Original Articles
The financial impact of teaching surgical residents in the operating room

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Abstract

Background: There have been no published data regarding the cost of training surgical residents in the operating room.

Methods: At the University of Tennessee Medical Center-Knoxville, in addition to resident-performed teaching cases, some cases are performed without the assistance of residents by the same faculty.

Results: Sixty-two case categories involving 14,452 cases were compared for operative times alone. In 46 case categories (10,787 procedures), resident operative times were longer than faculty alone. In 16 case categories, resident operating times were shorter than faculty times. The net incremental operative time cost was 2,050 hours between July 1993 and March 1997. Assuming 4 years of operative training for 11 graduating chief residents, the cost per graduating resident was $47,970.

Conclusion: Extrapolated to a national annual cost for the 1,014 general surgery residents who completed training in the 1997 academic year, the annual cost of training residents in the operating room is $53 million. This high monetary cost suggests the need for digital skills, selection criteria, the development of training curriculum and resource facilities, the pre-operating room need for suturing and stapling techniques, and perhaps the acquisition of virtual surgery training modules.

Section snippets

Methods

Since our residency is not large enough to allow resident participation in all operative procedures, surgical faculty perform some cases without resident participation. Since the faculty surgeon is constant, the variable of resident participation was thought to be an adequate means of separating cases into those definitely not done by a resident and those probably done by a resident. Both resident and faculty evaluations have suggested that over 95% of the procedures that involve a resident are

Results

There were 14,452 total cases for analysis, 9,733 with a resident and 4,719 with no resident (Table IV). There were 46 operative case categories (10,787 cases) in which procedures performed with a resident required longer operative times (103 minutes average time) when compared with cases done without a resident (61 minutes average time). This resulted in a total of 148,812 more minutes (2,480 hours), of operating time than would have been expected if the case times had been the same as those

Comments

One can certainly take exception to the methodologies used in this analysis. Some of the cases listed with the resident may actually have been done by faculty, but our internal analysis seems to indicate that cases done with a resident listed by operating room personnel as assistant serves as a reasonable proxy for “case done by resident with faculty in attendance.” If anything, the potential to have some resident cases actually done by faculty would minimize the effect of lost time rather than

References (3)

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