부산대학교 도서관

Purpose: There is growing concern over the readiness of orthopedic surgical residents and fellows for independent surgical practice upon completion of their training. This study aims to explore orthopedic surgery (OS) trainees’ experience of accessing operative autonomy by eliciting their perceptions and techniques implemented to gain autonomy.Methods: OS residents and fellows were invited to participate in focus group interviews via a convenience sampling approach. A non-faculty facilitator led the discussions using an interview guide to prompt conversation. All interviews were recorded, de-identified, and then transcribed. Three investigators iteratively analyzed transcripts to identify emerging themes until thematic saturation was achieved. All interviews were performed at Ohio State University Wexner Medical Center, an academic medical institution, in Columbus, Ohio.Results: A total of 16 residents and 2 fellows participated. Two themes emerged: (1) optimal setting: trainees were allowed more operative autonomy in trauma and on-call cases than elective cases, though they perceived it was their responsibility to earn autonomy; (2) techniques: two techniques promote trainees’ access to autonomy, including trainee-initiated techniques (i.e., building relationship, preoperative planning, knowing attending preferences, and effective communication); and (3) faculty-initiated techniques (i.e., setting expectations, indications conference, and providing graduated autonomy).Conclusions: Our study findings suggest OS trainees tend to access least autonomy in elective OS cases. Although trainees perceived earning autonomy as their responsibility, faculty and resident development is recommended to enhance teaching and learning techniques to increase trainees’ practice readiness.