title: Graduating general surgery resident operative confidence: perspective from a national survey.
abstract: BACKGROUND
  General surgical training has changed significantly over the last decade with work hour restrictions, increasing subspecialization, the expanding use of minimally invasive techniques, and nonoperative management for solid organ trauma. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing open surgical operations and to determine factors associated with increased confidence.
  
  
  METHODS
  A survey was developed and sent to general surgery residents nationally. We queried them regarding demographics and program characteristics, asked them to rate their confidence (rated 1-5 on a Likert scale) in performing open surgical procedures and compared those who indicated confidence with those who did not.
  
  
  RESULTS
  We received 653 responses from the fifth year (postgraduate year 5) surgical residents: 69% male, 68% from university programs, and 51% from programs affiliated with a Veterans Affairs hospital; 22% from small programs, 34% from medium programs, and 44% from large programs. Anticipated postresidency operative confidence was 72%. More than 25% of residents reported a lack of confidence in performing eight of the 13 operations they were queried about. Training at a university program, a large program, dedicated research years, future fellowship plans, and training at a program that performed a large percentage of operations laparoscopically was associated with decreased confidence in performing a number of open surgical procedures. Increased surgical volume was associated with increased operative confidence. Confidence in performing open surgery also varied regionally.
  
  
  CONCLUSIONS
  Graduating surgical residents indicated a significant lack of confidence in performing a variety of open surgical procedures. This decreased confidence was associated with age, operative volume as well as type, and location of training program. Analyzing and addressing this confidence deficit merits further study.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: annabelle.fonseca@yale.edu.
authors.forename: Annabelle L
authors.initials: AL
authors.lastname: Fonseca
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Vikram
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Longo
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gusberg
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data; D003219:Confidentiality / Q000523:psychology; D003625:Data Collection / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D013502:General Surgery / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male
keywords: Open surgery; Operative confidence; Surgical resident confidence; Surgical resident training