Resident training in a teaching hospital: how do attendings teach in the real operative environment?

• Published in: The American journal of surgery Vol. 214; no. 1; pp. 141 - 146
• Main Authors: Glarner, Carly E., M.D., M.S, Law, Katherine E., M.S, Zelenski, Amy B., Ph.D, McDonald, Robert J., Ph.D, Greenberg, Jacob A., M.D., Ed.M, Foley, Eugene F., M.D, Wiegmann, Douglas A., Ph.D, Greenberg, Caprice C., M.D., M.P.H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017; Elsevier Limited
• Subjects: Aversion learning; Cameras; Colectomy - education; Data processing; Education; Education behavior; Environmental education; Flow disruptions; Hospitals, Teaching; Human factors; Humans; Integration; Internship and Residency; Laparoscopy; Laparoscopy - education; Learning; Medical personnel; Medical research; Medical Staff, Hospital; Operating Rooms; Patient safety; Perioperative Period; Recording; Researchers; Safety; Serial learning; Studies; Surgeons; Surgery; Surgical education; Task analysis; Teaching; Teaching hospitals; Teaching methods; Work system; Workflow; Flow disruptions; Education behavior; Work system; Surgical education; Human factors
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.12.024

Abstract Background The study aim was to explore the nature of intraoperative education and its interaction with the environment where surgical education occurs. Methods Video and audio recording captured teaching interactions between colorectal surgeons and general surgery residents during laparoscopic segmental colectomies. Cases and collected data were analyzed for teaching behaviors and workflow disruptions. Flow disruptions (FDs) are considered deviations from natural case progression. Results Across 10 cases (20.4 operative hours), attendings spent 11.2 hours (54.7%) teaching, using directing ( M  = 250.1), and confirming ( M  = 236.1) most. FDs occurred 410 times, accounting for 4.4 hours of case time (21.57%). Teaching occurred with FD events for 2.4 hours (22.2%), whereas 77.8% of teaching happened outside FD occurrence. Teaching methods shifted from active to passive during FD events to compensate for patient safety. Conclusions Understanding how FDs impact operative learning will inform faculty development in managing interruptions and improve its integration into resident education.