Resident training in a teaching hospital: How do attendings teach in the real operative environment?
作者信息
Glarner Carly E, Law Katherine E, Zelenski Amy B, McDonald Robert J, Greenberg Jacob A, Foley Eugene F, Wiegmann Douglas A, Greenberg Caprice C
机构信息
Wisconsin Surgical Outcomes Research Program, Department of Surgery, Clinical Science Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin, Madison, WI, USA.
出版信息
Am J Surg. 2017 Jul;214(1):141-146. doi: 10.1016/j.amjsurg.2015.12.024. Epub 2016 Mar 23.
BACKGROUND
The study aim was to explore the nature of intraoperative education and its interaction with the environment where surgical education occurs.
METHODS
Video and audio recording captured teaching interactions between colorectal surgeons and general surgery residents during laparoscopic segmental colectomies. Cases and collected data were analyzed for teaching behaviors and workflow disruptions. Flow disruptions (FDs) are considered deviations from natural case progression.
RESULTS
Across 10 cases (20.4 operative hours), attendings spent 11.2 hours (54.7%) teaching, using directing (M = 250.1), and confirming (M = 236.1) most. FDs occurred 410 times, accounting for 4.4 hours of case time (21.57%). Teaching occurred with FD events for 2.4 hours (22.2%), whereas 77.8% of teaching happened outside FD occurrence. Teaching methods shifted from active to passive during FD events to compensate for patient safety.
CONCLUSIONS
Understanding how FDs impact operative learning will inform faculty development in managing interruptions and improve its integration into resident education.
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