Resident and faculty expectations for resident PGY performance for laparoscopic cholecystectomy

Achieving competency is the main goal of surgical residency, but the best way to achieve and assess competency during training is evolving. While Entrusted Professional Activities (EPAs) were recently developed and nationally implemented to measure progressive levels of competency for surgery residents, little guidance exists regarding when residents should be given autonomy during specific steps of commonly performed procedures, such as laparoscopic cholecystectomy. We aimed to define faculty and resident expectations for the progression of resident autonomy while performing a laparoscopic cholecystectomy.

An anonymous survey of faculty and residents at three hospitals was conducted. The survey asked what the lowest PGY faculty and residents individually expected residents to complete seven key steps of a laparoscopic cholecystectomy.

Residents and faculty generally agreed upon when residents should be competent in a step, except for clipping the cystic duct/artery (median expectation of PGY: resident = 2, Interquartile range (IQR) = [1,2] vs. faculty = 2, IQR = [2,3]; p = 0.0036) and dissection of the gallbladder (median expectation of PGY: resident = (2(1,2) vs faculty = 2 (2,3), p = 0.02), with residents expecting to be competent at an earlier PGY compared to faculty. The median expected PGY, reported by both faculty and residents, to achieve competency for all steps of a laparoscopic cholecystectomy was PGY3.

Residents and faculty generally agreed that residents should be competent in steps of LC prior to PGY3. Residents expected to be competent in clipping the cystic duct/artery and dissection of gallbladder at an earlier PGY compared to faculty.