Today’s academic surgeon deals with many competing demands and limited time: operating, grant writing, writing papers, spending time with family, and so on. But even with those demands, it is critical surgeons take the necessary time to teach trainees, Rebecca W. Schroll, MD, FACS, New Orleans, LA, said in the Monday, October 5 panel session, Making Time to Teach.
This and other sessions from the virtual Clinical Congress are available for on-demand viewing through December 31.
Barriers exist to prioritizing teaching, “But the need for quality teaching becomes clear when remembering the goal is to produce the best possible surgeons and to meet the needs of the community,” Dr. Schroll said. When it comes to fostering a sense of surgical autonomy in residents, evidence exists that not all surgeons are currently achieving that educational goal.
In fact, survey data show many graduating residents feel unprepared for independent practice, and faculty and residency directors feel the same. “Autonomy is an essential component of the transition from supervised training to independent practice,” where residents cultivate the competence and independence needed to succeed, according to Dr. Schroll.
While improving a sense of autonomy is vital for surgical residents as they approach independent practice, Mary E. Klingensmith, MD, FACS, St. Louis, MO, suggested that increased hands-on time between faculty and trainees presents multiple opportunities and time to teach. The diminished surgical case log is well known, “but I would argue that, through this change, there are more opportunities for deliberate teaching of transferability of skills,” Dr. Klingensmith said.
Ultimately, the question of autonomy when a resident performs an operation is one of patient safety. “It is our responsibility to the public to ensure that as the trainee graduates from residency, he or she is prepared to practice independently in the absence of supervision,” Keith A. Delman, MD, FACS, said. He is the Carlos Professor of Surgical Anatomy and Techniques; director, Carlos and Davis Center for Surgical Anatomy and Technique; and co-chair, Melanoma Working Group, Winship Cancer Institute, Emory University, Atlanta, GA.
To facilitate autonomy while keeping safety top of mind, Dr. Delman suggested multiple elements. First is public communication to change any misperceptions that an operation conducted by a resident is “less safe” than by an attending surgeon.
Additionally, resident competency in surgical technique is vital. A study at Emory University found that “most trainees can complete the technical aspects of the majority of operations by midway through their training,” according to Dr. Delman.
Faculty also need a mechanism to communicate the resident’s role, as well as data to support the safety of resident autonomy, and an understanding of the challenges of training.
Finally, residents must become empowered learners and accept the profound, but necessary, responsibility that comes with being an autonomous surgeon.