Autonomy and intraoperative teaching from faculty and resident perspectives

The ability to operate autonomously is one of the most desirable traits surgical residents seek to obtain by the end of their training. This study assesses the relationship between autonomy and intraoperative teaching as graded by faculty and residents.

We retrospectively analyzed intraoperative evaluations completed by general and subspecialty surgical faculty for general surgery residents between July 2014 and June 2024 using the Global Rating Scale of Operative Performance and the Zwisch autonomy scale. Both faculty and residents assessed autonomy and intraoperative teaching. Correlation analyses examined the relationship between autonomy scores as rated by faculty and as rated by residents, and the association between intraoperative teaching and autonomy.

A total of 2,338 elective procedures were independently evaluated to assess resident's performance by 53 faculty (faculty evaluation) and 70 residents (self-evaluation) at various postgraduate years. Commonly evaluated procedures included hernia repairs, cholecystectomies, colorectal and anal, breast, and soft tissue. Faculty-assigned teaching and autonomy scores were moderately positively correlated (r = 0.45, P < .001), as were resident self-assessed teaching and autonomy scores (r = 0.37, P < .001). A moderate correlation was found between faculty and resident autonomy scores (r = 0.44, P < .001), whereas the correlation between faculty and resident intraoperative teaching scores was weak (r = 0.13, P < .001). A paired samples t test was used to compare the means of scores as assessed by faculty and residents.

Faculty and resident assessments reveal strong internal correlations between autonomy and teaching, but notable discordance exists in perceived intraoperative teaching, highlighting the need to clarify how both groups assess these skills.