A. Hussain1, D. Golden1, S. Casos1, L. Mitchell1, S. Tsirgotis1, J. Ragan1, A. Pamula1, J. Miner1, B. Cagir1, R. Behm1 1Guthrie Clinic,General Surgery,Sayre, PA, USA
Introduction: The American Board of Surgery In Training Examination (ABSITE) is a proven marker for successful first time passing of both the qualifying and certifying general surgery board examinations. Resident work hour restrictions and protected didactic time limit the residents’ ability to perform clinical duties. Nurse practitioners (NPs) have been shown to positively impact patients’ outcomes and overall hospital costs when utilized on an Acute Care Surgery (ACS) service. We describe a model of adding NPs to a busy ACS service in order to protect resident didactic time and decrease resident work load thereby improving resident education and ABSITE scores.
Methods: With declining board pass rates in our general surgery residency program, a new educational model was created increasing protected didactic time four-fold and protecting an hour at the end of the day to finish all work prior to handoffs. The addition of 3 full and one part time NP allowed the ACS service to function nearly independent of residents. The NPs provided ICU, trauma activation and emergency general surgery coverage during resident protected time. They also absorbed some of the resident daily workload allowing the ACS service to focus on resident education rather than clinical responsibilities. ABSITE scores were evaluated before and after these changes.
Results: Only those ABSITE scores earned before and after the implementation of the program reform were included. Eleven residents’ scores met inclusion criteria. To analyze pre-and post-intervention ABSITE scores, we used a mixed model with time and level-of-training as fixed effects and each resident as a random effect. We showed that the effect of taking the test before or after the intervention was not significantly different between the levels of training; however, when simply controlling for the main effect of level of training, we showed a significant and similar increase in scores after the intervention for all levels of residents (standard score increased 77.3; p=0.001, percent correct increased 5.9; p=0.0023 and percentile increased 23.8 p=0.0229). Prior to the reform, 45% of the residents' ABSITE scores were below the 35th percentile putting them at risk of failing their board exams on the first try. After the reform, no residents were below the 35th percentile.
Conclusion: Utilization of NPs on an ACS service has previously shown to have a positive impact on patient outcomes and overall hospital costs. We have shown NPs are vital to a training program as they provide critical patient care coverage allowing the residents the time needed to learn and prepare for surgical board examinations.