Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents

Herbert P. Stride, Brian C. George, Reed G. Williams, Jordan T. Bohnen, Megan J. Eaton, Mary C. Schuller, Lihui Zhao, Amy Yang, Shari L. Meyerson, Rebecca Scully, Gary Dunnington, Laura Torbeck, John T. Mullen, Samuel P. Mandell, Michael Choti, Eugene Foley, Chandrakanth Are, Edward Auyang, Jeffrey Chipman, Jennifer Choi & 9 others Andreas Meier, Douglas Smink, Kyla P. Terhune, Paul Wise, Debra DaRosa, Nathaniel Soper, Jay B. Zwischenberger, Keith Lillemoe, Jonathan P. Fryer

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. Methods: Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. Results: Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. Conclusions: We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StateAccepted/In press - Jan 1 2017

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Herniorrhaphy
Mental Competency
Ventral Hernia
Appendectomy
Colectomy
Inguinal Hernia
Laparoscopic Cholecystectomy
Internship and Residency
Education

ASJC Scopus subject areas

  • Surgery

Cite this

Stride, H. P., George, B. C., Williams, R. G., Bohnen, J. T., Eaton, M. J., Schuller, M. C., ... Fryer, J. P. (Accepted/In press). Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents. Surgery (United States). https://doi.org/10.1016/j.surg.2017.10.011

Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents. / Stride, Herbert P.; George, Brian C.; Williams, Reed G.; Bohnen, Jordan T.; Eaton, Megan J.; Schuller, Mary C.; Zhao, Lihui; Yang, Amy; Meyerson, Shari L.; Scully, Rebecca; Dunnington, Gary; Torbeck, Laura; Mullen, John T.; Mandell, Samuel P.; Choti, Michael; Foley, Eugene; Are, Chandrakanth; Auyang, Edward; Chipman, Jeffrey; Choi, Jennifer; Meier, Andreas; Smink, Douglas; Terhune, Kyla P.; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Jay B.; Lillemoe, Keith; Fryer, Jonathan P.

In: Surgery (United States), 01.01.2017.

Research output: Contribution to journalArticle

Stride, HP, George, BC, Williams, RG, Bohnen, JT, Eaton, MJ, Schuller, MC, Zhao, L, Yang, A, Meyerson, SL, Scully, R, Dunnington, G, Torbeck, L, Mullen, JT, Mandell, SP, Choti, M, Foley, E, Are, C, Auyang, E, Chipman, J, Choi, J, Meier, A, Smink, D, Terhune, KP, Wise, P, DaRosa, D, Soper, N, Zwischenberger, JB, Lillemoe, K & Fryer, JP 2017, 'Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents', Surgery (United States). https://doi.org/10.1016/j.surg.2017.10.011
Stride, Herbert P. ; George, Brian C. ; Williams, Reed G. ; Bohnen, Jordan T. ; Eaton, Megan J. ; Schuller, Mary C. ; Zhao, Lihui ; Yang, Amy ; Meyerson, Shari L. ; Scully, Rebecca ; Dunnington, Gary ; Torbeck, Laura ; Mullen, John T. ; Mandell, Samuel P. ; Choti, Michael ; Foley, Eugene ; Are, Chandrakanth ; Auyang, Edward ; Chipman, Jeffrey ; Choi, Jennifer ; Meier, Andreas ; Smink, Douglas ; Terhune, Kyla P. ; Wise, Paul ; DaRosa, Debra ; Soper, Nathaniel ; Zwischenberger, Jay B. ; Lillemoe, Keith ; Fryer, Jonathan P. / Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents. In: Surgery (United States). 2017.
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abstract = "Background: Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. Methods: Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. Results: Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. Conclusions: We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice.",
author = "Stride, {Herbert P.} and George, {Brian C.} and Williams, {Reed G.} and Bohnen, {Jordan T.} and Eaton, {Megan J.} and Schuller, {Mary C.} and Lihui Zhao and Amy Yang and Meyerson, {Shari L.} and Rebecca Scully and Gary Dunnington and Laura Torbeck and Mullen, {John T.} and Mandell, {Samuel P.} and Michael Choti and Eugene Foley and Chandrakanth Are and Edward Auyang and Jeffrey Chipman and Jennifer Choi and Andreas Meier and Douglas Smink and Terhune, {Kyla P.} and Paul Wise and Debra DaRosa and Nathaniel Soper and Zwischenberger, {Jay B.} and Keith Lillemoe and Fryer, {Jonathan P.}",
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AU - Stride, Herbert P.

AU - George, Brian C.

AU - Williams, Reed G.

AU - Bohnen, Jordan T.

AU - Eaton, Megan J.

AU - Schuller, Mary C.

AU - Zhao, Lihui

AU - Yang, Amy

AU - Meyerson, Shari L.

AU - Scully, Rebecca

AU - Dunnington, Gary

AU - Torbeck, Laura

AU - Mullen, John T.

AU - Mandell, Samuel P.

AU - Choti, Michael

AU - Foley, Eugene

AU - Are, Chandrakanth

AU - Auyang, Edward

AU - Chipman, Jeffrey

AU - Choi, Jennifer

AU - Meier, Andreas

AU - Smink, Douglas

AU - Terhune, Kyla P.

AU - Wise, Paul

AU - DaRosa, Debra

AU - Soper, Nathaniel

AU - Zwischenberger, Jay B.

AU - Lillemoe, Keith

AU - Fryer, Jonathan P.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. Methods: Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. Results: Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. Conclusions: We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice.

AB - Background: Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. Methods: Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. Results: Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. Conclusions: We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice.

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