A survey of critical care training amongst surgical residents: will they be ready?

Residents' duty-hour limitations and the trends towards closed-staffing for surgical critical care (SCC) have reshaped educational paradigms. No study has yet addressed the impact of these changes on resident SCC training. In our study, we investigated residents' experiences and perceptions of SCC education and practice.

At the end of the academic year 2007-2008, we distributed anonymous surveys to categorical general surgery residents in a large, university-based residency. All dedicated SCC rotations are currently completed by the end of PGY3. The survey measured residents' ratings of teaching, experiences, satisfaction, and self-assessed comfort with common SCC diseases and procedures.

The response rate was 78% (n = 52/67). At the time of the survey, the 52 respondents had completed 9.3 +/- 4.5 wk of SCC rotations. Despite no rotations beyond PGY3, senior residents (PGYs 4/5) reported significantly greater SCC training time (13.1 versus 7.8 wk) and comfort managing SCC diseases and procedures than juniors (PGY 3). Attendings were rated the most effective didactic teachers, and senior residents the most effective procedural teachers. The mean education satisfaction score was 3.9 +/- 0.9 (5 = extremely satisfied). Residents anticipated performing minimal SCC management of their own patients, but most felt that SCC-trained surgeons should manage critically ill surgery patients. Seniors reported greater SCC fellowship interest (19% versus 0%). The addition of acute care surgery increased interest in 30% of respondents.

Senior residents reported greater comfort with SCC management despite the lack of senior SCC rotations, whilst dedicated training time for junior residents appears to be declining. Residents wish subspecialist care for their critically ill patients, but the low interest in SCC fellowships suggests future physician shortages in this subspecialty.