APGO

Background: Residents’ trustworthiness is a key factor that impacts attending surgeons’ decision on the level of autonomy granted. In order to entrust residents with OR autonomy, it is necessary to elicit what expert GYN surgical teachers use as evidence to guide them in their determinations.

Methods: Four selection criteria were used to define and purposefully sample expert GYN surgical teachers from 16 institutions to participate in a 30-minutes semi-structured interview.  Audio recordings of interviews were transcribed, iteratively analyzed, and emergent themes identified. 

Results: Twenty-five expert GYN surgical teachers from 4 US regions (Northeast 9, West 3, South 8, and Midwest 5) completed the interviews. Forty-eight percent practiced in medium-size residency programs (6-10 residents/year), 32% in small programs, and 20% in large programs. Expert GYN surgeons tended to use observable evidence from 3 domains to assess OB/GYN residents’ readiness for OR autonomy: affective (i.e. resident’s personal efforts and engagement), cognitive (i.e. knowledge and operative plans), and action (i.e. technical skills). Onsite observation, proactive questioning, and indirect inquiry were the common methods used by experts to obtain the above evidence.    

Discussions: Observable evidence from affective, cognitive and action domains were commonly used by expert gynecologic surgical teachers to assess OB/GYN residents’ readiness for autonomy in the OR. These findings may provide a potential framework for which to define and describe progressive OR autonomy and entrustment development.  

Keywords: Assessment, Faculty Development, Instructional Materials/Methods, Mentoring, Other