Defining a new paradigm for surgical education

Department of Surgery, Division of General Surgery, University of California San Francisco, San Francisco, CA, USA.
American journal of surgery (Impact Factor: 2.41). 02/2012; 204(5). DOI: 10.1016/j.amjsurg.2011.10.011
Source: PubMed
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine whether duty-hour restrictions have been consequential for various aspects of the work of surgical faculty and if those consequences differ for faculty in academic and nonacademic general surgery residency programs. Questionnaires were distributed in 2004 to 233 faculty members in five academic and four nonacademic U.S. residency programs in general surgery. Participation was restricted to those who had been faculty for at least one year. Ten items on the questionnaire probed faculty work experiences. Results include means, percentages, and t-tests on mean differences. Of the 146 faculty members (63%) who completed the questionnaire, 101 volunteered to be interviewed. Of these, 28 were randomly chosen for follow-up interviews that probed experiences and rationales underlying items on the questionnaire. Interview transcripts (187 single-spaced pages) were analyzed for main themes. Questionnaire respondents and interviewees associated duty-hour restrictions with lowered faculty expectations and standards for residents, little change in the supervision of residents, a loss of time for teaching, increased work and stress, and less satisfaction. No significant differences in these perceptions (p < or = .05) were found for faculty in academic and nonacademic programs. Main themes from the interviews included a shift of routine work from residents to faculty, a transfer of responsibility to faculty, more frequent skill gaps at night, a loss of time for research, and the challenges of controlling residents' hours. Duty-hour restrictions have been consequential for the work of surgical faculty. Faculty should not be overlooked in future studies of duty-hour restrictions.
    Academic Medicine 02/2006; 81(1):50-6. DOI:10.1097/00001888-200601000-00014 · 3.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The goal of this study was to analyze the impact of the 80-hour work week on the emergency operative experience of surgical residents. A 2-year retrospective comparison of the operative experience in emergency abdominal procedures of postgraduate year 4 and 5 residents in a city hospital before (group 1) and after (group 2) duty hour restriction. There was no difference between groups in the mean number of procedures performed as the primary surgeon, but group 2 showed a 40% decrease in technically advanced procedures with a 44% increase in basic procedures. The study also demonstrated a 54% decrease in the operative volume as first assistant. Operative continuity of care by residents decreased from 60% to 26% of cases. The ACGME regulatory environment is adversely affecting the emergency operative experience of surgical residents. Our findings underscore the need to develop alternative methods to augment the residents' operative experience.
    The American Journal of Surgery 01/2006; 190(6):947-9. DOI:10.1016/j.amjsurg.2005.08.025 · 2.41 Impact Factor
  • American journal of surgery 09/2011; 202(3):372-3. DOI:10.1016/j.amjsurg.2011.02.014 · 2.41 Impact Factor