Who did the case? Perceptions on resident operative participation

•Residents and faculty agree on the resident's role in only 63% of operative cases.•Agreement on the percentage of a case a resident performs occurs in 61% of cases.•Residents perceive more involvement than do faculty in most cases of disagreement.•There's a shared understanding that operating surgeon means doing >50% of a case.

BackgroundThe ACGME case log is one of the primary metrics used to determine resident competency; it is unclear if this is an accurate reflection of the residents' role and participation.MethodsResidents and faculty were independently administered 16-question surveys following each case over a three-week period. The main outcome was agreement between resident and faculty on resident role and percent of the case performed by the resident.ResultsMatched responses were collected for 87 cases. Agreement on percent performed occurred in 61% of cases, on role in 63%, and on both in 47%. Disagreement was more often due to resident perception they performed more of the case. Faculty with <10 years experience were more likely to have disagreement compared to faculty with ≥10 years (p = 0.009).ConclusionsThere was a high degree of disagreement between faculty and residents regarding percent of the case performed and role. Accurate understanding of participation and competency is vital for accrediting institutions and for resident self-assessment meriting further study of the causes for this disagreement to improve training and evaluation.