Resident and Fellow Performance and Supervision in Surgical Oncology Procedures

Abstract

Background: Previous research has highlighted concerns among trainees and attendings that general surgery training and fellowship are inadequately preparing trainees for practice. Providing trainees with supervision that matches their proficiency may help bridge this gap. We sought to benchmark operative performance and supervision levels among senior surgery residents (PGY-4 or -5) and fellows performing general surgical oncology procedures.

Study design: Observational data were obtained from the Society for Improving Medical Procedural Learning OR application for core general surgical oncology procedures performed at 103 unique residency and fellowship programs. Procedures were divided into breast and soft tissue, endocrine, and hepatopancreatobiliary. Case evaluations completed by trainees and attendings were analyzed to benchmark trainee operative performance and level of supervision.

Results: There were 4,907 resident cases and 425 fellow cases. Practice-ready performance, as assessed by trainees and faculty, was achieved by relatively low proportions of residents and fellows for breast and soft tissue cases (residents: 38%, fellows: 48%), endocrine cases (residents: 22%, fellows: 41%), and hepatopancreatobiliary cases (residents: 10%, fellows: 40%). Among cases in which trainees did achieve practice-ready performance, supervision only was provided for low proportions of cases as rated by trainees (residents: 17%, fellows: 18%) and attendings (residents: 21%, fellows 25%).

Conclusions: In a sample of 103 residency and fellowship programs, attending surgeons rarely provided senior residents and fellows with levels of supervision commensurate to performance for surgical oncology procedures, even for high-performing trainees. These findings suggest a critical need for surgical training programs to prioritize providing greater levels of independence to trainees that have demonstrated excellent performance.

Figure 1.

Association between case type and achievement of practice-ready performance. Asterisks indicate significantly different proportions, as measured by Fisher’s exact test. HPB, hepatopancreatobiliary. *Indicates significance.

Figure 2.

(A) Association between trainee performance and supervision. (B) Association between case complexity and supervision. Asterisks indicate significantly different distributions, as measured by the Kruskal-Wallis test. Distributions are represented as violin plots that illustrate the kernel density of ratings in shapes that contain box and whisker plots in which the white dot is the median value, the box is the interquartile range, and the whiskers are the upper (75th percentile + [1.5 × 75th percentile]) and lower (25th percentile – [1.5 × 25th percentile]) extremes.

Figure 3.

Supervision provided to trainees achieving practice-ready performance by case type. Plots illustrate kernel density estimates of underlying distributions. Long-dash lines represent median values. Short-dash lines represent 25th and 75th percentiles. HPB, hepatopancreatobiliary.