• World Neurosurg · Jun 2024

    Comparative Study

    Through the Looking Glass: Comparing Resident and Attending Views on Competency and Autonomy.

    • Taylor Niznik, Sixia Chen, and Joanna Gernsback.
    • Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Neurosurgery, Section of Pediatric Neurosurgery, Oklahoma Children's Hospital, University of Oklahoma School of Medicine, Oklahoma City, OK, USA.
    • World Neurosurg. 2024 Jun 1; 186: e290e295e290-e295.

    BackgroundSurgical residencies act as an apprenticeship to train new surgeons, ideally with increasing trainee autonomy and competency. Objective methods of measuring these two qualities are needed.MethodsThe objective of this pilot study is to use the Surgical Autonomy Program to compare resident and attending perception of competency, via Zones of Proximal Development (ZPDs), and autonomy, via Teach, Advise, Guide, Solo (TAGS) scale for a common pediatric neurosurgical procedure. The most common pediatric neurosurgical procedure, a ventriculoperitoneal shunt, was broken down into four ZPDs. After each procedure, the resident and the attending rated the competency of the resident by ZPD and their autonomy using TAGS. These ratings were then compared to see if the attending and the resident agreed on their levels of competency and autonomy.ResultsThere were no significant differences in the rating of competency or autonomy between the residents and the attendings. Postgraduate year was significantly associated with differences in TAGS ratings with those having less experience showing a positive perception gap. Other covariates (age, gender) were not associated with differences in rating. The residents found that the ZPDs checklist was a useful tool for communicating with the attending and for getting appropriate autonomy in the operating room.ConclusionsPediatric neurosurgical trainees and attendings had concordance on their perceptions of resident autonomy and competency, suggesting that this tool could be a useful way of objectively grading the progress of neurosurgical residents in surgery.Copyright © 2024 Elsevier Inc. All rights reserved.

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