Learning Interrupted: Educational Impact of Interruptions on Surgical Residents

• Published in: Journal of surgical education Vol. 79; no. 4; pp. 875 - 884
• Main Authors: Zhang, Chris J., Walser, Eric, Mierzwa, Anna, Ott, Michael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022
• Subjects: education; Humans; Internship and Residency; interruption; Learning; Medical Errors; Ontario; resident; surgery; time-motion study; Workflow; Ontario; ACS; time-motion study; education; Systems-Based Practice; CBME; interruption; Practice-Based Learning and Improvement; TMS; Interpersonal and Communication Skills; surgery; resident
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2022.01.009

The complex workflow of surgical residents in the workplace-based learning environment makes interruptions an unavoidable aspect of clinical work. Interruptions have been shown to affect cognitive load, surgical performance, and medical error. The purpose of this study was to describe the effects of interruptions on surgical resident education. Junior residents were observed by 2 trained observers using time-motion methodology between September 2018-August 2019. Interruptions were identified and coded retroactively based on predefined criteria. We captured key features of interruptions including frequency, duration, task interrupted, outcome, and learner perceived educational value. This study took place at London Health Sciences Centre in London, Ontario, Canada, a tertiary level academic health care center associated with the Schulich School of Medicine & Dentistry at Western University. Junior residents on a General Surgery service were eligible for participation. Participation was voluntary. 8 residents were observed over 24 clinical periods. A total of 278.2 hours of resident workflow were observed, and 229 interruptions were recorded. Interruptions account for 57.9 minutes/day of a surgical resident (SD = 60.7). Interruptions occur at a frequency of 0.82 interruptions/hour. Disruptive interruptions, that interfere with the continuation or completion of the original task, occur at a frequency of 0.11 interruptions/hour. Disruptive interruptions occurred at a higher frequency of 0.34 interruptions/hour during periods of feedback, coaching and informal teaching. We observed that tasks of higher learner perceived educational value are often interrupted by tasks of lower learner perceived education value. Valuable educational experiences such as feedback, coaching and informal teaching are interrupted at a greater rate and experience disruptions at a disproportionate rate. We identified feedback, coaching and informal teaching as an education task vulnerable to disruptive interruptions that would benefit from interventions targeted toward preventing interruption. Suggested interventions include “formalizing” feedback, coaching and informal teaching.