Inguinal Hernia Repairs on the Chief's Service: A Safe Educational Model in Resident Entrustment

Area of Science:

• Surgical Education
• Patient Safety
• General Surgery

Background:

• The traditional model of surgical residency involves rotating residents learning from attending physicians.
• The Chief Resident Service model offers chief residents supervised autonomy in patient care.
• Evaluating the safety and efficacy of the Chief Resident Service model is crucial for surgical training.

Purpose of the Study:

• To compare patient safety and outcomes between a Chief Resident Service and standard academic services for inguinal hernia repairs.
• To assess recurrence rates, complications, and postoperative care utilization in both models.

Main Methods:

• Retrospective cohort study of patients undergoing inguinal hernia repair from July 2016 to June 2019.
• 1:1 matching of Chief's service patients to standard academic service patients based on CPT code, sex, and age.
• Comparison of patient demographics, operative times, recurrence rates, complications, ED visits, and readmissions.

Main Results:

• No significant differences in recurrence rates (6.5% vs. 3.9%) or major complications between the two services.
• Chief's service had longer operative times for both open and laparoscopic repairs.
• Chief's service patients had higher post-operative ED presentation rates (14.3% vs. 1.3%) but similar low readmission rates.

Conclusions:

• The Chief Resident Service model provides safe patient care for inguinal hernia repairs.
• This educational model facilitates a safe transition to independent practice for chief residents.
• Patient safety should not impede entrustment of core surgical diagnoses and operations to chief residents.