In this surgical education episode, the Cleveland Clinic General Surgery Education Team explores the past, present, and future of resident autonomy in the operating room. With guest colorectal surgeons Dr. Tracy Hull (recently retired) and Dr. David Rosen (early career faculty), we discuss how autonomy was granted in “the good ole days,” how educational culture and institutional pressures shape current practice, and what thoughtful autonomy looks like moving forward. Through candid stories—from emergent cases and missed enterotomies to thumbtacks pulled off the wall to stop bleeding—we get a nuanced look at what surgical independence really means, and how to responsibly develop it. Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE, for this conversation about what it means to train competent, confident, and independent surgeons. Learning Objectives By the end of this episode, listeners will be able to 1. Define operative autonomy and its educational value in surgical training 2. Identify barriers to providing resident autonomy in modern surgical environments 3. Discuss strategies for tailoring autonomy to the skill level and readiness of the trainee 4. Describe approaches to communicating resident involvement to patients References 1. Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ. Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases. J Surg Res. 2023;281(k7b, 0376340):328-334. doi:10.1016/j.jss.2022.08.041 https://pubmed.ncbi.nlm.nih.gov/36240719/ 2. Teman NR, Gauger PG, Mullan PB, Tarpley JL, Minter RM. Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy. J Am Coll Surg. 2014;219(4):778-787. doi:10.1016/j.jamcollsurg.2014.04.019 https://pubmed.ncbi.nlm.nih.gov/25158911/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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