PS4 - 08: RESIDENT PERCEPTIONS AND EVALUATIONS OF FELLOW-LED AND RESIDENT-LED SURGICAL SERVICES
Aaron M Williams, MD, Britta Han, BS, Meredith Barrett, MD, Niki Matusko, BS, Isabel S Dennahy, MD, Umar F Bhatti, MD, Kenneth J Woodside, MD, Gurjit Sandhu, PhD; University of Michigan Health System

Background: There are increasing numbers of fellow-led surgical services that impact core requirement rotations for surgical training. While previous investigations have focused on operative volume and index cases, we sought to investigate surgical resident perceptions of fellow-led and resident-led surgical services.

Methods: Retrospective cross-sectional data were collected from categorical general surgery and integrated vascular and cardiothoracic surgery residents’ service evaluations from 7/2014 through 7/2017.  Surgical services were categorized as resident-led (Trauma/ACS, Endocrine, MIS, Oncology, Colorectal, HPB, and VA General & Vascular) and fellow-led (Transplant, Thoracic, Pediatric). A total of 31 variables were evaluated utilizing a 9-point, Likert-type scale and collapsed into 7 factors including clinical experience, educational experiences, clinical staff, workload, feedback, treatment of residents, and overall rotation. Postgraduate year (PGY) levels were grouped as PGY1-2, PGY3, and PGY4-5.  Factor analysis and Cronbach’s alpha were used to assess the uni-dimensionality and internal consistency of the factors.  Mixed-effects modeling was used to ascertain differences in these factors, comparing fellow-led and resident-led surgical services.

Results: Overall, 1538 resident evaluations were obtained. Among all PGY levels, fellow-led surgical services were rated significantly higher (P < 0.05) regarding clinical experience (7.14 vs 6.84), clinical staff (6.93 vs 6.74), treatment of residents (7.37 vs 7.16), and overall rotation (7.03 vs 6.83) when compared to resident-led services. However, no differences were noted in educational experiences, workload, and feedback. Regarding PGY level, PGY1-2 residents rated fellow-led services significantly higher in the area of clinical staff with no differences in other categories when compared to resident-led surgical services. No significant differences were noted at the PGY 3 level for all categories. However, PGY4-5 residents rated fellow-led services significantly higher in all categories, including clinical experience, educational experiences, clinical staff, workload, feedback, treatment of residents, and overall rotation.

Conclusions: Surgical residents appear to value the experiences of fellow-led surgical services. Overall, senior residents report significant advantages to training, while junior and mid-level residents viewed fellow-led and resident-led surgical services similarly. Fellow-led services provide unique educational opportunities and resources at different PGY levels, and should be included in core surgical rotations.