(APPLICATION ABSTRACT): Graduate surgical education in the United States emphasizes attainment of graded authority and increasing responsibility for surgery residents as experience is gained. Factors such as personal stress, fatigue or sleep deprivation, workload, and adequacy of supervision and support services may adversely affect the residents' judgment and performance and threaten patient safety. Changes in the delivery of surgical care, such as short hospital stays and outpatient surgical care, have increased the acuity of patients in the hospital where surgery residents are primarily based and have increased their workload. Simultaneous cost-cutting measures by hospitals, such as elimination or reduction of support staff, have placed additional work burdens on surgery residents. Changes in nursing staffing patterns have impaired the development of teamwork and adversely affected communication between residents and nurses. The principle of education as the top priority of a surgery residency program is threatened by an increasing need for service. The influence of each of these factors on quality of care and patient safety is unknown. To study these issues and determine the relative importance of stress factors on surgery resident performance and patient safety, we propose to develop surveys for residents, attending staff, and nurses on surgery and anesthesiology services. The surveys will assess teamwork, collaboration, safety culture, organizational culture, and stress. Additional survey items specific for surgery residents will assess working hours, indebtedness, family issues and support services, the balance of service versus education, and attitudes and behavior. Correlation and linkage of survey results with documentation of adverse events in the institution and an analysis of preventable adverse events will provide information concerning the relative effects of various resident stress factors on patient safety.
