Preventing Error in the Operating Room: Five Teaching Strategies for High-Stakes Learning

Area of Science:

• Medical Education
• Surgical Safety
• Communication in Medicine

Background:

• Effective communication between attending and resident surgeons is crucial for preventing surgical errors.
• Current research lacks detailed descriptions of successful intraoperative teaching methods and their error-prevention mechanisms.

Purpose of the Study:

• To identify and describe successful intraoperative teaching strategies.
• To compare attending and resident perspectives on teaching moments to understand effective communication.

Main Methods:

• A naturalistic inquiry was conducted, filming five live surgical teaching cases.
• Over 250 teaching exchanges were analyzed, focusing on high-risk surgical steps.
• Attending surgeons and residents were interviewed separately after viewing video clips of teaching moments.

Main Results:

• Five key strategies for communicating error avoidance were identified: augmenting verbal instruction with physical actions, pausing for broader explanations, querying resident knowledge, using coined names, and issuing specific commands.
• A near-miss uterine perforation during dilation and curettage highlighted the impact of miscommunication.

Conclusions:

• Attending surgeons employ strategic communication during intraoperative teaching, contributing to fewer errors when residents operate.
• Successful intraoperative teaching relies on tacit knowledge and a shared understanding between attending and resident surgeons.
• Real-world examples of effective teaching strategies are presented to improve surgical education and patient safety.