Massachusetts Chapter of the American College of Surgeons

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A Comparison of Patient Satisfaction when Office-based Surgical Procedures are Performed by Surgical Residents versus an Attending
Brandon M. Wojcik, Noor Amari, Sophia K. McKinely, David C. Chang, Heather Wachtel, Emil Petrusa, John T. Mullen, Roy Phitayakorn
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Background: Patient satisfaction is an increasingly important quality metric nationwide. However, the impact that surgical trainees have on patient satisfaction when they perform operations independently has not been studied. We sought to define this relationship within the context of a minor surgery clinic over the course of a single academic year.

Methods: A questionnaire was developed and administered to 170 patients to assess periprocedural satisfaction from 10/2016 to 5/2017. Patients reported whether their operation was completed by an attending surgeon or a rotating third-year general surgery resident. The study was adequately powered to detect primary outcomes, including a rating of procedural pain (0=no pain, 10=worst pain) and quality of care (0=worst care, 10=best care). Multivariate analysis was performed adjusting for surgeon, age, education level, and multiple procedures.

Results: The response rate was 89% (n=84 resident vs n=86 attending). Soft tissue mass excisions were the most commonly performed procedure in the clinic. There was no significant difference in average pain ratings (0.90.1 resident vs 0.60.1 attending; range 0-5; p=0.13) or quality of care ratings (9.90.05 resident vs 9.90.03 attending; range 7-10; p=0.22). On adjusted analysis, patients rating quality of care as a 10 was not influenced by residents performing the operation.

Conclusions: Patient satisfaction was very high when residents performed minor surgical operations in an office-based setting. Importantly, there was no difference in satisfaction when compared to the levels attained by an attending surgeon. This study demonstrates that high resident operative autonomy and patient satisfaction are not mutually exclusive educational goals.

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