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Is the operative autonomy granted to a resident consistent with operative performance quality.
Williams, Reed G; George, Brian C; Bohnen, Jordan D; Meyerson, Shari L; Schuller, Mary C; Meier, Andreas H; Torbeck, Laura; Mandell, Samuel P; Mullen, John T; Smink, Douglas S; Chipman, Jeffrey G; Auyang, Edward D; Terhune, Kyla P; Wise, Paul E; Choi, Jennifer; Foley, Eugene F; Choti, Michael A; Are, Chandrakanth; Soper, Nathaniel; Zwischenberger, Joseph B; Dunnington, Gary L; Lillemoe, Keith D; Fryer, Jonathan P.
Afiliación
  • Williams RG; Department of Surgery, Indiana University, Indianapolis, IN, USA. Electronic address: reedwill@iupui.edu.
  • George BC; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Bohnen JD; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
  • Meyerson SL; Department of Surgery, Northwestern University, Surgery, Chicago, IL, USA.
  • Schuller MC; Department of Surgery, Northwestern University, Surgery, Chicago, IL, USA.
  • Meier AH; Department of Surgery, State University of New York, Syracuse, NY, USA.
  • Torbeck L; Department of Surgery, Indiana University, Indianapolis, IN, USA.
  • Mandell SP; Department of Surgery, University of Washington, Seattle, WA, USA.
  • Mullen JT; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
  • Smink DS; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
  • Chipman JG; Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
  • Auyang ED; Department of Surgery, University of New Mexico, Albuquerque, NM, USA.
  • Terhune KP; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
  • Wise PE; Department of Surgery, Washington University, Saint Louis, MO, USA.
  • Choi J; Department of Surgery, Indiana University, Indianapolis, IN, USA.
  • Foley EF; Department of Surgery, University of Wisconsin, Madison, WI, USA.
  • Choti MA; Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
  • Are C; Department of Surgery, University of Nebraska College of Medicine, Omaha, NE, USA.
  • Soper N; Department of Surgery, Northwestern University, Surgery, Chicago, IL, USA.
  • Zwischenberger JB; Department of Surgery, University of Kentucky, Lexington, KY, USA.
  • Dunnington GL; Department of Surgery, Indiana University, Indianapolis, IN, USA.
  • Lillemoe KD; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
  • Fryer JP; Department of Surgery, Northwestern University, Surgery, Chicago, IL, USA.
Surgery ; 164(3): 566-570, 2018 09.
Article en En | MEDLINE | ID: mdl-29929754
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.
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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 Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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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 Pais de publicación: Estados Unidos