Contributions of surgical residents to patient satisfaction: Impact of residents beyond clinical care

effects of change and for identifying opportunities for future interventions and improvements in the educational curriculum. Contributions of surgical residents to patient satisfaction: Impact of residents beyond clinical care. Resnick AS, Disbot M, Wurster A, Mullen JL, Kaiser LR, Morris JB. From the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Purpose: Little is known about the relationship between resident performance and patient satisfaction. To this end, this institution added housestaff-specific questions to Press–Ganey surveys administered to patients. This study sought to investigate the impact residents have on patient’s overall rating of care provided compared with faculty and nursing staff. Methods: Between March 2005 and April 2006, half of all discharged patients randomly received Press–Ganey surveys, including questions on the following categories: admissions, patient room, food, diagnostic testing, guest services, faculty/attending physician, discharge, emotional needs, housestaff, nurse practitioners, and primary nurse. Responses were grouped in overall category scores and used as predictor variables for regression analysis. A separate question asked patients to directly rate overall care provided. Simple and multiple regression models were run using JMP software. Results: During this period, there were 38,206 patient discharges, 19,100 surveys mailed and 4,340 surveys returned (23% response rate vs 26% nationally). In a simple regression analysis, the predictor variables for nursing, housestaff, and faculty accounted for 56%, 34%, and 30% of the variation of overall rating of care delivered (p ⬍ 0.005). The actual overall score for each group varied slightly: faculty (89.7), nursing (86.6), and housestaff (84.8) (p ⬍ 0.005). In a multiple regression analysis, all predictors above were significant (p ⬍ 0.05). A small difference in scores occurred between surgical (83.5) and nonsurgical (84.8) housestaff (p ⬍ 0.05). When data were sorted by surgical services, ratings of surgical housestaff ranged from a high of 87.9 (thoracic) to a low of 79.1 (orthopedics) (p ⬍ 0.05). Admission month had no significant effect on overall rating of care (range, 85–90), although comparing the means of resident scores by month (range, 81– 86) showed that at the end (May–June) and at the beginning (July–August) of an academic year, a significant reduction in resident scores occurred (p ⬍ 0.05). The lowest score of the year (81) occurred in June, whereas the highest scores occurred in January–April (85– 86). Conclusions: Compared with faculty and residents, nurses have a greater impact on the variation of patient satisfaction. However, the actual scores given to residents, faculty, and nurses are all quite high. A slight difference in scores of surgical and nonsurgical residents was found. For all residents, the time of the academic year impacts positively in the middle and negatively in the beginning and end on resident scores. For surgical residents, clear differences exist between specialty services, but it is not apparent whether these differences are from individual residents or the clinical service milieu. Residents contribute significantly to overall satisfaction, and more investigation of the variation in resident scores is needed. A multidisciplinary systems-based practice learning experience and its impact on surgical residency education. Siri J, Behrns K, Flynn T, Reed A. From the University of Florida, Gainesville, Florida. Purpose: To design and implement a multidisciplinary systems-based practice learning experience that focused on improving and standardizing the preoperative quality of care of general surgical patients. Methods: Four parameters of preoperative care were designated as quality assessment variables, including bowel preparation, perioperative beta-blockade, prophylactic antibiotic use, and deep venous thrombosis prevention. Four groups of general surgery residents (PGY I-V) each led by 1 chief resident were assigned a quality parameter and performed an evidence-based current literature review and formulated a standardized management approach based on the level of evidence and recommendations available. Because preoperative preparation includes anesthetic care and operating room preparation, these findings were presented at the Department of Surgery Grand Rounds in a multidisciplinary format that included presentations by each resident group, the Depart72

ment of Anesthesia, and the Department of Nursing. The aim of the multidisciplinary quality assurance conference was to present the evidence-based literature findings to determine how standardization of preoperative care would alter anesthetic and nursing care and to obtain feedback about management protocols. To determine the educational impact of this model of integrated systems-based practice quality assessment conference, residents were queried regarding the value of this educational venue and responses were rated on a Likert scale. Results: Resident participation was excellent. The residents garnered valuable information by performing a literature review and evaluating the best preoperative preparation for each parameter. Furthermore, integration of their findings into systems-based practice including anesthesia and nursing care provided an appreciation of the complexities of care and the need for appropriate medical knowledge, communication, and professionalism. The derivation of treatment protocols included an opportunity to incorporate several competencies across disciplines. The residents evaluated 5 questions and deemed the educational exercise an effective model to enrich surgical resident education while improving patient care. The residents also strongly agreed that they would participate in similar projects in the future and recommend this educational exercise to other residents. Conclusions: This multidisciplinary systems-based practice learning experience focused on improving and standardizing the preoperative quality of care and general surgery residents were pivotal participants. This exercise had a positive impact on general surgery residency education and proved to be a value model of systems-based practice competency. Multi-institutional validation of a web-based core competency assessment system. Tabuenca A,* Welling R,† Sachdeva A,‡ Blair P,‡ Horvath K,㛳 Tarpley J,§ Savino J,¶ Gray R,** Gulley J,† Arnold T,† Wolfe K,†† Risucci D. ¶From the *Loma Linda University Medical Center, Loma Linda, California, †the Good Samaritan Hospital, Cincinnati, Ohio, the ‡American College of Surgeons, Chicago, Illinois, the 㛳University of Washington, Seattle, Washington, the § Vanderbilt University Medical School, Nashville, Tennessee, the ¶New York Medical College, Valhalla, New York, the **Mayo Clinic College of Medicine, Rochester, Minnesota, and the ††Hofstra University, Hempstead, New York. Purpose: The Association of Program Directors in Surgery and the American College of Surgeons collaborated in development and implementation of a Web-based system for end-of-rotation faculty assessment of ACGME core competencies of residents. The purpose of this study was to examine internal consistency and aspects of postdictive, concurrent, and construct validity of these assessments. Methods: Each assessment included ratings on 23 items reflecting the 6 ACGME core competencies (1–5 scale: 1 ⫽ Deficient; 3 ⫽ Competent for PGY level; 5 ⫽ Competent at level of faculty surgeon). A total of 346 general surgery residents were assessed by 206 faculty surgeons at 5 institutions participating in this study during the 2004/2005 and 2005/2006 academic years. Of these residents, 14 residents were assessed on less than 5 occasions and were excluded from analyses, which resulted in a study sample of 332 residents. The mean rating obtained by each resident on each item was computed for each academic year. The mean ratings of the items constituting each competency were then averaged for each resident, which resulted in 1 composite rating representing each of the 6 core competencies. Additional data collected included USMLE and ABSITE scores, PGY, and status in program (categorical, designated preliminary, undesignated preliminary). Results: Coefficient alpha was greater than 0.90 for each competency score. Analysis of variance identified statistically significant differences (p ⬍ 0.01) across PGY levels for each competency score, with means increasing as a function of PGY (Fig.). Ratings for professionalism and interpersonal/communication skills (IPC) were significantly higher than all other competencies across all PGY levels. Ratings of knowledge, (r ⫽ 0.16) and practicebased learning and improvement (PBLI), but none of the other competencies correlated significantly with USMLE Step I scores (r ⫽ 0.15, p ⬍ 0.05). Only ratings of knowledge correlated significantly (r ⫽ 0.19, p

Journal of Surgical Education • Volume 64/Number 2 • March/April 2007