Yue-Yung Hu1, Laura M Mazer2, Steven J Yule3, Alexander F Arriaga4, Caprice C Greenberg5, Stuart R Lipsitz6, Atul A Gawande7, Douglas S Smink3. 1. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts2Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts3currently with the Department of Surgery, Connecticut Children's Medical Center, Hartford. 2. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts4Goodman Surgical Education Center, Department of Surgery, Stanford University, Palo Alto, California. 3. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts5STRATUS (Simulation, Training, Research and Technology Utilization System) Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts6Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 4. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts7Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts8currently with the Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia. 5. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts9Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison. 6. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts. 7. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts6Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts10Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Abstract
Importance: Surgical expertise demands technical and nontechnical skills. Traditionally, surgical trainees acquired these skills in the operating room; however, operative time for residents has decreased with duty hour restrictions. As in other professions, video analysis may help maximize the learning experience. Objective: To develop and evaluate a postoperative video-based coaching intervention for residents. Design, Setting, and Participants: In this mixed methods analysis, 10 senior (postgraduate year 4 and 5) residents were videorecorded operating with an attending surgeon at an academic tertiary care hospital. Each video formed the basis of a 1-hour one-on-one coaching session conducted by the operative attending; although a coaching framework was provided, participants determined the specific content collaboratively. Teaching points were identified in the operating room and the video-based coaching sessions; iterative inductive coding, followed by thematic analysis, was performed. Main Outcomes and Measures: Teaching points made in the operating room were compared with those in the video-based coaching sessions with respect to initiator, content, and teaching technique, adjusting for time. Results: Among 10 cases, surgeons made more teaching points per unit time (63.0 vs 102.7 per hour) while coaching. Teaching in the video-based coaching sessions was more resident centered; attendings were more inquisitive about residents' learning needs (3.30 vs 0.28, P = .04), and residents took more initiative to direct their education (27% [198 of 729 teaching points] vs 17% [331 of 1977 teaching points], P < .001). Surgeons also more frequently validated residents' experiences (8.40 vs 1.81, P < .01), and they tended to ask more questions to promote critical thinking (9.30 vs 3.32, P = .07) and set more learning goals (2.90 vs 0.28, P = .11). More complex topics, including intraoperative decision making (mean, 9.70 vs 2.77 instances per hour, P = .03) and failure to progress (mean, 1.20 vs 0.13 instances per hour, P = .04) were addressed, and they were more thoroughly developed and explored. Excerpts of dialogue are presented to illustrate these findings. Conclusions and Relevance: Video-based coaching is a novel and feasible modality for supplementing intraoperative learning. Objective evaluation demonstrates that video-based coaching may be particularly useful for teaching higher-level concepts, such as decision making, and for individualizing instruction and feedback to each resident.
Importance: Surgical expertise demands technical and nontechnical skills. Traditionally, surgical trainees acquired these skills in the operating room; however, operative time for residents has decreased with duty hour restrictions. As in other professions, video analysis may help maximize the learning experience. Objective: To develop and evaluate a postoperative video-based coaching intervention for residents. Design, Setting, and Participants: In this mixed methods analysis, 10 senior (postgraduate year 4 and 5) residents were videorecorded operating with an attending surgeon at an academic tertiary care hospital. Each video formed the basis of a 1-hour one-on-one coaching session conducted by the operative attending; although a coaching framework was provided, participants determined the specific content collaboratively. Teaching points were identified in the operating room and the video-based coaching sessions; iterative inductive coding, followed by thematic analysis, was performed. Main Outcomes and Measures: Teaching points made in the operating room were compared with those in the video-based coaching sessions with respect to initiator, content, and teaching technique, adjusting for time. Results: Among 10 cases, surgeons made more teaching points per unit time (63.0 vs 102.7 per hour) while coaching. Teaching in the video-based coaching sessions was more resident centered; attendings were more inquisitive about residents' learning needs (3.30 vs 0.28, P = .04), and residents took more initiative to direct their education (27% [198 of 729 teaching points] vs 17% [331 of 1977 teaching points], P < .001). Surgeons also more frequently validated residents' experiences (8.40 vs 1.81, P < .01), and they tended to ask more questions to promote critical thinking (9.30 vs 3.32, P = .07) and set more learning goals (2.90 vs 0.28, P = .11). More complex topics, including intraoperative decision making (mean, 9.70 vs 2.77 instances per hour, P = .03) and failure to progress (mean, 1.20 vs 0.13 instances per hour, P = .04) were addressed, and they were more thoroughly developed and explored. Excerpts of dialogue are presented to illustrate these findings. Conclusions and Relevance: Video-based coaching is a novel and feasible modality for supplementing intraoperative learning. Objective evaluation demonstrates that video-based coaching may be particularly useful for teaching higher-level concepts, such as decision making, and for individualizing instruction and feedback to each resident.
Authors: Thomas J Sitzman; Raymond W Tse; Alexander C Allori; David M Fisher; Thomas D Samson; Stephen P Beals; Damir B Matic; Jeffrey R Marcus; Daniel H Grossoehme; Maria T Britto Journal: Plast Reconstr Surg Date: 2020-07 Impact factor: 4.730
Authors: B Joseph Elmunzer; Catharine M Walsh; Gretchen Guiton; Jose Serrano; Amitabh Chak; Steven Edmundowicz; Richard S Kwon; Daniel Mullady; Georgios I Papachristou; Grace Elta; Todd H Baron; Patrick Yachimski; Evan L Fogel; Peter V Draganov; Jason R Taylor; James Scheiman; Vikesh K Singh; Shyam Varadarajulu; Field F Willingham; Gregory A Cote; Peter B Cotton; Violette Simon; Rebecca Spitzer; Rajesh Keswani; Sachin Wani Journal: Gastrointest Endosc Date: 2020-07-30 Impact factor: 9.427