Kristopher M Day1, Evon S Zoog2, Chase T Kluemper3, Jillian K Scott4, Caleb M Steffen5, James Woodfin Kennedy6, David Marshall Jemison6, Jason P Rehm6, Mark A Brzezienski6. 1. University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee. Electronic address: krisophermday@gmail.com. 2. University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of General Surgery, Hayes Hand Center, Chattanooga, Tennessee. 3. University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee. 4. University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee. 5. University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee. 6. University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee.
Abstract
OBJECTIVE: Resident clinics (RCs) are intended to catalyze the achievement of educational milestones through progressively autonomous patient care. However, few studies quantify their effect on competency-based surgical education, and no previous publications focus on hand surgery RCs (HRCs). We demonstrate the achievement of progressive surgical autonomy in an HRC model. DESIGN: A retrospective review of all patients seen in a weekly half-day HRC from October 2010 to October 2015 was conducted. Investigators compiled data on patient demographics, provider encounters, operational statistics, operative details, and dictated surgical autonomy on an ascending 5 point scoring system. SETTING: A tertiary hand surgery referral center. RESULTS: A total of 2295 HRC patients were evaluated during the study period in 5173 clinic visits. There was an average of 22.6 patients per clinic, including 9.0 new patients with 6.5 emergency room referrals. Totally, 825 operations were performed by 39 residents. Trainee autonomy averaged 2.1/5 (standard deviation [SD] = 1.2), 3.4/5 (SD = 1.3), 2.1/5 (SD = 1.3), 3.4/5 (SD = 1.2), 3.2/5 (SD = 1.5), 3.5/5 (SD = 1.5), 4.0/5 (SD = 1.2), 4.1/5 (SD = 1.2), in postgraduate years 1 to 8, respectively. Linear mixed model analysis demonstrated training level significantly effected operative autonomy (p = 0.0001). Continuity of care was maintained in 79.3% of cases, and patients were followed an average of 3.9 clinic encounters over 12.4 weeks. CONCLUSIONS: Our HRC appears to enable surgical trainees to practice supervised autonomous surgical care and provide a forum in which to observe progressive operative competency achievement during hand surgery training. Future studies comparing HRC models to non-RC models will be required to further define quality-of-care delivery within RCs.
OBJECTIVE: Resident clinics (RCs) are intended to catalyze the achievement of educational milestones through progressively autonomous patient care. However, few studies quantify their effect on competency-based surgical education, and no previous publications focus on hand surgery RCs (HRCs). We demonstrate the achievement of progressive surgical autonomy in an HRC model. DESIGN: A retrospective review of all patients seen in a weekly half-day HRC from October 2010 to October 2015 was conducted. Investigators compiled data on patient demographics, provider encounters, operational statistics, operative details, and dictated surgical autonomy on an ascending 5 point scoring system. SETTING: A tertiary hand surgery referral center. RESULTS: A total of 2295 HRCpatients were evaluated during the study period in 5173 clinic visits. There was an average of 22.6 patients per clinic, including 9.0 new patients with 6.5 emergency room referrals. Totally, 825 operations were performed by 39 residents. Trainee autonomy averaged 2.1/5 (standard deviation [SD] = 1.2), 3.4/5 (SD = 1.3), 2.1/5 (SD = 1.3), 3.4/5 (SD = 1.2), 3.2/5 (SD = 1.5), 3.5/5 (SD = 1.5), 4.0/5 (SD = 1.2), 4.1/5 (SD = 1.2), in postgraduate years 1 to 8, respectively. Linear mixed model analysis demonstrated training level significantly effected operative autonomy (p = 0.0001). Continuity of care was maintained in 79.3% of cases, and patients were followed an average of 3.9 clinic encounters over 12.4 weeks. CONCLUSIONS: Our HRC appears to enable surgical trainees to practice supervised autonomous surgical care and provide a forum in which to observe progressive operative competency achievement during hand surgery training. Future studies comparing HRC models to non-RC models will be required to further define quality-of-care delivery within RCs.
Keywords:
Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; hand surgery; operative autonomy; resident clinic; surgical education