Balancing autonomy of thought and action in the context of patient safety: resident perspectives on intraoperative autonomy

Abstract

PurposeThe goal of surgical residency is to produce technically competent surgeons who can safely operate autonomously. This study aimed to explore residents’ perception of intraoperative autonomy across post-graduate years (PGY).MethodsGeneral surgery residents at a single academic institution were invited to participate in focus groups divided by PGY to explore their opinions on operative autonomy. Focus groups were audio recorded, transcribed, and analyzed using constant comparative technique. Thematic analysis was performed using an inductive approach.ResultsThirty-nine residents participated in five focus groups. Five themes emerged from the data. Residents distinguished between autonomy of thought representing graduated decision-making and autonomy of action representing technical maneuvers in the operating room. Residents vocalized a respect for the balance of autonomy and patient safety and stated a desire to have clear expectations to minimize the impact of external factors on autonomy.ConclusionsResidents differentiated autonomy as a parallel of autonomy of thought and autonomy of action and were empathetic to the responsibility of faculty to balance patient safety and autonomy. Surgical educators can improve resident autonomy by clearly managing expectations and minimizing external factors negatively affecting intraoperative autonomy.