The Intersection of Surgical Outcomes and Medical Education:

The Resident Perspective

Caroline E. Reinke, MD MSPH

Division of Surgery Education Hospital of the University of Pennsylvania

Philadelphia, PA

Nothing To Disclose

The Resident Perspective

Introduction

• Why are outcomes data relevant to surgical education?

• Does my program take good care of patients?

• Will I be blamed for patient complications outside of my control?

The Resident Perspective

Why are outcomes data relevant to surgical education?

• Future Practice

• Continuity of Care and Self-Evaluation

• Launch point for Problem Based Learning and Improvement and Systems Based Practice

The Resident Perspective

Why are outcomes data relevant to surgical education?

• Future Practice

• Continuity of Care and Self-Evaluation

• Launch point for PBLI

The Resident Perspective

Future Practice

• Surgical outcomes are now starting to be publically reported on Hospital Compare for the first time

• In order to understand one’s data, it is imperative that surgeons understand how the data is collected and its limitations

The Resident Perspective

Why are outcomes data relevant to surgical education?

• Future Practice

• Continuity of Care and Self-Evaluation

• Launch point for PBLI

The Resident Perspective

Continuity of Care and Self-Evaluation

• RRC GS Program Requirements– Residents must demonstrate the ability to… (PBLI)

• Investigate and evaluate their care of patients• Continuously improve patient care based on constant self-

evaluation and life-long learning– Residents must demonstrate… (Professionalism)

• Accountability to patients, society, and the profession

The Resident Perspective

Continuity of Care and Self-Evaluation

• Continuity of care– In a study of residents on a vascular surgery rotation, 0% of

patients were seen by the same resident pre-, intra-, and post-operatively (Turner et al, Annals of Surgery, 2012)

– The RRC requires that residents participate in diagnosis and preoperative care, the operation, and direction of the postoperative care in order to log cases.

The Resident Perspective

Why are outcomes data relevant to surgical education?

• Future Practice

• Continuity of Care and Self-Evaluation

• Launch point for Problem Based Learning and Improvement and Systems Based Practice

The Resident Perspective

Launch point for PBLI

• RRC General Surgery program requirements– Residents must be able to… systematically analyze practice

using quality improvement methods (PBLI)– Residents are expected to… work in interprofessional teams to

enhance patient safety and improve patient care quality (SBPL)

• By providing residents with their outcomes data, we can stimulate an interest in understanding quality improvement and a desire to participate

The Resident Perspective

Does my program take good care of patients?

• In the operating room, sometimes you learn how to do something, and sometimes you learn how not to do something…

• Prior research has demonstrated an ability to rank obstetric and gynecology training programs by the maternal complication rates of their graduates’ patients (Asch et al, JAMA, 2012)

• How will residents be able to critically assess their education if they don’t accurately understand the outcomes they are producing?

The Resident Perspective

Challenges in sharing outcomes data with residents

• Perceived lack of relevance to resident-directed care

• “Unfair blame” for things outside of their control

• Some residents already think they know this information – Mortality & Morbidity conferences– Electronic medical records– Peer feedback

• Potential methods for engaging residents– Use hospital/program/team/resident-specific data

The Resident Perspective

Thank You

The Resident Perspective

Questions?