Tutorial Assistance for Board Certification in Surgery: Frequency, Associated Time and Cost.
Tutorial assistance is related to extra time and cost, and the hospitals' financial compensation for this activity is under debate. We therefore aimed at quantifying the extra time and resulting cost required to train one surgical resident in the operating theatre for board certification in Switzerland as an example of a training curriculum involving several surgical subspecialties. Additionally, we intended to quantify the percentage of tutorial assistance.



We analysed 200,700 operations carried out between 2008 and 2012. Median duration of procedure categories was calculated according to four different seniority levels. The extra time if the procedure was performed by residents, and resulting cost were analysed. The percentage of procedures carried out by residents as compared to more experienced surgeons was assessed over time.



On average, residents performed about a third of all operations including typical teaching procedures like appendectomies. An increase in duration and cost of well-defined procedures categories, e.g. cholecystectomies was demonstrated if a resident performed the procedure. In less well-defined categories, residents seemed to perform less difficult procedures than senior consultants resulting in shorter durations of surgery.



The financial impact of tutorial assistance is important, and solutions need to be found to compensate for this activity. The low percentage of procedures performed by trainees may make it difficult to fulfil requirements for board certification within a reasonable period of time. This should be addressed within the training curriculum.
Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. Robert.Mechera@usb.ch.
Robert
R
Mechera
Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.|Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
Salome
S
Dell-Kuster
Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.|Department of Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
Marco
M
von Strauss Und Torney
Department of Surgery, Lindenhof Hospital Bern, Bremgartenstrassse 117, 3012, Bern, Switzerland.|Swiss Association for Quality Assurance in Surgery (AQC), Birmensdorferstrasse 470, 8055, Zurich, Switzerland.
Igor
I
Langer
Department of Surgery, Cantonal Hospital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
Markus
M
Furrer
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
Heiner C
HC
Bucher
Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Rachel
R
Rosenthal
D000328:Adult; D000368:Aged; D002568:Certification; D003365:Costs and Cost Analysis; D005260:Female; D013502:General Surgery / Q000191:economics / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000191:economics; D008297:Male; D008875:Middle Aged; D013997:Time Factors