Trainee Autonomy in Minimally Invasive General Surgery in the United States: Establishing a National Benchmark

Area of Science:

• Surgical Education and Training
• Minimally Invasive Surgery (MIS)
• Resident Autonomy Assessment

Background:

• Minimally invasive surgery (MIS) is a core component of General Surgery training.
• Current understanding of resident autonomy levels in MIS procedures is limited.
• Establishing benchmarks for trainee autonomy in MIS is crucial for effective education.

Purpose of the Study:

• To establish a contemporary benchmark for trainee autonomy in MIS procedures.
• To assess the progression of autonomy in MIS throughout General Surgery residency.
• To determine if residents achieve sufficient autonomy in MIS prior to graduation.

Main Methods:

• Prospective data collection from 50 US General Surgery residency programs (2015-2020).
• Trainee autonomy assessed using the 4-level Zwisch scale via the SIMPL smartphone application.
• Analysis focused on 'meaningful autonomy' (top 2 Zwisch levels) and 'progressive autonomy' across postgraduate years (PGY).

Main Results:

• Over 38,000 MIS evaluations showed meaningful autonomy increased from 14.1% (PGY1) to 75.9% (PGY5) (p < 0.001).
• Meaningful autonomy rates were higher in MIS (57.2%) versus non-MIS (48.0%) procedures (p < 0.001).
• PGY5 residents achieved high meaningful autonomy in basic MIS (e.g., appendectomy 95%, cholecystectomy 93%) but lower rates in complex procedures (e.g., sleeve gastrectomy 45%).

Conclusions:

• General Surgery residents demonstrate progressive autonomy in MIS, with faster progression in MIS versus non-MIS.
• A significant percentage of residents (nearly 25%) do not achieve meaningful autonomy in MIS cases by graduation.
• Meaningful autonomy is largely concentrated in a subset of basic MIS procedures.