It's not that SIMPL-Identifying deficiencies in general surgery trainees' autonomy and competence performing parathyroidectomy and thyroidectomy

Background: Although many parathyroid and thyroid operations are performed by nonfellowship-trained general surgeons in the United States, there is growing uncertainty of whether graduating residents can perform these procedures competently. This study investigates trends in competency and autonomy among general surgery residents performing parathyroid and thyroid operations using a national survey-based dataset.

Methods: A retrospective analysis of the Society for Improving Medical Professional Learning database was performed. Case data from categorical general surgery residents performing parathyroidectomy or thyroidectomy between 2015 and 2023 were included. Competent performance and meaningful autonomy were dichotomized on the basis of faculty surgeon responses. Agreement between resident and faculty evaluations were assessed. Logistic regression was used to examine resident performance and autonomy using postgraduate year level and case complexity as covariates.

Results: The study included 907 parathyroidectomies and 1,555 thyroidectomies from 724 residents at 77 residency programs. Competent performance was observed in 34.0% of parathyroidectomies and 38.6% of thyroidectomies. Meaningful autonomy was observed in 31.6% of parathyroidectomies and 32.3% of thyroidectomies. Residents and faculty agreed on performance (50.3%) and autonomy (59.1%) in most cases, however when discordant residents often underestimated their performance (44.7%) or autonomy (25.3%). The likelihood of postgraduate year 5 residents demonstrating competent performance or meaningful autonomy was 65.9% and 51.6%, respectively for parathyroidectomy and 77.2% and 58.4%, respectively for thyroidectomy.

Conclusion: Many graduating residents do not demonstrate competent performance or meaningful autonomy in parathyroidectomy and thyroidectomy. Further initiatives are needed to improve graduating general surgeons' competence for these operations, given access disparities to high-volume endocrine surgeons.