Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
J Surg Educ. 2024 Jan;81(1):93-105. doi: 10.1016/j.jsurg.2023.09.008. Epub 2023 Oct 12.
To provide a systematic literature review of intraoperative entrusted autonomy for surgical residents. Specifically, perceptions from residents and supervising surgeons, supervising behavior and influencing factors on intraoperative teaching and learning are analyzed.
Increasing demands on surgical training and the need for effective development of technical skills, amplify the importance of making the most of intraoperative teaching and learning opportunities in the operating room. It is critical for residents to gain the greatest benefit from every surgical case and to achieve operative competence.
A systematic literature search identified 921 articles from 2000 to 2022 that addressed surgical education/training, intraoperative supervision/teaching, autonomy and entrustment. 40 studies with heterogeneous designs and methodologies were included.
Four themes were established in the analysis: patient safety, learner, learning environment and supervising surgeon. The patient is identified as the primary responsibility during intraoperative teaching and learning. Supervisors continuously guard patient safety as well as the resident's learning process. Ideal intraoperative learning occurs when the resident has optimal entrusted autonomy during the procedure matching with the current surgical skills level. A safe learning environment with dedicated time for learning are prerequisites for both supervising surgeons and residents. Supervising surgeons' own preferences and confidence levels also play an important role.
This systematic literature review identifies patient safety as the overriding principle for supervising surgeons when regulating residents' entrusted autonomy. When the supervisor's responsibility toward the patient has been met, there is room for intraoperative teaching and learning. In this process the learner, the learning environment and the supervising surgeon's own preferences all intertwine, creating a triangular responsibility. This review outlines the challenge of establishing an equilibrium in this triangle and the broad arsenal of strategies supervising surgeons use to keep it in balance.
对手术住院医师术中委托自主权进行系统文献回顾。具体来说，分析住院医师和上级外科医师的看法、监督行为以及对术中教学和学习的影响因素。
对外科培训的需求不断增加以及对有效发展技术技能的需求，突显了充分利用手术室中教学和学习机会的重要性。住院医师从每例手术中获得最大收益并实现手术能力至关重要。
系统文献检索确定了 2000 年至 2022 年期间 921 篇涉及外科教育/培训、术中监督/教学、自主性和委托的文章。纳入了 40 项设计和方法学具有异质性的研究。
分析中确定了四个主题：患者安全、学习者、学习环境和监督外科医师。患者被确定为术中教学和学习的主要责任方。上级外科医师在手术过程中不断保护患者安全和住院医师的学习过程。当住院医师在手术过程中拥有最佳委托自主权并与当前手术技能水平相匹配时，理想的术中学习就会发生。安全的学习环境和专门的学习时间是监督外科医师和住院医师的先决条件。监督外科医师的自身偏好和信心水平也起着重要作用。
本系统文献回顾确定了患者安全是监督外科医师在规范住院医师委托自主权时的首要原则。当上级外科医师对患者的责任得到满足时，就有术中教学和学习的空间。在这个过程中，学习者、学习环境和监督外科医师自身的偏好交织在一起，形成了一个三角责任。本综述概述了在这个三角关系中建立平衡的挑战以及监督外科医师用来保持平衡的广泛策略。
