Using patient outcomes to assess surgical residency program performance

Editor's Note

The 2014 Institute of Medicine report calls for restructuring of Medicare funding for graduate medical education to incorporate pay-for-performance methods. However, to evaluate and financially reward residency programs based on performance, performance must be defined and measurable.

This study assesses general surgery residency program performance using outcomes, including in-hospital death, development of one or more postoperative complications before discharge, prolonged length of stay, and failure to rescue.

Patients operated on by surgeons from residency programs ranked in the top tertile were significantly less likely to experience adverse events than patients operated by surgeons ranked in the bottom tertile. The magnitude of difference across programs was small, however.

The authors note that careful consideration must be used when identifying potential targets for pay-for-performance initiatives in graduate medical education. 

Importance To evaluate and financially reward general surgery residency programs based on performance, performance must first be defined and measureable. Objective To assess general surgery residency program performance using the objective clinical outcomes of patients operated on by program graduates.