Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Surg Res. 2011 Sep;170(1):1-5. doi: 10.1016/j.jss.2011.01.022. Epub 2011 Feb 24.
The operating room (OR) remains the main teaching venue for surgical trainees. The OR is considered a pure-discovery learning environment; the downsides of this can be putatively overcome when faculty and trainee arrive at a shared understanding of learning. This study aimed to better understand preoperative learning goals to identify areas of commonalities and potential barrier to intraoperative teaching.
Brief, structured preoperative interviews were conducted outside the OR with the resident and faculty member who were scheduled to operate together. Answers were analyzed and grouped using grounded theory.
Twenty-seven resident-faculty pairs were interviewed. Nine residents (33.3%) were junior (PGY 1 and 2) and 18 (66.7%) were senior (PGY 3 through 5). Learning goal categories that emerged from the response analysis were anatomy, basic and advanced surgical skills, general and specific procedural tasks, technical autonomy, and pre-, intra-, and postoperative considerations. Residents articulated fewer learning goals than faculty (1.5 versus 2.4; P = 0.024). The most frequently identified learning goal by both groups was one classifiable under general procedural tasks; the greatest divergence was seen regarding perioperative considerations, which were identified frequently by faculty members but rarely by residents.
Faculty articulate significantly more learning goals for the residents they will operate with than residents articulate for themselves. Our data suggest that residents and faculty align on some learning goals for the OR but residents tend to be more limited, focusing predominantly on technical aspects of the operation. Faculty members tend to hold a broader view of the learning potential of the OR. These discrepancies may present barriers to effective intraoperative teaching.
手术室（OR）仍然是外科受训者的主要教学场所。OR 被认为是一个纯粹的发现式学习环境；当教师和学员达成对学习的共同理解时，这种情况的缺点可以被克服。本研究旨在更好地了解术前学习目标，以确定共同的领域和潜在的术中教学障碍。
在 OR 外与预定一起进行手术的住院医师和教员进行简短的、结构化的术前访谈。使用扎根理论对答案进行分析和分组。
对 27 对住院医师-教员进行了访谈。9 名住院医师（33.3%）为初级（PGY 1 和 2），18 名（66.7%）为高级（PGY 3 至 5）。从响应分析中得出的学习目标类别包括解剖学、基本和高级手术技能、一般和具体手术任务、技术自主、术前、术中和术后考虑因素。住院医师提出的学习目标比教员少（1.5 比 2.4；P = 0.024）。教员和住院医师都认为最常见的学习目标是可归类为一般手术任务的学习目标；最大的分歧是围手术期的考虑因素，教员经常提到这些因素，但住院医师很少提到。
教员为他们将要进行手术的住院医师陈述的学习目标明显多于住院医师为自己陈述的学习目标。我们的数据表明，住院医师和教员在 OR 的一些学习目标上是一致的，但住院医师往往更受限制，主要关注手术的技术方面。教员往往对 OR 的学习潜力有更广泛的看法。这些差异可能会对有效的术中教学构成障碍。
