Journal Review in Surgical Education: Resident Autonomy in the Good Ole Days

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 26 June 2025

⏱️ 40 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this surgical education episode, the Cleveland Clinic General Surgery Education Team explores the past, present, and future of resident autonomy in the operating room. With guest colorectal surgeons Dr. Tracy Hull (recently retired) and Dr. David Rosen (early career faculty), we discuss how autonomy was granted in “the good ole days,” how educational culture and institutional pressures shape current practice, and what thoughtful autonomy looks like moving forward. Through candid stories—from emergent cases and missed enterotomies to thumbtacks pulled off the wall to stop bleeding—we get a nuanced look at what surgical independence really means, and how to responsibly develop it.

Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE, for this conversation about what it means to train competent, confident, and independent surgeons.

Learning Objectives
By the end of this episode, listeners will be able to
1. Define operative autonomy and its educational value in surgical training
2. Identify barriers to providing resident autonomy in modern surgical environments
3. Discuss strategies for tailoring autonomy to the skill level and readiness of the trainee
4. Describe approaches to communicating resident involvement to patients

References
1. Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ. Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases. J Surg Res. 2023;281(k7b, 0376340):328-334. doi:10.1016/j.jss.2022.08.041 https://pubmed.ncbi.nlm.nih.gov/36240719/

2. Teman NR, Gauger PG, Mullan PB, Tarpley JL, Minter RM. Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy. J Am Coll Surg. 2014;219(4):778-787. doi:10.1016/j.jamcollsurg.2014.04.019 https://pubmed.ncbi.nlm.nih.gov/25158911/

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Transcript

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0:00.0	Behind the Knife.
0:24.3	This is Patrick Georgeoff, and I want to share an important message.
0:28.4	Our oral board review kicks ass.
0:31.1	We have over 100 scenarios with top-notch commentary to get you prepared for the exam,
0:35.5	or maybe even just prepare for your next rotation.
0:38.5	We're also adding over 30 new scenarios this fall and a brand new interactive video feature
0:43.1	so that you can practice for the real thing. Get quick and easy access via our app for on-the-go use.
0:48.3	It's still the best and it is still significantly less expensive than anything else out there.
0:52.8	Group discounts are available.
0:56.9	Now, enjoy the episode and dominate the day.
1:02.1	Hello and welcome to this episode of Behind the Knife in Surgical Education.
1:06.5	We are the General Surgery Education team from Cleveland Clinic.
1:10.6	I'm Pooja Varmine, a general surgery resident and surgical education research fellow.
1:15.1	I'm Judith French. I'm the Ph.D. Education scientist for the Department of General Surgery,
1:20.0	the Cleveland Clinic. And I'm Jeremy Liman. I'm the D.I. and Director of Graduate Medical Education here.
1:25.0	On today's episode, we discuss resident autonomy in the operating room.
1:28.4	Surgeons who've been in practice a long time now might remember being awarded a frightening amount of independence in the OR, but feeling that it built character
1:33.1	and skills and made them better surgeons. Many surgical residents today worry they don't get enough
1:38.4	autonomy, and there are data supporting that claim, and they feel unprepared for independent
1:42.9	practice by the time they graduate.
1:45.2	Today, we're joined by two surgeons, one early career, and one recently retired to hear
1:49.8	perspectives on the past, present, and future of resident autonomy. How much is the right amount?
	...

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