Improving the feasibility and utility of OpTrust—A tool assessing intraoperative entrustment

Published:November 01, 2017DOI:


      • Using OpTrust, short-course video-based review of intraoperative interactions reliably assessed entrustment behaviors.
      • This observation form demonstrated feasibility, utility, and non-disruptive approach to assessment of operative entrustment.
      • OpTrust lends itself to qualitative and quantitative feedback related to entrustment in procedural-based specialties.



      Changes in the surgical training landscape have sparked an interest in developing new educational models anchored on entrustment assessment. We sought to optimize the validated OpTrust entrustment assessment tool by comparing ratings from short-course video reviews to previously validated intraoperative assessments.


      Entrustment assessment scores for video-based and 1-h (short-course) observations were compared to previously validated intraoperative assessment scores. Faculty and residents were surveyed for their perceptions related to operative observation.


      There was a strong association between entrustment scores when comparing in-person to video-based observations (R2 = 0.76–0.84, p < 0.01) as well as short-course to full-duration observations (R2 = 0.65–0.76, p < 0.01). The majority of faculty and residents (>97%) felt observation did not negatively impact operative experience.


      Assessment of entrustment behaviors using short-course video review provides a feasible approach to intraoperative assessment. This latest application of OpTrust allows for the tool to be incorporated into surgical training programs across a variety of environments.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hashimoto D.A.
        • Bynum W.E.
        • Lillemoe K.D.
        • Sachdeva A.K.
        See more, do more, teach more: surgical resident autonomy and the transition to independent practice.
        Acad Med. 2016 Mar 1; 91 (PubMed PMID: 26934694): 757-760
        • Sandhu G.
        • Teman N.R.
        • Minter R.M.
        Training autonomous surgeons: more time or faculty development?.
        Ann Surg. 2015 May; 261 (PubMed PMID: 25575257): 843-845
        • Scally C.P.
        • Sandhu G.
        • Magas C.
        • et al.
        Investigating the impact of the 2011 ACGME resident duty hour regulations on surgical residency programs: the program director perspective.
        J Am Coll Surg. 2015 Oct; 221 (883–889 e1. PubMed PMID: 26272015. Pubmed Central PMCID: 4569491)
        • Mattar S.G.
        • Alseidi A.A.
        • Jones D.B.
        • et al.
        General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors.
        Ann Surg. 2013 Sep; 258 (PubMed PMID: 24022436): 440-449
        • Sandhu G.
        • Magas C.P.
        • Robinson A.B.
        • et al.
        Progressive entrustment to achieve resident autonomy in the operating room: a national qualitative study with general surgery faculty and residents.
        Ann Surg. 2017 June; 265 (PubMed PMID: 27163961): 1134-1140
        • Napolitano L.M.
        • Savarise M.
        • Paramo J.C.
        • et al.
        Are general surgery residents ready to practice? A survey of the american college of surgeons board of governors and young fellows association.
        J Am Coll Surg. 2014 May; 218 (1063–1072 e31. PubMed PMID: 24661851)
        • Kempenich J.W.
        • Willis R.E.
        • Rakosi R.
        • et al.
        How do perceptions of autonomy differ in general surgery training between faculty, senior residents, hospital administrators, and the general Public? A multi-institutional study.
        J Surg Educ. 2015 Nov-Dec; 72 (PubMed PMID: 26160132): e193-201
        • Teman N.R.
        • Gauger P.G.
        • Mullan P.B.
        • et al.
        Entrustment of general surgery residents in the operating room: factors contributing to provision of resident autonomy.
        J Am Coll Surg. 2014 Oct; 219 (PubMed PMID: 25158911): 778-787
        • Soper N.J.
        • DaRosa D.A.
        Presidential address: engendering operative autonomy in surgical training.
        Surgery. 2014 Oct; 156 (PubMed PMID: 25239310): 745-751
        • Aggarwal R.
        Entrustment, autonomy, and performance in the operating room.
        Surgery. 2015 Oct; 158 (PubMed PMID: 26298031): 1113-1115
        • Sterkenburg A.
        • Barach P.
        • Kalkman C.
        • et al.
        When do supervising physicians decide to entrust residents with unsupervised tasks?.
        Acad Med. 2010 Sep; 85 (PubMed PMID: 20736669): 1408-1417
        • Ten Cate O.
        • Hart D.
        • Ankel F.
        • et al.
        Entrustment decision making in clinical training.
        Acad Med. 2016 Feb; 91 (PubMed PMID: 26630606): 191-198
        • Sandhu G.
        • Nikolian V.C.
        • Magas C.P.
        • et al.
        OpTrust: validity of a tool assessing intraoperative entrustment behaviors.
        Ann Surg. 2017 Mar 27; (PubMed PMID: 28350564. [Epub ahead of print])
        • Team RC
        R: A Language and Environment for Statistical Computing.
        R Foundation for Statistical Computing, Vienna, Austria2013 (ISBN 3-900051-07-0; 2014)
        • Rekman J.
        • Hamstra S.J.
        • Dudek N.
        • et al.
        A new instrument for assessing resident competence in surgical clinic: the ottawa clinic assessment tool.
        J Surg Educ. 2016 Jul-Aug; 73 (PubMed PMID: 27052202): 575-582
        • Gofton W.T.
        • Dudek N.L.
        • Wood T.J.
        • et al.
        The ottawa surgical competency operating room evaluation (O-SCORE): a tool to assess surgical competence.
        Acad Med. 2012 Oct; 87 (PubMed PMID: 22914526): 1401-1407
        • George B.C.
        • Teitelbaum E.N.
        • Meyerson S.L.
        • et al.
        Reliability, validity, and feasibility of the Zwisch scale for the assessment of intraoperative performance.
        J Surg Educ. 2014 Nov-Dec; 71 (PubMed PMID: 25192794): e90-e96
        • Birkmeyer J.D.
        • Finks J.F.
        • O'Reilly A.
        • et al.
        Surgical skill and complication rates after bariatric surgery.
        N Engl J Med. 2013 Oct 10; 369 (PubMed PMID: 24106936): 1434-1442
        • Dimick J.B.
        • Varban O.A.
        Surgical video analysis: an emerging tool for improving surgeon performance.
        BMJ Qual Saf. 2015 Aug; 24 (PubMed PMID: 26077990): 490-491
        • Greenberg C.C.
        • Dombrowski J.
        • Dimick J.B.
        Video-based surgical coaching: an emerging approach to performance improvement.
        JAMA Surg. 2016 Mar; 151 (PubMed PMID: 26650338. Pubmed Central PMCID: PMC4794349): 282-283
        • Ibrahim A.M.
        • Varban O.A.
        • Dimick J.B.
        Novel uses of video to accelerate the surgical learning curve.
        J Laparoendosc Adv Surg Tech A. 2016 Apr; 26 (PubMed PMID: 27031876. Pubmed Central PMCID: PMC4845634): 240-242
        • Madani A.
        • Vassiliou M.C.
        • Watanabe Y.
        • et al.
        What are the principles that guide behaviors in the operating Room?: creating a framework to define and measure performance.
        Ann Surg. 2017 Feb; 265 (PubMed PMID: 27611618): 255-267
        • McCambridge J.
        • Witton J.
        • Elbourne D.R.
        Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects.
        J Clin Epidemiol. 2014 08/13; 67 (PubMed PMID: PMC3969247): 267-277