Vikis Elena A, Mihalynuk Tanis V, Pratt Dan D, Sidhu Ravi S
Division of Vascular Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Am J Surg. 2008 May;195(5):594-8; discussion 598. doi: 10.1016/j.amjsurg.2008.01.004.
The transformation of a trainee into a surgeon is influenced strongly by communication patterns in the operating room (OR). In the current era of limited educational opportunities, elucidation of teaching and learning strategies in this environment is critical. The aim of this study was to further understand the elements of an effective communicative instructional interaction (CII) as perceived by surgical residents.
Qualitative research methodology was used to explore University of British Columbia surgery residents' perceptions of what constitutes an effective CII in the OR. Purposeful sampling was used to select participants from various years of training. Eighteen residents participated in semistructured interviews to facilitate reflection of their OR experiences. Interviews were transcribed, analyzed, and fed back to residents to confirm their accuracy. Independent coding and analysis led to the development of key emergent themes.
Themes represented the interplay of ideals expressed by the residents. The primary emergent theme was that both teacher and learner play a major role in the creation of an effective CII. The ideal teacher had an instructional plan, facilitated surgical independence, and showed support and empathy for the surgical resident. The ideal resident was receptive, prepared, and acknowledged limitations. The contextual constraints of the OR played a central role in learning, and residents identified ways to maintain educational value despite primarily nonmodifiable contextual elements (ie, time constraints).
In a unique environment such as the OR, both teacher and learner may benefit by an enhanced understanding of the elements of an effective CII.
手术室（OR）中的沟通模式对外科住院医师转变为外科医生有着重大影响。在当前教育机会有限的时代，阐明这种环境下的教学策略至关重要。本研究的目的是进一步了解外科住院医师所认为的有效沟通性教学互动（CII）的要素。
采用定性研究方法，探讨英属哥伦比亚大学外科住院医师对手术室中有效CII构成要素的看法。采用目的抽样法从不同培训年份的人员中选取参与者。18名住院医师参与了半结构化访谈，以促进对他们手术室经历的反思。访谈内容被转录、分析并反馈给住院医师以确认其准确性。独立编码和分析得出了关键的新出现主题。
主题代表了住院医师所表达理想之间的相互作用。主要新出现主题是教师和学习者在创建有效CII中都发挥着重要作用。理想的教师有教学计划，促进手术独立性，并对外科住院医师表现出支持和同理心。理想的住院医师善于接受、做好准备并认识到自身局限。手术室的环境限制在学习中起核心作用，住院医师确定了尽管主要是不可改变的环境因素（即时间限制）但仍能保持教育价值的方法。
在手术室这样独特的环境中，教师和学习者都可能因增强对有效CII要素的理解而受益。
