Is the operative autonomy granted to a resident consistent with operative performance quality.
Surgery
; 164(3): 566-570, 2018 09.
Article
en En
| MEDLINE
| ID: mdl-29929754
ABSTRACT
BACKGROUND:
We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality.METHODS:
Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as "practice ready performance/meaningfully autonomous" or "not practice ready/not meaningfully autonomous." Discordant circumstances were practice ready/not meaningfully autonomous or not practice ready/meaningfully autonomous. Resident training level, patient-related case complexity, procedure complexity, and procedure commonality were investigated to determine impact on autonomy.RESULTS:
A total of 8,798 assessments were collected from 429 unique surgeons assessing 496 unique residents. Practice-ready and exceptional performances were 20 times more likely to be performed under meaningfully autonomous conditions than were other performances. Meaningful autonomy occurred most often with high-volume, easy and common cases, and less complex procedures. Eighty percent of assessments were concordant (38% practice ready/meaningfully autonomous and 42% not practice ready/not meaningfully autonomous). Most discordant assessments (13.8%) were not practice ready/meaningfully autonomous. For fifth-year residents, practice ready/not meaningfully autonomous ratings (9.7%) were more frequent than not practice ready/meaningfully autonomous ratings (7.5%). Ten surgeons (2.3%) failed to afford residents meaningful autonomy on any occasion.CONCLUSION:
Resident operative performance quality is the most important determinant in attending surgeon decisions regarding resident autonomy.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Cirugía General
/
Autonomía Profesional
/
Competencia Clínica
/
Internado y Residencia
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
Surgery
Año:
2018
Tipo del documento:
Article