Lemonade from lemons: a program response to RRC-determined probation

To assess resident satisfaction as a result of changes made to an integrated surgical residency in response to probation.The University of Connecticut Integrated General Surgery Residency (UCIGSR), which consists of 5 hospitals, 18 rotations, and has a complement of 44 residents, was placed on probation by the Residency Review Committee (RRC) in Surgery in November 1998. Among the deficiencies cited by the RRC were inadequate evaluation of the program, rotations, residents, and the faculty by the residents, along with inadequate documentation issues. Lack of organized educational conferences, lack of faculty involvement, excessive service responsibilities and work hours, and hospital environmental issues were also cited. It was also apparent that morale of the residents and faculty had significantly eroded. Rather than trying patchwork "fixes" of deficiencies, we used this opportunity to reengineer the program, rededicating ourselves to educating and developing future surgeons. Task forces, including joint faculty and resident participation, were set up to develop solutions, based on the answer to the question: "Do we want a residency or not?" This focus was especially helpful to create hospital administration and faculty support.A survey was created to assess the changes made in the program. The survey included 65 questions pertaining to the learning environment, hospital and departmental support, and balance between clinical and educational responsibilities and overall working environment. Each resident was asked to fill out 3 identical surveys, 1 just before the RRC report, and the other 2 at 6-month intervals after the probation announcement. A 4-point grading scale was used.Our results were reflective of resident perceptions of improvement and increased satisfaction. These data demonstrated that the changes implemented as a result of the RRC findings had a positive effect on the residency program, and they corresponded to the areas where changes were implemented. This survey also gave us a method to evaluate ongoing changes in our residency.Probation can be a potent stimulus for improvement of a surgical residency. (Curr Surg 57:373-376. Copyright 2000 by the Association of Program Directors in Surgery.)