Prevention of surgical resident attrition by a novel selection strategy.

Objective(s): We modified the resident selection strategy in an attempt to reduce resident attrition (RA).

Summary Background Data: Despite implementation of the Accreditation Council for Graduate Medical Education work rules, lifestyle and generational priorities have fostered a persistent and relatively high attrition rate for surgical trainees.

Methods: An independent external review of residents who left the training program and a detailed analysis of the resident selection strategy were performed by an organizational management expert.

Contributions of surgical residents to patient satisfaction: impact of residents beyond clinical care.

Purpose: Little is known about the relationship between resident performance and patient satisfaction. To this end, our institution added housestaff-specific questions to Press-Ganey surveys (Press-Ganey, South Bend, Indiana) administered to patients. This study sought to investigate the impact residents have on patients' overall rating of care compared with faculty and nursing staff.

The Patient Safety Leadership Academy at the University of Pennsylvania: the first cohort's learning experience.

Background: We based the Patient Safety Leadership Academy (PSLA) on the premise that improving management skills could improve patient safety and employee satisfaction.

Study Design: Fellows completed baseline surveys on leadership skills knowledge, patient safety knowledge, and program goals. They completed the same surveys 7 months later at the final PSLA session.

Living long with short bowel syndrome: a historical case of twenty-nine years of living with home parenteral nutrition.

Background: This paper traces the 29-year survival of Robert Thomas, who received home parenteral nutrition (PN), and contrasts his oral narrative with the clinical history of PN.

Methods: Interviews, chart review, review of the literature, and historical analysis.

Results: Bobby Thomas was part of an early group of patients scattered throughout the country who, with their medical team, provided the foundation for more successful survival with home PN.

Patterns and predictions of resident misbehavior--a 10-year retrospective look.

Background: Surgical educators are charged with ensuring that their trainees conduct themselves in a professional manner. The authors retrospectively reviewed a 10-year experience of incident reports on surgical housestaff to determine patterns and predictors of behavior.

Methods: A retrospective review of all letters, e-mails, and incident reports was conducted for general surgery residents from 1995 to 2005.

How do surgical residents and non-physician practitioners play together in the sandbox?

Introduction: The reduction of resident work hours due to the 80-hour workweek has created pressure on academic health-care systems to find "replacement residents." At the authors' institution, a group of nurse practitioners (NPs) and physician assistants (PAs), collectively referred to as non-physician practitioners (NPPs), were hired as these reinforcements, such that the number of NPPs (56) was almost twice the number of clinical categorical surgery residents (37). An experienced leader with national credibility was hired to run the NPP program.

Surgeon contribution to hospital bottom line: not all are created equal.

Objective: We hypothesized that surgeon productivity is directly related to hospital operating margin, but significant variation in margin contribution exists between specialties.

Summary Background Data: As the independent practitioner becomes an endangered species, it is critical to better understand the surgeon's importance to a hospital's bottom line. An appreciation of surgeon contribution to hospital profitability may prove useful in negotiations relating to full-time employment or other models.