Quantification of Resident Work in Colorectal Surgery

Abstract

Objective: To examine resident intraoperative participation, perceived autonomy, and communication patterns between residents and attending surgeons using a novel survey tool.

Design: This was a prospective multi-institutional study. Operative residents completed the survey tool immediately after each colorectal resection performed during the study period. Resident intraoperative participation was quantified including degree of involvement in the technical aspects of the case, self-perception of autonomy, and communication strategies between the resident and attending.

Setting: This study was conducted at 7 general surgery residency programs: 5 academic medical centers, and 2 independent training programs.

Participants: Residents and fellows rotating on a colorectal surgery service or general surgery service.

Results: Sixty-three residents participated in this study with 417 surveys completed (range 19-79 per institution) representing a 95.4% response rate across all sites. Respondents ranged from clinical year 1 (CY1) to fellows. CY3s (35.7%) and CY5s (34.7%) were most heavily represented. Residents completed ≥50% of the skin closure in 88.7% of cases, ≥50% of the fascial closure in 87.1%, and t ≥ 50% of the anastomosis in 78.4% of the cases. Increasing resident participation was associated with advancing resident CY across all technical aspects of the case. This trend remained significant when controlling for site (p < 0.001). Resident self-perception of autonomy revealed learners of all stages: Observer (11.5%, n = 48), Assistant (53.7%, n = 224), Surgeon (33.8%, n = 141), and Teacher (0.96%, n = 4). Level of perceived autonomy increased with resident CY when controlling for site (p < 0.001). Residents who discussed the case before the day of surgery were twice as likely to rate themselves as Surgeon or Teacher (OR = 2.01) when controlling for CY (p = 0.011).

Conclusions: Brief surveys can easily capture resident work in the operating room. Resident intraoperative involvement and perceived autonomy are associated with CY. Early communication with the attending is significantly associated with increased perception of autonomy regardless of CY.

Keywords: Interpersonal and Communication Skills; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; autonomy; communication; quality; resident education; resident work; surgery resident.