Senior surgical resident autonomy and teaching assistant cases: A prospective observational study

Area of Science:

• Surgical Education
• Resident Training
• Patient Safety

Background:

• Teaching assistant (TA) cases are crucial for senior residents (SR) to develop autonomy.
• The impact of direct versus indirect staff supervision on TA cases requires further investigation.

Purpose of the Study:

• To compare the safety and efficiency of TA cases performed under direct versus indirect staff supervision.
• To evaluate resident perceptions of difficulty and comfort levels in TA cases based on supervision type.

Main Methods:

• A prospective observational study included 161 TA cases performed by SRs from July 2014 to June 2017.
• Data collected included patient and operative characteristics, 30-day outcomes, and SR survey responses.
• Cases were analyzed based on whether the SR had direct or indirect staff supervision.

Main Results:

• Indirectly supervised TA cases were shorter (61 vs. 76 min) with less blood loss (11 vs. 24 ml) and lower conversion rates (0% vs. 5.7%).
• Perceived difficulty was lower in indirectly supervised cases (20% vs. 49%), while resident comfort remained high (4.4 vs. 4.6/5).
• No significant differences in 30-day complication rates were observed between direct and indirect supervision groups.

Conclusions:

• Selected TA cases under indirect supervision provide SRs autonomy without compromising operative efficiency or patient safety.
• Indirect supervision in TA cases is a viable strategy for enhancing resident surgical training and confidence.