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Am J Surg. 2017 Jul;214(1):141-146. doi: 10.1016/j.amjsurg.2015.12.024. Epub 2016 Mar 23.

Resident training in a teaching hospital: How do attendings teach in the real operative environment?

Author information

1
Wisconsin Surgical Outcomes Research Program, Department of Surgery, Clinical Science Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
2
Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin, Madison, WI, USA.
3
Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
4
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.
5
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. Electronic address: greenberg@surgery.wisc.edu.

Abstract

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.

KEYWORDS:

Education behavior; Flow disruptions; Human factors; Surgical education; Work system

PMID:
28476201
DOI:
10.1016/j.amjsurg.2015.12.024
[Indexed for MEDLINE]

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