A Qualitative Study of the Barriers and Benefits to Resident Education in Ambulatory Surgical Centers

Andrew D Zale; Christopher I Song; Ashley Zhou; Jonathan Lai; Minyoung Jang; Pamela A Lipsett; Sanjay V Desai; Laura A Hanyok; Jessica L Bienstock

doi:10.1016/j.jsurg.2021.04.002

A Qualitative Study of the Barriers and Benefits to Resident Education in Ambulatory Surgical Centers

J Surg Educ. 2021 Nov-Dec;78(6):1825-1837. doi: 10.1016/j.jsurg.2021.04.002. Epub 2021 Jun 3.

Authors

Andrew D Zale¹, Christopher I Song², Ashley Zhou², Jonathan Lai², Minyoung Jang², Pamela A Lipsett³, Sanjay V Desai², Laura A Hanyok², Jessica L Bienstock²

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: azale2@jhmi.edu.
² Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

PMID: 34092534
DOI: 10.1016/j.jsurg.2021.04.002

Abstract

Objective: As Ambulatory Surgical Centers (ASCs) become more common in academic medical centers, large hospital systems must determine how to shift resident education from inpatient to outpatient surgical centers. This study aims to define stakeholders' views regarding the integration of surgical residents into ASCs.

Design: Long-form interviews lasting 30 to 60 minutes were conducted. Interviews were hand-transcribed and analyzed by qualitative analysis to determine benefits of learning in ASCs for residents, challenges that arise from integrating residents, and recommendations to improve resident incorporation.

Setting: Interviews were conducted using a video conferencing platform.

Participants: Residency program directors, attending surgeons, graduate medical learners, and a nursing manager were interviewed. Twenty-one total interviews were conducted, representing ten different departments.

Results: Stakeholders agreed that residents benefit from being placed in ASCs because the fast, surgical pace allows the residents to engage in more cases. However, different stakeholders highlighted different challenges, all centered around the notion of inter-stakeholder conflict due to conflicting priorities among residents, attending physicians, and administration. Likewise, recommendations differed by stakeholder group-faculty members sought more defined learning objectives and enhanced communication, whereas residents desired that ambulatory surgical time be more structured.

Conclusions: Despite the pressures of rapid case turnover, stakeholders agreed that there are many benefits to resident education in ASCs. Findings related to challenges and recommendations support the need to strengthen communication between stakeholder groups and better plan for resident integration into ASCs.

Keywords: Ambulatory medical centers; Ambulatory surgical procedures; Graduate medical education; Learning objectives; Surgical specialties.

MeSH terms

Ambulatory Care Facilities
Education, Medical, Graduate
Humans
Internship and Residency*
Medical Staff, Hospital
Qualitative Research