Evaluating Narrative Operative Reports for Endoscopic Sinus Surgery in a Residency Training Program

Abstract

Methods: The quality of NRs for endoscopic sinus surgery (ESS) was evaluated by studying 90 NRs for ESS written between 2014-2017. Thirty-three elements that the attending surgeon regards as “critical” variables, or quality indicators (QIs), that should be documented in the NR, were studied to evaluate quality. “NR efficiency” (average percent of QIs dictated / total word count) was studied. Subgroup analysis by the level of training was additionally performed. Results: Surgical indications, procedural steps and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest quality (proportion of included key elements) of NR (89% +/- 6.2%) followed by junior residents (87% +/- 5.7%) and then senior residents (80% +/- 14%) [p=0.008]. The attending surgeon also demonstrated the highest degree of “NR efficiency”, followed by senior and then junior residents (p<0.0001). Conclusions: The quality of NRs was found to be high overall, but not “perfect” for either the attending or trainee surgeon. NR efficiency amongst residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs.