title: Resident Surgeons Underrate Their Laparoscopic Skills and Comfort Level When Compared With the Rating by Attending Surgeons.
abstract: OBJECTIVE
  The development of operative skills during general surgery residency depends largely on the resident surgeons' (residents) ability to accurately self-assess and identify areas for improvement. We compared evaluations of laparoscopic skills and comfort level of residents from both the residents' and attending surgeons' (attendings') perspectives.
  
  
  METHODS
  We prospectively observed 111 elective cholecystectomies at the University of Michigan as part of a larger quality improvement initiative. Immediately after the operation, both residents and attendings completed a survey in which they rated the residents' operative proficiency, comfort level, and the difficulty of the case using a previously validated instrument. Residents' and attendings' evaluations of residents' performance were compared using 2-sided t tests.
  
  
  METHODS
  The University of Michigan Health System in Ann Arbor, MI. Large academic, tertiary care institution.
  
  
  METHODS
  All general surgery residents and faculty at the University of Michigan performing laparoscopic cholecystectomy between June 1 and August 31, 2013. Data were collected for 28 of the institution's 54 trainees.
  
  
  RESULTS
  Attendings rated residents higher than what residents rated themselves on a 5-point Likert-type scale regarding depth perception (3.86 vs. 3.38, p < 0.005), bimanual dexterity (3.75 vs. 3.36, p = 0.005), efficiency (3.58 vs. 3.18, p < 0.005), tissue handling (3.69 vs. 3.23, p < 0.005), and comfort while performing a case (3.86 vs. 3.38, p < 0.005). Attendings and residents were in agreement on the level of autonomy displayed by the resident during the case (3.31 vs. 3.34, p = 0.85), the level of difficulty of the case (2.98 vs. 2.85, p = 0.443), and the degree of teaching done by the attending during the case (3.61 vs. 3.54, p = 0.701).
  
  
  CONCLUSIONS
  A gap exists between residents' and attendings' perception of residents' laparoscopic skills and comfort level in performing laparoscopic cholecystectomy. These findings call for improved communication between residents and attendings to ensure that graduates are adequately prepared to operate independently. In the context of changing methods of resident evaluations that call for explicitly defined competencies in surgery, it is essential that residents are able to accurately self-assess and be in general agreement with attendings on their level of laparoscopic skills and comfort level while performing a case.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Alameddine
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Jake
authors.initials: J
authors.lastname: Claflin
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: cscally@med.umich.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Scally
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: David M
authors.initials: DM
authors.lastname: Noble
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Reames
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
mesh_terms: D001291:Attitude of Health Personnel; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008505:Medical Staff, Hospital; D011446:Prospective Studies; D012647:Self-Assessment
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; clinical competence; education; general surgery/education; graduate/standards; internship/residency; medical