Mind the Gap: The Autonomy Perception Gap in the Operating Room by Surgical Residents and Faculty.

Autor: Kim GJ; Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan. Electronic address: gracejk@med.umich.edu., Clark MJ; Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, Michigan., Meyerson SL; Department of Surgery, University of Kentucky, Lexington, Kentucky., Bohnen JD; Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts., Brown KM; Department of Surgery and Perioperative Care, UT Austin Dell Medical School, Austin, Texas., Fryer JP; Department of Surgery, Northwestern University, Chicago, Illinois., Szerlip N; Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan., Schuller M; Department of Surgery, Northwestern University, Chicago, Illinois., Kendrick DE; Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan., George B; Department of Surgery, Center for Surgical Training and Research, University of Michigan, Ann Arbor, Michigan.
Jazyk: angličtina
Zdroj: Journal of surgical education [J Surg Educ] 2020 Nov - Dec; Vol. 77 (6), pp. 1522-1527. Date of Electronic Publication: 2020 Jun 19.
DOI: 10.1016/j.jsurg.2020.05.023
Abstrakt: Objective: Examine the concordance of perceived operative autonomy between attendings and resident trainees.
Design: Faculty and trainees rated trainee operative autonomy using the 4-level Zwisch scale over a variety of cases and training years. The respective ratings were then compared to explore the effects of experience, gender, case complexity, trainee, trainer, and other covariates to perceived autonomy.
Setting: This study was conducted over 14 general surgery programs in the United States, members of the Procedural Learning and Safety Collaborative.
Participants: Participants included faculty and categorical trainees from 14 general surgery programs.
Results: A total of 8681 observations was obtained. The sample included 619 unique residents and 457 different attendings. A total of 598 distinct procedures was performed. In 60% of the cases, the autonomy ratings between trainees and attendings were concordant, with only 3.5% of cases discrepant by more than 1 level. An autonomy perception gap was modeled based on the discrepancy between the trainee and attending Zwisch ratings for the same case. The mean Zwisch score expected for a trainee was lower than the attending across all scenarios. Trainees were more likely to perceive relatively more autonomy in the second half of the year. The autonomy perception gap decreased with increasing case complexity. As trainees gained experience, the perception gap increased with trainees underestimating autonomy.
Conclusions: Trainees and attendings generally demonstrated concordance on autonomy perception scores. However, in 40% of cases, a perception gap exists between trainee and attending with the trainee generally underestimating autonomy. The gap worsens as the trainee progresses through residency. This perception gap suggests that attendings and trainees could be better aligned on teaching goals and expectations.
(Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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