ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS 249

ACGME core competencies, communication skills, logging dutyhours, operative logs, professionalism, and accessing feedback. Stan-dardized feedback evaluations were anonymously collected at orien-tation completion and in follow-up 1 month later. These evaluationsassessed intern perceptions of component usefulness and self-re-ported confidence levels on a variety of job-related tasks before thesessions, immediately afterward, and 1 month later (Likert scale, 1to 5). Statistical analysis comparing confidence levels was performedusing Student’s t-test (p< 0.05 significant). Results: Interns rankedthe orientation components’ usefulness, indicating didactic instruc-tion on medical record documentation as most useful. Participantsprovided self-reports of confidence on 10 job-related tasks beforeand after the sessions. Overall confidence levels for these tasks priorto the orientation were low, with most interns indicating moderateanxiety for all routine tasks. Participation in the orientation sessionsresulted in immediate confidence increases in all areas (Table 1), in-cluding: chart documentation (2.63 pre 3.60 post), day-to-day inpa-tient tracking (2.63 pre; 3.53 post), hospital discharges (2.05 pre;2.84 post), and handoffs (2.36 pre; 3.26 post). Evaluations collected1 month later showed that, while confidence levels trended towardfurther increases with experience, they were not significantly greaterthan those measurements from immediately after the orientation in 7of the 10 tasks queried (Table 1). Furthermore, interns continued toindicate that the orientation sessions contributed to their task-specific confidence levels after 1 month of clinical experiences.

Conclusion: Interns reported considerable anxiety in all job-relatedtasks prior to the orientation. However, following the sessions,confidence levels were significantly and durably improved in all areas.Interns found the sessions useful, particularly instruction on chartdocumentation. Our findings indicate a need for specific instructionon job-related tasks of surgical internship. Further, an expandedorientation program can effectively improve intern confidence inexecution of these tasks with potentially sustained impact.

27.10. An Analysis of Communication Patterns BetweenNurses and Physicians in the Era of Reduced ResidentWork Hours. C. L. Leaphart, J. J. Tepas, III, C. K. Haan;University of Florida College of Medicine-Jacksonville,Jacksonville, FL

Background: Nursing shortagesand limitedresidentworkhourshavealtered daily hospital operations. Patient safety and quality of care arecontingent on effective communication between physicians and nurses.This study was designed to determine the relationship of nursing as-sessment techniques and patterns of nurse-physician communicationto volume and urgency of calls to on-call physicians. Methods: After ap-provalbythe Institutional ReviewBoard, non-ICU surgicalnurseswere

voluntarily surveyed to describe their patient assessment style and in-terpretation of emergent or non-emergent patient needs. Communica-tion with physicians was assessed in terms of the number and time ofpages received by on call interns. Identical surveys were distributedto interns assigned to night call on surgical floors. Over a fourteenday period these interns compiled logs of pages, which were then desig-nated as emergent or non-emergent by an Associate Professor of Nurs-ing blinded to the study’s purpose. Mann-Whitney U test was used tocompare incidence of emergent to non-emergent calls per hour. Therelationship of hourly volume to acuity was assessed by Spearman cor-relation. Non-emergent pages were then analyzed to define the mostcommon reasons for these calls. Results: Of 49 participating surgicalnurses, 52% reported that the most common method of patient assess-ment was head-to-toe followed by physician order review (18%). Themajority of the time, nurses notified interns of patient needs as theyare identified (72%) compared to notification after all assigned patient’sassessments (23%), or rarely, at the completion of each patient’s assess-ment (2%). All surgical interns (n¼ 6) taking non-ICU call participatedand recorded pages for a two week period. Highest call volume occurredbetween 8PM - 2 AM (median number of pages/hour:11). Only 19%(25/130) of pages were emergent. Across all hours, non-emergent calls weresignificantly more common than emergent (Mann-Whitney U26.5,p<.0001). There was, however, no correlation between hourly pro-portionofemergentandnon-emergentcalls(Spearman: r¼.195,p¼.49).The most common reasons to page an intern were for order clar-ification(n¼ 41) and pain management(n¼ 25). Conclusions: Thesedata suggest that volume and efficiency between nurses and physicianhousestaff could be improved by reviewing non-emergent patient needsbefore on-call duty begins. Standardizing nursing assessment protocolsand routine admission orders will decrease variability and improvepatient care. The low incidence of emergent pages hiding among thenon-essential communication and not correlated with time suggeststhat improved control of the non-emergent phone calls should be animmediate mandate for improved patient safety.

27.11. How to Emphasize the Importance of Minor Complica-tion Reporting: Development of a New Curriculum.M. K. Stelzer, R. J. McDonald, E. F. Foley, S. M. Weber;University of Wisconsin School of Medicine and PublicHealth; Department of Surgery, Madison, WI

Introduction: Morbidity and Mortality (M&M) conference has beena long-standing tradition of surgical residency programs’ didactictraining. Programs have attempted various ways to improve the edu-cational value of M&M conference and increase the rate of complica-tions reported. Minor complications are sometimes not reported inM&M conference because they are considered insignificant to patientoutcome or occur commonly after surgery. As part of a larger effort toimprove the educational quality of our M&M conference, we sought tointegrate a specific, focused curriculum for minor complication report-ing and evaluate the perception of the educational value of this curric-ulum. Methods: A minor complications curriculum was designed togive residents formal training in how to recognize, treat and prevent