E. A. Bailey1, A. Johnson2, I. Leeds3, E. C. Wick4, M. Rachel5, S. W. Cowan2, R. R. Kelz1 1Hospital Of The University Of Pennsylvania,Center For Surgery And Health Economics, Department Of Surgery,Philadelphia, PA, USA 2Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 3Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 4University Of California – San Francisco,Department Of Surgery,San Francisco, CA, USA 5Emory University School Of Medicine,Department Of Surgery,Atlanta, GA, USA
Introduction: Residents play an integral role in patient care, yet their contribution in the operating room is incompletely understood. We created a novel tool to quantify the work that residents perform in the operating room. This study examines resident intraoperative participation by clinical year.
Methods: This was a prospective multi-institutional study with 7 institutions over a 3 month period. Operative residents from each institution’s colorectal surgery service were queried after each colectomy. Residents were asked about their communication strategy with the attending, their overall level of participation, and techinical aspects of the operation including construction of the anastomosis, fascial closure, and skin closure. Survey data was collected in REDCap. Descriptive statistics were performed for each item. Logistic multivariable regression was used to test the association between resident work and resident participant status.
Results: Sixty-three residents participated in this study with 417 surveys completed (range 19-79 per institution) resulting in a 95.4% response rate across all sites (range 42-100% per institution). Respondents ranged from clinical year 1 (CY1) to fellows. CY3’s (35.7%) and CY5’s (34.7%) were most heavily represented. Only 117 (27.3%) indicated that they discussed the case with the attending prior to the day of surgery (DOS). Most (65.0%) discussed the case only on the DOS. Earlier resident communication increased by CY with 0% of CY1’s, 23.1% (33) CY3’s, and 39.6% (55) CY5’s reporting communication prior to the DOS (p<0.001). Overall, residents were actively involved in all aspects of the surgical procedure. Increasing autonomy was associated with advancing CY and inversely related to complexity of technical skill (e.g., less autonomy with anastomosis than skin closure) (Figure 1). Resident perception of overall participation revealed learners of all stages: Observer (12%, n=48), Assistant (54%, n=224), Surgeon (34%, n=141), and Teacher (1%, n=4). Level of perceived autonomy increased with CY level with 11.2% of CY3’s, 52.5% of CY5’s, and 80.9% of fellows describing themselves as either surgeon or teacher. Residents who discussed the case prior to the DOS were twice as likely to rate themselves as Surgeon or Teacher (OR 2.01) when controlling for CY (p=0.011).
Conclusion: Brief surveys can easily capture resident work in the operating room. Residents reported a graduated level of perceived autonomy associated with CY, yet early communication with the attending was also significantly associated with autonomy regardless of CY. Rich data such as this may be used by individuals and programs to inform and enhance best practices in surgical education.
