Autonomy Maps: Building a Shared Mental Model for Progressive Resident Operative Autonomy on the Road to Entrustable...

Area of Science:

• Medical Education
• Surgical Training
• Competency-Based Education

Background:

• Resident dissatisfaction with operative autonomy and inconsistent faculty feedback on technical skills were identified.
• Variability in faculty-assigned operative autonomy levels created ambiguity in surgical training.
• A need existed to establish a shared understanding of intraoperative performance expectations between residents and faculty.

Purpose of the Study:

• To create a shared mental model for intraoperative performance expectations between surgical residents and faculty.
• To standardize faculty expectations regarding resident operative autonomy across different procedures and postgraduate years.
• To improve resident satisfaction and the quality of technical skills feedback.

Main Methods:

• Faculty assigned autonomy levels (using the Zwisch scale) for procedural steps based on resident postgraduate year.
• An iterative process standardized these expectations into "Autonomy Maps" across service lines.
• Maps were distributed, educational sessions were conducted, and benchmarks were integrated into assessments.

Main Results:

• Initial mapping revealed significant variability in faculty expectations for resident operative autonomy.
• Residents reported increased satisfaction due to a clearer understanding of performance expectations.
• The "Autonomy Maps" facilitated more specific and actionable feedback on residents' technical skills.

Conclusions:

• Faculty expectations for resident operative autonomy are inherently variable.
• "Autonomy Maps" establish a structured framework for progressive operative autonomy, enhancing resident satisfaction.
• Case-specific technical benchmarks are valuable for assessing resident technical milestones and advancing surgical competency.