Progressive Surgical Autonomy in a Plastic Surgery Resident Clinic

Abstract

Background:Resident clinics are thought to catalyze educational milestone achievement through opportunities for progressively autonomous surgical care, but studies are lacking for general plastic surgery resident clinics (PSRCs). We demonstrate the achievement of increased surgical autonomy and continuity of care in a PSRC.Methods:A retrospective review of all patients seen in a PSRC from October 1, 2010, to October 1, 2015, was conducted. Our PSRC is supervised by faculty plastic surgery attendings, though primarily run by chief residents in an accredited independent plastic surgery training program. Surgical autonomy was scored on a 5-point scale based on dictated operative reports. Graduated chief residents were additionally surveyed by anonymous online survey.Results:Thousand one hundred forty-four patients were seen in 3,390 clinic visits. Six hundred fifty-three operations were performed by 23 total residents, including 10 graduating chiefs. Senior resident autonomy averaged 3.5/5 (SD = 1.5), 3.6/5 (SD = 1.5), to 3.8/5 (SD = 1.3) in postgraduate years 6, 7, and 8, respectively. A linear mixed model analysis demonstrated that training level had a significant impact on operative autonomy when comparing postgraduate years 6 and 8 (P = 0.026). Graduated residents’ survey responses (N = 10; 100% response rate) regarded PSRC as valuable for surgical experience (4.1/5), operative autonomy (4.4/5), medical knowledge development (4.7/5), and the practice of Accreditation Council of Graduate Medical Education core competencies (4.3/5). Preoperative or postoperative continuity of care was maintained in 93.5% of cases.Conclusion:The achievement of progressive surgical autonomy may be demonstrated within a PSRC model.

How Educational Theory Can Inform the Training and Practice of Plastic Surgeons

“…As this is a prominent model referred to in the surgical education literature, 3,4 it is noteworthy exploring it in greater depth, particularly as it has been tabulated into stages/levels that trainees can resonate with in plastic surgery. 32–34 In fact, the PSMP levels/milestones were guided by the Dreyfus Model. 33,35…”

Resident Autonomy

“…Furthermore, graduated chief residents were surveyed and reported significant value in the surgical experience, operative autonomy, medical knowledge and ACGME core competencies afforded by supporting a resident run clinic. These findings have been echoed in other studies as well in the settings of a resident-run aesthetic clinic [80] which demonstrated a structured, autonomous experience in rhinoplasty with acceptable complication rates as well as good satisfaction as rated by both patients and residents [81].…”

Perceptions of Preparedness in Plastic Surgery Residency Training

“…In regard to plastic surgery resident clinics, they continue to be an arena for the development of senior resident autonomy, decision-making, and maturation. 23 Increased case volume and autonomy have been shown to increase resident confidence and competence, 24 and resident clinics provide an ideal avenue for this. Various resident clinic models have been proposed, 23 , 25 – 28 with residents consistently supporting the importance of their role in training.…”

“… 23 Increased case volume and autonomy have been shown to increase resident confidence and competence, 24 and resident clinics provide an ideal avenue for this. Various resident clinic models have been proposed, 23 , 25 – 28 with residents consistently supporting the importance of their role in training. Despite concerns with patient safety in resident clinics, multiple studies have validated the safety and complication profiles in this setting.…”