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150. Declining Interest in Vascular Surgery Among General Surgery Residents
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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
Background: In 2003 the Accreditation Council for Graduate Medical Education mandated all American residency programs to comply with 80-hour work week (80hrWW) restrictions. The stated goals were to improve patient care, surgical education, and resident quality of life (QoL). We hypothesized that surgical attendings and residents differ in their perceptions of whether or not the 80hrWW is achieving its stated goals. Methods: A survey-based study was undertaken at our three academic tertiary-referral centers. Physicians of all training levels in nine surgical specialties were sent a 30-item web survey in April 2007. Subjects were categorized into three groups: surgical attendings (‘A’), surgical residents who began their surgical training before (R-B) or after (R-A) the 80hrWW. Differences in responses between the three groups was assessed using Chi-squared analysis; p-values ⬍0.05 were considered significant. Results are reported as percent of respondents within each group. Results: Overall response rate was 382/676 (57%). General surgeons (45%) were most likely to respond, as were R-A (72% vs. ⱕ52%, p⬍0.001) of all specialties. Gender was proportionate in all three groups (females ⱕ22%, p⫽not significant (NS)), but the majority of ‘A’ group was ⱖ40 years old (78% vs. ⱕ3%, p⬍0.001). A minority in all three groups (ⱕ33%, p⫽NS) felt the 80HrWW has improved patient care (Figure 1). Likewise only 15% and 35% of ‘A’ and R-B felt patients were safer; similarly 85% and 76% of ‘A’ and R-B felt continuity of care has been compromised by work-hour restrictions. All three groups (⬎84%) felt midlevel providers have become critical to successful delivery of healthcare. Significantly fewer respondents from ‘A’ or R-B perceived that surgical education has benefitted from the 80hrWW compared with R-A (ⱕ26% vs. 62%, p⬍0.001). A majority of R-B and R-A felt the 80hrWW has improved resident QoL (ⱖ74%) and that surgery was now a more career option for medical students (⬎74%), while a majority of ‘A’ (76%) report that their own job satisfaction has been impaired by the 80hrWW. Conclusion: Four years after the 80hrWW implementation, a majority of both residents and attendings perceive patient care and surgical education as not having been improved. Surgical residents, however, report their own quality of life has improved, while that of surgical attendings has been negatively impacted. Understanding how surgeons at various levels of training perceive the 80hrWW has important implications for the delivery of successful patient care and surgical training in the 21st century.
on level of training and interest. We hypothesized that interest in vascular surgery was decreasing among general surgery residents, as evidence by lack of resident case coverage or increasing coverage by junior level residents who did not have the technical skills and/or clinical knowledge to benefit from participating in the case. Methods: A retrospective review of the Vascular Surgery database from July 1, 2002 thru June 30, 2008 was undertaken to evaluate the level of resident involvement. Based upon a discussion of attending staff expectations of acquired knowledge and technical skills by training year, a guideline to identify a “qualified resident” appropriate for the selected case was first created. Each case was then deemed to have resident coverage of an appropriate level for learning versus inappropriate or absent resident participation. The percentage of vascular cases with appropriate resident coverage was then compared over time by academic years and evaluated for trends. Results: A precipitous drop in resident coverage of vascular surgery cases has occurred. The percent appropriate resident level coverage in 2002-2003 was 87.3%. This has decreased over the subsequent years to 78.3%, 81.1%, 72.3%, 53.8%, and 37.9% for the most recent academic year. The falling percentages correspond with an increasing percentage of vascular cases being done by endovascular methods. Conclusions: In our general surgery training program, the residents have the free will to cover whichever cases they desire. Other than the established minimum RRC defined category requirements for 44 major vascular cases, they are not obligated or required to cover any other vascular or endovascular surgical cases. In our experience, with the increasing volume of endovascular surgery, the interest and coverage of vascular cases by the general surgery residents has declined. Considering that they are the traditional source for future vascular fellows, this is an alarming trend. Furthermore, these results highlight the need to recruit earlier in training or medical school or to change the training paradigms to encourage more involvement by general surgery residents in vascular surgery.
151. AN ASSESSMENT OF CROSS-CULTURAL TRAINING NEEDS AMONG SURGICAL RESIDENTS: IMPLICATIONS FOR SURGICAL EDUCATION CURRICULUMS. S. K. Horwitz1, I. B. Horwitz2, F. C. Brunicardi2, S. S. Awad2; 1 University of St. Thomas, Houston, TX; 2Baylor Collegeof Medicine, Houston, TX 150. DECLINING INTEREST IN VASCULAR SURGERY AMONG GENERAL SURGERY RESIDENTS. M. J. Sideman, K. E. Taubman, T. A. Broughan; OU, College of Medicine, Tulsa, Tulsa, OK Introduction: The evolution of vascular surgery over the past ten years has changed the traditional manner in which vascular surgeons practice. Several studies have investigated the impact on residency training and case volumes. To our knowledge, no study has looked into the interest level of general surgery residents in vascular surgery. Our training program is based in a private urban tertiary care hospital where 17 surgical residents function on four general surgical teams. The program has no fellows or dedicated vascular service. The residents divide the cases among themselves daily based
Background: The importance of optimizing medical care to patients of different cultures is an increasingly important skill in medicine. Prior research has demonstrated that the ability of physicians to acquire cross-cultural skills affect the quality of health outcomes. Additionally, the ACGME has established interpersonal communication, professionalism through sensitivity and responsiveness to diverse patient populations, and patient care as three essential core competencies. This study examined a surgical resident cohort to identify training needs for improving surgical care among culturally diverse racial and ethnic populations. Methods: Following IRB protocol approval, and obtaining permission from the survey developers, a modified version of the Residency Training in Cross-Cultural Survey (Betancourt and Weissman, 2003) was administered to 63 sur-
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
Background: In 2003 the Accreditation Council for Graduate Medical Education mandated all American residency programs to comply with 80-hour work week (80hrWW) restrictions. The stated goals were to improve patient care, surgical education, and resident quality of life (QoL). We hypothesized that surgical attendings and residents differ in their perceptions of whether or not the 80hrWW is achieving its stated goals. Methods: A survey-based study was undertaken at our three academic tertiary-referral centers. Physicians of all training levels in nine surgical specialties were sent a 30-item web survey in April 2007. Subjects were categorized into three groups: surgical attendings (‘A’), surgical residents who began their surgical training before (R-B) or after (R-A) the 80hrWW. Differences in responses between the three groups was assessed using Chi-squared analysis; p-values ⬍0.05 were considered significant. Results are reported as percent of respondents within each group. Results: Overall response rate was 382/676 (57%). General surgeons (45%) were most likely to respond, as were R-A (72% vs. ⱕ52%, p⬍0.001) of all specialties. Gender was proportionate in all three groups (females ⱕ22%, p⫽not significant (NS)), but the majority of ‘A’ group was ⱖ40 years old (78% vs. ⱕ3%, p⬍0.001). A minority in all three groups (ⱕ33%, p⫽NS) felt the 80HrWW has improved patient care (Figure 1). Likewise only 15% and 35% of ‘A’ and R-B felt patients were safer; similarly 85% and 76% of ‘A’ and R-B felt continuity of care has been compromised by work-hour restrictions. All three groups (⬎84%) felt midlevel providers have become critical to successful delivery of healthcare. Significantly fewer respondents from ‘A’ or R-B perceived that surgical education has benefitted from the 80hrWW compared with R-A (ⱕ26% vs. 62%, p⬍0.001). A majority of R-B and R-A felt the 80hrWW has improved resident QoL (ⱖ74%) and that surgery was now a more career option for medical students (⬎74%), while a majority of ‘A’ (76%) report that their own job satisfaction has been impaired by the 80hrWW. Conclusion: Four years after the 80hrWW implementation, a majority of both residents and attendings perceive patient care and surgical education as not having been improved. Surgical residents, however, report their own quality of life has improved, while that of surgical attendings has been negatively impacted. Understanding how surgeons at various levels of training perceive the 80hrWW has important implications for the delivery of successful patient care and surgical training in the 21st century.
on level of training and interest. We hypothesized that interest in vascular surgery was decreasing among general surgery residents, as evidence by lack of resident case coverage or increasing coverage by junior level residents who did not have the technical skills and/or clinical knowledge to benefit from participating in the case. Methods: A retrospective review of the Vascular Surgery database from July 1, 2002 thru June 30, 2008 was undertaken to evaluate the level of resident involvement. Based upon a discussion of attending staff expectations of acquired knowledge and technical skills by training year, a guideline to identify a “qualified resident” appropriate for the selected case was first created. Each case was then deemed to have resident coverage of an appropriate level for learning versus inappropriate or absent resident participation. The percentage of vascular cases with appropriate resident coverage was then compared over time by academic years and evaluated for trends. Results: A precipitous drop in resident coverage of vascular surgery cases has occurred. The percent appropriate resident level coverage in 2002-2003 was 87.3%. This has decreased over the subsequent years to 78.3%, 81.1%, 72.3%, 53.8%, and 37.9% for the most recent academic year. The falling percentages correspond with an increasing percentage of vascular cases being done by endovascular methods. Conclusions: In our general surgery training program, the residents have the free will to cover whichever cases they desire. Other than the established minimum RRC defined category requirements for 44 major vascular cases, they are not obligated or required to cover any other vascular or endovascular surgical cases. In our experience, with the increasing volume of endovascular surgery, the interest and coverage of vascular cases by the general surgery residents has declined. Considering that they are the traditional source for future vascular fellows, this is an alarming trend. Furthermore, these results highlight the need to recruit earlier in training or medical school or to change the training paradigms to encourage more involvement by general surgery residents in vascular surgery.
151. AN ASSESSMENT OF CROSS-CULTURAL TRAINING NEEDS AMONG SURGICAL RESIDENTS: IMPLICATIONS FOR SURGICAL EDUCATION CURRICULUMS. S. K. Horwitz1, I. B. Horwitz2, F. C. Brunicardi2, S. S. Awad2; 1 University of St. Thomas, Houston, TX; 2Baylor Collegeof Medicine, Houston, TX 150. DECLINING INTEREST IN VASCULAR SURGERY AMONG GENERAL SURGERY RESIDENTS. M. J. Sideman, K. E. Taubman, T. A. Broughan; OU, College of Medicine, Tulsa, Tulsa, OK Introduction: The evolution of vascular surgery over the past ten years has changed the traditional manner in which vascular surgeons practice. Several studies have investigated the impact on residency training and case volumes. To our knowledge, no study has looked into the interest level of general surgery residents in vascular surgery. Our training program is based in a private urban tertiary care hospital where 17 surgical residents function on four general surgical teams. The program has no fellows or dedicated vascular service. The residents divide the cases among themselves daily based
Background: The importance of optimizing medical care to patients of different cultures is an increasingly important skill in medicine. Prior research has demonstrated that the ability of physicians to acquire cross-cultural skills affect the quality of health outcomes. Additionally, the ACGME has established interpersonal communication, professionalism through sensitivity and responsiveness to diverse patient populations, and patient care as three essential core competencies. This study examined a surgical resident cohort to identify training needs for improving surgical care among culturally diverse racial and ethnic populations. Methods: Following IRB protocol approval, and obtaining permission from the survey developers, a modified version of the Residency Training in Cross-Cultural Survey (Betancourt and Weissman, 2003) was administered to 63 sur-