Effect of Ongoing Assessment of Resident Operative Autonomy on the Operating Room Environment

Area of Science:

• Medical Education
• Surgical Training
• Health Informatics

Background:

• The Procedural Autonomy and Supervision System (PASS) is a smartphone-based tool designed to assess surgical resident performance and promote progressive autonomy using the Zwisch autonomy scale.
• Previous studies demonstrated the feasibility and validity of PASS.

Purpose of the Study:

• To evaluate potential negative consequences of implementing PASS in a general surgery residency program.
• To test the hypothesis that PASS does not negatively affect resident or faculty satisfaction in the operating room (OR) or increase mean OR times.

Main Methods:

• Mean OR times for 20 common procedures were compared before and after PASS implementation using electronic medical records and two-sample t-tests.
• Resident and faculty satisfaction in the OR was assessed using the OR Educational Environment Measure tool before and after implementation, with data analyzed via Mann-Whitney rank sum test.

Main Results:

• Only 1 of 20 procedures showed a significant increase in mean OR time post-PASS implementation.
• No significant differences in overall OR Educational Environment Measure scores were found for residents or faculty.
• While residents showed no significant changes in satisfaction, faculty responses indicated minor differences in 7 of 35 items, which were not significant after Bonferroni correction.

Conclusions:

• PASS implementation did not substantially increase mean OR times for common surgical procedures.
• Resident operating room satisfaction remained stable, but some faculty satisfaction changes suggest a potential minor negative effect requiring further investigation.
• The findings support that autonomy-based OR performance assessment systems like PASS do not appear to have a major negative influence on OR times or satisfaction.