Intraoperative Entrustment in Cardiac Surgery

M. Schultz, J. Burdine, N. Matusko, R. Ozuna-Harrison, D. Buchanan, D. Tubbs, G. Sandhu
University of Michigan, Ann Arbor, Michigan

Purpose: Surgical trainee preparedness for practice is increasingly being measured by competency and entrustability. The OpTrust tool, validated in general surgery, measures entrustment within the faculty-trainee dyad. We aim to adapt OpTrust to cardiac surgery by grounding entrustment scores to the specific sequence of events shared amongst most cardiac cases.

Methods: Elective cardiac surgeries were observed from November 2022 – June 2023. The OpTrust tool was used to assign a global entrustment score to each case (2 = low, 8 = full). Fifteen surgical benchmarks were defined, and it was noted whether the faculty or trainee performed that benchmark (“Faculty-Led” vs. “Trainee-Led”). Benchmarks that were unobserved or absent in a given case were excluded from analysis. Global entrustment scores for cases with Faculty-Led benchmarks were compared to scores for cases with Trainee-Led benchmarks using a Student’s two-tailed t-test. Analysis was not performed on benchmarks with one or fewer cases in a category. Additionally, entrustment scores were compared between majority Faculty-Led versus majority Trainee-Led cases. Significance was set at p< 0.05.

Results: Forty-nine cases performed by twelve trainees and seven faculty were observed by three raters. For most benchmarks, the global entrustment score is significantly different between cases where the benchmark was Faculty-Led and cases where the benchmark was Trainee-Led. The only exception is Protamine Administration (Table 1). Entrustment is also significantly different between cases that were majority Faculty-Led versus Trainee-Led (Figure 1).

Conclusion: Applying the OpTrust tool to the cardiac surgery operating room’s specific environment is feasible. Our data suggest that the chosen surgical benchmarks are meaningful, and the member of the faculty-trainee dyad that performs them is associated with entrustment. Herein we lay the groundwork for further analysis of the factors that may influence entrustment in cardiac surgery.

Identify the source of the funding for this research project: None