Resident Surgeons Underrate Their Laparoscopic Skills and Comfort Level When Compared With the Rating by Attending Surgeons

Abstract

Objective The development of operative skill during general surgery residency depends largely on the resident surgeons’ ability to accurately self-assess and identify areas for improvement. We compared evaluations of laparoscopic skill and comfort level of resident surgeons from both the resident surgeon’s and attending surgeon’s perspectives. Design We prospectively observed 111 elective cholecystectomies at the University of Michigan as part of a larger quality improvement initiative. Immediately after the operation, both resident and attending surgeons completed a survey in which they rated the resident’s operative proficiency, comfort level, and the difficulty of the case using a previously validated instrument. Resident’s and attending’s evaluations of resident performance were compared using two-sided t-tests. Setting The University of Michigan Health System in Ann Arbor, MI. Large academic, tertiary care institution. Participants All general surgery residents and faculty at the University of Michigan performing laparoscopic cholecystectomy between June 1st and August 31st 2013. Data was collected for 28 of the institution’s 54 trainees. Results Attendings rated residents higher than residents rated themselves on a five-point Likerttype scale with regards to depth perception (3.86 vs. 3.38, p<0.005), bimanual dexterity (3.75 vs. 3.36, p=0.005), efficiency (3.58 vs. 3.18, p<0.005), tissue handling (3.69 vs. 3.23, p<0.005), and comfort performing case (3.86 vs. 3.38, p<0.005). Attendings and residents were in agreement on the level of autonomy displayed by the resident during the case (3.31 vs. 3.34, p=0.85), the level of difficulty of the case (2.98 vs. 2.85, p=0.443), and the degree of teaching done by the attending surgeon during the case (3.61 vs. 3.54, p=0.701). Conclusions A gap exists between resident and attending surgeons’ perception of residents’ laparoscopic skills and comfort level in performing laparoscopic cholecystectomy. These findings call for improved communication between residents and attendings in order to ensure that graduates are adequately prepared to operate independently. In the context of changing methods of resident evaluations that call for explicitly defined competencies in surgery, it is essential that residents are able to accurately self-assess, and be in general agreement with attending surgeons on their level of laparoscopic skill and comfort level performing a case.

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

“…Some authors have described a tendency among surgical residents to overestimate their operative skill set, 1 whereas others have shown that residents underestimate it. [12][13][14] In specific operative skills, residents have a greater degree of confidence than suggested in earlier studies. 15 We observed that, compared with faculty ratings, residents rated their performance in most global EPAs higher than faculty ratings, but not in most operative EPAs.…”

Performance of Residents During Laparoscopic Cholecystectomy: Is Self-assessment Reliable?

“…However, the consistent finding of residents' exaggerated perception deserves further evaluation, and the use of an assessment scale developed in our clinic could be another drawback. However, standardized criteria 4,25 were not validated for Turkish students and did not completely fulfill the items in our study.…”

Using Self-Rated Examinations to Ensure Competence in Laparoscopy

“…Accuracy of self-rating was also found in other studies where residents were asked to rate their surgical performance of a laparoscopic procedure, which was then compared with the rating done by a more senior member of staff. [12][13][14] However, other studies have found that trainees tend to overestimate their own performance. 15,16 A recent review concludes that inexperienced trainees overestimate their own performance but that self-rating also depends on the type of task.…”