title: Do residents receive the same OR guidance as surgeons report? Difference between residents' and surgeons' perceptions of OR guidance.
abstract: OBJECTIVE
  Operating room (OR) guidance is important for surgical residents' performance and, ultimately, for the development of independence and autonomy. This study explores the differences in surgical residents' and attending surgeons' perceptions of OR guidance in prerecorded surgical cases.
  
  
  METHODS
  A total of 9 attending surgeons and 8 surgical residents observed 8 prerecorded surgical cases and were asked to identify both the presence and the type of attending surgeons' OR guidance. Each recorded case was observed by 2 attending surgeons and 1 resident. A previously developed taxonomy for types of OR guidance was applied to analyze the data to explore the difference. Agreement by both attending surgeons on the presence and the type of OR guidance served as the concordant guidance behaviors to which the responses of the residents were compared.
  
  
  RESULTS
  Overall, 116 OR guidance events were identified. Attending surgeons agreed on the presence of guidance in 80 of 116 (69.8%) events and consistently identified the type of OR guidance in 91.4% (73/80, Cohen κ = 0.874) of them. However, surgical residents only agreed with attending surgeons on the presence of guidance in 61.25% (49/80) of the events. In addition, there was significant disagreement (Cohen κ = 0.319) between surgical residents and attending surgeons in the type of OR guidance; the residents only identified 54.8% (40/73) of concordant guidance behaviors in the same guidance category as both the surgeons. Among the types of OR guidance, residents and attending surgeons were most likely to agree on the teaching guidance (66.67%) and least likely to agree on the assisting guidance (36.84%).
  
  
  CONCLUSIONS
  Surgical residents and attending surgeons have different perceptions of both the presence and the type of OR guidance. This difference in perception of OR guidance has important implications for the efficiency of training surgical residents in the OR, and, ultimately on residents' development of independence and autonomy.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: xpchen@partners.org.
authors.forename: Xiaodong Phoenix
authors.initials: XP
authors.lastname: Chen
authors.affiliation: Department of Surgery, School of Medicine, Indiana University, Indianapolis, Indiana.
authors.forename: Reed G
authors.initials: RG
authors.lastname: Williams
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Smink
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D017009:Professional Autonomy; D013663:Teaching
keywords: Interpersonal and Communication Skills; OR teaching; Patient Care; Practice-Based Learning and Improvement; operating room (OR) guidance; resident autonomy; surgical education