See one, do one, but never teach one? An analysis of resident teaching assist cases under various levels of attending supervision

Background: Surgical training has traditionally relied on increasing levels of resident autonomy. We sought to analyze the outcomes of senior resident teaching assist (TA) cases performed with a structured policy including varying levels of staff supervision. Methods: Retrospective review at a military medical center of TA cases from 2009 to 2014. The level of staff supervision included staff scrubbed (SS), staff present and not scrubbed (SP), or staff not present but available (NP). Operative variables were analyzed. An anonymous survey of residents and attendings at 6 military programs regarding experience and opinions on TA cases was distributed. Results: 389 TA cases were identified. The majority (52%) were performed as NP. Operative times were shorter for NP cases (p < 0.05). Overall complication rate and length of stay were not different between groups (p > 0.05). Survey results demonstrated agreement amongst staff and residents that allowing selective NP was critical for achieving resident competence. Conclusion: There were no identified adverse effects on intraoperative or postoperative complications. This practice is a critical component of training senior residents to transition to independent practice.