부산대학교 도서관

Purpose: Community-based (CB) surgical training programs have traditionally been felt to offer an earlier operative experience than university-based programs (UB), with CB residents reporting higher levels of confidence to operate independently upon completion of residency. Greater autonomy during training may be one potential contributor of higher levels of confidence to operate independently, but this has not yet been evaluated. The purpose of this study was to compare resident operative autonomy ratings at different types of surgical training programs.Methods: Surgical residents and faculty at 68 general surgery training programs used a workplace-based assessment app to assess the level of operative autonomy provided to residents. Ratings were collected using the Zwisch scale following cases that involved a categorical general surgery resident. Program type was determined based on designation in the American Medical Association’s Fellowship and Residency Electronic Interactive Database Access System (CB, UB, community-based university-affiliated (CBUA), or military). Linear mixed models were used to explore the association between program type and resident autonomy while accounting for differences in trainee post-graduate year (PGY) and other related factors.Results: A total of 82,154 evaluations from 1,982 surgical faculty were included (CB: 3,409, CBUA: 12,629, and UB: 66,197). When adjusting for factors including PGY level, there was no significant difference in the adjusted resident autonomy ratings between program types by the end of training (CB = 2.54 (CI 2.44–2.64), CBUA = 2.48 (CI 2.43–2.53), UB = 2.49 (CI 2.45–2.52)). However, there was a difference in rate of change of autonomy, with CB programs reporting earlier operative autonomy.Conclusions: There is no significant difference in the overall amount of operative autonomy provided to residents in university-based, community-based university-affiliated, or community-based general surgery training programs.