Perspectives of faculty and residents while overlapping were different in emphasis. Better understanding faculty-resident interactions, individual behaviors, contextual influences, and national regulations that influence intraoperative education have the potential to significantly affect progressive entrustment in training paradigms.

OpTrust successfully assesses behaviors associated with entrustment during intraoperative faculty-resident interactions, and has the potential to be adopted across other procedural-based specialties to promote autonomous training progression.

Background The 2011 ACGME regulations required significant change in the structure of general surgery residency programs, due primarily to the 16-hour in-house rule for PGY 1 residents. However, the scope of changes that programs have undertaken to meet these requirements, and the educational impact of those changes, are poorly understood. Study Design We performed in-depth qualitative interviews with general surgery program directors (PDs). 20 PDs participated in the study; interviews were conducted until adequate thematic saturation was achieved. Participants were recruited from a stratified random sampling of residency programs in the United States to ensure a representative cohort. Interviews focused on changes in call schedule, interns’ educational requirements, development, and satisfaction. Results Most programs used a month-long night float rotation (NF) (14/20, 75%). A minority of programs (5/20, 25%) used a weekly rotating schedule, where interns worked 5–6 nights out of a month. Multiple programs (65%) had a NF in place prior to 2011; these programs made changes to and expanded their existing schedule to accommodate the new regulations. Commonly cited challenges to instituting NF included weekend coverage (60%) and providing adequate days off during day-to-night transition. Interns spent as much as 3 months of the year on NF. Only 5 programs made explicit changes to teaching schedules or developed a curriculum for residents on NF. 75% of programs excused interns, explicitly or implicitly, from didactic teaching while on NF. Common themes noted by PDs included delayed maturation of trainees, interns feeling isolated from the team culture, and a conflict between the professional behaviors of “following the rules” and “doing what is right”.

No abstract

No abstract

Intraoperative questioning is not aligned with higher level thinking. The majority of questions were Bloom's level 3 or below, limiting the complexity of answer formulation. Most responses were given within 2 s, hindering opportunity to pursue higher-order thinking. This suggests including higher level questions and tailoring questions to learner level may improve retention and maximize gains. In addition, with attendings answering 20% of their own questions, increasing their wait time offers another area for teaching development.

Research in the area of role modeling has primarily focused on the qualities and attributes of exceptional role models, and less attention has been given to the act of role modeling itself (Elzubeir & Rizk, 2001; Jochemsen-van der Leeuw, van Dijk, van Etten-Jamaludin, & Wieringa-de Waard, 2013; Wright, 1996; Wright, Wong, & Newill, 1997). A standardized understanding of role modeling in medical education remains elusive (Kenny, Mann, & MacLeod, 2003). This is problematic given that role modeling is pervasively documented as an approach to teaching (Reuler & Nardone, 1994). Our study attempts to fill a void in this body of research by looking at what faculty are thinking, saying, and doing when they say they are role modeling. Individual semi-structured interviews with faculty members were conducted in the Department of General Surgery at Queen’s University, Kingston, Ontario, Canada. Interviews were recorded, transcribed, and analyzed using qualitative methods for themes surrounding teaching and role modeling. Three major themes emerged from the data: (1) faculty members think they are teaching when they are acting professionally; (2) faculty members become aware of teaching opportunities and act on them; and (3) faculty members employ evidence-based teaching methods, but they are incorrectly labeling them as “role modeling.” As a whole, our findings should help distinguish between role modeling as roles and responsibilities enacted while doing one’s job well, and teaching as facilitated instruction that helps connect knowledge with action (Clayton, 2006; Fassbinder, 2007). Contributing to a better understanding of how teaching is separate from role modeling has the potential to improve the scope and quality of teaching, ultimately enhancing the learning experience for trainees. Les recherches menées dans le domaine de l’imitation de rôles ont porté principalement sur les qualités et les attributs de modèles de rôles exceptionnels et on a fait moins attention à l’acte lui-même d’imitation de rôle (Elzubeir & Rizk, 2001; Jochemsen-van der Leeuw, van Dijk, van Etten-Jamaludin, & Wieringa-de Waard , 2013; Wright, 1996; Wright, Wong, & Newill, 1997). La compréhension standardisée de l’imitation de rôles dans les situations médicales reste élusive (Kenny, Mann, & MacLeod, 2003). Ceci est problématique du fait que l’imitation de rôles est fortement documentée en tant qu’approche pour l’enseignement (Reuler & Nardone, 1994). Notre étude tente de combler un vide dans ce corps de recherche, nous visons à examiner ce que les enseignants pensent, disent et font quand ils affirment qu’ils pratiquent l’imitation de rôles. Des entrevues semi-structurées ont été menées avec des professeurs du département de chirurgie générale de l’Université Queen’s, à Kingston, en Ontario, Canada. Les entrevues ont été enregistrées, transcrites et analysées en utilisant des méthodes qualitatives pour des thèmes liés à l’enseignement et à l’imitation de rôles. Trois thèmes principaux sont ressortis de ces données : (1) les professeurs pensent qu’ils enseignent quand ils agissent de façon professionnelle; (2) les professeurs prennent conscience des occasions d’enseignement et les mettent à profit; et (3) les professeurs utilisent des méthodes d’enseignement basées sur l’évidence, mais ils les qualifient à tort d’« imitation de rôles ». Dans l’ensemble, nos résultats devraient aider à établir la distinction entre l’imitation de rôles en tant que rôles et responsabilités adoptés pendant que l’on fait correctement son travail, et l’enseignement en tant qu’instruction facilitée qui permet de relier la connaissance avec l’action (Clayton, 2006; Fassbinder, 2007). La contribution à une meilleure compréhension de la manière dont l’enseignement est séparé de l’imitation de rôles pourrait améliorer la portée et la qualité de l’enseignement pour, en fin de compte, améliorer l’expérience d’apprentissage des stagiaires.

No abstract