Melanie Hammond Mobilio, MA; Ryan Brydges, PhD; Priyanka Patel, MD, Msc; Daniel Glatt, MD; Carol-anne Moulton, MBBS, PhD, MEd.

Training in General Surgery has evolved in recent decades. Residents now have less time to work with attending surgeons to establish entrustment. Limited entrustment can impact resident learning and engagement in the operating room. Ultimately the goal of completing surgical residency is to develop the autonomy to become an attending surgeon. Research has shown that there are factors that affect a resident’s progressive development of autonomy and independence.

Using a constructivist grounded theory approach, interviews with general surgery residents and attending surgeons were conducted to characterize how engagement in the OR is perceived as fundamental to achieving autonomy.

Our results identified three key tensions:
1. Residents and attendings balance dual roles in the OR as learner/teacher and worker;
2. System demands constantly put those dual roles in tension and opposition;
3. Residents and attendings have derived strategies to balance those competing identities.

In an academic OR setting, competing priorities between workplace efficiency and patient safety can impact resident engagement. Some strategies for helping residents and attendings prioritize learning and teaching include goal setting and planning ahead.

Cover image by Douglas Buller