Impact of the acute care surgery model on resident operative experience in emergency general surgery

Abstract

Background: The acute care surgery (ACS) model has been shown to improve patient, hospital and surgeon-specific outcomes. To date, however, little has been published on its impact on residency training. Our study compared the emergency general surgery (EGS) operative experiences of residents assigned to ACS versus elective surgical rotations. Methods: Resident-reported EGS case logs were prospectively collected over a 9-month period across 3 teaching hospitals. Descriptive statistics were tabulated and group comparisons were made using χ2 statistics for categorical data and t tests for continuous data. Results: Overall, 1061 cases were reported. Resident participation exceeded 90%). Appendiceal and biliary disease accounted for 49.7% of EGS cases. Residents on ACS rotations reported participating in twice as many EGS cases per block as residents on elective rotations (12.64 v. 6.30 cases, p < 0.01). Most cases occurred after hours while residents were on call rather than during daytime ACS hours (78.8% v. 21.1%, p < 0.01). Senior residents were more likely than junior residents to report having a primary operator role (71.3% v. 32.0%, p < 0.01). Although the timing of cases made no difference in the operative role of senior residents, junior residents assumed the primary operator role more often during the daytime than after hours (50.0% v. 33.1%, p = 0.01). Conclusion: Despite implementation of the ACS model, residents in our program obtained most of their EGS operative experience after hours while on call. Although further research is needed, our study suggests that improved daytime access to the operating room may represent an opportunity to improve the quantity and quality of the EGS operative experience at our academic network.

Operating room use for emergency general surgery cases: analysis of the Patterns of Complex Emergency General Surgery in Canada study

“…services. 34 As trainee education is a core mandate of academic health sciences centres, such impacts must be considered in these centres. 35 Canadian ACS services are frequently composed of staff surgeons of varied subspecialties, and not necessarily a fellowship-trained trauma or acute care surgeon.…”

The next frontier of acute care general surgery: fellowship training

“…Further, we know that resident experience with EGS care remains somewhat dependent on the ACS model under which they train, and the volume of EGS cases to which they are exposed. 4 In response to these realities in Canada, the rise of ACS as a concentration of surgical skill and content expertise has resulted in the establishment and proliferation of dedicated ACS fellowship training programs ( https://canucs.ca/fellowships/ ), as well as research in this area. These university-accredited fellowships provide advanced training, as well as scholarly opportunities to contribute to an exploding field of research and patient quality innovation.…”