Is the operative autonomy granted to a resident consistent with operative performance quality

Area of Science:

• Medical Education
• Surgical Training
• Healthcare Quality Improvement

Background:

• Attending surgeons' decisions on resident operative autonomy are crucial for surgical training.
• Understanding the alignment between resident performance and granted autonomy is essential for effective skill development.

Purpose of the Study:

• To investigate attending surgeon decisions regarding resident operative autonomy.
• To analyze situations where operative autonomy was discordant with resident performance quality.

Main Methods:

• 8,798 assessments from 429 surgeons on 496 residents across 14 general surgery programs.
• Defined concordance/discordance between performance (practice ready/not practice ready) and autonomy (meaningfully autonomous/not meaningfully autonomous).
• Investigated impact of training level, case complexity, procedure complexity, and commonality on autonomy.

Main Results:

• Practice-ready performances were 20 times more likely to occur under meaningful autonomy.
• 80% of assessments were concordant; 13.8% were discordant (most often not practice ready/meaningfully autonomous).
• Fifth-year residents showed more 'practice ready/not meaningfully autonomous' ratings than 'not practice ready/meaningfully autonomous'.

Conclusions:

• Resident operative performance quality is the primary factor in decisions about surgical autonomy.
• Ensuring alignment between performance and autonomy optimizes surgical resident education and patient safety.