Intern Perceptions and Participation in the Operating Room

Abstract

Objective: ACGME work hour restrictions and decreasing resident case volumes have led to concern regarding competence of surgical residency graduates. Early operative experience is an important component of surgical education, providing a foundation for further learning. Intern year represents an opportunity for increased exposure. We sought to examine factors impacting intern perceptions and participation in the operating room.

Methods: This cross-sectional retrospective study evaluated the experience of interns from June 2019 through June 2020. Data was collected from nursing operative case logs, self-reported ACGME intern case logs, and an intern survey from the 2019 to 2020 academic year for 3 surgical services at a large academic institution. The primary endpoint was intern presence in operative cases and perceived experience.

Setting: University of California, Davis Medical Center, a large academic training institution and tertiary referral center located in Sacramento, California.

Participants: A total of 31 interns comprised the 2019 to 2020 training cohort, including preliminary, categorical general surgery, and integrated subspecialty residents classified as intern by the institution, regardless of postgraduate training year.

Results: Interns were present in 945 (46%) of 2054 operative cases. Multivariable analysis indicated the presence of an APP (OR 1.68, 95% C.I. 1.34-2.10, p = 0.00) and a female attending (OR 1.30, 95% C.I. 1.07-1.58, p = 0.01) increased the likelihood of intern participation, while presence of an upper level resident decreased the likelihood (OR 0.35, 95% C.I. 0.22-0.57, p = 0.00). Interns participated in more cases later in the year compared to earlier (43% vs 59%, Z = 4.72, p = < 0.001). Surveys demonstrated participation was associated with encouragement by faculty and senior residents and a positive learning environment. Competing floor and clinic responsibilities negatively impacted participation (p < 0.001).

Conclusions: Intern operative experience can be robust in the setting of ACGME work hour guidelines. Identified factors represent possible areas for improvement in service organization.

Keywords: Intern education; Intern perceptions; Surgical education.