TY - JOUR
T1 - Senior surgical resident autonomy and teaching assistant cases
T2 - A prospective observational study
AU - Do, Woo S.
AU - Sheldon, Rowan R.
AU - Phillips, Cody J.
AU - Eckert, Matthew J.
AU - Sohn, Vance Y.
AU - Martin, Matthew J.
N1 - Publisher Copyright:
© 2020
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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.
KW - Autonomy
KW - Resident education
KW - Surgical training
UR - http://www.scopus.com/inward/record.url?scp=85080961131&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2020.02.039
DO - 10.1016/j.amjsurg.2020.02.039
M3 - Article
C2 - 32139104
AN - SCOPUS:85080961131
SN - 0002-9610
VL - 219
SP - 846
EP - 850
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 5
ER -