Increased Intraoperative Faculty Entrustment and Resident Entrustability Does Not Compromise Patient Outcomes After General Surgery Procedures

Abstract

Background: Intraoperative resident autonomy has been compromised secondary to expectations for increased supervision without defined parameters for safe progressive independence, diffusion of training experience, and more to learn with less time. Surgical residents who are insufficiently entrusted during training attain less autonomy, confidence, and even clinical competency, potentially affecting future patient outcomes. Objective: To determine if OpTrust, an educational intervention for increasing intraoperative faculty entrustment and resident entrustability, negatively impacts patient outcomes after general surgery procedures. Methods: Surgical faculty and residents received OpTrust training and instruction to promote intraoperative faculty entrustment and resident entrustability. A post-intervention OpTrust cohort was compared to historical and pre-intervention OpTrust cohorts. Multivariable logistic and negative binomial regression was used to evaluate the impact of the OpTrust intervention and time on patient outcomes. Setting: Single tertiary academic center. Participants: General surgery faculty and residents. Main Outcome(s) and Measure(s): Thirty-day postoperative outcomes, including mortality, any complication, reoperation, readmission, and length of stay. Results: A total of 8890 surgical procedures were included. After risk adjustment, overall patient outcomes were similar. Multivariable regression estimating the effect of the OpTrust intervention and time revealed similar patient outcomes with no increased risk (P > 0.05) of mortality {odds ratio (OR), 2.23 [95% confidence interval (CI), 0.87-5.6]}, any complication [OR, 0.98 (95% CI, 0.76-1.3)], reoperation [OR, 0.65 (95% CI, 0.42-1.0)], readmission [OR, 0.82 (95% CI, 0.57-1.2)], and length of stay [OR, 0.99 (95% CI, 0.86-1.1)] compared to the historic and pre-intervention OpTrust cohorts. Conclusions: OpTrust, an educational intervention to increase faculty entrustment and resident entrustability, does not compromise postoperative patient outcomes. Integrating faculty and resident development to further enhance entrustment and entrustability through OpTrust may help facilitate increased resident autonomy within the safety net of surgical training without negatively impacting clinical outcomes.

Faculty Entrustment and Resident Entrustability

“…Faculty are often challenged with trying to balance the dual responsibility of education and patient care through the medium of the trainee . However, appropriate entrustment allows satisfactory care to be provided to the patient at hand while also allowing the resident to develop competence, ultimately benefiting the patients they will one day go on to care for independently . In the new surgical education model incorporating entrustable professional activities, faculty entrustment will become an even greater driver of resident progression.…”

“…OpTrust allows for the assessment of both intraoperative faculty entrustment and resident entrustability behaviors in real time and acknowledges the relationship between the educator and learner during these interactions . Previous studies have demonstrated that increased resident entrustablity advances resident autonomy, does not compromise postoperative patient outcomes, and is associated with progression through milestones . Importantly, faculty entrustment has shown to be a key factor in how residents exhibit entrustability, and faculty surgeons who demonstrate progressive intraoperative entrustment can help propel resident autonomy forward .…”

Preserving and Enhancing Resident Autonomy—Strategies for Surgical Educators

“…OpTrust, an educational package aimed at improving resident entrustment, is one such model that has been previously described . Analyzing their experience with this intervention, Williams and colleagues reported no difference in outcomes between historical controls and a cohort of more than 8000 patients who underwent surgery after implementation of OpTrust. These authors concluded that increasing resident entrustment does not worsen patient outcomes, and that a formal educational intervention may encourage increased resident autonomy.…”

“…As we transition toward a competency-based educational model, continued professional development will help improve opportunities for autonomy. OpTrust, an educational package aimed at improving resident entrustment, is one such model that has been previously described . Analyzing their experience with this intervention, Williams and colleagues reported no difference in outcomes between historical controls and a cohort of more than 8000 patients who underwent surgery after implementation of OpTrust.…”

Operative Autonomy of Surgical Residents and Patient Outcomes

“…Enstrustibility to perform independent surgery is the elephant in the room that cannot be accounted for in the registry analysis. Despite competency-based curriculums, training techniques, and multiple objective scales, entrustibility remains a subjective realm that depends on human factors beyond competency alone.…”