S. Coster1, S. Shebrain1, G. Munene1, R. Sawyer1 1Western Michigan University Homer Stryker M.D. School of Medicine, Surgery, Kalamazoo, MICHIGAN, USA
Introduction:
Appropriate faculty supervision and conditional independence of residents during training are required for autonomous and independent postgraduate practice. However, there is growing concern that competence for transition to independent practice is not universally met. We hypothesize that surgery residents play a significant and active role in achieving their own independent status.
Methods:
Over six academic years, between July 2015 and June 2020, 43 surgeons (9 female and 34 male) supervised and intraoperatively assessed the performance of 46 residents (28 male, 18 female) using validated Objective Structured Assessment of Technical Skill (OSATS) and Zwisch Operative Autonomy (ROA) assessments. The latter is a 4-point scale describing faculty supervision behaviors associated with different degrees of resident autonomy (1: show & help, 2: active help, 3: passive help, and 4: supervision only). Resident readiness to perform procedures independently (RRI) was assessed. Data were analyzed using descriptive statistics with categorical variables reported as frequencies and percentages.
Results:
A total of 1,464 elective procedures were performed by residents at different postgraduate years (PGY) supervised by faculty as follows; 279 (19.1%) by PGY1 residents, 338 (23.1%) by PGY2, 331 (22.6%) by PGY3, 224 (15.3%) by PGY4, and 292 (19.9%) by PGY5. Correlational analyses were conducted to examine the relationship between RRI, OSATS, operative autonomy scores, and resident preparation. Results indicated positive correlation between RRI and summative OSATS score (r=0.510, p<0.001) and ROA (r=0.473, p<0.001). There was a strong relation between RRI and PGY (r=0.535, p<0.001). The proportion ratings of overall RRI increased from 7.5% at PGY1 to 16.1% at PGY2, 29.1% at PGY3, 56.9% at PGY4, and 78.7% at PGY5. Meaningful autonomy ratings (3: passive help, and 4: supervision only) increased from 22.7% at PGY1 to 49.8% at PGY2, 65.6% at PGY3, 79.1% at PGY4, to 89.5% at PGY5. At PGY5, proportion ratings of RRI vary based on the ACGME procedure category (83% for abdominal, 81.8% for alimentary tract, 91% for endocrine, 85% for endoscopy, and 43% for vascular procedures). Additionally, proportion ratings of RRI vary based on case difficulty from 96.1% for basic, to 83.3% for advanced, and 74.7% for complex cases.
Conclusion:
Although resident readiness to perform procedures independently increases with years of training, there is a wide variation when considering the specialty/ACGME procedure category and the complexity of cases. The residents’ technical skills play a crucial role in the residents’ readiness and granting operative autonomy. Specialty fellowships are an integral component of postgraduate training to address the gap in ACGME categories where graduation cannot reach appropriate independence