Present Status of Autonomy in Surgical Residency--a Program Director's Perspective.

Area of Science:

• Medical Education
• Surgical Training
• Resident Autonomy

Background:

• The transition from residency to independent practice raises questions about surgical residents' ability to perform procedures autonomously.
• Defining and achieving surgical autonomy during residency is crucial for preparing junior attending surgeons.

Purpose of the Study:

• To survey general surgery residency program directors regarding their approaches to fostering resident autonomy.
• To understand how different programs define and implement surgical autonomy for residents.

Main Methods:

• An 18-question online survey was distributed to general surgery residency program directors in the U.S. from April to June 2013.
• Survey responses were analyzed to determine classifications of autonomy, percentage of cases completed independently, and areas of minimal supervision.

Main Results:

• 42% of program directors responded to the survey.
• 78% of programs defined a resident as a junior surgeon if they completed >50% of a case.
• Most programs defined autonomy as completing >75% of a case or performing critical surgical steps; however, 88% reported chief residents operated under supervision, with only 12% having full operating room autonomy.

Conclusions:

• Significant variation exists in how surgical autonomy is defined and achieved across general surgery residency programs.
• Most program directors perceive that chief residents do not attain complete autonomy by graduation.
• Implementing progressive responsibility in the fourth and fifth years of residency is recommended to enhance resident autonomy.