Effect of structuring clinical services based on resident educational objectives.

Abstract

Traditionally, surgical rotations are established based on attending surgeon clinical specialty and department/section organizational structure. Consequently, resident clinical rotations are forced to adopt an underlying structure that may not align with resident educational needs. An option is to realign clinical services based on resident educational objectives. We performed a comprehensive reorganization of the clinical service lines by emphasizing resident educational objectives. Effects on resident education were evaluated qualitatively and using a semistructured interview. Effects on clinical referral patterns and patient volumes for individual faculty and sections were also evaluated. New rotations and services (clarifying faculty roles and appointments) were designed. Examples of new rotations include hepatobiliary/transplant, acute care surgery, elective surgery, cardiac/vascular, and minimally invasive surgery. Clinical case mix was evaluated by using Residency Review Committees-defined categories for general surgery and used as a component of clinical service reorganization. Since the reorganization, all residents completed the minimum case number requirements before beginning postgraduate year 5. Program quality improved in key measurable areas, including American Board of Surgery In-Training Examination mean and median and total resident operative cases performed. Individual faculty clinical volume increased during the same time period. Evaluation of faculty volumes reveals that the new clinical services lines allowed for coordination of clinical services into centers with a multidisciplinary focus. If carefully performed, reorganization of clinical rotations based on resident goals and objectives can result in measurable improvements in resident education without disrupting faculty practices. Unanticipated benefits for faculty include new collaborative opportunities that cross traditional section/department barriers. The process allows for rapid change focused on educational effectiveness, not simply revision of existing paradigms, but it requires faculty cooperation and willingness to change traditional clinical service organization.