PS5-05: RESIDENTSâ PATH TOWARD AUTONOMY IN THE OPERATING ROOM: A HURDLE RACE
Ingrid Woelfel, MD, Brentley Smith, MD, David Strosberg, MD, Michael Villareal, MD, Alan Harzman, MD, Ritu Salani, Amalia Cochran, MD, Xiaodong (Phoenix) Chen, PhD; Ohio State University
Introduction: The goal of surgical residency is to produce independent surgeons that are both clinically thoughtful in their decision-making in addition to technically skilled in the operating room (OR). Previous studies have been conducted to explore effective approaches to improve resident OR training efficiency, including entrustment and autonomy, through faculty development or new training modalities. However, little is known about how residents view their progression to autonomy and shape themselves into independent surgeons. The goal of this study was to describe the resident construct for a successful pathway of actions and behaviors that lead to acquired OR autonomy and entrustment during residency.
Methods: Following IRB approval, we conducted focus group interviews with 38 residents from the General Surgery (GS) and Obstetrics & Gynecology (OBGYN) departments at a single institution across all clinical postgraduate years (PGY) using convenience sampling. Audio recordings of each interview were transcribed and iteratively analyzed. Emergent themes were identified using a framework method.
Results: A total of 16 junior (PGY 1-2; 8 GS, 8 OBGYN) and 22 senior (PGY >3; 10 GS, 12 OBGYN) residents participated. We identified 4 common strategies used by residents to gain entrustment and autonomy in the OR: smart communication (e.g. how to ask/answer questions), mindful observation (e.g. make mental notes of attending behaviors and the local context), helpful allies (e.g. conferring with the scrub tech), and visible attributes (e.g. demonstrating to faculty personal and professional characteristics). A process for resident progression to independent practice consistently emerged. This pathway progresses from building rapport, developing mutual entrustment, and finally to obtaining autonomy. The challenges of this pathway include the nature of residents’ reputation, expectation and responsibility.
Conclusion: Our findings describe resident strategies to achieve progressive autonomy and entrustment in the OR. Better understanding of resident approaches, pathways, and the challenges that they face have the potential to enhance resident OR training efficiency as well as resident autonomy and success with surgical entrustable professional activities.