Factors affecting operative autonomy and performance during otolaryngology training: A multicenter trial

Abstract

Objective Surgical education is changing in an era of new regulations and evolving training cultures. We sought to understand the factors that affect operative experiences during otolaryngology residency. Methods From December 2019 to December 2020, five otolaryngology training programs used the SIMPL OR smartphone application to evaluate residents after each operation. Residents and attendings rated the trainee's autonomy on a 4‐level Zwisch scale, performance on a 5‐level scale, and case complexity on a 3‐level scale. We examined associations between ratings of autonomy and performance with variables including postgraduate year (PGY), case complexity, gender, week of the academic year (AY), and whether multiple procedures were logged. Results 78 attendings and 92 residents logged 2984 evaluations. PGY level and week of the AY were positively associated with attending ratings of autonomy and performance (PGY3 vs. PGY2: B = 0.63, p < .001 for autonomy and B = 1.05, p < .001 for performance; week of the AY: B = 0.013, p = .002 for autonomy; B = 0.025, p < .001 for performance). Multiple procedures logged and increasing case complexity were negatively associated with attending ratings (multiple procedures: B = −0.19, p = .04 for autonomy and B = −0.48, p < .001 for performance; hardest vs. easiest 1/3 of cases: B = −1.01, p < .001 for autonomy and B = −0.59, p < .001 for performance). Attending and trainee genders were not associated with attending ratings of autonomy or performance. Conclusion Resident autonomy and performance were positively associated with PGY level and week of the academic year, and negatively associated with case complexity and multiple procedures. These findings highlight the need to align training level with case complexity to promote quality operative experiences. Level of Evidence 2.

Surgical resident experience with common bile duct exploration and assessment of performance and autonomy with formative feedback

“…Prior studies have demonstrated an improvement in operative efficiency or error rate with formative feedback [ 13 , 27 – 29 ]. Peer-reviewed literature on resident performance shows a positive association between postgraduate year and operative performance and autonomy [ 30 ]. In practice, surgeons with higher case volumes and experience are noted to have shorter duration of surgery and improved performance and patient outcomes [ 31 , 32 ].…”

Quality of Office‐based Procedure Training During Laryngology Fellowship

“…Minimum case volume required for achievement of office procedure proficiency at the fellowship level will ultimately require case log data that does not currently exist, accounting for variability in both reporting and trainee ability to accurately self-assess performance. 16,17 Determination of minimum case volume for surgical mastery is an extensive and complex process when done correctly and was beyond the intended scope of the present study; however, we hope it will serve as a springboard for future research on this topic and eventually inform the development of national case benchmarks.…”