P2D319: Defining Practice Readiness in Pediatric Surgery Fellowship: A Qualitative Analysis

Background: General surgery residents may not be universally ready to operate independently at the time of graduation. While competency-based training is on the forefront of educational innovation in general surgery, pediatric surgery training programs should not wait for downstream changes. In a field where there are multiple infrequent index procedures, minimum case requirements and milestones for trainees may not adequately reflect a fellow’s readiness to perform a procedure without supervision. There is currently no consensus on what it means for a pediatric surgery fellow to be “practice-ready”. In this study, we sought to better understand how practicing surgeons perceive practice readiness and competency in pediatric surgery fellows. We aimed to provide a framework for better defining competency and practice readiness in a way that can support the milestones and allow for improved assessment of pediatric surgery fellows.

Methods: We developed a qualitative interview guide with 9 questions focused on how faculty recognize competency and advance autonomy among pediatric surgery fellows. We interviewed pediatric surgery attendings using snowball sampling for approximately 25 minutes each. All demographic information including race, gender, hospital and years of experience was collected using an anonymous online survey platform. We iteratively reviewed data from each interview to ensure adequate information power was achieved to answer the research question. Interviews were recorded on Zoom with transcription documentation for accuracy. All transcripts were uploaded to Nvivo coding software. We used inductive reasoning and thematic analysis to determine appropriate codes. Through this method, we generated common themes.

Results: We identified four major themes from 127 codes that practicing pediatric surgeons associate with practice-readiness of a fellow: skill-based competency, the recognition and benefits of struggle, developing expertise and facilitating autonomy, and difficulties in variability of evaluation. Competency was further divided into interpersonal vs technical skills (Table 1). Sub-themes within struggle included personal and professional struggle, benefits of struggle and how to identify and assist those who are struggling (Table 2). Autonomy was commonly stated as variable based on the attending’s as well as the resident’s confidence level and the resident’s ability to make independent decisions. Lastly, evaluation was found to be a combination of both objective and subjective measures with variability in the frequency of occurrences.

Conclusion: Qualitative analysis of interviews of practicing pediatric surgeons yielded several themes associated with practice readiness of pediatric surgery fellows. We aim to further refine our list of themes using the Dreyfus Model as our interpretive framework and establish consensus amongst the community of pediatric surgeons in order to define what are the key elements that make a fellow practice-ready or competent. Further work will then focus on establishing assessment metrics and educational interventions directed at achieving such key elements.