title: Senior residents as teaching assistants during laparoscopic cholecystectomy in the 80-hour workweek era: effect on biliary injury and overall complication rates.
abstract: OBJECTIVE
  The resident as teaching assistant (TA) in the operating room is an important role in the maturation of surgical trainees. One concern in the current 80-hour workweek era is that current senior residents (SRs) are unprepared to serve as TAs, potentially leading to higher complication rates and a significant increase in the length of operations. The aim of this study was to analyze whether SRs serving as TAs during laparoscopic cholecystectomy (LC) resulted in an adverse effect on complication rates in the 80-hour workweek era.
  
  
  METHODS
  A retrospective review was conducted of 1668 LC performed at 2 affiliated general surgery teaching hospitals from 2003 through 2007. Teaching hospital A was a public teaching hospital where junior residents (JR) performed the LC with a scrubbed SR as TA under faculty supervision. Teaching hospital B was a community-based affiliate hospital where the JR performed LC with only scrubbed faculty supervision. Operative case duration, JR level, patient gender/age, operative indication, final pathology, and complication data were gathered and univariate and multivariate analyses were performed.
  
  
  RESULTS
  Despite a higher rate of acute cholecystitis in the TA hospital, LC-associated complications occurred at similar rates with and without SR as TA. The rate of biliary injury was also the same in both hospitals. On multivariable analysis, only male gender was associated with complications (odds ratio = 1.7; p = 0.004).
  
  
  CONCLUSIONS
  In the 80-hour resident workweek era, SRs acting as TAs during LC is not associated with increased total complications or an increased rate of biliary injury.
authors.affiliation: Department of Surgery, Harbor UCLA Medical Center, Torrance, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California.
authors.forename: Samuel I
authors.initials: SI
authors.lastname: Schwartz
authors.forename: Arezou T
authors.initials: AT
authors.lastname: Yaghoubian
authors.forename: Iden D
authors.initials: ID
authors.lastname: Andacheh
authors.forename: Sari H
authors.initials: SH
authors.lastname: Green
authors.forename: Ann E
authors.initials: AE
authors.lastname: Falor
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.forename: Gerald D
authors.initials: GD
authors.lastname: Wilmoth
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Stabile
authors.forename: Christian M
authors.initials: CM
authors.lastname: de Virgilio
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001659:Biliary Tract / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000193:education / Q000379:methods; D002983:Clinical Competence; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007396:Internship and Residency / Q000458:organization & administration*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D007857:Leadership; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D013663:Teaching / Q000379:methods / Q000458:organization & administration*; D014940:Work Schedule Tolerance
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; laparoscopic cholecystectomy teaching