General Surgery Resident Participation in a Mandatory Wellness Program: Six Years Later.

INTRODUCTION: Following the approval of a resident-created physician wellness program in 2016, an initial survey demonstrated majority support for the implementation of a mandatory curriculum. The purpose of this study is to survey surgical residents about the wellness curriculum six years after implementation and re-evaluate preference for mandatory participation. METHODS: In 2016, the CORE7 Wellness Program didactic sessions were integrated into the general surgery resident education curriculum. A comparison between 2016 and 2022 resident survey results was done to examine overall approval and resident experience. RESULTS: A total of 25 general surgery residents responded to the 2022 survey which equaled to a response rate of 67.5% compared to a response rate of 87.1% in 2016. Similar to the results in 2016, there was unanimous support (100%, n = 25) in favor of the ongoing development of a general surgery wellness program. The majority of residents (88% versus 85.2% in 2016) preferred quarterly "wellness half-days" remain a mandatory component of the program. In 2016, most of the residents (50%) stated that the reason for mandatory preference for wellness half-days was ease of explanation to faculty. In 2022, the reason changed to a combination of reasons with most residents (59%) selecting ease of explanation to attendings, feeling too guilty otherwise to leave the shift, and forcing the resident to think about self-care. Complaints about taking a wellness half-day from other team members increased from 29% in 2016 to 48% in 2022. CONCLUSIONS: Six years after implementation, there is unanimous support for the mandatory components of a general surgery residency wellness curriculum. Increased perceived complaints from faculty and staff about resident wellness present an opportunity for improvement.

Implementation of a Clinical Documentation Improvement Curriculum Improves Quality Metrics and Hospital Charges in an Academic Surgery Department.

BACKGROUND: Accurate clinical documentation (CD) is necessary for many aspects of modern health care, including excellent communication, quality metrics reporting, and legal documentation. New requirements have mandated adoption of ICD-10-CM coding systems, adding another layer of complexity to CD. A clinical documentation improvement (CDI) and ICD-10 training program was created for health care providers in our academic surgery department. We aimed to assess the impact of our CDI curriculum by comparing quality metrics, coding, and reimbursement before and after implementation of our CDI program. STUDY DESIGN: A CDI/ICD-10 training curriculum was instituted in September 2014 for all members of our university surgery department. The curriculum consisted of didactic lectures, 1-on-1 provider training, case reviews, e-learning modules, and CD queries from nurse CDI staff and hospital coders. Outcomes parameters included monthly documentation completion rates, severity of illness (SOI), risk of mortality (ROM), case-mix index (CMI), all-payer refined diagnosis-related groups (APR-DRG), and Surgical Care Improvement Program (SCIP) metrics. Financial gain from responses to CDI queries was determined retrospectively. RESULTS: Surgery department delinquent documentation decreased by 85% after CDI implementation. Compliance with SCIP measures improved from 85% to 97%. Significant increases in surgical SOI, ROM, CMI, and APR-DRG (all p < 0.01) were found after CDI/ICD-10 training implementation. Provider responses to CDI queries resulted in an estimated $4,672,786 increase in charges. CONCLUSIONS: Clinical documentation improvement/ICD-10 training in an academic surgery department is an effective method to improve documentation rates, increase the hospital estimated reimbursement based on more accurate CD, and provide better compliance with surgical quality measures.

Using Qualitative and Quantitative Assessment to Develop a Patient Safety Curriculum for Surgical Residents.

OBJECTIVE: The objective is to use qualitative and quantitative analysis to develop a patient safety curriculum for surgical residents. DESIGN: A prospective study of surgical residents using both quantitative and qualitative methods to craft a patient safety curriculum. Both a survey and focus groups were held before and 4 months after delivery of the patient safety curriculum. SETTING: The University of New Mexico Hospital, a tertiary academic medical center. PARTICIPANTS: General surgery residents, postgraduate years 1 to 5 RESULTS: Qualitative and quantitative analysis revealed areas that required attention and thus helped to mold the curriculum. Qualitative analysis after delivery of the curriculum showed positive changes in attitudes and normative beliefs toward patient safety. Specifically, attitudes and approach to quality improvement and teamwork showed improvement. Survey analysis did not show any significant change in resident perception of the environment during the time frame of this study. CONCLUSIONS: Using qualitative analysis to uncover attitudinal barriers to a safe patient environment can help to enhance the relevance and content of a patient safety curriculum for general surgery residents.

Commentary: the case for expanding general surgery residencies.

Despite the significant growth in population in the United States since 1980 and societal and demographic factors such as an aging population, there has been no increase in the number of graduating general surgery residents each year, which has created a worsening shortage of general surgeons. Other factors, such as stricter duty hours requirements and an increase in the number and variety of procedures general surgeons must perform, have also contributed to this shortage. Yet, applicant demand for general surgery positions is currently strong and will increase as new medical schools are created and current medical schools expand class size. The authors of this commentary propose an expansion of the Accreditation Council for Graduate Medical Education-approved general surgery categorical resident positions as the necessary first step in addressing the current and projected shortage of general surgeons. Before this expansion of general surgery residencies can occur, impediments such as the availability of residency spots for both U.S. and international medical graduates, the availability of educational opportunities for residents in teaching hospitals, and inadequate financial resources, such as a lack of funding from the Centers for Medicare and Medicaid, must be overcome.