Are young surgeons competent to perform alimentary tract surgery?
BACKGROUND
Assessment of competency during residency training has received increased attention recently. There has been less attention given to the competency of residents after training.


OBJECTIVE
Patient outcomes for alimentary tract surgery (ATS) should be similar for surgeons who recently completed their residency training compared with more experienced surgeons, indicating that the younger surgeons had achieved clinical competency on completion of their residency training.


METHODS
Retrospective analysis of Illinois inpatient discharge data (January 1, 1996-December 31, 1999).


METHODS
All 205 nonfederal acute care hospitals in Illinois.


METHODS
The patients were 120 160 adult Illinois residents who underwent ATS in Illinois.


METHODS
Mortality rate, morbidity rate, and hospital length of stay.


RESULTS
Regression analyses demonstrated that surgeon experience was a significant determinant of mortality and morbidity rates, with worse outcomes observed for patients of young surgeons undergoing high-complexity ATS (ie, procedures other than appendectomy and cholecystectomy).


CONCLUSIONS
For high-complexity ATS, there was a significant disparity in outcomes between young and more experienced surgeons, whereas for low-complexity ATS, there was no disparity. Attention to competency during residency training is warranted, especially as it relates to high-complexity ATS. Furthermore, patient outcomes provide an opportunity to assess competency after training that can complement assessments during training and together identify educational strengths and weaknesses of residency training.
Prystowsky
Jay B
JB
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. jprystowsky@nmff.org
D000328:Adult; D002568:Certification; D002983:Clinical Competence; D004066:Digestive System Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000193:education* / Q000592:standards*; D005260:Female; D006801:Humans; D007087:Illinois; D007396:Internship and Residency / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome