Resident and Attending Perceptions of Resident Involvement: An Analysis of ACGME Reporting Guidelines.
OBJECTIVE
For general surgery residents (Residents) to log an operation, the ACGME requires "significant involvement" in diagnosis (DX), operation selection (SEL), operation (OPR), preoperative (PRE), and postoperative (POC) care. We compared how residents and attending surgeons (Attendings) perceived residents' role in each of these core requirements.


METHODS
Residents and attendings completed surveys postoperatively regarding responsibility for each core requirement on a 5-point Likert scale from "Completely Attending" to "Completely Resident." Significance was determined using Chi-square analysis (p < 0.05) and degree of agreement was calculated using Spearman's rank correlation (rs).


METHODS
Boston Medical Center, Boston, MA (tertiary institution).


RESULTS
A total of 302 paired surveys were analyzed. Residents more often performed a significant portion of the later stages of care (DX = 27%, PRE = 29%, SEL = 27%, OPR = 87%, and POC = 84%). Residents completed the majority of each requirement more frequently in operations performed in the acute setting compared to elective operations: DX (70% vs 8%, p < 0.01), PRE (74% vs 10%, p < 0.01), SEL (65% vs 11%, p < 0.01), OPR (100% vs 89%, p = 0.02), POC (100% vs 77%, p < 0.01). Resident participation was inversely related to operational complexity for DX (p < 0.01), PRE (p < 0.01), SEL (p < 0.01), and OPR (p = 0.01). Resident involvement in OPR increased at the end of the academic year (p = 0.05) and when working with junior attendings (<5 years in practice) (p = 0.01). Interpair agreement was greatest for DX (rs= 0.70) and lowest for POC (rs= 0.35). When residents and attendings did not agree in their answers, residents generally overstated their contribution to the DX (68%), PRE (58%), and SEL (64%) but understated their contribution in OPR (63%) and POC (62%).


CONCLUSIONS
Residents and attendings demonstrated reliable agreement for most core requirements, but residents were often unable to be involved in all 5 core requirements. Resident involvement was weighted toward later stages of patient care, yet residents often underestimated their contributions. Operational acuity, complexity, and attending experience correlated with resident operative involvement.
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
Ryan
R
Morgan
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
Douglas F
DF
Kauffman
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
Gerard
G
Doherty
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts. Electronic address: teviah.sachs@bmc.org.
Teviah
T
Sachs
D000328:Adult; D001900:Boston; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000639:trends; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards* / Q000639:trends; D010465:Perception; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D000071836:Professional Practice Gaps; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
ACGME; Interpersonal and Communication Skills; Patient Care; Practice-Based Learning and Improvement; attending agreement; case log; resident education; resident perception; surgical training