Multi-institutional Study of Otolaryngology Resident Intraoperative Experiences for Key Indicator Procedures

Otolaryngol Head Neck Surg. 2022 Aug;167(2):268-273. doi: 10.1177/01945998211050350. Epub 2021 Oct 5.


Objective: There is concern that current otolaryngology residents may not receive adequate surgical training. We aimed to characterize residents' surgical experiences at 5 academic centers performing the 14 key indicator procedures (KIPs) outlined by the Accreditation Council for Graduate Medical Education.

Study design: Prospective study.

Setting: Five otolaryngology training programs.

Methods: Data were gathered from December 2019 to December 2020 with a smartphone application from the Society for Improving Medical Professional Learning. After each operation, residents and faculty rated trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale.

Results: Residents and attendings (n = 92 and 78, respectively) logged 2984 evaluations. Attending ratings of resident autonomy and performance increased with training level (P < .001). Resident self-assessments of autonomy and performance were lower than paired attending assessments (P < .001). Among attending evaluations of KIPs performed by senior residents (postgraduate year 4 or 5), 55% of cases were performed with meaningful autonomy (passive help or supervision only). Similarly, attendings rated 55% of these cases as a practice-ready or exceptional performance. Senior residents had meaningful autonomy for ≥50% of cases for most KIPs, with the exception of flaps and grafts (40%), pediatric/adult airway (39%), and stapedectomy/ossiculoplasty (33%). Similarly, senior residents received practice-ready or exceptional performance ratings for ≥50% of cases across all KIPs other than pediatric/adult airway (42%) and stapedectomy/ossiculoplasty (33%).

Conclusion: In this multicenter study, resident surgical autonomy and performance varied across otolaryngology KIPs. The development of nationwide benchmarks will help programs and residents set educational goals.

Level of evidence: 2.

Keywords: autonomy; competency; performance; residency training; surgical education.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Child
  • Clinical Competence
  • Education, Medical, Graduate / methods
  • General Surgery* / education
  • Humans
  • Internship and Residency*
  • Otolaryngology* / education
  • Professional Autonomy
  • Prospective Studies