title: The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy.
abstract: OBJECTIVE
  General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program.
  
  
  METHODS
  Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort.
  
  
  METHODS
  Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program.
  
  
  METHODS
  Ten third-year general surgery residents.
  
  
  RESULTS
  Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing increased operative autonomy as the greatest strength.
  
  
  CONCLUSIONS
  Implementation of a resident-run minor surgery clinic is a safe and effective method to increase trainee operative autonomy. The rotation is well suited for mid-level residents, as it provides an opportunity for realistic self-evaluation and focused learning that may enhance their operative experience during senior level rotations.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Wojcik
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Zhi Ven
authors.initials: ZV
authors.lastname: Fong
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Emil
authors.initials: E
authors.lastname: Petrusa
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: rphitayakorn@mgh.harvard.edu.
authors.forename: Roy
authors.initials: R
authors.lastname: Phitayakorn
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D016022:Case-Control Studies; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008404:Massachusetts; D013511:Minor Surgical Procedures / Q000379:methods; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010819:Physician's Role; D010865:Pilot Projects; D017009:Professional Autonomy; D012449:Safety; D000070319:Student Run Clinic / Q000458:organization & administration*
keywords: Patient Care, Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; autonomy; deliberate practice model; graduate medical education; minor surgery; patient outcomes; resident clinic