Implementation and Evaluation of a New Surgical Residency Model

Joseph R. Schneider, John J. Coyle, Elizabeth R. Ryan, Richard H. Bell, Debra A. DaRosa

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background: The Accreditation Council for Graduate Medical Education (ACGME) duty-hour requirements prompted program directors to rethink the organizational structure of their residency programs. Many surgical educators have expressed concerns that duty-hour restrictions would negatively affect quality of resident education. This article summarizes evaluation research results collected to study the impact of our reengineered residency program designed to preserve important educational activities while meeting duty-hour accreditation requirements. Study Design: The traditional residency structure was redesigned to include a mixture of apprenticeship, small team, and night-float models. Impact evaluation data were collected using operative case logs, standardized test scores, quality assurance data, resident perception surveys, a faculty survey, and process evaluation measures. Results: PGY1s and PGY2s enjoyed a substantial increase in operative cases. Operative cases increased overall and no resident has failed to meet ACGME volume or distribution requirements. American Board of Surgery In-Training Examination performance improved for PGY1s and PGY2s. Patient outcomes measures, including monthly mortality and number of and charges for admissions, showed no changes. Anonymously completed rotation evaluation forms showed stable or improved resident perceptions of case load, continuity, operating room teaching, appropriate level of faculty involvement and supervision, encouragement to attend conferences, and general assessment of the learning environment. A quality-of-life survey completed by residents before and after implementation of the new program structure showed substantial improvements. Faculty surveys showed perceived increases in work hours and job dissatisfaction. New physician assistant and nurse positions directly attributed to duty-hour restrictions amounted to about 0.2 full-time equivalent per resident. Conclusions: Duty-hour restrictions produce new challenges and might require additional resources but need not cause a deterioration of surgical residents' educational experience.

Original languageEnglish (US)
Pages (from-to)393-404
Number of pages12
JournalJournal of the American College of Surgeons
Volume205
Issue number3
DOIs
StatePublished - Sep 1 2007

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Anatomic Models
Internship and Residency
Accreditation
Graduate Medical Education
Education
Physician Assistants
Process Assessment (Health Care)
Operating Rooms
Teaching
Nurses
Quality of Life
Outcome Assessment (Health Care)
Learning
Mortality
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery

Cite this

Implementation and Evaluation of a New Surgical Residency Model. / Schneider, Joseph R.; Coyle, John J.; Ryan, Elizabeth R.; Bell, Richard H.; DaRosa, Debra A.

In: Journal of the American College of Surgeons, Vol. 205, No. 3, 01.09.2007, p. 393-404.

Research output: Contribution to journalArticle

Schneider, Joseph R. ; Coyle, John J. ; Ryan, Elizabeth R. ; Bell, Richard H. ; DaRosa, Debra A. / Implementation and Evaluation of a New Surgical Residency Model. In: Journal of the American College of Surgeons. 2007 ; Vol. 205, No. 3. pp. 393-404.
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