Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
J Surg Educ. 2021 Nov-Dec;78(6):1838-1850. doi: 10.1016/j.jsurg.2021.04.003. Epub 2021 Jun 4.
A resident-run minor surgery clinic was developed to increase resident procedural autonomy. We evaluated whether 1) there was a significant difference between complications and patient satisfaction when procedures were independently performed by surgical residents vs. a surgical attending and 2) if participation was associated with an increase in resident procedural confidence.
Third year general surgery residents participated in a weekly procedure clinic from 2014-2018. Post-procedure complications and patient satisfaction were compared between patients operated on by residents vs. the staff surgeon. Residents were surveyed regarding their confidence in independently performing a variety of clinic-based patient care tasks.
Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program.
Post-graduate year three general surgery residents that ran the clinic as part of a general surgery rotation.
1230 patients underwent 1592 procedures (612 in resident clinic, 980 in attending clinic). There was no significant difference in the 30-day complication rate between patients operated on by the resident vs. attending (2.5% vs. 1.9%, p = 0.49). 459 patient satisfaction surveys were administered with a 79.1% response rate. There was no significant difference in the overall quality of care rating between residents and the attending surgeon (87.5% top-box rating vs. 93.1%, p = 0.15). Twenty-one residents completed both a pre- and post-rotation survey (77.8% response rate). The proportion of residents indicating that they could independently perform a variety of patient care tasks significantly increased across the rotation (all p < 0.05).
Mid-level general surgery residents can independently perform office-based procedures without detriment to safety or patient satisfaction. The resident-run procedure clinic serves as an environment for residents to grow in confidence in both technical and non-technical skills. Given the high rate at which patients provide resident feedback, future work may investigate how to best incorporate patient derived evaluations into resident assessment.
开设住院医生主导的小手术门诊旨在提高住院医生的手术自主性。我们评估了手术由住院医生独立完成与由外科主治医生完成相比：1）在并发症和患者满意度方面是否存在显著差异；2）如果参与其中，是否会增加住院医生的手术信心。
2014 年至 2018 年期间，普外科三年级住院医生每周参加一次手术门诊。比较了由住院医生和主治医生手术的患者的术后并发症和患者满意度。住院医生接受了关于他们独立完成各种门诊患者护理任务的信心的调查。
马萨诸塞州波士顿的麻省总医院普通外科；学术性三级普通外科住院医师培训项目。
参加该门诊的普外科三年级住院医生，这是普外科轮转的一部分。
共有 1230 名患者接受了 1592 次手术（住院医生门诊 612 次，主治医生门诊 980 次）。由住院医生和主治医生手术的患者在 30 天内的并发症发生率无显著差异（2.5%比 1.9%，p=0.49）。共发放了 459 份患者满意度调查，回复率为 79.1%。住院医生和主治医生的整体护理质量评分无显著差异（87.5%的最佳评分与 93.1%，p=0.15）。21 名住院医生完成了轮转前后的调查（77.8%的回复率）。住院医生表示他们可以独立完成各种患者护理任务的比例在整个轮转过程中显著增加（均 p<0.05）。
中级普外科住院医生可以独立完成门诊手术，而不会对安全性或患者满意度造成影响。住院医生主导的手术门诊为住院医生在技术和非技术技能方面增强信心提供了环境。鉴于患者提供的住院医生反馈率很高，未来的工作可以研究如何将患者评估结果最佳地纳入住院医生评估中。
