Operative Performance and Autonomy Across Training Years: Does a Preliminary Year Matter?

Area of Science:

• Surgical Education
• Medical Training Outcomes
• Resident Performance Evaluation

Background:

• Preliminary surgery positions often carry a stigma, potentially affecting residents who transition to categorical roles.
• Little is known about whether general surgery residents completing a preliminary year perform differently than their categorical peers during training.

Purpose of the Study:

• To compare the operative performance and autonomy of general surgery residents who completed a preliminary year versus those who did not.
• To investigate potential differences across all five years of residency training.

Main Methods:

• Faculty ratings from the SIMPL application were collected for 1,108 categorical general surgery residents across 89 programs (2015-2023).
• Residents were categorized as 'Previous Prelim' (PP) or 'Traditional Categorical' (TC).
• Operative performance and autonomy were analyzed using generalized mixed effects models, comparing 'competent' vs. 'not competent' and 'meaningful autonomy' vs. 'no meaningful autonomy' ratings.

Main Results:

• Analysis of 42,416 evaluations revealed no significant differences in the adjusted probabilities of achieving 'competent' ratings between PP and TC residents at junior or senior levels.
• Similarly, no significant differences were found in the adjusted probabilities of achieving 'meaningful autonomy' between PP and TC residents in either junior or senior training years.

Conclusions:

• Preliminary (PP) and traditional categorical (TC) residents exhibit similar operative performance and autonomy ratings throughout residency.
• These findings may help mitigate the stigma associated with preliminary surgery training, though further study on senior residents is recommended.