16

157

ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS

Table 1. * indicates statistical significance, p⬍0.05 Emax

IR

5.6⫾2.0

PRSW

55.9⫾9.0

- dP/dt max

2.1⫾0.1

1872⫾148

44.9⫾2.2 0.029⫾0.007 0.79⫾0.01

2100⫾227

48.9⫾5.7 0.033⫾0.004 0.74⫾0.01* 0.81⫾0.01*

IR ⫹ LD 12.4⫾3.6* 84.7⫾12.4* 2.9⫾0.3*

Tau

EDPVR

Heart Water Intestine % Water %

CO

0.86⫾0.02

EDUCATION I 15. INTEGRATING AVIATION TEAM TRAINING INTO THE MEDICAL CENTER ENVIRONMENT: BEHAVIORAL OUTCOMES. H. C. Sax 1, L. Clayton 2, R. Panzer 2, R. Mayewski 2, P. Browne 3; 1Miriam Hospital, Providence, RI, 2 URMC, Rochester, NY, 3IN Delta Learning Systems, Rochester, NY Introduction: To improve team functioning and reduce medical errors, some institutions have initiated aviation-based Crew Resource Management (CRM) training. However, objective outcomes are difficult to quantify. We measured self reporting of errors, perioperative checklist utilization, OR work environment, and perceived personal / institutional behavioral changes after CRM training. Methods: Since 2003, a dynamic, six hour, multidisciplinary Medical CRM course was taught at an academic medical center. Attendance incentives included malpractice premium reductions, free CME credit, registration fee waivers, and paid time for hourly staff. Topics covered CRM rationale, error chains/ nonpunitive reporting, communications, team dynamics, and checklists. A web-based system documented self reporting of errors and near misses to an outside, independent agency. Perioperative checklists were installed in ORs and utilization monitored. OR work environment survey continued annually. A Delphi poll of perceived behavioral and institutional cultural changes was constructed with results obtained from participants at least 2 months after course completion to assess sustainability. Results: Five courses trained 402 participants. Self reporting increased from 703 reports/qtr in 2002 to 893 and 1140/qtr subsequently (p⬍0.01, ANOVA). Consistent checklist utilization rose (75% 2003, 86% 2004, 94% 2005). Nurses led checklist initiation, followed by surgeons and anesthesiologists. Perception of the OR environment improved 0.4 points (1-5 scale), with credit given to improved communication, enforcement of a code of behavior, and improved feedback of correction of reported unsafe conditions. In the 10 realms of measured behavioral change, individuals felt they had integrated changes to a greater degree than the institution. (7.5 ⫾ .22 vs 5.2⫾ .42, p⬍0.01, t test). Conclusions: CRM programs influence personal behaviors that lead to a reduction in medical errors and an improved work environment. Perceived institutional cultural change lagged personal empowerment. Although other, ongoing hospital initiatives may have contributed to some of these findings, CRM programs provide a structured learning experience that enhances personal and team functioning. 16. DEFINING EDUCATION AND SERVICE: A STEP TOWARDS DEVELOPING THE CORRECT BALANCE. H. D. Reines, L. Robinson, S. Nitzschke, A. Rizzo; Inova Fairfax Hospital, Falls Church, VA Introduction: Surgical residency serves two purposes: education of surgical residents and provision of service to patients, attendings, and the institution. Constraints of the 80-hour workweek, limitations on the number of residents, and implementation of the core competencies have contributed to a re-evaluation of educational aspects of surgical residency programs. However, the activities that constitute service and education have not been well defined or studied. The purpose of this study is to describe how attendings and residents categorize common resident activities on a continuum between service and education. Methods: A web-based survey was

designed to assess the perceived educational value of common resident activities. A panel of residents and surgical educators reviewed the survey for content validity. The survey was administered on a secure internet survey site. Data analysis was performed using SPSS ver.12. Residents and attendings categorized 27 resident activities on a 5-point scale from 1 (pure service) to 5 (pure education). Missing data were imputed for each activity using the PGY or attending specific mean. A total educational value score was computed by adding each of the activity scores. ANOVA was used for comparison of means and linear regression to identify factors predictive of activity ratings and the overall educational score. Results: 125 residents and 71 attendings from 8 residency programs completed the survey. Response rates varied by institution and by physician type (resident or attending). 3 programs were university-based and 5 were nonuniversity teaching hospitals. Males accounted for 66% of residents and 90% of attendings. On average, attendings had practiced 14.3years. Residents ranged from PGY1 to PGY6 (mean of 2.78). There was agreement between attendings and residents regarding the educational value of most activities. However, there was substantial variance in the degree of agreement between residents and attendings among programs. Every year of additional residency was associated with an increase in the overall education score (B⫽.96). Residents felt more time should be devoted to pure education than did attendings in general surgery (30 % vs 22%), subspecialty (36% vs 25%) and elective (39% vs 26%) rotations. 40% of residents felt that more than half of their time was spent in pure service vs 10% of attendings. 25% of residents and 23% of attendings were dissatisfied with the service/education balance. Discussion: The RRC mandates that education is the central purpose of the surgical residency without clearly defining the balance between education and service. This study identifies areas of agreement among residents and attendings regarding the service/education categorization of various common resident activities. Attendings and residents agree on the educational value of most activities and that the balance between education and service is acceptable. When compared with attendings, residents feel they spend significantly more time in service and need significantly more time in education. Adequate learning can be facilitated by the development of clear definitions of service and education and guidelines for the distribution of resident time.

Significant differences (p<0.05) in perception of educational value Activity

Residents (mean score)

Attendings (mean score)

Attending morning rounds Attending afternoon rounds Pre-operative H&P Picking up X-rays from Radiology Changing dressings Writing scholarly paper Teaching medical students Operating independently Scheduling hours for residents

2.1 2.3 2.2 1.6 2.1 4.1 3.7 3.9 1.5

2.6 2.7 2.6 1.2 2.4 4.3 4.0 3.3 2.0

17. THE ACGME COMPETENCIES IN THE OPERATING ROOM. J. A. Greenberg 1, J. L. Irani 1, C. C. Greenberg 1, M. A. Blanco 2, S. R. Lipsitz 1, S. W. Ashley 1, E. M. Breen 1, J. P. Hafler 3; 1 Brigham and Women’s Hospital, Boston, MA, 2Harvard Graduate School of Education, Cambridge, MA, 3Harvard Medical School, Boston, MA Introduction: Traditionally the operating room (OR) has been a major focus for surgical education. Although this is clearly appropriate for procedural skills, it may not be an ideal setting for teaching the other General Competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). To test this, we performed a qualitative observational study to: (1) Examine whether the ACGME