Bridging the gap: The intersection of entrustability and perceived autonomy for surgical residents in the OR

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

doi:10.1016/j.amjsurg.2018.07.057

Cited by 21 publications

(24 citation statements)

References 23 publications

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“…To rectify discrepancies in the residency training experience between female and male residents, surgical programs must develop an objective method of evaluating each trainee's entrustability. 25 There is evidence that training supervisor behavior may be the primary contributor to whether a trainee is given autonomy, and this comportment may be amenable to change with appropriate education. 26 Our study did not seek to identify the underlying causes of the difference in autonomy seen between female and male trainees.…”

Section: Discussionmentioning

confidence: 99%

“…If the provision of resident autonomy was based purely on this observation, then the autonomy given to female trainees should be at least equal to that of male trainees. To rectify discrepancies in the residency training experience between female and male residents, surgical programs must develop an objective method of evaluating each trainee’s entrustability . There is evidence that training supervisor behavior may be the primary contributor to whether a trainee is given autonomy, and this comportment may be amenable to change with appropriate education …”

Section: Discussionmentioning

confidence: 99%

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Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

et al. 2020

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examining all endoscopic, major, and minor procedures performed by all New Zealand general surgery trainees in every training hospital in New Zealand. MAIN OUTCOMES AND MEASURESThe primary outcome was the level of meaningful autonomy by each New Zealand general surgery trainee (ie, trainee as primary operator without the surgeon mentor scrubbed for the case). Outcomes were compared using multivariable analysis. RESULTSThis study included 120 New Zealand general surgery trainees (42 women [35%] and 78 men [65%]) who were analyzed over 279.5 trainee-years (88.5 trainee-years for women and 191.0 trainee-years for men). Included were 119 380 general surgery procedures (17 465 endoscopic, 56 964 major, and 44 951 minor) in 18 hospitals. By the end of the 5-year training program, female trainees had a lower cumulative mean autonomous caseload than male trainees for endoscopic (284.0 [95% CI, 207.0-361.0] vs 352.2 [95% CI, 282.9-421.6], P = .03), major (139.9 [95% CI,.0], P = .02), and minor (456.3 [95% CI,.9] vs 519.9 [95% CI, 465.6-574.2], P = .007) procedures. CONCLUSIONS AND RELEVANCEAfter accounting for differences among trainees, hospital type, number of female and male surgeon mentors at each hospital, and trainee seniority, female trainees performed fewer cases with meaningful autonomy compared with male trainees. These findings support the need for pragmatic solutions to address this bias and further investigations on mechanisms contributing to discrepancies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

et al. 2020

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“…[19][20][21][22][23] This reflects our experience documented in a study we published in 2020 in which we found women PGY-1 and PGY-3-PGY-6 residents significantly underrated and men PGY-2-PGY-6 residents significantly overrated their operative performance compared to attending assessments. 10 Given the finding by Sandhu et al that residents' self-perceived autonomy was significantly associated with attending-awarded OR entrustability, 24 men attendings may be more likely to award more entrustability to individuals displaying confident behaviors and requesting increases in autonomy rather than based on actual operative readiness. Similarly, resident self-assessments may be priming attendings' thoughts, contributing to unconscious anchoring of attendings' ratings.…”

Section: Level 5 Consultatory Guidancementioning

confidence: 99%

An Analysis of Gender Bias in Plastic Surgery Resident Assessment

Cooney

Aravind

Hultman

et al. 2021

Journal of Graduate Medical Education

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Background Previous studies have shown men and women attending physicians rate or provide operating room (OR) autonomy differently to men and women residents, with men attendings providing higher ratings and more OR autonomy to men residents. Particularly with the advent of competency-based training in plastic surgery, differential advancement of trainees influenced by gender bias could have detrimental effects on resident advancement and time to graduation. Objective We determined if plastic surgery residents are assessed differently according to gender. Methods Three institutions' Operative Entrustability Assessment (OEA) data were abstracted from inception through November 2018 from MileMarker, a web-based program that stores trainee operative skill assessments of CPT-coded procedures. Ratings are based on a 5-point scale. Linear regression with postgraduate year adjustment was applied to all completed OEAs to compare men and women attendings' assessments of men and women residents. Results We included 8377 OEAs completed on 64 unique residents (25% women) by 51 unique attendings (29% women): men attendings completed 83% (n = 6972; 5859 assessments of men residents; 1113 of women residents) and women attendings completed 17% (n = 1405; 1025 assessments of men residents; 380 of women residents). Adjusted analysis showed men attendings rated women residents lower than men residents (P < .001); scores by women attendings demonstrated no significant difference (P = .067). Conclusions Our dataset including 4.5 years of data from 3 training programs showed men attendings scored women plastic surgery residents lower than their men counterparts.

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“…In a recent OpTrust pilot study, it has been found that observed resident entrustability is positively associated with perceived resident autonomy. 12…”

Section: Optrust Interventionmentioning

confidence: 99%

“…11 Although OpTrust has been shown to promote beneficial interactions that lead to increased faculty entrustment and resident entrustability, 10 the impact of this educational intervention on patient outcomes remains unknown. 12 In this study, we sought to evaluate the impact of OpTrust on 30-day postoperative outcomes after core general surgery procedures. We hypothesized that this educational intervention would increase faculty entrustment and resident entrustability without compromising patient outcomes.…”

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confidence: 99%

Increased Intraoperative Faculty Entrustment and Resident Entrustability Does Not Compromise Patient Outcomes After General Surgery Procedures

et al. 2020

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Background: Intraoperative resident autonomy has been compromised secondary to expectations for increased supervision without defined parameters for safe progressive independence, diffusion of training experience, and more to learn with less time. Surgical residents who are insufficiently entrusted during training attain less autonomy, confidence, and even clinical competency, potentially affecting future patient outcomes. Objective: To determine if OpTrust, an educational intervention for increasing intraoperative faculty entrustment and resident entrustability, negatively impacts patient outcomes after general surgery procedures. Methods: Surgical faculty and residents received OpTrust training and instruction to promote intraoperative faculty entrustment and resident entrustability. A post-intervention OpTrust cohort was compared to historical and pre-intervention OpTrust cohorts. Multivariable logistic and negative binomial regression was used to evaluate the impact of the OpTrust intervention and time on patient outcomes. Setting: Single tertiary academic center. Participants: General surgery faculty and residents. Main Outcome(s) and Measure(s): Thirty-day postoperative outcomes, including mortality, any complication, reoperation, readmission, and length of stay. Results: A total of 8890 surgical procedures were included. After risk adjustment, overall patient outcomes were similar. Multivariable regression estimating the effect of the OpTrust intervention and time revealed similar patient outcomes with no increased risk (P > 0.05) of mortality {odds ratio (OR), 2.23 [95% confidence interval (CI), 0.87-5.6]}, any complication [OR, 0.98 (95% CI, 0.76-1.3)], reoperation [OR, 0.65 (95% CI, 0.42-1.0)], readmission [OR, 0.82 (95% CI, 0.57-1.2)], and length of stay [OR, 0.99 (95% CI, 0.86-1.1)] compared to the historic and pre-intervention OpTrust cohorts. Conclusions: OpTrust, an educational intervention to increase faculty entrustment and resident entrustability, does not compromise postoperative patient outcomes. Integrating faculty and resident development to further enhance entrustment and entrustability through OpTrust may help facilitate increased resident autonomy within the safety net of surgical training without negatively impacting clinical outcomes.

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Bridging the gap: The intersection of entrustability and perceived autonomy for surgical residents in the OR

Cited by 21 publications

References 23 publications

Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

An Analysis of Gender Bias in Plastic Surgery Resident Assessment

Increased Intraoperative Faculty Entrustment and Resident Entrustability Does Not Compromise Patient Outcomes After General Surgery Procedures

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