title: Surgical residents' clinical activity during research: shedding light on moonlighting practices.
abstract: OBJECTIVE
  General surgery residents who are planning an academic career typically interrupt their clinical residency training with a dedicated period of research. During these research interludes, many residents engage in clinical work, but the characteristics, motivations, and perceived value of such "moonlighting" practices are unknown. We sought to objectively characterize residents' clinical experiences during intervals primarily dedicated to research.
  
  
  METHODS
  Surveys were administered to all residents in a university-based general surgery residency program as well as residents from other programs included in the moonlighting pool. Surveys consisted of Likert-type and open-response elements. Residents' personal operative logs were abstracted for the period of their research fellowships. Hospital schedules over 32 months were used to determine hours spent on clinical duty objectively. Residents were excluded from the analysis if not actively engaged research, if not supported by intramural or extramural funding, or if moonlighting at a facility from which duty records could not be obtained.
  
  
  RESULTS
  Survey response rates were 97.7% (43/44) for preresearch (junior) residents and 90.7% (39/43) for current and postresearch (senior) residents. Average self-reported moonlighting volume was 20.0 hours/week (SD 11.3). Average actual moonlighting volume was 20.2 hours/week (SD 2.4), or 1.45 shifts/week (SD 0.2). Shifts were tabulated independent of shift length. The option to moonlight was felt to be an important component of research fellowships by 92.5% of senior residents and 70% of junior residents. The 2 greatest motivations to moonlight were listed as financial benefit (96.0%) and maintenance of clinical acumen (93.3%). In all, 45% of senior residents felt that moonlighting did not impact their research productivity; 30% of senior residents felt that moonlighting did impact research. Of operations performed while moonlighting, 76.9% of senior residents reported that at least some operations were particularly valuable because of rarity, complexity, or limited prior exposure. Overall, 86.2% of surveyed residents believed operations performed during research should be recognized by the Accreditation Council for Graduate Medical Education (ACGME).
  
  
  CONCLUSIONS
  Residents derive financial and educational benefit from clinical activity during research fellowships, and the option to pursue such moonlighting is considered important. The moonlighting system within this training program is voluntary, and residents are treated with graduated responsibility according to their postgraduate year. Most residents had some particularly valuable operative experiences while moonlighting; inclusion of these operations in residents' ACGME case logs should be considered.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, California 94143-0470, USA. ramin.jamshidi@ucsf.edu
authors.forename: Ramin
authors.initials: R
authors.lastname: Jamshidi
authors.forename: Linda M
authors.initials: LM
authors.lastname: Reilly
mesh_terms: D000328:Adult; D002140:California; D005257:Fellowships and Scholarships; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009042:Motivation; D012106:Research; D011795:Surveys and Questionnaires; D016526:Workload