Tracking Residents' Surgical Outcomes Using Data from the Quality In-Training Initiative

OBJECTIVES: Monitoring resident trainees' patient outcomes is essential to improving surgical performance; however, resident-specific follow-up is rarely provided in the current surgical training environment. Whether there is a correlation between individual resident's surgical performance and patients' clinical outcomes remains undefined. In this study, we aimed to use risk-adjusted patient outcomes as an educational tool to track individual surgical trainee performance. STUDY DESIGN: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) appendectomy and partial colectomy operations (20132021) were examined. Residents performing >= 25 operations were included. The primary outcome was ACS NSQIP-defined morbidity adjusted using estimated probability of morbidity. Observed-to-expected ratios (O/E) of morbidity measured overall performance and risk- adjusted cumulative sum (RA-CUSUM) methodology represented surgical resident's performance over time. SETTING: Academic quaternary care institution. PARTICIPANTS: Highest-ranking surgical resident participating in an operation and included in Quality In-Training Initiative. RESULTS: A total of 449 operations were examined. 12 residents performed 343 appendectomy operations. 7 residents (29.3 f 5.1 operations each) did not have any postoperative morbidity and demonstrated better-thanexpected patient outcomes. Three residents did not have morbidity after their seventh/eleventh/fifteenth appendectomies. Two residents (case volume 29, 33) had an O/E ratio > 3. Partial colectomy (n = 106) performed by 4 residents had 2 residents (case volume 30, 26) with better-than-expected outcomes and 2 with worse-than-expected (case volume 25, 25). CONCLUSION: Longitudinal monitoring of postoperative patient outcomes provides an opportunity for trainee self-reflection and system examination. RACUSUM methodology offers sequential monitoring allowing for early evaluation and intervention when RACUSUM results for a trainee demonstrate higher-than- expected morbidity. ( J Surg Ed 81:1110-1118. (c) 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)