World Journal of Surgery

, Volume 36, Issue 9, pp 2011–2014 | Cite as

Participation of Surgical Residents in Operations: Challenging a Common Classification

  • Jeff Bezemer
  • Alexandra Cope
  • Omar Faiz
  • Roger Kneebone



One important form of surgical training for residents is their participation in actual operations, for instance as an assistant or supervised surgeon. The aim of this study was to explore what participation in operations entails and how it might be described and analyzed.


A qualitative study was undertaken in a major teaching hospital in London. A total of 122 general surgical operations were observed. A subsample of 14 laparoscopic cholecystectomies involving one or more residents was analyzed in detail. Audio and video recordings of eight operations were transcribed and analyzed linguistically.


The degree of participation of trainees frequently shifted as the operation progressed to the next stage. Participation also varied within each stage. When trainees operated under supervision, the supervisors constantly adjusted their degree of control over the resident’s operative maneuvers.


Classifications such as “assistant” and “supervised surgeon” describing a trainee’s overall participation in an operation potentially misrepresent the varying involvement of resident and supervisor. Video recordings provide a useful alternative for documenting and analyzing actual participation in operations.


Laparoscopic Cholecystectomy Operative Maneuver Junior Trainee National Health Service Research Wireless Microphone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The research was supported by the Royal College of Surgeons of England, which funded a research fellowship (2009–2010), and the London Deanery, which granted an award under the Simulation and Technology-Enhanced Learning Initiative (2009–2011).

Conflicts of interest



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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Jeff Bezemer
    • 1
  • Alexandra Cope
    • 1
  • Omar Faiz
    • 1
  • Roger Kneebone
    • 1
  1. 1.Division of SurgeryImperial College LondonLondonUK

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