Can Residents Be Trained and Safety Maintained?

Teaching hospitals and faculty need to balance the educational mission for training residents with patient safety. There are no data studying the change in trauma patient outcomes before and after implementation of a surgical residency. The objective of this study was to compare trauma center outcomes before and after the advent of a surgical training program. We predicted that patient-centric outcome metrics would not be affected by the integration of surgical residents into trauma patient care.

A retrospective review was performed using the Crimson Continuum of Care (CCC) dataset and the Trauma Injury Severity Scores (TRISS) for the year before implementation of a surgical residency, compared to the 6 months following initiation of the residency. Severity and risk-adjusted performance measures included mortality, readmissions, complications, and length of stay. Using TRISS, actual, and predicted mortality was compared.

There were 1535 trauma admissions to the acute Care Trauma Service the year before starting the residency, and 856 admissions for the 6 months following the implementation of the program. The demographics were similar between the 2 groups. There was no clinically significant difference in observed mortality after the initiation of a surgery residency, based on CCC dataset variables and TRISS datasets. There were also no significant differences in complications and readmission rates.

We found that initiating a surgical training program did not affect mortality rates or complications of trauma patients. Training of general surgery residents in a high-performing trauma center can be effectively implemented without compromising patient safety.