1. Are We There Yet: Optimal Duration for Direct Supervision of Surgical Interns Joseph M. Galante, MD, Jonathan Pierce, MD, Soman Sen, MD, Ahmed Mahmoud, MD* University of California, Davis, Sacramento, CA *San Joaquin General Hospital, French Camp, CA

2. JULY 1 st, 2011 ACGME- Common Program Requirements –16 hour max intern shifts –Strategic napping –Direct / Indirect supervision requirements Addressed most important issue of resident supervision A date which will live in infamy… A date which will live in infamy…

3. Supervision Requirements Direct Supervision Indirect Supervision with direct immediately available Indirect Supervision with direct available

4. RRC- Surgery Patient Management –Critically ill patients –Common postoperative complications –Evaluation and management of urgent consults, including trauma Procedural Program Directors determine when to shift level of supervision

5. Active Learning Adequate supervision Exploration Experimentation Reflection on results Patient Safety

6. Study Goals Determine if incoming residents competent Time component for postoperative care competency

7. Methods Designed a 20 question multiple choice test Focused on patient care (postoperative complications) Administered to outgoing and incoming PGY-1s and 60 days into training Two programs: University & Community

8. Competency Training University –Focused didactics / Fundamentals of Surgery Curriculum –Simulators (patient assessment & nursing script) –Focused bedside faculty directed teaching Community –Focused didactics –Faculty directed bedside teaching

9. Results PGY-1Completed Percent Correct Departing12/22 88.3% (75-100) Incoming23/23 77.8% (55-100) p<0.01 PGY-1Completed Percent Correct Departing3/3 81.6% (75-90) Incoming3/3 73.3% (70-80) p<0.05 Community University

10. Results – 60 Days Percent Correct p value Community 60 day 86.7% 60 day vs. Incoming 86.7% vs. 73.3% p<0.05 60 day vs. Outgoing 86.7% vs. 81.6% Ns Percent Correct p value University 60 day 89.1% (65-100) 60 day vs. Incoming 89.1% vs. 77.8% p<0.01 60 day vs. Outgoing 89.1% vs. 88.3% Ns

11. Competency Not competent at start of internship Test scores at 60 days similar to departing interns Scores improve regardless of training format Not all passed = Not all competent

12. Future Study Expand to include more programs Develop and utilize a standardized examination focusing specifically on these postoperative management topics

13. Conclusions Template upon which to work Consider competence after 60 days Begin transition to indirect supervision