Improving Resident Experience On Vascular Surgery By Standardizing Dissemination Of Operative Steps

Surgical residency programs have experienced a shift in resident procedural experience due to technologic advancements and resident work hour restrictions, making it imperative to maximize learning from each operative case. Studies on surgeon perspective identified "coming prepared to operate" and "knowing what comes next" as the most important principles a trainee can learn. However, the way in which a case is performed varies by attending preference, institutional resources, and regional variability. Literature has shown these attending preferences informally documented by residents is a highly utilized resource. The objective of this study was to assess the effect of providing standard operative steps and attending preferences on surgical resident performance in Vascular Surgery. This prospective observational study with a survey-based design was approved by the IRB. Vascular operative steps for 24 different vascular surgery operations were created and attending variations reviewed with each vascular attending. These steps were made available to participating residents on Google Drive at the beginning of each rotation. We assessed resource utilization and overall self-perception of performance in operative knowledge based on previously validated surveys. There were a total of 31 residents that rotated on Vascular Surgery as a junior who completed the survey. On a scale of 0 indicating never used and "5" indicating every-day use, advice from colleagues was the most frequently utilized resource (3.2 ± 0.97), followed by web-based materials (3.1 ± 1.2). Of the web-based materials, almost all residents utilized Google searches (81%) over other web-based resources designed to specifically help surgical trainees. The vascular operative steps resource created was used by 90% of residents more than three times per week to prepare for cases. There was significant improvement in patient positioning, instrument selection, operative field exposure, anatomy, sequence of procedure, procedure choices, and perioperative care knowledge (Fig 1). The vascular operative steps resource created was the most frequently used resource by vascular surgery junior residents and led to self-rated improvement in many domains of operative knowledge. Development of institutional resources that specifically capture attending surgeon procedural variations can improve resident performance, encourage resident autonomy, and provide a catalog of approaches to challenging operative situations.