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The Josiah Macy Jr. Foundation
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Our Grantees

Across the Foundation’s priority areas, our grantees are working to improve the health of the public through innovative research and programs.  The Foundation awards up to 40 grants on a rotating schedule each year.

A New Model for Clinical Education and Progressive Entrustment of Residents in the Operating Room

Theme: New Models for Clinical Education

Institution: University of Michigan

Grant Type: Board Grant

Award Amount: $352,589

Grant Awarded: May 2015

Principal Investigator: Gurjit Sandhu, PhD

The degree of autonomy surgical residents experience in the operating room (OR) has decreased, and a growing number of residents are finishing training without sufficient experience or confidence to practice autonomously. While faculty supervision in the OR is essential, there has been a failure to ensure the residents’ progression to independence. This project in the Department of Surgery aims to develop the competence of faculty to evaluate residents’ capabilities and guide them to achieve graduated autonomy so that they can operate independently by the completion of training. Ninety faculty surgeons will be randomized into a group that receives formal faculty development training and one that does not. Residents will have equal exposure to both groups. OpTrust, a tool scored by an independent rater in the OR, has been developed to evaluate faculty-resident interactions and to help assess faculty progress in entrustment of residents. Another tool, the Zwisch Scale, will be used to rate the level of operative autonomy of the resident at the conclusion of a case. The intervention group of faculty, and all residents, will be taught separately about the framework that informs trusting behaviors. Then the faculty intervention group and the residents will each have a training session focusing on OpTrust and the Zwisch Scale. The hierarchical nature of surgery departments and training makes it unlikely, though not impossible, that residents working with both trained and untrained faculty will influence the behavior of the latter group. There has been considerable interest in the problem and in this project elsewhere. The methodology could be applied to faculty behavior in both procedural and non-procedural specialties.