Hands-on operative experience is critical for surgical trainees to achieve proficiency. However, faculty entrustment of residents in the operating room (OR) is variable. We sought to understand faculty perceptions of how participating in surgical simulation influenced entrustment of residents.
This explanatory sequential mixed-methods study included surgical faculty who participated as raters or instructors during two simulation sessions: a basic surgical skills assessment for surgical interns and a robotic cholecystectomy for second- and third-year General Surgery residents. Faculty completed post-session surveys on simulation and entrustment. Responses were summarized descriptively. A subset of faculty participated in semi-structured interviews, which probed survey responses. Interviews were transcribed, codes identified using an inductive approach, and themes generated.
Of 16 faculty who participated in the two simulations, 15 (94%) responded to the post-session survey. Majority of respondents perceived that resident performance during simulation exceeded their expectations; that the simulation helped their understanding of resident competency; that the simulation will affect their entrustment of residents in the OR; and that they will feel more comfortable with residents in their OR after the simulation. Interviews revealed two themes: 1) impact of knowledge on faculty entrustment of residents and 2) limitations of simulation.
Faculty participation in simulation sessions as assessors and/or instructors may play a role in clarifying faculty understanding of resident competency level, informing decisions around entrustment, and instilling a sense of confidence in faculty.
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The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Nasca TJ, Day SH, Amis ES. The new recommendations on duty Hours from the ACGME task force. N Engl J Med. 2010;363: e3.
Klingensmith ME, Lewis FR. General surgery residency training issues. Adv Surg. 2013;47:251–70.
Sandhu G, Teman NR, Minter RM. Training autonomous surgeons: more time or faculty development? Ann Surg. 2015;261:843–5.
Jamal MH, Rousseau MC, Hanna WC, Doi SAR, Meterissian S, Snell L. Effect of the ACGME duty hours restrictions on surgical residents and faculty: a systematic review. Acad Med. 2011;86:34–42.
Rosenbaum L. Leaping without looking — duty hours, autonomy, and the risks of research and practice. N Engl J Med. 2016;374:701–3.
Hirschl RB. The making of a surgeon: 10,000hours? J Pediatr Surg. 2015;50:699–706.
Sterkenburg A, Barach P, Kalkman C, Gielen M, ten Cate O. When do supervising physicians decide to entrust residents with unsupervised tasks? Acad Med. 2010;85:1408–17.
Meyerson SL, Teitelbaum EN, George BC, Schuller MC, DaRosa DA, Fryer JP. Defining the autonomy gap: when expectations do not meet reality in the operating room. J Surg Educ. 2014;71:e64-72.
Mattar SG, Alseidi AA, Jones DB, Jeyarajah DR, Swanstrom LL, Aye RW, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258:440–9.
Napolitano LM, Savarise M, Paramo JC, Soot LC, Todd RS, Gregory J, et al. Are general surgery residents ready to practice? a survey of the American College of Surgeons Board of Governors and Young Fellows Association. J Am Coll Surg. 2014;218:1063-1072e31.
Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV. Early subspecialization and perceived competence in surgical training: are residents ready? J Am Coll Surg. 2013;216:764–71.
Patel M, Bhullar JS, Subhas G, Mittal V. Present status of autonomy in surgical residency–a program director’s perspective. Am Surg. 2015;81:786–90.
Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ. A systematic review of skills transfer after surgical simulation training. Ann Surg. 2008;248:166–79.
Dawe SR, Pena GN, Windsor JA, Broeders JAJL, Cregan PC, Hewett PJ, et al. Systematic review of skills transfer after surgical simulation-based training. Br J Surg. 2014;101:1063–76.
Hauer KE, ten Cate O, Boscardin C, Irby DM, Iobst W, O’Sullivan PS. Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv Health Sci Educ. 2013. https://doi.org/10.1007/s10459-013-9474-4.
Choo KJ, Arora VM, Barach P, Johnson JK, Farnan JM. How do supervising physicians decide to entrust residents with unsupervised tasks? a qualitative analysis: entrusting residents with tasks. J Hosp Med. 2014;9:169–75.
Hashimoto DA, Bynum WE, Lillemoe KD, Sachdeva AK. See more, do more, teach more: surgical resident autonomy and the transition to independent practice. Acad Med. 2016;91:757–60.
Hamadani FT, Deckelbaum D, Sauve A, Khwaja K, Razek T, Fata P. Abolishment of 24-hour continuous medical call duty in quebec: a quality of life survey of general surgical residents following implementation of the new work-hour restrictions. J Surg Educ. 2013;70:296–303.
Creswell, J.W., Creswell, J. D. Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications; 2017.
Sandhu G, Magas CP, Robinson AB, Scally CP, Minter RM. Progressive entrustment to achieve resident autonomy in the operating room: A National Qualitative Study with general surgery faculty and residents. Ann Surg. 2017;265:1134–40.
Teman NR, Gauger PG, Mullan PB, Tarpley JL, Minter RM. Entrustment of general surgery residents in the operating room: factors contributing to provision of resident autonomy. J Am Coll Surg. 2014;219:778–87.
Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26:1753–60.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
Dedoose 7.0.23, web application for managing, analyzing, and presenting qualitative and mized method research data 2018, Los Angeles, CA: Sociocultural Research Consultatnats, LLC, www.dedoose.com.
Kim SC, Fisher JG, Delman KA, Hinman JM, Srinivasan JK. Cadaver-based simulation increases resident confidence, initial exposure to fundamental techniques, and may augment operative autonomy. J Surg Educ. 2016;73:e33-41.
Hauer KE, Oza SK, Kogan JR, Stankiewicz CA, Stenfors-Hayes T, ten Cate O, et al. How clinical supervisors develop trust in their trainees: a qualitative study. Med Educ. 2015;49:783–95.
DaRosa DA, Zwischenberger JB, Meyerson SL, George BC, Teitelbaum EN, Soper NJ, et al. A theory-based model for teaching and assessing residents in the operating room. J Surg Educ. 2013;70:24–30.
Acton RD, Chipman JG, Lunden M, Schmitz CC. Unanticipated teaching demands rise with simulation training: strategies for managing faculty workload. J Surg Educ United States. 2015;72:522–9.
Pentiak PA, Schuch-Miller D, Streetman RT, Marik K, Callahan RE, Long G, et al. Barriers to adoption of the surgical resident skills curriculum of the American College of Surgeons/Association of Program Directors in Surgery. Surgery. 2013;154:23–8.
Oslock WM, Satiani B, Way DP, Tamer RM, Maurer J, Hawley JD, et al. A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands. Am J Surg. 2022;223:28–35.
Stefanidis D, Sevdalis N, Paige J, Zevin B, Aggarwal R, Grantcharov T, et al. Simulation in surgery: what’s needed next? Ann Surg. 2015;261:846–53.
Christy JM, Kolovich GP, Beal MD, Mayerson JL. Pilot study for an orthopedic surgical training laboratory for basic motor skills. Am J Orthop (Belle Mead NJ). 2014;43:246-E252.
Melnyk R, Campbell T, Holler T, Cameron K, Saba P, Witthaus MW, et al. See like an expert: gaze-augmented training enhances skill acquisition in a virtual reality robotic suturing task. J Endourol. 2021;35:376–82.
Soucisse ML, Boulva K, Sideris L, Drolet P, Morin M, Dubé P. Video coaching as an efficient teaching method for surgical residents—a randomized controlled trial. J Surg Educ. 2017;74:365–71.
No outside funding was received for this work.
Conflict of interest
The authors declare no competing interests.
This study was reviewed by our Institutional Review Board (study # 22–37166) and was granted exempt status.
Informed consent was obtained from all individual participants included in the study.
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Greenberg, A.L., Barnes, K.E., Syed, S.M. et al. Faculty entrustment of residents in the operating room: the role for surgical simulation. Global Surg Educ 2, 48 (2023). https://doi.org/10.1007/s44186-023-00128-2