Explicit teaching in the operating room: Adding the why to the what.

Area of Science:

• Medical Education
• Surgical Training
• Qualitative Research

Background:

• Supervisors are crucial for teaching surgical residents expertise for current and future procedures.
• Explicit teaching mechanisms by supervisors are not well understood, despite decreasing procedural access for residents.
• Effective supervisor teaching is vital for maintaining high-quality patient care in surgical training programs.

Purpose of the Study:

• To analyze supervisor practices in explicit teaching during surgical procedures.
• To understand how supervisors integrate explicit teaching in real-time during operations.

Main Methods:

• An observational qualitative study videotaped nine supervisor-resident dyads during total hip replacement surgeries.
• Conversation analysis was used to examine interactions involving explicit or implicit teaching of expertise.
• The iterative inductive process guided the analysis of supervisor-resident communication.

Main Results:

• Supervisors employed a core "if/then" rule structure for explicit teaching.
• This structure was customized with metaphors, motivations, and context-specific details (preference, prevalence, consequence).
• "If/then" rules were initiated to address or prevent patient outcome issues based on resident actions and local circumstances.

Conclusions:

• "If/then" rules provide the rationale ('why') behind surgical actions ('what'), enhancing resident understanding.
• Supervisors foster residents' "professional vision" and understanding of procedural variability and expert standards.
• These findings offer insights for improving supervisor teaching skills in surgical residency.