Effective Senior Surgical Residents as Defined by Their Peers: A Qualitative Content Analysis of Nontechnical Skills Development.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
pmc-release:
01
03
2024
pubmed:
3
8
2021
medline:
9
2
2023
entrez:
2
8
2021
Statut:
ppublish
Résumé
This study aims to define an effective senior resident and understand the process of leadership and nontechnical skill development in the transition from junior to senior surgery resident. General surgery residents are responsible for patient care, technically demanding operations, and diverse care team management. However, leadership skill development for the transition from junior to senior resident roles is often overlooked. We conducted 15 semi-structured focus groups with surgery residents from an urban, academic institution. Focus group transcripts were inductively coded. Using content analysis and constant comparative methodology, primary codes were refined into categories and organized into higher-level themes. Thirty-three general surgery residents completed fifteen focus groups. Six themes were identified. Three themes describe the process of becoming an effective senior resident: how to define a senior resident's scope of practice, the transition process, and the importance of personal investment. Three themes were identified regarding effective seniors: ideal traits, teachable skills, and the team and patient impact. Surgery residents define an effective senior resident as the team member with the highest level of experience who manages the big picture of patient care. The transition is improved by personal engagement and acknowledgement of the transition. Ideal traits of effective seniors, including emotional intelligence and inherent personality traits, allow a resident to more naturally assume this role; however, teachable skills, such as communication, expectation setting and competence, can be taught to improve one's effectiveness. The actions of a senior resident impact the team and patient care, underscoring the importance of understanding this role.
Sections du résumé
OBJECTIVE
This study aims to define an effective senior resident and understand the process of leadership and nontechnical skill development in the transition from junior to senior surgery resident.
SUMMARY BACKGROUND
General surgery residents are responsible for patient care, technically demanding operations, and diverse care team management. However, leadership skill development for the transition from junior to senior resident roles is often overlooked.
METHODS
We conducted 15 semi-structured focus groups with surgery residents from an urban, academic institution. Focus group transcripts were inductively coded. Using content analysis and constant comparative methodology, primary codes were refined into categories and organized into higher-level themes.
RESULTS
Thirty-three general surgery residents completed fifteen focus groups. Six themes were identified. Three themes describe the process of becoming an effective senior resident: how to define a senior resident's scope of practice, the transition process, and the importance of personal investment. Three themes were identified regarding effective seniors: ideal traits, teachable skills, and the team and patient impact.
CONCLUSIONS
Surgery residents define an effective senior resident as the team member with the highest level of experience who manages the big picture of patient care. The transition is improved by personal engagement and acknowledgement of the transition. Ideal traits of effective seniors, including emotional intelligence and inherent personality traits, allow a resident to more naturally assume this role; however, teachable skills, such as communication, expectation setting and competence, can be taught to improve one's effectiveness. The actions of a senior resident impact the team and patient care, underscoring the importance of understanding this role.
Identifiants
pubmed: 34334653
doi: 10.1097/SLA.0000000000005106
pii: 00000658-900000000-93384
pmc: PMC8799772
mid: NIHMS1725907
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e707-e713Subventions
Organisme : NIAID NIH HHS
ID : R25 AI147393
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Dedy NJ, Bonrath EM, Zevin B, et al. Teaching nontechnical skills in surgical residency: a systematic review of current approaches and outcomes. Surgery. 2013;154:1000–1008.
Hull L, Arora S, Aggarwal R, et al. The impact of nontechnical skills on technical performance in surgery: a systematic review. J Am Coll Surg. 2012;214:214–230.
Yule S, Flin R, Paterson-Brown S, et al. Non-technical skills for surgeons in the operating room: a review of the literature. Surgery. 2006;139:140–149.
Barnes T, Rennie SC. Leadership and surgical training part 1: preparing to lead the way? ANZ J Surg. 2021;91:1068–1074.
O'Keeffe DA, Losty M, Traynor O, et al. Objective assessment of surgical trainees' non-technical skills: Improved performance following a two-year program of instruction. Am J Surg. 2020;220:1566–1571.
Gordon M, Darbyshire D, Baker P. Non-technical skills training to enhance patient safety: a systematic review. Med Educ. 2012;46:1042–1054.
Barnes T, Yu TW, Webster CS. Preparedness of medical students and junior doctors for their role as clinical leaders: a systematic review. Med Teach. 2020;42:79–85.
Cope A, Bezemer J, Mavroveli S, et al. What attitudes and values are incorporated into self as part of professional identity construction when becoming a surgeon? Acad Med. 2017;92:544–549.
Beasley SW, Smith K, Watters D. What leadership means as a core surgical competence in everyday practice. ANZ J Surg. 2020;90:154–158.
Patel VM, Warren O, Humphris P, et al. What does leadership in surgery entail? ANZ J Surg. 2010;80:876–883.
Horwitz IB, Horwitz SK, Daram P, et al. Transformational, transactional, and passive-avoidant leadership characteristics of a surgical resident cohort: analysis using the multifactor leadership questionnaire and implications for improving surgical education curriculums. J Surg Res. 2008;148:49–59.
Awad SS, Hayley B, Fagan SP, et al. The impact of a novel resident leadership training curriculum. Am J Surg. 2004;188:481–484.
Awad SS, Fagan SP, Bellows C, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg. 2005;190:770–774.
Pradarelli JC, Jaffe GA, Lemak CH, et al. A leadership development program for surgeons: first-year participant evaluation. Surgery. 2016;160:255–263.
Sadowski B, Cantrell S, Barelski A, et al. Leadership training in graduate medical education: a systematic review. J Grad Med Educ. 2018;10:134–148.
Pettit JE, Dahdaleh NS, Albert GW, et al. Neurosurgery resident leadership development: an innovative approach. Neurosurgery. 2011;68:546–550. discussion 550.
Nicksa GA, Anderson C, Fidler R, et al. Innovative approach using interprofessional simulation to educate surgical residents in technical and nontechnical skills in high-risk clinical scenarios. JAMA Surg. 2015;150:201.
Neylan CJ, Nelson EF, Dumon KR, et al. Medical school surgical boot camps: a systematic review. J Surg Educ. 2017;74:384–389.
Sachdeva AK, Flynn TC, Brigham TP, et al. Interventions to address challenges associated with the transition from residency training to independent surgical practice. Surgery. 2014;155:867–882.
Lee-Riddle GS, Sigmon DF, Newton AD, et al. Surgical boot camps increases confidence for residents transitioning to senior responsibilities. J Surg Educ. 2020;78:987–990.
Wipf JE, Pinsky LE, Burke W. Turning interns into senior residents: preparing residents for their teaching and leadership roles. Acad Med. 1995;70:591–596.
Blumenthal DM, Bernard K, Fraser TN, et al. Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned. BMC Med Educ. 2014;14:257.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–1288.
Kahlke RM. Generic qualitative approaches: pitfalls and benefits of methodological mixology. Int J Qual Methods. 2014;13:37–52.
Cho JY, Lee E-H. Reducing confusion about grounded theory and qualitative content analysis: Similarities and differences. Qual Rep. 2014;19:1–20.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–357.
Kallio H, Pietilä A-M, Johnson M, et al. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. J Adv Nurs. 2016;72:2954–2965.
Creswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Sage publications; 2017.
Carey MA. “The group effect in focus groups: Planning, implementing and interpreting focus group research”. In : J. Morse (Ed.). Critical Issues in Qualitative Research Methods. Thousand Oaks, CA: Sage Publications. 2014:225–251.
MacQueen KM, McLellan E, Kay K, et al. Codebook development for team-based qualitative analysis. CAM J. 1998;10:31–36.
Vygotsky LS. Mind in Society: Development of Higher Psychological Processes . Harvard University Press; 1978.
Zaretskii VK. The zone of proximal development. J Rus E Eur Psychol. 2009;47:70–93.
Dickinson KJ, Bass BL, Pei KY. What embodies an effective surgical educator? A grounded theory analysis of resident opinion. Surgery. 2020;168:730–736.
The Accreditation Council for Graduate Medical Education. Surgery Milestones. Available at: https://www.acgme.org/Portals/0/PDFs/Milestones/SurgeryMilestones.pdf?ver=2020-09-01-152718-110 . Published 2019. Accessed 2021.