INTRODUCTION The academic surgical conference has long been a hub for sharing knowledge and fostering connections. Initially designed to curate an “elite and exclusive surgical society, ” the academic conference has remained consistent in several key missions: (i) showcasing premier surgical science, (ii) raising professional standards, and (iii) strengthening interprofessional networks. 1 In addition to being places for sharing the latest discoveries, conferences are increasingly serving as platforms for advocacy. For example, the 2007 American Surgical Association meetings “Forum on the State of the Health Workforce” addressed workforce shortages by advocating against policies limiting graduate medical education expansion. Despite these efforts, surgical workforce shortages persist, with projections indicating a shortfall of up to 30, 200 surgeons by the year 2034 in the United States. 2 Moreover, interest among learners to pursue careers in surgery has been declining across North America for decades. 3–5 Given these trends, there is a strong impetus to consider novel strategies to engage trainees to pursue surgical careers. The “medical school pipeline” metaphor describes the path from elementary school to the end of medical training. Along this journey, members of certain at-risk groups “leak out” due to several factors, including lack of mentorship, financial constraints, lower rates of successful applications, and higher rates of attrition. The resultant underrepresentation in medicine (URiM) means certain social groups are disproportionately absent from the medical profession relative to their numbers in the general population. However, early intervention is an effective strategy to counteract the leaky pipeline by enhancing interest, academic preparedness, and confidence in pursuing a career in surgery. 6 The Canadian Surgery Forum (CSF), organized by the Canadian Association of General Surgeons (CAGS), is Canada’s largest surgical conference. The 2 CAGS strategic priorities of (i) advocacy (to improved workforce planning) and (ii) diversity, are complementary to a grassroots resident-led initiative called UpSurge. Established in 2022 within the Department of Surgery at the University of Toronto, UpSurge has created opportunities to support URiM learners, from high school through medical school, to pursue careers in surgery. The 2024 partnership between CSF and UpSurge was a novel integration of grassroots access-building initiatives paired with the well-established academic surgical conference format to deliver mentorship to high school students from a socioeconomically disadvantaged community. In this piece, we outline the framework utilized for this initiative, including the practical steps taken to execute the event, outcomes and impact, and future direction. APPROACH Partnerships and Team Structure Partnerships were formed between 4 key stakeholders. First, UpSurge acted as the primary organizer and liaison. Second, the surgical society’s team included leadership (president and board of directors) and an operational team (CEO and administrative staff). Before the conference, UpSurge held several meetings with society’s leadership team to establish strategic priorities and secure financial commitment. Subsequently, UpSurge worked closely with the operational team to execute the program. Third, collaboration with the local Department of Surgery at the conferences host city was crucial for on-site support. Faculty, residents, and medical students ran the surgical simulation stations and participated in panel discussions. Their community knowledge was also key in identifying a high school within the target population (ie, students from economically disadvantaged, new-immigrant, or visible minority backgrounds). Lastly, a close partnership with the target high school was critical to the program’s success. We worked with a local Grade 11/12 science teacher to recruit 25 students based 2 criteria: (i) high academic performance and potential interest in a medical career, or (ii) varying academic engagement but a potential to benefit most from the program (eg, lower performing or less academically engaged students who may need additional motivation). A detailed description of roles is provided in Supplemental Table 1, https: //links. lww. com/AOSO/A592. Leadership and Mentorship Model A primarily bottom-up leadership model was used to guide this program. The bottom-up approach allows primary stakeholders—those lower on the leadership hierarchy—to set learning goals and direct the program. 7 Local medical students led recruitment of local surgical residents and staff for the event. Local medical students were heavily involved in organizing the structure of the event in collaboration with the UpSurge resident chairs, who worked closely with the surgical society’s leadership team. This structure fostered leadership skills development at all levels. For example, the resident chairs working closely with the CAGS leadership benefitted from learning about surgical society governance and finance, learning how to leverage partnerships with industry to meet educational objectives, and understand logistics of academic surgical conferences. Medical students benefited from working closely with the resident chairs to organize an effective medical education event, including the development of a surgical curriculum and data collection/appraisal for future quality improvement. Event Structure The event was carried out in 3 phases, each developed with clear goals. In phase 1, the goal was to introduce the students to a career in surgery through hands-on experiential learning. Surgical simulation significantly enhances interest, academic preparedness, and confidence in pursuing a career in surgery for at-risk and minority youth. 8, 9 Twenty-five students were organized into small groups and cycled through 5 stations, including: hand ties, skin suturing, laparoscopic surgery, bowel and vascular anastomosis, and virtual reality suturing. A detailed agenda and learning objectives are outlined in Supplemental Tables 2 and 3, https: //links. lww. com/AOSO/A592. The entire cost for simulation materials was ~ 1500 Canadian dollars. In phase 2, the goal was to spark interest in surgery by providing students with an opportunity to hear from surgeons and medical students as they shared their unique journeys into the field. A panel of medical students, residents, and surgeons shared their journeys into surgery. Moderated by a medical student, the session was held in an auditorium and designed to create a welcoming environment where students felt comfortable asking questions. The panelists, including URiM participants, provided diverse perspectives, ensuring that students received insights from various stages of the medical pipeline. By sharing their challenges and successes, the panelists conveyed that a career in surgery is achievable, regardless of background or circumstances. Finally, phase 3 was a networking session held at a nearby restaurant. The goal was to create a relaxed environment that encouraged open conversation between students and mentors. This setting allowed students to ask personal questions, receive advice, and begin building relationships with mentors who could guide them on their educational journeys. OUTCOMES Data Collection and Reporting A key component of assessing the event’s impact was the distribution of a feedback survey immediately following the simulation stations and panel discussion for both quantitative and qualitative insights (Table 1). TABLE 1. - Goals of Program and Evidence of Impact From Postsession Narrative Feedback Goals Evidence of Impact Introduce surgery as a viable career path and inspire students to pursue surgery • Illustrative quote 1 “You all are so cool. . . I couldn’t stop smiling and being in awe of everything today”• Illustrative quote 2 “Thank you very much for this. I loved everything and everyone. You have a good team of kind and hardworking people. It’s inspiring. ” Have students see themselves in the medical students, residents, and staff developing informal networking opportunities Answer to the prompt “My favorite part of the event was. . . ”• Illustrative quote 1 “Getting to learn how to suture, and getting to know everyone helping out today”• Illustrative quote 2: “Learning how to suture, and talking with all the residents, students, and surgeons” Run an effective hands-on session • Median response to the question “Did you feel the surgical workshops were well run and organized? ” was 5 (IQR 5–5). • Illustrative quote: “My favorite part is that this event was more hands-on, giving participants the chance to actively engage, practice skills, and experience surgical techniques firsthand and the useful advice for high schoolers who are interested in medicine” Enhance students’ understanding of careers in surgery • Median response to the question “How helpful were the workshops in giving you a better understanding of what surgeons do? ” was 5 (IQR 5–5). • Median response to the question “To what extent did the panel improve your understanding of having a career in surgery? ” was 5 (IQR 4–5). • Illustrative quote 1: “I really loved the panel discussion because it clarified a lot of questions”• Illustrative quote 2: “My favorite part of the event was listening to the doctors speak about their jobs and passion. ”• Illustrative quote 3: “My favorite part of the event was doing the workshop and hearing the experience that some of the doctors had to go through” Create an enjoyable overall experience for the students • 100% of students stated they were “very satisfied” with the event or very likely to recommend the event to a friend (5/5 on Likert scale) • 100% of the studies stated the activities in each station were “extremely engaging and exciting” (5/5 on Likert scale) • Illustrative quote 1: “So engaging, I loved it”• Illustrative quote 2: “I would like to say it was a perfect experience for me” IQR indicates interquartile range. All students reported that they were extremely satisfied with the event with 100% stating the event as “extremely engaging and exciting, ” that they were “very likely” to recommend it to a friend, and that the workshops were well run (5/5 on the Likert scale). Furthermore, students reported that the event was helpful in giving a better understanding a career in surgery. The median response to the question “How helpful were the workshops in giving you a better understanding of what surgeons do? ” was 5 interquartile range (IQR) 5–5. The median response to the question “To what extent did the panel improve your understanding of having a career in surgery? ” was 5 (IQR 4–5). Knowledge Dissemination Successful advocacy relies on effectively communicating important messages that are both heard and acted upon. While academic writing is one way to communicate, social media has become an increasingly powerful tool in advocacy. With over 1000 followers and 10, 000 monthly impressions, UpSurge uses social media (@uoftᵤpsurge) to engage a broader audience and amplify our key messages. 10 To capture key moments and interactions a professional photographer and videographer was hired, and content was shared on social media in collaboration with CAGS (Video 1) https: //links. lww. com/AOSO/A604. 10 "href": "Single Video Player", "role": "media-player-id", "content-type": "play-in-place", "position": "float", "orientation": "portrait", "label": "Video 1. ", "caption": "", "object-id": {"pub-id-type": "doi", "id": "", "pub-id-type": "other", "content-type": "media-stream-id", "id": "1w3x0qa7g", "pub-id-type": "other", "content-type": "media-source", "id": "Kaltura"} NEXT STEPS The collaboration between UpSurge and CAGS/CSF was a novel integration of a grassroots access-building initiative with an academic conference. Data from the event highlighted a significant impact, with evidence suggesting this collaboration cultivated and supported youth interest in surgery. However, this work is still in its early stages. Though the data presented herein is promising, it represents preliminary work. Future research building on this hypothesis-generating data will leveraging mix-methodology to assess the impacts of programing. Future steps will also include establishing longitudinal mentorship for these youth in collaboration with local Departments of Surgery. To support these efforts, UpSurge and CAGS are establishing a strategy for long-term sustainability. Through the CAGS foundation, we have established a mechanism for charitable donations earmarked for outreach events. Furthermore, industry partnerships through sponsorship and/or contributing materials to programming will significantly enhance the learning experience and long-term sustainability. With the academic surgical conference venue serving as the premier meeting place for science, innovation, and advocacy in surgery, it represents the perfect backdrop for engaging future surgeons. The issue of anticipated workforce shortages is complicated. However, the approach to proactively inspire youth from diverse backgrounds to pursuit careers in surgery using simulation at the surgical conference may be an effective, reproducible, low-cost, and feasible option to reinforce the leaky pipeline and create a strong surgical workforce for years to come. Acknowledgments The authors thank Carol Broderick (CEO CAGS), Marbella Berroa (CSF organizer), Karin Lindsay (Administrative Associate, CAGS), and Jennifer Scott (Manager, Memberships & Communication CAGS) for their tremendous support and assistance in running this event. The authors would also like to thank the UpSurge committee for running of the UpSurge program. A. B. S. , V. M. , and K. B. did the initial drafting of the manuscript. A. B. S. and B. Y. contributed to the configuration of tables and figures, editing, revision of the manuscript, and are the co-founders of UpSurge. A. K. M. and D. D. N. are the coresearch leads of UpSurge. K. A. is the chair and resident-lead of UpSurge. A. B. S. , B. Y. , V. M. , K. B. , A. K. M. , D. D. N. , K. A. , T. M. , B. K. , B. Z. , S. P. C. , and S. B. contributed to editing of manuscript and revision of the manuscript. S. B. is the faculty co-founder and program director of UpSurge.
Bondzi-Simpson et al. (Tue,) studied this question.