PS5-06: PULLED FROM THE PASSENGER SEAT: RESIDENT ENGAGEMENT IN THE OR
Melanie Hammond Mobilio, MA1, Priyanka Patel, MD2, Daniel Glatt, MD3, Ryan Brydges, PhD2, Carol-anne Moulton, MD, PhD2; 1University Health Network, 2University of Toronto, 3Queens University
Background: Autonomy is a key goal of surgical training, achieved through a process of ‘graded responsibility.’ Residents may struggle to attain autonomy, partially due to systemic issues such as duty hour restrictions, patient safety concerns, and fiscal realities regarding operating room (OR) resources. Individual factors such as engagement during the operative procedure may also impact resident learning and skill development. This study aimed to explore resident engagement from the perspective of both residents and attending surgeons.
Methods: Using a constructivist grounded theory methodology, semi-structured interviews were conducted with 10 attending surgeons and 12 residents. Data were coded and analyzed iteratively by the study team until theoretical saturation was achieved. Questions explored the experience of resident engagement from the perspective of both residents and staff surgeons.
Results: Our study revealed that resident engagement in the OR is perceived by both residents and attendings as fundamental to learning, and is therefore a critical step to achieving autonomy. Residents described being engaged in the OR as a state in which they were actively learning, and felt disengaged when doing activities that they did not associate with learning (“…as a junior you don’t feel that the attendings talk to you much, you feel like a little workhorse” (RS06). Our study uncovered three key tensions that underlie the disconnect between resident and surgeon priorities in the OR as they relate to resident engagement: 1. Residents and attendings both occupy dual roles in the OR (i.e. worker and learner/teacher); 2. System demands require that one role be prioritized over the other; 3. These roles are in fundamental opposition to one another.
Conclusion: Residents and surgeons occupy the same space with the shared goal of optimal patient care during the operative procedure. However, the immediate goals and priorities of each group are markedly different. While residents prioritize their role as learners, surgeons prioritize their role as workers. When resident training is bound within the confines of the academic hospital system, competing priorities can result in resident engagement being negatively impacted. These disconnects can lead to strategies such as false learning/teaching, and hinder the development of resident autonomy.