Resident Autonomy in the Operating Room: Expectations Versus Reality

Meyerson, Shari L.; Sternbach, Joel M.; Zwischenberger, Joseph B.; Bender, Edward M.

doi:10.1016/j.athoracsur.2017.05.034

Cited by 60 publications

(36 citation statements)

References 13 publications

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“…Since ascertaining competence is so difficult, we often will use surrogate markers, such as case logs, procedural checklists, and summative evaluations . Case logs can be inaccurate, and deciding whether an individual was the assistant surgeon, resident surgeon, or supervising surgeon is open to interpretation . For example, to meet the key indicator for ossiculoplasty and stapedectomy, a resident must complete 10 cases as primary surgeon, where they perform greater than 50% of the case in addition to the key portions of the procedure .…”

Section: Discussionmentioning

confidence: 99%

Experience with key indicator cases among otolaryngology residents

O’Brien

Kellermeyer

Chung

et al. 2019

Laryngoscope Investig Oto

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Objective To describe the resident experience with respect to key indicator cases for each year of training. Study Design Multi‐institution, cross‐sectional assessment. Methods Using an electronic survey, current otolaryngology residents were solicited to complete a survey regarding their experiences with the key indicator cases to that point. The survey was sent to this cohort in the winter of 2017–2018. Results Three hundred and three residents responded, with 293 completing the survey. Twenty‐three percent were PGY1, 19% PGY2, 21% PGY3, 18% PGY4, and 19% PGY5 or higher. The majority of residents progress from resident assistant as a PGY2, to resident surgeon as a PGY3 and self‐assessed competent surgeon as a PGY4 for the majority of the key indicator cases. Less than 50% of the surveyed PGY5 residents had reached independent practice in all the key indicator cases, with stapedectomy (16%), rhinoplasty (18%), and paramedian forehead flap (14.5%) being the cases least frequently performed independently. Ninety‐five percent of the respondent residents felt their program provided adequate training, but 20% of the respondents were either unsure or believed that they would be unable to perform all the key indicator cases by the completion of their training. Conclusions The majority of otolaryngology residents feel confident in their training, but experience with certain cases lags behind and may not currently be taught as resident level cases. These findings raise the question of whether the current key indicator cases are the best option for assessing breadth and depth of residency training. Level of Evidence NA

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Section: Discussionmentioning

confidence: 99%

Experience with key indicator cases among otolaryngology residents

O’Brien

Kellermeyer

Chung

et al. 2019

Laryngoscope Investig Oto

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“…Despite its importance, surgery residents receive less operative autonomy in training than either they or faculty expect for common operations. 1,2 There are known procedural and surgeon factors that contribute to the operative autonomy allowed, including resident clinical skill, level of training and contact time, and attending confidence and operative complexity or difficulty. 3 Additional social and cultural factors, however, may also influence operative autonomy, such as productivity demands, the medical-legal climate, and the gender of the resident and/or faculty surgeon.…”

Section: Introductionmentioning

confidence: 99%

The effect of gender on operative autonomy in general surgery residents

Meyerson

Odell

Zwischenberger

et al. 2019

Surgery

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Background: Despite an increasing number of women in the field of surgery, bias regarding cognitive or technical ability may continue to affect the experience of female trainees differently than their male counterparts. This study examines the differences in the degree of operative autonomy given to female compared with male general surgery trainees. Methods: A smartphone app was used to collect evaluations of operative autonomy measured using the 4-point Zwisch scale, which describes defined steps in the progression from novice ("show and tell") to autonomous surgeon ("supervision only"). Differences in autonomy between male and female residents were compared using hierarchical logistic regression analysis. Results: A total of 412 residents and 524 faculty from 14 general surgery training programs evaluated 8,900 cases over a 9-month period. Female residents received less autonomy from faculty than did male residents overall (P < .001). Resident level of training and case complexity were the strongest predictors of autonomy. Even after controlling for potential confounding factors, including level of training, intrinsic procedural difficulty, patient-related case complexity, faculty sex, and training program environment, female residents still received less operative autonomy than their male counterparts. The greatest discrepancy was in the fourth year of training.

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“…When measuring the autonomy of residents in common operations, both residents and attendings expected the same level of autonomy based on survey responses. 29 Autonomy was classified on the 4-step scale: ''Show and Tell'' (1 point), ''Active Help,'' ''Passive Help,'' and ''Supervision Only'' (4 points). Following cases, residents and attendings rated the autonomy the resident demonstrated during the case on the Zwisch Me!!…”

Section: Thoracicmentioning

confidence: 99%

“…Although senior residents receive greater levels of autonomy compared with junior residents, they performed only 44% of operations with significant autonomy. 29 When looking specifically at female resident autonomy, evaluations showed a significant bias against female residents across seven integrated and traditional thoracic programs. 30 These autonomy studies indicate that faculty education could aid in fostering autonomy among female residents and help bridge the mismatch in expected and experienced autonomy for all residents.…”

Section: Thoracicmentioning

confidence: 99%

Educational research and training innovation in cardiothoracic surgery: A year in review

Hunt

Zhou

Lui

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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, it has been an exciting year for the field. However, this volume of research renders it difficult to keep abreast with the latest innovations in education. This year alone in CT surgery, there were 35 education-focused abstracts, 24 sessions oriented toward emerging technology, and more than 180 sessions devoted to surgical skills and simulations. Many studies explored the role of technology-based tools in augmenting CT surgery training. These were applied to the field broadly, within subspecialties, and at all levels of medical training from medical student to senior attending. Research also grappled with how to best enhance recruitment of students into CT surgery. It is these advances in education that will prove vital to the future of CT surgery education. Reflecting on the extensive scholarly work published and presented at the major CT surgical conferences, the aim of this paper is to explore the education highlights of the 2017 to 2018 academic year and provide commentary on where the field may be headed. EDUCATIONAL RESEARCH ACROSS THE FIELD OF CT SURGERY Structure of the Field Many researchers over the course of the year investigate how the field of CT surgery is changing and how trainees in particular are responding. The presence of physician extenders within CT surgery has increased in recent years. A national survey assessing opinions of physician extender involvement showed that overall impression is favorable but that their role can occasionally impede resident education, especially in regard to patient management on the ward. 1 In regard to training structure, residents appear to prefer traditional programs to the integrated 6-year (I-6) program. The most common reasons given for not applying to the I-6 program were lack of commitment to CT surgery as a medical student and uncertainty of adequacy of I-6 training-from the belief that general surgery training is more well-rounded. 2 For general thoracic surgery, the 4/3 and traditional programs were the preferred and more common route compared with the I-6 residents, who nearly all were set on a cardiac career (adult or congenital). 2,3 I-6 programs also increase concern about decreased general surgery operative volume, which emphasizes the need for cooperation and communication between integrated and categorical program directors to ensure adequate training for all residents. 4 Understanding the advantages and challenges of the various educational paradigms, programs continue to modify and improve their curriculum to better address the perceived needs of the specialty and those of the trainees. Support for Residents' Transition to Training and to Practice Research this year focused on understanding how to better support CT surgery residents. Throughout the conferences this year, many sessions were oriented toward

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Resident Autonomy in the Operating Room: Expectations Versus Reality

Cited by 60 publications

References 13 publications

Experience with key indicator cases among otolaryngology residents

Experience with key indicator cases among otolaryngology residents

The effect of gender on operative autonomy in general surgery residents

Educational research and training innovation in cardiothoracic surgery: A year in review

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