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Trainee Operative Autonomy in Plastic Surgery
Christina R Vargas, MD
Tobias C Long, MD
Anand R Kumar, MD
University Hospitals Cleveland Medical Center / Case Western Reserve University
2018-12-12
Presenter: Christina Vargas, MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. This project represents entirely the original work of the resident submitter under the mentorship of Drs. Long and Kumar.
Director Name: Anand Kumar, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose
Appropriate, progressive trainee autonomy is critical for training competent plastic surgeons who are adequately prepared to enter independent practice. The degree of meaningful operative autonomy trainees currently achieve in plastic surgery is unknown. This study aims to investigate the current state of trainee operative autonomy in plastic surgery and to explore associated implications for achieving and assessing preparedness to enter practice.
Methods
Parallel survey instruments were developed using the Zwisch metric for progressive operative autonomy and distributed to trainees and faculty in accredited training programs. Participants were queried about trainee operative autonomy in 17 core plastic surgery procedures.
Results
Trainees in 28 programs and faculty in 35 programs participated. Final-year trainees reported the most operative independence with breast tissue expander reconstruction and carpal tunnel release, and the least with facelift and rhinoplasty. A mean 40% of final-year trainees reached "supervision only" autonomy in the procedures queried; none achieved this in rhinoplasty (Figure 1). Faculty identified the most final-year trainee autonomy with botulinum toxin injection, and the least with rhinoplasty, cleft lip repair, and facelift (Figure 2). Faculty perception of final-year trainee autonomy was higher than that of trainees for 82% of procedures.
Conclusions
While plastic surgery trainees endorse gradual operative autonomy overall, a majority of final-year trainees do not report "supervision only" independence in the majority of core procedures queried. Faculty perceive higher trainee autonomy than trainees for most procedures. This study identifies opportunities for improvement in the assessment and progression of operative autonomy during plastic surgery training.
