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

doi:10.1016/j.amjsurg.2020.02.039

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

Surgery

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

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 language	English
Pages (from-to)	846-850
Number of pages	5
Journal	American Journal of Surgery
Volume	219
Issue number	5
DOIs	https://doi.org/10.1016/j.amjsurg.2020.02.039
State	Published - May 2020

Keywords

Autonomy
Resident education
Surgical training

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title = "Senior surgical resident autonomy and teaching assistant cases: A prospective observational study",

abstract = "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.",

keywords = "Autonomy, Resident education, Surgical training",

author = "Do, {Woo S.} and Sheldon, {Rowan R.} and Phillips, {Cody J.} and Eckert, {Matthew J.} and Sohn, {Vance Y.} and Martin, {Matthew J.}",

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doi = "10.1016/j.amjsurg.2020.02.039",

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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.

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

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