Who Picks Up the Slack? Impact of Interprofessional Role Ambiguity on Resident Education, Team Function, and Patient Care.

Abstract

GME unfolds in high-stakes clinical environments where residents function as both learners and frontline providers. In surgery, rising case volume, staffing shortages, and rapid expansion of advanced practice provider (APP) roles have intensified long-standing tensions between education and service. Although APPs are essential to continuity and efficiency, their integration has often outpaced the development of shared expectations and competency-based frameworks. The result is role ambiguity-most visible during periods of workload surge-about who should absorb excess demand. Unclear responsibility for "picking up the slack" disrupts teamwork, redistributes learning opportunities, increases cognitive load, and contributes to burnout among both residents and APPs. These effects are amplified by short resident rotations, APP continuity, and the absence of formal mechanisms to guide workload redistribution.