Creation of an emergency surgery service concentrates resident training in general surgical procedures.

INTRODUCTION: Emergency general surgery (EGS) is increasingly being provided by academic trauma surgeons in an acute care surgery model. Our tertiary care hospital recently changed from a model where all staff surgeons (private, subspecialty academic, and trauma academic) were assigned EGS call to one in which an emergency surgery service (ESS), staffed by academic trauma faculty, cares for all EGS patients. In the previous model, many surgeries were "not covered" by residents because of work-hour restrictions, conflicting needs, or private surgeon preference. The ESS was separate from the trauma service. We hypothesize that by creating a separate ESS, residents can accumulate needed and concentrated operative experience in a well-supervised academic environment. METHODS: A prospectively accrued EGS database was retrospectively queried for the 18-month period: July 2010 to June 2011. The Accreditation Council for Graduate Medical Education (ACGME) databases were queried for operative numbers for our residency program and for national resident data for 2 years before and after creating the ESS. The ACGME operative requirements were tabulated from online sources. ACGME requirements were compared with surgical cases performed. RESULTS: During the 18-month period, 816 ESS operations were performed. Of these, 307 (38%) were laparoscopy. Laparoscopic cholecystectomy and appendectomy were most common (138 and 145, respectively) plus 24 additional laparoscopic surgeries. Each resident performed, on average, 34 basic laparoscopic cases during their 2-month rotation, which is 56% of their ACGME basic laparoscopic requirement. A diverse mixture of 70 other general surgical operations was recorded for the remaining 509 surgical cases, including reoperative surgery, complex laparoscopy, multispecialty procedures, and seldom-performed operations such as surgery for perforated ulcer disease. Before the ESS, the classes of 2008 and 2009 reported that only 48% and 50% of cases were performed at the main academic institution, respectively. This improved for the classes of 2010 and 2011 to 63% and 68%, respectively, after ESS creation. CONCLUSION: An ESS rotation is becoming essential in large teaching hospitals by helping to fulfill ACGME requirements and by providing emergent general surgical skills an efficient and well-supervised academic environment. Movement toward concentrating EGS on a single service can enhance resident education and may decrease the need to supplement certain aspects of general surgery education with away rotations.

Transition to a semiclosed surgical intensive care unit (SICU) leads to improved resident job satisfaction: a prospective, longitudinal analysis.

OBJECTIVE: Patients, family members and ICU nurses have a higher level of satisfaction with the semiclosed ICU model. Whether or not resident physicians have this same reaction has not yet been investigated. We hypothesized that surgical residents would have improved job satisfaction with the transition from a mandatory consultation SICU to a semiclosed SICU model. DESIGN: Prospective, longitudinal survey. SETTING: Tertiary-care University Hospital. PARTICIPANTS: Categorical general surgery residents. INTERVENTIONS: Change from mandatory consultation SICU to semiclosed SICU. MEASUREMENTS AND MAIN RESULTS: Categorical surgery residents at a tertiary-care university hospital were surveyed at 3 time points during and after the transition from a mandatory consultation SICU to a semiclosed SICU. The survey consisted of 12 questions designed to gauge the residents' overall job satisfaction as related to the SICU. All questions were on a 5-point Likert scale. Analysis of variance for trend and Fisher exact test were performed to compare the responses. 97 surveys were received. The response rates for the 3 periods were 66, 62 and 72%. Residents were less likely to feel "out of the loop" regarding the care of their ICU patients in the later periods (p = 0.046). There was significant improvement over time in scores for the statement "there is often confusion about placing orders for the care of my patients in the ICU" (p = 0.001). The critical care team's management of all orders in the SICU significantly improved resident job satisfaction over the 3-year period (p = 0.027). There were no significant differences between the responses of junior and senior residents. CONCLUSIONS: Resident satisfaction improved significantly over time with the transition from a mandatory consultation SICU to a semiclosed SICU.