Williams Reed G, George Brian C, Meyerson Shari L, Bohnen Jordan D, Dunnington Gary L, Schuller Mary C, Torbeck Laura, Mullen John T, Auyang Edward, Chipman Jeffrey G, Choi Jennifer, Choti Michael, Endean Eric, Foley Eugene F, Mandell Samuel, Meier Andreas, Smink Douglas S, Terhune Kyla P, Wise Paul, DaRosa Debra, Soper Nathaniel, Zwischenberger Joseph B, Lillemoe Keith D, Fryer Jonathan P
Department of Surgery, Indiana University, Indianapolis, IN.
Department of Surgery, University of Michigan, Ann Arbor, MI.
Surgery. 2017 Dec;162(6):1314-1319. doi: 10.1016/j.surg.2017.07.028. Epub 2017 Sep 23.
Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents.
We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty.
Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74).
Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.
在手术室培训住院医师需要平衡患者安全、手术室效率要求以及住院医师的学习需求。本研究探讨了影响监督外科医生给予住院医师自主权限的4个因素。
我们评估了487名普通外科住院医师实施的7297例手术，并由来自14个培训项目的424名监督外科医生进行评估。主要结局指标是手术过程中监督外科医生给予住院医师的自主权限。预测变量包括住院医师在该病例中的表现、监督外科医生给予自主权限的历史记录、住院医师培训水平以及病例难度。
住院医师的表现是给予自主权限的最强预测因素。监督外科医生的典型自主权限是第二重要的预测因素。每增加一个因素，预测监督外科医生自主决策的能力虽有较小但仍显著的提高。这4个因素共同解释了54%的决策差异（r = 0.74）。
住院医师在每个病例中的手术表现是该病例中允许的自主权限的最强预测因素。监督外科医生给予的典型自主权限是第二重要的预测因素，它与住院医师的熟练程度无关，因此需要努力确保住院医师在许多不同监督医生的指导下完成每个手术。
