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Invited Commentary
September 07, 2016

Sometimes Wrong, Always In DoubtIs There a Crisis of Confidence in General Surgery Residents?

Author Affiliations
  • 1STRATUS Center for Medical Simulation, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
  • 2Department of Surgery, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
JAMA Surg. Published online September 7, 2016. doi:10.1001/jamasurg.2016.2825

The aphorism, “whether you believe you can or believe you can’t, you’re right” is usually attributed to Henry Ford, the great industrialist, but it seems appropriate in a surgical context. Confidence is an essential aspect of performance and there are few arenas where it can be more critical than in the operating room. In this issue of JAMA Surgery, Elfenbein1 describes a systematic review of studies on the level of general surgical residents’ confidence. She found that most, but not all, studies suggest that such confidence is low. This seems to agree with a frequent observation that “things ain’t the way they used to be,” usually accompanied by the suggestion that our graduates are not ready for independent practice. However, Elfenbein1 argues that this is not an attribute that is easy to define or measure, and there is no standard test of confidence to establish readiness for independent practice. With a lack of historical data to compare current residents against previous generations, a counter-argument is that perhaps things were never that way in the first place. There is no doubt that each surgical cohort has unique challenges and opportunities that provide a foundation for building confidence. For the current generation, it has been suggested that reduced autonomy, advancing technology, reduced work hours, and the increasing role and presence of subspecialist trainees are defining characteristics that may have reduced confidence—but is this really so bad?

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