Recruiting expertise: how surgical trainees engage supervisors for learning in the operating room

Abstract

Context For centuries now, the operating room (OR) has been the environment in which surgical trainees come to master procedures. Restricted working hours and insufficient levels of autonomy at the end of their training necessitate a shift towards alternative effective learning strategies. Self‐regulated learning is a promising strategy by which surgical trainees can learn more with fewer exposures. However, the challenge is to understand how surgical trainees regulate their learning in the clinical context of the OR. Objectives The purpose of this study is to identify and understand the strategies of surgical trainees in engaging their supervisors for learning purposes and how these strategies contribute to effective learning. Methods Total hip replacement procedures performed by four surgical trainees and their supervisors were videotaped. Using the iterative inductive process of conversation analysis, each verbal initiative to engage the supervisor was identified, analysed (‘why that now’) and categorised. Results Surgical trainees used a range of practices to engage supervisors and recruit expertise, ranging from explicit recruitment to implicit hints. We identified four major categories. Surgical trainees: (i) invite the supervisor to provide an evaluation of the ongoing task; (ii) express an evaluation of the ongoing task and then explicitly invite the supervisor to provide an evaluation; (iii) express an evaluation of the ongoing task and then invite the supervisor to provide confirmation, and (iv) express an evaluation of the ongoing task without engaging the supervisor. Conclusions Surgical trainees recruit expertise from supervisors using practices of four different categories. Trainees’ actions are provoked by the moment at which they experience insufficient expertise and are focused on the task at hand in the immediate present. Supervisors can and do elaborate on these requests to provide explicit teaching. Insight into these practices provides tools for reflection on OR learning, proficiency assessment and deliberation to adapt guidance in the real time of the procedure.

Beyond the self: The role of co‐regulation in medical students’ self‐regulated learning

“…Elsewhere, paediatric residents have been found to benefit from interacting with supervisors when pursuing goals . Similarly, surgical residents actively employ different strategies to engage their supervisors in the monitoring of performance during surgery …”

Expanding the definition of learning: from self to social to system

“…In this issue of the journal, Nieboer et al . demonstrate how learning in the workplace often occurs through the interactions between supervisors and trainees rather than simply within the cognitive processes of the learner.…”

The regulation of learning in clinical environments: A comment on ‘Beyond the self’

“…Clinical workplaces bring learners on to the main stage of learning: the place in which they meet patients and supervisors. This stage has important features that are distinct from those of pre‐clinical classroom‐based environments: supervisors co‐regulate learning by entrusting learners with autonomy for their patients, and supervisors bring experience, and theoretical, procedural and practical knowledge that can directly influence learners' recruitment of SRL processes . Further, learners face the challenge of managing their learning in an environment in which patient care is the over‐riding priority.…”

“…The fundamental tenet of CA is that concrete patterns of interaction between individuals embody information about their individual goals and offer insight into how they try to achieve those goals . We applied this approach in our work on collaboration and learning in the operating room (OR) by analysing how residents shape (self‐regulate) their learning strategies in the OR and identified four strategies used by residents to recruit expertise …”

“…Unpublished paper, 2019). Importantly, both residents and supervisors demonstrated variation in the use and frequency of strategies within and between clinical procedures, (Nieboer P, Huiskes M, Stevens M, Cnossen F, Bulstra SK, Jaarsma DACD. The supervisor's toolkit: strategies of supervisors to entrust and regulate autonomy of residents in the operating room.…”