Effective Senior Residents, as Defined by Their Peers: A Qualitative Assessment

Taylor Coe, MD

PGY4

General Surgery Resident

Department of Surgery

Massachusetts General Hospital
02/29/2020

Surgical training aims to create doctors who are clinically competent and technically sound; however, there are many nontechnical skills that are imperative to surgical practice as well.  These include, and are not limited to, team leadership and management, teaching of all members of the team, such as patients, medical students, advanced care providers and junior residents, communication, and providing feedback. There is a clear change in role and responsibility that occurs as one transitions from being a junior to a senior resident in which these nontechnical skills become more prominent and central to successful patient care and team leadership.  Therefore, I plan to use qualitative methods to define what makes an effective senior surgical resident and the current process of leadership and nontechnical skills development in the transition from junior to senior surgical resident.

As all projects begin, first I navigated IRB approval. This was a monumental exercise for me, as it was my first IRB application and my first project of my own generation from start to finish. I drafted my proposal and focus group guide and finally submitted, about two months later than I had initially hoped. My first takeaway from this project is that sometimes, the hardest part is just getting started. This task was intimidating and I delayed submission due to my own fears of sharing my work and navigating a new process. Ultimately, I received approval after a round of revisions and was ready to start my focus groups.

Fellows of the MGH Surgical Education Research Group

Here, my first lesson comes into play again. I had approval to start, but now I had to actually recruit the first residents for a focus group. This task brought up a mix of emotions again. I was intimidated to ask my peers to volunteer one hour of their time and to put my research out in the open and receive feedback about a project that I developed and nurtured. The theme continues, in which it took me two extra months to work up the courage to embark on my first focus groups; however, once I started, I found them to be an incredibly insightful and rewarding experience that was beneficial for my work, but also for the participating residents.

So far, I have completed ten focus groups with 23 residents spanning PGY2 to PGY4 residents. I am scheduling the PGY1 and PGY5 residents and will be finished collecting data by the end of March. From there, my next task is qualitative analysis of over fifteen hours of transcription. On preliminary review of the first few focus groups, there are interesting findings starting to take shape. In an effort to first define a senior resident, it is clear that the senior resident has ‘extreme ownership’ of the team resulting in ‘complete responsibility for the patient experience’. The senior resident is viewed as a role model, teacher, and leader who is responsible for not only clinical and technical excellence, but also for management of team morale and creating opportunities for junior autonomy and junior wellness. These skills are mostly obtained through ‘osmosis’ through the gradual transition from junior to senior, with minimal structured education.

Overall, this project has been a wonderful experience for both my own personal growth as a researcher and in defining an effective senior resident. I look forward to completing the project over the next 3 months and using the findings to create a curriculum to help ease the transition from junior to senior resident. This work will be applicable to other programs and hopefully will help all surgeons understand the role of a senior resident in more detail.