How ready are new surgical graduates for independent practice?
That’s a question that’s gotten a lot of attention in recent years:
- Survey of Surgical Fellowship Directors:
- 30% of first-year fellows couldn’t perform basic procedures independently (e.g., laparoscopic cholecystectomy).
- 38% lacked patient ownership.
- 66% couldn’t operate unsupervised for 30 minutes during major procedures.
- Survey of Surgical Fellowship Directors:
Survey of Surgical Fellowship Directors:
- 30% of first-year fellows couldn’t perform basic procedures independently (e.g., laparoscopic cholecystectomy).
- 38% lacked patient ownership.
- 66% couldn’t operate unsupervised for 30 minutes during major procedures.
30% of first-year fellows couldn’t perform basic procedures independently (e.g., laparoscopic cholecystectomy).
38% lacked patient ownership.
66% couldn’t operate unsupervised for 30 minutes during major procedures.
- Survey of Gynecological Surgery Fellowship Directors:
- 20% of fellows could perform a vaginal hysterectomy independently.
- 46% could perform an abdominal hysterectomy.
- 34% could handle basic hysteroscopic procedures.
- Survey of Gynecological Surgery Fellowship Directors:
Survey of Gynecological Surgery Fellowship Directors:
- 20% of fellows could perform a vaginal hysterectomy independently.
- 46% could perform an abdominal hysterectomy.
- 34% could handle basic hysteroscopic procedures.
20% of fellows could perform a vaginal hysterectomy independently.
46% could perform an abdominal hysterectomy.
34% could handle basic hysteroscopic procedures.
- New surgeons had a higher risk of complications and mortality than experienced surgeons. The relative risk (RR) of mortality in the first year of practice was 1.17, compared to 15-year veterans.
New surgeons had a higher risk of complications and mortality than experienced surgeons. The relative risk (RR) of mortality in the first year of practice was 1.17, compared to 15-year veterans.
Yikes.
So, when data from the 2020 American Board of Surgery In-Training Examination (ABSITE) revealed that only 7.7% of graduating surgical residents were confident in their ability to perform 10 common general surgery operations without attending supervision, people started asking some questions.
Dr. Rachel Jensen and her colleagues went looking for some answers and recently published their results in the Journal of Graduate Medical Education (June 2024).
Article Title: Looking Beyond the Numbers: A Comparison of Operative Self-Efficacy, Supervision, and Case Volume in General Surgery Residency
Study Overview: The study compared residents' self-efficacy, their level of operative independence (as rated by both residents and supervisors in the SIMPL app), and case logs.
What is Self-Efficacy?
Self-efficacy, a concept introduced by cognitive psychologist Albert Bandura, is an individual’s belief in their ability to accomplish specific tasks or goals. In the context of surgery, it refers to a resident's confidence in their ability to perform procedures independently.
Key Findings:
Correlation with Independence: Higher levels of attending-reported operative independence were significantly associated with greater self-efficacy.
Case Volume: While logging more cases was helpful, the correlation did not reach statistical significance.
👉 Key Takeaways
🗝️ Self-efficacy is crucial for surgical residents' transition to independent practice.
🗝️ Improving the quality of operative experience is more effective than increasing the quantity of cases.
How do we increase autonomy for trainees? That’s the million-dollar question.
Note: Originally published 9/22/2024