PS5-11: INTRAOPERATIVE TRUST BETWEEN FACULTY AND RESIDENTS PREDICTS CLINICAL COMPETENCY AMONG GENERAL SURGERY RESIDENTS
Sunjong Ji¹, Charles Hwang¹, Monita Karmakar¹, Niki Matusko¹, Julie Thompson-Burdine¹, Rebecc M Minter², Gurjit Sandhu¹; ¹University of Michigan, ²University of Wisconsin

Background: Trust is a salient feature of educational interactions in the operating room. OpTrust is a validated tool for measuring intraoperative trust between faculty and residents. However, it is unknown how intraoperative trust is related to residents’ clinical competency.

Objective: This study explores whether faculty entrustment and resident entrustability in the OR predict clinical competency among general surgery residents.

Method: A total of 115 intraoperative observations were conducted between September 2015 to June 2017. Faculty entrustment and resident entrustability were measured by observing intraoperative behaviors in 5 domains, and scored (on a four-point scale) using the validated OpTrust rating instrument. Post-observation clinical competency scores on patient care (PC), medical knowledge (MK), systems-based practice (SBP), practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal communication skills (ICS) were measured using ACGME surgical milestone scores. An exploratory factor analysis showed that all 16 sub-competency items measuring the 6 competencies loaded on a single factor. Mixed model linear regressions were used to assess if the faculty entrustment and resident entrustability scores during observations significantly predicted the overall post-observation resident milestone scores and individual competency scores with random effects to account for repeated measures on residents.

Results: 12 raters observed 115 operative cases conducted by 22 surgical faculty and 37 general surgery residents (N=151 observations due to some multiple observations). The mean resident entrustability was 2.17 (±0.79) while the mean faculty entrustment was 2.33 (±0.74). The overall mean milestone score ranged from 1.19 to 4 with a mean score of 3.13 (±0.79). Both resident entrustability (β=0.12; p<0.001) and faculty entrustment (β=0.12; p<0.001) significantly predicted the overall surgical milestone score. Looking at the individual competencies, resident entrustability significantly predicted the following: PC (β=0.18; p<0.001); MK (β=0.16; p<0.001); SBP (β=0.07; p=0.001); PBLI (β=0.13; p<0.001); PROF (β=0.10; p=0.001); ICS (β=0.13; p<0.001). Similarly, faculty entrustment significantly predicted the following competencies: PC (β=0.18; p<0.001); MK (β=0.16; p<0.001); SBP (β=0.07; p=0.002); PBLI (β=0.12; p<0.001); PROF (β=0.09; p=0.002); ICS (β=0.11; p<0.001).

Conclusions: OpTrust scores are positively associated with ACGME general surgery clinical competency scores. Therefore, intraoperative faculty entrustment and resident entrustability behaviors can help identify areas for improvement in residents.