Resident Autonomy in the Operating Room: Expectations Versus Reality.

Area of Science:

• Cardiothoracic Surgery
• Surgical Education
• Operative Autonomy

Background:

• Concerns exist regarding graduating thoracic trainees' independent operative skills due to limited training autonomy.
• This study aimed to compare faculty and trainee expectations of autonomy with intraoperative measurements for common cardiothoracic operations.

Purpose of the Study:

• To assess the discrepancy between expected and actual operative autonomy for cardiothoracic trainees.
• To evaluate perceptions of autonomy among faculty and residents for common cardiothoracic procedures.

Main Methods:

• Trainees and faculty used the Zwisch scale and a mobile app to evaluate operative autonomy in real-time.
• A survey assessed expected autonomy levels for six common cardiothoracic operations (decortication, wedge resection, thoracoscopic lobectomy, CABG, AVR, MVR).

Main Results:

• Trainee and attending expectations for autonomy did not significantly differ for senior trainees.
• Both groups expected higher autonomy levels than were observed intraoperatively across all six procedures.
• Data collected from 33 trainees and 30 attendings across 7 institutions over 18 months.

Conclusions:

• A significant gap exists between expected and actual operative autonomy in cardiothoracic surgery training.
• Addressing this gap necessitates a collaborative effort between faculty and residents to foster independent surgical skill development.