Ong Caroline C P, Dodds Agnes, Nestel Debra
Department of Paediatric Surgery, KK Women's and Children's Hospital, SingHealth Institution and Duke-NUS Graduate Medical School, 100 Bukit Timah Road, Singapore, 229899, Singapore.
Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
Adv Health Sci Educ Theory Pract. 2016 Aug;21(3):587-607. doi: 10.1007/s10459-015-9654-5. Epub 2015 Nov 21.
Surgeons require advanced psychomotor skills, critical decision-making and teamwork skills. Much of surgical skills training involve progressive trainee participation in supervised operations where case variability, operating team interaction and environment affect learning, while surgical teachers face the key challenge of ensuring patient safety. Using a theoretical framework of situated learning including cognitive apprenticeship, we explored teachers' and trainees' beliefs and values about intra-operative training and reasons for any differences. A qualitative case study method was used where five teacher-trainee pairs participating in an observed teaching operation were separately interviewed about the same operation. Thematic analysis of transcribed interviews and observations was performed with iterative refinement and a reflexive approach was adopted throughout the study. We found that in all cases, teachers and trainees had shared recognition of learning about technical skills whereas they differed in three cases regarding non-technical skills such as surgical reasoning and team management. Factors contributing to teacher and trainee satisfaction with the process were successful trainee completion of operation without need for surgeon take-over, a positive learning environment and learning new things. Teaching-learning behaviours observed and discussed were modeling, coaching and scaffolding, while exploration, reflection and articulation were less common. Our study reveals differing teacher and trainee perspectives of some aspects of intra-operative training and surfaces new reasons other than amount of feedback and autonomy given. Factors contributing to different perspectives include teacher and trainee abilities, values and situational influences. Targeted teaching-learning strategies could enhance intra-operative learning.
外科医生需要具备先进的心理运动技能、批判性决策能力和团队协作技能。外科技能培训大多涉及学员在监督下逐步参与手术操作，在此过程中，病例的多样性、手术团队的互动以及环境都会影响学习效果，而外科教师面临的关键挑战是确保患者安全。我们运用包括认知学徒制在内的情境学习理论框架，探究了教师和学员对于术中培训的信念和价值观，以及存在差异的原因。我们采用了定性案例研究方法，对五对参与观察性教学手术的师生就同一台手术分别进行了访谈。对访谈记录和观察结果进行了主题分析，并不断进行完善，整个研究过程采用了反思性方法。我们发现，在所有案例中，教师和学员都认同学习技术技能，然而在三个案例中，他们在诸如手术推理和团队管理等非技术技能方面存在分歧。促使教师和学员对该过程感到满意的因素包括学员成功完成手术且无需外科医生接手、积极的学习环境以及学到新东西。观察和讨论到的教学行为包括示范、指导和搭建支架，而探索、反思和表达则较少见。我们的研究揭示了教师和学员在术中培训某些方面的不同观点，并揭示了除反馈量和自主权之外的新原因。导致观点不同的因素包括教师和学员的能力、价值观以及情境影响。有针对性的教学策略可以提高术中学习效果。
