The Wilson Centre for Research in Education. University Health Network, Toronto, Ontario, Canada.
The Wilson Centre for Research in Education. University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto and Allan Waters Family Simulation Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
Am J Surg. 2020 Feb;219(2):233-239. doi: 10.1016/j.amjsurg.2019.12.010. Epub 2019 Dec 14.
Developing autonomy is a critical component of becoming an attending surgeon. General surgery training has evolved in recent decades, however, leaving residents less time to work with attendings to establish entrustment. Limited entrustment can impact resident learning and engagement.
A constructivist grounded theory approach was used to guide interviews of 12 general surgery residents and 10 attendings.
Engagement in the OR is perceived by both residents and attendings as fundamental to achieving autonomy. Our study uncovered three key tensions: 1. Residents and attendings both occupy dual roles in the OR; 2. System demands put those roles in tension and opposition constantly; 3. Residents and attendings do deploy strategies to seek balance in those tensions.
In an academic OR setting, competing priorities can negatively impact resident engagement. Participants described some strategies for helping residents and attendings prioritize learning and teaching to better prepare residents for future practice.
培养自主性是成为主治医生的关键组成部分。然而，最近几十年来，普通外科培训发生了变化，这使得住院医师与主治医生合作的时间减少，从而难以建立委托关系。委托关系不足会影响住院医师的学习和参与度。
采用建构主义扎根理论方法，对 12 名普通外科住院医师和 10 名主治医生进行了访谈。
住院医师和主治医生都认为在手术室中的参与对于实现自主性至关重要。我们的研究发现了三个关键的紧张关系：1. 住院医师和主治医生在手术室中都扮演着双重角色；2. 系统需求使这些角色不断处于紧张和对立的状态；3. 住院医师和主治医生确实采取了一些策略来平衡这些紧张关系。
在学术性手术室环境中，相互竞争的优先级可能会对住院医师的参与产生负面影响。参与者描述了一些帮助住院医师和主治医生确定学习和教学优先级的策略，以更好地为住院医师未来的实践做准备。
