Resident Self-Entrustment and Expectations of Autonomy: OB > GYN?

Abstract

PURPOSE: The goal of this study was to identify the definition and expectations of autonomy from residents’ perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures. BACKGROUND: Entrustment in the operating room (OR) is a two-way street. Resident self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons determined and entrusted OB/GYN residents in the OR. There is little to no data, however, in examining these issues from the resident perspective. METHODS: We conducted three focus group interviews with 20 OB/GYN residents across four post-graduate year (PGY) levels. Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method. RESULTS: A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and twelve senior residents (PGY3-4) participated. Our data illustrated that 1) the definition of autonomy shifted significantly throughout residency training; 2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; 3) case volume, modalities of OR teaching (e.g., teaching style, attending experience, rotation site) and mutual communication are three factors influencing resident self-entrustment of their surgical competencies. DISCUSSION: Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the three influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.