Does Perceived Resident Operative Autonomy Impact Patient Outcomes?

Area of Science:

• Surgical Education
• Patient Outcomes Research
• Colorectal Surgery

Background:

• Trainee autonomy is a critical component of surgical education.
• The impact of perceived trainee autonomy on patient clinical outcomes in colorectal surgery remains under-investigated.

Purpose of the Study:

• To investigate the association between perceived trainee autonomy and patient clinical outcomes, specifically death and serious morbidity (DSM) and 30-day readmissions, following colorectal surgery.

Main Methods:

• A prospective, multi-institutional study involving 63 surgery trainees across 7 programs.
• Trainees completed surveys rating perceived autonomy (observer, assistant, surgeon/teacher) post-colorectal resection.
• Trainee survey data was linked with patient outcomes from the National Surgical Quality Improvement Program (NSQIP) database.

Main Results:

• Trainees perceived their roles as observer (9.2%), assistant (51.6%), or surgeon/teacher (39.3%).
• Higher perceived autonomy as surgeon/teacher was associated with a 4-fold lower rate of death and serious morbidity (DSM) (OR: 0.23, p=0.045).
• Increased perceived autonomy as surgeon/teacher correlated with a 10-fold lower rate of 30-day readmissions (OR: 0.09, p=0.022).

Conclusions:

• Increased perceived trainee autonomy in colorectal surgery is significantly associated with improved patient outcomes.
• When trainees perceive a greater role (surgeon/teacher), patients experience reduced death, serious morbidity, and readmissions.
• Further research is warranted to elucidate the mechanisms behind this association and optimize surgical training environments.