Massachusetts Chapter of the American College of Surgeons

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Building Entrustability to Facilitate General Surgery Teaching Assistant Cases
Erin J. Kim, BA1, Alaina D. Geary, MD MHPE1,2, Hannah Buettner, MD3, Luise I. M. Pernar, MD, MHPE, FAC1,2
1Boston University School of Medicine; Boston, MA; 2Boston University Medical Center, Department of Surgery; Boston, MA; 3University of Massachusetts Medical Center, Department of Surgery; Worcester, MA

Background: Teaching assistant (TA) cases can be considered as the final level of supervised autonomy in general surgery training. However, the number and breadth of general surgery TA cases have been decreasing. As attending surgeons are the primary gatekeepers for case permissibility, this study explored what resident behavior can improve TA case participation.
Methods: Eleven general surgery attendings, from eight hospitals across the US, participated in semi-structured interviews about their experiences with TA cases. One interview was excluded due to faulty recording. Participants were selected by purposive and snowball sampling. Audio recordings were transcribed and qualitative codes were inductively derived. Iterative coding was applied until saturation and the resulting coded material was analyzed for themes.
Results: Attending experience ranged from 5 to 22 years in practice. Factors that influenced the permissibility of TA cases consolidated around 5 themes: logistical pressures from clinical administration, characteristics of the surgical case, resident factors, the attending-resident relationship, and the surgeon-patient relationship. The most prevalent theme across interviews was the importance of established attending-resident relationships. Attendings emphasized the necessity of longitudinal relationships to evaluate a residentís technical and decision-making capabilities, and incorporation of feedback. Factors that limited the TA experience from the attending perspective included lack of resident availability, lack of specific case experience, lack of perceived interest, and the difficulty of integrating residents into preexisting surgeon-patient relationships especially for elective procedures.
Conclusion: To maximize TA case participation, longitudinal attending-resident relationship must be prioritized in order to build entrustability.


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