Senior surgical resident autonomy and teaching assistant cases: A prospective observational study

Woo S. Do*, Rowan R. Sheldon, Cody J. Phillips, Matthew J. Eckert, Vance Y. Sohn, Matthew J. Martin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Introduction: Teaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision. Methods: Prospective observational study of operative cases where a SR served as the TA between 7/2014-6/2017 (n = 161). Patient/operative characteristics, 30-day outcomes, and SR survey data were compared by level of supervision. Results: Case mix included 68 laparoscopic appendectomies (42%), 49 laparoscopic cholecystectomies (30%), 10 I&Ds (6%), 10 umbilical hernia repairs (6%), 4 port placements (3%), and 11 others. Indirectly supervised cases were shorter (61 vs. 76 min, p < 0.01), with less blood loss (11 vs. 24 ml, p < 0.05), and lower conversion rates (0% vs. 5.7%, p < 0.05). Perceived difficulty was high in 20% of cases with indirect vs. 49% with direct supervision (p < 0.01). Mean SR comfort was high (4.4 vs. 4.6 out of 5) regardless of level of staff supervision. 30-day complications did not differ for indirect vs. direct supervision (all p = NS). Discussion: Carefully selected TA cases offer SRs opportunities to practice autonomy without sacrificing operative time or patient safety.

Original languageEnglish
Pages (from-to)846-850
Number of pages5
JournalAmerican Journal of Surgery
Issue number5
StatePublished - May 2020


  • Autonomy
  • Resident education
  • Surgical training


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