What do physician extenders in a general surgery residency really do?

Area of Science:

• Medical Education
• Surgical Residency
• Physician Extender Utilization

Background:

• The Accreditation Council for Graduate Medical Education's 80-hour workweek mandate necessitates strategies to manage resident workload.
• Physician extenders (PEs) are increasingly employed in surgical residency programs to address these hour restrictions and enhance the educational environment.

Purpose of the Study:

• To objectively document the workload managed by PEs in a general surgery residency program.
• To evaluate the objective and subjective benefits of PE integration into residency training.

Main Methods:

• A 4-month retrospective review of all orders written by two PEs exclusively serving the general surgery residency.
• Orders were categorized by time (day/night) and type (admission, preoperative, postoperative, acute care, PRN, discharge, etc.).
• Analysis included order appropriateness, volume, and specific breakdown by category.

Main Results:

• A total of 3101 orders were reviewed, with PEs writing an average of 35 orders per shift at night versus 18.8 during the day.
• Nighttime orders were predominantly admissions (27.7%), preoperative (22%), and acute care (16.4%).
• Daytime orders focused on routine postoperative care (27%) and discharge orders (22%).

Conclusions:

• PEs effectively manage a significant workload, writing appropriate orders and reducing resident duty hours.
• Integration of PEs improved educational opportunities by minimizing resident interruptions and absences.
• Enhanced resident performance on the American Board of Surgery In-Training Examination (ABSITE) was observed, alongside potential for significant reduction in non-educational work hours through optimized systems.