Characterizing the Relationship Between Surgical Resident and Faculty Perceptions of Autonomy in the Operating Room

Objective Characterize the concordance among faculty and resident perceptions of surgical case complexity, resident technical performance, and autonomy in a diverse sample of general surgery procedures using case-specific evaluations. Design A prospective study was conducted in which a faculty surgeon and surgical resident independently completed a postoperative assessment examining case complexity, resident operative performance (Milestone assessment) and autonomy (Zwisch model). Pearson correlation coefficients ( r ) reaching statistical significance (p r ≥ 0.40), strong ( r ≥ 0.60), or very strong ( r ≥ 0.80). Setting This study was conducted in the General Surgery Residency Program at an academic tertiary care facility (Geisinger Medical Center, Danville, PA). Participants Participants included 6 faculty surgeons, in addition to 5 postgraduate year (PGY) 1, 6 midlevel (PGY 2-3), and 4 chief (PGY 4-5) residents. Results In total, 75 surgical cases were analyzed. Midlevel residents accounted for the highest number of cases (35, 46.6%). Overall, faculty and resident perceptions of case complexity demonstrated a strong correlation ( r = 0.76, p r = 0.66, p r = 0.56, p Subgroup analysis revealed very strong correlations among faculty perceptions of case complexity and the perceptions of PGY 1 ( r = 0.80, p r = 0.82, p Conclusions General surgery residents generally demonstrated high correlations with faculty perceptions of case complexity, technical performance, and operative autonomy. This generalized accord supports the use of the Milestone and Zwisch assessments in residency programs. However, discordance among perceptions of midlevel resident autonomy and chief resident operative performance suggests that these trainees may need more direct communication from the faculty.