Defining the Deficit in US Surgical Training: The Trainee's Perspective

Abstract

BACKGROUND: Self-efficacy is the personal judgment of how well one can successfully complete a task. The goal of this study was to assess self-efficacy of PGY5 residents for common general surgery operations. We hypothesized there are deficits in self-efficacy of PGY5 residents, and self-efficacy of a given operation correlates with experience performing the operation without attending assistance (independently) and teaching the operation from start to finish. METHODS: A survey was linked to the 2020 American Board of Surgery In-Training Examination. From the ACGME case log's 15 most commonly performed surgeon-chief operations and AHRQ's 15 most common operations, 10 operations were selected. Residents evaluated their ability to perform these operations independently using a 5-point self-efficacy scale. Residents were asked whether they had experience performing these operations independently or teaching the operation from start to finish. Descriptive statistics and Pearson correlation were used to examine the relationship between self-efficacy and operative experience. RESULTS: In all, 1,145 of 1,367 PGY5 residents (84%) responded. Highest self-efficacy was in performing wide-local excision (90.24%) and lowest was in performing open thyroidectomy (19.58%). Eighty-eight (7.7%) reported self-efficacy in all procedures. Statistically significant positive correlations were identified between experience and self-efficacy for cases performed without assistance (r = 0.98, p < 0.01) and cases taught (r = 0.91, p < 0.01). CONCLUSIONS: With 5 months left in training, 92.3% of residents report deficits in preparation for practice, as defined by self-efficacy to complete common procedures independently. Resident self-efficacy increased in direct relation to performed cases and cases taught.

Impact of the COVID-19 pandemic on the training of general surgery residents

“…There have been increasing concerns regarding the disadvantages and limitations of the current educational process for general surgery residents; this is reflected in several articles [3][4][5][6] published in the medical literature that try to identify the current problems and offer solutions. We believe that this subject is worth exploring, and raised awareness of in this topic might be the way to successfully meet the needs of residents in training.…”

The Program Director Perspective: Perceptions of PGY5 Residents’ Operative Self-Efficacy and Entrustment

“…Consistent with the methods previously described, self-efficacy was considered to be a binary construct; thus, only a score of 5 was considered indicative of self-efficacy. 2 The entrustment scale utilized in the PD survey matched that of the 2020 post-ABSITE survey as described in Kearse et al in 2021. 8 Program directors were queried about how frequently residents' preoperative assessments and operative plans were modified by the attending surgeon using the following scale: 1-always, 2frequently, 3-occasionally, 4-rarely, 5-never.…”

“…Previous literature has shown that graduating general surgery residents do not consider themselves to be self-efficacious at many commonly performed general surgery procedures. 2 Anderson et al conducted a survey associated with the American Board of Surgery In-Training Examination (ABSITE) in 2020 and identified a significant training deficit in general surgery residency programs, with 92.3% of graduating trainees feeling incapable of independently performing 1 or more of the 10 common core general surgery procedures included on the survey. 2 These operations included 4 laparoscopic procedures (laparoscopic appendectomy, cholecystectomy, right hemicolectomy, and diagnostic laparoscopy) and 6 open procedures (thyroidectomy, trauma exploratory laparotomy, trauma thoracotomy, wide local excision, breast biopsy, and inguinal hernia repair).…”

Leveraging the Health Services Research Toolbox for Surgical Education Research

“…2 Moreover, we learned that the majority of the difference in patient outcomes between new and experienced surgeons is related to differences in the types of operations performed and the emergent state of presentation for many patients of the new surgeons. 3 To complement this work, health services research methods using a novel educational data source 4 have been used to demonstrate that, although 90% of graduating chiefs are rated as practice ready by supervising surgeons, results vary substantially across procedure types, and many graduating residents (>90%) report deficits in their preparation to practice just 6 months before graduation 5,6 This means that for the individual patient treated by an individual new surgeon, there may be room for improvement. Health services research tools, including matching to provide superior risk adjustment, a difference-in-difference study design to control for simultaneous changes to the nature of surgical practice across time, and collaboration across programs to collect data on trainee performance, provide a mechanism to measure the performance of educational paradigms.…”