@article{1737,
  author = {Brian C. George and Jordan D. Bohnen and Reed G. Williams and Shari L. Meyerson and Mary C. Schuller and Michael J. Clark and Andreas H. Meier and Laura Torbeck and Samuel P. Mandell and John T. Mullen and Douglas S. Smink and Rebecca E. Scully and Jeffrey G. Chipman and Edward D. Auyang and Kyla P. Terhune and Paul E. Wise and Jennifer N. Choi and Eugene F. Foley and Justin B. Dimick and Michael A. Choti and Nathaniel J. Soper and Keith D. Lillemoe and Joseph B. Zwischenberger and Gary L. Dunnington and Debra A. DaRosa and Jonathan P. Fryer and Procedural Learning and Safety Collaborative},
  title = {Readiness of US General Surgery Residents for Independent Practice.},
  abstract = {<p><b>OBJECTIVE: </b>This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy.</p><p><b>BACKGROUND: </b>The American Board of Surgery has designated 132 procedures as being "Core" to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role.</p><p><b>METHODS: </b>Attendings in 14 General Surgery programs were trained to use a) the 5-level System for Improving and Measuring Procedural Learning (SIMPL) Performance scale to assess resident readiness for independent practice and b) the 4-level Zwisch scale to assess the level of guidance (ie, autonomy) they provided to residents during specific procedures. Ratings were collected immediately after cases that involved a categorical GS resident. Data were analyzed using descriptive statistics and supplemented with Bayesian ordinal model-based estimation.</p><p><b>RESULTS: </b>A total of 444 attending surgeons rated 536 categorical residents after 10,130 procedures. Performance: from the first to the last year of training, the proportion of Performance ratings for Core procedures (n = 6931) at "Practice Ready" or above increased from 12.3% to 77.1%. The predicted probability that a typical trainee would be rated as Competent after performing an average Core procedure on an average complexity patient during the last week of residency training is 90.5% (95% CI: 85.7%-94%). This falls to 84.6% for more complex patients and to less than 80% for more difficult Core procedures. Autonomy: for all procedures, the proportion of Zwisch ratings indicating meaningful autonomy ("Passive Help" or "Supervision Only") increased from 15.1% to 65.7% from the first to the last year of training. For the Core procedures performed by residents in their final 6 months of training (cholecystectomy, inguinal/femoral hernia repair, appendectomy, ventral hernia repair, and partial colectomy), the proportion of Zwisch ratings (n = 357) indicating near-independence ("Supervision Only") was 33.3%.</p><p><b>CONCLUSIONS: </b>US General Surgery residents are not universally ready to independently perform Core procedures by the time they complete residency training. Progressive resident autonomy is also limited. It is unknown if the amount of autonomy residents do achieve is sufficient to ensure readiness for the entire spectrum of independent practice.</p>},
  year = {2017},
  journal = {Ann Surg},
  volume = {266},
  pages = {582-594},
  month = {12/2017},
  issn = {1528-1140},
  doi = {10.1097/SLA.0000000000002414},
  language = {eng},
}