Skip to main content
Log in

Faculty entrustment of residents in the operating room: the role for surgical simulation

Global Surgical Education - Journal of the Association for Surgical Education Aims and scope Submit manuscript

Cite this article



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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Availability of data and materials

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.


  1. Nasca TJ, Day SH, Amis ES. The new recommendations on duty Hours from the ACGME task force. N Engl J Med. 2010;363: e3.

    Article  PubMed  Google Scholar 

  2. Klingensmith ME, Lewis FR. General surgery residency training issues. Adv Surg. 2013;47:251–70.

    Article  PubMed  Google Scholar 

  3. Sandhu G, Teman NR, Minter RM. Training autonomous surgeons: more time or faculty development? Ann Surg. 2015;261:843–5.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Rosenbaum L. Leaping without looking — duty hours, autonomy, and the risks of research and practice. N Engl J Med. 2016;374:701–3.

    Article  PubMed  Google Scholar 

  6. Hirschl RB. The making of a surgeon: 10,000hours? J Pediatr Surg. 2015;50:699–706.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. Creswell, J.W., Creswell, J. D. Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications; 2017.

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26:1753–60.

    Article  PubMed  Google Scholar 

  23. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

    Article  Google Scholar 

  24. 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,

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

Download references


No outside funding was received for this work.

Author information

Authors and Affiliations



Study conception and design: HC, PSO'S; acquisition of data: HC, PSO'S and ALG; analysis and interpretation of data: HC, PSOS, ALG, and KEB; drafting of manuscript: KEB and ALG; review and editing: HC, PSO'S, AA, JHR, SMS, KEB, and ALG.

Corresponding author

Correspondence to Hueylan Chern.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval

This study was reviewed by our Institutional Review Board (study # 22–37166) and was granted exempt status.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 KB)

Supplementary file2 (DOCX 14 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: