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General Surgery Resident Complement and Operative Autonomy - Size Matters.

Yasong Yu1, Anastasia Kunac1, Joseph B Oliver1

  • 1Department of Surgery, VA New Jersey Healthcare System, East Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

Journal of Surgical Education
|October 17, 2022
PubMed
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Larger general surgery resident programs in VA hospitals correlate with increased resident operative autonomy. While autonomy has declined overall, larger programs mitigate this trend, enhancing surgical education.

Area of Science:

  • Medical Education
  • Surgical Training
  • Healthcare Administration

Background:

  • Operative autonomy for surgery residents has seen a progressive decline.
  • Understanding factors influencing resident operative autonomy is crucial for surgical education.
  • Veterans Affairs (VA) hospitals provide a unique setting to study resident training dynamics.

Purpose of the Study:

  • To investigate the impact of general surgery resident complement size on operative autonomy within VA hospitals.
  • To test the hypothesis that smaller resident groups lead to fewer operative autonomy opportunities.
  • To analyze trends in resident operative autonomy across different resident complement sizes.

Main Methods:

  • Retrospective analysis of the VA Surgical Quality Improvement Program (VASQIP) database.
Keywords:
general surgery residencyprogram complementresident operative autonomyveterans affairs

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  • Inclusion of general surgery procedures from teaching VA hospitals between 2004 and 2019.
  • Categorization of operative autonomy into Attending Primary (AP), Resident Primary with Attending Scrubbed (AR), and Resident Primary without Attending Scrubbed (RP) levels.
  • Stratification of resident complement size into small (≤4), medium (>4-<7), and large (≥7) groups.

    • Main Results:

    • Analysis included 461,734 procedures across 92 VA hospitals.
    • The percentage of Resident Primary (RP) procedures increased with resident complement size (2.1% vs 6.8% vs 9.9%, p < 0.001).
    • RP procedures decreased over time, with a less pronounced decrease in larger resident complement groups (79.5% vs 73.3% vs 64.7%, p < 0.001).
    • No significant difference in adjusted 30-day all-cause mortality was observed between groups.

    Conclusions:

    • Increased resident complement size is associated with greater operative autonomy for residents in primary procedures.
    • While resident autonomy has declined universally, larger programs show a slower rate of decline.
    • Expanding resident programs may enhance operative autonomy and improve the educational experience for surgical residents.