Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Surgery

Supervisor

Ott, Michael

2nd Supervisor

Sayra Cristancho

Co-Supervisor

Abstract

Introduction: Surgical training has transitioned to competency-based medical education. There is incomplete understanding of current resident workload and how workload is perceived by trainees and faculty.

Methods: A prospective time-motion study was conducted in a Canadian general surgery training program. A web-based survey was used to compare observational data with faculty and learner perceptions of actual and ideal resident workloads and the educational value of workload components.

Results: 54 clinical periods were assessed (662.8 hours, 6375 individual events). 39.7% of time was spent on direct patient care, 33.2% on indirect patient care and 7.5% on education, including

Conclusion: Curriculum changes should aim to increase participation in educational activities, with a focus on assessment, and protect direct patient care activities.

Summary for Lay Audience

Surgical training has historically been based on a time-based apprenticeship model. As part of an overall transition in medical training towards competence-based training, surgical residency requires redesign with an emphasis on frequent assessment. The current surgical resident workload has not been extensively studied prior to implementing these changes to training.

Trained observers recorded the activities of general surgery residents throughout their work periods (daytime activities or overnight call). 54 periods were recorded, comprising 663 hours of data and 6375 data points. Residents spent 40% of their time engaged in bedside care tasks such as operating or seeing patients outside of the operating room. One third of time was spent on tasks required for care but not at the bedside including using the electronic medical record or discussions with other health care providers. 7.5% of time was spent on education tasks such as lectures, informal teaching or studying; with only 0.1% of time spent on assessment of residents.

Faculty surgeons and residents from the same training program completed a web-based survey regarding their perception of resident workload. Participants were asked to define what they felt the ideal resident workload comprised of and what was the value of components of the work done by surgical residents. There was good participation from both groups. Faculty overestimated the amount of time residents spent on education tasks. Both groups greatly overestimated the amount of time spent on assessment and informal teaching. Both groups felt that in an ideal workload there would be more direct than indirect (away from the bedside) patient care activities, but residents desired a greater ratio than faculty. There was agreement that direct patient care and education tasks had high educational value and that downtime and transit had low educational value; faculty felt that these indirect care tasks had higher value than residents.

This study allows for a greater understanding of current resident workload and provides goals when planning the next generation of surgical residency programs. Curriculum changes should aim to increase participation in educational activities, especially assessment, and protect direct patient care activities.

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