Autonomy Maps: Building a Shared Mental Model for Progressive Resident Operative Autonomy on the Road to Entrustable Professional Activities (EPAs)

Leah Carey Tatebe*, Kimberly B. Golisch, Lauren M. Janczewski, Mackenzie Krueger, Amy Halverson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Our residents expressed dissatisfaction with operative autonomy and faculty feedback regarding technical skills. They reported variability among faculty regarding allowed operative autonomy. Our goals were to establish a shared mental model among residents and faculty regarding intraoperative performance expectations. We asked faculty to assign a level of expected autonomy (Zwisch scale) for various steps of common procedures according to the resident post-graduate year. Through an iterative process, the maps were standardized across service lines. The resulting “Autonomy Maps” were distributed to the faculty and residents. We held educational sessions and set expectations for use. Selected benchmarks were incorporated into resident end-of-rotation assessment forms. Initial operative case mapping identified variability in faculty expectations for a given post-graduate year and procedure. Residents reported improved satisfaction with understanding expectations regarding operative performance. Establishing autonomy benchmarks facilitated more specific feedback regarding residents’ technical skills. Faculty expectations for resident operative autonomy are variable. Autonomy Maps provide structure for a shared mental model between faculty and residents for progressive operative autonomy and serve as a framework for expectations that improve resident satisfaction. Case-specific technical benchmarks are useful tools for assessing residents’ technical milestones.

Original languageEnglish (US)
Pages (from-to)1351-1354
Number of pages4
JournalJournal of Surgical Education
Volume80
Issue number10
DOIs
StatePublished - Oct 2023

Keywords

  • feedback
  • operative autonomy
  • Patient Care
  • Professionalism
  • resident satisfaction
  • surgical education

ASJC Scopus subject areas

  • Surgery
  • Education

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