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

Procedural Learning and Safety Collaborative

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)566-570
Number of pages5
JournalSurgery (United States)
Volume164
Issue number3
DOIs
StatePublished - Sep 2018

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Internship and Residency
Surgeons

ASJC Scopus subject areas

  • Surgery

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Is the operative autonomy granted to a resident consistent with operative performance quality. / Procedural Learning and Safety Collaborative.

In: Surgery (United States), Vol. 164, No. 3, 09.2018, p. 566-570.

Research output: Contribution to journalArticle

Procedural Learning and Safety Collaborative. / Is the operative autonomy granted to a resident consistent with operative performance quality. In: Surgery (United States). 2018 ; Vol. 164, No. 3. pp. 566-570.
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title = "Is the operative autonomy granted to a resident consistent with operative performance quality",
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.",
author = "{Procedural Learning and Safety Collaborative} and Williams, {Reed G.} and George, {Brian C.} and Bohnen, {Jordan D.} and Meyerson, {Shari L.} and Schuller, {Mary C.} and Meier, {Andreas H.} and Laura Torbeck and Mandell, {Samuel P.} and Mullen, {John T.} and Smink, {Douglas S.} and Chipman, {Jeffrey G.} and Auyang, {Edward D.} and Terhune, {Kyla P.} and Wise, {Paul E.} and Jennifer Choi and Foley, {Eugene F.} and Choti, {Michael A.} and Chandrakanth Are and Nathaniel Soper and Zwischenberger, {Joseph B.} and Dunnington, {Gary L.} and Lillemoe, {Keith D.} and Fryer, {Jonathan P.}",
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AU - Procedural Learning and Safety Collaborative

AU - Williams, Reed G.

AU - George, Brian C.

AU - Bohnen, Jordan D.

AU - Meyerson, Shari L.

AU - Schuller, Mary C.

AU - Meier, Andreas H.

AU - Torbeck, Laura

AU - Mandell, Samuel P.

AU - Mullen, John T.

AU - Smink, Douglas S.

AU - Chipman, Jeffrey G.

AU - Auyang, Edward D.

AU - Terhune, Kyla P.

AU - Wise, Paul E.

AU - Choi, Jennifer

AU - Foley, Eugene F.

AU - Choti, Michael A.

AU - Are, Chandrakanth

AU - Soper, Nathaniel

AU - Zwischenberger, Joseph B.

AU - Dunnington, Gary L.

AU - Lillemoe, Keith D.

AU - Fryer, Jonathan P.

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N2 - 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.

AB - 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.

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