Chen Xiaodong Phoenix, Sullivan Amy M, Bengtson Joan M, Dalrymple John L
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2017 Oct;130 Suppl 1:8S-16S. doi: 10.1097/AOG.0000000000002201.
To identify entrustment evidence used by expert gynecologic surgical teachers to determine obstetrics and gynecology residents' level of autonomy in the operating room.
A qualitative interview study was undertaken from March to November 2016. Four selection criteria were used to define and purposefully sample expert gynecologic surgical teachers across the United States to represent all four geographic regions. All interviews were audio-recorded and transcribed. We applied the Framework Method of content analysis. Transcripts were iteratively analyzed and emergent themes identified.
Twenty-seven expert gynecologic surgical teachers from 15 institutions across the United States participated in 30-minute interviews. We identified four domains of entrustment evidence (resident characteristics, medical knowledge, technical performance, and "beyond current surgical case") commonly reported by expert gynecologic surgical teachers to determine residents' autonomy as well as the particular evidence associated with expert gynecologic surgical teachers' determination of resident autonomy at two decision-making points (surgical time-out and taking over certain intraoperative steps) in the operating room. Onsite direct observation and conversation were two common methods used by expert gynecologic surgical teachers to obtain this evidence.
Entrustment evidence from resident characteristics, medical knowledge, and technical performance domains and from "beyond current surgical case" was commonly used by expert gynecologic surgical teachers to determine residents' autonomy. Our findings provide a potential framework for designing educational interventions that aim to increase residents' readiness for autonomy and entrustment in the operating room.
确定妇科手术专家教师用于判定妇产科住院医师在手术室自主水平的委托证据。
于2016年3月至11月进行了一项定性访谈研究。采用四项选择标准来界定并有意抽取美国各地的妇科手术专家教师作为样本，以代表所有四个地理区域。所有访谈均进行了录音和转录。我们应用了内容分析的框架法。对转录本进行反复分析并确定新出现的主题。
来自美国15家机构的27名妇科手术专家教师参与了30分钟的访谈。我们确定了妇科手术专家教师普遍报告的用于判定住院医师自主性的四个委托证据领域（住院医师特征、医学知识、技术操作以及“当前手术病例之外的情况”），以及与妇科手术专家教师在手术室两个决策点（手术暂停和接管某些术中步骤）判定住院医师自主性相关的具体证据。现场直接观察和交谈是妇科手术专家教师获取这些证据的两种常用方法。
妇科手术专家教师通常利用来自住院医师特征、医学知识、技术操作领域以及“当前手术病例之外的情况”的委托证据来判定住院医师的自主性。我们的研究结果为设计旨在提高住院医师在手术室自主性准备程度和委托能力的教育干预措施提供了一个潜在框架。
