Confidence Crisis Among General Surgery Residents

Abstract

Importance: In the surgical community, there is concern that general surgery residents are choosing subspecialty training in large numbers because of a crisis in confidence at the end of training. Survey studies are used as evidence to support modifications in the training paradigm.Objectives: Confidence is an essential quality of surgeons, and recent studies have attempted to quantify and measure it in graduating general surgery residents. This study was undertaken to systematically review the quality of evidence provided, and to critically analyze the language used to describe the findings using quantitative methods..Evidence Review: A systematic review of the PubMed indexed literature on general surgery resident confidence was performed. A summative table of each study's hypothesis, definition of confidence, quality using MERSQI, influence using Web of Science citations, results and conclusions was created, and qualitative coding was applied to identify emerging themes. Conclusions and Relevance: Confidence is difficult to define and measure. Despite limitations, survey studies are used to shape discourse and influence policies. Social and cultural factors influence selfefficacy, and focusing on operative volume and autonomy alone may not address all of the reasons that some residents express concerns about readiness to practice.

Motivation to access laparoscopic skills training: Results of a Canadian survey of obstetrics and gynecology residents

“…Self-efficacy can be thought of as the formal psychological construct that most closely captures confidence about a particular task [26]. We found that residents who spent more time performing minimally invasive surgery had greater self-efficacy beliefs about both their ability to master laparoscopic simulation exercises and become competent in minimally invasive surgery and that senior residents, compared to junior residents, had greater self-efficacy beliefs in both domains.…”

Assessment of Operative Autonomy and Readiness for Independent Practice Among Pediatric Surgery Fellows

“…Concern exists within the surgical community that general surgery trainees may not be ready for autonomous practice when they graduate [8]. The reasons behind these concerns are multifactorial, with some citing duty hour restrictions, medicolegal implications, increased subspecialization, and/or heightened requirements for direct supervision of surgical trainees [21][22][23][24][25]. Whether these issues exist in fellowship training is not well known.…”

Current issues and future directions for vascular surgery training from the results of the 2016-2017 and 2017-2018 Association of Program Directors in Vascular Surgery annual training survey

“…The majority of studies suggest a deterioration in the level of confidence of general surgery graduates compared with previous generations, inversely correlated with higher case volume and advanced age. 5 Solutions to increase trainees’ confidence have centered around the use of simulation, as simulation has been demonstrated to produce procedural proficiency comparable to direct patient care in many procedures. 6 Our results similarly showed that trainees ranked an increase in simulation as a high priority.…”