Variation in Competence of Graduating General Surgery Trainees

• Published in: Journal of surgical education 2024-01, Vol.81 (1), p.17-24
• Main Authors: Thelen, Angela E., Marcotte, Kayla M., Diaz, Sarah, Gates, Rebecca, Chen, Xilin, George, Brian C., Krumm, Andrew E.
• Format: Article
• Language: English
• Subjects: Bayes Theorem; Clinical Competence; competency; Education, Medical, Graduate - methods; General Surgery - education; Hernia, Inguinal - surgery; Hernia, Ventral - surgery; Humans; Internship and Residency; operative assessment; patient care; performance variation; resident education; surgical resident; workplace-based assessment
• ISSN: 1931-7204; 1878-7452; 1878-7452
• DOI: 10.1016/j.jsurg.2023.11.005

•Wide variation exists in the competency of graduating general surgery residents.•Almost all residents competent to perform appendectomy by graduation.•Many residents not ready to independently perform hernia repair or colectomy.•Incremental improvements could be implemented to decrease this variation. To examine the readiness of general surgery residents in their final year of training to perform 5 common surgical procedures based on their documented performance during training. Intraoperative performance ratings were analyzed using a Bayesian mixed effects approach, adjusting for rater, trainee, procedure, case complexity, and postgraduate year (PGY) as random effects as well as month in academic year and cumulative, procedure-specific performance per trainee as fixed effects. This model was then used to estimate each PGY 5 trainee's final probability of being able to independently perform each procedure. The actual, documented competency rates for individual trainees were then identified across each of the 5 most common general surgery procedures: appendectomy, cholecystectomy, ventral hernia repair, groin hernia repair, and partial colectomy. This study was conducted using data from members of the SIMPL collaborative. A total of 17,248 evaluations of 927 PGY5 general surgery residents were analyzed from 2015 to 2021. The percentage of residents who requested a SIMPL rating during their PGY5 year and achieved a ≥90% probability of being rated as independent, or "Practice-Ready," was 97.4% for appendectomy, 82.4% for cholecystectomy, 43.5% for ventral hernia repair, 24% for groin hernia repair, and 5.3% for partial colectomy. There is substantial variation in the demonstrated competency of general surgery residents to perform several common surgical procedures at the end of their training. This variation in readiness calls for careful study of how surgical residents can become more adequately prepared to enter independent practice.