OMS Chief Resident Experience as a Predictor of Future Scope of Practice and Confidence

Abstract

Residency training requires gradual transfer of entrustable professional activities (EPAs) to residents over time to ensure professional development and competence in a given discipline. To date, surgical literature has addressed neither measurements of resident autonomy and level of responsibility nor the effects these factors may have on resident confidence and future practice plans. Our preliminary study sought to: 1) characterize perceived autonomy in different types of surgeries during the final year of training, 2) characterize actual resident experience in the same areas, and 3) correlate these with resident confidence to meet the standard of care and anticipated scope of practice following completion of training. An online survey was made available to residents in their final year of OMS training in all US programs. The survey addressed resident case exposure and level of participation in care in several domains within OMS: mandibular trauma, midface trauma, TMJ surgery, orthognathics, pathology, reconstruction, craniofacial, cosmetics, implants, and other dentoalveolar surgery. The questionnaire also measured the perceived ability to meet the standard of care and anticipated frequency of practice in each of these domains. Some basic respondent demographics were also recorded. Data collection was from May 2010 to September 2010. Statistical analysis was performed using JMP 8.0 software. Differences were assessed using one-way ANOVA and Student t test as well as Pearson correlations. Trends were identified using Mantel-Haenszel test and an ROC curve was utilized to identify values at which frequencies changed. Statistical significance was defined at P values or rho values less than 0.05. A total of 84 surveys (45%) were completed. Mean age was 33 years. Respondents were 89% male. 13% of respondents had plans for fellowship training and 58% planned to practice in an area population of over 500,000. Over the course of residency, practice plans narrowed in 23%, broadened in 29%, and remained the same in 49%. Increases in autonomy from junior to senior level were noted in all domains. As primary surgeon, mean cases during chief year were 24.6 (midface trauma), 40.7 (mandibular trauma), 9.9 (TMJ), 32 (orthognathic), 11.3 (cosmetics), 33.5 (pathology), 23.7 (reconstruction), 4.5 (craniofacial), 61.4 (implants), and 174.7 (dentoalveolar). Confidence to meet the standard of care among the respondents in each of the domains was: 89% (midface trauma), 100% (mandibular trauma), 45% (TMJ), 80% (orthognathic), 29% (cosmetics), 78% (pathology), 73% (reconstruction), 30% (craniofacial), 94% (implants), and 100% (dentoalveolar). The number of cases as primary surgeon to determine the frequency of future practice in a particular domain was found to be: 12 (midface trauma), 10 (TMJ), 11 (cosmetics), 35 (pathology), 13 (reconstruction), and 8 (craniofacial). In general, resident autonomy showed a statistical correlation with the confidence to meet the standard of care. In addition, the number of cases as primary surgeon during the chief year was associated with the anticipated frequency of practice in a given domain. Consistent measures of autonomy are involvement in treatment planning, involvement in performing the case, and overall sense or autonomy and not the presence or absence of the attending faculty during the procedure. These preliminary findings could help guide residency programs in the training of competent residents in the future. Plans are in place to repeat this survey for consecutive years with a broader, more expansive inquiry in order to quantify year-to-year variations in experience and attitudes.