Definition And Perception Of Autonomy In Vascular Surgery Training
Camila Villacreses, MD1, Nisarg Patel, BS1, Charles DeCarlo, MD2, Laura T. Boitano, MD, MMSc2, Mathew Wooster, MD, MBA1, Ravi Veeraswamy, MD1, Murray L. Shames, MD3, Adam Tanious, MD, MMSc1.
1Medical University of South Carolina, Charleston, SC, USA, 2Massachusetts General Hospital, Boston, MA, USA, 3University of South Florida, Tampa, FL, USA.
OBJECTIVES: A discrepancy between the definition and perception of autonomy between trainees and their attendings is suspected. This study aims to determine where in the patient-care pathway these discrepancies lie and, additionally, if any regional variations exist in trainer/trainee autonomy expectations.
METHODS: An IRB approved, anonymous survey was emailed to vascular trainees and attending faculty at all ACGME-approved vascular surgery training programs in the United States. Data was compared using chi-square statistical analysis.
RESULTS: One-hundred fifty responses from vascular surgery trainees (n=89) and faculty (n=61) were obtained. There were no significant differences in factors deemed most important for autonomy between trainees at any PGY level. However, there were differences found when comparing trainee and faculty responses. Table 1 breaks down significant differences between skills perceived as most and least important by trainees versus faculty.All PGY-levels found case-planning as highly important when compared to faculty, though only 40% of responding trainees are expected to prepare an operative plan at their programs. Trainees at all levels ranked initial exposure and exposure of critical structures as more important compared to faculty. At the intern level, faculty ranked double-scrubbing as more important than did trainees. Double-scrubbing was ranked as more important to trainees than faculty at the chief level, while responding interns and chiefs reported that they are currently double-scrubbing less than a quarter of their cases.Regionally, double-scrubbing was deemed important by trainees in the South (7.4%) and West (33.3%) regions of the US as compared to the Northeast (0.0%), and Midwestern (0.0%); p=0.03. The majority of trainees reported double-scrubbing less than 25% of cases nationally (South=80.8%, West=66.7%, Northeast=78.8%, Midwest=60%).CONCLUSIONS: This study demonstrates that there are several areas of discrepancy between trainees and faculty in ranking the factors important to training autonomy. There are also vast discrepancies in real versus perceived expectations of trainees at all levels of training. Despite responding-trainees sentiment of its inherent value, double-scrubbing cases is rarely done nationally and at all levels of training. This information may be used to close the gap between trainee and faculty definitions of autonomy and expectations during training. 
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