Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments

Objective

The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments.

Design

Questionnaire-based cross-sectional study.

Setting

Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire containing 15 questions within the areas of workload, surgical procedures, outpatient clinic, and research activities. The residents targeted worked at small-to-large hospitals and in tertiary care centers.

Participants

Every resident in Denmark (n = 163) with at least 3 active months at a department was included. Questionnaires with less than 80% completion were excluded. In total, 152 entries were registered. Among those, 27 did not meet the inclusion criteria and 29 were excluded, leaving 96 participants, representing 22 of 26 departments, for further analysis.

Results

The average number of operative procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10 h a month [range: 3-60]) to increase the amount of surgical procedures.

Conclusions

A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate in more surgical procedures.

Introduction

Little is known concerning the educational exposure during residency in orthopedic surgery in Denmark. A systematic search in the PubMed database (search string: (“Orthopedics”[MeSH Terms]) AND (education OR learning) AND (evaluation OR survey OR questionnaire OR quality) AND Residency)) gave 0 relevant hits. Studies are needed to evaluate the educational exposure during residency in orthopedic surgery.

In the United States, the residents register their surgical procedures on a website run by the Accreditation Council for Graduate Medical Education (ACGME).¹ Through this website, it is possible to track the surgical activity across the whole country for every resident.

In Denmark, the education of orthopedic surgeons is competency-driven. To become a specialist in orthopedic surgery, one must acquire comprehensive competencies set down by the Danish Health and Medicines Authority in a Statement of Aims.² These competencies are made up by a specified number of quantitative and qualitative skills such as actual experience with different surgical procedures, development of research skills, theoretical knowledge, and experience with work in an outpatient clinic. The competencies are acquired based on a 5-year educational program with a workweek of 37 hours. The education is administered by 3 educational regions named North, South, and East. A total of 26 departments are responsible for the education of residents. Before residency, the residents must complete a 1-year preresidency introduction with separate goals and evaluation. Residency takes 4 years. The residents reside at 2 to 3 primary departments and have a variety of focused stays at subspecialized departments. The education is completed by a structured evaluation of the competencies set down by the Danish Health and Medicines Authority.³

In 2003, the United States set up an 80-hour workhour restriction for doctors. This raised a concern that the restrictions would have a negative influence on education, as it has been hypothesized that the quality of education is correlated to the number of hours spent at work during education.4, 5, 6, 7, 8 It seems though that the operative experience has not suffered during residency following the restriction.5, 8 This is an important finding for the US residents, but it is difficult to transfer to a Danish context with a 37-hour workweek.

To raise the quality of education of orthopedic surgeons, it is necessary to shed light on the present educational exposure in orthopedic departments. Such a study might serve as a tool to fortify the educational strong sides and improve the weak sides,⁹ which may in a broader perspective benefit the patient. By making the educational exposure visible, it may also help future residents to choose residency according to their needs. The purpose of this study was to examine the educational exposure during residency in Danish orthopedic departments through quantifiable parameters found in the Statement of Aims² from the Danish Health and Medicines Authority.