Background Several challenges threaten the traditional premise of graduated independence in general surgery training, leading to a lack of readiness in graduating surgeons. The objective of this study was to determine the factors contributing to faculty decisions to grant residents autonomy in the operating room, the barriers to granting this autonomy, and the factors that facilitate entrustment. Study Design An anonymous online survey was distributed to 239 attending surgeons at 7 institutions. Questions consisted of open-ended and structured 5-point Likert scale questions. Descriptive statistics were calculated, and a qualitative analysis of free-text responses was performed to identify emergent themes. Results There were 116 attending surgeons who responded to the survey (49%). Factors most important to increasing resident responsibility and autonomy in the operating room were the resident's observed clinical skill and the attending surgeon's confidence level with the operation. Factors believed to prevent awarding graduated responsibility and autonomy in the operating room included an increased focus on patient outcomes, a desire to increase efficiency and finish operations earlier, and expectations of attending surgeon involvement by the hospital and patients. Among themes discerned in faculty responses to an open-ended question about the greatest challenges in graduate surgical education, 47% of faculty identified work-hour regulations/time restrictions. Fourteen percent pointed to a change to a shift-work mentality and decreased ownership of responsibility for patients by residents; 13% described a lack of resident autonomy due to increased supervision requirements. Conclusions This study identified several factors that attending surgeons report as significant limitations to transitioning autonomy to surgical residents in the operating room. These issues must be addressed in a direct manner if progressive graduated responsibility to independence is to occur in the next era of graduate surgical training.

https://www.journalacs.org/article/S1072-7515(14)00442-6/pdf

Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy

Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP.

Virtual reality simulators and training in laparoscopic surgery.

Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery.

Introduction. Motion metrics have become an important source of information when addressing the assessment of surgical expertise. However, their direct relationship with the different surgical skil...

/pdf/relevance-of-motion-related-assessment-metrics-in-4popathr33.pdf

Relevance of Motion-Related Assessment Metrics in Laparoscopic Surgery

Purpose
Laparoscopic techniques have nowadays become a gold standard in many surgical procedures, but they imply a more difficult learning skills process. Simulators have a fundamental role in the formative stage of new surgeons. This paper presents the construct and face validity of SINERGIA laparoscopic virtual reality simulator in order to decide whether it can be considered as an assessment tool.

/pdf/construct-and-face-validity-of-sinergia-laparoscopic-virtual-327259mhiv.pdf

Enrique J. Gómez-Aguilera

Papers

Construct and face validity of SINERGIA laparoscopic virtual reality simulator.