RESIDENT TRAINING IN THE 80 HOUR WORK WEEK ERA
Walter Longo, MD, FACS (West Haven VA, Professor of Surgery and Section Chief Colon and Rectal Surgery Yale University); George Sarosi, MD, FACS (Gainesville VA, Professor of Surgery University Gainesville); Avo Artinyan, MD, FACS (Michael DeBakey VA Houston, Baylor University); Lygia Stewart, MD, FACS (Chief of Surgery, San Francisco VA Medial Center, Professor of Surgery and Associate Director, General Surgery Residency Program UCSF)
On the second day, the theme of the morning panel session was “Resident Training in the 80-hour work week era”. Walter Longo MD initiated the discussion with a talk entitled “Overview of the ACGME Duty-Hour Reform” during which he described the history and current regulations pertaining to the ACGME duty-hour reform, and discussed the fact that the original IOM recommendations were based on the supposition that errors made by residents were due to sleep loss, inexperience, workload intensity, inadequate supervision, poor hand-off processes, and generalized communication issues. Following implementation of duty hour restrictions, it was not clear that these measures corrected supervisory and communication problems while these policies did address sleep deprivation and workload issues. Of concern were studies describing residents who self-reported leaving in the midst of an operation and handing off active patient issues rather than remaining to provide patient care. The data from the recent FIRST trial noted an improvement in resident perception of patient safety, continuity of care, professionalism and education. Dr. Longo concluded by stating that current patient care is a team-based approach which depends upon the electronic medical record.
George Sarosi MD then presented a talk entitled “Surgery Resident Autonomy” in which he discussed that while our perception that overall resident operative volume has decreased, in fact, over the past several years, resident operative volume is similar to pre-duty hour restriction. Nevertheless, opportunities for senior residents to function as teaching assistants may be reduced and this may explain why graduating residents are concerned about autonomy. The lack of autonomy is likely due to an increased attending presence in the operating room.
Given the potential reduction in actual operating room experience, alternative surgical skill development environments were discussed by Avo Artinyan, MD in his discussion “Surgical Skill Development Outside the OR”. The simulated environment is an excellent environment in which to reinforce both technical and non-technical skills.
The discussion was concluded by a presentation on the “Objective Assessment of Surgical Ability”, by Lygia Stewart, MD. The goal of producing proficient surgeons in five years of training is increasingly difficult. Several standardized rating systems (OSATS, NOTECHS, ABS OPRS) were discussed as models utilized during training to identify areas that needed to be addressed in an individuals’ performance.