Surgeon training: University Teaching Hospitals, Community Non- teaching Hospitals at par, says study

General surgeons who trained in residency programs at community hospitals can achieve patient outcomes that are similar to their peers who were trained in university hospitals, a U.S. study suggests.

Researchers examined data on practice patterns for about 3,600 general surgeons and more than 1.2 million patients, representing 214 surgical training programs in Florida, New York, and Pennsylvania. They also looked at clinical outcomes for more than 321,000 patients of nearly 2,300 surgeons.

Overall, the general surgeons who trained in non-university settings tended to perform more operations and do a greater proportion of these procedures in outpatient facilities, the study found.

But there was no meaningful difference in patient survival or complication rates based on where surgeons trained after researchers accounted for factors that can influence the results of procedures, such as the type of surgery and the characteristics of individual patients and hospitals.

“We have shown that trainees are likely to have different practice patterns based on the type of residency program in which they trained but that they achieve equivalent results . . . for the patients that they treat,” said senior author Dr. Rachel Kelz of the University of Pennsylvania in Philadelphia.

“Therefore, patients should only have to ask the surgeon about the surgeon’s experiences in order to understand the surgeon’s suitability to treat them,” Kelz said by email. “The patient does not have to focus as much on the details of their training.”

During the past decade, amid an increased national focus on improving safety and quality, many in the medical community have questioned whether differences in patient outcomes might be explained by differences in how doctors were trained.

Some previous research has found surgeons trained in non-university programs tend to be more satisfied with their operating experience and more satisfied with their programs than their counterparts who train in university settings, researchers note online January 10 in JAMA Surgery.

Surgical residents in non-university programs are also more likely to pursue general surgery instead of continuing their training in fellowship programs to specialize in areas like orthopedics or neurosurgery, the study authors write.

In the current study, surgeons trained in community-based residency programs appeared to achieve better outcomes before researchers factored in the type of procedure or individual patient or hospital characteristics.

On average, the non-university trained surgeons had fewer patients die or experience major complications. With these surgeons, patients also had shorter hospital stays, another indication of high quality care.

These differences were too small to rule out the possibility that they were due to chance, however, and it’s possible the study didn’t include enough surgeons or patients to illustrate meaningful distinctions in outcomes, the authors note.

Medical students who decide to become surgeons may choose a non-university training program because they want to go into private practice, and it may give them more opportunities to focus on “bread and butter” general surgery instead of the more esoteric cases referred to academic medical centers, said Dr. Lillian Kao of the McGovern Medical School at the University of Texas Health Science Center at Houston.

Non-university programs may also have fewer trainees and provide more opportunities to learn directly from experienced surgeons and practice operations, Kao, author of an accompanying editorial, said by email.

“Although the study suggests that non-university-based residency-trained surgeons tend to work at smaller and more rural hospitals, patients will not know based on a surgeon’s current practice where he/she trained,” Kao said.

“However, the study is reassuring that for patients with few comorbidities who are undergoing an outpatient procedure or a common procedure, that outcomes are not significantly different based on what type of training program one’s surgeon attended,” Kao added.