G. Sandhu1, V. C. Nikolian1, C. P. Magas1, D. C. Sutzko1, N. Matusko1, R. M. Minter2 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA
Introduction: Resident operative autonomy has become increasingly limited secondary to hospital demands for efficiency, medico-legal provisions, alterations in duty hours, and increased supervision requirements. These factors have directly contributed to a decreased sense of autonomy for many surgical trainees. To counteract this growing trend, further assessment and optimization of faculty-resident intraoperative interactions is necessary to ensure that entrustment decisions can progressively advance residents toward supervised autonomy. We sought to identify differences in entrustment behaviors exhibited by faculty and resident surgeons using a newly developed and validated instrument, OpTrust.
Methods: Research team members observed elective general, vascular, plastic, and thoracic surgery cases performed at a single academic institution. Following observation, resident and faculty members were independently assessed across various domains (e.g. types of questions asked, operative planning, instruction, problem solving, and leadership) related to operative entrustment. Behaviors were quantified using a 4-point scale (from 1 = low entrustability to 4 = full entrustability) for each dyad in order to identify entrustment differences as a function of resident training level.
Results: From September 2015 to June 2016 we assessed 89 surgery cases using OpTrust. Mean entrustment scores were calculated for each case, revealing significant differences in entrustment behaviors during cases performed by junior residents (PGY1-2), with faculty displaying significantly more entrustment during these operations. No significant differences were identified during cases performed by senior residents (PGY4-5). High entrustability was only identified in cases performed by fellows.
Conclusion: Positive differences in entrustment can stimulate residents to improve their surgical skills in ways they may not be inclined to do so on their own, through the concept of constructive friction. In our study, we identify the greatest margin for constructive friction in cases performed by junior residents. These differences in entrustment behavior decrease as residents progress through training. Improvements in faculty entrustment behaviors should continuously target constructive friction in order to accelerate the acquisition of surgical autonomy of trainees during residency.
