Autonomy and Competence in Cardiac Surgical Training: A Qualitative Analysis

Area of Science:

• Medical Education
• Surgical Training
• Qualitative Research

Background:

• Concerns exist regarding surgical residents' preparedness for independent practice.
• Current cardiac surgery training goals require clarification regarding competency and autonomy.

Purpose of the Study:

• To explore Canadian cardiac surgery program directors' and trainees' perceptions of competency, autonomy, and surgical training goals.
• To identify discrepancies between stated training objectives and practical realities.

Main Methods:

• Qualitative study utilizing semistructured interviews.
• Thematic and content analysis of transcribed interviews from 16 participants (7 trainees, 9 program directors).
• Interviews conducted online via Zoom across 10 Canadian cardiac surgery programs.

Main Results:

• Both trainees and staff prioritized producing competent surgeons over autonomous ones.
• Technical and nontechnical skills, particularly decision-making, were identified as crucial for competency.
• A significant majority (81%) viewed nontechnical skills as more critical for independent practice than technical skills.
• A minority of trainees (57%) and staff (33%) found current Royal College of Physicians and Surgeons of Canada competencies achievable during residency.

Conclusions:

• Discrepancies exist in perceptions of competency, autonomy, and training goals within Canadian cardiac surgery.
• The Royal College of Physicians and Surgeons of Canada's goal of practice-ready graduates conflicts with program and trainee perspectives.
• Identified barriers to training must be addressed to better prepare graduates for independent practice.