The acgme outcome project and workhours: realistic expectations or false hopes?

Abstract

Background: The ACGME Outcome Project and work guidelines are proposed to improve resident education and are changing the landscape of surgical training. The multi-generational workforce has highlighted varying expectations as the first Generation X surgeons are completing training. We sought to examine the effect of ACGME guidelines on the attitudes of those in academic surgery. Methods: Anonymous surveys addressing Core Competencies were distributed in an ACGME-accredited, university-affiliated, surgical training program. Results: 100% responded. Faculty (F; n = 30) and surgeons-in-training (T: n = 30) agree lifestyle expectations and long work hours are the biggest issues (79% & 57%/F & T, respectively). Implementation of ACGME guidelines is perceived as NOT improving Patient Care or Medical Knowledge by 30%/43% (F/T) and reducing operative experience by 50%/70% (F/T). Most faculty (>80%) worry ACGME guidelines will diminish patient care experiences as opposed to only 30% of trainees. Although most F (60%) and T (70%) agree that hiring physician extenders and more trainees will help maximize Core Competencies, many (30%, both F & T) disagree with the implementation of ACGME guidelines fearing the loss of Professionalism. While F (54%) and T (45%) reproach deficient Interpersonal and Communication Skills (“generation gaps” & “unrealistic expectations”) as the biggest impediment to ACGME guideline implementation, opinions regarding the impetus for implementation differ drastically. Most faculty (75%) believe ACGME-imposed deadlines are the most influential reason; however, trainees (58%) believe the guidelines should be promptly implemented to address long-awaited changes in work environment, surgical corporate culture and education. Conclusions: Although faculty and trainees’ perception of the issues facing surgical education converge, their perception of the changes following ACGME guideline implementation is quite divergent. For successful implementation, the leaders in surgery must address the prevailing attitudes and corporate cultures in their workplaces. Realistic expectations must be established based on the ACGME Outcome Project to monitor progress in our ever-changing environment. These data have important implications for planning the future of surgical education, bridging the gap between multi-generational colleagues and improving Systems-Based Practice.