How do Perceptions of Autonomy Differ in General Surgery Training Between Faculty, Senior Residents, Hospital Administrators, and the General Public? A Multi-Institutional Study

Use of Entrustable Professional Activities in the Assessment of Surgical Resident Competency

“…7,[16][17][18] There are several challenges for surgical faculty, including regulatory hurdles imposed by institutions or by governments, patient safety concerns, public opinion and perceptions thereof, and a prevailing culture of despondency among faculty regarding resident work-hours limitations. 17, [19][20][21] Our findings suggest that another challenge to this autonomy issue is faculty perception of autonomy entrusted to residents. In comparing F O with R A (Figure 1B), we determined that residents at PGY levels 1 to 3 indicated a greater degree of autonomy entrusted than that implied by faculty ratings of residents' global capabilities, whereas there was high concordance among global EPAs for residents at PGY levels 4 to 5.…”

Resident Autonomy

“…Multiple other studies have shown, however, that patients want to know if residents are going to be involved in their care, particularly if they are going to be involved in an operation they are having [28][29][30]. Several studies have also found that although the general public is overwhelmingly supportive of physicians-in-training learning through hands on practice, even among patients being treated in teaching hospitals, a significant number of them report they do not want residents involved in their care [31,32], particularly if that care involves an operation and the resident involved is an intern [2,29,33]. Many of these studies have found that the general public has a limited level of understanding of the level of training of residents [28,31,32], but if education is provided about the role of residents and their extent of training, comfort levels with resident participation in their care greatly increases [28,30].…”

“…Autonomy in residency has been previously defined as the ability of a resident "to manage patients on his or her own" [1]. Residents, teaching faculty, hospital administrators, and members of the general public all understand the importance of autonomy in training for developing the skills necessary for independent practice [1,2]. The Accreditation Council for Graduate Medical Education (ACGME), the organization that oversees residency programs in the United States, specifies that "the privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members" [3].…”

“…The Accreditation Council for Graduate Medical Education (ACGME), the organization that oversees residency programs in the United States, specifies that "the privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members" [3]. Benefits of autonomy include increased resident self-confidence, engagement in learning, sense of ownership of patients, and self-directed learning [1,2]. The benefits of autonomy, however, must be balanced (Figure 1) against the potential risk to patient safety.…”

Trainee participation and perioperative complications in benign hysterectomy: the effect of route of surgery

“…2,3 Conversely, patients often perceive trainee involvement in surgery as a potential detriment to high-quality care. 4,5 The evidence, however, regarding trainee participation in medical care, and specifically in surgical procedures, is mixed. Studies across a large number of elective surgical procedures and specialties have found that trainee participation in the operating room is safe, with no changes in major complication rates, [6][7][8] whereas one study of trainee participation in emergent surgery found an association with major complications.…”