SURGICAL EDUCATION

Evaluation of resident training activities using anovel time-motion study prior to theimplementation of the 80 hour work weekLyssa N Ochoa MD, Francis C Brunicardi MD, Mary L Brandt MD,Samir Awad MDBaylor College of Medicine, Houston, TX

INTRODUCTION: To incorporate the 80-hour workweek into ourresidency program, we evaluated how upper level (UL) and lowerlevel (LL) residents spent their work time using a novel time-motionalgorithm.

METHODS: Pre-80 hour workweek, 19 residents [12 UL; 7 LL]documented activities performed each hour for 1 week and assignedan educational and service value to each activity. Activities were di-vided into 4 value categories: C1 - high educational and service (e.g.OR); C2 - high educational and low service (e.g. Conferences) ; C3- low educational and high service (e.g. Performing H&Ps); and C4- low educational and service (e.g. Waiting for rounds). Total hours ineach category and corresponding educational and service scores weretabulated and compared between residents. ANOVA and student’st-test were used for analyses.

RESULTS: All residents worked comparable hours per day [UL �11.8 � 0.8; LL � 12.4 � 0.8]. In addition, all residents spent themajority of their time in C3 [UL � 41.1%; LL � 61.3%, p�0.05].However, ULs spent a higher percentage in C1 activities than LLs[UL � 35.8%; LL � 30.0%; p� 0.05]). Overall, ULs perceived C1activities to be of more educational and service value than LLs [UL �9.7 & 9.7; LL � 7.6 & 7.4; p�0.05.

CONCLUSIONS: Prior to the 80-hour workweek, all residentsspent most time in C3 activities. This information was used to re-structure our program to maximize C1 and C2 activities while min-imizing C3 and C4 activities.

The impact of work hour restrictions on surgicalresident educationEmily T Durkin MD, Robert McDonald PhD,Alejandro Munoz PhD, David Mahvi MDUniversity of Wisconsin, Madison, WI

INTRODUCTION: Resident work hour restrictions were institutedin July 2003 based on ACGME mandates. The American Board ofSurgery In-Training Examination (ABSITE) has traditionally beenone measure of surgical resident education and competency. Theobjective of this study was to determine the effect of reduced workhours on resident ABSITE scores and operative volume at our insti-tution.

METHODS: We reviewed ABSITE scores and operative logs from1997-2005 of general surgery residents. Linear mixed-effectsmodels were fitted for each component ABSITE score (total, basicscience, and clinical management), and compared using a chi-squared likelihood ratio. Operative logs of graduating residentswere compared before and after the work restrictions and evalu-

ated for association with ABSITE score. P values � 0.05 wereconsidered significant.

RESULTS: The program was compliant with ACGME mandateswithin 6 months of institution. ABSITE scores improved signifi-cantly after the restriction of work hours both in basic science (p �0.003) and total score (p � 0.008). Clinical management scores werenot affected. The number of major cases recorded by graduatingresidents did not change (p � 0.373). A positive correlation wasfound between number of cases performed during residency andclinical management ABSITE scores (p � 0.045).

CONCLUSIONS: ABSITE scores improved significantly after therestriction of resident work hours. Resident operative experience wasnot affected. An unexpected consequence of work hour restrictionsmay be an improvement in surgical resident education.

Assessing decision making in operative trauma:Development of a novel tool and evaluation of itsutilityTracy M Scott MD,* Morad Hameed MD, MPH, David Evans MD,Eric Webber MD, Ross Brown MD, MA, Jay Doucet CD, MD, MSc,Richard Simons MD, Ravi Sidhu MD, MEdUniversity of British Columbia, Vancouver, BC, Canada

INTRODUCTION: As trauma is an essential component of surgi-cal training, educators must ensure trainees are achieving compe-tency in an era of decreased operative management. There is aneed for assessment of decision-making skills. The purpose of thisstudy was 1) to survey trainees for perceived gaps in trauma sur-gical management; and 2) to develop and evaluate the utility of anovel assessment tool of decision making in trauma based on theresults of the survey.

METHODS: A survey on the perceptions of adequacy of traumatraining was given to all UBC general surgery residents. After ananalysis of the perceived deficiencies, a multimedia case-based short-answer examination assessing operative decision-making was devel-oped by a panel of trauma surgeons and implemented to evaluate itsutility (validity and reliability).

RESULTS: 33 residents participated in the survey (86% responserate). Residents felt inadequate in their experience and decision-making skills on operative trauma involving head and neck, thoracicand major abdominal injuries (mean of �5 cases each). The results ofthe 45-minute assessment tool demonstrated good reliability (Cron-bach’s alpha 0.81). Construct validity was shown by a significantcorrelation of scores with increasing PGY level (r�.53,p�.005).Overall scores for junior and senior trainees were low (42% and59%).

CONCLUSIONS: It is difficult to assess decision-making in opera-tive trauma due to the low number of cases. We have developed anovel assessment tool which shows reliability and validity and fulfillsa currently unmet role. Further work is needed to determine itsgeneralizability.

S74© 2006 by the American College of Surgeons ISSN 1072-7515/06/$32.00Published by Elsevier Inc.