Lyon Patricia
Office of Teaching and Learning in Medicine, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
Med Educ. 2004 Dec;38(12):1278-87. doi: 10.1111/j.1365-2929.2004.02020.x.
This paper extends the work of an earlier publication by the same author which reported the findings of a case study designed to investigate how medical students learn and are taught in the operating theatre. The earlier paper was descriptive in nature, examining the challenges students face as learners in theatres. These were conceptualised around 3 key domains: the challenge posed by the physical environment; the challenge of the educational task, and the challenge of managing and negotiating a role as a participant in the professional workplace of theatres. This paper focuses exclusively on the third domain. It presents an interpretive model of teaching and learning in the operating theatre, drawing largely on conceptual frameworks developed within the literature on learning in work-based settings.
A multimethod strategy included observation in theatres, interviews with students and surgeons, and a student survey. The themes that characterised the case were identified and the relationships among these themes were explored, leading to the development of the model. Symbolic interactionism provided the underlying theoretical framework.
In any particular theatre session, the way in which learning evolves or is obstructed for any student, and the shape that teaching takes, depends on the interpretations that the student and the surgeon make in 'sizing up' the teaching and learning environment. How surgeons and students interpret and respond to each others' behaviour, style, attitude and even demeanour, has consequences for the way teaching and learning develop. The concepts of legitimacy and trust underpin these interpretations and are central to understanding the processes of teaching and learning in this setting.
本文扩展了同一作者早期发表的一篇论文的研究工作，该论文报告了一项案例研究的结果，该研究旨在调查医学生在手术室中的学习方式以及他们是如何被教导的。早期的论文本质上是描述性的，研究了学生在手术室作为学习者所面临的挑战。这些挑战围绕三个关键领域进行了概念化：物理环境带来的挑战；教育任务的挑战，以及在手术室这个专业工作场所中作为参与者进行角色管理和协商的挑战。本文专门关注第三个领域。它提出了一个手术室教学与学习的解释性模型，主要借鉴了基于工作场所学习的文献中所发展的概念框架。
采用了多种方法的策略，包括在手术室进行观察、对学生和外科医生进行访谈以及开展学生调查。确定了该案例的特征主题，并探索了这些主题之间的关系，从而形成了该模型。象征互动主义提供了基础理论框架。
在任何特定的手术室课程中，任何一名学生学习过程的推进方式或受阻方式，以及教学所呈现的形式，都取决于学生和外科医生在“评估”教学与学习环境时所做出的解释。外科医生和学生如何解读并回应彼此的行为、风格、态度甚至举止，会对教学与学习的发展方式产生影响。合法性和信任的概念支撑着这些解释，并且对于理解这种环境下的教学与学习过程至关重要。
