Senior surgical resident autonomy and teaching assistant cases: A prospective observational study |
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| Affiliation: | 1. Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA;2. Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA;1. School of Medicine, Oregon Health & Science University, Portland, OR, USA;2. Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR, USA;3. School of Public Health, Texas A and M University, College Station, TX, USA;1. University of Washington School of Medicine, Seattle, WA, 98195, USA;2. Institute for Disease Modeling, Bellevue, WA, 98005, USA;3. Seattle Children’s Hospital, Seattle, WA, 98105, USA;4. Seattle Children’s Research Institute, Seattle, WA, 98101, USA;1. Division of Surgical Oncology, Oregon Health & Science University, USA;2. Department of General Surgery, Oregon Health & Science University, USA;1. BC Cancer-Sindi Ahluwalia Hawkins Centre, Dept. of Surgical Oncology, 399 Royal Ave, Kelowna, BC, V1Y 5L3, Canada;2. University of British Columbia Southern Medical Program, 2312 Pandosy Street, Kelowna, BC, V1Y 1T3, Canada;1. Department of Surgery, Oregon Health & Science University, Portland, OR, USA;2. Quality Management, Oregon Health & Science University, Portland, OR, USA;3. Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA;4. Perioperative Services, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR, USA;1. Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA;2. Pharmacy Department, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA |
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| Abstract: | IntroductionTeaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision.MethodsProspective observational study of operative cases where a SR served as the TA between 7/2014-6/2017 (n = 161). Patient/operative characteristics, 30-day outcomes, and SR survey data were compared by level of supervision.ResultsCase mix included 68 laparoscopic appendectomies (42%), 49 laparoscopic cholecystectomies (30%), 10 I&Ds (6%), 10 umbilical hernia repairs (6%), 4 port placements (3%), and 11 others. Indirectly supervised cases were shorter (61 vs. 76 min, p < 0.01), with less blood loss (11 vs. 24 ml, p < 0.05), and lower conversion rates (0% vs. 5.7%, p < 0.05). Perceived difficulty was high in 20% of cases with indirect vs. 49% with direct supervision (p < 0.01). Mean SR comfort was high (4.4 vs. 4.6 out of 5) regardless of level of staff supervision. 30-day complications did not differ for indirect vs. direct supervision (all p = NS).DiscussionCarefully selected TA cases offer SRs opportunities to practice autonomy without sacrificing operative time or patient safety. |
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| Keywords: | Resident education Autonomy Surgical training |
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