Department of Surgery, The Ohio State University, Columbus, Ohio.
Department of Surgery, The Ohio State University, Columbus, Ohio.
J Surg Res. 2021 May;261:236-241. doi: 10.1016/j.jss.2020.12.033. Epub 2021 Jan 15.
Prospective resident entrustment (i.e., trust an attending surgeon intends to give to a resident in the near future) in the operating room (OR) closely associates with granted future autonomy. However, the process of determining resident entrustment takes time and effort. Thus, this study aimed to assess the efficiency of granting incremental resident entrustment for upcoming surgical cases.
We analyzed prospective resident entrustment of 6 chief residents in 76 cases of laparoscopic cholecystectomy, laparoscopic colectomy, ventral hernia, and inguinal hernia scored by attending surgeon, resident, and a surgeon observer. Matched direct costs and operative time were extracted from hospital billing. We assessed the efficiency of granting incremental prospective resident entrustment with direct cost per minute incurred in the evaluated case. Effect size was computed to assess the differences between groups.
Sixty-three cases (82.9%) were matched; 47.6% (30/63) of matched cases received prospective resident entrustment score ≥ 4. The direct cost per minute increased in three procedures (laparoscopic cholecystectomy, laparoscopic colectomy, and ventral hernia) with increased intention of granting incremental resident entrustment. Inguinal hernia was the only procedure in which chiefs were entrusted with future independence while the direct cost per minute decreased.
Our findings demonstrate more time and effort are required (except for inguinal hernia) for residents to be entrusted with increased independence in the future. Faculty and resident development programs are recommended to improve the efficiency of the process of granting incremental operative entrustment to optimize resident training quality and cost of care delivery.
手术室中预期的住院医师委托（即，信任主治医生打算在不久的将来交给住院医师）与未来自主的授予密切相关。然而，确定住院医师委托的过程需要时间和精力。因此，本研究旨在评估为即将进行的手术病例授予增量住院医师委托的效率。
我们分析了 6 名主任住院医师在 76 例腹腔镜胆囊切除术、腹腔镜结肠切除术、腹疝和腹股沟疝中的预期住院医师委托情况，这些手术由主治医生、住院医师和外科医生观察者进行评分。从医院计费中提取了匹配的直接成本和手术时间。我们评估了授予增量预期住院医师委托的效率，使用评估病例中每分钟发生的直接成本。计算效应大小以评估组间差异。
63 例（82.9%）病例匹配；30/63（47.6%）例匹配病例的预期住院医师委托评分≥4。在三种手术（腹腔镜胆囊切除术、腹腔镜结肠切除术和腹疝）中，随着授予增量住院医师委托的意图增加，每分钟直接成本增加。腹股沟疝是唯一一种主治医生委托住院医师未来独立手术的手术，而每分钟直接成本降低。
我们的发现表明，住院医师需要更多的时间和精力（腹股沟疝除外）才能被委托未来更高的独立性。建议制定教员和住院医师发展计划，以提高授予增量手术委托的效率，从而优化住院医师培训质量和医疗服务成本。
