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Surgery. 2017 Dec;162(6):1314-1319. doi: 10.1016/j.surg.2017.07.028. Epub 2017 Sep 23.

What factors influence attending surgeon decisions about resident autonomy in the operating room?

Author information

1
Department of Surgery, Indiana University, Indianapolis, IN. Electronic address: reedwill@iupui.edu.
2
Department of Surgery, University of Michigan, Ann Arbor, MI.
3
Department of Surgery, Northwestern University, Chicago, IL.
4
Department of Surgery, Massachusetts General Hospital, Boston, MA.
5
Department of Surgery, Indiana University, Indianapolis, IN.
6
Department of Surgery, University of New Mexico, Albuquerque, NM.
7
Department of Surgery, University of Minnesota, Minneapolis, MN.
8
Department of Surgery, University of Texas Southwestern, Surgery, Dallas, TX.
9
Department of Surgery, University of Kentucky, Lexington, KY.
10
Department of Surgery, University Of Wisconsin, Madison, WI.
11
Department of Surgery, University of Washington, Surgery, Seattle, WA.
12
Department of Surgery, State University of New York, Surgery, Syracuse, NY.
13
Department of Surgery, Brigham and Women's Hospital, Surgery, Boston, MA.
14
Department of Surgery, Vanderbilt University Medical Center, Surgery, Nashville, TN.
15
Department of Surgery, Washington University, Surgery, St. Louis, MO.

Abstract

BACKGROUND:

Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents.

METHODS:

We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty.

RESULTS:

Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74).

CONCLUSION:

Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.

PMID:
28950992
DOI:
10.1016/j.surg.2017.07.028
[Indexed for MEDLINE]

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