PMID- 28967577 OWN - NLM STAT- MEDLINE DCOM- 20181211 LR - 20181211 IS - 1878-7452 (Electronic) IS - 1878-7452 (Linking) VI - 75 IP - 2 DP - 2018 Mar-Apr TI - Progressive Surgical Autonomy Observed in a Hand Surgery Resident Clinic Model. PG - 450-457 LID - S1931-7204(17)30073-9 [pii] LID - 10.1016/j.jsurg.2017.07.022 [doi] AB - OBJECTIVE: Resident clinics (RCs) are intended to catalyze the achievement of educational milestones through progressively autonomous patient care. However, few studies quantify their effect on competency-based surgical education, and no previous publications focus on hand surgery RCs (HRCs). We demonstrate the achievement of progressive surgical autonomy in an HRC model. DESIGN: A retrospective review of all patients seen in a weekly half-day HRC from October 2010 to October 2015 was conducted. Investigators compiled data on patient demographics, provider encounters, operational statistics, operative details, and dictated surgical autonomy on an ascending 5 point scoring system. SETTING: A tertiary hand surgery referral center. RESULTS: A total of 2295 HRC patients were evaluated during the study period in 5173 clinic visits. There was an average of 22.6 patients per clinic, including 9.0 new patients with 6.5 emergency room referrals. Totally, 825 operations were performed by 39 residents. Trainee autonomy averaged 2.1/5 (standard deviation [SD] = 1.2), 3.4/5 (SD = 1.3), 2.1/5 (SD = 1.3), 3.4/5 (SD = 1.2), 3.2/5 (SD = 1.5), 3.5/5 (SD = 1.5), 4.0/5 (SD = 1.2), 4.1/5 (SD = 1.2), in postgraduate years 1 to 8, respectively. Linear mixed model analysis demonstrated training level significantly effected operative autonomy (p = 0.0001). Continuity of care was maintained in 79.3% of cases, and patients were followed an average of 3.9 clinic encounters over 12.4 weeks. CONCLUSIONS: Our HRC appears to enable surgical trainees to practice supervised autonomous surgical care and provide a forum in which to observe progressive operative competency achievement during hand surgery training. Future studies comparing HRC models to non-RC models will be required to further define quality-of-care delivery within RCs. CI - Copyright (c) 2017. Published by Elsevier Inc. FAU - Day, Kristopher M AU - Day KM AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee. Electronic address: krisophermday@gmail.com. FAU - Zoog, Evon S AU - Zoog ES AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of General Surgery, Hayes Hand Center, Chattanooga, Tennessee. FAU - Kluemper, Chase T AU - Kluemper CT AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee. FAU - Scott, Jillian K AU - Scott JK AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee. FAU - Steffen, Caleb M AU - Steffen CM AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee. FAU - Kennedy, James Woodfin AU - Kennedy JW AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee. FAU - Jemison, David Marshall AU - Jemison DM AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee. FAU - Rehm, Jason P AU - Rehm JP AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee. FAU - Brzezienski, Mark A AU - Brzezienski MA AD - University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee; Department of Plastic Surgery, University of Tennessee College of Medicine, Hayes Hand Center, Chattanooga, Tennessee; Department of Orthopedic Surgery, Hayes Hand Center, Chattanooga, Tennessee. LA - eng PT - Journal Article DEP - 20170928 PL - United States TA - J Surg Educ JT - Journal of surgical education JID - 101303204 SB - IM MH - Ambulatory Surgical Procedures/*education MH - *Clinical Competence MH - Cohort Studies MH - Competency-Based Education MH - Education, Medical, Graduate/*methods MH - Female MH - Hand/surgery MH - Humans MH - Internship and Residency/*methods MH - Male MH - Orthopedics/*education MH - *Professional Autonomy MH - Retrospective Studies MH - United States OTO - NOTNLM OT - Interpersonal and Communication Skills OT - Medical Knowledge OT - Patient Care OT - Practice-Based Learning and Improvement OT - Professionalism OT - Systems-Based Practice OT - hand surgery OT - operative autonomy OT - resident clinic OT - surgical education EDAT- 2017/10/03 06:00 MHDA- 2018/12/12 06:00 CRDT- 2017/10/03 06:00 PHST- 2017/02/05 00:00 [received] PHST- 2017/05/31 00:00 [revised] PHST- 2017/07/24 00:00 [accepted] PHST- 2017/10/03 06:00 [pubmed] PHST- 2018/12/12 06:00 [medline] PHST- 2017/10/03 06:00 [entrez] AID - S1931-7204(17)30073-9 [pii] AID - 10.1016/j.jsurg.2017.07.022 [doi] PST - ppublish SO - J Surg Educ. 2018 Mar-Apr;75(2):450-457. doi: 10.1016/j.jsurg.2017.07.022. Epub 2017 Sep 28.