Caroline E. Reinke, MD MSPH, Rachel R. Kelz , MD MSCE,

Trimming the Fat:Optimizing Overall Educational Value by Defining Factors Associated with Overall Educational Value and Service to Education Ratio Caroline E. Reinke, MD MSPH, Rachel R. Kelz, MD MSCE, Lori Pray, BA, Noel Williams, MD, Joshua Bleier, MD, Kenric Murayama, MD, Jon B. Morris, MD Division of Surgery Education Hospital of the University of Pennsylvania Philadelphia, PA

Optimizing Overall Educational Value Nothing To Disclose

Optimizing Overall Educational Value Background • Accreditation Council for Graduate Medical Education (ACGME) responsible for assessing and advancing the quality of resident physicians’ education • Founded in 1981 • Requires programs to achieve a balance between education and service • With decreasing work hours, defining which characteristics are educational is critical to effective education • Little is known about which modifiable rotation characteristics impact perceived service and education ACGME Resident Survey: In your opinion, how often do your rotations and other major assignments provide an appropriate balance between your residency education and other clinical demands? How often has your clinical education been compromised by excessive service obligations?

Optimizing Overall Educational Value Specific Aims • AIM 1: To identify rotation characteristics associated with service to education ratio and overall educational value AIM 2: To understand the relationship between the perceived overall educational value and the service to education ratio AIM 3: To understand how these relationships differ between junior (CY1-2) and senior residents (CY3-5)

Optimizing Overall Educational Value Data Source • Responses to an 11-item Web-based survey during FY2011 • Distributed to all residents at the end of each rotation • Exclusion criteria: • Non-clinical rotations (simulation month) • Subspeciality-specific rotations (ie. plastic surgery) • Survey responses were linked to additional rotation data: • Length of the rotation in number of weeks • Number of attending surgeons on each service • Presence or absence of fellows

Optimizing Overall Educational Value Rotation Survey

Optimizing Overall Educational Value Study Population • 57 general surgery training program rotations were evaluated by 85 residents • Excluded rotations in which less than three residents in a given CY evaluated the rotation (n=9) • Overall survey response rate = 87% • Final study population = 48 general surgery rotations • with 578 resident evaluations (range 3-36)

Optimizing Overall Educational Value Statistical Analyses • Linear regression used to assess the relationship between rotation characteristics (RC), rotation data (RD), and • Overall Educational Value (OEV) • Service to Education Ratio (SER) • Linear regression used to assess the relationship between OEV and SER • Multivariate linear regression was used to examine the relationship between SER and OEV after controlling for significant RC and RD • Subgroup analyses performed for junior (PGY1-2) and senior (PGY3-5) residents

Optimizing Overall Educational Value Relationship between OEV and SER

Optimizing Overall Educational Value RC, RD and the relationship with OEV

Optimizing Overall Educational Value RC, RD and the relationship with SER

Optimizing Overall Educational Value Relationship between OEV and SER

Optimizing Overall Educational Value The relationship between SER and OEV

Optimizing Overall Educational Value Subgroup Analysis of Junior and Senior Rotations

Optimizing Overall Educational Value Summary • We identified an inverse relationship between the service to education ratio and overall educational value, which was not fully explained by other rotation characteristics • This relationship differed significantly for junior and senior rotations • Individual rotation characteristics varied in their relationship with overall educational value • The value of fellows varied, but their simple presence or absence was not predictive of OEV • Number of attending surgeons was negatively correlated with overall educational value

Optimizing Overall Educational Value Thank You PENN Surgery

Optimizing Overall Educational Value RC, RD and the relationship with OEV – Junior

Optimizing Overall Educational Value RC, RD and the relationship with OEV – Senior

Optimizing Overall Educational Value Background – ACGME Resident Survey • In your opinion, how often do your rotations and other major assignments provide an appropriate balance between your residency education and other clinical demands? • How often has your clinical education been compromised by excessive service obligations?

Caroline E. Reinke, MD MSPH, Rachel R. Kelz , MD MSCE,

Caroline E. Reinke, MD MSPH, Rachel R. Kelz , MD MSCE,

Presentation Transcript

Howard Hays, MD, MSPH RPMS Program Manager, IHS

Greggory R. DeVore MD

Barbara Phillips, MD, MSPH, FCCP

MD-MPH Joint Degree Program Giang T. Nguyen, MD, MPH, MSCE Chair, MD-MPH Advisory Committee Fall 2010

Elias R. Melhem, MD

Glenn R. Buttermann, MD

Elsa Margarita Arrieta, MD 1 and Hyunah Caroline Choi , MD 2

A Kheirkhah MD, A Izadi MD, R Nazari MD H Hashemi MD, M Jabbarvand MD, H Hashemian MD

Evelyn P. Whitlock, MD, MPH Al L. Siu, MD, MSPH

Glenn R. Buttermann, MD

R. Cionni, MD

Peter Pronovost, MD John R. Combes, MD

Rachel Bensen, MD, MPH Dana Steidtmann, PhD Yana Vaks, MD Mentor: Arnold Milstein, MD, MPH

R Rodríguez-Roisin, MD

JAIRO E. HOYOS, MD MELANIA CIGALES, MD

Katrina Abuabara , MD, MA 1 Esther E Freeman MD, PhD 2 ; Robert Dellavalle , MD, PhD, MSPH 3

Rachel E. Peck, MD * Kendall R. Dobbins, MD *

Katerina Venovska MSPH, FM Spec. MD

Holly Hedegaard, MD, MSPH

Rebecca A. Snyder, MD Sharon E. Phillips, MSPH Kyla P. Terhune, MD

R. Diaz-Garcia MD, J. Bernardo MD

Steven E. Wolf, MD Golden Charity Guild Charles R Baxter MD Chair