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percentage of knowledge gained from residents as equal to or greater than that
gleaned from faculty, second only to what is gathered from their own independent
study efforts [ 1 , 3 – 5 ].
Challenges Encountered in Preparing Residents to Teach
In order for surgical residents to teach junior house staff and medical students, the resi-
dent must first themselves develop the technical skills and clinical knowledge required
to perform operative tasks and manage complex patients. The increasing demands of
documentation and electronic health records, alongside the pressures of duty hour
reform, have created a challenging environment for such development. Recent studies
have shown that there is a gap between the amount of experience US general surgery
graduates receive while in residency and what is expected [ 6 ]. Bell et al. performed a
study which categorized operative procedures that graduating residents were expected
to be able to perform independently. This study identified a large variation of experience
between residents nationwide and many cases in which residents had limited or no expe-
rience yet were expected to achieve competence. Accordingly, many graduating resi-
dents do not feel confident to enter independent general surgery practice following
residency, and this may be a significant factor in motivating them to pursue further train-
ing in fellowship [ 7 ]. Finally, Pugh et al. reported that surgical faculty and residents have
significantly different perceptions of residents’ learning needs, especially as pertained to
learning goals and priorities in the operating room [ 8 ]. All these factors represent signifi-
cant challenges facing residents seeking to develop their own competence as a requisite
foundation for teaching and instructing junior residents and students.
There are many factors contributing to this decrease in experience and lack of
confidence in the current training paradigm. Kairys et al. evaluated operative experi-
ence among general surgery residents since the implementation of the 80-h work
duty restrictions [ 9 ]. They observed a decrease in total major cases, cases performed
as a chief resident, and, most significantly, cases logged as both first assistant and
teaching assistant. This decrease in teaching assistant cases and first assistant cases
represents a significant loss of educational opportunities, not only for the junior
resident but also for the chief resident practicing and refining his or her ability to
teach. Additionally, there has been a shift in the degree of autonomy allotted to a
resident in many programs due to the general public’s expectations and supervision
requirements. Whereas in the past, many programs offered a “chief-run” service in
which the chief resident performed cases not directly supervised by the attending
physician, this experience is now lacking in many programs. With increased super-
vision requirements and expectations, and decreased operative case volume, gradu-
ating residents may feel inadequately prepared to commence the independent
practice of general surgery, as well as to give their time and personal experience
opportunity to teach more junior learners.
Recognizing these challenges, there are conversely some very important reasons
why residents may be the most effective teachers for junior colleagues and students.
We will now turn to detailing some of these.
J. Feimster et al.