Intraoperative communication of residents with faculty: perception versus reality

INTRODUCTION: During a surgical procedure, an attending may propose a surgical treatment that a resident believes is not the standard of care based on previous readings, discussions with other faculty, or experience. We hypothesized that resident disagreements over intraoperative management are common and are handled differently by residents than faculty members perceive. METHODS: Surveys were sent to 68 residents (82% response) and 45 faculty (91% response) in general surgery and seven subspecialties. Questions were asked to determine the frequency of disagreements and the differences in perceptions of how residents should act when they have disagreements over the intraoperative decisions of attendings. Significance was defined using Fisher's exact test at P < 0.05. RESULTS: Residents reported having major disagreements with faculty over intraoperative decisions as often as monthly (41%) or two to three times per year (37%). Estimates of the frequency of major resident disagreements did not differ between attendings and residents. Fewer residents felt comfortable asking the faculty to discuss their intraoperative decisions than was perceived by faculty members (41% vs 78%, P < 0.001). Residents at all levels are less comfortable than perceived by their mentors in discussing intraoperative decisions even when residents believe that patient injury may result. Residents felt that most of their disagreements occurred because of attending knowledge deficit, while most attendings attributed these differences to resident knowledge deficits. CONCLUSION: Residents frequently have disagreements with faculty over intraoperative management. Education to improve preoperative and intraoperative communication between surgical residents and faculty is needed.