See one, do one, be competent in one? Resident rotations broaden the perceived scope of general surgery

To compare the scope of general surgery as perceived by general surgery program directors (PDs) nationally and our residents (RES), and to assess the effect of clinical rotation assignments on resident perception.

A background questionnaire and survey document drawn from the Resident Operative Report submitted by finishing residents to the American Board of Surgery (ABS) was sent to our general surgery residents. Respondents categorized 309 items as procedures with which a finishing resident should be competent (A), familiar (B), or neither (C). Data from an identical survey of PDs were obtained from the ABS. Procedures were assigned to Groups 1-4 based on resident rotations. PD responses were considered the reference data set. RES answers outside the range of 0.5x to 1.5x, where x = PD% for each item, were labeled as different. Differences were categorized as residents having a "narrower" perception of general surgery if RES %A less than 0.5x and %C greater than 1.5x and "broader" if RES %A greater than 1.5x and %C less than 0.5x. Chi-square testing was also performed as a "cross-check" analysis.

After eliminating consensus items, 60 Group 1 items, 103 in Group 2, 19 in Group 3, and 16 in Group 4 remained. When linked to resident rotations, RES took a broader view of general surgery scope for 27/163 items and a narrower view for only 1 item (0.6%). Without related rotation experience, RES viewed 0/19 procedures more broadly than PD and categorized 7/19 items more narrowly. When items overlapped 2 surgical specialties, RES assigned no items as broader or narrower. Chi-square testing produced similar results.

Our residents perceived the scope of general surgery more broadly than did a national sample of PDs for content areas in which residents completed rotations. A broader view of general surgery could influence resident decision making about postresidency fellowships.