Participation of surgical residents in operations: challenging a common classification.
BACKGROUND
One important form of surgical training for residents is their participation in actual operations, for instance as an assistant or supervised surgeon. The aim of this study was to explore what participation in operations entails and how it might be described and analyzed.


METHODS
A qualitative study was undertaken in a major teaching hospital in London. A total of 122 general surgical operations were observed. A subsample of 14 laparoscopic cholecystectomies involving one or more residents was analyzed in detail. Audio and video recordings of eight operations were transcribed and analyzed linguistically.


RESULTS
The degree of participation of trainees frequently shifted as the operation progressed to the next stage. Participation also varied within each stage. When trainees operated under supervision, the supervisors constantly adjusted their degree of control over the resident's operative maneuvers.


CONCLUSIONS
Classifications such as "assistant" and "supervised surgeon" describing a trainee's overall participation in an operation potentially misrepresent the varying involvement of resident and supervisor. Video recordings provide a useful alternative for documenting and analyzing actual participation in operations.
Division of Surgery, Imperial College London, 2nd Floor Paterson Wing, South Wharf Road, London, W2 1BL, UK. j.bezemer@imperial.ac.uk
Jeff
J
Bezemer
Alexandra
A
Cope
Omar
O
Faiz
Roger
R
Kneebone
D017081:Cholecystectomy, Laparoscopic / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D013502:General Surgery / Q000145:classification* / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency; D013637:Tape Recording; D014741:Video Recording