Outcomes Following Cholecystectomy on a Service Designed to Maximize Chief Resident Entrustment.

Area of Science:

• Surgical Education
• Patient Outcomes
• Health Services Research

Background:

• The chief resident service offers final-year surgical trainees increased responsibility and decision-making autonomy.
• Supervised chief residents practice based on personal preferences, differing from attending physician preferences.
• This study investigates if cholecystectomy outcomes differ between chief resident and standard academic services.

Purpose of the Study:

• To compare patient outcomes following cholecystectomy performed by chief residents versus standard academic services.
• To evaluate the safety and efficacy of care provided by chief residents.
• To determine if chief residents' independent decision-making impacts patient outcomes.

Main Methods:

• A retrospective matched cohort study comparing 186 patients undergoing cholecystectomy.
• Patients on the chief resident service were matched to two patients on standard academic services based on operative indication and age.
• Demographics, operative details, and 30-day complications were compared between groups.

Main Results:

• Demographics and comorbidity indices were similar between chief resident and standard academic services.
• Laparoscopic cholecystectomy rates were comparable; however, chief residents performed more cholangiograms and had longer operative times.
• Thirty-day complication rates were similar (5.2% vs. 5.0%), with no bile duct injuries or reoperations. Readmissions were lower on the chief resident service (0.0% vs. 5.0%).

Conclusions:

• Supervised chief residents can safely manage patients undergoing cholecystectomy.
• Chief residents effectively direct medical decisions and practice according to their preferences.
• The chief resident service provides equivalent patient outcomes to standard academic services for cholecystectomy.