Use of decision-based simulations to assess resident readiness for operative independence

Background Recent literature has called into question resident readiness for operative independence at the end of general surgery training.

Methods We used a simulation-based exit examination to assess resident readiness. Six chief residents performed 3 simulated procedures: bowel anastomosis, laparoscopic ventral hernia (LVH) repair, and pancreaticojejunostomy. Faculty assessed resident performance using task-specific checklists, Objective Structured Assessment of Technical Skills (OSATS), and final product analysis.

Results Residents' individual task-specific checklist scores ranged from 25% to 100% across all 3 procedures. Mean OSATS scores ranged from 4.06 to 4.23/5.0. Residents scored significantly higher on "instrument knowledge" (mean = 4.78, standard deviation [SD] = 23) than "time and motion" (mean = 3.94, SD =.48, P =.025) and "ability to adapt to individual pathologic circumstances" (mean = 4.06, SD =.12, P =.002). Final product analysis revealed a range of errors, including incorrect technique and poor intraoperative planning.

Conclusions Despite relatively high OSATS ratings, residents had a wide range of errors and procedure outcomes. Exit assessments using multiple evaluation metrics may improve awareness of residents' learning needs.