Operating Without Direct Supervision During Pediatric Surgery Fellowship: When, How, and Why?

Area of Science:

• Medical Education
• Surgical Training
• Pediatric Surgery

Background:

• Concerns exist regarding pediatric surgical fellows' readiness for independent practice due to limited unsupervised operating experience.
• Entrustable Professional Activities (EPAs) emphasize the need to assess policies on fellow operative autonomy.

Purpose of the Study:

• To evaluate current practices and policies concerning pediatric surgical fellow operative autonomy in North America.
• To understand the criteria and variability in allowing fellows to operate without direct supervision.

Main Methods:

• A survey was sent to 59 North American pediatric surgical program directors (PDs).
• PDs reported on program policies for fellow operative autonomy and unsupervised operating scenarios.
• Inquiries included details on attending surgeon presence and any resulting malpractice cases.

Main Results:

• 44 PDs (75%) responded, revealing few programs with clear protocols for indirectly supervised operating.
• Most PDs reported fellows performing basic procedures without a scrubbed attending, but complex cases were rarely performed with only trainee supervision.
• Parental consent for fellows acting as teaching assistants was not a standard requirement, and one malpractice suit was reported.

Conclusions:

• Substantial variability exists in pediatric surgical training programs regarding fellow operative autonomy.
• Few programs have established protocols to assess trainee readiness for independent operating.
• Standardized parental consent for teaching assistant roles is not consistently obtained.