Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals

The impact of resident involvement in minimally-invasive urologic oncology procedures

“…[10][11][12][13][14][15] In an increasingly cost-conscious medical culture, delivering high quality care is of utmost importance, translating in greater involvement of attending surgeons and less resident independence. 12 Moreover, surgical resident education is increasingly challenging due to expense, 19 work hour limitations 20 and an ever-increasing array of minimally-invasive surgical options to complement open surgical techniques. Thus, in an effort to maintain efficiency while achieving the highest standards of care, resident education will need to be optimized.…”

“…In the general surgery literature, Itani and colleagues showed that among surgeries within the Veterans Affairs system, cases in which attendings were not scrubbed had no increased morbidity or 30-day mortality after risk adjustment, suggesting that attendings are able to determine the appropriate degree of resident supervision and adjust their involvement accordingly. 12 As some of the first adopters of minimally-invasive techniques and as a group of surgeons uniquely reliant upon it, academic urologists have long had the opportunity to assess trainee readiness in varying complexity laparoscopic and robotic surgeries and grade responsibility accordingly in real-time. This may stand in contrast to laparoscopic appendectomies and cholecystectomies, which are cases in which residents first gain their laparoscopic independence, and in which increased morbidity has been shown.…”

“…This has been evaluated in the past in the general surgery literature with mixed results, while data on safety of resident participation in minimallyinvasive urologic surgery is limited. [10][11][12][13][14][15] We examine the impact of resident involvement on critical perioperative outcomes, including operative time, complications, readmission and reoperation rates, as well as length-of-stay. We assessed these endpoints for the commonly performed minimally-invasive urologic oncology procedures using data from American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) participating hospitals.…”

Measuring Progressive Independence With the Resident Supervision Index: Empirical Approach

“…Our data provide support for the RSI method by showing intensity scores covarying with resident experience, complexity of patient cases, clinic workload, and attending physician characteristics, consistent with the patient-centered theory of optimal supervision. Supervision has often been described as an oversight function designed to ensure the quality of care 15,16 and measured by whether the attending physician made a medical chart notation, 17 was physically present, 18 was involved, 19,20 identified discrepancies, 21 or participated on the health team.…”

Is open tracheotomy performed by residents in otorhinolaryngology a safe procedure? a retrospective cohort study

“…numerous studies demonstrated the efficacy of laparoscopic appendectomy performed by residents, with the same risk for the onset of complications [12,[19][20][21][22] as senior surgeons. Finally, in a recent work, Graat et al [7] reported no differences in terms of complications after appendectomy among surgeons, supervised and unsupervised residents.…”