Early career surgeon performance - a patient safety blind spot

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Project Summary/Abstract A recent multi-institutional study suggested that graduating general surgery trainees could not independently perform common operations over 20% of the time. These findings raise serious concerns about the readiness of early career surgeons to provide safe, high-quality surgical care. The degree to which these training deficiencies compromise patient safety is unknown. A better understanding of the relationship between surgical training, surgeon performance, and patient outcomes is needed to effectively tackle these issues. Ultimately, we must update the standards that must be met by all surgical trainees prior to graduation. There are, however, several knowledge gaps that must be addressed before the full potential of this approach can be realized. The purpose of this proposal is to close those gaps and map a policy response moving forward. The specific research aims of this proposal are to (i) determine the operative performance of early career surgeons assessed using risk-adjusted outcomes in national Medicare claims data; (ii) determine if a surgeon’s trainee performance ratings are valid predictors of their early career risk-adjusted patient outcomes; and (iii) determine if initial certification of surgeons immediately after training reliably discriminate early career surgeon performance. This study will, for the first time, determine the degree to which early career surgeon competence impacts health care quality and whether existing measures of trainee competence are useful predictors of early career performance. The results of this study can ultimately be used to implement new training standards to ensure that all early career surgeons are competent. These changes are urgently needed to safeguard the health of millions of American patients. This project will also facilitate the career development of the candidate. The highly experienced and multidisciplinary mentorship team, the proposed career development and research plan, and the unparalleled research environment are ideally suited to address the career goals and educational needs of the candidate PI, Brian George, MD, MA. Although he has substantial prior experience assessing surgical trainee performance, he has no experience using Medicare claims data to assess risk-adjusted outcomes. These skills are necessary for him to achieve his goal of ensuring that all early career surgeons provide safe care. This proposal therefore includes additional training which will be essential both for the successful completion of this research and for Dr. George’s career development, including graduate level courses in Medicare claims data analysis, the use of risk-adjusted outcomes for performance measurement, and advanced statistical modeling. This career development award will lay the groundwork for Dr. George to mature as an independent investigator and national leader in understanding how to ensure all surgeons provide safe care when they enter practice.