Balancing autonomy of thought and action in the context of patient safety: resident perspectives on intraoperative autonomy
Tóm tắt
The goal of surgical residency is to produce technically competent surgeons who can safely operate autonomously. This study aimed to explore residents’ perception of intraoperative autonomy across post-graduate years (PGY). General surgery residents at a single academic institution were invited to participate in focus groups divided by PGY to explore their opinions on operative autonomy. Focus groups were audio recorded, transcribed, and analyzed using constant comparative technique. Thematic analysis was performed using an inductive approach. Thirty-nine residents participated in five focus groups. Five themes emerged from the data. Residents distinguished between autonomy of thought representing graduated decision-making and autonomy of action representing technical maneuvers in the operating room. Residents vocalized a respect for the balance of autonomy and patient safety and stated a desire to have clear expectations to minimize the impact of external factors on autonomy. Residents differentiated autonomy as a parallel of autonomy of thought and autonomy of action and were empathetic to the responsibility of faculty to balance patient safety and autonomy. Surgical educators can improve resident autonomy by clearly managing expectations and minimizing external factors negatively affecting intraoperative autonomy.
Tài liệu tham khảo
George BC, et al. Readiness of US General Surgery Residents for Independent Practice. Ann Surg. 2017;266(4):582–94.
Bell RH Jr. Why Johnny cannot operate. Surgery. 2009;146(4):533–42.
Lewis FR, Klingensmith ME. Issues in general surgery residency training–2012. Ann Surg. 2012;256(4):553–9.
Elfenbein DM. Confidence crisis among general surgery residents: a systematic review and qualitative discourse analysis. JAMA Surg. 2016;151(12):1166–75.
Napolitano LM, et al. Are general surgery residents ready to practice? A survey of the American College of Surgeons Board of Governors and Young Fellows Association. J Am Coll Surg. 2014;218(5):1063-1072.e31.
Meyerson SL, et al. Resident autonomy in the operating room: expectations versus reality. Ann Thorac Surg. 2017;104(3):1062–8.
Kendrick DE, et al. The reliability of resident self-evaluation of operative performance. Am J Surg. 2021;222(2):341–6.
Teman NR, et al. Entrustment of general surgery residents in the operating room: factors contributing to provision of resident autonomy. J Am Coll Surg. 2014;219(4):778–87.
Thiels CA, et al. Medical malpractice lawsuits involving surgical residents. JAMA Surg. 2018;153(1):8–13.
Cassidy DJ, et al. Surgical autonomy: a resident perspective and the balance of teacher development with operative independence. Am J Surg. 2021;221(2):336–44.
Hill KA, et al. How can surgeons facilitate resident intraoperative decision-making? Am J Surg. 2017;214(4):583–8.
DaRosa DA, et al. A theory-based model for teaching and assessing residents in the operating room. J Surg Educ. 2013;70(1):24–30.
Young KA, et al. Characterizing the relationship between surgical resident and faculty perceptions of autonomy in the operating room. J Surg Educ. 2017;74(6):e31–8.
Senders ZJ, et al. Factors influencing the entrustment of resident operative autonomy: comparing perceptions of general surgery residents and attending surgeons. J Grad Med Educ. 2021;13(5):675–81.
George BC, et al. Reliability, validity, and feasibility of the Zwisch scale for the assessment of intraoperative performance. J Surg Educ. 2014;71(6):e90–6.
Meyerson SL, et al. Defining the autonomy gap: when expectations do not meet reality in the operating room. J Surg Educ. 2014;71(6):e64-72.
Dickinson KJ, et al. Public perception of general surgery resident autonomy and supervision. j Am Coll Surg. 2021;232(1):8-15.e1.
Oliver JB, et al. Association between operative autonomy of surgical residents and patient outcomes. JAMA Surg. 2022;157(3):211–9.
Siam B, et al. Comparison of appendectomy outcomes between senior general surgeons and general surgery residents. JAMA Surg. 2017;152(7):679–85.
Fieber JH, et al. Does perceived resident operative autonomy impact patient outcomes? J Surg Educ. 2019;76(6):e182–8.
Bohnen JD, Chang DC, George BC. Operating room times for teaching and nonteaching cases are converging: less time for learning? J Surg Educ. 2021;78(1):148–59.
Park J, et al. Improving the intraoperative educational experience: understanding the role of confidence in the resident-attending relationship. J Surg Educ. 2019;76(5):1187–99.
Rivard SJ, et al. Resident perceptions of faculty behaviors promoting learner operative skills and autonomy. J Surg Educ. 2022;79(2):431–40.
Roberts NK, et al. The briefing, intraoperative teaching, debriefing model for teaching in the operating room. J Am Coll Surg. 2009;208(2):299–303.