Is the operative autonomy granted to a resident consistent with operative performance quality

Williams, Reed G.; George, Brian C.; Bohnen, Jordan D.; Meyerson, Shari L.; Schuller, Mary C.; Meier, Andreas H.; Torbeck, Laura; Mandell, Samuel P.; Mullen, John; Smink, Douglas S.; Chipman, Jeffrey G.; Auyang, Edward D.; Terhune, Kyla P.; Wise, Paul E.; Foley, Eugene F.; Choti, Michael A.; Are, Chandrakanth; Soper, Nathaniel J.; Zwischenberger, Joseph B.; Dunnington, Gary L.; Lillemoe, Keith D.; Fryer, Jonathan P.

doi:10.1016/j.surg.2018.04.034

Cited by 15 publications

(7 citation statements)

References 9 publications

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“…They appreciate it, and they recognize that the resident has been thinking about the incisions, the The results of our study suggest that entrustment decisions are strongly influenced by perceptions that residents and attendings have of one another, which has been reported previously. 21 For example, residents whose personality traits do not align with the attendings are provided less operative autonomy. 22 Residents and attendings in our study also noted that engagement with one another could improve entrustment.…”

Section: Open-ended Responsesmentioning

confidence: 99%

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Senders

Brady²,

Ladhani³

et al. 2021

Journal of Graduate Medical Education

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Background General surgery residents may be underprepared for practice, due in part to declining operative autonomy during training. The factors that influence entrustment of autonomy in the operating room are unclear. Objective To identify and compare the factors that residents and faculty consider influential in entrustment of operative autonomy. Methods An anonymous survey of 29-item Likert-type scale (1–7, 1 = strongly disagree, 7 = strongly agree), 9 multiple-choice, and 4 open-ended questions was sent to 70 faculty and 45 residents in a large ACGME-approved general surgery residency program comprised of university, county, and VA hospitals in 2018. Results Sixty (86%) faculty and 38 (84%) residents responded. Faculty were more likely to identify resident-specific factors such as better resident reputation and higher skill level as important in fostering entrustment. Residents were more likely to identify environmental factors such as a focus on efficiency and a litigious malpractice environment as impeding entrustment. Both groups agreed that work hour restrictions do not decrease autonomy and entrustment does not increase risk to patients. More residents considered low faculty confidence level as a barrier to operative autonomy, while more faculty considered lower resident clinical skill as a barrier. Improvement in resident preparation for cases was cited as an important intervention that could enhance entrustment. Conclusions Differences in perspectives exist between general surgery residents and faculty regarding entrustment of autonomy. Residents cite environmental and attending-related factors, while faculty cite resident-specific factors as most influential. Residents and faculty both agree that entrustment is integral to surgical training.

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Section: Open-ended Responsesmentioning

confidence: 99%

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Senders

Brady²,

Ladhani³

et al. 2021

Journal of Graduate Medical Education

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Operative autonomy, defined as the ability to independently perform surgical procedures, is a crucial component in the development of general surgery residents (GSRs). 1 However, there is nationwide concern that GSRs are lacking the skills needed to operate autonomously by the time they complete their residency. 2 There are numerous factors that influence operative autonomy for GSRs including resident performance, level of independence granted, case difficulty, and trainee experience.…”

Section: Introductionmentioning

confidence: 99%

“…2 General surgery resident autonomy and overall performance score have been traditionally evaluated by the attending physician. [1][2][3]6,7 Autonomy is largely built on GSRs' confidence in their own abilities, and therefore this traditional method of evaluating autonomy is limited because it does not measure the GSR's own perception of their confidence to perform surgery autonomously. Previous literature on GSR autonomy was either conducted solely within 1 institution, with sample size <25, or produced from the same pool of programs.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] The Procedural Learning and Safety Collaborative has provided important perspectives from both GSRs and attendings, from 14 university-based surgery programs; however, the perspective of GSRs from a more comprehensive cohort is necessitated. [1][2][3]7 Confidence in one's own ability can contribute to surgical skill proficiency and therefore it is important to ascertain GSRs' perception of their own surgical autonomy. 10 While there are numerous publications regarding GSR autonomy, gaps in the literature persist.…”

Section: Introductionmentioning

confidence: 99%

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Operative Confidence Among U.S General Surgery Residents

Elkbuli

Ehrlich

Gargano

et al. 2021

The American Surgeon™

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Background General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors. Methods A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs. Multivariable logistic regression was used for calculating the adjusted odds ratio (aOR) for binary outcomes. Significance was defined as P-values ≤ .05 or 95% confidence intervals (CIs) >1 or <1. Results There were 120/558 (21.5%) GSR respondents. General surgery residents with >200 overall operative case volume reported significantly higher confidence with minor cases (P = .05) and major cases (P = .02). General surgery residents that performed both minor and major surgeries reported higher confidence with minor cases at 85.7% compared to GSRs that performed mostly minor surgeries (64.7%) and mostly major surgeries (62.5%). General surgery residents who performed >50 minor surgeries during their PGY 1 and 2 were less confident with major cases than GSRs who performed <50 minor surgeries (aOR: 19.98, 95% CI: 1.26, 318). General surgery residents from community teaching hospitals reported higher confidence with major and minor cases than GSRs from university teaching hospitals and combined programs. Conclusion Increased case volume, predominant case type, early surgical experience during PGY 1 and 2 years, and training at community teaching hospitals were identified as the most important factors that positively influence perception of operative confidence and autonomy among GSRs. These may have important implications in the development of future surgeons.

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Effect modification of resident autonomy and seniority on perioperative outcomes in laparoscopic cholecystectomy

et al. 2020

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Is the operative autonomy granted to a resident consistent with operative performance quality

Cited by 15 publications

References 9 publications

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Operative Confidence Among U.S General Surgery Residents

Effect modification of resident autonomy and seniority on perioperative outcomes in laparoscopic cholecystectomy

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