I. Woelfel1, D. Strosberg1, B. Q. Smith2, A. Harzman1, R. Salani2, A. Cochran1, X. (. Chen1 1Ohio State University,Department Of Surgery,Columbus, OH, USA 2Ohio State University,Department Of Obstetrics And Gynecology,Columbus, OH, USA
Introduction: Developing resident autonomy in the operating room (OR) is a complex process that involves resident readiness, preparation and flexibility; instructor feedback and guidance; and is impacted by environmental and patient factors. Resident-established case specific learning goals have long been promoted as a way to increase resident OR training efficiency and the preparedness for autonomy. However, little is known about residents’ experience of identifying learning goals for a given case. The aim of this study was to investigate the developmental process of residents’ case specific goals based upon residency training level.
Methods: After obtaining IRB consent, we conducted focus group interviews with 18 general surgery residents across five clinical postgraduate years (PGY) using convenience sampling. Audio recordings of each interview were transcribed and iteratively analyzed. Emergent themes were identified using a framework method.
Results: A total of eight junior (PGY 1-2) and 10 senior (PGY 3-5) residents participated; 10 were female and 8 were male. Focus group participants indicated that the ability of residents to self-identify case specific learning goals for an upcoming surgical case is closely associated with residents’ medical knowledge and surgical experience throughout residency training. The more experience and knowledge gained, the easier for residents to identify a specific learning goal for a case. In the early stage of residency training, residents have difficulty self-identifying actionable case specific learning goals. Junior residents tend to rely on attending and/or senior residents to assign a learning goal. During the intermediate stage of residency training, residents were more comfortable in specifying a goal for some high-volume common procedures than the junior residents. Approaching the final stage of residency training, residents are able to articulate specific and achievable learning goals for most cases. However, they perceived practical challenges when serving as a Teaching Assistant in the OR with junior residents. Numerous internal and external factors influence the development of residents’ case specific learning goals, including resident operative experience, resident self-entrustment and entrustment of attending, as well as case assignment timeline, attending teaching style and attending reputation in granting operative autonomy.
Conclusion: Although self-identifying case specific learning goals functions well for senior residents, it is not practical for junior residents to develop actionable, specific goals due to their limited medical knowledge and operative experience. Residency programs could provide a set of procedure-based learning goals for junior residents to enhance their training efficiency and to solidify their foundation for future OR autonomy. Resident-as-Teacher programs would be beneficial to enhance senior residents' identification of learning goals for their junior peers.