The "Key" or "Critical" Portions of an Operation: Understanding Attending Supervision and Resident Autonomy From a Legal Perspective.

OBJECTIVE

To obtain a legal understanding of the "key" or "critical" portions of an operation, pertaining to attending supervision, resident autonomy, and patient safety.

DESIGN

Snowball sampling, a subset of purposive sampling, was used to develop a population of 47 risk managers and legal counsel, who were given an online, qualitative questionnaire. Interpretive description was used to analyze qualitative data. Individual responses were coded with simultaneous categorization and assessment of underlying relationships.

SETTING

Online, qualitative questionnaire.

PARTICIPANTS

Hospital risk managers and legal counsel from across the United States.

RESULTS

Overall, 25 of 47 (53%) risk managers completed the survey. Qualitative responses could be organized into 3 major themes (1) variation in the definition of "key" or "critical" portions of an operation, (2) differing expectations of attending supervision and resident autonomy, and (3) the need for clear communication and trust among attendings, residents, and patients.

CONCLUSIONS

Among risk managers, the primary liaisons between surgeons and patients in malpractice litigation, there is widespread variation in understanding the "key" and "critical" portions of an operation and the dynamic between appropriate attending supervision and resident autonomy. Better collaboration and transparency between surgeons and legal experts are required to facilitate a shared mental model regarding attending supervision and resident autonomy.