Resident hesitation in the operating room: does uncertainty equal incompetence?

Area of Science:

• Medical Education
• Surgical Training
• Patient Safety

Background:

• Postgraduate medical training requires residents to develop autonomy while managing uncertainty.
• Operating room environments present unique challenges for resident supervision and autonomy.

Purpose of the Study:

• To explore the phenomenon of hesitation in surgical residents.
• To understand the social behaviors surrounding supervision and progressive autonomy in the operating room.

Main Methods:

• Nine surgical residents and their supervisors were observed during procedures.
• Semi-structured interviews were conducted post-observation.
• Constructivist grounded theory guided data collection and analysis.

Main Results:

• Hesitation was linked to the 'principle of progress,' a norm prioritizing surgical procedure continuity.
• Hesitation was perceived by both residents and supervisors as a sign of incompetence.
• This perception negatively impacted the teaching-learning process during critical moments.

Conclusions:

• The 'principle of progress' shapes how hesitation is interpreted, influencing competence judgments.
• Current perceptions of hesitation as incompetence limit its potential as a teaching opportunity.
• Revising the perception of hesitation is crucial for supporting residents' progressive autonomy in surgical training.