How Does a New General Surgery Residency Program's Junior Residents Impact Hospital Efficiency and Productivity?

Evaluating the Impact of Surgical Residents on Hospital Quality and Operational Metrics

OBJECTIVE

The purpose of this study is to conduct a follow up analysis comparing operational and quality measures of the pre-residency period with those of a mature program comprised of a full cohort of 15 residents, with 3 residents in each post graduate year (PGY) 1-5.

DESIGN

A retrospective review of 25,900 surgeries performed by the general, breast, plastics, thoracic, and vascular services at a single regional medical center was performed and surgeries were classified as pre-residency period and residency period. Independent variables included patient demographics, comorbidity burden, emergency department arrivals, and outcomes of interest included daily elective case volume, the percent of cases performed during 'off-hours' (defined as 7p-7a), operating room (OR) and procedure minutes, average length of stay (LOS), average total hospital charges, rates of 30-day return to OR (ROR), ED visits, and readmissions, and patient satisfaction. Univariate and multivariate analysis performed to compare pre-residency period outcomes with residency period outcomes.

SETTING

Luminis Health Anne Arundel Medical Center, Annapolis, Maryland, a community hospital and tertiary care center, home to 3 graduate medical education programs.

PARTICIPANTS

25,900 surgical cases performed by the general, breast, plastics, thoracic, and vascular services.

RESULTS

25,900 surgeries reviewed and with a full complement of residents the odds of cases being performed off hours increased by 14.5%, odds of 30-day return to the OR decreased by 23.9%, and odds of 30-day readmission decreased by 17.1%. Additionally, length of stay was decreased by ½ day. OR time and procedure time both increased after the addition of a full resident complement. All of these findings were of statistical significance.

CONCLUSIONS

Surgical residents appear to enhance the value of surgical care delivered to patients by improving outcomes without increasing costs, as well as improving the availability of emergency surgical care.

The Impact of a New Anesthesiology Residency Program on the Number of Medical Students Matching Into Anesthesiology at a Single Institution: A Retrospective Longitudinal Study

Introduction There are projected workforce shortages within anesthesiology exacerbated by an increase in demand for anesthesia services and an aging anesthesia workforce. Given this mismatch, it is critical for the specialty to recruit the next generation of anesthesiologists and understand the factors affecting medical students' decision to apply to anesthesiology. This study aims to evaluate the impact of establishing a new anesthesiology residency program at a single institution on the number of medical students that match into anesthesiology in the subsequent years. Methods A single-center, retrospective longitudinal study examined the number of medical students matching into anesthesiology at a single institution between 2013 and 2023, five years before and after the establishment of an accredited anesthesiology residency program. The data were compared to aggregated data on all US medical student applicants through the National Resident Matching Program. Results The pre-anesthesiology residency match rate (2013-2018) of medical students from Alpert Medical School (AMS) was 2.47% while the post-anesthesiology residency match rate (2019-2023) was 4.30%. This represents a 74% increase in the average proportion of medical students matching into anesthesiology after the start of the residency program compared to a 20% increase nationally over the same time period. The rate of change of AMS matched applicants after the implementation of the AMS anesthesia residency program increased compared to the national applicant pool (p= 0.002). Conclusion The establishment of a new accredited anesthesiology residency program increased the proportion of medical students matching into anesthesiology at the affiliated medical school in the subsequent five years. Exposure to an academic anesthesiology program improves medical student interest and ultimately matches rates in anesthesiology, a vital tool to address the projected shortages in the anesthesiology workforce.

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

OBJECTIVE

To conduct a scoping review of literature on financial implications of surgical resident well-being.

BACKGROUND

Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited.

METHODS

Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis.

RESULTS

Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective.

CONCLUSIONS

Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area's importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.

Impact of the primary care residents on the productivity of the ambulatory health centres in Portugal: a cross-sectional study

BACKGROUND

The presence of residents in Primary Care health centres may influence their operational results.

AIM

To examine the relationship between the presence of residents and the results of the evaluation in Portuguese Primary Care Health Centres.

METHODS

We conduct a cross-sectional study, comparing the results achieved by the mainland Portuguese Primary Care Health Centres measured by the Global Performance Index (Índice de desempenho global - IDG) by the presence of General & Family Medicine residents in training. Analysis took into consideration the distribution by region and typology of the health centres.

RESULTS

We evaluated 906 units, 55.7% involved in the training of General & Family Medicine residence. The presence of residents was associated with higher Global Performance Index values (77.3 vs 57.6; p < 0.001). The higher difference was found in the less developed Personalized Health Care Units and in the region of Lisbon and Tagus Valley.

CONCLUSION

The presence of residents in training is a contributing factor in the productivity of the Primary Health Care facilities. It may model the asymmetry in the performance of Portuguese Health Centres.