Is the operative autonomy granted to a resident consistent with operative performance quality

Reed G Williams; Brian C George; Jordan D Bohnen; Shari L Meyerson; Mary C Schuller; Andreas H Meier; Laura Torbeck; Samuel P Mandell; John T Mullen; Douglas S Smink; Jeffrey G Chipman; Edward D Auyang; Kyla P Terhune; Paul E Wise; Jennifer Choi; Eugene F Foley; Michael A Choti; Chandrakanth Are; Nathaniel Soper; Joseph B Zwischenberger; Gary L Dunnington; Keith D Lillemoe; Jonathan P Fryer; Procedural Learning and Safety Collaborative

doi:10.1016/j.surg.2018.04.034

Is the operative autonomy granted to a resident consistent with operative performance quality

Surgery. 2018 Sep;164(3):566-570. doi: 10.1016/j.surg.2018.04.034. Epub 2018 Jun 19.

Authors

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; Procedural Learning and Safety Collaborative

Affiliations

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.

PMID: 29929754
DOI: 10.1016/j.surg.2018.04.034

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attitude of Health Personnel
Clinical Competence*
Decision Making
General Surgery / education*
Humans
Internship and Residency*
Professional Autonomy*