3 in 10 Surgery Residents Need Remediation

Cheryl Clark, for HealthLeaders Media , September 18, 2012

"Resident remediation places additional strain on the program director and entire clinical faculty," they wrote.  It may complicate patient care, load more work on other providers, increase the need for communication and faculty supervision.

De Virgilio says an open question is whether the 80-hour work-week limitation for such medical school trainees is to blame. The researchers did not compare periods before that limit took effect in 2003.  But de Virgilio says it raises an important question about whether the end result may be that "our surgeons in the future come out of these programs with the same amount of training as in the past."

But he and his fellow authors wrote that the 31% remediation rate for these residents is "surprising given that the resident cohort was a relatively high-achieving group," which picks the top students from high school and undergraduate institutions.

Additionally, de Virgilio says, "California has one of the more competitive areas for surgery in the country and surgery is one of the more competitive fields in medicine, so we have the fortune to be educating the top students of the future. I would say that the vast majority of them are very trainable, they have the intelligence and skill. It's just a matter of carefully trying to tweak them to get to that point."

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2 comments on "3 in 10 Surgery Residents Need Remediation"

Napoleon Knight (9/20/2012 at 3:36 PM)
I agree with some of the comments, but I think the core issue is that we have cut back the number of hours that residents can care for patients, and not lenghthed the residency programs that they are in. If you simply do teh math, you can see that there likely is not enough time to develop the skills that are needed at the time that they finish their programs. I would suspect if you talked to others across the country, that you would likely hear that in residency programs with a large technical aspect, and even in those that are cognitive in nature, that the new physicians coming out do not seem to be at the same level as in the past. Further restriction of duty hours does not seem to be the issue to me. Ensuring adequate oversight of residents, and having a culture in which help and assistance can be summoned when needed worked well for me as a resident years ago, and I suspect could once again. As the old adage goes, you get what you pay for, and if we are paying for less experiences for those in training, then we should not be surprised out some of the outcomes. Not a great solution for the amazing needs of this great country going forward.

Larry R. Kaiser (9/18/2012 at 11:03 AM)
Harbor-UCLA is not the same as the UCLA School of Medicine that you refer to in your article. The surgery program that De Virgilio heads is separate and distinct from the program at the UCLA Medical Center in Westwood and you fail to make that distinction in your article. I would venture to say that attrition and remediation at the UCLA program (Program Director: O. Joe Hines)likely is not at the level of the other programs (though I don't have the actual data) that form the basis of the article reviewed. That being said the data presented certainly give one cause for concern not just from the actual educational experience provided during the residency but also as to the way that residents are selected. In addition you repeatedly refer to residents as "students' which is confusing. These "students" are graduates of approved medical schools and thus are physicians, albeit in residency programs.




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