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Invited Commentary
June 2018

Surgical Training Is a 2-Way Street—The Faculty-Resident Entrustability Dynamic

Author Affiliations
  • 1General Surgery, Gundersen Medical Foundation, La Crosse, Wisconsin
  • 2Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Surg. 2018;153(6):524-525. doi:10.1001/jamasurg.2017.6122

Teaching operative procedures is complex, involving both teacher and trainee in a dynamic relationship which relies on cognitive ability, motor skills, communication, and professionalism. Sandhu and colleagues at the University of Michigan1 had previously studied progressive faculty entrustment as 1 strategy to achieve the autonomy of residents in the operating room. In a study in this issue of JAMA Surgery, Sandhu et al2 used the OpTrust observational assessment tool3 to find that faculty entrustment behaviors were the primary factors affecting the entrustability of residents (defined as the ability of the trainee to carry out specific tasks unsupervised after the attainment of sustained competence in those tasks). Case difficulty and faculty experience were not found to affect faculty entrustment or resident entrustability, but the postgraduate year of participating residents was associated with resident entrustability. The authors concluded that “it is faculty behavior that propels resident entrustability forward” and suggested that resident autonomy could be addressed by education designed to improve faculty behaviors. While I agree that faculty teaching styles and behaviors are very important to successful surgical training, this is only 1 piece of a complex educational puzzle.

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