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Application of a Validated Assessment Tool to Compare Autonomy and Operative Performance Between Surgical Residency
E Joy Trimble1, Kenneth Stewart1, Pawan Acharya2
1Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Journal of Surgical Education
|January 31, 2025
Summary
Residency programs with more advanced surgical cases may not improve resident readiness for independent practice. Objective assessment tools like SIMPL show lower performance ratings in programs with higher proportions of complex procedures.
Area of Science:
- Surgical Education
- Medical Simulation
- Competency Assessment
Background:
- Objective assessment of surgical resident competency is crucial for safe practice.
- The System for Improving and Measuring Procedural Learning (SIMPL) app utilizes the Zwisch scale for real-time operative performance evaluation.
- Limited research compares SIMPL scores across general surgery programs to assess the impact of procedure difficulty.
Purpose of the Study:
- To compare resident performance and supervision ratings across general surgery programs using the SIMPL application.
- To investigate if the difficulty of surgical procedures influences resident ratings and program-wide evaluations.
- To identify variations in resident exposure to advanced and high-value procedures.
Main Methods:
- Utilized the SIMPL database to analyze attending ratings for Post Graduate Year (PGY) 1-5 residents.
- Defined Meaningful Autonomy (MA) and Satisfactory Performance (SP) based on established criteria.
- Classified procedures as 'core' or 'advanced' using American Board of Surgery SCORE criteria and by Work Relative Value Units (wRVU).
- Employed generalized estimating equations (GEE) logistic regression to assess the predictive relationship between procedure complexity and resident performance outcomes.
Main Results:
- Significant variation exists in the proportion of advanced and high wRVU procedures across programs.
- Higher proportions of advanced/high wRVU procedures correlated with lower Meaningful Autonomy (MA) and Satisfactory Performance (SP) ratings overall.
- This association was less consistent for PGY 5 residents and when analyzing advanced procedures specifically.
Conclusions:
- Programs with a higher percentage of advanced procedures did not consistently demonstrate improved Meaningful Autonomy (MA) or Satisfactory Performance (SP) for residents, particularly PGY 5s.
- Increased exposure to complex procedures does not guarantee readiness for independent surgical practice.
- Findings suggest that high-volume advanced case programs may not adequately prepare surgeons for independent practice.
