Mind the Gap: Confidence Declines with Increasing Surgical Complexity Among Obstetrics & Gynecology Residents

Abstract

Introduction: Confidence is a crucial trait for surgeons to develop. Research has shown that confidence levels among surgical trainees are declining. A survey of 653 graduating General Surgery residents revealed that over 25% felt uncertain about performing the surgeries expected of them (Fonseca et. al, 2014). Methods: IRB approval obtained to survey 18 Obstetrics & Gynecology (Ob/Gyn) residents at a single, academic program on their confidence in three areas: performing surgeries, seeking feedback, and communicating with the attending physicians. The surgeries assessed ranged from low-complexity (hysteroscopy with dilation and curettage) to medium-complexity (laparoscopic hysterectomy) and high-complexity (exploratory laparotomy, total abdominal hysterectomy, and tumor debulking). Results: For low-complexity surgeries, residents reported high median confidence levels: 9/10 for performing (IQR 5, 9), seeking feedback (IQR 7, 10), and communicating with the attending physician (IQR 7, 10). For medium-complexity surgeries, confidence decreased, with median scores of 6/10 for performing the surgery (IQR 3, 6) and 8/10 for both seeking feedback and communication (IQR 6, 9). Confidence levels were lowest for high-complexity surgeries, with median scores of 2/10 for performing (IQR 1, 3), 5/10 for seeking feedback (IQR 3, 8), and 4.5/10 for communication (IQR 3, 7). Conclusions/Implications: Increased complexity in gynecologic surgeries can diminish residents’ confidence in performing procedures, seeking feedback, and communicating with attending physicians, potentially affecting professional growth and patient safety. A formal curriculum centered on case debriefing and feedback after complex surgeries may enhance residents’ confidence and improve care quality.