Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Surgery, Tenwek Hospital, Bomet, Kenya.
J Surg Res. 2021 Feb;258:137-144. doi: 10.1016/j.jss.2020.08.057. Epub 2020 Sep 30.
The education of surgical trainees is ideally designed to produce surgeons with both confidence and competence. This involves the development of autonomy in the operating room. Factors associated with autonomy and entrustment have been studied in high-resource settings. In a resource-limited context, where autonomy is solely at the discretion of faculty, and there are fewer external constraints to restrict it, we hypothesized that assessment of a trainee's performance would be dependent upon reported confidence levels of both faculty and trainees in those trainees' abilities.
At a teaching hospital in rural Kenya, operative experience surveys were administered to eleven general surgery trainees (PGY1-5) and six faculty paired dyads immediately following operative procedures in May 2016 to elicit self-reported assessments of confidence, hesitation, and ability as measured by the Zwisch Scale. We examined factors related to learning and used dyadic structural equation models to understand factors related to the assessment of ability.
There were 107 paired surveys among 136 trainees and 130 faculty evaluations. Faculty scrubbed into 76 (72%) cases. In comparison to trainees, faculty were more likely to give a higher average score for confidence (4.08 versus 3.90; P value: 0.005), a lower score for hesitation (2.67 versus 2.84; P value: 0.001), and a lower score for the ability to perform the operation independently (2.73 versus 3.02; P value: 0.01). Faculty and trainee perceptions of hesitation influenced their ability scores. Trainee hesitation (OR 12.1; 1.2-127.6, P = 0.04) predicted whether trainees reported experiencing learning.
Between trainees and faculty at a teaching program in rural Kenya, assessment scores of confidence, hesitation, and ability differ in value but remain fairly correlated. Hesitation is predictive of ability assessment, as well as self-reported learning opportunities. Focus upon identifying when trainees hesitate to proceed with a case may yield important educational opportunities.
外科培训生的教育旨在培养既自信又有能力的外科医生。这涉及到在手术室中培养自主性。在资源丰富的环境中，已经研究了与自主性和委托相关的因素。在资源有限的环境中，自主性完全由教师决定，并且没有更多的外部限制来限制它，我们假设对学员表现的评估将取决于教师和学员对学员能力的信心水平。
在肯尼亚农村的一家教学医院，2016 年 5 月，在 11 名普通外科培训生（PGY1-5）和 6 名教员配对的双人组完成手术操作后，立即进行了手术经验调查，以征集Zwisch 量表衡量的自我报告的信心、犹豫和能力评估。我们研究了与学习相关的因素，并使用对偶结构方程模型来理解与能力评估相关的因素。
在 136 名学员和 130 名教师评估中，有 107 对配对调查。有 76 名（72%）教员进行了手术刷手。与学员相比，教员更有可能对信心（4.08 对 3.90；P 值：0.005）、犹豫（2.67 对 2.84；P 值：0.001）和独立进行手术操作的能力（2.73 对 3.02；P 值：0.01）给予更高的平均评分。学员和教员对犹豫的看法影响了他们的能力评分。学员的犹豫（OR 12.1；1.2-127.6，P = 0.04）预测学员是否报告有学习机会。
在肯尼亚农村的教学项目中，培训生和教员之间的评估分数在价值上存在差异，但仍具有相当的相关性。犹豫是能力评估以及自我报告的学习机会的预测因素。关注识别学员在进行病例时犹豫不决的情况可能会带来重要的教育机会。
