Stoeckl Elizabeth M, Garren Margaret E, Nishii Akira, Evans Julie, Minter Rebecca M, Sandhu Gurjit, Jung Sarah A
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
J Surg Educ. 2022 May-Jun;79(3):574-578. doi: 10.1016/j.jsurg.2021.12.007. Epub 2021 Dec 29.
Toolkits to assess progressive resident autonomy are integral to the movement toward competency-based surgical education. OpTrust is one such tool validated for intraoperative assessment of both faculty and resident entrustment behaviors. We developed a supplementary tool to OpTrust that would aid faculty and residents in making meaningful improvements in entrustment behavior by providing talking points and reflection items tailored to different motivational styles as defined by Regulatory Focus Theory (RFT).
Existing literature about surgical entrustment was used to build a list of sample dialogue and self-reflection items to use in the operating room. This list was distributed as a survey to individuals familiar with OpTrust and RFT, asking them to categorize each item as Promotion-oriented, Prevention-oriented, or Either. The respondents then met to discuss survey items that did not reach a consensus until the group agreed on their categorization.
University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin Michigan Medicine, Ann Arbor, Michigan PARTICIPANTS: Clinician and education researchers familiar with intraoperative entrustment and RFT RESULTS: Eight respondents completed the survey categorizing the talking points and reflection items by RFT (100% response rate). Six of these respondents attended the additional meeting to discuss discordant items. The input from this panel was used to develop "TrustEd," the supplementary tool that faculty and residents can quickly reference before beginning a case.
Although tools such as OpTrust allow intraoperative entrustment behaviors to be quantified, TrustEd offers concrete strategies for faculty and residents who are interested in improving those behaviors over time. Further study is needed to assess whether the use of TrustEd does in fact lead to durable behavior change and improvement in OpTrust scores.
评估住院医师逐步获得自主权的工具包是基于胜任力的外科学教育运动的重要组成部分。OpTrust就是这样一种经过验证的工具，可用于术中评估教师和住院医师的委托行为。我们开发了一种OpTrust的补充工具，通过提供根据监管焦点理论（RFT）定义的针对不同动机风格的谈话要点和反思项目，帮助教师和住院医师在委托行为方面做出有意义的改进。
利用现有的关于手术委托的文献，构建一份在手术室使用的示例对话和自我反思项目清单。该清单作为一项调查分发给熟悉OpTrust和RFT的个人，要求他们将每个项目分类为促进导向型、预防导向型或两者皆可。然后，受访者开会讨论未达成共识的调查项目，直到小组就其分类达成一致。
威斯康星大学医学院和公共卫生学院，麦迪逊，威斯康星州；密歇根大学医学中心，安娜堡，密歇根州
熟悉术中委托和RFT的临床医生和教育研究人员
八名受访者完成了调查，根据RFT对谈话要点和反思项目进行了分类（回复率100%）。其中六名受访者参加了额外的会议，讨论不一致的项目。该小组的意见被用于开发“TrustEd”，这是一种教师和住院医师在开始病例前可以快速参考的补充工具。
虽然OpTrust等工具可以量化术中委托行为，但TrustEd为有兴趣随着时间推移改善这些行为的教师和住院医师提供了具体策略。需要进一步研究来评估使用TrustEd是否实际上会导致持久的行为改变和OpTrust分数的提高。
