ImportanceAs the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs.ObjectiveTo assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs.Design, Setting, and ParticipantsThis cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level.Main Outcomes and MeasuresObserved resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients.ResultsA total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years’ experience: 67 [20.9%]; 6-14 years’ experience: 186 [58%]; ≥15 years’ experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P < .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P < .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions.Conclusions and RelevanceFaculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.

中文翻译：

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教师信任度和居民信任度

重要性随着外科教育范式转变为可信赖的专业活动，需要更好地理解与住院医师可信赖性相关的因素。之前的工作已经证明术中教师的信任与住院医师的信任度相关。然而，需要更大规模的研究来了解这种关联是否存在于各种外科培训项目中。目的评估术中住院医师的行为，并确定在 4 个大学外科培训项目中，教师的信任是否与住院医师的信任度相关。设计、设置和参与者这项横断面研究是在 2018 年 10 月至 2022 年 5 月期间在 4 个大学外科培训项目中进行的。OpTrust 是一种经过验证的工具，旨在独立评估术中教职人员的信任和住院医师的委托行为，用于评估教职人员与住院医师的互动。总共观察了 94 名教职员工和 129 名住院医师。有目的的抽样用于在所执行的手术类型、病例难度、教职人员与住院医师配对、教职人员经验和住院医师培训水平方面产生差异。主要结果和措施比较观察到的住院医师可信任度分数（1-4 级，其中 4 表示完全可信赖）报告的衡量标准（教师级别、案例难度、住院医师研究生年份[PGY]、住院医师性别、观察月份）和观察到的教师委托分数（1-4 级，其中 4 表示完全委托）。路径分析用于探索预测变量的直接和间接影响。采用两两Pearson相关系数评估住院医师信任度与教师信任度之间的关联。结果共观察338例病例。观察到的病例按教师经验均匀分布（1-5年经验：67 [20.9%]；6-14年经验：186 [58%]；≥15年经验：67 [20.9%]），常驻PGY （PGY 1：28 [8%]；PGY 2：74 [22%]；PGY 3：64 [19%]；PGY 4：40 [12%]；PGY 5：97 [29%]；≥PGY 6： 36 [11%]），以及居民性别（女性：183 [54%]；男性：154 [46%]）。在单变量水平上，PGY（平均 [SD] 居民可信度评分范围，PGY 1 为 1.44 [0.46]，PGY 6 为 3.24 [0.65]；F= 38.92；磷< .001）和教职人员委托（2.55 [0.86]；右2= 0.94；磷< .001）与居民的信任度显着相关。路径分析表明，教师的信任与住院医师的信任度相关，并且 PGY 与住院医师的信任度之间的关联是由所有 4 个机构的教师的信任度来调节的。结论和相关性在各种外科培训项目中，教师的信任度仍然与住院医师的信任度相关。这些发现表明，努力发展教师的信任行为可以通过促进住院医师的信任来增强术中教学和住院医师的进步。