Reed G Williams1, Brian C George2, Jordan D Bohnen3, Shari L Meyerson4, Mary C Schuller4, Andreas H Meier5, Laura Torbeck6, Samuel P Mandell7, John T Mullen3, Douglas S Smink8, Jeffrey G Chipman9, Edward D Auyang10, Kyla P Terhune11, Paul E Wise12, Jennifer Choi6, Eugene F Foley13, Michael A Choti14, Chandrakanth Are15, Nathaniel Soper4, Joseph B Zwischenberger16, Gary L Dunnington6, Keith D Lillemoe3, Jonathan P Fryer4. 1. Department of Surgery, Indiana University, Indianapolis, IN, USA. Electronic address: reedwill@iupui.edu. 2. Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 3. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 4. Department of Surgery, Northwestern University, Surgery, Chicago, IL, USA. 5. Department of Surgery, State University of New York, Syracuse, NY, USA. 6. Department of Surgery, Indiana University, Indianapolis, IN, USA. 7. Department of Surgery, University of Washington, Seattle, WA, USA. 8. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 9. Department of Surgery, University of Minnesota, Minneapolis, MN, USA. 10. Department of Surgery, University of New Mexico, Albuquerque, NM, USA. 11. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 12. Department of Surgery, Washington University, Saint Louis, MO, USA. 13. Department of Surgery, University of Wisconsin, Madison, WI, USA. 14. Department of Surgery, University of Texas Southwestern, Dallas, TX, USA. 15. Department of Surgery, University of Nebraska College of Medicine, Omaha, NE, USA. 16. Department of Surgery, University of Kentucky, Lexington, KY, USA.
Abstract
BACKGROUND: We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality. METHODS: Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as "practice ready performance/meaningfully autonomous" or "not practice ready/not meaningfully autonomous." Discordant circumstances were practice ready/not meaningfully autonomous or not practice ready/meaningfully autonomous. Resident training level, patient-related case complexity, procedure complexity, and procedure commonality were investigated to determine impact on autonomy. RESULTS: A total of 8,798 assessments were collected from 429 unique surgeons assessing 496 unique residents. Practice-ready and exceptional performances were 20 times more likely to be performed under meaningfully autonomous conditions than were other performances. Meaningful autonomy occurred most often with high-volume, easy and common cases, and less complex procedures. Eighty percent of assessments were concordant (38% practice ready/meaningfully autonomous and 42% not practice ready/not meaningfully autonomous). Most discordant assessments (13.8%) were not practice ready/meaningfully autonomous. For fifth-year residents, practice ready/not meaningfully autonomous ratings (9.7%) were more frequent than not practice ready/meaningfully autonomous ratings (7.5%). Ten surgeons (2.3%) failed to afford residents meaningful autonomy on any occasion. CONCLUSION: Resident operative performance quality is the most important determinant in attending surgeon decisions regarding resident autonomy.
BACKGROUND: We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality. METHODS: Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as "practice ready performance/meaningfully autonomous" or "not practice ready/not meaningfully autonomous." Discordant circumstances were practice ready/not meaningfully autonomous or not practice ready/meaningfully autonomous. Resident training level, patient-related case complexity, procedure complexity, and procedure commonality were investigated to determine impact on autonomy. RESULTS: A total of 8,798 assessments were collected from 429 unique surgeons assessing 496 unique residents. Practice-ready and exceptional performances were 20 times more likely to be performed under meaningfully autonomous conditions than were other performances. Meaningful autonomy occurred most often with high-volume, easy and common cases, and less complex procedures. Eighty percent of assessments were concordant (38% practice ready/meaningfully autonomous and 42% not practice ready/not meaningfully autonomous). Most discordant assessments (13.8%) were not practice ready/meaningfully autonomous. For fifth-year residents, practice ready/not meaningfully autonomous ratings (9.7%) were more frequent than not practice ready/meaningfully autonomous ratings (7.5%). Ten surgeons (2.3%) failed to afford residents meaningful autonomy on any occasion. CONCLUSION: Resident operative performance quality is the most important determinant in attending surgeon decisions regarding resident autonomy.
Authors: Thomas H Shin; Robert Naples; Judith C French; Cathleen M Khandelwal; Warren Rose; Diya Alaedeen; Jie Dai; Jeremy Lipman; Michael J Rosen; Clayton Petro Journal: Surg Endosc Date: 2020-07-08 Impact factor: 4.584