Too much autonomy?

[7abiby]

Is there such as thing as too much autonomy? or is more merrier? does your education really suffer when you're left alone in an OR

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[skiz knot]

Is there such as thing as too much autonomy? or is more merrier? does your education really suffer when you're left alone in an OR

Your education probably doesn't suffer as much as the patient might. If you don't know what you're doing you need staff. If you know what you are doing, staff can (almost) always teach you something at some point in the case, keeping in mind that having the resident perform the case without assistance is part of the learning process.

 

[SOLDIER]

Is there such as thing as too much autonomy? or is more merrier? does your education really suffer when you're left alone in an OR

Hi
U can never know to much anatomy. How more u read and educate your self how better
Try to get random facts about anatomy in your head

The 1st surgery is like driving a car for the 1st time alone so u know the rules of the road and u know how to park your car right?
But there are always a well trained staff to help u

 

[Winged Scapula]

Hi
U can never know to much anatomy. How more u read and educate your self how better
Try to get random facts about anatomy in your head

The 1st surgery is like driving a car for the 1st time alone so u know the rules of the road and u know how to park your car right?
But there are always a well trained staff to help u

The OP is asking about AUTONOMY not ANATOMY.

 

[SOLDIER]

The OP is asking about AUTONOMY not ANATOMY.

Oh **** sorry lol maybe I should not read everyting half

 

[tussy]

You do need some autonomy but you also need supervised instruction. If you are left alone to "figure it out" you will not develop the best technique. You need to be taught the technique, allowed to practice with supervision and only then be given autonomy to do it alone. It's a graduated progression.

 

[opr8n]

any attending/senior res think there is too LITTLE autonomy for todays graduating surgical residents?
i know this varies both program to program and even rotation to rotaion within a program and even residient to resident, but overall ... i think it has gone down, and prob not for the better. Are you doing residents any service by making them ill preparred to come out of residency hitting the ground running without feeling like they can be completely independent?

 

[Winged Scapula]

any attending/senior res think there is too LITTLE autonomy for todays graduating surgical residents?
i know this varies both program to program and even rotation to rotaion within a program and even residient to resident, but overall ... i think it has gone down, and prob not for the better. Are you doing residents any service by making them ill preparred to come out of residency hitting the ground running without feeling like they can be completely independent?

Absolutely.

 

[thedrjojo]

This is something big I have been looking at on the trail. It is sometimes hard to tell, which is where aways and second looks play a big part. One of the programs I was looking at, the incredible lack of chief resident autonomy turned me off (dropped from #1 to like #6) where as my #1 and #2 both have the residents essentially running the show during chief year... it helps that they are urban, public hospitals with a large amount of uninsured teaching cases to get away with that, but that is essentially the only place it seems autonomy still exists.

 

[Pir8DeacDoc]

It's a fine line. You need to learn and push your boundaries, but ultimately we are responsible for the best possible care for the patient. Mucking your way unsafely through something in the name of autonomy is unprofessional IMHO.

 

[DrDawg]

Is there such as thing as too much autonomy? or is more merrier? does your education really suffer when you're left alone in an OR

In todays reduced work hours, and sue happy society, there has certainly been a reduction in the resident "experience". Many attending recall being a 4th or 5th year at the county hospital where attendings may have not even been in the hospital.

Knowing that you are going to be all alone is a great motivator to prepare for cases. Today there is always a safty net. I feel it is difficulty if not impossible to mature as a surgeon without going it alone, and taking junior residents through cases during residency. However, autonomy should be earned and given in gradation.

When looking at programs it becomes important to match your goal with theirs. Large programs with lots of fellows may give less autonomy to residents. A community program who has no fellows, and trains surgeons who go straight into practice may allow more autonomy.

Too much autonomy can be given by senior residents to junior residents on the wards. Juniors may feel isolated, and become judged harshly based on poor decisions. This may take a while to recover from, and is ultimately a bad thing.

 

[Pilot Doc]

It's a fine line. You need to learn and push your boundaries, but ultimately we are responsible for the best possible care for the patient. Mucking your way unsafely through something in the name of autonomy is unprofessional IMHO.

There's also a balance to be struck between teh best possible care for the patient and the best possible care for patients. Holding a resident's hand in the name of safety and then kicking him unprepared, out of sight and out of mind, into the real world doesn't help matters either.

 

[Celiac Plexus]

It's a fine line. You need to learn and push your boundaries, but ultimately we are responsible for the best possible care for the patient. Mucking your way unsafely through something in the name of autonomy is unprofessional IMHO.

I agree with this sentiment. However, a chief resident operating without an attending is not typically "mucking" one's way through a case. If there has been adequate training, then a chief resident, or even a junior resident, should be able to complete cases on their own, safely.

The trend with time outs, and OR checklists, and the like, has been for residents to assume more of the observer role and less of the participant/leader role IMHO. That's not to say that time outs, or checklists are inherently bad things because there is evidence that these things make the OR a safer place. However, speaking from experience, there is a lot of learning that goes on when you don't have an experienced attending "assisting" you through a case.

The pendulum has swung pretty far toward less resident autonomy. How that affects training remains to be seen.

 

[teddybear]

The OP is asking about AUTONOMY not ANATOMY.