Participants: Amy Cohn, Rishindra Reddy, F. Jacob Seagull, Mark Daskin, Billy Pozehl, Brooke Szymanski, Roshun Sankaran, Tiffany Ballard, Tyler Grenda
Project Contact: Billy Pozehl, [email protected]
Project Synopsis: The purpose of this project is to address challenges in scheduling surgical residents, ensuring that they get adequate training opportunities, and to educate clinicians about the impact that randomness (such as in the arrivals of opportunities to perform certain surgical procedures) can have on planned activities. For example, consider the case of training fellows in the University of Michigan Cardiothoracic training program to perform heart and lung transplants. There are four fellows who each must perform 20 transplants in a two-year program to attain their certification. According to historical case data, the University Hospital sees approximately 40 cases per year. In theory, the cases can be equitably distributed amongst the fellows so that each should receive the 20 cases necessary over the program duration. In practice, the fellows work a rotating call schedule to comply with ACGME rest rules. This call schedule determines who will actually perform a transplant when the opportunity arises. Because transplants are randomly occurring events, it is unlikely that the transplants are split up evenly amongst the fellows, leading to significant challenges in certifying every fellow. As our simulator shows, it turns out the probability of successfully certifying all four fellows is only about 5%.
Understanding these challenges can allow program facilitators to make informed decisions about their existing program structure and plan for appropriate changes. The Surgical Training Experience and Procedure Simulator (STEPS) is a tool developed at CHEPS which allows users to visualize and assess the impact of variability on planned activities within a training program given specific requirements and constraints input by the user.
Papers, Presentations, & Posters:
Papers
- T. Grenda, T. Ballard, A. Obi, W. Pozehl, R. Chen, F.J. Seagull, A. Cohn, M. Daskin, and R. Reddy. “Simulation to Evaluate Residency Procedure Volume in an Era of Changing Technology.” Under Review with Surgery.
- A. Obi, J. Chung, R. Chen, W. Lin, S. Sun, W. Pozehl, A. Cohn, F.J. Seagull, M. Daskin, and R. Reddy. “Achieving ACGME Duty Hours Compliance within Advanced Surgical Training: A Simulation-based Feasibility Assessment.” Accepted for publication in The American Journal of Surgery, March 2015.
- T. Ballard, T. Grenda, A. Cohn, M. Daskin, F.J. Seagull, and R. Reddy. “Innovative Scheduling Solutions for Graduate Medical Education.” Accepted for publication in Journal of Graduate Medical Education, January 2015.
- J. Chung, A. Obi, R. Chen, W. Lin, S. Sun, Z. Chen, A. Gulati, X. Xu, W. Pozehl, F.J. Seagull, A. Cohn, M. Daskin, and R. Reddy. “Estimating Minimum Program Volume Needed to Train Surgeons: When 4 x 15 Really Equals 90.” Journal of Surgical Education 72 (1): pp. 61–67, January 2015.
Presentations
- Accreditation Council for Graduate Medical Education (ACGME) Case Requirements for General Surgeons in Pediatric Surgery: Evaluation of Current Operative Volume on Resident Completion of Index Cases, Submitted by T. Thomas to American College of Surgeons Clinical Congress, Chicago IL, October 2015
- Accreditation Council for Graduate Medical Education (ACGME) Pediatric Surgery Requirements for the General Surgery Resident in the Era of Technological Advancement and Fellowship Programs, Submitted by T. Thomas to American Academy of Pediatrics, Washington DC, October 2015
- A Novel Case Simulator to Help Predict Completion of Plastic Surgery Core Operative Requirements, University of Michigan Moses Gunn Research Conference, Ann Arbor MI, April 2015
- Using Simulation to Show the Impact of Variability on Training Transplant Surgeons, Healthcare Systems Process Improvement Conference, Orlando FL, February 2015
- A Novel Case Simulator to Help Predict Completion of Plastic Surgery Core Operative Requirements, Academic Surgical Congress Annual Meeting, Las Vegas NV, February 2015
- Demonstration of a Novel Scheduling Simulator for Achieving Mediastinoscopy Requirements for American Board of Thoracic Surgery, Society of Thoracic Surgeons 51st Annual Meeting, San Diego CA, January 2015
- Linear Programming Tools for Scheduling Trainees in Healthcare, NCIBI Tools & Technology Seminar Series, Ann Arbor MI, January 2015
- Block Scheduling for a Surgical Residency Program, INFORMS Annual Meeting, San Francisco CA, November 2014
- Predicting Completion of ACGME Core Operative Requirements Utilizing a Scheduling Simulator, University of Michigan Department of Surgery Dingman Lecture, Ann Arbor MI, June 2014
- Scheduling Fellows to Achieve Adequate Training on Procedures with Random Occurrences, ISERC, Montreal Quebec, June 2014
- Scheduling Fellows for Cardiothoracic Transplant Surgery Short Talk, University of Michigan Healthcare Engineering and Patient Safety Symposium, Ann Arbor MI, November 2013
- Improving Resident Rotation Scheduling to Maximize Training Opportunities, University of Michigan MCubed Symposium, Ann Arbor, November 2013
- Scheduling Residents to Achieve Adequate Training on Procedures with Random Occurrences, INFORMS Annual Meeting, Minneapolis MN, November 2013
- Scheduling Residents to Achieve Adequate Training on Procedures with Random Occurrences, INFORMS Healthcare, Chicago IL, June 2013
Posters
- Block Scheduling for Surgical Residency Programs using Combinatorial Optimization, University of Michigan MCubed Symposium, Ann Arbor MI, October 2014
- Use of Simulation to Assess Surgical Training Opportunities, University of Michigan Healthcare Engineering and Patient Safety Symposium, Ann Arbor MI, October 2014
- A Simulation-Based Tool to Improve Matching of Fellows to Surgical Training Opportunities, Healthcare Systems Process Improvement Conference, Orlando FL, February 2014
- Scheduling Fellows to Achieve Adequate Training on Procedures with Random Occurrences, University of Michigan Medical Education Day, Ann Arbor MI, June 2013
- Evaluating and Analyzing Conflicts Between ACGME Restrictions and Adequate Training Opportunities in Cardiothoracic Transplant Surgery, University of Michigan Medical Education Day, Ann Arbor MI, June 2013
- Scheduling Surgical Fellows to Achieve Adequate Training on Procedures with Random Occurrences: An Evaluation, University of Michigan Engineering Graduate Symposium, Ann Arbor MI, November 2013
- Scheduling Surgical Fellows to Achieve Adequate Training on Procedures with Random Occurrences: An Evaluation,University of Michigan Healthcare Engineering and Patient Safety Symposium, Ann Arbor MI, November 2013
Acknowledgments: We gratefully acknowledge the financial support of The Seth Bonder Foundation, The Doctors Company Foundation, the University of Michigan Department of Surgery, the University of Michigan College of Engineering SURE Program, and the MCubed Program. We also thank all prior CHEPS students and collaborators who have contributed to this project.