Tracking Residents’ Surgical Outcomes Using Data from the Quality In-Training Initiative

• Published in: Journal of surgical education Vol. 81; no. 8; pp. 1110 - 1118
• Main Authors: Turrentine, Florence E, Turkheimer, Lena M, Jin, Ruyun, Zaydfudim, Victor M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2024
• Subjects: Adult; Appendectomy - education; Clinical Competence; Colectomy - education; Education, Medical, Graduate - methods; Female; General Surgery - education; Humans; Internship and Residency; Male; Quality Improvement; risk-adjusted cumulative sum; surgical performance; surgical quality; surgical resident outcomes; surgical trainee self-evaluation; United States; United States; Patient Safety and Quality Improvement; Systems-Based Practice; surgical performance; surgical resident outcomes; surgical quality; surgical trainee self-evaluation; risk-adjusted cumulative sum
• ISSN: 1931-7204; 1878-7452; 1878-7452
• DOI: 10.1016/j.jsurg.2024.05.012

•Longitudinal tracking of postoperative outcomes allows for trainee self-reflection.•RA-CUSUM methodology offers real-time monitoring and opportunity for early evaluation.•Higher than expected trainee complications, offers early opportunity for intervention. Monitoring resident trainees’ patient outcomes is essential to improving surgical performance; however, resident-specific follow-up is rarely provided in the current surgical training environment. Whether there is a correlation between individual resident's surgical performance and patients’ clinical outcomes remains undefined. In this study, we aimed to use risk-adjusted patient outcomes as an educational tool to track individual surgical trainee performance. American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) appendectomy and partial colectomy operations (2013-2021) were examined. Residents performing ≥25 operations were included. The primary outcome was ACS NSQIP-defined morbidity adjusted using estimated probability of morbidity. Observed-to-expected ratios (O/E) of morbidity measured overall performance and risk-adjusted cumulative sum (RA-CUSUM) methodology represented surgical resident's performance over time. Academic quaternary care institution. Highest-ranking surgical resident participating in an operation and included in Quality In-Training Initiative. A total of 449 operations were examined. 12 residents performed 343 appendectomy operations. 7 residents (29.3 ± 5.1 operations each) did not have any postoperative morbidity and demonstrated better-than-expected patient outcomes. Three residents did not have morbidity after their seventh/eleventh/fifteenth appendectomies. Two residents (case volume 29, 33) had an O/E ratio > 3. Partial colectomy (n = 106) performed by 4 residents had 2 residents (case volume 30, 26) with better-than-expected outcomes and 2 with worse-than-expected (case volume 25, 25). Longitudinal monitoring of postoperative patient outcomes provides an opportunity for trainee self-reflection and system examination. RA-CUSUM methodology offers sequential monitoring allowing for early evaluation and intervention when RA-CUSUM results for a trainee demonstrate higher-than-expected morbidity.