Disparity between recent graduates’ and experienced surgeons' assessment of time to operative independence

Abstract

Background: In cardiothoracic surgery, little data exist on the transition to operative independence. We aimed to compare current perceptions of operative autonomy of junior cardiothoracic surgeons and senior colleagues who oversee transitional years.Methods: An anonymous online survey was sent to currently practicing North American board-certified/eligible cardiothoracic surgeons to assess reported time to operative independence and comfort with cardiothoracic operations. The c2 test, Fisher exact test, and Mann-Whitney U test were used to compare junior surgeons' self-reported experience to the junior experience as reported by the midcareer and senior surgeons with whom they practiced. Logistic regression was performed to assess factors associated with operative independence.Results: Responses from 436 completed surveys were analyzed (82 juniors and 354 midcareer/seniors). Two hundred fifty-four midcareer/senior surgeons reported on the experience of 531 junior partners. Juniors reported high immediate posttraining comfort with basic cardiac cases and moderate comfort with all other categories. Time to operative independence was significantly different between juniors' self-report and midcareer/senior reports of junior partners except for complex thoracic cases. In multivariable logistic regression analysis, senior, and not midcareer, surgeon status was independently associated with junior operative independence status for cardiac cases and for basic thoracic cases.Conclusions: Most junior surgeons perceived operative independence with basic thoracic, basic cardiac, and complex cardiac operations earlier in their surgical career than that reported by senior colleagues. Objective measures of operative independence may clarify this discrepancy. This study establishes a baseline by which to compare the effects of integrated 6-year programs on operative independence. The discrepant perceptions may have implications for how training programs prepare graduates for the transition to independent practice.

Risk prediction models for difficult cholecystectomy.

“…The results of our study show that intraoperative blood loss, rate of conversion to laparotomy, rate of postoperative drainage tube placement, frequency of postoperative 24 h vomiting, time of first postoperative exhaust, and length of hospital stay in the DC group were significantly greater than those in the NLC group, which further reflected the rationality of using P 75 to measure the difficulty of cholecystectomy. Considering that the experience of surgeons often directly affects the operation time [ 7 , 8 ], we selected a fixed and experienced surgical team to perform all operations, to reduce the influence of anthropic factors on operation time. In addition, unsatisfactory intraoperative anaesthesia, poor intraoperative carbon dioxide pneumoperitoneum, and intraoperative machine malfunction were also excluded to ensure the rationality of case selection.…”

Commentary: The sky's the limit, but where's the ground?

“…Objective data are important, given that subjective perceptions of a surgeon's readiness for operative independence differ between senior and junior surgeons. 3 Lin and colleagues 4 examine the learning curve of aTAAD operations performed by early-career cardiovascular surgeons. The study raises a number of questions around training philosophy in cardiac surgery.…”

“…Objective data are important, given that subjective perceptions of a surgeon's readiness for operative independence differ between senior and junior surgeons. 3 …”

Commentary: Hold 'em or fold 'em

“…Hui and colleagues 1 have completed a very insightful study. A very wise, respected, and senior surgeon shared a sage recommendation decades ago about a potential hire who had grown to become a fine surgeon.…”