Patient Outcome Reports for Senior Residents: An Opportunity to Foster Reflection and Identify Outliers for Intervention

OBJECTIVE: Using patient outcomes to provide feedback with benchmarking has been shown to lead to improved performance among attending surgeons. Residents seldom receive information about their patient outcomes during training, which may limit their ability to develop a reflective practice. This study aimed to compare patient outcomes across individual senior residents in complex surgical oncology. We hypothesized that patient outcomes would vary by resident assignment. DESIGN: This was a retrospective cohort study of senior residents who contributed surgical oncology operations (colectomy, hepatectomy, pancreatectomy, or thyroidectomy) to the National Surgical Quality Improvement Program database. Resident pseudo-identifier was the exposure and outcomes included the presence of any adverse event including post-operative complications, length of stay (LOS), operative duration, and 30-day readmissions. Mixed effects regression was used to estimate expected outcome probabilities for each patient. Observed-minus-expected (O-E) rates were then calculated at the resident level. SETTING: Single university-based hospital with a general surgery residency program (2018-2025). PARTICIPANTS: Clinical year 4 and 5 general surgery residents contributing more than 10 surgical oncology operations to the NSQIP registry. RESULTS: Fifty-one senior residents contributed a median of 41 operations per resident (IQR: 25, 65) (n = 2,294 patients). After adjustment for potential confounders, two residents had higher (O-E rates: 18.3%-20.0%) and one resident had a lower adverse event rate than expected (O-E rate: -21.1%). Fifteen residents were outliers in LOS with five residents demonstrating poor performance and 10 residents demonstrating exemplary performance. A total of 15 residents were outliers in operative duration. Two residents were poor performers, and one resident was an exemplary performer across these three metrics. No performance outliers in 30-day readmission were identified. CONCLUSIONS: Risk-adjusted patient outcomes can be used to identify performance outliers at the individual resident level. These data provide residents with valuable feedback necessary to develop practice-based learning and improvement skills.