Resident Perspectives on Teaching During Awake Surgical Procedures

• Published in: Journal of surgical education Vol. 76; no. 6; pp. 1492 - 1499
• Main Authors: Smith, Claire S., Nolan, Robert, Guyton, Kristina, Siegler, Mark, Langerman, Alexander, Schindler, Nancy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2019
• Subjects: anesthesia; ethics; general surgery; obstetrics and gynecology; surgical education; urology; urology; obstetrics and gynecology; general surgery; surgical education; ethics; Interpersonal and Communication Skills; anesthesia
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2019.04.007

Residents learn technical and communication skills during training and practice both concurrently during awake surgical procedures. Patients have expressed mixed views on resident involvement in their surgical care, making this context challenging for residents to navigate. We sought to qualitatively explore resident perspectives on teaching during awake surgical procedures. Residents in Urology, Obstetrics and Gynecology, and General Surgery who had been exposed to 10 or more awake surgical procedures were recruited for recorded focus groups at the University of Chicago. Recordings were transcribed, coded, and reviewed by 3 researchers using the constant comparative method until thematic saturation was reached. Twenty-five residents participated in 5 focus groups. Residents identified positive educational techniques during awake surgery including preprocedural communication, explaining teaching and the resident role, whispering/nonverbal communication, involving the patient in education, and confident educator. Residents described challenges and failures in education, including hesitating to ask questions, hesitating to correct a learner, whispering/nonverbal communication, and taking over. In discussing informed consent during awake procedures, some residents described that the consent process should or did change during awake procedures, for example, to include more information about the resident role. Residents participating in awake surgical procedures offer new insights on successful techniques for teaching during awake surgery, emphasizing that good communication in the procedure room starts beforehand. They also identify challenges with teaching in this context, often related to a lack of open and clear communication.