E. L. Chang1, A. M. Williams1, R. C. Boothman1, J. Thompson-Burdine1, R. M. Minter2, G. Sandhu1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: Achieving an appropriate level of supervision remains a national problem in surgical education. Often, the regulations regarding resident supervision are in reference to “the critical portion of a case.” We sought to develop a better understanding of ‘key and critical portions’ of surgical cases, pertaining to intraoperative resident supervision and patient safety.
Methods: Hospital risk managers and legal counsel from cross the United States were surveyed using an online, qualitative questionnaire from May to June 2018. Snowball sampling, a subset of purposive sampling, was used to identify and develop a population of 47 risk managers. Interpretive description was used to analyze qualitative data. Individual responses were coded with NVivo software with simultaneous categorization and assessment of underlying relationships. Response variation was discussed among the research team and resolved accordingly.
Results: Overall, 25 of 47 (53%) risk managers completed the survey. Qualitative responses could be organized into three major themes: (1) “differing expectations”, (2) “variations in defining the ‘key and critical’ portions of a case, and (3) “developing trusting relationships in the operating room.” Little consensus was found regarding an attending’s role in the operating room and how “key and critical” portions of a procedure are defined. However, all participants agreed regarding the importance of patient safety and need for developing intraoperative trust among all parties in the operating room.
Conclusion: Expectations and definitions remain highly variable regarding “key and critical” portions of a surgical case. Even among risk managers, who have a considerable influence on guidelines and definitions for health systems, multiple interpretations may exist. Continuing to develop and highlight the transparency of “key and critical” portions of a case will support optimizing the teaching-learning experience within the safety net of supervised surgical resident training.