Is confidence an appropriate measure of competence? A Viewpoint published in the March issue of JAMA Surgery explores this question.
Research shows general surgery residents lack confidence in their operative abilities, and the surgical community increasingly perceives its residents to be less confident—and less competent—than previous generations.
But “there is no current evidence to support the perception that graduating residents today are less competent than general surgery residents in the past,” the Viewpoint said. “If graduating surgical residents are not less competent, then why might they be less confident?”
According to the article, only 72 percent of residents believe their ability is “level appropriate,” and 26 percent are concerned they won’t feel confident enough to perform procedures independently.
A lot of factors may be contributing to this lack of confidence. Residents now are expected to master an exponentially growing scientific and medical knowledge base and a more advanced surgical skill set. Duty-hour restrictions mean there’s less time to accomplish these things.
While the total number of cases performed by residents hasn’t changed much, the case mix has changed dramatically, including a wider distribution of more complex procedures. Patient volumes and complexities are increasing, and patient turnover is more rapid.
Besides regulatory changes and information expansion, there is increased professional scrutiny in the field. Electronic health records make adverse outcomes more easily documented and tracked, and clinical performance is much more public and transparent. New surgeons also are concerned with litigation— three out of four surgical residents report being taught to take liability concerns into account when making clinical decisions, instilling a fear of litigation and potentially altering practice patterns.
Taking a multitude of factors into consideration, the Viewpoint concluded, “perhaps we should not view graduating general surgery residents as unprepared or unqualified for autonomy, but instead as cautious and wise in today’s high-stakes practice environment.”
