M. M. Sellers1,2, M. Fordham3, C. W. Miller3, C. Y. Ko3, R. R. Kelz1 1Hospital Of The University Of Pennsylvania,Center For Surgery And Health Economics Department Of Surgery,Philadelphia, PA, USA 2Mount Sinai School Of Medicine,Department Of General Surgery,New York, NY, USA 3American College Of Surgeons,National Surgical Quality Improvement Program,Chicago, IL, USA
Introduction: Residents are supposed to review data on their clinical effectiveness to learn self-assessment and strive for continuous quality improvement. Identification of meaningful data has been a challenge for program directors. The Quality In-Training Initiative (QITI) collects information on resident participation in operations captured by the ACS NSQIP. This study sought to examine data available for resident education in the QITI component of the ACS NSQIP and to compare differences across participant(P) and non-participant(NP) academic sites.
Methods: Starting in 2013, QITI sites were taught to link individual cases in the NSQIP database with participating resident(s). Cases could be tagged with principle operative resident, resident service team, and/or post-graduate year (PGY) of the operative resident. Free text comments on resident performance were solicited from patients at 30 days post-op. Individual resident and team reports with associated patient outcomes can be generated by P sites for use in graduate medical education. NP sites collect PGY data only. Descriptive statistics of cases captured from July 2013 through June 2016 were analyzed centrally. Differences in case collection between P and NP sites were compared using the Wilcoxon rank-sum test.
Results:163 sites captured 417816 cases (range 1 to 9775). 68% of all cases captured had resident participation indicated by PGY (n=285435). An additional 9.5% had fellow participation indicated (n=39798). The most common cases tagged with PGY were laparoscopic appendectomy (n=17082, 6.0%) and laparoscopic cholecystectomy (n=15502, 5.4%). Specialty cases were collected for orthopedics (n=38793; 9.3%), vascular (n=34912; 8.4%), gynecology (n=22275; 5.3%), neurosurgery (n=18046; 4.3%), urology (n=15800; 3.8%), and plastic surgery (n=9556; 2.3%). There were 74 P sites (45%) and 89 NP sites (55%). A median of 2141.5 cases (IQR: 1027.5,3730.8) were captured per P site compared to a median of 2307 (IQR: 785,3068) per NP site (p=0.32). P sites recorded 9.27 teams per site, with a median of 113 (IQR: 18,520) cases per team. Reports allow residents to assess individual and team performance over time and enable comparison with other residents of the same PGY locally and at P sites in aggregate. (See Figure 1)
Conclusion:Identifying resident participation in captured NSQIP cases is feasible on a large scale. The time for extra data collection does not diminish the quantity of cases abstracted when compared to NP sites. Types of captured cases reflect national case mix and can be extended to multiple specialties. The reports yield information on resident effectiveness in patient care and can be used in conjunction with other tools to promote continuous quality improvement.
