Resident Autonomy in the Operating Room: How Faculty Assess Real-time Entrustability

Area of Science:

• Medical Education
• Surgical Training
• Qualitative Research

Background:

• Assessing real-time entrustability is crucial for surgical residents' intraoperative autonomy.
• Understanding attending surgeons' evaluation methods is key to fostering resident independence.

Purpose of the Study:

• To identify empirical processes and evidence used by expert surgical teachers.
• To determine criteria for taking over surgical steps or granting resident autonomy.

Main Methods:

• Qualitative semi-structured interviews with 43 expert surgical teachers.
• Purposeful and snowball sampling across 21 institutions in the US.
• Framework Method of content analysis for interview transcripts.

Main Results:

• A 3-phase process was identified: performance monitoring, entrustability assessment, and autonomy granting.
• Factors influencing decisions included surgeon-specific (comfort, experience) and contextual (patient safety, case complexity) elements.
• These factors impacted entrustability determinations and residents' final autonomy.

Conclusions:

• Expert surgical teachers utilize a 3-phase decision-making process for intraoperative autonomy.
• This process offers a framework for identifying opportunities to enhance residents' progressive autonomy.
• Engaging residents in entrustability assessment can inform take-over decisions.