‘The other right’: control strategies and the role of language use in laparoscopic training

• Published in: Medical education Vol. 51; no. 12; pp. 1269 - 1276
• Main Authors: Emmerton‐Coughlin, Heather, Schlachta, Christopher, Lingard, Lorelei
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.12.2017
• Subjects: Cholecystectomy, Laparoscopic - instrumentation; Cholecystectomy, Laparoscopic - methods; Education, Medical, Graduate; General Surgery - education; Humans; Internship and Residency; Language; Laparoscopy; Medical education; Minimally Invasive Surgical Procedures - methods; Patient safety; Spatial Navigation; Surgeons; Videotape Recording
• ISSN: 0308-0110; 1365-2923; 1365-2923
• DOI: 10.1111/medu.13420

Context Laparoscopic techniques present a particular challenge to the academic surgeon in maintaining control and patient safety. The authors explored the use of verbal and physical control strategies including deixis, language used to locate subject in spatio‐temporal, social and discoursal contexts, in this setting. Methods Forty cases of laparoscopic cholecystectomy at an academic centre were video and audio‐recorded. Surgeon and trainee discourses and physical gestures during the crucial anatomical steps of the operation were qualitatively analysed using a hybrid inductive and deductive technique with explicit attention to the use of deixis. Results Laparoscopic surgeon educators use verbal and physical strategies and engage in bidirectional communication to maintain indirect control of an operation where direct control is not possible. Among verbal strategies, deictic language predominates. Discussion As in open surgery, laparoscopic surgical educators attempt to exert control over surgical procedures when the instruments are in the hands of a trainee. One dominant strategy is the use of deictic language, which may be ambiguous. In addition to the physical manoeuvres and bidirectional communication used to disambiguate, instructors must attend to potential uncertainties and explicitly clarify frames of reference in order to enhance educational experiences and maximise patient safety.