Evaluating the Impact of Effective Neurosurgical Educators on Resident Operative Progression Using the Surgical Autonomy Program

INTRODUCTION: Surgical education remains a core goal of all neurosurgical programs, however limited research exists on the impact of highly effective educators vs. less effective educators on trainee progression1. METHODS: The SAP breaks a surgical case into four zones of proximal development (ZPD). For each ZPD, residents are evaluated on a 4-tier autonomy scale (“stages) (TAGS scale: T: Teach/Demonstrate, A: Advise/Scaffold, G: Guide/Monitor, S: Solo/Observe) in a surgical case. All neurosurgery residents at Duke University Hospital from July 2017-July 2021 participated in this study. Trainee autonomy was rated by both attendings and residents, and resident progression was defined as the difference in a resident’s autonomy for a case compared to the resident’s prior comparable case. Relative Value Units (RVUs) were utilized to correct for difficulty of an index case. Faculty were divided into performance quartiles (top – “strong educators”, bottom – “poor educators”). RESULTS: There were a total of 3993 cases logged by 28 different residents and 27 attendings. Resident progression was significantly higher with strong educators compared to poor educators, both when evaluated by the attending (+1 stage vs. -1 stage, p = .002) and by the resident (+1 vs. -0.5 stage, p = .001). Resident regression was noted in the poor educator cohort. Differences in resident progression remained when accounting for difficulty of cases (resident self-evaluation, p < .0001; attending evaluation, p = .002). CONCLUSIONS: Differences exist in the quality of neurosurgical educators. Strong educators compared to poor educators make a demonstrable difference in resident surgical progression. Poor educators are associated with resident autonomy regression. Moving forward, the SAP will be used to provide faculty feedback on the quality of their surgical instruction.