Tracking Residents' Surgical Outcomes Using Data from the Quality In-Training Initiative.
J Surg Educ
; 81(8): 1110-1118, 2024 Aug.
Article
em En
| MEDLINE
| ID: mdl-38825561
ABSTRACT
OBJECTIVES:
Monitoring resident trainees' patient outcomes is essential to improving surgical performance; however, resident-specific follow-up is rarely provided in the current surgical training environment. Whether there is a correlation between individual resident's surgical performance and patients' clinical outcomes remains undefined. In this study, we aimed to use risk-adjusted patient outcomes as an educational tool to track individual surgical trainee performance. STUDYDESIGN:
American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) appendectomy and partial colectomy operations (2013-2021) were examined. Residents performing ≥25 operations were included. The primary outcome was ACS NSQIP-defined morbidity adjusted using estimated probability of morbidity. Observed-to-expected ratios (O/E) of morbidity measured overall performance and risk-adjusted cumulative sum (RA-CUSUM) methodology represented surgical resident's performance over time.SETTING:
Academic quaternary care institution.PARTICIPANTS:
Highest-ranking surgical resident participating in an operation and included in Quality In-Training Initiative.RESULTS:
A total of 449 operations were examined. 12 residents performed 343 appendectomy operations. 7 residents (29.3 ± 5.1 operations each) did not have any postoperative morbidity and demonstrated better-than-expected patient outcomes. Three residents did not have morbidity after their seventh/eleventh/fifteenth appendectomies. Two residents (case volume 29, 33) had an O/E ratio > 3. Partial colectomy (nâ¯=â¯106) performed by 4 residents had 2 residents (case volume 30, 26) with better-than-expected outcomes and 2 with worse-than-expected (case volume 25, 25).CONCLUSION:
Longitudinal monitoring of postoperative patient outcomes provides an opportunity for trainee self-reflection and system examination. RA-CUSUM methodology offers sequential monitoring allowing for early evaluation and intervention when RA-CUSUM results for a trainee demonstrate higher-than-expected morbidity.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Apendicectomia
/
Competência Clínica
/
Colectomia
/
Melhoria de Qualidade
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Internato e Residência
Limite:
Adult
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Female
/
Humans
/
Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article