G. Sandhu1,2, C. P. Magas1, A. B. Robinson1, R. M. Minter1,2 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Department Of Learning Health Sciences,Ann Arbor, MI, USA
Introduction: The operating room is a critical learning environment for surgical residents. Transitioning residents from observers to assistants to safe independent practitioners, while keeping patient safety paramount, is a complex feat. Faculty must make entrustment decisions and determine the degree to which they can safely release gradual responsibility to residents. It is imperative to better understand faculty-resident interactions in the operating room and means by which to identify entrustment that would allow for progressive autonomy.
Methods: Field notes were documented from 30 general surgery cases resulting in 160 hours of operating room observations with variations in pairing among 20 general surgery residents and 10 faculty. All observations were conducted at a single institution. Thematic analysis of field notes in combination with preliminary data from 32 resident interviews informed development of the Faculty-Resident Operative Entrustment Tool – OpTrust. OpTrust focuses on assessment of faculty-resident interactions which enhance or inhibit intraoperative entrustment decisions.
Results: Through a highly iterative process of systematically reviewing OpTrust, the tool was refined to 6 items and 4 levels of descriptive anchors with each item describing behaviors on both sides of the faculty resident dyad. The 6 items are: (?) types of questions asked; (?) operative plan; (?) instruction; (?) problem solving; (?) leadership by the surgical resident; (?) near miss or error. Collectively, these items and leveled anchors provide a robust and multi-dimensional view of faculty-resident operative entrustment interactions, and the impact of behavior of each in achieving autonomy (Figure 1).
Conclusion: Identifying intraoperative behaviors and the level of entrustment associated with each behavior for both faculty and residents, OpTrust provides a novel pedagogical intervention to enhance resident progress towards greater autonomy.
