Operative experiences of preliminary versus categorical general surgery residents

Purpose General surgery training programs should provide equitable experiences to both categorical and preliminary residents, as up to 60% of non-designated preliminary general surgery residents will go on to complete surgical residencies. However, self-reported data suggest that preliminary general surgery residents perceive inferior operative experiences when compared with their categorical peers. In this study, we used workplace-based data to determine if there are differences in operative experiences between categorical and preliminary general surgery residents. Methods This study included operative evaluations for all categorical and preliminary PGY-1 and PGY-2 residents in the Society for Improving Medical Professional Learning (SIMPL) data registry from 2015 to 2023. Comparison of proportions and linear mixed models were used to compare frequency of feedback (both numerical and narrative) as well as mean operative autonomy and operative performance ratings between groups (categorical, designated preliminary, non-designated preliminary) within each PGY cohort. Results 49,737 faculty and resident operative evaluations from 65 institutions were included. Faculty were more likely to complete a SIMPL evaluation for categorical PGY-1’s than for designated or non-designated preliminary PGY-1’s (58 vs. 50% and 58 vs. 48%, respectively; both p < 0.01), and equally as likely to complete a SIMPL evaluation for categorical and preliminary PGY-2’s (54 vs. 52%, p = 0.11). Though performance ratings did not differ by PGY-1 group, both faculty and resident ratings of resident autonomy were lower for non-designated preliminary than categorical PGY-1’s (both p < 0.01). In the PGY-2 cohort, faculty ratings of performance and autonomy were higher for categorical compared to non-designated preliminary residents. Conclusions Though preliminary and categorical general surgery PGY-1’s have similar operative performance ratings, preliminary PGY-1’s (specifically, non-designated preliminary PGY-1’s) have less operative autonomy and are less likely to receive operative feedback than their categorical peers. For PGY-2 residents, preliminary residents continue to have lower operative autonomy ratings, though performance ratings are also lower compared to their categorical peers. More equitable operative experiences may accelerate preparation of preliminary residents for future careers in surgery or other procedural fields.