Evaluation of Senior General Surgery Residents in the Teaching Assistant Role for Inguinal Hernia Repair

• First systematic evaluation of senior residents in the TA role for IHR. • Technical skill strongly correlated with teaching effectiveness in TA cases. • Higher autonomy is associated with stronger technical performance. • Technical proficiency may identify readiness for operative teaching. To evaluate senior General Surgery residents’ performance in the teaching assistant (TA) role during inguinal hernia repair (IHR) and examine relationships among technical skills, teaching effectiveness, and operative autonomy. Observational study using an explanatory correlational design. John Cochran Veterans Affairs Medical Center training General Surgery residents from Washington University in St. Louis and St. Louis University. PGY-4 and PGY-5 General Surgery residents serving as TA or in Chief Resident role during IHR performed between July 2023 and March 2024. Evaluations were completed for 16 of the 47 eligible IHRs (34% response rate). Case distribution was 63% open and 37% robotic. The mean technical score was 16.6 (±1.8, out of 20), and the mean teaching score was 17.2 (±1.9). Technical and teaching scores were strongly correlated (r = 0.81, p = 0.002). Technical scores demonstrated a strong correlation with the Zwisch autonomy score (rho = 0.60, p = 0.05), whereas teaching scores showed a more modest association that did not meet statistical significance (rho = 0.54, p = 0.085). Senior residents perform well in the teaching role for open IHR, which were the primary context in which formal TA activity occurred. Technical performance strongly correlates with teaching performance. Future work should explore strategies to enhance teaching skills prior to independent practice.