Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons

ABSTRACT Background General surgery residents may be underprepared for practice, due in part to declining operative autonomy during training. The factors that influence entrustment of autonomy in the operating room are unclear. Objective To identify and compare the factors that residents and faculty consider influential in entrustment of operative autonomy. Methods An anonymous survey of 29-item Likert-type scale (1–7, 1 = strongly disagree, 7 = strongly agree), 9 multiple-choice, and 4 open-ended questions was sent to 70 faculty and 45 residents in a large ACGME-approved general surgery residency program comprised of university, county, and VA hospitals in 2018. Results Sixty (86%) faculty and 38 (84%) residents responded. Faculty were more likely to identify resident-specific factors such as better resident reputation and higher skill level as important in fostering entrustment. Residents were more likely to identify environmental factors such as a focus on efficiency and a litigious malpractice environment as impeding entrustment. Both groups agreed that work hour restrictions do not decrease autonomy and entrustment does not increase risk to patients. More residents considered low faculty confidence level as a barrier to operative autonomy, while more faculty considered lower resident clinical skill as a barrier. Improvement in resident preparation for cases was cited as an important intervention that could enhance entrustment. Conclusions Differences in perspectives exist between general surgery residents and faculty regarding entrustment of autonomy. Residents cite environmental and attending-related factors, while faculty cite resident-specific factors as most influential. Residents and faculty both agree that entrustment is integral to surgical training.

The Virtual Interview Experience for MATCH 2021: A Pilot Survey of General Surgery Residency Program Directors

Background Virtual interviews (VIs) for the 2020 residency application season were mandated as a result of the COVID-19 pandemic. We aimed to determine the perspectives of general surgery (GS) program directors (PDs) on the benefits and drawbacks of VIs. Methods A 14-item survey was emailed to all GS PDs from programs identified on the American Council for Graduate Medical Education website. Program directors were asked about the cost-time benefit of VIs, its ability to assess candidates, and their thoughts on the future of VIs for evaluating residency applicants. Results 60 PDs responded corresponding to a response rate of 21%. While 93% agreed/strongly agreed that VIs were less expensive, only 35% found VIs to be less time-consuming. 75% and 67%, respectively, disagreed/strongly disagreed that VIs allowed for an easier assessment of an applicant’s fit, and personality and communication skills. Almost one-half of our survey respondents suggested that VIs made the selection committee rely more heavily on objective applicant data. Almost two-thirds of GS PDs suggested that they would adopt both VI and in-person interview formats for future application cycles. The median [interquartile range] cost saved through the implementation of VIs was US$ 4500 [1625 – 10 000]. Conclusion Remarkably, VIs have been swiftly imbibed by all residency programs and many aspects of the VI experience were positive. While MATCH 2021 has definitely proved to be one of its kind, the implementation of VIs has been met with overall broad success and a promising future awaits this novel modality of resident selection to GME programs in the United States.

Do Orthopedic Surgery Residency Program Web Sites Address Diversity and Inclusion?

Background: Orthopedic surgery is one of the least diverse medical specialties. Other medical specialties have employed diversity-related initiatives to increase the number of students underrepresented in medicine (URM). Furthermore, with the suspension of visiting student rotations during the COVID-19 pandemic, medical students used residency program Web sites as a main source of program-specific information. Aims/Purpose: The purpose of this study was to measure the extent to which orthopedic surgery residency program Web sites describe diversity and inclusion initiatives. Methods: The Electronic Residency Application Service (ERAS) was used to identify U.S. orthopedic surgery residency programs. The programs’ Web sites were reviewed, and data on commitments to diversity and inclusion were collected. Descriptive statistics of these data were generated. Results: There were 192 residency programs identified and 3 were excluded from the analysis due to lack of Web sites. Of the remaining 189 residency program Web sites, only 55 (29.10%) contained information on diversity and inclusion. Information on a commitment to improving diversity and inclusion was the most prevalent data point found among program Web sites, although it was found on only 15% of program Web sites. Conclusion: Orthopedic surgery residency programs rarely address topics related to diversity and inclusion on their program Web sites. An emphasis on opportunities for URM students and initiatives related to diversity and inclusion on program Web sites may improve URM outreach and serve as one method for increasing URM matriculation into orthopedic surgery.

An Evaluation of the Content of Canadian Plastic Surgery Residency Websites

Background: Plastic surgery residency program websites are an important source of information to prospective applicants, especially given the ongoing COVID-19 pandemic and resulting suspension of all visiting electives and in-person interviews. This study aimed to analyze the online content of Canadian plastic surgery residency program websites. Methods: The content of all accredited Canadian plastic surgery residency websites was evaluated using 77-point criteria in the following 10 domains: recruitment, faculty, residents, research and education, surgical program, clinical work, benefits and career planning, wellness, environment, and gender of faculty leadership. Results: All accredited Canadian plastic surgery residency programs (n = 13) were identified using Canadian Resident Matching Service and had their dedicated program websites available for analysis. On average, residency program websites obtained a score of 33.5 (standard deviation = 13.7). The majority of programs did not score differently on the criteria by geographical distribution ( P > .05) nor by ranking ( P > .05). Conclusions: Most Canadian plastic surgery residency program websites are lacking content relevant to prospective applicants. Addressing inadequacies in online content may support programs to inform and recruit strong applicants into residency programs.

Increasing Social Media Presence for Graduate Medical Education Programs

Virtual residency interviews during COVID-19 pandemic created a need for residency programs to use social media to increase their visibility and connect with potential applicants. This was, however, new and a road never travelled for many programs. This report describes how our General Surgery Residency Program increased its presence through social media by using various exposure methods and approaches, including diversifying presence and developing candid personalized content. Results suggest that these methods have increased our exposure and reach from an average of 7 people per post to posts reaching over 4500 people. Moreover, the video posts introducing our residents and faculty provided the highest activity and reach. Thus, appropriate use of social media with described interventions and new content creation could exponentially increase the visibility of a residency program. Moreover, educating faculty and residents on the use and importance of social media could increase their interest and participation as well.

Using a Systematic Approach to Teach Analysis of the Aging Face

Objective To assess the efficacy of a novel systematic approach aimed at improving a resident physician’s ability to perform analysis of the aging face. Study Design Prospective randomized case-control study. Setting Accreditation Council for Graduate Medical Education accredited Otolaryngology–Head and Neck Surgery residency program. Methods Twenty otolaryngology–head and neck surgery residents were randomized into 2 groups with even representation in each postgraduate year level in each cohort. One group used traditional materials (textbooks), and the other group was given exclusive access to the online learning module featuring a systematic approach to aging-face analysis. Both groups completed preactivity, postactivity, and retention assessments to gauge their ability to perform a comprehensive analysis of the aging face. Results When compared with a matched control cohort, the residents who used the systematic approach performed more comprehensive facial aging assessments immediately after the intervention and at a retention time point. Conclusion A systematic approach delivered via an 11-minute online module can significantly improve a resident physician’s ability to perform analysis of the aging face. This systematic approach could be easily integrated into other online or traditional educational curriculums. Moreover, this methodology could be applied to additional areas in which residents have limited exposure but must develop expertise.

Surgical Skills Olympiad: A 4-Year Experience in a General Surgery Residency Program

Background The acquisition of operative skills is the critical defining component of general surgery training. Performing simulated tasks has been shown to increase a resident's technical skills. As such, we devised the Surgical Skills Olympiad, an annual simulation-based skills competition. We examined our 4-year experience with the Olympiad at a large academic general surgery residency program. Objective This study aimed to use competition to motivate trainees to increase the time they spent practicing basic surgical skills, resulting in improved performance over time. Methods Teams were formed from members of each postgraduate year (PGY) class. Competition tasks were level specific: knot tying for PGY-1, basic laparoscopy for PGY-2, handsewn bowel anastomosis for PGY-3, vascular anastomosis for PGY-4, and advanced laparoscopy for PGY-5. Task scores over a 4-year period (2014–2017) were analyzed and a survey of participating teaching faculty was conducted. Results Ten faculty members responded to the survey, for a response rate of 63%. A total of 50% respondents felt that the caliber of surgical skills increased since the Olympiad was implemented. Ninety percent agreed that the Olympiad was beneficial for residents to assess their skills against their peers. Over 4 years, there was an improvement in scores for suturing task, advanced laparoscopy, and bowel anastomosis (p < 0.05 for all three). Conclusion A residency-wide surgical skills competition can improve resident performance in technical tasks and promote faculty engagement in resident skills training.