• Patrick Nieboer, Mike Huiskes, Fokie Cnossen, Martin Stevens, Sjoerd K Bulstra, and JaarsmaDebbie A D CDADCCenter for Research and Innovation in Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands..
• Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
• Ann. Surg. 2022 Jan 1; 275 (1): e264e270e264-e270.

ObjectiveTo identify what strategies supervisors use to entrust autonomy during surgical procedures and to clarify the consequences of each strategy for a resident's level of autonomy.BackgroundEntrusting autonomy is at the core of teaching and learning surgical procedures. The better the level of autonomy matches the learning needs of residents, the steeper their learning curves. However, entrusting too much autonomy endangers patient outcome, while entrusting too little autonomy results in expertise gaps at the end of training. Understanding how supervisors regulate autonomy during surgical procedures is essential to improve intraoperative learning without compromising patient outcome.MethodsIn an observational study, all the verbal and nonverbal interactions of 6 different supervisors and residents were captured by cameras. Using the iterative inductive process of conversational analysis, each supervisor initiative to guide the resident was identified, categorized, and analyzed to determine how supervisors affect autonomy of residents.ResultsIn the end, all the 475 behaviors of supervisors to regulate autonomy in this study could be classified into 4 categories and nine strategies: I) Evaluate the progress of the procedure: inspection (1), request for information (2), and expressing their expert opinion (3); II) Influence decision-making: explore (4), suggest (5), or declare the next decision (6); III) Influence the manual ongoing action: adjust (7), or stop the resident's manual activity (8); IV) take over (9).ConclusionsThis study provides new insights into how supervisors regulate autonomy in the operating room. This insight is useful toward analyzing whether supervisors meet learning needs of residents as effectively as possible.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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