Improving the feasibility and utility of  OpTrust —A tool assessing intraoperative entrustment

Nikolian, Vahagn C.; Sutzko, Danielle C.; Georgoff, Patrick E.; Matusko, Niki; Boniakowski, Anna; Prabhu, Kaustubh; Church, John; Thompson-Burdine, Julie; Minter, Rebecca M.; Sandhu, Gurjit

doi:10.1016/j.amjsurg.2017.10.036

Cited by 15 publications

(8 citation statements)

References 21 publications

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“…They also facilitate resident-attending engagement and implicitly encourage entrustment. 27 Respondents in our study agreed that entrustment does not put patients at increased risk, though a surprising number reported observing patient complications resulting from resident involvement. As this finding is incongruent with multiple studies supporting the safety of resident involvement in patient care, 10,28,29 it is unclear whether complications were misattributed to resident involvement, if patient harms are underreported in the literature, or if this represents recall bias.…”

Section: Open-ended Responsesmentioning

confidence: 63%

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Senders

Brady²,

Ladhani³

et al. 2021

Journal of Graduate Medical Education

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Background General surgery residents may be underprepared for practice, due in part to declining operative autonomy during training. The factors that influence entrustment of autonomy in the operating room are unclear. Objective To identify and compare the factors that residents and faculty consider influential in entrustment of operative autonomy. Methods An anonymous survey of 29-item Likert-type scale (1–7, 1 = strongly disagree, 7 = strongly agree), 9 multiple-choice, and 4 open-ended questions was sent to 70 faculty and 45 residents in a large ACGME-approved general surgery residency program comprised of university, county, and VA hospitals in 2018. Results Sixty (86%) faculty and 38 (84%) residents responded. Faculty were more likely to identify resident-specific factors such as better resident reputation and higher skill level as important in fostering entrustment. Residents were more likely to identify environmental factors such as a focus on efficiency and a litigious malpractice environment as impeding entrustment. Both groups agreed that work hour restrictions do not decrease autonomy and entrustment does not increase risk to patients. More residents considered low faculty confidence level as a barrier to operative autonomy, while more faculty considered lower resident clinical skill as a barrier. Improvement in resident preparation for cases was cited as an important intervention that could enhance entrustment. Conclusions Differences in perspectives exist between general surgery residents and faculty regarding entrustment of autonomy. Residents cite environmental and attending-related factors, while faculty cite resident-specific factors as most influential. Residents and faculty both agree that entrustment is integral to surgical training.

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Section: Open-ended Responsesmentioning

confidence: 63%

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Senders

Brady²,

Ladhani³

et al. 2021

Journal of Graduate Medical Education

View full text Add to dashboard Cite

show abstract

“…However, the study was limited by a small caseload and the measurement tool (OpTrust), which required observation and assessment of each operative case by a third party. An earlier study 18 of the feasibility of OpTrust found an increase in resident autonomy with observed cases; therefore, the results of the study by Thompson-Burdine et al 17 may be subject to the Hawthorne effect. Furthermore, a 2019 study 12 also observed that female residents received less autonomy than male residents, despite controlling for resident's level of training, case complexity, faculty sex, and training program.…”

Section: Discussionmentioning

confidence: 90%

“…Although few studies 10,12,17,18 have investigated the interaction between trainee sex and operative autonomy, numerous studies have investigated the sex equity of surgical training programs. A study 19 in otolaryngology found that male residents spent on average more time in the operating room than female residents; however, this finding was in the context of men working longer hours than women.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

et al. 2020

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examining all endoscopic, major, and minor procedures performed by all New Zealand general surgery trainees in every training hospital in New Zealand. MAIN OUTCOMES AND MEASURESThe primary outcome was the level of meaningful autonomy by each New Zealand general surgery trainee (ie, trainee as primary operator without the surgeon mentor scrubbed for the case). Outcomes were compared using multivariable analysis. RESULTSThis study included 120 New Zealand general surgery trainees (42 women [35%] and 78 men [65%]) who were analyzed over 279.5 trainee-years (88.5 trainee-years for women and 191.0 trainee-years for men). Included were 119 380 general surgery procedures (17 465 endoscopic, 56 964 major, and 44 951 minor) in 18 hospitals. By the end of the 5-year training program, female trainees had a lower cumulative mean autonomous caseload than male trainees for endoscopic (284.0 [95% CI, 207.0-361.0] vs 352.2 [95% CI, 282.9-421.6], P = .03), major (139.9 [95% CI,.0], P = .02), and minor (456.3 [95% CI,.9] vs 519.9 [95% CI, 465.6-574.2], P = .007) procedures. CONCLUSIONS AND RELEVANCEAfter accounting for differences among trainees, hospital type, number of female and male surgeon mentors at each hospital, and trainee seniority, female trainees performed fewer cases with meaningful autonomy compared with male trainees. These findings support the need for pragmatic solutions to address this bias and further investigations on mechanisms contributing to discrepancies.

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“…OpTrust feasibility studies have shown that entrustment or entrustability behaviors do not differ in observed versus nonobserved cases. 18 The raters included 4 surgery residents, 2 nonclinical behavioral research specialists, a medical student, and a surgery education faculty member. Immediately after the case, raters reviewed their notes and completed an OpTrust assessment.…”

Section: Methodsmentioning

confidence: 99%

Impact of a resident's sex on intraoperative entrustment of surgery trainees

Thompson-Burdine

Sutzko

Nikolian

et al. 2018

Surgery

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Improving the feasibility and utility of OpTrust —A tool assessing intraoperative entrustment

Cited by 15 publications

References 21 publications

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

Impact of a resident's sex on intraoperative entrustment of surgery trainees

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