The Influence of Resident Involvement on Surgical Outcomes

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Teaching hospitals are often thought to provide a high quality of surgical care based on the complexity of patients referred, access to specialized technology, experience with rare diseases, high surgical volumes, education and reputa-tion of affiliated staff, and participation in clinical research.1 x 1 Ayanian, J.Z. and Weissman, J.S. Teaching hospitals and quality of care: a review of the literature. Milbank Q. 2002; 80: 569–593 (v) Crossref | PubMed | Scopus (238) | Google Scholar See all References Many of the top medical centers, as identified by publicly available sources such as US News and World Report and the Leapfrog Group, are major teaching institutions.2 x 2 U.S. News and World Report. America's best hospitals. http://health.usnews.com/health/best-hospitals. (Accessed February 4, 2011) Google Scholar See all References , 3 x 3 The Leapfrog Group. Evidence-based hospital referral. http://www.leapfroggroup.org/media/file/Leapfrog-Evidence-Based_Hospital_Referral_Fact_Sheet.pdf. (Accessed February 4, 2011) Google Scholar See all References Increasingly, resident and trainee participation in the operative and nonoperative management of patients has come under scrutiny as a potential area for improved surgical safety and efficiency.4 x 4 Curet, M.J. Resident work hour restrictions: where are we now?. J Am Coll Surg. 2008; 207: 767–776 Abstract | Full Text | Full Text PDF | PubMed | Scopus (71) | Google Scholar See all References Concerns of resident inexperience as a contributing factor to surgical error have long sparked debate over the existence of a “July phenomenon,” and resident involvement in surgical patient care is sometimes not preferred by patients.5 x 5 Englesbe, M.J., Pelletier, S.J., Magee, J.C. et al. Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg. 2007; 246: 456–462 (discussion 463–465) Crossref | PubMed | Scopus (117) | Google Scholar See all References , 6 x 6 Brennan, T.A., Hebert, L.E., Laird, N.M. et al. Hospital characteristics associated with adverse events and substandard care. JAMA. 1991; 265: 3265–3269 Crossref | PubMed | Scopus (192) | Google Scholar See all References , 7 x 7 Englesbe, M.J., Fan, Z., Baser, O., and Birkmeyer, J.D. Mortality in Medicare patients undergoing surgery in July in teaching hospitals. Ann Surg. 2009; 249: 871–876 Crossref | PubMed | Scopus (35) | Google Scholar See all References , 8 x 8 Cowles, R.A., Moyer, C.A., Sonnad, S.S. et al. Doctor-patient communication in surgery: attitudes and expectations of general surgery patients about the involvement and education of surgical residents. J Am Coll Surg. 2001; 193: 73–80 Abstract | Full Text | Full Text PDF | PubMed | Scopus (54) | Google Scholar See all References , 9 x 9 Dutta, S., Dunnington, G., Blanchard, M.C. et al. “And doctor, no residents please!”. J Am Coll Surg. 2003; 197: 1012–1027 Abstract | Full Text | Full Text PDF | PubMed | Scopus (39) | Google Scholar See all References Resident education using technologically advanced simulation laboratory training has been advocated as a mechanism to codify performance and has been gaining acceptance at most teaching centers.10 x 10 Gurusamy, K.S., Aggarwal, R., Palanivelu, L., and Davidson, B.R. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2009; (CD006575) Google Scholar See all References Nevertheless, the relationship between surgical outcomes and intraoperative resident participation has not been well studied.