Comparative Study Regarding Autonomy of Final-Year Surgical Residents: A Case Study of Perception among Surgical Residents, Surgical Staff, Administrators, and Patients at Siriraj University Hospital

Abstract

Objective: To identify barriers towards resident autonomy as perceived through four groups; surgical residents, surgical staff, administrators, and patients.Materials and Methods: Anonymous surveys were distributed to these four groups. Data were thematically analyzed.Results: 401 responses were collected including 231 patients. The response rate of residents, surgical staff, and administrators was 62.2% (119), 44.8% (26), and 43.1% (25) respectively. Patients had more favorable views of resident participation than administrators and surgical staff. Administrators and surgical staff indicated that residents have a positive effect on overall quality of care provided and so do the patients, however, administrators and surgical staff believed that too much autonomy for a resident deceased patient safety. When resident autonomy increased, increased cost of patient care was considered. Residents and patients have the same opinion that patients should receive a discount on medical expenses, which is opposite to administrators’ and surgical staff’s opinion.The presence of surgical staff in the operation room had a major impact on resident autonomy and a big influence on patient acceptance of operative complications. Even in complicated operations, most patients felt comfortable having a resident perform on with surgical staff controlling the operation. Surgical staff provided too much direction in either patient care or operation and did not take residents’ input as seriously as expected and seldom explained the reasons before changing treatment regimens.Conclusion: Surgical residents, surgical staff, and patients had discordant perceptions of resident autonomy in many aspects. Self-determination theory should be applied. Scaffolding strategy, mentoring program would be the solutions.