Resident and Fellow Performance and Supervision in Surgical Oncology Procedures

Area of Science:

• Surgical Education
• Operative Performance Benchmarking
• Supervision Levels

Background:

• Concerns exist regarding the adequacy of general surgery training and fellowship preparation for practice.
• Supervision tailored to trainee proficiency may address these training gaps.
• This study benchmarks operative performance and supervision for senior residents and fellows in general surgical oncology.

Purpose of the Study:

• To benchmark operative performance and supervision levels among senior surgery residents (PGY-4 or -5) and fellows.
• To assess trainee and attending evaluations of performance and supervision in general surgical oncology procedures.

Main Methods:

• Observational data from 103 residency and fellowship programs were analyzed.
• Core general surgical oncology procedures were categorized into breast/soft tissue, endocrine, and hepatopancreatobiliary.
• Trainee and attending evaluations were used to benchmark operative performance and supervision levels.

Main Results:

• Practice-ready performance was achieved by low proportions of residents and fellows across all procedure types (e.g., breast/soft tissue: 38% residents, 48% fellows).
• Even when practice-ready performance was achieved, supervision was provided in only a small fraction of cases (trainees: 17-18%, attendings: 21-25%).
• Significant disparities in performance and supervision were noted across procedure complexities.

Conclusions:

• Attending surgeons infrequently provided supervision commensurate with performance for senior residents and fellows in surgical oncology.
• A critical need exists for surgical training programs to offer greater independence to high-performing trainees.
• Optimizing supervision based on demonstrated proficiency is essential for effective surgical training.