The Resident-Run Minor Surgery Clinic: A Four-Year Analysis of Patient Outcomes, Satisfaction, and Resident Education

J Surg Educ. 2021 Nov-Dec;78(6):1838-1850. doi: 10.1016/j.jsurg.2021.04.003. Epub 2021 Jun 4.

Abstract

Objective: A resident-run minor surgery clinic was developed to increase resident procedural autonomy. We evaluated whether 1) there was a significant difference between complications and patient satisfaction when procedures were independently performed by surgical residents vs. a surgical attending and 2) if participation was associated with an increase in resident procedural confidence.

Design: Third year general surgery residents participated in a weekly procedure clinic from 2014-2018. Post-procedure complications and patient satisfaction were compared between patients operated on by residents vs. the staff surgeon. Residents were surveyed regarding their confidence in independently performing a variety of clinic-based patient care tasks.

Setting: Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program.

Participants: Post-graduate year three general surgery residents that ran the clinic as part of a general surgery rotation.

Results: 1230 patients underwent 1592 procedures (612 in resident clinic, 980 in attending clinic). There was no significant difference in the 30-day complication rate between patients operated on by the resident vs. attending (2.5% vs. 1.9%, p = 0.49). 459 patient satisfaction surveys were administered with a 79.1% response rate. There was no significant difference in the overall quality of care rating between residents and the attending surgeon (87.5% top-box rating vs. 93.1%, p = 0.15). Twenty-one residents completed both a pre- and post-rotation survey (77.8% response rate). The proportion of residents indicating that they could independently perform a variety of patient care tasks significantly increased across the rotation (all p < 0.05).

Conclusion: Mid-level general surgery residents can independently perform office-based procedures without detriment to safety or patient satisfaction. The resident-run procedure clinic serves as an environment for residents to grow in confidence in both technical and non-technical skills. Given the high rate at which patients provide resident feedback, future work may investigate how to best incorporate patient derived evaluations into resident assessment.

Keywords: Autonomy; Patient outcomes; Patient satisfaction; Resident clinic; Resident feedback; Surgical education.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence
  • General Surgery* / education
  • Humans
  • Internship and Residency*
  • Minor Surgical Procedures
  • Patient Satisfaction
  • Personal Satisfaction