Surgeons as Educators A Guide for Academic Development and Teaching Excellence

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The study was conducted over a single academic year from July 1, 2014 to June
30, 2015. The randomized design created two well-balanced groups in regard to
residents, hospital metrics, residency program types, and patient populations under
study. The NSQIP database provided outcomes on 138,691 patients during the study
period. As shown in Fig. 9.1, the rate of primary outcomes (e.g., death or serious
complications) did not differ between the groups and met criteria for noninferiority.
In a similar fashion, the rate of the secondary outcomes was the same in each group
and also noninferior. The only exception was renal failure and failure to rescue,
which in the adjusted model did not meet criteria for noninferiority. Subgroup anal-
ysis of the type of surgery, risk of death, and surgical setting also showed no differ-
ence between the two study arms.
The resident-related outcomes in this study were obtained by a questionnaire
administered to participating residents (2220  in the standard-policy group and
2110 in the flexible-policy group) during the January 2015 ABSITE exam. Those
results are shown in Table 9.3. Importantly, there was no difference between resi-
dent dissatisfaction with education quality, overall well-being, patient safety, and
work hours between the standard-policy group and the flexible-policy group. The
flexible-policy group was significantly less likely to perceive a negative effect of

30-day postoperative
outcomes
Death or serious
complication
Unadjusted
Adjusted
Death
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted
Unadjusted
Adjusted

Serious complication

Any complication

Failure to rescue

Pneumonia

Renal failure

Unplanned reoperation

Sepsis

Surgical-site infection 137,346

138,258

138,691

138,596

138,375

11,937

138,691

138,691

138,691

Urinary tract infection 138,691

0.500.550.600.650.700.750.800.850.900.951.001.051.101.151.20

Flexible policies better Standard policies better

1.251.301.351.401.451.50

138,691

Patients included

in analysis Odds ratio (92% CI)

0.0

Inconclusive

Inferior

Noninferior

Superior

Regions of noninferiority

0.5 1.0 1.5

Fig. 9.1 Patient related outcomes from the FIRST trial

9 Resident Duty Hours in Surgical Education