Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada.
Centre for Education Research and Innovation, Western University, London, ON, Canada.
Med Educ. 2021 Jun;55(6):733-740. doi: 10.1111/medu.14449. Epub 2021 Feb 2.
This study sought to increase understanding of preoperative preparatory strategies utilised by senior surgical residents and identify how social and material forces come together to shape practice.
SUMMARY/BACKGROUND DATA: Preoperative preparation can play a powerful role in operative learning. Residents rarely receive guidance, feedback, or explicit expectations on how to prepare for the OR. Understanding current practice and how to support preoperative preparation represents an important gap in our efforts to improve surgical training.
Constructivist grounded theory with sensitizing concepts from sociomateriality guided data collection and analysis. Fifteen senior surgical residents from a range of surgical disciplines were purposefully sampled and participated in an in-depth individual interview. Two return-of-finding focus groups followed with seven residents. Rigor was enhanced through constant comparison, theoretical sampling, pursuit of discrepant data, and investigator triangulation.
Residents utilised a range of strategies addressing four areas of focus: develop technical skills, improve procedural knowledge, enhance patient-specificity, and know surgical preferences. However, residents also described receiving limited guidance on what it means to 'be prepared' and experience significant challenges in achieving preparedness. A mix of social and material things that enabled or constrained preparatory efforts influenced individual strategies. These included rotation structure, relationships, the OR list, and time.
Our findings offer possible solutions by elaborating on preparatory variability and considerations for residents, faculty, and programs to improve practice. As a first step, we suggest programs begin to engage in explicit dialogue and reflection with their residents, faculty, and residency program committees.
本研究旨在增进对资深外科住院医师术前准备策略的理解，并确定社会和物质力量如何共同塑造实践。
摘要/背景资料：术前准备可以在手术学习中发挥强大作用。住院医师很少在如何准备手术室方面获得指导、反馈或明确的期望。了解当前的实践以及如何支持术前准备是我们努力改进外科培训的一个重要空白。
建构主义扎根理论，结合社会物质性的敏感概念指导数据收集和分析。从各种外科专业中精心挑选了 15 名资深外科住院医师，并对他们进行了深入的个人访谈。随后进行了两次返回发现焦点小组，其中有 7 名住院医师参加。通过不断比较、理论抽样、寻求差异数据和调查员三角测量，提高了严谨性。
住院医师采用了一系列策略，重点关注四个方面：发展技术技能、提高程序知识、增强患者特异性和了解手术偏好。然而，住院医师也表示，他们在“准备好”的含义方面得到的指导有限，并在实现准备方面面临重大挑战。一系列能够促进或限制准备工作的社会和物质因素影响了个人策略。这些因素包括轮转结构、关系、手术室清单和时间。
我们的研究结果通过详细说明预备工作的可变性和为住院医师、教师和项目提供的考虑因素，为改进实践提供了可能的解决方案。作为第一步，我们建议项目开始与住院医师、教师和住院医师项目委员会进行明确的对话和反思。
