The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy

• Published in: Journal of surgical education 2016-11, Vol.73 (6), p.e142-e149
• Main Authors: Wojcik, Brandon M., MD, Fong, Zhi Ven, MD, Patel, Madhukar S., MD, MBA, ScM, Chang, David C., MPH, MBA, PhD, Petrusa, Emil, PhD, Mullen, John T., MD, Phitayakorn, Roy, MD, MHPE
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Surgical Procedures - methods; autonomy; Case-Control Studies; Clinical Competence; deliberate practice model; Education, Medical, Graduate - methods; Female; General Surgery - education; graduate medical education; Humans; Internship and Residency - organization & administration; Male; Massachusetts; minor surgery; Minor Surgical Procedures - methods; Organizational Innovation; Outcome Assessment (Health Care); Patient Care, Medical Knowledge; patient outcomes; Physician's Role; Pilot Projects; Practice-Based Learning and Improvement; Professional Autonomy; resident clinic; Safety; Student Run Clinic - organization & administration; Surgery; Systems-Based Practice
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2016.08.016

Objective General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Design Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Setting Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Participants Ten third-year general surgery residents. Results Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision ( n = 275), abscess incision and drainage ( n = 66), skin lesion excision ( n = 37), skin tag removal ( n = 15), and lymph node excision ( n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing increased operative autonomy as the greatest strength. Conclusions Implementation of a resident-run minor surgery clinic is a safe and effective method to increase trainee operative autonomy. The rotation is well suited for mid-level residents, as it provides an opportunity for realistic self-evaluation and focused learning that may enhance their operative experience during senior level rotations.