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Factors Affecting Resident Participation in Surgical Cases Jesse Loeffler, MD; Jennifer Griffin, MD, MPH; Harlan Sayles, MS Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE 68198 The Accreditation Council for Graduate Medical Education (ACGME) has established minimum number standards for select surgical procedures for graduating residents in surgical training programs, including Obstetrics and Gynecology. These numbers reflect the lowest acceptable clinical volume of procedures performed as primary surgeon per graduating resident for program accreditation. Many OB/GYN residency programs are concerned about their ability to meet the minimum numbers standards. We wish to assess what factors contribute to the attending physician’s decision regarding the level of participation of the resident in the surgical case. Materials A 41-question survey on Survey Monkey was sent to 123 OB/GYNs in Omaha via email. The survey assessed the type of setting (academic or private) in which the surgeon practices, how often surgeries are performed typical for an obstetrician and gynecologist, and factors that influence whether or not they allow a resident to perform as a primary on the case. Other Factors References 1. Bell, R. H., Biester, T. W., Tabuenca, A., Rhodes, R. S., Cofer, J. B., Britt, L. D., Lewis, F. R., & , (2009). Operative experience of residents in US general surgery programs.Annals of Surgery,249(5), 719-724. 2. Geoffrion, R., Choi, J. W., & Lentz, G. M. (2011). Training surgical residents: The current Canadian perspective.Journal of Surgical Education ,68(6), 247-259. 3. Gouri, B. D., & Jelosvek, J. E. (2010). Measuring surgical trainee perceptions to assess the operating room educational environment.Journal of Surgical Education ,67(4), 210-216. 4. Kanashiro, J., McAleer, S., & Roff, S. (2006). Assessing the educational environment in the operating room - a measure of resident perception at one Canadian institution.Surgery,139(2), 150-158. 5. van der Houwen, C., Boor, K., Essed, G. G. M., Boendermaker, P. M., Scherpbier, A. J. J. A., & Scheele, F. (2011). Gynaecological surgical training in the operating room: an exploratory study.European Journal of Obstetrics & Gynecology and Reproductive Biology ,154, 90-9. Background Objective This study assesses factors that contribute to the attending physician’s decision regarding the level of participation of the house officer in the surgical case. 45 (37 percent) OB/GYNs responded to the survey. When the number of cases a surgeon performs were compared with how often a resident gets to primary a case, only robotic assisted total laparoscopic hysterectomies was statistically significant. Results How often are residents allowed to serve as primary? Conclusions We hope to use this information to modify residency rotations and program structure to optimize resident participation in surgical cases by better understanding the needs and concerns of supervising physicians. Suggestions for improvement based on survey: Longer rotations Standards for residents to follow when following a patient Rotations that are appropriate for the patient’s PGY Exposure to private physicians earlier in residency • Their knowledge of the procedure, anatomy, have they met the pt? Am I needing to get back to the office in a hurry, do I have someone in labor, etc, etc. • If they have not talked to the patient before, also I frequently have patients request that I do their surgery and not someone else perform it. Frequently residents are not present for enough of my surgeries for me to have counseled the patient that a resident may perform the surgery. • How much work the resident has done to help me in the past regarding all my patients. • When the resident struggles and cannot perform the procedure effectively, I am more likely to take over. • Residents level of preparation and interaction with the patient. • Recently started as an attending, as I continue to progress plan to allow residents to perform robotic surgeries more. • Time. I just want to get done with my cases and go home. • Residents previous surgical experience. • I need to be comfortable with the skills of the resident surgeon before I will allow them to operate a the primary surgeon. They are not out at our institution for more than a month at a time and thus we will never establish that comfort. Most of the residents never are present for procedures as they are down at UNMC for continuity clinics, conferences, are out on maternity leave or just don't care to be present because they feel they never get to do anything anyway. Importance of factors affecting decision to let resident serve as primary. Minimal experience needed to allow resident to serve as primary.
