Operative Performance and Autonomy Across Training Years: Does a Preliminary Year Matter?

Preliminary surgery positions are associated with a negative stigma, and this stigma may persist for those residents who later go on to obtain a categorical position. However, it is currently unknown if general surgery residents who complete a preliminary year perform differently than their categorical peers throughout training. To examine these potential differences, we compared operative performance and autonomy across all 5 years of training for those who completed a nondesignated preliminary training year with those who did not. Faculty ratings of categorical general surgery residents were collected from the Society for Improving Medical and Professional Learning (SIMPL) application. Residents were categorized based on the completion of a nondesignated preliminary year (“Previous Prelim” [PP]) or not (“Traditional Categorical” [TC]). Operative performance and autonomy ratings were tracked over 5 training years and analyzed using generalized mixed effects models. Performance and autonomy outcomes were dichotomized: “not competent” or “competent” and “no meaningful autonomy” or “meaningful autonomy”, respectively. Fixed effects included cohort group, academic month, case complexity, resident level (junior [PGYs 1 and 2] vs senior [PGYs 3, 4, and 5] residents), and an interaction term between cohort group and resident level, while random effects included resident, faculty, program, and procedure. Operative performance and autonomy ratings were collected from the SIMPL application between 2015 and 2023. A total of 89 general surgery residency programs, which encompassed 1,108 categorical general surgery residents. A total of 42,416 evaluations were analyzed. Of these, 809 evaluations were from PP residents. Faculty ratings of PP vs TC residents revealed no significant differences in adjusted probabilities of achieving a “competent” rating as a junior (5.6%, 95% Confidence Interval [CI] 2.7%-11.1% vs 3.0%, 95% CI 2.4%-3.7%, p = 0.28) or senior (23.7%, 95% CI 12.2%-41% vs 34.1%, 95% CI 29.1%-39.5%, p = 0.59) resident. Similarly, no significant differences were identified in adjusted probabilities of achieving a “meaningful autonomy” rating between PP and TC junior (9.0%, 95% CI 5.4%-14.6% vs 8.1%, 95% CI 6.9%-9.5%, p = 0.97) or senior (42.3%, 95% CI 28.7%-57.1% vs 49.6%, 95% CI 44.9%-54.2%, p = 0.76) residents. PP and TC residents may have similar operative performance and autonomy ratings throughout their residency training. Although further study of more senior residents is warranted, these initial findings could help combat the negative stigma associated with a preliminary year of training.