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A large national group of residency programs, hospitals, professional organizations, and oversight groups enthusiastically came together for the FIRST Trial. The strengths were the large number of programs, the high quality, validated patient data platform, and the ability to survey residents with high response rates. There remain many challenges in training surgical residents. How could we leverage our existing platform to conduct the SECOND Trial? What are the important issues that need to be addressed and could be addressed with the current infrastructure?