Perceptions Of Residents’ Autonomy In The Operating Room
OBJECTIVE: Graded autonomy is an essential component of General Surgery training. This study compares perceptions of autonomy between residents and faculty in the operating room.
METHODS: Operative procedures performed by general surgery residents between July 2016 and June 2018 were each assigned an autonomy score by the operating surgeon and the surgical resident using the Zwisch score. The degree of agreement between the residents' self-evaluated measure of autonomy and surgeons' evaluation of resident autonomy was assessed.
RESULTS: Over the study period, 23 faculty members and 24 residents scored 546 operative cases (total 1,092 evaluations) using the Zwisch scale. About half of these evaluations were completed by PGY5 (24.4%) and PGY2 (24.2%), while the rest were completed by PGY1 (16.3%), PGY3 (21.1%) and PGY4 (14.1%). Overall, there was moderate agreement between resident and faculty evaluation with intraclass correlation coefficient of 0.50 (95% CI 0.41, 0.58). PGY5 and PGY1 residents appeared to have more agreement with the faculty (0.51, 0.50 respectively) than PGY2 (0.39), PGY3 (0.37) and PGY4 (0.31) residents. Spearman correlation between ranks of resident and faculty evaluations of resident autonomy was 0.31 (p<0.001). Agreement did vary by type of case.
CONCLUSIONS: Surgical faculty and residents appear to share similar perceptions of autonomy in the operating room. Greater degree of agreement was noticed at PGY5 and PGY1 levels.