Operational Autonomy Research Articles

Declining Surgical Resident Operative Autonomy—All Trainees Are Not Created Equal

IntroductionWe have previously shown that resident autonomy has decreased over time overall for all surgery residents. The purpose of this study is to examine changes in operative autonomy in general surgery residency within each postgraduate year (PGY) level. Materials and methodsThis is a retrospective analysis of the Veterans Association Surgical Quality Improvement Program database from July 1, 2004 to September 30, 2019. All general surgery, vascular surgery, and thoracic surgery procedures were analyzed and categorized by level of resident supervision as attending primary, attending operating with resident, or resident primary without attending scrubbed. Procedure work portion of relative value unit was used to capture procedure complexity. Changes in resident autonomy over time, procedure complexity, and outcomes were compared among PGY levels 1 to 5. ResultsA total of 385,482 cases were analyzed. At each PGY level from 2014 to 2018, the relative decrease in resident primary cases ranged from −37.3% (PGY 4) to −75.5% (PGY 3). Mean work portion of relative value unit saw steady increase with PGY level (8.4 ± 3.5 in PGY 1 to 10.8 ± 5.7 in PGY 5, P < 0.001) and did not show a trend over time. ConclusionsSurgical resident operative autonomy has markedly decreased over time across all PGY levels. This effect is most profound at the PGY 3 level, while more senior residents are affected to a lesser degree. Case complexity show PGY level-appropriate increase in resident autonomous cases. Decrease in resident autonomy over time is not associated with changes in case complexity.

Value of Critical Thinking in the Labour Market: Variations in Employers’ and Employees’ Views

The fragmentation and narrowness of research on critical thinking in the labour market and the lack of critical thinking analysis in the context of the interplay between lifelong learning, education and the labour market presuppose the relevance of this article. The article analyses the views of employers and employees, highlighting their attitude toward the importance and manifestation of critical thinking in the labour market and the need for improving critical thinking competency. The article aims to answer the following problematic questions: (1) How important are critical thinking skills and dispositions in the labour market? (2) How do employers’ and employees’ opinions vary regarding critical thinking in professional activities? (3) What need is there to improve critical thinking skills and dispositions? Quantitative research methodology was chosen for data collection using a questionnaire. It was found that both employers and employees consider inference and argumentation to be the most important critical thinking skills in the modern labour market; however, their attitude toward self-regulation, which is highly regarded by employees, but not by employers, is fundamentally different. Both employers and employees understand the importance of dispositions and value them similarly. Both groups have the least regard for having scepticism. The assessment of critical thinking skills and dispositions in specific professional activities differs from the assessment in the labour market in general. In professional activities, substantiated decisions, flexibility and unbiased decisions are especially valued by both groups, and the skills listed as being in most need of improvement are the same ones that were given as being important. The attitudes of both groups were distinguished by assigning value to dispositions that need improvement. Employees are more likely than employers to work on dispositions that denote operational autonomy. The study also revealed correlations between various groups of critical thinking skills and dispositions, demonstrating both employers’ and employees’ deliberate choice in assessing one or other constituent of critical thinking competence and the perception of their interrelationships.

Post-‘Lee-Luda’ personal information protection in Korea: developer responsibility and autonomous AI governance

In South Korea, artificial intelligence (AI)-related personal information protection has long been an issue, and the Lee-Luda (also referred to as ‘Iruda’) incident drove the development of specific policies and guidelines. The Lee-Luda case is fairly important for AI governance in Korea, since the Personal Information Protection Commission (PIPC) decision was the first to make a judgment on the Personal Information Protection Act (PIPA) violations as a result of development and operation of AI. Following the Lee-Luda case, Korean society became more aware of the risks posed by privacy infringement in the age of intelligent information technology. Lawmakers began to establish legal frameworks for the protection of personal information while developing AI products and services. This study reviews legal issues and suggests policy directions while highlighting the significance of the Lee-Luda case, which was an epochal turning point in the protection of personal information related to AI products and services in Korea. First, the authors review the PIPC’s decision on Scatter Lab’s violation of the PIPA, analyse the legal issues in the Lee-Luda case, and derive the significance and limitations of the decision. Next, the authors suggest that it is desirable for AI governance to move towards self-regulation in a manner that ensures the autonomy of AI developers and operators; they also review the recent trends in the laws and policies on data protection that have been continually developed since the Lee-Luda case, especially with a focus on the AI Personal Information Protection Self-Checklist (Self-Checklist).

A simulation curriculum for laparoscopic common bile duct exploration, balloon sphincterotomy, and endobiliary stenting: Associations with resident performance and autonomy in the operating room.

Laparoscopic common bile duct exploration is safe and effective for managing choledocholithiasis, but laparoscopic common bile duct exploration is rarely performed, which threatens surgical trainee proficiency. This study tests the hypothesis that prior operative or simulation experience with laparoscopic common bile duct exploration is associated with greater resident operative performance and autonomy without adversely affecting patient outcomes. This longitudinal cohort study included 33 consecutive patients undergoing laparoscopic common bile duct exploration in cases involving postgraduate years 3, 4, and 5 general surgery residents at a single institution during the implementation of a laparoscopic common bile duct exploration simulation curriculum. For each of the 33 cases, resident performance and autonomy were rated by residents and attendings, the resident's prior operative and simulation experience were recorded, and patient outcomes were ascertained from electronic health records for comparison among 3 cohorts: prior operative experience, prior simulation experience, and no prior experience. Operative approach was similar among cohorts. Overall morbidity was 6.1% and similar across cohorts. The operative performance scores were higher in prior experience cohorts according to both residents (3.0 [2.8-3.0] vs 2.0 [2.0-3.0]; P= .01) and attendings (3.0 [3.0-4.0]; P < .001). The autonomy scores were higher in prior experience cohorts according to both residents (2.0 [2.0-3.0] vs 2.0 [2.0-2.0]; P= .005) and attendings (2.5 [2.0-3.0] vs 2.0 [1.0-2.0]; P= .001). Prior simulation and prior operative experience had similar associations with performance and autonomy. Simulation experience with laparoscopic common bile duct exploration was associated with greater resident operative performance and autonomy, with effects that mimic prior operative experience. This illustrates the potential for simulation-based training to improve resident operative performance and autonomy for laparoscopic common bile duct exploration.

415 Gender Differences in Operative Autonomy Using the Surgical Autonomy Program

INTRODUCTION: While efforts to recruit females into surgical fields have increased, gender differences in surgical training exist. METHODS: The SAP divides a surgical case into four parts, or zones of proximal development (ZPD). For each ZPD, residents are evaluated on a 4-tier autonomy scale (TAGS scale). Using logistic regression analysis, we evaluated neurosurgery residents at Duke University Hospital from July 2017-July 2021 to compare differences in male and female trainee autonomy as rated by both attendings and residents. RESULTS: There were a total of 4,441 cases logged by 26 different residents and 30 attendings. 69% of residents were male (n = 18) and 31% (n = 8) were female. An ordinal regression analysis showed that female residents were given less autonomy than males by attendings (OR 0.59, 0.51-0.69 95% CI, p &lt; 0.001). Females were also less likely to focus on a more complex ZPD (OR 0.53, 95% CI 0.46-0.61, p &lt; 0.001). Based on self-evaluation, female residents rated their autonomy lower than males (OR 0.71, 0.61-0.82 95% CI, p &lt; 0.001). Faculty provided greater intraoperative feedback in cases with female residents (84%, n = 539) compared to male residents (79%, n = 1,875) (X2 = 7.52, df = 1, p &lt; 0.01). Female and male residents were fully autonomous on a similar proportion of cases in post-graduate year seven (73% and 72%, respectively). CONCLUSIONS: Female residents were given less autonomy compared to their male counterparts for index neurosurgical cases and were less likely to focus on a more complex portion of a case. Female residents were more self-critical, though received greater significant intraoperative feedback. Nonetheless, females and males were fully autonomous on a similar number of cases in their final residency year. Increased efforts are needed to address the gender gap within surgical education.

Consensus for Flow Cytometry Clinical Report on Multiple Myeloma: A Multicenter Harmonization Process Merging Laboratory Experience and Clinical Needs

Flow cytometry is a highly sensitive and specific approach for discriminating between normal and clonal plasma cells in multiple myeloma. Uniform response criteria after treatment have been established by the International Myeloma Working Group and the EuroFlow Group; however, the way in which flow cytometry data are reported has suffered from no collaborative or multicentre efforts. This study, involving 8 expert laboratories and 12 clinical hematology units of the Lazio region in Italy, aims to produce a uniform and shared report among the various Centres. From the pre-analytical phase to sample processing, data acquisition, analysis, and evaluation of the potential limitations and pitfalls of the entire process, the study reaches a final conclusion shared by laboratories and clinicians according to the most updated principles and recommendations. The aim was to identify the necessary data to be included in the clinical report by using multiple-choice questionnaires at every single stage of the process. An agreement of more than 75% of the laboratories was considered mandatory for the data to be included in the report. By ensuring the operational autonomy of each laboratory, this study provides a clear report that limits subjective interpretations and highlights possible bias in the process, better supporting clinical decision-making.

Early Career Experiences of Cardiothoracic Surgery Graduates by Training Model: A National Survey

BackgroundAs the practice of cardiothoracic surgery continues to evolve, the optimal training model represents an area of uncertainty. We sought to describe and to compare the early career experiences of cardiothoracic surgery graduates from the 3 training models. MethodsAn anonymous survey with questions pertaining to an individual's demographic characteristics, training model, first employment experience, experience as junior faculty, career satisfaction, and personal reflection was sent to graduates from US cardiothoracic surgery training programs between 2012 and 2020. Respondents completed a traditional fellowship (2-3 years), a 4+3 model, or an integrated 6-year (I-6) residency. ResultsOf the 670 graduates who received the survey, there were 267 (40%) respondents. Of these, 209 (78%) respondents graduated from a traditional fellowship, 27 (10%) respondents graduated from a 4+3 pathway, and 31 (12%) respondents graduated from an I-6 residency. There was no difference in overall satisfaction, major case volume, operative autonomy, burnout, and lifestyle satisfaction between the models (P>.05). When respondents were asked about the ideal model, the 4+3 and I-6 models were favored by its graduates, regardless of the surgeons’ field of practice. ConclusionsImportant early career outcomes were not different between graduates of traditional, 4+3, or I-6 models. Most graduates of the 4+3 and I-6 models believe these are the ideal training models, regardless of their field of practice.

Unconscious Work Doesn’t Work

ABSTRACT Why do creative ideas and solutions to unresolved problems benefit from taking a break? The idea of unconscious work as an explanation is so appealing that even after reading this paper, which states clearly that unconscious work is a fantasy based on no clear theory and no clear empirical evidence, some readers will claim that we are saying the opposite. Here, we explain why the imaginary meme of unconscious work is so difficult to eradicate from the scientific literature, including the fact that there is no clearly testable theory of unconscious work. Because the lack of a truly testable theory is one of the things that makes this meme so slippery, we propose a testable theory of unconscious work, the Autonomous Unconscious Thought Operations (AUTO) theory, which states that autonomous unconscious operations continuing over time is an essential feature of unconscious work. We describe some requirements of such a theory, and we propose empirical tests of the AUTO theory. We predict that autonomy of unconscious operations will be empirically falsified. The mechanism of unconscious work is not needed to explain so-called “incubation” effects, because there are several testable (and tested) explanations of what happens as a function of breaks from fixated problems, such as multiple bouts of forgotten conscious work, forgetting fixating responses, mind wandering, or set-shifting.

Operative Autonomy in a Gender-Balanced Cohort of Surgical Trainees.

Gender inequity continues to be a major focus of improvements within surgical education. Female trainees are fewer and experience reduced quality of surgical training. Prior studies have demonstrated that surgical autonomy for female trainees in a range of surgical disciplines is less than that of male trainees. As a unique example among Australasian specialty training boards, the New Zealand Board of Plastic and Reconstructive Surgery has boasted a gender-balanced cohort of surgical trainees since 2013. The authors sought to examine the effect of gender on surgical autonomy in a cohort of trainees where gender balance has been achieved. A retrospective cohort study was undertaken. Anonymized logbook data for New Zealand plastic surgery trainees were analyzed, for the study period, consisting of rotations from December of 2013 to June of 2020. Self-reported levels of trainee supervision were compared against gender. Outcomes were tested using multivariate analysis. Thirty-eight trainees were included in the study (58% female), with a total of 81,178 cases recorded over the 6.5-year study period. No overall statistically significant difference in surgical autonomy was identified when analyzed by gender. Male and female trainees showed similar trends of increasing surgical autonomy throughout the course of surgical training. In a cohort of surgical trainees that has reached gender balance, the negative impact of gender on surgical autonomy was not identified. These findings suggest that where women make up an equal proportion of trainees, the implicit gender bias within surgical training may be ameliorated.

Does anesthesia type affect surgical resident operative autonomy for open inguinal hernia repairs?

Does anesthesia type affect surgical resident operative autonomy for open inguinal hernia repairs?

Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender.

This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents. Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy. A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021. Overall sentiment, adjectives, and gendered words in verbal feedback were quantified by natural language processing. Resident operative autonomy and performance, as evaluated by attendings, were reported on 5-point ordinal scales. Performance-adjusted autonomy was calculated as autonomy minus performance. The final dataset included objective assessments and dictated feedback for 2683 surgical procedures. Sentiment scores were higher for female residents (95 [interquartile range (IQR), 4-100] vs 86 [IQR 2-100]; P < 0.001). Gendered words were present in a greater proportion of dictations for female residents (29% vs 25%; P = 0.04) due to male attendings disproportionately using male-associated words in feedback for female residents (28% vs 23%; P = 0.01). Overall, attendings reported that male residents received greater performance-adjusted autonomy compared with female residents (P < 0.001). Sentiment and gendered words in verbal feedback and performance-adjusted operative autonomy differed for female and male general surgery residents. These findings suggest a need to ensure that trainees are given appropriate and equitable operative autonomy and feedback.

Design of Hexacopter Tethered Drone

Abstract: This paper proposed the development of an tethered Drone to be used for application. Drones become essential for various application. The main drawback of the drones is that the time of flight is very less (around 20 minutes).The proposed system aims to provide continuous power supply to the drone by using power supply from ground. The twisting and tangling of wires is another problem, so we have provided a slip ring mechanism to avoid twisting of cable. In this system author used IMU 6DOF (3-axis accelerometer&amp; 3-axis gyroscope) which ensure it smooth movement, graceful motion and trajectory tracing. GPS system and barometric sensor makes it more efficient in autonomous mode. UAVs have limited operational autonomy, determined by their on-board available power. An autonomous power tethered UAV-UGV team couples those two classes through a power linkage. This serves to increase the UAV’s autonomy in terms of flight time, while concurrently the aerial platform’s utility as an eye-in-the-sky can provide the UGV with increased knowledge of its surroundings. Finally, this physical constraint can grant additional benefits at aerial vehicle control level, especially under the potential presence of strong wind gusts. The developed autonomous operation strategy is examined within a simulated scenario with limited prior map knowledge, which includes a number of unmapped challenges.

Development of the Generator for a Small Capacity Bulb Hydropower Unit

The generator design development matters for a small bulb hydropower unit is discussed. Synchronous units with a brushless exciter and a brush contact system, with excitation from permanent magnets, as well as an inductor generator were considered as design options. Electromagnetic, ventilation, and thermal analyses are performed, and the dynamics and strength of the main components of a synchronous generator with a brushless exciter are evaluated. The main technical problems have been solved: reducing the generator mass and dimension parameters, reducing its material intensity, decreasing the production cost, increasing the efficiency, and increasing installation readiness and maintainability, reducing windage losses, working out the ventilation system, and enhancement of operational autonomy. It is shown that the generator quantitative and qualitative characteristics can be improved significantly by applying the concept of a synchronous salient pole electrical machine. The possibility of stable generator operation in various modes of its use is shown.

The effect of operator's experience on mechanical thrombectomy outcomes: A systematic review.

Mechanical thrombectomy (MT) has become the standard of care for stroke patients. The majority of the clinical trials and publications analyzing the outcomes related to the procedures report interventional performance by experienced practitioners. However, few of them individualize their preliminary metrics according to the operator's experience. To summarize the literature and report safety and efficacy outcomes following MT procedures and correlate them with the operator's experience. Primary outcomes were successful recanalization, defined as modified thrombolysis in cerebral infarction greater or equal to 2b or 3, duration of the procedure measured in minutes, and serious adverse event. This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase, and Cochrane databases were utilized. There were six studies comprising 9348 patients (mean age 69.8 years; 51.2% males), and 9361 MT procedures were included. Each publication used for this review used a different experience definition to report their data. Higher interventionists' experience demonstrated a positive relationship with the possibility of successful recanalization and an inverse relationship with the duration needed for the operation in almost all of the included studies. As for the complications, none of the authors reported a statistically significant risk reduction of an adverse event, except Olthuis et al. correlating increasing training with lower odds of stroke progression. A higher experience level is associated with better recanalization rates and shorter procedural duration in MT operations. Further studies are warranted to define the minimum required level of experience for operational autonomy.

Surgical resident experience with common bile duct exploration and assessment of performance and autonomy with formative feedback

BackgroundCommon bile duct exploration (CBDE) is safe and effective for managing choledocholithiasis, but most US general surgeons have limited experience with CBDE and are uncomfortable performing this procedure in practice. Surgical trainee exposure to CBDE is limited, and their learning curve for achieving autonomous, practice-ready performance has not been previously described. This study tests the hypothesis that receipt of one or more prior CBDE operative performance assessments, combined with formative feedback, is associated with greater resident operative performance and autonomy.MethodsResident and attending assessments of resident operative performance and autonomy were obtained for 189 laparoscopic or open CBDEs performed at 28 institutions. Performance and autonomy were graded along validated ordinal scales. Cases in which the resident had one or more prior CBDE case evaluations (n = 48) were compared with cases in which the resident had no prior evaluations (n = 141).ResultsCompared with cases in which the resident had no prior CBDE case evaluations, cases with a prior evaluation had greater proportions of practice-ready or exceptional performance ratings according to both residents (27% vs. 11%, p = .009) and attendings (58% vs. 19%, p < .001) and had greater proportions of passive help or supervision only autonomy ratings according to both residents (17% vs. 4%, p = .009) and attendings (69% vs. 32%, p < .01).ConclusionsResidents with at least one prior CBDE evaluation and formative feedback demonstrated better operative performance and received greater autonomy than residents without prior evaluations, underscoring the propensity of feedback to help residents achieve autonomous, practice-ready performance for rare operations.

Affiliated Associations in China's Education Sector: Between Passive Autonomy, Discretion and Control

AbstractUnder President Xi Jinping, the strengthening of the Chinese Communist Party's political control occurs in conjunction with an evolving administrative role for government-affiliated associations. Analysing associations that are subordinate within China's strict hierarchy but which have degrees of operational freedom yields insights into the changing nature of public service and administration in China. Evidence from 63 interviews conducted from 2018 to 2022 with government departments and affiliated associations in the education sector reveals the complexity of state control and degrees of constrained autonomy achieved by affiliated associations. The government exerts control over financing, personnel appointments and core business activities but, over time, associations gain varying degrees of operational autonomy to influence the education agenda and fill gaps in public services. The interdependency and relational variance we find in the case of Ministry of Education-affiliated associations contributes to broader understandings of the complex and fragmentary nature of the Chinese state and public administration.

Tecnologie digitali e consapevolezza culturale

Cultural heritage, in the educational and training sphere, is of great impact due to its multidimensional and multidisciplinary being. Promotes a relationship of knowledge and conscious identity with the territory; it offers ways of inter- acting with cultural resources, allowing the school to guarantee pupils well-being, educational success and above all operational autonomy, through creativity and productivity. In this way, students become “producers” of content - complex and structured - and digital architectures. The digital skills of students allow them to learn, participating in society, characterized by cultural diversity, with a critical and responsible spirit, developing emotions and enhancing places and cultures. The specific tools used are all open source platforms, which allow a transfer between the virtual world and the real world, through collaboration and sharing.

12. Implicit Bias in Plastic Surgery Resident Evaluations: A Scoping Review

Background: Evaluations are a critical component of resident education and training in plastic surgery. With the advent of competency-based training models that rely on objective evaluations of resident performance, there is a need to understand the risk of implicit bias in current evaluative methods of surgical residents. Methods: A scoping review was conducted within PubMed, Embase, Web of Science, and ERIC in May 2022 to assess the landscape of implicit bias research in surgical resident evaluations. Studies were screened and reviewed in duplicate by three reviewers. Conflicts were resolved by a fourth reviewer or discussion. English-language studies conducted in the United States that assessed implicit bias in the evaluation of surgical residents were included. A descriptive analysis was conducted for studies that explicitly included or were specific to plastic surgery trainees. Results: The search yielded 1641 unique studies. After screening titles and abstracts according to inclusion criteria in duplicate, 88 studies underwent full-text review. Of these, 53 studies met study inclusion criteria and 8 studies (15.1%) were specific to or inclusive of evaluations of plastic surgery residents. Six studies (75.0%) focused on gender bias, of which 4 studies demonstrated significant differences. In particular, evaluations of female trainees showed significantly lower operative autonomy ratings, with one study noting that the difference existed only when male attendings rated female residents. Evaluations of females were also more likely to consist of modulating phrases that may undermine performance. Two studies (25.0%) found that self-evaluations of both female and male trainees tended to be worse than observers’ evaluations. One study showed that interns rated themselves significantly lower than attendings; however, PGY2-6 male residents rated themselves significantly higher, while female residents rated themselves significantly lower, than attendings. Of the evaluation methods used, most were survey-format forms or qualitative evaluations (88.0%, n = 7), whereas one study assessed a mobile application. No studies assessed racial bias. Conclusion: Current methods used to evaluate plastic surgery residents may be prone to gender bias. Research is warranted regarding other implicit biases, such as racial bias, as well as bias within newer smartphone-based evaluation modalities.

Surgical resident operative autonomy on nights and weekends: What happens to surgical education during off-hours?

Surgical resident operative autonomy is critical for trainee maturation to independence. Acute care surgery (ACS) cases commonly occur off-hours and tension between operating room availability and on-call staff can affect resident operative autonomy. We examined operative resident autonomy for general, vascular, and thoracic (GVT) surgery during nights and weekends. We hypothesized that residents would be afforded less operative autonomy during off - hours than weekdays. This retrospective cohort study uses the Veterans Affairs Surgical Quality Improvement Program database, we examined all GVT cases at Veterans Affairs teaching hospitals from 2004 to 2019. All cases are coded for the level of supervision at the time of surgery: AP, attending primary surgeon; AR, attending and resident operating together; and RP, resident primary (attending supervising but not scrubbed). Cases starting between 6 pm to 7 am Monday through Friday were considered nights, cases on Saturday/Sunday were considered weekends, and collectively considered "off-hours." Resident primary case rates were compared by start time and type. Over the 15-year study period, there were 666,421 GVT cases performed with 38,097 cases (6%) performed off-hours. During off-hours, 31,396 (83%) were ACS compared with 5% of daytime cases. Overall, off-hours cases have higher RP rate than daytime cases (6.8% vs. 5.8%, p < 0.001). Daytime ACS cases have higher rates of RP than nights/weekends (7.6% vs. 6.8%, p < 0.001). Conversely, daytime elective cases have lower RP than nights (5.7% vs. 7.9%, p < 0.001). During off-hours, there are more RP cases on nights compared with weekends (7.1% vs. 6.5%, p = 0.02). Overall, residents were afforded more operative autonomy during off-hours, with nights having greater RP than weekends. In contrast, ACS cases have more autonomy during weekdays. These data have potentially significant implications for ACS service staffing, night float rotations, and overall resident operative experience on ACS services. Prognostic and Epidemiological; Level III.

Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study.

Surgical skill, a summation of acquired wisdom, deliberate practice and experience, has been linked to improved patient outcomes. Graded mentored exposure to pathologies and operative techniques is a cornerstone of surgical training. Appendectomy is one of the first procedures surgical trainees perform independently. We hypothesize that, given the embedded training ethos in surgery, coupled with the steep learning curve required to achieve trainer-recognition of independent competency, 'real-world' clinical outcomes following appendectomy for the treatment of acute appendicitis are operator agnostic. The principle of graded autonomy matches trainees with clinical conditions that they can manage independently, and increased complexity drives attending input or assumption of the technical aspects of care, and therefore, one cannot detect an impact of operator experience on outcomes. This study is a subgroup analysis of the SnapAppy international time-bound prospective observational cohort study (ClinicalTrials.gov Trial #NCT04365491), including all consecutive patients aged ≥ 15 who underwent appendectomy for appendicitis during a three-month period in 2020-2021. Patient- and surgeon-specific variables, as well as 90-day postoperative outcomes, were collected. Patients were grouped based on operating surgeon experience (trainee only, trainee with direct attending supervision, attending only). Poisson and quantile regression models were used to (adjusted for patient-associated confounders) assess the relationship between surgical experience and postoperative complications or hospital length of stay (hLOS), respectively, adjusted for patient-associated confounders. The primary outcome of interest was any complications within 90days. A total of 4,347 patients from 71 centers in 14 countries were included. Patients operated on by trainees were younger (Median (IQR) 33 [24-46] vs 38 [26-55] years, p < 0.001), had lower ASA classifications (ASA ≥ 3: 6.6% vs 11.6%, p < 0.001) and fewer comorbidities compared to those operated on by attendings. Additionally, trainees operated alone on fewer patients with appendiceal perforation (AAST severity grade ≥ 3: 8.7% vs 15.6%, p < 0.001). Regression analyses revealed no association between operator experience and complications (IRR 1.03 95%CI 0.83-1.28 for trainee vs attending; IRR 1.13 95%CI 0.89-1.42 for supervised trainee vs attending) or hLOS. The linkage of case complexity with operator experience within the context of graduated autonomy is a central tenet of surgical training. Either subconsciously, or by design, patients operated on by trainees were younger, fitter and with earlier stage disease. At least in part, these explain why clinical outcomes following appendectomy do not differ depending on the experience of the operating surgeon.