Patrick Nieboer1, Mike Huiskes2, Fokie Cnossen3, Martin Stevens1, Sjoerd K Bulstra1, Debbie A D C Jaarsma4. 1. Department of Orthopaedic Surgery, University Medical Centre Groningen, Groningen, the Netherlands. 2. Centre for Language and Cognition, University of Groningen, Groningen, the Netherlands. 3. Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands. 4. Centre for Research and Innovation in Medical Education, University Medical Centre Groningen, Groningen, the Netherlands.
Abstract
CONTEXT: For centuries now, the operating room (OR) has been the environment in which surgical trainees come to master procedures. Restricted working hours and insufficient levels of autonomy at the end of their training necessitate a shift towards alternative effective learning strategies. Self-regulated learning is a promising strategy by which surgical trainees can learn more with fewer exposures. However, the challenge is to understand how surgical trainees regulate their learning in the clinical context of the OR. OBJECTIVES: The purpose of this study is to identify and understand the strategies of surgical trainees in engaging their supervisors for learning purposes and how these strategies contribute to effective learning. METHODS: Total hip replacement procedures performed by four surgical trainees and their supervisors were videotaped. Using the iterative inductive process of conversation analysis, each verbal initiative to engage the supervisor was identified, analysed ('why that now') and categorised. RESULTS: Surgical trainees used a range of practices to engage supervisors and recruit expertise, ranging from explicit recruitment to implicit hints. We identified four major categories. Surgical trainees: (i) invite the supervisor to provide an evaluation of the ongoing task; (ii) express an evaluation of the ongoing task and then explicitly invite the supervisor to provide an evaluation; (iii) express an evaluation of the ongoing task and then invite the supervisor to provide confirmation, and (iv) express an evaluation of the ongoing task without engaging the supervisor. CONCLUSIONS: Surgical trainees recruit expertise from supervisors using practices of four different categories. Trainees' actions are provoked by the moment at which they experience insufficient expertise and are focused on the task at hand in the immediate present. Supervisors can and do elaborate on these requests to provide explicit teaching. Insight into these practices provides tools for reflection on OR learning, proficiency assessment and deliberation to adapt guidance in the real time of the procedure.
CONTEXT: For centuries now, the operating room (OR) has been the environment in which surgical trainees come to master procedures. Restricted working hours and insufficient levels of autonomy at the end of their training necessitate a shift towards alternative effective learning strategies. Self-regulated learning is a promising strategy by which surgical trainees can learn more with fewer exposures. However, the challenge is to understand how surgical trainees regulate their learning in the clinical context of the OR. OBJECTIVES: The purpose of this study is to identify and understand the strategies of surgical trainees in engaging their supervisors for learning purposes and how these strategies contribute to effective learning. METHODS: Total hip replacement procedures performed by four surgical trainees and their supervisors were videotaped. Using the iterative inductive process of conversation analysis, each verbal initiative to engage the supervisor was identified, analysed ('why that now') and categorised. RESULTS: Surgical trainees used a range of practices to engage supervisors and recruit expertise, ranging from explicit recruitment to implicit hints. We identified four major categories. Surgical trainees: (i) invite the supervisor to provide an evaluation of the ongoing task; (ii) express an evaluation of the ongoing task and then explicitly invite the supervisor to provide an evaluation; (iii) express an evaluation of the ongoing task and then invite the supervisor to provide confirmation, and (iv) express an evaluation of the ongoing task without engaging the supervisor. CONCLUSIONS: Surgical trainees recruit expertise from supervisors using practices of four different categories. Trainees' actions are provoked by the moment at which they experience insufficient expertise and are focused on the task at hand in the immediate present. Supervisors can and do elaborate on these requests to provide explicit teaching. Insight into these practices provides tools for reflection on OR learning, proficiency assessment and deliberation to adapt guidance in the real time of the procedure.
Authors: Patrick Nieboer; Mike Huiskes; Fokie Cnossen; Martin Stevens; Sjoerd K Bulstra; Debbie A D C Jaarsma Journal: Med Educ Date: 2021-11-02 Impact factor: 7.647
Authors: Jasper Prijs; Bram Schoolmeesters; Denise Eygendaal; Jean-Paul P M de Vries; Paul C Jutte; Job N Doornberg; Ruurd L Jaarsma; Frank F A IJpma Journal: Eur J Trauma Emerg Surg Date: 2021-10-08 Impact factor: 2.374
Authors: Lisanne S Welink; Tessa C van Charldorp; Laura Di Colandrea; Marie-Louise L Bartelink; Peter Pype; Roger A M J Damoiseaux; Esther de Groot Journal: Med Educ Date: 2021-07-16 Impact factor: 7.647
Authors: Derk Bransen; Marjan J B Govaerts; Dominique M A Sluijsmans; Jeroen Donkers; Piet G C Van den Bossche; Erik W Driessen Journal: Perspect Med Educ Date: 2021-04-30