Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
UT Southwestern Medical Center, Dallas, TX.
Ann Surg. 2019 Dec;270(6):1058-1064. doi: 10.1097/SLA.0000000000002813.
To determine the association between intraoperative entrustment and personality alignment.
For surgical residents, achieving operative autonomy has become increasingly difficult. The impact of faculty-resident operative interactions in accomplishing this goal is not well understood. We hypothesized that if operative dyads (faculty and resident) had personality alignment or congruency, then resident entrustment in the operating room would increase.
We completed a retrospective analysis of 63 operations performed from September 2015 to August 2016. Operations were scored using OpTrust, a validated tool that assesses progressive entrustment of responsibility to surgical residents in the operating room. All dyads were classified as having congruent or incongruent personality alignment as measured by promotion or prevention orientation using the regulatory focus questionnaire. The association between personality congruence and OpTrust scores was identified using multivariable linear regression.
A total of 35 congruent dyads and 28 incongruent dyads were identified. Congruent dyads had a higher percentage of "very difficult" cases (33.3 vs. 7.4%, P = 0.017), female residents (37.1 vs. 14.3%, P = 0.042) and faculty with fewer years of experience (10.4 vs. 14.8%, P = 0.028) than incongruent dyads. In addition to post-graduate year level, dyad congruency was independently associated with a 0.88 increase (95% CI [0.27-1.49], P = 0.006) in OpTrust scores (overall range 2-8), after adjusting for case difficulty, faculty experience, and post-graduate year.
Congruent operative dyads are associated with increased operative entrustment as demonstrated by increased OpTrust scores. Developing awareness and strategies for addressing incongruence in personality in the operative dyad is needed.
确定术中委托与人格一致之间的关联。
对于外科住院医师来说，实现手术自主性变得越来越困难。教职员工与住院医师在完成这一目标的手术互动的影响尚不清楚。我们假设，如果手术二人组（教职员工和住院医师）具有人格一致或一致性，那么住院医师在手术室中的委托程度将会增加。
我们对 2015 年 9 月至 2016 年 8 月期间进行的 63 例手术进行了回顾性分析。使用 OpTrust 对手术进行评分，OpTrust 是一种经过验证的工具，可评估住院医师在手术室中逐步承担责任的能力。根据监管重点问卷，使用促进或预防导向将所有二人组分类为具有一致或不一致的人格一致性。使用多变量线性回归确定人格一致性与 OpTrust 评分之间的关联。
共确定了 35 个一致的二人组和 28 个不一致的二人组。一致的二人组中“非常困难”的病例比例较高（33.3%比 7.4%，P=0.017），女性住院医师比例较高（37.1%比 14.3%，P=0.042），且教师经验较少（10.4%比 14.8%，P=0.028）。除研究生水平外，在调整病例难度、教师经验和研究生水平后，二人组的一致性与 OpTrust 评分增加 0.88 （95%CI[0.27-1.49]，P=0.006）独立相关（总体范围为 2-8）。
一致的手术二人组与增加的手术委托有关，表现为 OpTrust 评分增加。需要提高对手术二人组中人格不一致的认识，并制定解决策略。
