Obstetrics and Gynecology Attendings' Comfort Level in Allowing Residents to Operate.

Abstract

Study Objective To assess attendings’ comfort level in allowing residents to operate. Design Cross-sectional study. Setting Gynecology conferences from November 2018 to April 2019 and hospitals where authors had access to. Patients or Participants 91 attendings. Interventions Paper survey. Measurements and Main Results Attendings' self- comfort level in performing various gynecologic procedures and their comfort in allowing different level of residents’ participation was surveyed using a Likert-scale ranging from -3 (not at all comfortable) to 3 (extremely comfortable). Means and standard deviation (SD) were calculated and Kruskal-Wallis test was applied when appropriate. Survey response rate was 91%. Mean participant age was 47, and 60% were female. Mean years in practice was 14, respondents averaged 13.1 non-obstetrical surgeries per month, and 77.8% practiced in a teaching institution. 58.2% were generalists and the rest were subspecialty trained (27.5% FMIGS, 8.8% Gynecology Oncology, 3.3% UroGynecology, and 2.2% MFM). Attendings were least comfortable performing vaginal hysterectomies (mean=1.8, SD=1.7), followed by laparoscopic hysterectomy (mean=2.3, SD=1.2), and most comfortable with D&C hysteroscopy (mean=2.9, SD=0.2) and laparoscopic treatment of ectopic pregnancy (mean=2.9, SD=0.2). Both, attending's self-comfort level and attending's comfort level in allowing PGY4s to perform abdominal hysterectomy were higher than that of vaginal hysterectomy (p None of the participants reported that resident's gender would influence their decision to allow residents to operate. 71.4% reported that having a prior complication or law suit does not affect their decision. Participants stated that familiarity with resident's skill (96.5%), resident's surgical experience (94.1%), resident's request to do more (79.8%), resident's ownership of patient (76.2%) and time constraints (71.8%) would influence their decision. Conclusion Attendings were least comfortable to perform vaginal hysterectomy or allow residents participation, despite it being the recommended approach, when feasible.