Association of intraoperative entrustment with clinical competency amongst general surgery residents

Ji, Sunjong; Hwang, Charles; Karmakar, Monita; Matusko, Niki; Thompson-Burdine, Julie; Williams, Aaron M.; Leininger, Lisa; Minter, Rebecca M.; Sandhu, Gurjit

doi:10.1016/j.amjsurg.2019.12.012

Cited by 4 publications

(8 citation statements)

References 27 publications

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“…Surgical education continues to require evidence-based teaching congruent with learner-centered practices. However, evaluation of these teaching and learning practices is typically limited to self-reported evaluations and perceptions, which lend themselves to recall bias and differences in perceived autonomy . OpTrust provides objective feedback to both faculty and residents regarding entrustment and entrustability behaviors exhibited in the operating room.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical residency programs are charged with training competent surgeons prepared to operate independently at the time of graduation . However, the current surgical education model, based on progressive responsibility and autonomy, has changed very little despite evolving challenges in surgery, such as stringent faculty supervision requirements, increased demands for patient safety and improved patient outcomes, and duty hour restrictions . As a result, approximately 23% of graduating general surgery residents believe the current curriculum has not prepared them for independent practice and faculty do not universally consider residents ready for independent practice …”

Section: Introductionmentioning

confidence: 99%

“…Faculty-resident interactions remain an ongoing area of study to improve intraoperative learning, and the OpTrust tool was developed to better assess these interactions . OpTrust allows for the assessment of both intraoperative faculty entrustment and resident entrustability behaviors in real time and acknowledges the relationship between the educator and learner during these interactions . Previous studies have demonstrated that increased resident entrustablity advances resident autonomy, does not compromise postoperative patient outcomes, and is associated with progression through milestones .…”

Section: Introductionmentioning

confidence: 99%

“…OpTrust allows for the assessment of both intraoperative faculty entrustment and resident entrustability behaviors in real time and acknowledges the relationship between the educator and learner during these interactions . Previous studies have demonstrated that increased resident entrustablity advances resident autonomy, does not compromise postoperative patient outcomes, and is associated with progression through milestones . Importantly, faculty entrustment has shown to be a key factor in how residents exhibit entrustability, and faculty surgeons who demonstrate progressive intraoperative entrustment can help propel resident autonomy forward .…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7] As a result, approximately 23% of graduating general surgery residents believe the current curriculum has not prepared them for independent practice and faculty do not universally consider residents ready for independent practice. 3,4,[7][8][9] Entrustable professional activities are an assessment approach that encompasses essential responsibilities for which trainees are expected to demonstrate practice readiness during training. 10 Entrustable professional activities help address the challenge of balancing supervision with resident autonomy to promote progression toward competence during training.…”

mentioning

confidence: 99%

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Faculty Entrustment and Resident Entrustability

Millar,

Matusko,

Evans

et al. 2024

JAMA Surg

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ImportanceAs the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs.ObjectiveTo assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs.Design, Setting, and ParticipantsThis cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level.Main Outcomes and MeasuresObserved resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients.ResultsA total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years’ experience: 67 [20.9%]; 6-14 years’ experience: 186 [58%]; ≥15 years’ experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P &lt; .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P &lt; .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions.Conclusions and RelevanceFaculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%