Chief Resident Case Experience and Autonomy Are Associated With Resident Confidence and Future Practice Plans

Fillmore, W. Jonathan; Teeples, Tyson J.; Cha, Stephen; Viozzi, Christopher F.; Arce, Kevin

doi:10.1016/j.joms.2012.05.006

Cited by 38 publications

(20 citation statements)

References 27 publications

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“…A number of models have been published suggesting that supervision can be enhanced without severely compromising trainee autonomy [9, 19, 25, 26]. While the authors believe that this study reasonably measures important of aspects of supervision in the outpatient clinic setting, they concede that autonomy is a perception [14, 27, 28] and may be much more difficult to measure. However, the significant body of published literature describing the tension between autonomy and supervision suggest that they most likely vary inversely [15, 29–32].…”

Section: Discussionmentioning

confidence: 90%

Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs

et al. 2017

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BackgroundThe development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States.MethodsA link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored.ResultsThe response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated.ConclusionsThe majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The different degrees of faculty supervision outlined by this survey might provide a useful guide presuming they can be correlated with validated metrics of educational quality. Finally, this study could provide an adjunctive resource to current international efforts to standardize ophthalmic residency education.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0941-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 90%

Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs

et al. 2017

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“…Any investigation into the operative experience of CRs invites consideration of the role that supervised autonomy plays in the current era of surgical training. Fillmore et al 19 found that perceived autonomy had a measurable impact on the career expectations and anticipated practices of oral and maxillofacial surgery CRs. The authors stressed that “aloneness” per se did not appear to be a good measure of autonomy for these residents, but that supervised independence was sufficient for residents to report autonomous decision making (under the careful watch of supervising surgeons).…”

Section: Discussionmentioning

confidence: 99%

“…The authors stressed that “aloneness” per se did not appear to be a good measure of autonomy for these residents, but that supervised independence was sufficient for residents to report autonomous decision making (under the careful watch of supervising surgeons). Development of a fully trained professional requires “gradual transfer” of “entrustable professional activities.” 19 For surgeons, performance of such professional activities (ie, operations, perioperative care, outpatient care, and critical care) is gradually entrusted to residents over 5 years. Although this transfer must now take place within a health care context more attuned to notions of proper supervision, it nevertheless has to take place.…”

Section: Discussionmentioning

confidence: 99%

The General Surgery Chief Resident Operative Experience

et al. 2013

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IMPORTANCE The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. OBJECTIVE To evaluate changes in operative experience for general surgery CRs. DESIGN, SETTING, AND PARTICIPANTS Review of Accreditation Council for Graduate Medical Education case logs from 1989–1990 through 2011–2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. MAIN OUTCOMES AND MEASURES Total cases and defined categories were evaluated for changes over time. RESULTS The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P < .001). Total CR cases dropped to their lowest following implementation of the 80-hour work week (236 cases), but rebounded in period 5. The percentage of residents’ 5-year operative experience performed as CRs has decreased (30% in period 1 vs 25.6% in period 5, P < .001). Regarding case mix: thoracic, trauma, and vascular cases declined steadily, while alimentary and intra-abdominal operations increased. Recent graduates averaged 80 alimentary and 78 intra-abdominal procedures during their CR years. Compared with period 1, in which these 2 categories represented 47.1% of CR experience, in period 5, they represented 65.2% (P < .001). Endocrine experience has been relatively unchanged. CONCLUSIONS AND RELEVANCE Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

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“…This objective improvement came without expert oversight or correction—a more autonomous way of learning—believed to represent progression toward a higher level of expertise . Surgical proficiency is determined by a number of factors, including objective evaluation, autonomy, and self‐perceived confidence, all of which have been associated with increased resident competence . In this study, when comparing residents both within training groups and overall, residents reported improved confidence in microsurgical skills.…”

Section: Discussionmentioning

confidence: 71%

Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training

et al. 2017

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Chief Resident Case Experience and Autonomy Are Associated With Resident Confidence and Future Practice Plans

Cited by 38 publications

References 27 publications

Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs

Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs

The General Surgery Chief Resident Operative Experience

Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training

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