I thought this was an interesting article I wanted to share with our readers.
Every operation has risks. How does that change – or not – when surgical residents are involved?
Like anything, it takes time and practice to become a qualified surgeon. But what is the appropriate balance of allowing residents to gain experience and giving patients the best care possible? U.S. News explored the risks and benefits to surgery at teaching hospitals: Do the benefits of surgery at a major academic institution outweigh the costs of patients being used as a teaching tool? Is care from a surgical resident of lesser quality than care from an attending surgeon? While opinions vary among patients and medical professionals, the majority agree patients should be well-informed before making any major health care decisions.
Who Is Really Doing My Surgery at a Teaching Hospital?
When you undergo surgery at a hospital with a residency program, you should know residents are going to be involved with your operation and postoperative care. While attending surgeons are required to supervise, and inexperienced residents should not be performing complex procedures, a teaching hospital means new doctors are learning how to perform surgery – that’s how the system works.
David Shahian, a professor of surgery at Harvard Medical School and vice president of the Massachusetts General Hospital Center for Quality and Safety, says patients have the right to know about resident involvement, but he says they should not be concerned as institutions take the necessary precautions to keep patients safe.
“In our health care system, our first responsibility is to provide the best possible care to our patients. But unless we plan for the health care system to stop after this generation of physicians, we have to constantly be training the next generation,” he says.
Sid Schwab, a retired general surgeon from the Everett Clinic in Washington, who assists in the operating room and serves as a mentor for young surgeons, says doctor-patient communication is an important aspect of a successful surgical experience. “Patients ought to be aware that if they’re at a university hospital, there are going to be doctors in training involved in their care,” he says. “It’s up to the people involved in it to make sure the patient knows.”
What Are the Benefits of Surgery at a Teaching Hospital?
While some consider resident involvement a risk to surgery at a teaching hospital, many medical professionals consider residents to be extremely beneficial. Either way, their presence affects what teaching institutions can offer patients.
Shahian points out that teaching hospitals are at the forefront of medical research and are often referral centers for rare and extreme medical cases. They also encourage surgical attendings to be up to date on medical discoveries. “It forces [attending surgeons] to keep up with all the current literature because they are constantly getting questions from the residents,” he says. “The residents bring a vibrant intellectual atmosphere to the institution.”
Jon Schellack, a vascular surgeon in Baton Rouge, Louisiana, and clinical professor of surgery at Louisiana State University Health Sciences Center-New Orleans, has been working with surgical residents for 25 years. He says the residency program creates a better environment for patients and doctors.
“The medical students and the residents are very inquisitive, and they are also always looking up the patient’s problem and diagnosis and researching it and challenging me and asking me questions,” he says.
Shahian adds that people tend to forget residents are qualified medical doctors, and at a teaching institution, certified doctors are constantly available. “I don’t think people realize that after medical school, the period of residency for a surgeon can be anywhere from five to 10 years,” he says.
Shahian conducted a study that evaluated the outcomes of over 1.5 million Medicare patientsexperiencing three commonly treated health problems: heart attacks, heart failure and pneumonia. Using data from 2009 to 2010, the study found that there was a 10 percent reduced risk of mortality by being treated in a teaching hospital.
Stephen Yang, a professor of surgery and oncology at the Johns Hopkins University School of Medicine and chief of thoracic surgery at Johns Hopkins Medicine, wrote a 2008 paper that compared the outcomes for lung cancer patients at teaching hospitals versus nonteaching hospitals using the National Inpatient Sample database. “The mortality was better [and] the complications were less at teaching hospitals,” Yang says, “so overall I think the general outcomes were better.”
David Farley, a professor of surgery at the Mayo Medical School and former program director of the General Surgery Training Program, has also focused on the subject in his research and has seen a difference in procedure lengths. “When you let surgical residents participate in an operation with a staff person close by mentoring, proctoring, helping, the operative times tend to be a little bit longer,” Farley says. However, he adds that the outcomes of teaching versus nonteaching hospitals “are virtually the same and, if anything, maybe slightly improved.”