EP276 - Digesting the Data: Enhancing Trainee Understanding of Landmark Studies in Colorectal Surgery

ePoster Presenter(s)

• 

  Evan D. Adams, MD (he/him/his)

  Fellow
  The Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

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Author(s)

• 

  Kent J. Peterson, MD

  Fellow
  Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Melik K. Aktas, MD (he/him/his)

  Research Fellow
  The Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  JC Chen, MD (they/them/theirs)

  Resident
  Ohio State University
  Ohio State University
  Columbus, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Lisa A. Cunningham, MD

  Assistant Professor
  The Ohio State University
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AG

  Alessandra Gasior, DO

  Associate Professor
  The Ohio State University
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Syed Husain, MD

  Professor
  The Ohio State University
  Ohio State University
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AH

  Alan E. Harzman, MD

  Professor
  The Ohio State University
  Columbus, Ohio, United States

  Disclosure information not submitted.
• 

  Matthew F. Kalady, MD

  Professor, Division Director,
  The Ohio State University Wexner Medical Center and James Cancer Center
  Ohio State University
  Columbus, Ohio, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Emily Huang, MD

  Assistant Professor
  The Ohio State University
  Columbus, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Understanding clinical trials is essential for evidence-based practice. However, clinical trial results are written for experts. We hypothesize that despite being advanced learners, many colorectal surgery applicants, fellows, and recent graduates are unfamiliar with the details of landmark papers pertinent to colorectal surgery. We performed a needs assessment and propose an educational tool to help learners better interpret and utilize clinical trials.

Methods/Interventions: We performed a Google Scholar and Scopus search to identify “landmark” papers with at least 100 citations. We selected 9 colorectal surgery papers (German Rectal Cancer Trial, CReST, DIVERTI, ACCENT-II, PILLAR-III, OPRA, RAPIDO, SuPREMe-CD, and LIR!C; References in Figure 1). Independent expert opinion of colorectal surgeons confirmed the clinical impact of these studies. The list is intended as a sampling of papers important to modern colorectal surgical practice.

The colorectal surgery fellowship classes of 2023, 2024, 2025, and 2026 were surveyed via existing class communication methods. Respondents were asked to rate familiarity with each paper on an anchored scale:

1. I have never heard of this trial

2. I have heard of it, but do not know what it is about

3. I am familiar with the topic, but do not know the results

4. I know the main results, but cannot describe the specifics of the trial

5. I can speak in depth about the specifics of this trial, including its design, outcomes, and flaws

Means for groups were summed for total responses and compared between groups using analysis of variance. Pair-wise comparison of means directly compared individual groups.

Respondents were asked if they thought a Wikipedia-style resource for journal club would help solidify their understanding of important colorectal surgery trials. They were shown an example page for reference.

Results/Outcomes: We received responses from 48 of 500 individuals polled (9.6%). Each respondent (48) scored 9 trials, resulting in 432 responses. Respondents were 10 (21%) residents, 19 (39.5%) fellows, and 19 (39.5%) attendings within 2 years of fellowship.

Self-reported scores are shown for each trial in Table 1. Few responders 29/432 (6.7%) reported in-depth knowledge (a response of 5). Total score improved for subsequent progression of trainees (19.8 ± 6.1 for applicants, 23.6 ± 5.0 for fellows, 27.5 ± 6.9 for attendings, p < 0.01 Figure 2). This was driven by a significant difference between applicants and attendings (p < 0.01).

85% (40/48) strongly agreed that a summary style page of landmark papers would help solidify their understanding of colorectal surgery trials. 4 (8%) somewhat agreed, 1 (2%) was neutral, 2 (4%) strongly disagreed, and 1 (1%) did not respond.

Conclusion/Discussion: This interim analysis of our ongoing survey demonstrates many colorectal surgery applicants, fellows, and attendings self-report unfamiliarity with key clinical trials. This was particularly true regarding comfort with an in-depth discussion of trials (7%). We note an improvement in self-reported knowledge base with sequential years. Further, there is a strong desire for a learning tool to improve familiarity with these trials.

To address this, we propose creating an indexed system of landmark colorectal surgery papers on Wikipedia Journal Club, a publicly available internet resource (https://www.wikijournalclub.org). We next plan to incorporate this standardized journal club format into our general surgery and colorectal fellow curricula and measure its impact on trainee knowledge.

Figure 1: Self-Reported Survey Results of Trial Knowledge
Figure 1: Self-Reported Survey Results of Trial Knowledge. Results are color coded from 1 (No Knowledge of Trial, Red) to 5 (Ideal Knowledge, Green). % denotes the percentage of responders with each knowledge level and is reflected in relative height of the column. A dotted line denotes the percentage of responders with ideal clinical knowledge.

References:

1. Rödel C, Liersch T, Becker H, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: Initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol. 2012;13(7):679-687. doi:10.1016/S1470-2045(12)70187-0

2. Hill J, Lee S, Morton D, et al. Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: Randomized clinical trial. Br J Surg. 2022;109(11):1073-1080. doi:10.1093/bjs/znac141

3. Ouaissi M, Tuech J-J, Mauvais F, et al. Hartmann’s Procedure or Primary Anastomosis for Generalized Peritonitis due to Perforated Diverticulitis: A Prospective Multicenter Randomized Trial (DIVERTI). J Am Coll Surg. 2017;225(6):798-805. doi:10.1016/j.jamcollsurg.2017.09.004

4. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350(9):876-885. doi:10.1056/NEJMoa030815

5. Jafari MD, Pigazzi A, McLemore EC, et al. Perfusion Assessment in Left-Sided/Low Anterior Resection (PILLAR III): A Randomized, Controlled, Parallel, Multicenter Study Assessing Perfusion Outcomes with PINPOINT Near-Infrared Fluorescence Imaging in Low Anterior Resection. Dis Colon Rectum. 2021;(Pillar Iii):995-1002. doi:10.1097/DCR.0000000000002007

6. Garcia-Aguilar J, Patil S, Gollub MJ, et al. Organ Preservation in Patients with Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy. J Clin Oncol. 2022;18(23). doi:10.1200/JCO.22.00032

7. Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(1):29-42. doi:10.1016/S1470-2045(20)30555-6

8. Luglio G, Rispo A, Imperatore N, et al. Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohn’s Disease: The SuPREMe-CD Study - A Randomized Clinical Trial. Ann Surg. 2020;272(2):210-217. doi:10.1097/SLA.0000000000003821

9. Ponsioen CY, de Groof EJ, Eshuis EJ, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. lancet Gastroenterol Hepatol. 2017;2(11):785-792. doi:10.1016/S2468-1253(17)30248-0


Figure 2: Total Self-Reported Score by Respondent Type
Figure 2: Total Self-Reported Score (y-axis) is presented for Applicants, Fellows, and Attendings (x-axis). Error bars denote standard deviation. Overall analysis of variance noted significant differences between training levels (p < 0.01). P-values are shown for comparisons between groups, with significant self-reported differences between fellows and attendings.