- Email: [email protected]
Surgical careers and preparedness of graduating residents—An outcomes-based study
2001 APDS SPRING MEETING
Surgical Careers and Preparedness of Graduating Residents—An Outcomes-Based Study Michael J. Zdon, MD Department of Surgery, Finch University of Health Sciences/The Chicago Medical School, North Chicago, Illinois PURPOSE: Outcome-based measures have recently become
the focus of residency program evaluations. The ultimate outcome of a surgical training program is the successful development of surgical careers by its graduates. METHODS: We developed a survey that was sent to all resi-
dents completing our surgical residency from 1989 to 1999 in order to evaluate practice location, type of practice, practice mixture, additional training obtained after residency, Board certification, and membership in the American College (ACS) or other professional societies. Graduates were asked to report their impression of their residency education program’s ability to prepare them for surgical practice as well as to give an overall opinion of their training using a scale of 10 (high) to 1 (low). Solicitations were also made for means to improve the training program. RESULTS: Of 32 graduates sent surveys, 30 responded (94%).
A total of 29 of 30 responding graduates (97%) are active in surgery. A total of 26 of 30 graduates are in private or government practice, 3 of 30 are full-time academic, and 1 of 30 is completing fellowship training. A total of 13 of 30 (43%) immediately entered practice, whereas 17 of 30 (57%) received additional fellowship training. Board certification has been achieved by 24 graduates. A total of 17 of 30 (59%) are members of the ACS, and 24 of 30 (83%) are members of at least 1 regional or specialty society. The average score for practice preparedness was 8.35. Overall score for the residency program was 8.7. Specific graduate comments demonstrated a perceived need for additional vascular and oncology operative experience that led to changes in our program. These results demonstrate an overall high satisfaction with our training program by graduates over the past 10 years as well as high success rate as evidenced by successful surgical practices by 97% of our graduates. CONCLUSIONS: We believe this type of outcome informa-
Correspondence: Inquiries to Michael J. Zdon, MD, Department of Surgery, Finch University of Health Sciences/The Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064; fax: (773) 257-6548; e-mail: [email protected]
tion provides valuable feedback to programs with regard to planning and development based on the types of careers graduates choose as well as specific changes in curriculum based on perceived deficiencies. (Curr Surg 59:119-122. © 2002 by the Association of Program Directors in Surgery.) KEY WORDS: outcomes measures, residency training pro-
gram
INTRODUCTION The approach to defining quality in residency training has traditionally relied on demonstration of the achievement of a minimal standard of knowledge and function drawn from a controlled set of information and presented in a tightly controlled environment. The historically established minimum standards for goals and objectives have included the following: 1. An established curriculum 2. Fixed rotations designed to offer equality of experience to all graduates 3. Demonstration of scholarly activity by faculty and trainees 4. Appropriate institutional financial resources 5. Appropriate experience in complex and varied operative procedures. In the past, success in achieving these goals and objectives was demonstrated by periodic reviews by the Residency Review Committee for the Accreditation Council for Graduate Medical Education (ACGME), by evaluation of the program by its trainees, and by the ability to attract quality residents. Recent emphasis on the concept of evaluating outcomes has gained wider acceptance by the major accrediting bodies such as the ACGME and Association of American Medical Colleges (AAMC) as an indicator of assessing quality. Although general agreement exists on the need to assess outcomes, there is, as of yet, little agreement on what outcomes can or should be measured. It is the hypothesis of this paper that although some out-
CURRENT SURGERY • © 2002 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/02/$22.00 PII S0149-7944(01)00588-8
119
comes measures such as pass rate on the American Board of Surgery Qualifying, Certifying, and Recertifying examinations are useful in determining continued competency, the ultimate outcome for a surgical residency training program is measured in the ability of its graduates to initiate and maintain successful surgical practices and careers. To evaluate this, we surveyed graduates of our residency program from the 10-year period 1989 to 1999 and attempted to codify their careers after graduation. Specifically, we directed attention to the following areas: 1. Did graduates feel that their training prepared them for their current practice? 2. What is the demographic pattern of graduates with respect to location and type of practice, and do these correspond to the stated primary goal of our program, which is “to educate and train surgical residents in advanced surgical principles and techniques consistent with the requirements of the Accreditation Council for Graduate Medical Education in order to prepare them for careers as practicing surgeons” and our secondary goal of “training academic surgeons to fill faculty needs of surgical education programs?” 3. Did the graduates have specific feedback regarding perceived deficiencies that we could use in order to better prepare our trainees for their surgical careers?
METHODS A survey was developed and sent to all graduates who had completed our general surgical training program during the 10-year period from 1989 to 1999. This survey covered the following areas: 1. Demographic information 2. Integration into the profession 3. Feedback regarding satisfaction and areas for improvement. Demographic information included current practice location, number of practice locations since graduation, type of practice (solo, group, or academic), and practice mix. In addition, we inquired what, if any, additional training was obtained after residency. Information regarding integration into the profession included certification by the American Board of Surgery, membership in the American College of Surgeons, and membership in other medical and surgical professional societies. The Feedback section of the survey queried the graduates’ perceptions of the preparedness for entry into their surgical careers as well as their overall impression of their surgical training. Using a scale of 10 (high) to 1 (low), we specifically asked did graduates feel that their general surgical training prepared them well for their current practice/fellowship training situation and how would they grade their surgical training overall? In addition, in an open-ended question, we asked what deficiencies the graduates perceived were present in their training and what changes they would suggest. 120
RESULTS Surveys were sent to the 32 individuals completing our general surgery training program from 1989 to 1999, and 30 responded (94%). Of the 30 responding graduates, 29 of 30 (97%) are currently active in surgery, with 1 graduate having changed careers to emergency room medicine. Practice location is summarized in Figure 1. Although the largest number of graduates remained in the Chicago metropolitan area and the Midwest (13), the remainder of our graduates were fairly evenly distributed throughout the country with 6 in the West and Southwest, 4 in the Northeast, 4 in the Southeast, and 3 in Texas. Excluding fellowship training sites, 21 graduates reported having a single practice location after residency, whereas 7 reported having changed practice location once. One graduate had 3 different practice locations, but this individual was repaying a military obligation. One additional graduate was still in fellowship training at the time of the survey. Excluding the individual in emergency room medicine, type of surgical practice was categorized as solo private practice (6), surgical group (13), multispecialty group (4), full-time academic (4), government (1), and fellowship training (1). Fellowship training is summarized in Table 1. Thirteen of the 30 responding graduates (43%) received no additional training after their general surgery residency, and 12 listed their practice as 100% general surgery. The remaining 17 graduates (57%) went on to fellowships that included Cardiothoracic (5), Vascular (3), Plastics (2), Colorectal (2), Transplant (2), Critical Care (1), Trauma (1), and Advanced Laparoscopic (1). Twenty-four of the 30 responding graduates have attained certification by the American Board of Surgery, with 4 additional graduates currently in the process of taking the examination for the first time. Only 2 graduates who are eligible have failed to attain certification. One of these is the graduate who is practicing emergency room medicine. Thus, 24 of 26 graduates who have had the opportunity to take both examinations at least once have become certified (92%). Seventeen graduates are members of the American College of Surgeons, with 3 additional graduates currently in the application process. Twentyfour graduates (83%) report membership in other professional societies, which are summarized in Table 2. The mean score for the question regarding preparedness for current practice situation was 8.35 (range, 10 to 6). The mean score for overall quality of residency training was 8.75 (range, 10 to 7). Ten graduates had no specific changes to recommend for the program. Of the remaining graduates, the response was variable. Responses are summarized in Table 3. Among the most frequently cited comments were increased operative experience in atherosclerotic vascular disease (4), increased operative experience in complex oncologic procedures (3), and increased operative experience in advanced laparoscopic procedures (3). No significant difference was found in the satisfaction scores between residents having no suggestions compared with those with suggestions with mean scores being almost identical. In addition, we did not observe any specific trend with regard to CURRENT SURGERY • Volume 59/Number 1 • January/February 2002
FIGURE 1. Distribution of graduates by practice location.
satisfaction scores over the 10-year time period, although the small numbers make comparison difficult.
DISCUSSION Success in training residents can be measured in many ways. The traditional approach of setting minimal acceptable criteria to which a residency program must adhere to is coming under increased criticism as not being indicative of defining “quality.”1,2 However, what defines quality has also been elusive, and the subject of debate among various accrediting bodies, profesTABLE 1. Fellowship Training Following Residency (30 Responding Graduates) None Yes -Cardiothoracic -Vascular -Plastics -Colorectal -Transplant -Critical Care -Trauma -Advanced Laparoscopic
13/30 (43%) 17/30 (57%) 5 3 2 2 2 1 1 1
CURRENT SURGERY • Volume 59/Number 1 • January/February 2002
sional organizations, and residency director organizations.3– 6 Clearly, the emphasis is increasingly moving away from strictly looking at areas of structure and function, such as curricula, scholarly activity, and numbers of operations and moving toward the measurement of outcomes.1,7,8 Defining which outcomes should or can be measured is an area of current discussion. At a recent ACGME symposium entitled “Good Learning TABLE 2. Membership in Professional Societies Society American College of Surgeons Regional Surgical Societies American Medical Association SAGES Society of Laparoendoscopic Surgeons Society of Thoracic Surgeons American Society of Plastic and Reconstructive Surg. American Society of Colorectal Surgery Society of Clinical Vascular Surgery Peripheral Vascular Society Society for Surgery of the Alimentary Tract Transplant Society Bariatric Surgery Society Society for Critical Care Medicine
Number of Graduates 17 9 9 5 3 1 2 2 2 2 1 2 1 1 121
TABLE 3. Suggested Changes for Training Program Number of Responses None Additional Experience in -Atherosclerotic Vascular Procedures -Complex Oncologic Operations -Advanced Laparoscopic Procedures -Cardiothoracic Surgery -Plastic Surgery -Colon Rectal Surgery -Thoracic Surgery -Gynecology -Research -Practice Management Issues -Ambulatory Surgery
10 4 3 3 2 1 1 1 1 1 1 1
for Good Healthcare,” a discussion was held regarding potential indicators and measures of high-functioning education.9 Among measures discussed was “assessing the satisfaction of young graduate physicians with the degree to which their educational program has imparted them the knowledge, skills, attitudes, and socialization required for the practice of medicine in the current environment.” The ultimate outcome for surgical residency training programs is graduates who can successfully establish and maintain a surgical practice and gain professional acceptance among their peers. In the current study, we sought to obtain information on our graduates over an extended period of time in order to assess the degree to which we have been successful in preparing our residents for their surgical careers. In addition, we wished to obtain data on what percentage of our residents obtain additional training and the location and types of surgical practices our graduates choose in order to assess whether this corresponds with our particular program’s goals and objectives. A final added benefit of this information is feedback regarding changes that would improve our training from individuals who have the perspective of time and outcome rather than just feedback from our current residents, who, in general, have the more limited horizon of a 1- or 2-month rotation. Our results indicate that, in general, our graduates are very satisfied with their training overall and with respect to being prepared for either fellowship training or practice. Most of our graduates eventually choose clinical surgical careers, although a smaller number have become full-time academic surgeons. This mixture is consistent with our program’s goals and objectives of training clinical practicing surgeons. In addition, our graduates have demonstrated professional acceptance to the degree that most are members of the American College of Surgeons or other professional societies and greater than 90% have attained Board certification. From a practical standpoint, the feedback we received resulted in our providing additional surgical experience in the form of additional outside rotations in the areas of pe-
122
ripheral vascular and oncologic surgery beginning this academic year. Additional objective data would be desirable in order to better assess an individual’s professional standing in their practice. These may include case and complication records similar to that provided to the College in its application process as well as documentation of credentialing by hospitals in which a graduate practices. At present, however, it is unlikely that this type of information will be provided to individual program directors unless a formal effort by licensing or certifying bodies is made in this regard. In summary, we believe that information of this type is valuable in assessing success of surgical residencies with regard to their individual missions of training surgical residents, determining the demographics and practice profiles of their graduates, and obtaining meaningful feedback to effect positive changes in surgical programs. Although by no means inclusive, this does represent an effort to move toward the assessment of outcomes as a measure of quality.
REFERENCES 1. Kassebaum DG. The measurement of outcomes in the as-
sessment of educational program effectiveness. Acad Med. 1990;65:293-296. 2. Gonnella J, Hojat J, Erdmann JB, Veloski JJ. What have we
learned and where do we go from here? In Assessment measures in medical school, residency, and practice: the connections. Acad Med. 1993;68(Suppl.):S79-S87. 3. O’Leary DS. Quality assessment. Moving from theory to
practice. JAMA. 1988;260:1760. 4. Donabedian A. The quality of care. How can it be assessed?
JAMA. 1988;260:1743-1748. 5. Elliott RL, Juthani NV, Rubin EH, Greenfeld D, Skelton
WD, Yudkowsky R. Quality in residency training: toward a broader, multidimensional definition. Acad Med. 1996;71: 243-247. 6. Bowen JL, Leff L, Smith LG, Wolfsthal S. Beyond the mys-
tique of prestige: measuring the quality of residency programs. Am J Med. 1999;106:493-498. 7. Martini CJM. The long shadow of Flexner: a prolonged
polemic in assessing outcomes in medical education. JAMA. 1989;262:1008-1010. 8. Villanueva AM, Kaye D, Abdelhak SS, Morahan PS. Com-
paring selection criteria of residency directors and physicians’ employers. Acad Med. 1995;70:261-271. 9. Philbert I, ed. “Good learning for good healthcare”—Pursuing excellence in physician education-who will the players be? Accreditation Council for Graduate Medical Education. Chicago, IL. February 2000.
CURRENT SURGERY • Volume 59/Number 1 • January/February 2002
Surgical Careers and Preparedness of Graduating Residents—An Outcomes-Based Study Michael J. Zdon, MD Department of Surgery, Finch University of Health Sciences/The Chicago Medical School, North Chicago, Illinois PURPOSE: Outcome-based measures have recently become
the focus of residency program evaluations. The ultimate outcome of a surgical training program is the successful development of surgical careers by its graduates. METHODS: We developed a survey that was sent to all resi-
dents completing our surgical residency from 1989 to 1999 in order to evaluate practice location, type of practice, practice mixture, additional training obtained after residency, Board certification, and membership in the American College (ACS) or other professional societies. Graduates were asked to report their impression of their residency education program’s ability to prepare them for surgical practice as well as to give an overall opinion of their training using a scale of 10 (high) to 1 (low). Solicitations were also made for means to improve the training program. RESULTS: Of 32 graduates sent surveys, 30 responded (94%).
A total of 29 of 30 responding graduates (97%) are active in surgery. A total of 26 of 30 graduates are in private or government practice, 3 of 30 are full-time academic, and 1 of 30 is completing fellowship training. A total of 13 of 30 (43%) immediately entered practice, whereas 17 of 30 (57%) received additional fellowship training. Board certification has been achieved by 24 graduates. A total of 17 of 30 (59%) are members of the ACS, and 24 of 30 (83%) are members of at least 1 regional or specialty society. The average score for practice preparedness was 8.35. Overall score for the residency program was 8.7. Specific graduate comments demonstrated a perceived need for additional vascular and oncology operative experience that led to changes in our program. These results demonstrate an overall high satisfaction with our training program by graduates over the past 10 years as well as high success rate as evidenced by successful surgical practices by 97% of our graduates. CONCLUSIONS: We believe this type of outcome informa-
Correspondence: Inquiries to Michael J. Zdon, MD, Department of Surgery, Finch University of Health Sciences/The Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064; fax: (773) 257-6548; e-mail: [email protected]
tion provides valuable feedback to programs with regard to planning and development based on the types of careers graduates choose as well as specific changes in curriculum based on perceived deficiencies. (Curr Surg 59:119-122. © 2002 by the Association of Program Directors in Surgery.) KEY WORDS: outcomes measures, residency training pro-
gram
INTRODUCTION The approach to defining quality in residency training has traditionally relied on demonstration of the achievement of a minimal standard of knowledge and function drawn from a controlled set of information and presented in a tightly controlled environment. The historically established minimum standards for goals and objectives have included the following: 1. An established curriculum 2. Fixed rotations designed to offer equality of experience to all graduates 3. Demonstration of scholarly activity by faculty and trainees 4. Appropriate institutional financial resources 5. Appropriate experience in complex and varied operative procedures. In the past, success in achieving these goals and objectives was demonstrated by periodic reviews by the Residency Review Committee for the Accreditation Council for Graduate Medical Education (ACGME), by evaluation of the program by its trainees, and by the ability to attract quality residents. Recent emphasis on the concept of evaluating outcomes has gained wider acceptance by the major accrediting bodies such as the ACGME and Association of American Medical Colleges (AAMC) as an indicator of assessing quality. Although general agreement exists on the need to assess outcomes, there is, as of yet, little agreement on what outcomes can or should be measured. It is the hypothesis of this paper that although some out-
CURRENT SURGERY • © 2002 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/02/$22.00 PII S0149-7944(01)00588-8
119
comes measures such as pass rate on the American Board of Surgery Qualifying, Certifying, and Recertifying examinations are useful in determining continued competency, the ultimate outcome for a surgical residency training program is measured in the ability of its graduates to initiate and maintain successful surgical practices and careers. To evaluate this, we surveyed graduates of our residency program from the 10-year period 1989 to 1999 and attempted to codify their careers after graduation. Specifically, we directed attention to the following areas: 1. Did graduates feel that their training prepared them for their current practice? 2. What is the demographic pattern of graduates with respect to location and type of practice, and do these correspond to the stated primary goal of our program, which is “to educate and train surgical residents in advanced surgical principles and techniques consistent with the requirements of the Accreditation Council for Graduate Medical Education in order to prepare them for careers as practicing surgeons” and our secondary goal of “training academic surgeons to fill faculty needs of surgical education programs?” 3. Did the graduates have specific feedback regarding perceived deficiencies that we could use in order to better prepare our trainees for their surgical careers?
METHODS A survey was developed and sent to all graduates who had completed our general surgical training program during the 10-year period from 1989 to 1999. This survey covered the following areas: 1. Demographic information 2. Integration into the profession 3. Feedback regarding satisfaction and areas for improvement. Demographic information included current practice location, number of practice locations since graduation, type of practice (solo, group, or academic), and practice mix. In addition, we inquired what, if any, additional training was obtained after residency. Information regarding integration into the profession included certification by the American Board of Surgery, membership in the American College of Surgeons, and membership in other medical and surgical professional societies. The Feedback section of the survey queried the graduates’ perceptions of the preparedness for entry into their surgical careers as well as their overall impression of their surgical training. Using a scale of 10 (high) to 1 (low), we specifically asked did graduates feel that their general surgical training prepared them well for their current practice/fellowship training situation and how would they grade their surgical training overall? In addition, in an open-ended question, we asked what deficiencies the graduates perceived were present in their training and what changes they would suggest. 120
RESULTS Surveys were sent to the 32 individuals completing our general surgery training program from 1989 to 1999, and 30 responded (94%). Of the 30 responding graduates, 29 of 30 (97%) are currently active in surgery, with 1 graduate having changed careers to emergency room medicine. Practice location is summarized in Figure 1. Although the largest number of graduates remained in the Chicago metropolitan area and the Midwest (13), the remainder of our graduates were fairly evenly distributed throughout the country with 6 in the West and Southwest, 4 in the Northeast, 4 in the Southeast, and 3 in Texas. Excluding fellowship training sites, 21 graduates reported having a single practice location after residency, whereas 7 reported having changed practice location once. One graduate had 3 different practice locations, but this individual was repaying a military obligation. One additional graduate was still in fellowship training at the time of the survey. Excluding the individual in emergency room medicine, type of surgical practice was categorized as solo private practice (6), surgical group (13), multispecialty group (4), full-time academic (4), government (1), and fellowship training (1). Fellowship training is summarized in Table 1. Thirteen of the 30 responding graduates (43%) received no additional training after their general surgery residency, and 12 listed their practice as 100% general surgery. The remaining 17 graduates (57%) went on to fellowships that included Cardiothoracic (5), Vascular (3), Plastics (2), Colorectal (2), Transplant (2), Critical Care (1), Trauma (1), and Advanced Laparoscopic (1). Twenty-four of the 30 responding graduates have attained certification by the American Board of Surgery, with 4 additional graduates currently in the process of taking the examination for the first time. Only 2 graduates who are eligible have failed to attain certification. One of these is the graduate who is practicing emergency room medicine. Thus, 24 of 26 graduates who have had the opportunity to take both examinations at least once have become certified (92%). Seventeen graduates are members of the American College of Surgeons, with 3 additional graduates currently in the application process. Twentyfour graduates (83%) report membership in other professional societies, which are summarized in Table 2. The mean score for the question regarding preparedness for current practice situation was 8.35 (range, 10 to 6). The mean score for overall quality of residency training was 8.75 (range, 10 to 7). Ten graduates had no specific changes to recommend for the program. Of the remaining graduates, the response was variable. Responses are summarized in Table 3. Among the most frequently cited comments were increased operative experience in atherosclerotic vascular disease (4), increased operative experience in complex oncologic procedures (3), and increased operative experience in advanced laparoscopic procedures (3). No significant difference was found in the satisfaction scores between residents having no suggestions compared with those with suggestions with mean scores being almost identical. In addition, we did not observe any specific trend with regard to CURRENT SURGERY • Volume 59/Number 1 • January/February 2002
FIGURE 1. Distribution of graduates by practice location.
satisfaction scores over the 10-year time period, although the small numbers make comparison difficult.
DISCUSSION Success in training residents can be measured in many ways. The traditional approach of setting minimal acceptable criteria to which a residency program must adhere to is coming under increased criticism as not being indicative of defining “quality.”1,2 However, what defines quality has also been elusive, and the subject of debate among various accrediting bodies, profesTABLE 1. Fellowship Training Following Residency (30 Responding Graduates) None Yes -Cardiothoracic -Vascular -Plastics -Colorectal -Transplant -Critical Care -Trauma -Advanced Laparoscopic
13/30 (43%) 17/30 (57%) 5 3 2 2 2 1 1 1
CURRENT SURGERY • Volume 59/Number 1 • January/February 2002
sional organizations, and residency director organizations.3– 6 Clearly, the emphasis is increasingly moving away from strictly looking at areas of structure and function, such as curricula, scholarly activity, and numbers of operations and moving toward the measurement of outcomes.1,7,8 Defining which outcomes should or can be measured is an area of current discussion. At a recent ACGME symposium entitled “Good Learning TABLE 2. Membership in Professional Societies Society American College of Surgeons Regional Surgical Societies American Medical Association SAGES Society of Laparoendoscopic Surgeons Society of Thoracic Surgeons American Society of Plastic and Reconstructive Surg. American Society of Colorectal Surgery Society of Clinical Vascular Surgery Peripheral Vascular Society Society for Surgery of the Alimentary Tract Transplant Society Bariatric Surgery Society Society for Critical Care Medicine
Number of Graduates 17 9 9 5 3 1 2 2 2 2 1 2 1 1 121
TABLE 3. Suggested Changes for Training Program Number of Responses None Additional Experience in -Atherosclerotic Vascular Procedures -Complex Oncologic Operations -Advanced Laparoscopic Procedures -Cardiothoracic Surgery -Plastic Surgery -Colon Rectal Surgery -Thoracic Surgery -Gynecology -Research -Practice Management Issues -Ambulatory Surgery
10 4 3 3 2 1 1 1 1 1 1 1
for Good Healthcare,” a discussion was held regarding potential indicators and measures of high-functioning education.9 Among measures discussed was “assessing the satisfaction of young graduate physicians with the degree to which their educational program has imparted them the knowledge, skills, attitudes, and socialization required for the practice of medicine in the current environment.” The ultimate outcome for surgical residency training programs is graduates who can successfully establish and maintain a surgical practice and gain professional acceptance among their peers. In the current study, we sought to obtain information on our graduates over an extended period of time in order to assess the degree to which we have been successful in preparing our residents for their surgical careers. In addition, we wished to obtain data on what percentage of our residents obtain additional training and the location and types of surgical practices our graduates choose in order to assess whether this corresponds with our particular program’s goals and objectives. A final added benefit of this information is feedback regarding changes that would improve our training from individuals who have the perspective of time and outcome rather than just feedback from our current residents, who, in general, have the more limited horizon of a 1- or 2-month rotation. Our results indicate that, in general, our graduates are very satisfied with their training overall and with respect to being prepared for either fellowship training or practice. Most of our graduates eventually choose clinical surgical careers, although a smaller number have become full-time academic surgeons. This mixture is consistent with our program’s goals and objectives of training clinical practicing surgeons. In addition, our graduates have demonstrated professional acceptance to the degree that most are members of the American College of Surgeons or other professional societies and greater than 90% have attained Board certification. From a practical standpoint, the feedback we received resulted in our providing additional surgical experience in the form of additional outside rotations in the areas of pe-
122
ripheral vascular and oncologic surgery beginning this academic year. Additional objective data would be desirable in order to better assess an individual’s professional standing in their practice. These may include case and complication records similar to that provided to the College in its application process as well as documentation of credentialing by hospitals in which a graduate practices. At present, however, it is unlikely that this type of information will be provided to individual program directors unless a formal effort by licensing or certifying bodies is made in this regard. In summary, we believe that information of this type is valuable in assessing success of surgical residencies with regard to their individual missions of training surgical residents, determining the demographics and practice profiles of their graduates, and obtaining meaningful feedback to effect positive changes in surgical programs. Although by no means inclusive, this does represent an effort to move toward the assessment of outcomes as a measure of quality.
REFERENCES 1. Kassebaum DG. The measurement of outcomes in the as-
sessment of educational program effectiveness. Acad Med. 1990;65:293-296. 2. Gonnella J, Hojat J, Erdmann JB, Veloski JJ. What have we
learned and where do we go from here? In Assessment measures in medical school, residency, and practice: the connections. Acad Med. 1993;68(Suppl.):S79-S87. 3. O’Leary DS. Quality assessment. Moving from theory to
practice. JAMA. 1988;260:1760. 4. Donabedian A. The quality of care. How can it be assessed?
JAMA. 1988;260:1743-1748. 5. Elliott RL, Juthani NV, Rubin EH, Greenfeld D, Skelton
WD, Yudkowsky R. Quality in residency training: toward a broader, multidimensional definition. Acad Med. 1996;71: 243-247. 6. Bowen JL, Leff L, Smith LG, Wolfsthal S. Beyond the mys-
tique of prestige: measuring the quality of residency programs. Am J Med. 1999;106:493-498. 7. Martini CJM. The long shadow of Flexner: a prolonged
polemic in assessing outcomes in medical education. JAMA. 1989;262:1008-1010. 8. Villanueva AM, Kaye D, Abdelhak SS, Morahan PS. Com-
paring selection criteria of residency directors and physicians’ employers. Acad Med. 1995;70:261-271. 9. Philbert I, ed. “Good learning for good healthcare”—Pursuing excellence in physician education-who will the players be? Accreditation Council for Graduate Medical Education. Chicago, IL. February 2000.
CURRENT SURGERY • Volume 59/Number 1 • January/February 2002