J. A. Marks1, P. M. Batista1, S. M. Devitt1, F. Palazzo1, G. A. Isenberg1, C. J. Yeo1, K. A. Chojnacki1 1Thomas Jefferson University,Surgery,Philadelphia, PA, USA
Introduction:
With recent increased public awareness of concurrent surgery as a putative quality or outcome metric, delineating the critical part(s) of an operation for which a surgeon must be present is essential. We aim to define the critical portions of operations as seen by residents and faculty and hypothesize the two lack concordance.
Methods:
Each of our section chiefs (n=12) was asked to outline the key portion(s) of their most commonly performed operations for which attending surgeon presence is imperative. Our senior surgical residents (PGY≥3; n=24) were asked to submit the steps for a list of operations that required direct attending involvement. Residents did not collaborate across years. We had five lists with outlined critical steps submitted by faculty leadership and each PGY class. Results were tabulated and compared.
Results:
Data were obtained for 35 operations. PGY3s tended to list more critical steps (not all correct and in greater detail) than more senior residents. Attending surgeons were most concise in their descriptions and number of key steps. Residents noted most bedside procedures did not require attending presence. For some complex or emergent procedures, residents indicated the attending should be present for the entirety. Faculty noted the critical portions could differ given the resident’s skill. Residents identified many of the same steps as faculty, yet intermittently left out some or listed all operative steps.
Conclusion:
We demonstrated a greater concordance between residents and faculty in identifying critical portion(s) of operations than expected. There was a clear trend towards fewer critical portion(s) and more agreement with attending perceptions as residents progressed through training. Further evaluation of critical portions for which faculty must be present could have profound impact on resident education, reimbursement practices, and the delivery of surgical care.
