Defining the Deficit in US Surgical Training: The Trainee's Perspective

J Am Coll Surg. 2021 Apr;232(4):623-627. doi: 10.1016/j.jamcollsurg.2020.11.029. Epub 2020 Dec 29.


Background: Self-efficacy is the personal judgment of how well one can successfully complete a task. The goal of this study was to assess self-efficacy of PGY5 residents for common general surgery operations. We hypothesized there are deficits in self-efficacy of PGY5 residents, and self-efficacy of a given operation correlates with experience performing the operation without attending assistance (independently) and teaching the operation from start to finish.

Methods: A survey was linked to the 2020 American Board of Surgery In-Training Examination. From the ACGME case log's 15 most commonly performed surgeon-chief operations and AHRQ's 15 most common operations, 10 operations were selected. Residents evaluated their ability to perform these operations independently using a 5-point self-efficacy scale. Residents were asked whether they had experience performing these operations independently or teaching the operation from start to finish. Descriptive statistics and Pearson correlation were used to examine the relationship between self-efficacy and operative experience.

Results: In all, 1,145 of 1,367 PGY5 residents (84%) responded. Highest self-efficacy was in performing wide-local excision (90.24%) and lowest was in performing open thyroidectomy (19.58%). Eighty-eight (7.7%) reported self-efficacy in all procedures. Statistically significant positive correlations were identified between experience and self-efficacy for cases performed without assistance (r = 0.98, p < 0.01) and cases taught (r = 0.91, p < 0.01).

Conclusions: With 5 months left in training, 92.3% of residents report deficits in preparation for practice, as defined by self-efficacy to complete common procedures independently. Resident self-efficacy increased in direct relation to performed cases and cases taught.

MeSH terms

  • Clinical Competence / statistics & numerical data*
  • Female
  • General Surgery / education
  • General Surgery / statistics & numerical data
  • Humans
  • Internship and Residency / statistics & numerical data*
  • Male
  • Self Efficacy*
  • Surgeons / education
  • Surgeons / psychology*
  • Surgeons / statistics & numerical data
  • Surgical Procedures, Operative / education*
  • Surgical Procedures, Operative / statistics & numerical data
  • Surveys and Questionnaires / statistics & numerical data
  • United States