Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
Center for Language and Cognition, University of Groningen, Groningen, the Netherlands.
J Surg Educ. 2021 Jul-Aug;78(4):1197-1208. doi: 10.1016/j.jsurg.2020.12.010. Epub 2020 Dec 24.
Supervisors and residents agree that entrusted autonomy is central to learning in the Operating Room (OR), but supervisors and residents hold different opinions about entrustment: residents regularly experience that they receive insufficient autonomy while supervisors feel their guiding is not appreciated as teaching. These opinions are commonly grounded on general experiences and perceptions, instead of real-time supervisors' regulatory behaviors as procedures unfold. To close that gap, we captured and analyzed when and to what level supervisors award or restrain autonomy during procedures. Furthermore, we constructed fingerprints, an instrument to visualize entrustment of autonomy by supervisors in the OR that allows us to reflect on regulation of autonomy and discuss teaching interactions.
All interactions between supervisors and residents were captured by video and transcribed. Subsequently a multistage analysis was performed: (1) the procedure was broken down into 10 steps, (2) for each step, type and frequency of strategies by supervisors to regulate autonomy were scored, (3) the scores for each step were plotted into fingerprints, and (4) fingerprints were analyzed and compared.
University Medical Centre Groningen (the Netherlands).
Six different supervisor-resident dyads.
No fingerprint was alike: timing, frequency, and type of strategy that supervisors used to regulate autonomy varied within and between procedures. Comparing fingerprints revealed that supervisors B and D displayed more overall control over their program-year 5 residents than supervisors C and E over their program-year 4 residents. Furthermore, each supervisor restrained autonomy during steps 4 to 6 but with different intensities.
Fingerprints show a high definition view on the unique dynamics of real-time autonomy regulation in the OR. One fingerprint functions as a snapshot and serves a purpose in one-off teaching and learning. Multiple snapshots of one resident quantify autonomy development over time, while multiple snapshots of supervisors may capture best teaching practices to feed train-the-trainer programs.
主管和住院医师都认为委托自主权是手术室（OR）学习的核心，但主管和住院医师对委托授权持有不同的看法：住院医师经常感到自主权不足，而主管则觉得他们的指导没有得到教学认可。这些观点通常基于一般经验和看法，而不是程序展开时主管实时监管行为。为了弥补这一差距，我们捕捉并分析了主管在手术过程中何时以及在何种程度上授予或限制自主权。此外，我们构建了指纹，这是一种可视化 OR 中主管自主授权的工具，使我们能够反思自主权的监管，并讨论教学互动。
主管和住院医师之间的所有互动都通过视频进行了捕捉并记录下来。随后进行了多阶段分析：（1）将程序分解为 10 个步骤；（2）对于每个步骤，主管监管自主权的策略类型和频率进行了评分；（3）将每个步骤的分数绘制成指纹；（4）对指纹进行分析和比较。
格罗宁根大学医学中心（荷兰）。
六对不同的主管-住院医师。
没有相同的指纹：主管在程序内和程序间调整自主权的时机、频率和策略类型各不相同。比较指纹显示，主管 B 和 D 对他们的第 5 年住院医师的整体控制程度高于主管 C 和 E 对他们的第 4 年住院医师的控制程度。此外，每个主管在步骤 4 到 6 期间都限制了自主权，但强度不同。
指纹提供了手术室实时自主权监管独特动态的高清晰度视图。一个指纹作为一个快照，在一次性教学和学习中具有一定的作用。一个住院医师的多个快照可以随着时间的推移量化自主权的发展，而多个主管的快照则可以捕捉最佳教学实践，为培训师培训计划提供素材。
