A Theory-Based Model for Teaching and Assessing Residents in the Operating Room

DaRosa, Debra A.; Zwischenberger, Joseph B.; Meyerson, Shari L.; George, Brian C.; Teitelbaum, Ezra N.; Soper, Nathaniel J.; Fryer, Jonathan P.

doi:10.1016/j.jsurg.2012.07.007

Cited by 226 publications

(109 citation statements)

References 17 publications

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“…Given that both residents and faculty acknowledged that a dominant feature of residents' workplace learning is the navigation of thresholds, surgical education should prioritize teaching residents how to negotiate the nuanced variations they would encounter between patients, cases, and surgeons when operating. [49][50][51] The findings of this study indicate that the sociocultural constructs of surgical education may complicate this work.…”

Section: Navigating Those Normsmentioning

confidence: 86%

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Apramian¹,

Cristancho²,

Watling³

et al. 2016

Journal of Surgical Education

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OBJECTIVE-Clinical research increasingly acknowledges the existence of significant procedural variation in surgical practice. This study explored surgeons' perspectives regarding the influence of intersurgeon procedural variation on the teaching and learning of surgical residents.DESIGN AND SETTING-This qualitative study used a grounded theory-based analysis of observational and interview data. Observational data were collected in 3 tertiary care teaching hospitals in Ontario, Canada. Semistructured interviews explored potential procedural variations arising during the observations and prompts from an iteratively refined guide. Ongoing data analysis refined the theoretical framework and informed data collection strategies, as prescribed by the iterative nature of grounded theory research. RESULTS-Surgeons endorsed the use of intersurgeon procedural variations to teach residents about adapting to the complexity of surgical practice and the norms of surgical culture. Surgeons suggested that residents' efforts to identify thresholds of principle and preference are crucial to professional development. Principles that emerged from the study included the following: (1) knowing what comes next, (2) choosing the right plane, (3) handling tissue appropriately, (4) recognizing the abnormal, and (5) making safe progress. Surgeons suggested that learning to follow these principles while maintaining key aspects of surgical culture, like autonomy and individuality, are important social processes in surgical education. PARTICIPANTS-OurCONCLUSIONS-Acknowledging intersurgeon variation has important implications for curriculum development and workplace-based assessment in surgical education. Adapting to intersurgeon procedural variations may foster versatility in surgical residents. However, the existence of procedural variations and their active use in surgeons' teaching raises questions about the lack of attention to this form of complexity in current workplace-based assessment strategies. CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptFailure to recognize the role of such variations may threaten the implementation of competencybased medical education in surgery.

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Section: Navigating Those Normsmentioning

confidence: 86%

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Apramian¹,

Cristancho²,

Watling³

et al. 2016

Journal of Surgical Education

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“…The Zwisch model guides teachers in tailoring their teaching and granting autonomy in accordance to each individual trainee's level for each surgical procedure [24]. The model's first stage, 'show and tell,' applies to inexperienced trainees.…”

Section: The Zwisch Modelmentioning

confidence: 99%

“…The final step is called "no help" during which the teacher monitors the trainee performing the procedure and only provides minimal advice. The Zwisch model is supported by psychomotor learning theories [24]; however, research on the effectiveness is mostly lacking.…”

Section: The Zwisch Modelmentioning

confidence: 99%

Integrating Technical and Nontechnical Skills in Hands-On Surgical Training

Alken¹,

Fluit²,

Luursema³

et al. 2018

Medical and Surgical Education - Past, Present and Future

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Safe and effective surgery requires high-quality technical and nontechnical skills. Although the importance of nontechnical skills has become increasingly clear, today's surgical curricula still lack formal training in nontechnical skills. In this chapter, we discuss how to integrate technical and nontechnical skills training into surgical curricula and provide strategies on how to teach both skill sets concurrently in a hands-on setting.

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“…In contrast to the Smart Help stage, there is no direct guidance by the attending surgeon other than the aforementioned case. The last stage involves the attending surgeon assuming a completely assisting role and providing very little guidance, if any (DaRosa et al, 2012). While this particular model is useful in order to teach and in some cases, assess resident performance, it has limitations and drawbacks.…”

Section: Teaching Models and Milestonesmentioning

confidence: 99%

“…Global Tools: While the Zwisch model can be used as an assessment tool in itself, over the last 20 years many other tools have been developed to specifically measure resident's technical and intraoperative skills (DaRosa et al, 2012;George et al, 2014). While there are at least 13 different tools currently in use, many of them use a global rating scale to assess technical skills of residents.…”

Section: Assessment Toolsmentioning

confidence: 99%

Assessing Surgical Residents; Challenges and Future Options

Sandher¹,

Gibber²

2017

MedEdPublish

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Surgical education has changed significantly since the first formal program was established by William Halstead. Specifically, in the last ten years, surgical education has moved from the popular "See One, Do One, Teach One" model to a competency based model using distinct milestones. While these milestones and competencies have been successfully implemented in many fields, including Otolaryngology, there remains significant problems that need to be addressed. Specifically, the lack of assessment tools able to accurately measure whether trainee surgeons can perform steps or indeed an entire operation is a significant and underreported problem.

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A Theory-Based Model for Teaching and Assessing Residents in the Operating Room

Cited by 226 publications

References 17 publications

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Integrating Technical and Nontechnical Skills in Hands-On Surgical Training

Assessing Surgical Residents; Challenges and Future Options

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