This proposal outlines the proposed extension of the FIRST Trial including (aim 1) the ongoing prospective monitoring of patient outcomes and resident well-being with cumulative time under flexible duty hour policies and (aim 2) a comprehensive mixed-methods study to further assess issues of discrimination, harassment and abuse in U.S. surgical residency programs. To achieve aim 1, patient outcomes will be monitored using ACS NSQIP and Medicare data. Resident outcomes will continue to be assessed and followed using the post-ABSITE resident survey that is annually administered. Residency program directors interviews will provide further insight into the impact of the 2017 duty hour policy changes. Aim 2 activities will utilize an innovative mixed-methods approach to identify “high/low” performing surgical residency programs based on rates of mistreatment (discrimination, harassment, abuse, etc.). Site visits to 10 programs representative of different latent classes will provide insight about environmental, infrastructural, policy, programmatic, and cultural factors that enable or mitigate mistreatment and/or toxic outcomes. Information and knowledge gained from the aforementioned second objective activities (surveys, interviews, and site visits) will be used to inform the development of a cluster, randomized, pragmatic trial. The intervention utilized in the trial will include dissemination of a toolkit and program level report to programs randomized to receive the intervention. The toolkit will provide information on how to address mistreatment and toxic outcomes. The program level report will show how your program compares to the other programs on rates of mistreatment and toxic outcomes. The control group of the trial will continue with standard procedures and receive the toolkit/program report once the intervention has concluded.
|Effective start/end date||12/1/18 → 11/30/22|
- American College of Surgeons (Agmt 12/01/18)