R. W. Randle1, S. L. Ahle2, D. M. Elfenbein5, A. N. Hildreth4, J. A. Greenberg3, P. J. Schenarts7, J. W. Kempenich6 1University Of Kentucky,Department Of Surgery,Lexington, KY, USA 2Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 3University Of Wisconsin,Department Of Surgery,Madison, WI, USA 4Wake Forest University School Of Medicine,Department Of Surgery,Winston-Salem, NC, USA 5University Of California – Irvine,Department Of Surgery,Orange, CA, USA 6University Of Texas Health Science Center At San Antonio,Department Of Surgery,San Antonio, TX, USA 7University Of Nebraska College Of Medicine,Department Of Surgery,Omaha, NE, USA
Introduction:
Surgeon educators express concern about their current ability to impart a strong sense of patient ownership to trainees. We hypothesized that surgical residents’ sense of patient ownership would be associated with their perceived autonomy and other modifiable factors in the modern training environment. We aimed to compare resident and faculty perceptions on residents’ sense of personal responsibility for patient outcomes and to correlate patient ownership with resident and residency characteristics.
Methods:
An anonymous electronic questionnaire surveyed 373 residents and 390 faculty at 7 academic surgery residencies across the U.S. We used a modified version of a validated psychologic ownership scale to measure patient ownership among surgical trainees.
Results:
Respondents included 123 residents and 136 faculty (response rate 33% and 35%, respectively). Overall, 91.1% of resident respondents agreed that faculty modeled strong patient ownership, and 78.0% of faculty agreed that residents took personal responsibility for patient outcomes. 75.6% of residents perceived they felt a similar or higher degree of patient ownership than their faculty, but only 26.4% of faculty agreed. Faculty underestimated the proportion of residents that routinely checked on their patients when “off-duty” or “off-service” (36.8% vs 92.6% per resident report (p<0.001). Faculty and residents perceived that greater operative autonomy provided residents with a higher level of ownership (Figure). Almost all faculty (97.8%) reported providing more autonomy to residents who display strong patient ownership, but only 53.7% provide more autonomy in order to increase ownership.
Higher means on the patient ownership scale correlated with female sex (5.9 vs. 5.5 for males, p=0.009) and advanced PGY level (5.3, 5.5, 5.7, 5.8, 6.1, for PGY1-5, respectively, p=0.02). Additionally, residents who reported that patient outcomes affected their mood when off-duty achieved higher ownership means than those who claimed outcomes did not affect their mood (5.8 vs 4.8, p<0.001). Trainees who perceived better resident camaraderie (p=0.004), faculty mentorship (p<0.001), and that their program provided an appropriate degree of autonomy (p=0.03) felt greater responsibility for patient outcomes.
Conclusion:
Most faculty agree that residents assume personal responsibility for patient outcomes, but many still underestimate residents’ sense of patient ownership. Certain modifiable aspects of residency culture including camaraderie, mentorship, and autonomy are associated with patient ownership among trainees.
