedish medical students, considering gender and comparing students and practicing surgeons.

Methods:The Big Five Inventory was used to assess personality traits of medical students and surgeons in a cross-sectional study. The students were recruited from Umeå University and the University of Gothenburg, whereas the included surgeons were recruited from hospitals across Sweden. The data were collected between the 29th of August 2022 and the 2nd of December 2024. Differences in personality traits were analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA), adjusting for age and gender.

Results:The participants were 276 fourth-year medical students and 471 Swedish surgeons. Statistically significant differences were found between medical students who preferred surgical specialization compared to students preferring non-surgical specialization, with lower neuroticism (p = 0.007), higher extraversion (p = 0.01), and, after adjustment for gender and age, higher conscientiousness (p = 0.045) in the group who preferred surgical specialization. Female students scored higher than male students in conscientiousness (p < 0.001), agreeableness (p = 0.047), and neuroticism (p = 0.002). Female students scored higher in neuroticism than female surgeons (p = 0.005) and lower in conscientiousness (p = 0.043), while male students had lower conscientiousness scores than male surgeons (p < 0.001).

Conclusions:This study suggests that a combination of personality traits distinguishes Swedish medical students with interests in surgery from medical students with interest in non-surgical specialization. This difference is likely shaped by an interplay of student selection and professional socialization.

Background: We analyzed trends in age at surgery and surgical approach over time and geography.

Methods: We performed a systematic review according to PRISMA-IPD guidelines to include individual patient data. Collected data included age at surgery, location of surgery, and surgical approach. The surgical approach was independently categorized as the exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). EBP was defined as exploring the brachial plexus in the supraclavicular fossa and applying a choice of coaptation procedures. NTwoRE included those sourcing donor nerves from, or entirely occurring outside of the plexus without exploring the root of the brachial plexus.

Results: Regression analysis of age at surgery 1985–2020 showed that age at BPBI surgery is rising (p < 0.05). Surgery was performed at a younger age in patients from Europe (7.06 ± 7.77 months) and Asia (7.58 ± 5.33 months) than those from North America (10.44 ± 5.01 months) and South America (14.71 ± 4.53 months) (p < 0.05). NTwoRE was more common in North America (37%) and least common in Europe (12%). Age at EBP was 7.2 ± 5.77 months, and age at NTwoRE was 15.85 ± 13.18 months (p < 0.05). The incidence of NTwoRE is increasing time.

Conclusions: Age at NBPP surgery is increasing over time. Regional differences exist in age at NBPP surgery. Approaches to NBPP surgery that avoid exploration of BP roots are becoming more popular. Age at EBP is lower than age at NTwoRE.

Understanding of postoperative care is limited in patients who undergo ambulatory surgery. This study compares patients' recall of information regarding postoperative self-care when being verbally informed by either a surgeon or assistant nurse postoperatively prior to discharge. Secondary objectives for this study are to compare differences in patients' level of “feeling that they understood the information”, stress, and satisfaction. A non-blinded randomized single-center controlled trial was conducted at a hand surgical unit in Northern Sweden (Trial Registration ID: NCT03893968). Patients were randomized into a control (surgeon) or intervention group (assistant nurse). Patients were asked seven questions about postoperative self-care one week postoperatively via telephone call, yielding a maximum score of seven points. Thirty-nine patients were informed by assistant nurses, and thirty-three patients were informed by surgeons. There was no difference in recall between the two groups (4.95 vs. 5.15, p = 0.5). Patients from both groups lacked knowledge on postoperative outcomes (41.0% vs. 42.4%). The mean scores for “feeling of having understood the information” (mean of 9.23 for patients informed by assistant nurses vs. mean of 9.45 for patients informed by surgeons) and satisfaction (9.69 vs. 9.45, respectively) was high, while mean scores for stress was low (1.38 vs. 1.18, respectively). Few patients answered all questions correctly: 8.3% of the patients answered all questions correctly, and 37.5% of the patients answered six or more questions correctly. The findings suggest that surgeons and assistant nurses are equally good at verbally informing patients regarding postoperative hand-surgical self-care. More effort is needed to make patients understand symptoms of postoperative infections.

BACKGROUND AND AIMS: Evidence suggests that female surgeons achieve comparable or even more favorable outcomes than male surgeons. It is currently unclear what factors contribute to these potential differences. Possible explanations might be differences in personality traits, communication style, attitude, and risk-taking behavior. This cross-sectional study aimed to examine disparities in personality traits between male and female general surgeons in Sweden.

METHODS: The research was conducted as a cross-sectional study of personality traits. Between August 29, 2022, and December 15, 2023, Swedish specialists in general surgery were invited to participate in an online survey. The survey, assessed with the Big Five Inventory, collected information on self-reported surgeon gender, years in practice, employment data, and differences in personality traits.

RESULTS: The analysis encompassed responses from 223 Swedish general surgeons: 121 (54%) males and 102 (46%) females. In contrast to female surgeons, male surgeons were older and had longer surgical experience. A higher proportion of male surgeons were employed in rural hospitals. Higher mean scores were observed in all personality traits among female surgeons. The adjusted analysis showed significantly higher scores for conscientiousness (p < 0.001), extraversion (p < 0.001), agreeableness (p = 0.006), and neuroticism (p < 0.001); however, no such change was observed for openness.

CONCLUSION: This cross-sectional study demonstrates that Swedish female and male surgeons differ in personality traits. The implications of these results could lead to a deeper understanding of the variations in surgical outcomes based on the gender of the surgeon.

Purpose: Surgical treatments such as tendon transfers and muscle lengthening play a significant role in cerebral palsy management,but timing of upper extremity cerebral palsy surgery remains controversial. This study systematically reviews the current literature and investigates the correlation between age at surgery and follow-up time with surgical outcomes in pediatric upper extremity cerebral palsy patients.

Methods: A comprehensive search of PubMed, Cochrane, Web of Science, and CINAHL databases was performed from inception to July 2020 and articles were screened using PRISMA guidelines to include full-text, English papers. Data analysis was performed using itemized data points for age at surgery, follow-up length, and surgery outcomes, reported as changes in active forearm and wrist motion. A 3D linear model was performed, to analyze the relationship between age, follow-up length, and surgery outcomes.

Results: A total of 3,855 papers were identified using the search terms and a total of 8 studies with itemized patient data (n=126) were included in the study. The studies overall possessed moderate bias according to the ROBINS-I scale. Regression analysis showed that age is a significant predictor of change (|t| > 2) in active forearm supination (Estimate = -2.3465, Std. Error = 1.0938, t-value= -2.145) and wrist flexion (Estimate = -2.8474, Std. Error = 1.0771, t-value = -2.643) post-intervention, with older individuals showing lesser improvements. The duration of follow-up is a significant predictor of improvement in forearm supination (Estimate = 0.3664, Std. Error = 0.1797, t-value = 2.039) and wrist extension (Estimate = 0.7747, Std. Error = 0.2750, t-value = 2.817). In contrast, forearm pronation (Estimate = -0.23756, Std. Error = 0.09648, t-value = -2.462) and wrist flexion (Estimate = -0.4243, Std. Error=0.1859, t-value = -2.282) have a significant negative association with follow-up time.

Conclusion: These results suggest that there is significant correlation between the age and follow up after surgery with range of motion gains. Most notably, increased age at surgery had a significant negative correlation with select active range of motion postoperative outcomes. Future research should focus on identifying other factors that could affect results of surgical treatment in upper extremity.

Background: Efficient doctor-patient communication is essential for improving patient care. The impact of educational interventions on the communication skills of male and female students has not been systematically reviewed. The aim of this review is to identify interventions used to improve communication skills in medical curricula and investigate their effectiveness in improving the communication skills of male and female medical students.

Methods: A systematic review of the literature was conducted using the PRISMA guidelines. Inclusion criteria were as follows: used intervention strategies aiming to improve communication skills, participants were medical students, and studies were primary research studies, systematic reviews, or meta-analyses.

Results: 2913 articles were identified based on search terms. After title, abstract, and full-text review, 58 studies were included with interventions consisting of Training or Drama Courses, Curriculum-Integrated, Patient Learning Courses, and Community-Based Learning Courses. 69% of articles reported improved communication skills for both genders equally, 28% for women more than men, and 3% for men more than women. 16 of the 58 articles reported numerical data regarding communication skills pre-and post-intervention. Analysis revealed that post-intervention scores are significantly greater than pre-intervention scores for both male (p < 0.001) and female students (p < 0.001). While the post-test scores of male students were significantly lower than that of female students (p = 0.01), there is no significant difference between genders for the benefits, or difference between post-intervention and pre-intervention scores (p = 0.15), suggesting that both genders benefited equally.

Conclusion: Implementation of communication training into medical education leads to improvement in communication skills of medical students, irrespective of gender. No specific interventions benefitting male students have been identified from published literature, suggesting need of further studies to explore the phenomenon of gender gap in communication skills and how to minimize the differences between male and female students.

Introduction: While surgical literature exists on birth-related brachial plexus injury (BPI), there are not validated sources of information on BPI for patients, which can impact patient autonomy and decision-making. With YouTube as a popular source for patients to research diagnoses, this study aims to evaluate the quality of information regarding BPI and its treatment available on the platform.

Materials and Methods: BPI YouTube videos were screened independently by two reviewers. Videos were categorized by source: (1) academic, government, and non-profit organizations; (2) private practices, companies, and for-profit organizations; (3) independent users. Each video was evaluated for reliability, credibility, and quality using the modified DISCERN criteria (scale, 0–5), Journal of the American Medical Association (JAMA) criteria (scale, 0–4), and Global Quality Scale (GQS; scale, 1–5). Surgical treatment videos were analyzed by the senior author using a modified “treatment” DISCERN criteria (scale, 8–40). Non-English videos were excluded from this study. Analysis of variance tests were used to compare means.

Results: One hundred and fifteen videos were selected for final analysis. The mean modified DISCERN score was 3.26; JAMA was 2.31; GQS was 3.48. Videos were subdivided according to source. Group 1, 2, and 3 had 45, 24, and 46 videos, respectively. Modified DISCERN score was greater for Group 1 than Group 2 (3.58 vs. 3.04, p <.001) and Group 3 (3.58 vs. 3.07, p <.001). JAMA score was greater for Group 1 than Group 2 (2.63 vs 2.15, p =.041) and Group 3 (2.63 vs. 2.08, p =.002). GQS score was greater for Group 1 than Group 2 (3.93 vs. 3.31, p =.031) and Group 3 (3.93 vs. 3.13, p <.001). Of the 34 videos (44.7%) that mentioned treatment, the DISCERN score was 14.32.

Conclusion: The videos analyzed were found to have moderate reliability, credibility, and quality. The reliability of information regarding treatments for BPI was poor. Healthcare providers should supply additional information on treatment of BPI.