What factors influence attending surgeon decisions about resident autonomy in the operating room?

Reed G. Williams, Brian C. George, Shari L. Meyerson, Jordan D. Bohnen, Gary Dunnington, Mary C. Schuller, Laura Torbeck, John T. Mullen, Edward Auyang, Jeffrey G. Chipman, Jennifer Choi, Michael Choti, Eric Endean, Eugene F. Foley, Samuel Mandell, Andreas Meier, Douglas S. Smink, Kyla P. Terhune, Paul Wise, Debra DaRosa & 4 others Nathaniel Soper, Joseph B. Zwischenberger, Keith D. Lillemoe, Jonathan P. Fryer

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. Methods: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Results: Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Conclusion: Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.

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

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Operating Rooms
Aptitude
Operative Surgical Procedures
Patient Safety
Surgeons
Outcome Assessment (Health Care)
Learning
Efficiency
Education

ASJC Scopus subject areas

  • Surgery

Cite this

Williams, R. G., George, B. C., Meyerson, S. L., Bohnen, J. D., Dunnington, G., Schuller, M. C., ... Fryer, J. P. (Accepted/In press). What factors influence attending surgeon decisions about resident autonomy in the operating room? Surgery (United States). https://doi.org/10.1016/j.surg.2017.07.028

What factors influence attending surgeon decisions about resident autonomy in the operating room? / Williams, Reed G.; George, Brian C.; Meyerson, Shari L.; Bohnen, Jordan D.; Dunnington, Gary; Schuller, Mary C.; Torbeck, Laura; Mullen, John T.; Auyang, Edward; Chipman, Jeffrey G.; Choi, Jennifer; Choti, Michael; Endean, Eric; Foley, Eugene F.; Mandell, Samuel; Meier, Andreas; Smink, Douglas S.; Terhune, Kyla P.; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Joseph B.; Lillemoe, Keith D.; Fryer, Jonathan P.

In: Surgery (United States), 2017.

Research output: Contribution to journalArticle

Williams, RG, George, BC, Meyerson, SL, Bohnen, JD, Dunnington, G, Schuller, MC, Torbeck, L, Mullen, JT, Auyang, E, Chipman, JG, Choi, J, Choti, M, Endean, E, Foley, EF, Mandell, S, Meier, A, Smink, DS, Terhune, KP, Wise, P, DaRosa, D, Soper, N, Zwischenberger, JB, Lillemoe, KD & Fryer, JP 2017, 'What factors influence attending surgeon decisions about resident autonomy in the operating room?', Surgery (United States). https://doi.org/10.1016/j.surg.2017.07.028
Williams, Reed G. ; George, Brian C. ; Meyerson, Shari L. ; Bohnen, Jordan D. ; Dunnington, Gary ; Schuller, Mary C. ; Torbeck, Laura ; Mullen, John T. ; Auyang, Edward ; Chipman, Jeffrey G. ; Choi, Jennifer ; Choti, Michael ; Endean, Eric ; Foley, Eugene F. ; Mandell, Samuel ; Meier, Andreas ; Smink, Douglas S. ; Terhune, Kyla P. ; Wise, Paul ; DaRosa, Debra ; Soper, Nathaniel ; Zwischenberger, Joseph B. ; Lillemoe, Keith D. ; Fryer, Jonathan P. / What factors influence attending surgeon decisions about resident autonomy in the operating room?. In: Surgery (United States). 2017.
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title = "What factors influence attending surgeon decisions about resident autonomy in the operating room?",
abstract = "Background: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. Methods: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Results: Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54{\%} of decision variance (r = 0.74). Conclusion: Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.",
author = "Williams, {Reed G.} and George, {Brian C.} and Meyerson, {Shari L.} and Bohnen, {Jordan D.} and Gary Dunnington and Schuller, {Mary C.} and Laura Torbeck and Mullen, {John T.} and Edward Auyang and Chipman, {Jeffrey G.} and Jennifer Choi and Michael Choti and Eric Endean and Foley, {Eugene F.} and Samuel Mandell and Andreas Meier and Smink, {Douglas S.} and Terhune, {Kyla P.} and Paul Wise and Debra DaRosa and Nathaniel Soper and Zwischenberger, {Joseph B.} and Lillemoe, {Keith D.} and Fryer, {Jonathan P.}",
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T1 - What factors influence attending surgeon decisions about resident autonomy in the operating room?

AU - Williams, Reed G.

AU - George, Brian C.

AU - Meyerson, Shari L.

AU - Bohnen, Jordan D.

AU - Dunnington, Gary

AU - Schuller, Mary C.

AU - Torbeck, Laura

AU - Mullen, John T.

AU - Auyang, Edward

AU - Chipman, Jeffrey G.

AU - Choi, Jennifer

AU - Choti, Michael

AU - Endean, Eric

AU - Foley, Eugene F.

AU - Mandell, Samuel

AU - Meier, Andreas

AU - Smink, Douglas S.

AU - Terhune, Kyla P.

AU - Wise, Paul

AU - DaRosa, Debra

AU - Soper, Nathaniel

AU - Zwischenberger, Joseph B.

AU - Lillemoe, Keith D.

AU - Fryer, Jonathan P.

PY - 2017

Y1 - 2017

N2 - Background: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. Methods: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Results: Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Conclusion: Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.

AB - Background: Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. Methods: We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Results: Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Conclusion: Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.

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