K. Law1, S. J. Gannon2,3, A. D. D’Angelo2, D. A. Wiegmann1, C. M. Pugh1,2 1University Of Wisconsin,Industrial And Systems Engineering,Madison, WI, USA 2University Of Wisconsin,Surgery,Madison, WI, USA 3University Of Wisconsin,Kinesiology,Madison, WI, USA
Introduction: Resident participation in dedicated research is a tradition in general surgery programs. To alleviate concerns regarding maintenance of clinical skill during the research years, some residents take extra call shifts or moonlight to offset potential skill reduction. Several research studies have characterized lab resident experiences during moonlighting. However, few have investigated how residents’ surgical performance is impacted by moonlighting. The aim of this paper was to determine if the effects of moonlighting can be objectively measured during assessments of surgical skill. Our hypothesis is that the quality and accuracy (errors) of resident performance in a simulated laparoscopic ventral hernia (LVH) would be positively correlated with moonlighting experience.
Methods: Thirty-eight surgical lab residents (PGY2-4; 54% female) had 15 minutes to complete two steps of a simulated LVH procedure including securing mesh anchoring sutures to the abdominal wall and affixing the mesh with a laparoscopic tacker. Residents identified how often they take clinical shifts in a pre-simulation general survey. Resident performance was determined by analyzing the hernia skins and errors made during the procedure. Post-simulation, hernia skins were graded on a 24-point scale for quality of repair. Procedural errors were identified using a checklist of previously identified common errors committed during the LVH procedure. Based on their moonlighting activity, residents were grouped into low or high moonlighting groups based on whether they reported one or fewer clinical shifts per month (n=22) or two or more shifts (n=16). A logistic regression analysis was used to predict frequency of moonlighting in lab residents using errors and final hernia grades as predictors.
Results: The logistic regression analysis using repair quality and error scores as predictors reliably distinguished between the two moonlighting groups (χ2 = 7.78, p=.02). The model explained 25.1% (Nagelkerke’s R2) of the between-group variance in predictor scores and correctly classified 73.7% of residents into their respective moonlighting group. Residents’ hernia quality repair scores (p=.021) made a significant contribution to the prediction. Errors did not. Residents in the high moonlighting group had better repair quality scores on average (M=16.5, SD=5.0) than the low moonlighting group (M=14.2, SD=5.2). There was no significant difference in the frequency of errors committed between the two groups (p =.61).
Conclusion: Residents who reported moonlighting had higher quality hernia repair scores compared to those who rarely if ever moonlighted. However there were no differences in the number of errors made between groups. These findings suggest that there is either a qualitative difference in the types of errors made by residents who moonlight or that they are better able to identify and manage errors when they occur, thereby not affecting repair quality.