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Readiness of US General Surgery Residents for Independent Practice
Brian C George1, Jordan D Bohnen, Reed G Williams
1*Department of Surgery, University of Michigan, Ann Arbor, MI †Massachusetts General Hospital, Boston, MA ‡Indiana University, Bloomington, IN §Northwestern University, Evanston, IL ¶University of Michigan, Ann Arbor, MI ||SUNY Upstate Medical University, Syracuse, NY **University of Washington, Seattle, WA ††Brigham and Williams Hospital, Boston, MA ‡‡Brigham and Women's Hospital, Boston, MA §§University of Minnesota, Minneapolis, MN ¶¶University of New Mexico, Albuquerque, NM ||||Vanderbilt University, Nashville, TN ***Washington University, St. Louis, MO †††UT Southwestern, Dallas, TX ‡‡‡University of Wisconsin, Madison, WI §§§University of Kentucky, Lexington, KY.
General Surgery residents show improved operative skills but limited autonomy by graduation. Many still lack readiness for independent practice, especially for complex procedures.
Area of Science:
- Medical Education
- Surgical Training
- Resident Competency Assessment
Background:
- The American Board of Surgery identifies 132 core General Surgery procedures.
- Concerns exist regarding resident preparedness for independent practice upon graduation.
- Operative autonomy may influence resident skill acquisition.
Purpose of the Study:
- To evaluate the current General Surgery residency training model.
- To assess resident operative performance and autonomy.
- To investigate factors influencing readiness for independent practice.
Main Methods:
- Utilized the System for Improving and Measuring Procedural Learning (SIMPL) Performance scale.
- Employed the Zwisch scale to assess attending guidance and resident autonomy.
- Collected ratings from 444 attendings across 14 General Surgery programs.
- Analyzed 10,130 procedures involving 536 residents.
Main Results:
- Performance ratings for "Practice Ready" or above increased from 12.3% to 77.1% from the first to last year.
- Predicted competency for an average Core procedure in the last week of residency is 90.5%.
- Resident autonomy (Zwisch ratings) increased from 15.1% to 65.7% throughout training.
- Only 33.3% of final-six-month core procedures were rated as "Supervision Only" autonomy.
Conclusions:
- US General Surgery residents are not universally prepared for independent practice upon completing residency.
- Progressive resident autonomy during training remains limited.
- The sufficiency of achieved autonomy for full independent practice readiness is uncertain.
