Association of Faculty Entrustment With Resident Autonomy in the Operating Room

Sandhu, Gurjit; Thompson-Burdine, Julie; Nikolian, Vahagn C.; Sutzko, Danielle C.; Prabhu, Kaustubh; Matusko, Niki; Minter, Rebecca M.

doi:10.1001/jamasurg.2017.6117

Cited by 66 publications

(53 citation statements)

References 30 publications

(75 reference statements)

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“…Cases conducted by PGY 3 residents included 36% female cases and 10% male cases, and cases conducted by PGY 5 residents included 34% males and 7% females. It is important to note that in our previous work, postgraduate year was found to be statistically associated with resident entrustability; 19 the means of PGY entrustability scores in that study ranged from 1.31 (PGY 1) to 3.21 (PGY 6). Faculty experience differed by resident sex ( P < .005).…”

Section: Resultsmentioning

confidence: 60%

“…Interestingly, our previous work suggested that faculty experience was not associated with resident entrustability. 19 Independent sample t -tests did not detect a difference in faculty entrustment scores by resident sex (female = 2.54 vs male = 2.35, P = .117). The analysis of same-sex versus intersex faculty/resident case pairings revealed similar results (female = 2.34 vs male = 2.53, P = .10).…”

Section: Resultsmentioning

confidence: 81%

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Impact of a resident's sex on intraoperative entrustment of surgery trainees

Thompson-Burdine

Sutzko

Nikolian

et al. 2018

Surgery

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Section: Resultsmentioning

confidence: 60%

Section: Resultsmentioning

confidence: 81%

Impact of a resident's sex on intraoperative entrustment of surgery trainees

Thompson-Burdine

Sutzko

Nikolian

et al. 2018

Surgery

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“…A growing concern in current medical education is a lack of trainee autonomy during operative procedures 1 , 3 , 4 , 10 , 18 - 22 . Previously, a discordance has been demonstrated in certain disciplines between residents and attendings regarding resident competency and autonomy 2 , 6 , 13 , 20 , 21 , 23 .…”

Section: Discussionmentioning

confidence: 99%

“…In order for orthopaedic attendings to better promote resident autonomy, it is critical that they can accurately assess resident competence to allow safe entrustment 9 , 26 - 28 . Several general surgery studies enumerate common factors affecting faculty entrustment: resident competence, resident familiarity, PGY-level, and attending experience 18 , 19 , 27 , 29 , 30 . Given attending perception of resident competence is subjective and susceptible to bias based on resident familiarity and PGY-level, it is important that more objective measures of competence in orthopaedics are implemented 11 , 26 , 31 .…”

Section: Discussionmentioning

confidence: 99%

Difference in Resident Versus Attending Perspective of Competency and Autonomy During Arthroscopic Rotator Cuff Repairs

et al. 2021

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Background: A noted deficiency in orthopaedic resident education is a lack of intraoperative autonomy; however, no studies exist evaluating this issue. The purpose of this study was to determine whether there is a difference between resident and attending perception of resident competency and autonomy during arthroscopic rotator cuff repairs and whether increased perceived competency leads to more autonomy. Methods: This study included 21 orthopaedic residents and 7 attendings from a single residency program. A survey was developed that included the previously validated Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) and implemented novel arthroscopic rotator cuff repair questions concerning 5 key procedural steps determined by attendings. The survey assessed resident and attending perception of percent opportunity given and percent completed of each step and whether the resident could complete the surgery independently. Paired comparisons were conducted using the Wilcoxon signed-rank test. Agreement between residents and attendings was calculated using a linear-weighted Gwet's AC 2 . A secondary analysis investigated resident perception of autonomy stratified by attending perception of competency using Kruskal-Wallis tests. Results: One hundred forty-two surveys were completed over one academic year. Residents reported a 4-point higher median O-SCORE (34) than attendings (30; p < 0.01; agreement = 0.63). Residents perceived less opportunity compared with attendings, with a median opportunity to complete each step of 54% vs. 70% (p < 0.01; agreement = 0.39). Residents also perceived lower percent completed of the key steps compared with attendings, with medians of 52% vs. 61% (p < 0.01; agreement = 0.37). Resident perceived opportunity increased with higher attending reported O-SCOREs (p < 0.01) and percent completion of the key steps (p < 0.01). No statistically significant increase in perceived opportunity was observed the with post-graduate year (PGY) level (p = 0.35). Discussion: This study demonstrated a significant difference in perception between residents and attendings regarding resident competency and autonomy during arthroscopic rotator cuff repairs. It also demonstrated that with increasing attending perception of competency, there was an increasing resident perception of autonomy, but there was no statistically significant difference of perceived autonomy based on the PGY-level.

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“…1 As a result, all faculty and residents strive to provide the appropriate amount of autonomy and entrustment. [2][3][4][5][6][7][8][9][10] Though there are many articles on clinical teaching where there is implicit information on autonomy and learners, 11 and Carbo provides a toolkit to teach learners autonomy, 12 little is published that provides explicit strategies for assessing learner readiness for independent practice and supporting resident autonomy. 13 Family medicine residents are expected to progressively develop the ability to independently care for patients over the course of their 3-year residency.…”

Section: Introductionmentioning

confidence: 99%

Goldilocks and Entrustment: Finding the Amount of Learner Autonomy That's Just Right

et al. 2020

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Introduction: Faculty and residents strive for appropriate autonomy and entrustment. Initial direct supervision of clinical care gradually shifts to increasing levels of resident independence over time. Faculty members are inconsistent in resident supervision leading to missed opportunities for resident independence. Methods: Family medicine faculty workshop participants completed teaching style self-evaluations prior to discussion of clinical examples with excessive or insufficient autonomy. Participants reviewed real resident feedback examples to increase insight into teaching styles. Participants were presented with cases to discuss varying degrees of resident autonomy and entrustment. Learners committed to one specific behavior to calibrate the degree of autonomy they provide. Results: Of the faculty, 113 members participated in the workshop with the majority (98%) finding the workshop relevant in helping them to identify strategies for reflecting on their degree of autonomy allowed and to look for appropriate situations for enhancing their resident entrustment. Discussion: This interactive workshop provided clear ways for addressing the issue of independence versus control in supervision of patient care. It provided a feedback mechanism for educators who provide too much or too little autonomy for the best resident learning. Additionally, this conversation encouraged participants to engage in self-reflection on the autonomy given to their resident.

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Association of Faculty Entrustment With Resident Autonomy in the Operating Room

Abstract: Faculty entrustment behaviors may be the primary drivers of resident entrustability. Faculty entrustment is a feature of faculty surgeons' teaching style and could be amenable to faculty development efforts.

Cited by 66 publications

References 30 publications

Impact of a resident's sex on intraoperative entrustment of surgery trainees

Impact of a resident's sex on intraoperative entrustment of surgery trainees

Difference in Resident Versus Attending Perspective of Competency and Autonomy During Arthroscopic Rotator Cuff Repairs

Goldilocks and Entrustment: Finding the Amount of Learner Autonomy That's Just Right

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