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LONGITUDINAL OPERATIVE FEEDBACK TOOL FOR COLORECTAL SUBSPECIALTY TRAINING
Jerry Xiao
*1, Jeffrey Van Eps
2, Marianne Cusick
21Surgery, Houston Methodist Hospital, Houston, TX; 2UT Health Science Center, Houston, TX
Introduction
Surgical residents lack consistent formalized feedback in their operative training. Current options such as the SIMPL OR app (The Society for Improving Medical Professional Learning) are cost-intensive and provide limited longitudinal feedback. For colorectal surgery subspecialty training, the Accreditation Council for Graduate Medical Education (ACGME) does not require programs to provide trainees with standardized operative feedback.
Methods
A colectomy proficiency initiative was developed at an ACGME-accredited colorectal surgery program with 12 teaching faculty and 4 subspecialty residents per year. An operative feedback tool (OFT) was developed to track residents’ operative proficiency progression. Three procedures were included; right colectomies, left/sigmoid colectomies, and colectomies with a low anterior resection (LAR). The OFT queried attendings and residents about the residents’ proficiency at key components of procedures (i.e. vascular pedicle dissection, colon mobilization, anastomosis, etc.) and their overall proficiency using a Likert scale. This was distributed via electronic survey and included daily text message reminders to complete the survey. Surveys were required to be completed within 48 hours of a qualifying procedure. Participants were provided with periodic, graphical, progress reports tracking their responses. Compliance was assessed by comparing responses to residents’ surgical case logs.
Outcomes
This quality improvement initiative has been ongoing for 14 weeks with 127 responses (79 attending, 48 resident). Attending surgeon survey compliance was 44.1%. Resident surgeon survey compliance was 26.8% (range 13.3% - 47.9%). 66.1% of responses were recorded after the evening text message reminder. 94.5% of responses were submitted via the link included in the reminder text message as opposed to a printed QR code (5.5%). 20.3% of attending responses included descriptive commentary/feedback on resident performance. Attending scores of resident proficiency were significantly higher than resident self-assessments (3.36 vs 2.75, p=0.015). In feedback surveys, all residents indicated that their periodic progress reports were helpful for tracking their operative proficiency and for identifying procedural components where they required additional training. 30.8% of participants indicated that the 48-hour time frame for submitting responses was too short.
Conclusions
Developing a consistently utilized OFT requires commitment from both the attending surgeon and trainee, consistent reminders, and ease of access to the OFT. Our OFT is helpful for tracking longitudinal progress and identifying procedural components in need of additional improvement. As this initiative continues, we will examine trends in resident performance both from the attending surgeon’s perspective and from the trainees’ self-reflection.
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