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We investigated attending surgeon decisions regarding resident operative autonomy, including situations where operative autonomy was discordant with performance quality. Attending surgeons assessed operative performance and documented operative autonomy granted to residents from 14 general surgery residency programs. Concordance between performance and autonomy was defined as “practice ready performance/meaningfully...
Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements.Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and...
Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents.We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary...
Global, end-of-rotation evaluations are often difficult to interpret due to their high level of abstraction (eg, excellent, good, poor) and the bias toward high ratings. This study documents the utility of and measurement characteristics of serious problem items, an alternative item format.This report is based on 4,234 faculty performance ratings for 105 general surgery residents. Faculty members...
Guidance in the operating room impacts resident confidence and ability to function independently. The purpose of this study was to explore attending surgeon guidance practices in the operating room as reported by faculty members themselves and by junior and senior residents.This was an exploratory, cross-sectional survey research study involving 91 categorical residents and 82 clinical faculty members...
Operative performance rating (OPR) instruments have been developed to assess operative performance (OP). To guide program implementation, this study determined: 1) Appropriate intervals for OP progress decisions, 2) Number of OPRs and raters required per interval to achieve reproducible results.21 surgeons rated 897 OPs (3 procedures) by 36 residents. Six-month PGY intervals were compared to determine...
Teaching in the operating room is one of the major cornerstones of surgical education. As time available for intraoperative resident teaching diminishes, such teaching time becomes increasingly precious. We studied how surgeons communicate with residents during an operation, with the goal of enhancing intraoperative teaching opportunities.Grounded theory methodology was used to investigate intraoperative...
To elicit and analyze the strengths and weaknesses of resident operative performance (ROP) as identified by independent expert ratings.Four groups of expert surgeons, blinded to resident training level, evaluated ROP on 2 each of laparoscopic cholecystectomy, thyroidectomy, open inguinal, and laparoscopic ventral hernia repair audio videos, and listed strengths and weaknesses. Comments were coded...
Residents with performance problems are challenging to program directors and complicate the work of other residents and health care providers. Having an effective, targeted remediation process to address these problems is dependent on being able to diagnose their nature. The purpose of this study was to identify residents who had serious, substantive, and recurring academic, clinical, and/or professional...
This study analyzes specific elements of physician communication that lead patients to not recommend surgeons to family members or friends (FMoFs). Patients completed questionnaires after surgery clinic encounters. Questionnaires addressed whether surgeons used optimal communication behaviors and whether patients would recommend the surgeon. A total of 1,514 questionnaires were completed for...
Resident evaluation traditionally involves global assessments including clinical performance, professional behavior, technical skill, and number of procedures performed. These evaluations lack objective assessment of operative skills. We describe an operative performance rating system (OPRS) designed to provide objective operative performance ratings using a sentinel procedure format.Ten-item procedure-specific...
The tendency to add items to resident performance rating forms has accelerated due to new ACGME competency requirements. This study addresses the relative merits of adding items versus increasing number of observations. The specific questions addressed are (1) what is the reliability of single items used to assess resident performance, (2) what effect does adding items have on reliability, and (3)...
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