title: Effect of Ongoing Assessment of Resident Operative Autonomy on the Operating Room Environment.
abstract: We have previously demonstrated the feasibility and validity of a smartphone-based system called Procedural Autonomy and Supervision System (PASS), which uses the Zwisch autonomy scale to facilitate assessment of the operative performances of surgical residents and promote progressive autonomy. To determine whether the use of PASS in a general surgery residency program is associated with any negative consequences, we tested the null hypothesis that PASS implementation at our institution would not negatively affect resident or faculty satisfaction in the operating room (OR) nor increase mean OR times for cases performed together by residents and faculty.
  
  
  
  Mean OR times were obtained from the electronic medical record at Northwestern Memorial Hospital for the 20 procedures most commonly performed by faculty members with residents before and after PASS implementation. OR times were compared via two-sample t-test. The OR Educational Environment Measure tool was used to assess OR satisfaction with all clinically active general surgery residents (n = 31) and full-time general surgery faculty members (n = 27) before and after PASS implementation. Results were compared using the Mann-Whitney rank sum test.
  
  
  
  A significant prolongation in mean OR time between control and study period was found for only 1 of the 20 operative procedures performed at least 20 times by participating faculty members with residents. Based on the overall survey score, no significant differences were found between resident and faculty responses to the OR Educational Environment Measure survey before and after PASS implementation. When individual survey items were compared, while no differences were found with resident responses, differences were noted with faculty responses for 7 of the 35 items addressed although after Bonferroni correction none of these differences remained significant.
  
  
  
  Our data suggest that PASS does not increase mean OR times for the most commonly performed procedures. Resident OR satisfaction did not significantly change during PASS implementation, whereas some changes in faculty satisfaction were noted suggesting that PASS implementation may have had some negative effect with them. Although the effect on faculty satisfaction clearly requires further investigation, our findings support that use of an autonomy-based OR performance assessment system such as PASS does not appear to have a major negative influence on OR times nor OR satisfaction.
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois. Electronic address: jfryer@nmh.org.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Fryer
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Ezra N
authors.initials: EN
authors.lastname: Teitelbaum
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Brian C
authors.initials: BC
authors.lastname: George
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Schuller
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Meyerson
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Theodorou
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Amy
authors.initials: A
authors.lastname: Yang
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lihui
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Debra A
authors.initials: DA
authors.lastname: DaRosa
mesh_terms: D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D017009:Professional Autonomy; D014481:United States
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; autonomy; evaluation; graduate medical education; surgery