Protected educational rotations: a valuable paradigm shift in surgical internship.
OBJECTIVE
The first year of surgical training sometimes includes marginally educational or service-related tasks with limited direct interactions with faculty. We instituted a prototype rotation to address the changing needs and expectations of our intern class. This study was designed to evaluate the new rotation 17 months after it was implemented.


METHODS
Interns spend 4 weeks in our outpatient surgery center. Elements of the rotation include performance of operative cases and perioperative management of outpatients under direct faculty supervision, daily one-on-one structured teaching sessions with faculty, and call coverage twice monthly. At the conclusion of the rotation, interns make a presentation on a topic of their choosing to a teaching conference. Rotation evaluations and case and work-hour logs for the outpatient surgery rotation (OSR) were compared with those for the remaining intern rotations combined. A faculty survey of the OSR also was conducted.


RESULTS
The OSR consistently received maximum overall ratings (4 of 4), significantly higher than the average overall score for the remaining rotations (3.17, p < 0.01). Similarly, teaching by faculty, time spent in the operating room, and quality of operating room time were rated significantly higher than for the other intern rotations (p </= 0.05). Interns performed an average of 44 cases in 4 weeks of OSR, compared with an average of 94 in the remaining rotations (p < 0.001), and they worked an average of 62 hours per week (range, 49-76 hours). Of the participating faculty, 93% reported that the interaction gave them the opportunity to know the interns better at a personal level, that the sessions were beneficial and improved working relationships with interns, and that the program should continue.


CONCLUSIONS
Changing program requirements, time restrictions, public scrutiny, and increasing awareness for quality of life all obligate a paradigm shift in surgical education. Our outpatient rotation is logistically simple and rewarding both for residents and faculty.
Tillou
Areti
A
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095-6904, USA. atillou@mednet.ucla.edu
Hiatt
Jonathan R
JR
Leonardi
Michael J
MJ
Quach
Chi
C
Hines
O Joe
OJ
D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004521:Educational Measurement; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D015141:Los Angeles; D017145:Models, Educational; D010561:Personnel Staffing and Scheduling; D016730:Program Development; D015397:Program Evaluation; D016526:Workload