Looking Beyond the Numbers: A Comparison of Operative Self-Efficacy, Supervision, and Case Volume in General Surgery Residency

Abstract

Background A national survey of general surgery residents revealed significant self-assessed deficits in preparation for independent practice, with only 7.7% of graduating postgraduate year 5 residents (n=1145) reporting self-efficacy for all 10 commonly performed operations surveyed. Objective We sought to understand why this phenomenon occurs. We hypothesized that self-efficacy would be positively correlated with both operative independence and case volume. Methods We compared 3 independent datasets: case information for the same 10 previously surveyed operations for residents graduating in 2020 (dataset 1), operative independence data obtained through the SIMPL OR app, an operative self-assessment tool (dataset 2), and case volume data obtained through the Accreditation Council for Graduate Medical Education National Data Report (dataset 3). Operations were categorized into high, middle (mid), and low self-efficacy tiers; analysis of variance was used to compare operative independence and case volume per tier. Results There were significant differences in self-efficacy between high (87.7%), mid (68.3%), and low (25.4%) tiers (P=.008 [95% CI 6.2, 32.7] for high vs mid, P<.001 for high vs low [49.1, 75.6], and P<.001 for mid vs low [28.7, 57.1]). The percentage of cases completed with operative independence followed similar trends (high 32.7%, mid 13.8%, low 4.9%, P=.006 [6.4, 31.4] for high vs mid, P<.001 [15.3, 40.3] for high vs low, P=.23 [-4.5, 22.3] for mid vs low). The total volume of cases decreased from high to mid to low self-efficacy tiers (average 91.8 to 20.8 to 11.1) but did not reach statistical significance on post-hoc analysis. Conclusions In this analysis of US surgical residents, operative independence was strongly correlated with self-efficacy.