Exploring guidance provided by supervising surgeons in the operating room: the nature, the amount, and the decision-making of guidance

Operating Room Guiding Behavior;Surgical Education;Residency Training

Chen, Xiaodong

关键词: Operating Room Guiding Behavior;    Surgical Education;    Residency Training;   

Others  :  https://www.ideals.illinois.edu/bitstream/handle/2142/44816/Xiaodong_Chen.pdf?sequence=1&isAllowed=y

美国|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

The transformation of a surgical resident into a qualified surgeon is strongly influenced by supervising surgeons' guidance in the operating room (OR). Supervising surgeons not only guides residents' learning of technical skills and medical knowledge in the operating room, but also facilitate their independence development. Although OR guidance is one of the core components of the surgical faculties' duties, the nature of guidance and the means by which the OR guidance is to be provided by supervising surgeon are rarely explored in the past. Therefore, the elucidation of supervising surgeons' guiding behavior in the OR is greatly needed and is crucial for building up a theoretical base for future research. This study was designed to explore how and why supervising surgeons provide guidance to residents in the operating room. A qualitative research design was used. Data were collected from fifteen cases through video based observations with semi-structured interviews, stimulated recalls with semi-structured interviews, and onsite observations.Qualitative data was analyzed by obtaining emergent themes. Key findings include:1.A total of sixteen types of supervising surgeons' behaviors from the three OR guiding maneuvers (teaching maneuver, navigating maneuver, and assisting maneuver) were identified as OR guidance, including: physically showing, explain, learn from not appropriate decision, point out with instrument/finger, point out with camera, verbal direct/redirect, direct through teaching medical student, questioning, give feedback to resident's question, ask next step, confirm and compliment, direct OR team, double check, remind, general comments, and doing part of the procedure. 2.A majority of the reported guiding behaviors were identified in both open procedures and laparoscopic procedures;"point-out" and " verbal direct/redirect " were two types of reported behaviors used most commonly; the reported frequency of teaching maneuver guiding behaviors was lower than those of navigating maneuver guiding behaviors and assisting maneuver guiding behaviors. 3.The difference of OR guidance reported by supervising surgeons and residents were observed in the overall reported frequency and the reported amount of OR guidance: surgeons and residents reported the same amount of guidance on nearly half cases; but the agreement on the overall frequency of reported OR guidance among surgeons and residents had a great range of variation.4.A total of thirteen contributing factors which might influence supervising surgeons' decisions on guidance in the OR were identified. They were demonstrated in three dimensions: 1) Pre-OR initiators (case property, patient morbidity, case scheduling, trusted resident, and resident's foundation), 2) Intra-Operation influences (case progression, resident's confidence to perform, resident's personal traits, surgeon's previous experience, surgeon's comfort level, and surgeon's preferred way to do surgery), and 3) Rule-of-Control in the OR (surgeon's philosophy of training residents and patient safety). These four findings suggest that building up a shared perception of OR guidance among surgeons and residents is highly recommended for surgical residency training programs which are envisioning to seek for effective methods to improve the current residency training. Another suggestion from this study is that the scaffolding of residents' learning is suggested to be built on residents' intra-operative case-based Zone of Proximal Development (ZPDs) in order to maximize their learning outcome in the operating room.