title: Perioperative self-reflection among surgical residents.
abstract: BACKGROUND
  We studied prevalence and predictors of meaningful self-reflection among surgical residents and with prompting/structured interventions, sought to improve/sustain resident skills.
  
  
  METHODS
  Residents from six programs recorded 1032 narrative self-reflective comments (120 residents), using a web-based platform. If residents identified something learned or to be improved, self-reflection was deemed meaningful. Independent variables PGY level, resident/surgeon gender, study site/Phase1: July2014-August2015 vs. Phase2: September2015-September2016) were analyzed.
  
  
  RESULTS
  Meaningful self-reflection was documented in 40.6% (419/1032) of entries. PGY5's meaningfully self-reflected less than PGY1-4's, 26.1% vs. 49.6% (p = 0.002). In multivariate analysis, resident narratives during Phase 2 were 4.7 times more likely to engage in meaningful self-reflection compared to Phase1 entries (p < 0.001). Iterative changes during Phase2 showed a 236% increase in meaningful self-reflection, compared to Phase1.
  
  
  CONCLUSIONS
  Surgical residents uncommonly practice meaningful self-reflection, even when prompted, and PGY5/chief residents reflect less than more junior residents. Substantial/sustained improvements in resident self-reflection can occur with both training and interventions.
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: Andi.Peshkepija@hc.msu.edu.
authors.forename: Andi N
authors.initials: AN
authors.lastname: Peshkepija
authors.affiliation: University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, USA. Electronic address: marc.basson@med.und.edu.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Basson
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA; Grand Rapids Medical Education Partners Research Department, Grand Rapids, MI, USA. Electronic address: davisa@msu.edu.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: Muhammad.Ali@hc.msu.edu.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: Pam.Haan@ht.msu.edu.
authors.forename: Pam S
authors.initials: PS
authors.lastname: Haan
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: Guptaram@msu.edu.
authors.forename: Rama N
authors.initials: RN
authors.lastname: Gupta
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: John.Hardaway@hc.msu.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Hardaway
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: Cody.Nebeker@hc.msu.edu.
authors.forename: Cody A
authors.initials: CA
authors.lastname: Nebeker
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: Michael.mcLeod@hc.msu.edu.
authors.forename: Michael K
authors.initials: MK
authors.lastname: McLeod
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Osmer
authors.affiliation: Michigan State University College of Human Medicine, Department of Surgery, Lansing, MI, USA. Electronic address: Cheryl.anderson@ht.msu.edu.
authors.forename: Cheryl I
authors.initials: CI
authors.lastname: Anderson
mesh_terms: D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D059035:Perioperative Period; D058996:Quality Improvement; D012647:Self-Assessment; D013043:Specialties, Surgical / Q000193:education*
keywords: Debriefings; Gender; Residents; Self-reflection; Surgeons