Surgical rotations: the good, the bad, and the ugly

Every surgeon's career begins with a surgical residency. Each residency has dreaded rotations as well as those that seem ideal, but to date, no objective criteria exist to define such rotations. The aim of this study is to establish objective criteria that, when applied to a specific rotation, will define it as a "dream" or a "dreaded" rotation and, in the process, elucidate the good, the bad, and the ugly of surgical rotations in general.

All 39 residents from a multi-institutional residency program were asked to collaboratively identify the criteria they felt necessary for a dream rotation. Each resident evaluated 16 rotations at 4 hospitals using the identified criteria on a scale of "Inadequate," "Optimal," and "Ideal/Dream Rotation." Residents then gave an overall evaluation of each rotation as a dream rotation on a scale of "No," "For the Most Part," or "Yes." Finally, each resident was asked whether the individual rotations were following ACGME recommendations on duty hours.

The best correlations with a dream rotation were: clinical experience - quality and quantity of cases (r = 0.83), operative experience (r = 0.83), patient management responsibilities (r = 0.78), and outpatient office experience (r = 0.77). All p-values were < 0.05. The following correlated less with a dream rotation: conferences (r = 0.56, p < 0.05), medical student experience (r = 0.56, p < 0.05), and hospital facilities (r = 0.28, not significant.). Scut work was the only category for which there was a negative correlation with a dream rotation (r = -0.53, p < 0.05). Eighty-six percent of residents reported compliance with ACGME work hour recommendations, with no apparent correlation with a dream rotation.