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Learning and Teaching in the Operating Room: A Surgical Perspective

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Clinical Education for the Health Professions

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Abstract

The operating room (OR) is the main venue where trainee surgeons learn their craft. With educational challenges such as limited OR time and caseload, inconsistent faculty preparation and motivation, and the increasing complexity of cases, the case for efficient and structured intraoperative teaching in an environment optimized for learning is greater than ever.

A separate scoping review of literature of what is known about learner and teacher behaviors in the OR was undertaken and forms the basis of this chapter. We present a distillation of key features of this review. The intra-operative learning process and the factors which influence it are examined. The various interventions and models which may help in teaching and learning are summarized.

There are some findings that we intuitively know that enhance the learning experience, such as engaging learners and treating them well, giving learners consistent, constructive, and structured feedback, and allowing learners opportunities to operate with adequate supervision. What is less intuitive are findings on the use of humor, banter, and “war stories” to socialize trainees into the OR environment, the engagement of other stakeholders in the OR such as anesthesia and nursing colleagues to optimize learning, and the study of learning by motor and visual cues which has increasing relevance with the use of laparoscopic surgery where decisions are made on visual information alone.

The richness of the materials contributed by authors of the paper in this review provides a sound basis upon which to inform our practices, and to guide future research.

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Acknowledgments

The authors would like to thank Ms. Anne Young (Monash University Library, Monash University, Melbourne), Mr. Patrick Condron (Brownless Biomedical Library, University of Melbourne), and Ms. Kim Kee Toh (Medical Library, National University of Singapore) for their assistance in the article search.

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Authors and Affiliations

  1. National Heart Centre, Singapore, Singapore

    V. Chao

  2. KK Women’s and Children’s Hospital, Singapore, Singapore

    C. Ong

  3. Holmesglen Institute and Healthscope Hospitals, Melbourne, VIC, Australia

    D. Kiegaldie

  4. Monash University Institute for Health & Clinical Education, Monash University, Clayton, VIC, Australia

    D. Kiegaldie & D. Nestel

  5. Department of Surgery (Austin), University of Melbourne, Parkville, VIC, Australia

    D. Nestel

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  1. V. Chao
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  2. C. Ong
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Corresponding author

Correspondence to V. Chao .

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Editors and Affiliations

  1. Monash University, Clayton, VIC, Australia

    Debra Nestel

  2. King's College London, London, UK

    Gabriel Reedy

  3. School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia

    Lisa McKenna

  4. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia

    Suzanne Gough

Appendices

Appendix I: Search Strategy Used in the Scoping Review

VC performed a scoping review as part of a Master of Surgical Education thesis with the University of Melbourne, Australia. Scoping review methodology was chosen given the topic breadth, complexity, and heterogenous evidence, as it allows “a map of what evidence has been produced as opposed to seeking only the best available evidence to answer a particular question” (Arksey and O’Malley 2005). There were 94 out of 6383 English language suitable studies identified in online databases Ovid Medline, ERIC, and Embase published from the date of inception to 31 December 2018 using the following inclusion and exclusion criteria:

Inclusion Criteria

The Population (teachers and learners) was searched using text words: trainee, resident or residents, registrar, fellow or fellows, medical officer, consultant, attending, faculty, supervisor, mentor or mentors, coach or coaches, trainer or trainers, educator or educators, teacher or teachers, peer or peers, intern or interns.

The Context or setting was searched using text words: operating room, operating theatre, operating theater, intra-operative or intraoperative, peri-operative or perioperative, post-operative or postoperative, pre-operative or preoperative.

The Concept of learning and teaching was searched using text words: learn*, educat*, teach or teaching, instruct*, communicat*, train or training or trained or trains, debrief*, feedback.

Exclusion Criteria

Studies that were not in English, which studied the development of assessment tools, simulation including transfer from simulation to the OR, medical students, outcomes between trainees and consultants, tele-mentoring, patient safety, anesthesia, nursing, and non-technical skills, were excluded, as were opinion pieces and reviews of training programs/curricula. Studies on post-hoc teaching and/or coaching outside of the OR were also excluded.

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Chao, V., Ong, C., Kiegaldie, D., Nestel, D. (2022). Learning and Teaching in the Operating Room: A Surgical Perspective. In: Nestel, D., Reedy, G., McKenna, L., Gough, S. (eds) Clinical Education for the Health Professions. Springer, Singapore. https://doi.org/10.1007/978-981-13-6106-7_64-1

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