O. Kantor1, A. B. Schneider1, M. Rojnica1, A. J. Benjamin1, N. Schindler1,2, M. C. Posner1, J. B. Matthews1, K. K. Roggin1 1University Of Chicago,Department Of Surgery,Chicago, IL, USA 2Northshore University Health System,Department Of Surgery,Evanston, IL, USA
Introduction:
The American Board of Surgery recently changed the requirements for graduating surgery residents to a minimum of 25 cases as a teaching assistant (TA). To expand the resident education experience and allow for senior residents to be more autonomous in the management of patients both in the operating room and perioperatively, our program implemented a new Resident-run Acute Care Surgery (RACS) consult service. We hypothesized that creation of this service would increase TA cases and resident satisfaction, as well as be more efficient in evaluating consults.
Methods:
With the implementation of RACS, we switched from an attending-service based call model to a new admitting service that was mainly resident run with alternating attending supervision. Two residents (PGY4 or 5 and PGY2) staffed this service and all new surgical consults were directed to RACS. When appropriate based on resident experience and case complexity, the operative case was done as a TA case with the senior resident taking the junior resident through the case and the attending in the room. We collected information on TA case logs for senior residents pre (n=10) and post (n=11) implementation of the RACS service, independency data on the proportion of each case performed independently by residents, resident evaluations of general surgery services, and consult time (time from consultation to time patient seen) for the first 12 months of the service (June 2014-June 2015).
Results:
The number of total TA cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for pre-RACS residents to 30.8 ± 8.8 (range 27-36) for post-RACS residents (p<0.01). This increase was seen with a mean of one month spent on RACS for the post-RACS residents. Of 323 operative cases, the residents performed an average of 82% of the case independently. On resident service evaluations of RACS (n=27) compared to other general surgery services (n=127), there was a significant increase in the satisfaction with the variety of cases (mean 5.08 vs 4.52, p<0.01 on a 1-6 Likert scale) and complexity of cases (mean 5.35 vs 4.94, p<0.01). In addition, creation of a one-team consult service resulted in a more streamlined consult process, with average consult time of 22min for operative consults and 25min for non-operative consults.
Conclusion:
The implementation of a RACS service has increased resident autonomy, TA cases, and satisfaction with operative case variety, as well as increased the efficiency of surgical consultation at our institution.