Transitioning From a Level II to Level I Trauma Center Increases Resident Patient Exposure

Brian Carpenter, Lena Levine, Tim Niacaris, Sumihiro Suzuki

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Increased patient exposure has been shown to improve residency training as determined by better patient outcomes. The transition of John Peter Smith Hospital from a level II to a level I trauma center in 2009 provided a unique opportunity to investigate the direct effects of increased patient exposure on residency training in a relatively controlled setting. We evaluated the effect of the transition to a level I trauma center on residency training. In 2014, we examined the annual facility reports and separated the data into 2 groups: level II (2001 to 2008) and level I (2010 to 2013). The primary outcome measures were patient volume, surgical volume, patient acuity, and scholarly activity by the residents. The patient volume in all units increased significantly (p <.05 for all) after the transition to a level I center. The surgical volume increased significantly for the general surgery, orthopedics, and podiatry departments (p <.05 for all) but remained unchanged in the gynecology and oral maxillofacial surgery departments. The volume measures were performed on all 98 residents (100%). Patient acuity and scholarly activity increased by 17% and 52%, respectively; however, the differences in these data were not statistically significant. The scholarly activity per resident was measured for the orthopedic and podiatry departments. For those departments, the total number of residents was 30, and scholarly activity was measured for 100% of them. Overall, resident education improved when the hospital transitioned to a level I trauma center, although certain subspecialties benefited more than did others from this transition.

Original languageEnglish
Pages (from-to)1170-1172
Number of pages3
JournalJournal of Foot and Ankle Surgery
Issue number6
StatePublished - Nov 2017


  • level 1 trauma center
  • patient acuity
  • residency training
  • resident patient exposure
  • scholarly activity
  • surgical volume


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