C3 - 02: PERIOPERATIVE EDUCATION IN AN ACADEMIC TRAINING INSTITUTION: WHERE DO WE STAND?
Heather A Lillemoe, MD, David P Stonko, BS, MS, Kyla P Terhune, MD, MBA, Sunil K Geevarghese, MD, MSCI; Vanderbilt University Medical Center

Background:  Every operative case is a learning opportunity and patient care benefits from optimal preparation.  We collected data regarding the current status of preoperative planning, perioperative communication, and receipt of postoperative feedback from resident trainees and attending surgeons at an academic general surgery residency program as a means of needs assessment.

Methods:  All categorical surgery residents at and above the PGY2 level (n=45) and all clinically active surgical faculty interacting with these residents were surveyed (n=65).  Surveys contained five questions targeting preoperative preparation and discussion as well as post-operative feedback.  Responses were collected on a scale that ranged from “Never” (0) to “All of the time” (100).  Participants were then asked specifically how residents could better prepare for cases, with multiple-choice options as well as an option for open-ended response.

Results:  The overall response rate was 79.1% with 35 residents (77.8%) and 52 attending surgeons (80%).  On average, participating residents indicated that they come to the operating room with a specific learning objective 50.8% of the time, whereas attending surgeons perceived this to be the case 29.3% of the time (p<0.001).  When asked how residents could better prepare for a case, the majority of both residents and attending surgeons chose the option: “Breaking the operation down into key steps” (42.9% and 48.1%, respectively).  Both groups reported a low frequency of preoperative discussion of learning objectives (26.5% and 21.2%) and preoperative discussion of competence levels (23.1% and 13.9%).  Both residents and attendings reported that post-operative debriefing occurred approximately one third of the time. 

Conclusions:  Despite the fact that every case is a learning opportunity, a surprising number of trainees and faculty at our program did not report treating it as such.  Additionally, there was a discrepancy between resident-reported preoperative goal-setting and attending perceptions of resident goal-setting, as well as a low frequency of preoperative discussion between resident and attending.  This indicates not only a deficit in preoperative planning, but also in perioperative communication.  We are in the process of developing and implementing interventions to target these areas, and we share this needs assessment as a potential tool for other programs.