Utilization Of A Quality Reporting System To Increase Faculty Participation In Resident Operative Assessment
*Robert Naples, *Judith C French, *Jonah D Thomas, *Michael J Rosen, *Jeremy M Lipman
Cleveland Clinic, Cleveland, OH
Objective: Surgery milestones set forth by the Accreditation Council for Graduate Medical Education are vital in establishing a resident's progression. The accuracy of these evaluations depends on feedback from multiple faculty which remains challenging, particularly regarding resident operative assessment. We sought to determine whether incorporating resident operative performance assessment into a mandatory quality reporting system would increase the quantity and quality of these assessments. A secondary aim was to evaluate if these additional assessments would impact relevant milestones.
Methods: A quality collaborative (QC) was initiated across our hospital system in which faculty are required to complete a checkbox quality information database at the conclusion of all cholecystectomy and paraesophageal hernia repair cases. In February 2019, three multiple-choice questions were added regarding resident autonomy, operative performance, and case complexity. Surgery milestone evaluations are completed biannually by our Clinical Competency Committee. Three milestones directly related to operative performance were analyzed – Patient Care 3 (PC3), Medical Knowledge 2 (MK2), and Interpersonal and Communication Skills 3 (ICS3). Residents were divided in two groups: QC (those with ≥10 operative assessments) and no QC (<10 operative assessments). Baseline data was collected prior to implementation of the QC to determine the mean rate of change in resident milestone progression. Milestones from June 2019 and November 2019 were compared and analyzed. Continuous variables are reported as mean ± standard deviation, and a paired t-test was used.
Results: Faculty participation was 90% with 407 resident operative assessments completed from February-October 2019. Mean biannual increase in baseline resident performance (n=102) for PC3 was 0.55 ±0.83, MK2 was 0.58 ±0.85, and ICS3 was 0.52 ±0.94. A substantial difference in the rate of change in resident performance for PC3 (+0.95 vs +0.55, p=0.04) and ICS3 (+1.05 vs +0.52, p=0.02) was observed for those residents in the QC group (n=20) compared to the baseline.
Conclusion: Addition of a short easy-to-answer assessment of operative performance to a mandatory QC increases faculty participation and impacts resident milestone determination. These findings highlight opportunities to find innovative and efficient ways to engage faculty in resident operative assessment.
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