Implementing a resident acute care surgery service: Improving resident education and patient care

Abstract

To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n=10) and postimplementation (n=5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12months of the service (June 2014 to June 2015). During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4±13.0 (range 4-44) for preresident acute care surgery residents to 30.8±8.8 (range 27-36) for postresident acute care surgery residents (P<.01). Of 323 operative cases, the residents performed an average of 82% of the case independently. There was a significant increase in the satisfaction with the variety of cases (mean 5.08 vs 4.52, P<.01 on a 6-point Likert scale) and complexity of cases (mean 5.35 vs 4.94, P<.01) on service evaluations of resident acute care surgery (n=27) in comparison with other general operative services (n=127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with averageconsult time of 22minutes for operative consults and 25minutes for nonoperative consults (range 5-90minutes). The implementation of a resident acute care surgery service has increased resident autonomy, teaching assistant cases, and satisfaction with operative case variety, as well as the efficiency of operative consultation at our institution.