Surgical autonomy: A resident perspective and the balance of teacher development with operative independence

This study aims to understand the perspectives of operative autonomy of surgical residents at various postgraduate levels. Categorical general surgery residents at a single academic residency were invited to participate in focus groups to discuss their opinions and definitions of operative autonomy. Employing constructivist thematic analysis, focus groups were audio recorded, transcribed, and inductively analyzed using a constant comparative technique. Twenty clinical surgical residents participated in 6 focus groups. Overarching themes identified include autonomy as a dynamic, progressive path to operative independence and the complex interaction of resident-as-teacher development and operative autonomy. Four within operative case themes were intrinsic factors, extrinsic factors, autonomy promoting or inhibiting behaviors, and the relationship between residents and attendings. Residents define operative autonomy as a progressive and dynamic pathway to operative independence. Teacher development is viewed as both an extension beyond operative independence and potentially in conflict with their colleagues’ development. [Display omitted] •Residents define autonomy as a dynamic and progressive path to operative independence.•The autonomy granted is influenced by intrinsic factors and behaviors of residents and attendings.•Extrinsic pressures such as time, outcomes, and hospital metrics negatively impact autonomy.•Resident teacher development may come in direct conflict with operative autonomy.