Enhancing resident perceptions of autonomy, education, and psychological safety: effects of implementing a senior resident-led team-based service model on a trauma and acute care surgery rotation

Team-based service models (TBSMs) may result in greater satisfaction and perceptions of teamwork among residents. However, the applications of TBSMs in general surgery (GS) residency are poorly understood. We evaluated the implementation of a TBSM on the educational and operative experiences of GS residents on a trauma and acute care surgery (TACS) rotation.

A survey study was conducted to examine the impact of piloting a senior resident-led TBSM, focused on the principles of resident autonomy, teamwork, and patient care continuity, on the TACS rotation at a high-volume (> 5000 TACS-related admissions annually), urban Level 1 adult trauma center. Within the TBSM, GS residents and advanced practice providers were redistributed to form clinical teams. All GS residents were surveyed 2 months prior to (“pre-implementation group”, PRE) and 10 months after the implementation of the TBSM (“post-implementation group”, POST). The survey questions were scored on a five-point Likert scale. The survey responses were compared using descriptive statistics and Fisher’s exact test.

In total, 38 of 54 (70.4%) residents completed PRE surveys and 38 of 55 (69.1%) residents completed POST surveys. The residents reported significantly increased overall rotation satisfaction (23.5% PRE vs. 71.1% POST; p < 0.001) with the TBSM. The residents also reported an increased sense of team camaraderie (35.1% PRE vs. 81.6% POST; p < 0.001) and collaboration with other trainees (29.7% PRE vs. 76.3% POST; p < 0.001). Senior residents were more successful in incorporating teaching into their workflow (16.7% PRE vs. 76.9% POST; p = 0.041) with the TBSM. Intern and junior resident satisfaction with the quality of teaching during rounds also improved (33.3% PRE vs. 64.0% POST; p = 0.032). The senior residents reported significantly more autonomy in operative planning (16.7% PRE vs. 76.9% POST; p = 0.041) and performing level-appropriate operations (33.3% PRE vs. 100% POST; p = 0.004) within the TBSM. The residents also reported significantly less mental and emotional fatigue after in-house call (82.9% PRE vs. 47.4% POST; p = 0.003) and that the overall workload during in-house call felt more reasonable (22.9% PRE vs. 63.2% POST; p < 0.001) within the TBSM.

Implementation of a TBSM on a TACS rotation is feasible and can enhance GS resident perceptions of camaraderie, autonomy, education, and psychological safety.