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Tan H, Bowden SG, Siler DA, O'Neill BE, Shahin MN, Fecker AL, Fleming-Sheffels S, Han SJ, Selden NR, Winer J, Orina JN. On-Call Workload Differences in Neurosurgery: Resident Call "Weather" and a Departure from Colored Cloud Labels. Neurosurgery 2024; 94:756-763. [PMID: 37874131 DOI: 10.1227/neu.0000000000002740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/13/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Labeling residents as "black" or "white" clouds based on perceived or presumed workloads is a timeworn custom across medical training and practice. Previous studies examining whether such perceptions align with objective workload patterns have offered conflicting results. We assessed whether such peer-assigned labels were associated with between-resident differences in objective, on-call workload metrics in three classes of neurosurgery junior residents. In doing so, we introduce more inclusive terminology for perceived differences in workload metrics. METHODS Residents were instructed to complete surveys to identify "sunny", "neutral", and "stormy" residents, reflecting least to greatest perceived workloads, of their respective classes. We retrospectively reviewed department and electronic medical records to record volume of on-call work over the first 4 months of each resident's 2nd postgraduate academic year. Inter-rater agreement of survey responses was measured using Fleiss' kappa. All statistical analyses were performed with a significance threshold of P < .05. RESULTS Across all classes, there was strong inter-rater agreement in the identification of stormy and sunny residents (Kappa = 1.000, P = .003). While differences in on-call workload measures existed within each class, "weather" designations did not consistently reflect these differences. There were significant intraclass differences in per shift consult volume in two classes ( P = .035 and P = .009); however, consult volume corresponded to a resident's weather designations in only one class. Stormy residents generally saw more emergencies and, in 2 classes, performed more bedside procedures than their peers. CONCLUSION Significant differences in objective on-call experience exist between junior neurosurgery residents. Self- and peer-assigned weather labels did not consistently align with a pattern of these differences, suggesting that other factors contribute to such labels.
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Affiliation(s)
- Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Stephen G Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Dominic A Siler
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Brannan E O'Neill
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Maryam N Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Adeline L Fecker
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | | | - Seunggu Jude Han
- Department of Neurosurgery, Stanford Medicine, Palo Alto , California , USA
| | - Nathan R Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Jesse Winer
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
| | - Josiah N Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland , Oregon , USA
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Bowden SG, Tan H, Orina JN. Highlighting Differences in Neurosurgery Junior Resident On-Call Experience: Comparing Resident Call "Weather" with Objective Workload Metrics. World Neurosurg 2023:S1878-8750(23)01648-0. [PMID: 38105130 DOI: 10.1016/j.wneu.2023.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Stephen G Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Josiah N Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Bowden SG, Siler DA, Shahin MN, Mazur-Hart DJ, Munger DN, Ross MN, O’Neill BE, Nerison CS, Rothbaum M, Han SJ, Wright JM, Orina JN, Winer JL, Selden NR. Effects of 24-hour versus night-float call schedules on the clinical and operative experiences of postgraduate year 2 and 3 neurosurgical residents. Neurosurg Focus 2022; 53:E12. [DOI: 10.3171/2022.5.focus22181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
To comply with the removal of the 88-hour week exemption and to support additional operative experience during junior residency, Oregon Health & Science University (OHSU) switched from a night-float call schedule to a modified 24-hour call schedule on July 1, 2019. This study compared the volumes of clinical, procedural, and operative cases experienced by postgraduate year 2 (PGY-2) and PGY-3 residents under these systems.
METHODS
The authors retrospectively studied billing and related clinical records, call schedules, and Accreditation Council for Graduate Medical Education case logs for PGY-2 and PGY-3 residents at OHSU, a tertiary academic health center, for the first 4 months of the academic years from 2017 to 2020. The authors analyzed the volumes of new patient consultations, bedside procedures, and operative procedures performed by each PGY-2 and PGY-3 resident during these years, comparing the volumes experienced under each call system.
RESULTS
Changing from a PGY-2 resident–focused night-float call system to a 24-hour call system that was more evenly distributed between PGY-2 and PGY-3 residents resulted in decreased volume of new patient consultations, increased volume of operative procedures, and no change in volume of bedside procedures for PGY-2 residents. PGY-3 residents experienced a decrease in operative procedure volume under the 24-hour call system.
CONCLUSIONS
Transition from a night-float system to a 24-hour call system altered the distribution of clinical and procedural experiences between PGY-2 and PGY-3 residents. Further research is necessary to understand the impact of these changes on educational outcomes, quality and safety of patient care, and resident satisfaction.
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Affiliation(s)
- Stephen G. Bowden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Dominic A. Siler
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Maryam N. Shahin
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - David J. Mazur-Hart
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Daniel N. Munger
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Miner N. Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Brannan E. O’Neill
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Caleb S. Nerison
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Michael Rothbaum
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Seunggu J. Han
- Department of Neurosurgery, Stanford University, Palo Alto, California
| | - James M. Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Josiah N. Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Jesse L. Winer
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Nathan R. Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
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Sahin B, Hanalioglu S. The Continuing Impact of Coronavirus Disease 2019 on Neurosurgical Training at the 1-Year Mark: Results of a Nationwide Survey of Neurosurgery Residents in Turkey. World Neurosurg 2021; 151:e857-e870. [PMID: 33974985 PMCID: PMC9760305 DOI: 10.1016/j.wneu.2021.04.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic has led to a significant transformation in medical practice and training. This nationwide survey study aims to evaluate the 1-year impact of the pandemic on training of neurosurgical residents. METHODS A 38-question Web-based survey was sent to 356 neurosurgery residents. Two hundred and thirty-five participated in the study (66% response rate), representing more than half of all neurosurgical residents in the country. RESULTS Assignment to direct COVID-19 medical care was common (85.5%). Many of the neurosurgery residents (37.9%) were tested positive for COVID-19. Almost half of the respondents reported a decrease in work hours. Most participants (84.3%) reported a decline in total operative case volume (mean change, -29.1% ± 1.6%), largely as a result of a decrease in elective (-33.2% ± 1.6%) as opposed to emergency cases (-5.1% ± 1.8%). For theoretic education, most respondents (54.9%) indicated a negative impact, whereas 25.1% reported a positive impact. For practical training, most respondents (78.7%) reported an adverse effect. A decrease in elective surgical case volume predicted a positive impact on theoretic training but a negative impact on practical training. Research productivity was reported by 33.2% to have decreased and by 23% to have increased. Forty-two percent indicated an increase in concerns about their training and career, with a negative impact on practical training being the most important predictor. Most (57.4%) had considered extending residency training to overcome negative effects of the pandemic. CONCLUSIONS COVID-19 has had a significant impact on neurosurgical practice and training. Effective measures should be used to mitigate these effects and better prepare for the future challenges.
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Affiliation(s)
- Balkan Sahin
- Department of Neurosurgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Sisli, Istanbul, Turkey
| | - Sahin Hanalioglu
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
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Shahlaie K, Harsh GR. Editorial. The financial value of a neurosurgery resident. J Neurosurg 2021; 135:164-168. [PMID: 32916648 DOI: 10.3171/2020.4.jns20836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gordon WE, Mangham WM, Michael LM, Klimo P. The economic value of an on-call neurosurgical resident physician. J Neurosurg 2021; 135:169-175. [PMID: 32916653 DOI: 10.3171/2020.3.jns193454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The cost of training neurosurgical residents is especially high considering the duration of training and the technical nature of the specialty. Despite these costs, on-call residents are a source of significant economic value, through both indirectly and directly supervised activities. The authors sought to identify the economic value of on-call services provided by neurosurgical residents. METHODS A personal call log kept by a single junior neurosurgical resident over a 2-year period was used to obtain the total number of consultations, admissions, and procedures. Current Procedural Terminology (CPT) codes were used to estimate the resident's on-call economic value. RESULTS A single on-call neurosurgical resident at the authors' institution produced 8172 work relative value units (wRVUs) over the study period from indirectly and directly supervised activities. Indirectly supervised procedures produced 7052 wRVUs, and directly supervised activities using the CPT modifier 80 yielded an additional 1120 wRVUs. Using the assistant surgeon billing rate for directly supervised activities and the Medical Group Management Association nationwide median neurosurgery reimbursement rate, the on-call activities of a single resident generated a theoretical billing value of $689,514 over the 2-year period, or $344,757 annually. As a program, the on-call residents collectively produced 39,550 wRVUs over the study period, or 19,775 wRVUs annually, which equates to potential reimbursements of $1,668,386 annually. CONCLUSIONS Neurosurgery residents at the authors' institution theoretically produce enough economic value exclusively from on-call activities to far exceed the cost of their education. This information could be used to more precisely estimate the true overall cost of neurosurgical training and determine future graduate medical education funding.
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Affiliation(s)
- William E Gordon
- 1Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
| | - William M Mangham
- 1Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
| | - L Madison Michael
- 1Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
- 2Semmes Murphey, Memphis; and
| | - Paul Klimo
- 1Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis
- 2Semmes Murphey, Memphis; and
- 3Le Bonheur Children's Hospital, Memphis, Tennessee
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Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large U.S. Academic Medical Center. World Neurosurg 2020; 144:e926-e933. [PMID: 32992058 PMCID: PMC7521299 DOI: 10.1016/j.wneu.2020.09.125] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has led to sweeping changes in residency programs across the world, including cancellation of elective cases. The effects of safety measures on neurosurgical training remain unclear. To understand how neurosurgical residents have been affected, we analyzed the operative experience in the months leading up to and during the pandemic. METHODS The resident and institutional case totals were tallied for a single residency program in Miami-Dade County from January 1, 2019 to June 30, 2020. A matched cohort analysis was performed before and during the pandemic to assess the effects on resident surgical training. RESULTS The case totals for all levels of training were lower when restrictions were placed on elective surgeries. An average of 11 cases was logged in April 2020, a decrease from 26 cases in April 2019 (95% confidence interval, 8.7-22; P < 0.01). An average of 20 cases was logged in May 2020, a decrease from 25 cases in May 2019 (95% confidence interval, 1.2-8.8; P = 0.01). In April and May 2020, 299 (66%) and 148 (50%) fewer cases had been performed at our institution compared with April and May 2109. CONCLUSIONS Operative experience was reduced for residents during the months when the performance of elective cases was restricted. Our data suggest experience in some areas of neurosurgery were more affected than were others, and residents at different levels of training were also affected differently. However, the extent of the coronavirus disease 2019 pandemic on neurosurgical training is unlikely to be understood in the short term.
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Gordon WE, Gienapp AJ, Khan NR, Hersh DS, Parikh K, Vaughn BN, Madison Michael L, Klimo P. Commentary: The Clinical Experience of a Junior Resident in Pediatric Neurosurgery and Introduction of the Resident Experience Score. Neurosurgery 2020; 86:E447-E454. [DOI: 10.1093/neuros/nyz565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/20/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- William E Gordon
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Andrew J Gienapp
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - David S Hersh
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Kara Parikh
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | | | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Semmes Murphey, Memphis, Tennessee
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9
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Gillespie CS, Mcleavy CM, Islim AI, Prescott S, McMahon CJ. Rationalising neurosurgical head injury referrals: development and validation of the Liverpool Head Injury Tomography Score (Liverpool HITS) for mild TBI. Br J Neurosurg 2020; 34:127-134. [DOI: 10.1080/02688697.2019.1710825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Conor S. Gillespie
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Abdurrahman I. Islim
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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