3 in 10 Surgery Residents Need Remediation

Cheryl Clark, for HealthLeaders Media , September 18, 2012

For students who required remediation, nearly three in four were found to have significant deficiencies in medical knowledge rather than any of the other five competencies on which their competencies are judged.

In an invited critique in the same issue of the journal, Karen Deveney, MD, of the Department of Surgery at Oregon Health & Science University in Portland, asked:

"These surgical residents were a smart, high-achieving group of people. Why did so many stumble during residency and require remediation? The authors suggest deficient preparation during medial school for the rigors of surgical residency, inadequate education during residency, or the increased efficiency needed to compress required tasks into a shorter timeframe with decreased work hours.

"All of these are likely contributors." She added that these residents must care for patients who are sicker and more complex than in the past and fast-track them through the system.

"There is little time in the work day for contemplation or for learners who require a bit more time to master concepts or skills."

She called for the a renewed effort for educators to create systems that "eliminate nonessential tasks so that residents can devote more attention during the compressed work hours to learning what they need to become competent surgeons."


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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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