EP753 - Instituting a Colectomy Proficiency Initiative Provides Longitudinal Operative Feedback for Colorectal Surgery Subspecialty Residents

Purpose/Background: Within surgical training, consistent formalized feedback on operative progress and independency is lacking. In subspecialty fellowship training such as in colorectal surgery subspecialty training, formalized feedback is especially difficult. Interestingly, the Accreditation Council for Graduate Medical Education (ACGME) does not require programs to provide trainees with standardized operative feedback. For residents pursuing subspecialty training, attaining operative independence is a primary goal of training and a longitudinal tool to track progress would be beneficial.

Methods/Interventions: A colectomy proficiency initiative was developed at an ACGME-accredited colorectal surgery program with 12 teaching faculty and 4 subspecialty residents per year. An operative feedback tool (OFT) was developed to track residents' operative proficiency progression over the course of an academic year. Three procedures were included; right colectomies, left/sigmoid colectomies, and low anterior resection (LAR). All are index cases in colorectal subspecialty training and comprised of discrete, identifiable skills useful in objectively evaluating operative proficiency. The OFT queried attendings and residents about perceived residents' proficiency in completing key components of procedures and overall proficiency using a Likert scale. This was distributed via electronic survey and required to be completed within 48 hours of a qualifying procedure. Participants were provided with periodic graphical reports tracking their responsiveness and operative proficiency progress.

Results/Outcomes: The data from this quality improvement initiative for the academic year ranging from 8/1/24 to 7/31/25 was reviewed. There was a total of 245 responses available for analysis. More attending physicians responded (61.6%) to survey requests compared to residents (38.4%). When examining all procedures performed, residents perceived independence increased over the academic year (2.19 vs 5.00, p=0.0004). Attending physicians also perceived an increase in residents' operative independence (3.21 vs 4.44, p=0.0019). Upon subgroup analysis within academic quarters, attending physicians perceived a greater level of operative autonomy compared to residents in the first academic quarter (3.21 vs 2.19, p=0.0004) (Figure 1).

Conclusion/Discussion: Formalized structured operative feedback is essential to all surgical training but is especially important in subspecialty training programs prior to independent practice. Any OFT requires consistent participation from both surgical trainees and attending physicians to be of ongoing utility. With participation from both attending surgeons and residents, our OFT showed successful key colectomy skill acquisition and demonstrated an increase in residents perceived overall operative proficiency over the course of an academic year in three selected index operations in an ACGME-accredited colorectal surgery program. Residents appear to have a poorer opinion of their own subjective proficiency early in training compared to their training faculty. The reason(s) for this discrepancy are unknown but may warrant further investigation. It is reassuring and expected that residents' perceived operative independence within a subspecialty fellowship improves over the academic year, and our data verify successful skill training. We will continue to utilize this OFT in our training program and hope to provide further data for opportunities to use across the county.

Figure 1. Perceived Resident Operative Independence.