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Measuring Chief Resident Skill and Entrustment Progression in An Operative Coaching Program: Four Years' Experience. | LitMetric

AI Article Synopsis

  • The study aimed to evaluate how operative coaching (OC) impacts surgery residents' skills and perceived autonomy during their chief year, as well as collect feedback from participants about their experiences in the program.
  • Over 441 evaluations from multiple surgical cases indicated significant improvements in residents' general skills, step-specific guidance needs, and perceived entrustment by attendings throughout the year.
  • Both residents and attendings valued the OC elements like real-time feedback and direct observation, which enhanced learning and teaching, though there was a discrepancy between chiefs' self-assessment and attendings' perceptions of their autonomy.

Article Abstract

Objective: Operative coaching (OC) may facilitate improvement of surgery residents' competencies by optimizing learning and teaching. We investigated how residents' operative skills and prospective entrustment (PE) progress throughout the chief year in our OC program, how OC is perceived by participants, and how OC may facilitate learning and teaching.

Design, Setting, And Participants: This is a mixed-methods study conducted within the Ohio State University Wexner Medical Center General Surgery residency. Validated performance evaluations with procedural-specific skill, general skill (GS), step-specific guidance required (SSG) (an autonomy measure), and PE measures completed by chiefs, faculty coaches, and attending surgeons from 7/2018 to 6/2022 were reviewed. We also interviewed OC participants to understand their experience. Descriptive statistical and qualitative content analysis were applied.

Results: 441 evaluations from 147 OC cases completed by 22 chiefs, 5 faculty coaches, and 24 attendings were included. Overall, resident GS (p = 0.036), SSG (p = 0.023), and PE (p = 0.002) significantly improved throughout the year. PE significantly correlated (all p < 0.0001) with SSG (r = 0.73), followed by procedural-specific skill (r = 0.59), then GS (r = 0.57). On average, chiefs underestimated their surgical skills while attendings overestimated autonomy they permitted to residents. Chiefs, coaches, and attendings reached consensus on chiefs' PE upon graduation. Five graduated chiefs and 5 attendings were interviewed. Chiefs described OC as effective in improving their self-regulated learning and particularly valued 3 OC elements: neutral authentic feedback, third-party real-time observation, and actionable feedback. Attendings noted OC promoted their engagement in skills assessment and teaching.

Conclusions: Our findings suggest chief residents' skills, autonomy, and PE progress steadily along their OC journey. Despite differences in residents', coaches', and attendings' perceptions of skill, measures of autonomy reliably correlate with entrustment. OC promotes resident learning, faculty teaching, and assessment of resident skills, autonomy, and PE in the OR.

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Source
http://dx.doi.org/10.1016/j.jsurg.2023.12.014DOI Listing

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