How do supervising surgeons evaluate guidance provided in the operating room?

BackgroundThis study explored the amount of guidance provided to residents in the operating room (OR) and the relationship of OR guidance with postgraduate year (PGY) and operative performance rating (OPR).MethodsWe used OPR instruments to collect data from supervising surgeons after each performance. External expert raters blindly rated the amount of guidance for 5 videotaped performances.ResultsThree hundred sixty-eight performances were analyzed for 5 procedures performed by 26 residents with 16 supervising surgeons over 6 months. Guidance ratings varied with procedure, individual supervising surgeons varied in the amount of guidance reported, the amount of guidance decreased as residents' PGY level increased, and the correlation between guidance rating and overall performance was .62. In comparison cases, most supervising surgeons underestimated the amount of guidance provided.ConclusionsControlling for the amount of supervising surgeon guidance has important implications for training and evaluation as we strive to prepare residents to practice independently.