Early Results from the Flexibility in Surgical Training Research Consortium: Resident and Program Director Attitudes Toward Flexible Rotations in Senior Residency

• Published in: Journal of surgical education Vol. 72; no. 6; pp. e151 - e157
• Main Authors: Klingensmith, Mary E., MD, Awad, Michael, MD, PhD, Delman, Keith A., MD, Deveney, Karen, MD, Fahey, Thomas J., MD, Lees, Jason S., MD, Lipsett, Pamela, MD, Mullen, John T., MD, Smink, Douglas S., MD, MPH, Wayne, Jeffrey, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2015
• Subjects: Adult; Attitude; autonomy; Female; general surgery; graduate medical education; Humans; Internship and Residency - methods; Male; Middle Aged; Patient Care, Medical Knowledge; Personal Satisfaction; Physician Executives; postgraduate education; Practice-Based Learning and Improvement; Prospective Studies; Specialties, Surgical - education; subspecialty surgery training; Surgery; surgery residency training; Systems-Based Practice; graduate medical education; subspecialty surgery training; autonomy; postgraduate education; Patient Care, Medical Knowledge; Systems-Based Practice; surgery residency training; general surgery; Practice-Based Learning and Improvement
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2015.05.007

Objective To assess the attitudes of residents and program directors (PDs) involved in flexible training to gauge satisfaction with this training paradigm and elicit limitations. Design Anonymous surveys were sent to residents and PDs in participant programs. Respondents were asked to rate responses on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). Setting A total of 9 residency programs that are collaborating to prospectively study the effect of flexible tracks on resident performance and outcome. Participants A total of 138 residents who were in clinical years 4 and 5 and 10 PDs. Results Of the 138 possible residents, 100 responded to the resident survey (72.5% response rate). Among resident respondents, 33% were participating in a flexible track option. The most frequently listed specialties of focus were cardiothoracic surgery (19%), vascular surgery (13%), acute care surgery (11%), colorectal surgery (8%), surgical oncology (7%), and pediatric surgery (7%). Participants in flexible tracks tended to strongly agree that their career would be enhanced by flexible rotations; interestingly, of those not in flexible tracks, most tended to also agree that flexible rotations would enhance their future careers. Flexible track participants report receiving greater autonomy on flexible rotations and believe they would be better prepared for fellowship and career. They express overall very high satisfaction with the flexible experience. Limitations expressed by residents (in flexible tracks or not) include uncertainty for how this paradigm serves those interested in comprehensive general surgery, concern about scheduling difficulties, and some displeasure in missing high-volume general surgery rotations in lieu of specialty-focused rotations. The PD survey was completed by 8 of 9 PDs for a response rate of 89%. All the respondents agreed or strongly agreed that careers of residents are enhanced by flexible rotations and that important operative and clinical experiences are gained. Overall, 87.5% of PD respondents agreed or strongly agreed that those in flexible tracks have greater opportunities for mentorship in their chosen field. PDs also expressed high levels of satisfaction with flexible rotations. Limitations include concerns that the flexibility option presents scheduling difficulties and does not go far enough in reforming postgraduate education. Conclusions This survey of 9 residency programs participating in flexible tracks indicates satisfaction with this training option. The role of comprehensive general surgery as a training end point and scheduling difficulties remain as major challenges. Outcomes of graduates in these tracks and control peers are being prospectively evaluated.