Most Important Issues Facing Surgery Reimbursement 59.7% Malpractice 41.4% Resident education (80-hour work week) 32.7% Patient safety/quality initiatives 25.7% Recruitment of medical students 21.2% Specialization/future of general surgery 14.2% Impact/utilization of new technology 12.2% Family/career 9.6% Surgical research 8.2% Maintenance of skills/Continuing medical education 8.0% 147. SETTING THE STAGE: PATIENTS’ EXPECTATIONS FOR GREETINGS IN THE SURGICAL SETTING. L. S. Wallace, W. F. Ergen, M. H. Goldman; University of Tennessee Graduate School of Medicine, Knoxville, TN Background: While greetings may seem a rather mundane aspect of patient-physician communication, the first few minutes of the clinical encounter are essential in establishing rapport and making the patient feel at ease. Anecdotal evidence suggests that physicians should shake hands with patients and introduce themselves. How- ever, there is little evidence from the patients’ perspective regarding what behaviors constitute a proper greeting. Importantly, the liter- ature is devoid of studies examining patients’ preferences for sur- geon behaviors during the greeting phase of the clinical encounter. To address this gap, the purpose of this study was to examine patients’ expectations for greetings upon meeting a surgeon for the first time. A study such as this one is especially important because patients typically do not have an on-going, established relationship with their surgeon, making communication paramount to the foun- dation of the patient-surgeon relationship. Methods: Over a two month period (March-May, 2008) a convenience sample of English- speaking patients (’21 years of age) attending a university-based vascular surgery clinic were recruited to participate in this study. Eligible patients (n=152) were interviewed prior to their consulta- tion using valid and reliable questionnaires to obtain data about sociodemographic characteristics, general health status and expec- tations for greetings upon meeting a surgeon for the first time. Specifically, 3 closed-ended questions were asked: (1) “Would you want them to shake your hand?” (2) “Would you want them to use your first name only, your last name, or both?” and (3) “Should surgeons introduce themselves using their first name only, their last name, or both?” An open-ended question was also asked: “Is there anything else a surgeon should do when meeting you for the first time?” Results: Patients’ mean age was 61.414.6 years, slightly more than half (n=81;54.3%) were male, and most were Caucasian (n=148; 97.4%). Approximately ¼ (n=40) of patients had less than a high school education, while 82 (53.9%) reported their general health status to be either fair or poor. Most (n=132; 86.8%) patients wanted the surgeon to shake their hand, 113 (74.3%) wanted their first name to be used when a surgeon greets them (eg, Carol), and 86 (56.6%) wanted a surgeon to introduce him/herself using his/her last name (eg, “Hello. I’m Dr. Green.”). About half (n=74; 48.1%) of patients answered the open-ended question regarding other expectations for greetings, with the most common responses as follows: be attentive/ calm and make patient feel like a priority; be friendly, personable, and polite; and smile. Although not related to the greeting segment of the clinical encounter, 15 patients spontaneously indicated that surgeons should adjust their vocabulary (eg, “Talk to me in terms I can understand.”) accordingly to facilitate patient understanding. Conclusions: Surgeons should be encouraged to shake hands, use patients’ first names, and introduce themselves using their last names when greeting patients for the first time. They should also be pleasant, personable, and make the patient feel like a priority. Ad- ditionally, surgeons should be cognizant of the how they present information to patients and verify that patients understand what was discussed throughout the clinical encounter. 148. TARGETING EDUCATIONAL INTERVENTIONS TO EN- HANCE THE ACGME CORE COMPETENCIES USING THE NEO-5-FACTOR PERSONALITY INVENTORY. I. B. Horwitz, S. K. Horwitz, F. C. Brunicardi, S. S. Awad; Baylor College of Medicine, Houston, TX Background: The ACGME has recognized the areas of profession- alism, interpersonal communication skills and patient care to be three of the primary core competencies to be essential components of a comprehensive surgical education. A significant number of studies have borne out that enhancement in these areas lead to a reduction in medical errors, decreased ambiguity in communication, greater patient compliance, and overall improvement in medical care. How- ever, while surgeon personality has been studied using various psy- chometric tests, the focus of such research has been almost exclu- sively for determining sub-specialty choice and not on improved performance. Our research refocused the study of surgeon personal- ity as a means of identifying areas that would specifically augment the ACGME competencies most in need of intervention. Methods: Following IRB approval, a surgical resident cohort was administered the NEO-5-Factor Personality Inventory. The inventory, consisting of 240 items, is considered the gold standard by psychologists by which the strengths and weaknesses that groups can be assessed, and educational interventions designed. The five general areas of personality assessed are Neuroticism that measures emotional in- stability and self-consciousness factors; Extroversion that measures outgoing and personable factors; Openness that measures values and creative factors; Conscientiousness that measures competence and dutifulness factors; and Agreeableness that measures trust and comfort with social interaction factors. Each of these areas is com- prised of sub-scales which were likewise analyzed in the study. Statistical comparison to national norms was conducted. Results: 65 residents completed the survey of which 43 (66%) were male and 22 (34%) female. The mean age of the residents was 29.0 years (SD = 3.0). PGY was dichotomized into junior residents (PGY 1 & 2) n = 39 (60%), and senior residents (PGY 3-5) n = 26 (40%). For the resident cohort as a whole, a series of t-tests found they were significantly higher in Extroversion (t = 4.9, p 0.001), Openness (t = 2.5, p  0.05) and Conscientiousness (t = 2.4, p 0.05), and significantly lower in Neuroticism (t = 13.2, p 0.001) and Agreeableness (t= 2.7, p0.01) compared to previous findings of the national population. For all factors, no significant differences were found by gender except for Agreeableness, in which the female were significantly higher than their male counterparts (t = 2.1, p  0.05). No statistically differences were found by PGY year, with the exception of the Ex- troversion factors, in which senior PGY’s had significantly higher scores than the junior PGY’s (t = 2.0, p0.05). Conclusion: The NEO found that as a whole, the residents were higher than average in the areas of Extroversion, Openness and Conscientiousness, and lower in Neuroticism and Agreeableness than the national average. The lower scores in Agreeableness in particular demonstrates that educational interventions aimed at improving social interactions in the areas of eliciting trust and comfort with patients may be partic- ularly valuable. Extroversion increasing with PGY years may likely be due to increased experience and skill through the surgical train- ing process and is indicative of success in this area of surgical education. Overall, this study demonstrates that the NEO can be highly useful for targeting educational interventions that effectively augment ACGME core competencies among surgical residents. 149. SURGERY RESIDENT WORK-HOUR RESTRICTIONS: IMPACT ON PATIENT CARE, SURGICAL EDUCATION AND RESIDENT QUALITY OF LIFE. S. D. Holubar, V. L. Tsikitis, K. Malireddy, R. R. Cima, D. W. Larson, J. H. Pem- berton, D. R. Farley, E. J. Dozois; Mayo Clinic, Rochester, MN 241 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS