Implementation and evaluation of a new surgical residency model

Area of Science:

• Medical Education
• Surgical Residency Training
• Accreditation Standards

Background:

• Accreditation Council for Graduate Medical Education (ACGME) duty-hour requirements necessitated changes in residency program structures.
• Concerns were raised by surgical educators regarding potential negative impacts of duty-hour restrictions on resident education quality.
• This study evaluated a reengineered surgical residency program designed to maintain educational quality while adhering to new duty-hour mandates.

Purpose of the Study:

• To assess the impact of a redesigned surgical residency program on resident education and well-being.
• To determine if new duty-hour requirements could be met without compromising educational experiences.
• To evaluate the effects of program restructuring on operative case volume, in-training examination performance, and patient outcomes.

Main Methods:

• A traditional residency structure was modified using a blend of apprenticeship, small team, and night-float models.
• Data collection involved operative case logs, standardized test scores, quality assurance metrics, and resident/faculty surveys.
• Resident perceptions of learning environment, case load, and faculty supervision were assessed.

Main Results:

• Residents (PGY1s and PGY2s) experienced increased operative cases, meeting all ACGME requirements.
• Performance on the American Board of Surgery In-Training Examination improved for junior residents.
• Resident quality of life improved, with stable or enhanced perceptions of the learning environment; faculty reported increased work hours and dissatisfaction.

Conclusions:

• Duty-hour restrictions present challenges and may require additional resources.
• Surgical resident educational experiences need not deteriorate due to duty-hour limitations.
• Program redesign can successfully balance accreditation requirements with robust resident training.