Evaluation of Resident Satisfaction in the Current Era: A Local Perspective on a National Issue

Background: Mitigating resident burnout is a high priority for medical centers. Monitoring residents’ overall perceptions of their training environments could be a reliable indicator of potential future burnout. Furthermore, recent national studies suggest procedural specialties have a higher burnout rate and lower satisfaction than non-procedural specialties. In the current study, we utilized institutional data from the Accreditation Council for Graduate Medical Education (ACGME) resident survey to better understand trends related to our residency program learning environments over time (2012-2018) and by specialty grouping (procedural versus non-procedural). Methods: Annual ACGME survey results from 2012 to 2018 were retrospectively analyzed to determine trends in resident satisfaction. Specifically, satisfaction was defined as a “very positive” or “positive” response on the survey. Programs with an average of four or more residents were included. The programs were categorized into procedural versus non-procedural specialties and differential trends between the two groups were analyzed. Results: A total of 17 residency programs were included in this study (nine procedural and eight non-procedural), with a combined average satisfaction score (“very positive” plus “positive”) over all years of 89%, which is slightly better than the annual national means (87-88%). Using this combined average score, residents in procedural residency programs rated their satisfaction higher (93%) when compared to non-procedural specialties (87%). Further analysis demonstrated that procedural specialties had higher combined satisfaction scores every year of the study except for 2018. Conversely, residents in non-procedural specialties had a higher “positive” rating when compared to procedural specialties (range of 28.5-44% versus 15-33%, respectively). Conclusion: The results of our study demonstrate that the overall satisfaction scores for our academic center are comparable to or better than the national patterns, with a favorable trend towards the procedural specialties

A Content Analysis of the Scholarly Activity Requirements in ACGME-Accredited Residency and Fellowship Programs

Background: The Accreditation Council for Graduate Medical Education (ACGME) common and specialty program requirements stipulate that residents/fellows participate in scholarly activities. The ACGME provides a reporting template tool for scholarly activity to be utilized by all specialties for evaluation annually. In this study, we aimed to: 1) Conduct a content analysis of the specialty scholarly activity requirements for all ACGME-accredited training programs to identify commonalities and variations, and 2) Assess alignment between the specialty scholarly activity requirements and the reporting template tool provided by the ACGME. Methods: The scholarly activity requirements for all ACGME-accredited residency and fellowship specialties in the United States were reviewed. Three authors reviewed these requirements and reached consensus on a codebook. Using a content analytic approach, the requirements were then iteratively coded by two authors and reviewed by a third author until all three reached consensus. Frequency counts were analyzed using descriptive statistics. The verbiage in the requirements was also reviewed for alignment with the ACGME reporting template tool. Results: Several requirements were similar across various specialties; for example, 69% of specialties use the verbiage, “participate in research.” However, many differences exist among specialties and among fellowships within the same specialty. Fellowships more frequently emphasized teaching or publishing. Some of the specialty requirements and the ACGME reporting template tool were misaligned. Conclusion: The variability in requirements among the programs allows for flexibility; however, some of the stated scholarly activity requirements may not be easily assessed with the current ACGME reporting template tool

Thirty-Day Unplanned Readmission and Its Effect on 90-Day Mortality in Hepatocellular Carcinoma Patients Undergoing Partial Hepatectomy

Background: Despite advances of surgical techniques, hepatectomy continues to be potentially dangerous and is associated with postoperative mortality, morbidity and readmission. The objective of this study was to determine the effect of 30-day unplanned readmission on ‘conditional’ 90-day mortality among hepatocellular carcinoma (HCC) patients who underwent partial hepatectomy. Methods: National Cancer Database (NCDB) was queried from 2004 to 2012 for patients with hepatocellular carcinoma (HCC) who underwent partial hepatectomy. Thirty-day unplanned readmission rate, and associated risk factors, was determined for 7,696 patients. The association between 30-day unplanned readmission and conditional 90-day mortality was further addressed. Results: The 30-day unplanned readmission rate for patients with HCC who underwent partial hepatectomy was 5.2%. Risk factors associated with 30-day unplanned readmission were sex, race/ethnicity, Charlson-Deyo score, and annual hospital hepatectomy volume. An overall adjusted odds of having conditional 90-day mortality was 2.325 times higher (95% CI 1.643 - 3.219) among patients with a history of 30-day unplanned readmission than those without. This association was dependent on age, sex, race/ethnicity, insurance status, alpha-fetoprotein (AFP), liver fibrosis, Charlson-Deyo comorbidity score and annual hospital hepatectomy volume. Conclusion: Efforts in patient care should be taken to reduce 30-day unplanned readmission after partial hepatectomy for patients with HCC to reduce conditional 90-day mortality

Establishing an Institution-Wide Graduate Medical Education Research Collaborative to Promote Scholarly Activities among House Officers

Background: House officers’ ability to participate in research and quality improvement projects can be hindered by barriers, including lack of time, mentoring, and resources. Objective: Create a collaborative for house officers that provides readily accessible resources in study design as well as data collection, analysis, interpretation, and presentation. Methods: In 2017, we established a collaborative comprised of biostatisticians and an Associate Dean for Graduate Medical Research, providing a trove of experience in research and quality improvement. We worked closely with the Institutional Review Board and Electronic Health Records Core to simplify the process for house officers to utilize these research resources. The collaborative has weekly small group meetings to discuss new projects/updates and monthly large group meetings where house officers can present their ideas for additional feedback from peers and additional faculty. These formats are flexible, which allows us to tailor our assistance to the needs of each individual project. Results: In the first year since establishing the collaborative, we have received 51 project concepts from 44 house officers. Of the projects needing assistance (n=44), 100% were discussed in one of our weekly meetings and received assistance from the collaborative, and 34% presented at our large monthly meeting. A year into the collaborative, 20% of projects are either in the data analysis phase or have already been presented. Conclusion: As evidenced by the number of projects we received in our first year, there is a significant benefit for this type of collaborative resource to support and stimulate successful scholarly activity in house officers