High Quality Residency Education and Patient Safety are Directly Related David T. Harrington, MD Program Director, General Surgical Residency Program Associate Professor of Surgery Residency Work Hours Resident fatigue clinical errors Residency work hours surrogate for patient safety Effects of work hour rules - mixed Patient Safety Lack of definitive effect More cross-coverage and hand-offs Residency Education Improved resident well-being, less burn-out Decreased operative experience (FA, TA, continuity) Increased choice of fellowships Decreased medical student teaching KG Volpp et al, Mortality among hospitalized Medicare beneficiaries in the first 2 years.., JAMA 2007 Residency Work Hours Resident fatigue clinical errors Residency work hours surrogate for patient safety Effects of work hour rules - mixed Patient Safety Lack of definitive effect More cross-coverage and hand-offs Residency Education Improved resident well-being, less burn-out Decreased operative experience (FA, TA, continuity) Increased choice of fellowships Decreased medical student teaching Patient Safety and Surgical Quality Traditional M&M Process Joint Commission SCIP Centers of Excellence Trauma - ASC/COT Bariatric - ASBS Cancer, Orthopedic, Cardiac Performance NSQIP UHC CMS MSDRG and P4P NSQIP Observed to Expected (O/E) Ratio Represents the hospitals outcomes compared to the other ACS NSQIP hospitals, adjusted for inter-hospital differences in patients characteristics, comorbidities, and preoperative laboratory values LOW OUTLIER: If the upper bound of the O/E confidence interval is 1.0, the hospitals outcomes are statistically worse than expected. Thus, the hospitals outcomes Need Improvement. AS EXPECTED Surgical Residency Training Outcomes Process RRC accreditation Performance ABSITE scores Pass rates on QE & CE Fellowship placement Successful practice Hypothesis Programs which deliver high quality care as measured by: participation in NSQIP verification as a trauma center high rates of compliance in SCIP would have a sound educational programs evidenced by: high pass rates on QE and CE Methods & Materials NSQIP participation NSQIP annual report Trauma Center verification SCIP compliance for laparoscopic cholecystectomy: SCIP1, 2, 3, VTE1, VTE2 QE and CE https://home.absurgery.org/default.jsp?prog_passreport https://home.absurgery.org/default.jsp?prog_passreport Results NSQIP 85 (34%) participated Trauma Center Verification 82 (32.8%) verified trauma centers 65 (26%) were Level 1 trauma centers SCIP All hospitals had data available ABS Examinations 1 st time passage rate QE83.9 +/ CE84.5 +/ Combined80.0 +/- 16.2 NSQIP YesNSQIP - Nop-value Qualifying Exam (average) < Certifying Exam (average) Combined (average) NSQIP Participation & QE/CE Trauma Center Yes Trauma Center No p-value Qualifying Exam (average) Certifying Exam (average) Combined (average) Trauma Center Verification & QE/CE Level 1 YesLevel 1 - Nop-value Qualifying Exam (average) Certifying Exam (average) Combined (average) < Level 1 Verification & QE/CE Hypothesis Programs which deliver high quality care as measured by: participation in NSQIP verification as a trauma center high rates of compliance in SCIP would have a sound educational programs evidenced by: high pass rates on QE and CE Excellent Patient Safety = Excellent Education RRC site visit Trauma center verification Improving SCIP compliance Improving NSQIP performance Teaching hospitals are quintessential quality model New physicians Ascending levels of responsibility 6 core competencies System-based practice Practice-based learning Multi-disciplinary RRC, NSQIP, Trauma Verification, SCIP compliance Shortcomings QE/CE pass rates quality of training Study has no relevance to medical training Participation in NSQIP higher quality of patient care NSQIP: Changes in Morbidity Conclusions Hospitals that participate in NSQIP have a higher quality of surgical resident education than hospitals that do not. Hospitals that obtain Trauma Center verification have a higher quality of surgical resident education than hospitals that do not. Hospitals that obtain Level 1 Trauma Center verification have a higher quality of surgical resident education than hospitals that do not. High Quality Residency Education and Patient Safety are Directly Related David T. Harrington, MD Program Director, General Surgical Residency Program Associate Professor of Surgery