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Perceived Impact of Resident Travel on Transplant Surgery Experience during General Surgery Residency Training Bittner JG,1 Fryer JP,2Cofer JB,3Mellinger JD,4 Wynn JJ,1 Fuhrman GM,5Borman KR6 • Departments of Surgery, 1Medical College of Georgia, Augusta, GA; 2Northwestern University, Chicago, IL; 3University of Tennessee, Chattanooga, TN; 4Southern Illinois University, Springfield, IL; 5Atlanta Medical Center, Atlanta, GA; 6Abington Memorial Hospital, Abington, PA
Disclosures • No related conflicts of interest
Introduction • Current status of transplant surgery • Essential content area of residency training • Negative feedback from program directors (PDs) and residents prompted action. • High service-to-education ratio • Poor operative experience • Low educational benefit • Rare/negative interactions with attendings • Resident travel to transplant centers • Concern for equivalent educational experience • Associated costs / inconvenience
Introduction • RRC-S proposed to eliminate transplant as a requirement during residency training. • ABS asked the RRC-S to stay this action and requested involvement of ASTS through TAC. • ASTS issued a call to action • Involve general surgery leadership • Reevaluate the role of surgical residents on a transplant rotation • Immediately address concerns of the RRC-S • Commit to immediate and long-term educational excellence within transplant surgery
Purpose • To investigate the perceived impact of resident travel on transplant experience by comparing opinions of PDs who have transplant rotations at integrated (home) compared to non-integrated (away) hospitals.
Methods • A comprehensive survey was created on behalf of the APDS and ASTS. • Instrument was IRB-approved. • Content was validated by a focus group. • Internet-based survey • Administered anonymously via email to 251 PDs • Resent two weeks after first administration • Supported by the President of the APDS • Data analyzed using appropriate statistics • Significance set at α = 0.05
Results • 131 of 251 PDs (52%) responded • Sample size achieves a 5.9% confidence interval assuming 50% response distribution. • Response rates by program type similar to expected distribution • University (52%) • University-affiliated/Community (31%) • Community (17%)
Results • University PDs represent more chief residents on average (p<0.001) • 5.7 ± 1.9 University • 3.7 ± 1.0 University-affiliated / Community • 3.1 ± 1.1 Community • ASTS approved fellowships similar to expected distribution (p=0.439) • 20% responding PDs • 24% all US residency programs
Results • Disproportionate response from PDs with home transplant rotations • 66% of PDs use integrated (home) hospitals • 30% use non-integrated (away) hospitals • 80% of these feel the educational needs of all residents are given equal priority • 48% require resident commuting (<30 extra miles/day) • 52% purchase temporary housing • 43% of transplant services provide experience for visiting residents
Discussion • PDs and transplant surgeons might • Decide how many residents might rotate on a transplant service with or without a fellow. • 38% believed service > education • Assess ways to protect operative experience. • 53% claimed experience was less than excellent. • Share accountability for education outcomes. • 59% felt transplant offers a good educational value. • Address the burden of resident travel. • 78% felt travel is a poor/very poor aspect.
Discussion • PDs and transplant surgeons might • Guarantee visiting residents are treated the same as home residents. • 80% felt visiting residents have similar experience • Ensure duty-hours compliance. • 71% stated rotations were compliant. • Consider making transplant optional. • 60% believed transplant should become optional.
Discussion • ASTS action plan • Transplant programs need to: • Designate a transplant surgeon working alongside a PD to oversee the education of surgery residents • Change the transplant rotation structure to ensure residents have adequate time for education • Reeducate attending and resident surgeons about educational expectations • Establish a relevant operative experience • Create a feedback system to allow for improving the educational milieu.
Limitations • 52% response rate • Biased toward opinions of PDs with home transplant rotations • Not possible to tell if PDs also served as transplant fellowship director • No temporal survey administration
Conclusions • More PDs at Community / smaller programs use away hospitals. • PDs sending residents to away hospitals face educational, logistical, and financial burdens. • Most PDs challenge the paradigm of transplant as essential content. • More PDs employing away rotations felt transplant should be eliminated.
Thank You! • APDS Board of Directors • ASTS administrative staff • Responding Program Directors • Bruce V. MacFadyen, Jr., MD, FACS