The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy

Brandon M. Wojcik, Zhi Ven Fong, Madhukar S. Patel, David C. Chang, Emil Petrusa, John T. Mullen, Roy Phitayakorn

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations

Abstract

Objective General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Design Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Setting Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Participants Ten third-year general surgery residents. Results Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing increased operative autonomy as the greatest strength. Conclusions Implementation of a resident-run minor surgery clinic is a safe and effective method to increase trainee operative autonomy. The rotation is well suited for mid-level residents, as it provides an opportunity for realistic self-evaluation and focused learning that may enhance their operative experience during senior level rotations.

Original languageEnglish (US)
Pages (from-to)e142-e149
JournalJournal of Surgical Education
Volume73
Issue number6
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Keywords

  • autonomy
  • deliberate practice model
  • graduate medical education
  • minor surgery
  • Patient Care, Medical Knowledge
  • patient outcomes
  • Practice-Based Learning and Improvement
  • resident clinic
  • Systems-Based Practice

ASJC Scopus subject areas

  • Surgery
  • Education

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