Department of Medical Education, Southern Illinois University School of Medicine, Springfield, IL, USA.
Surgery. 2012 May;151(5):643-50. doi: 10.1016/j.surg.2011.12.011. Epub 2012 Jan 11.
Teaching in the operating room is one of the major cornerstones of surgical education. As time available for intraoperative resident teaching diminishes, such teaching time becomes increasingly precious. We studied how surgeons communicate with residents during an operation, with the goal of enhancing intraoperative teaching opportunities.
Grounded theory methodology was used to investigate intraoperative verbal communication during four videotaped surgical procedures. Utterance-by-utterance analysis was performed to generate codes for each surgeon-resident interaction. Interactions were then analyzed to determine the percentage time spent in verbal teaching, number of topics covered, times each topic was visited, and time per topic.
Four main types of teaching surgeon-resident verbal interaction were identified from 1306 interactions. Instrumental interactions were intended solely to move the operation forward. Pure teaching interactions served to educate the trainee, shape judgment, or enhance performance. Instrumental and Teaching interactions were directive but also contained teaching. Banter was discussion unrelated to the operation. Analysis of a subset of the operations demonstrated 13-29 topics covered per procedure, with each topic addressed between 1 and 8 times, and 25-330 seconds spent per topic. Most teaching instances were prompted by errors in resident performance.
Instances of verbal teaching were numerous, arose opportunistically in this study, and focused typically on multiple points. To maximize teaching opportunities, the authors propose a structured approach to intraoperative teaching that involves identification of a limited set of specific learning objectives, followed by intraoperative teaching and postoperative debriefing targeted to those objectives.
手术室教学是外科教育的重要基石之一。随着术中住院医师教学时间的减少，这种教学时间变得越来越宝贵。我们研究了外科医生在手术过程中与住院医师的沟通方式，旨在增加术中教学机会。
采用扎根理论方法研究了 4 个录像手术过程中的术中口头交流。对每个外科医生-住院医生的互动进行逐句分析，为每个互动生成代码。然后对这些互动进行分析，以确定口头教学的时间百分比、涵盖的主题数量、每个主题的访问次数以及每个主题的时间。
从 1306 次互动中确定了四种主要的教学外科医生-住院医生口头互动类型。仪器互动仅旨在推动手术进行。纯粹的教学互动旨在教育学员、塑造判断或提高绩效。仪器和教学互动具有指令性，但也包含教学内容。打趣是与手术无关的讨论。对部分手术的分析表明，每个手术过程涵盖 13-29 个主题，每个主题的讨论次数在 1 到 8 次之间，每个主题的时间在 25-330 秒之间。大多数教学实例都是由住院医师表现中的错误引起的。
在本研究中，口头教学实例很多，是偶然出现的，通常集中在多个点上。为了最大限度地提高教学机会，作者提出了一种结构化的术中教学方法，包括确定一组有限的具体学习目标，然后针对这些目标进行术中教学和术后讨论。
