Impact of objectively assessing surgeons' teaching on effective perioperative instructional behaviors.
OBJECTIVE
Advancing surgical technology and decreasing resident learning hours have limited exposure to perioperative training, necessitating more effective and efficient perioperative teaching by faculty surgeons. Participation in collaborative efforts and process improvement can change behaviors and enhance teaching.


OBJECTIVE
To promote deliberate teaching of residents, change resident perception of their teachers, and produce sustainable improvements by objectively measuring surgeons' perioperative teaching performance.


METHODS
This 3-phase observational study of surgeons' perioperative teaching behaviors included university-based surgeons, general surgery residents, and preclinical student observers and involved elective cases at a 600+ bed tertiary hospital. Initially, we measured teaching behaviors by surgeons unaware of study objectives, provided aggregate and confidential individual feedback, and developed standardized preoperative briefings and postoperative debriefings. Phase 2 applied a deliberate teaching model and reinforced behaviors with continuous process improvement efforts (Plan, Do, Check, Act) and repeat observations. Phase 3 used resident prompts to enhance teaching behaviors and demonstrate sustainability. Resident surveys conducted 3 times assessed perceptions of deliberate guidance by faculty when compared with national benchmarks.


METHODS
Introduction of deliberate faculty preprocedural focusing and postprocedural reinforcement to facilitate resident learning.


METHODS
More frequent and complete perioperative teaching by faculty and the perception of enhanced teaching by residents.


RESULTS
Faculty more commonly and more completely performed the 10-step preoperative briefings and postoperative debriefings (P < .001) during phase 2 (250% improvement over baseline). Intraoperative teaching styles significantly improved and residents' survey-reported assessments of faculty teaching improved over national data for describing procedural steps (P = .02) and requests for resident self-evaluation (P = .006).


CONCLUSIONS
Objective recording of teaching behavior frequency motivated adoption of deliberate guided teaching behaviors by surgeons, resulting in both subjective reports by residents of more frequent teaching and objective recording of parallel improvements. A deliberate focus on objectively assessing surgeon educators' periprocedural teaching may motivate improved teaching.
Department of Surgery, College of Human Medicine, Michigan State University, East Lansing.
Cheryl I
CI
Anderson
Rama N
RN
Gupta
Joseph R
JR
Larson
Omar I
OI
Abubars
Andrew J
AJ
Kwiecien
Alexander D
AD
Lake
Ahmed E
AE
Hozain
Adam
A
Tanious
Trevor
T
O'Brien
Marc D
MD
Basson
D004503:Education, Medical, Graduate / Q000592:standards*; D004650:Employee Performance Appraisal / Q000379:methods*; D005180:Faculty, Medical / Q000592:standards*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D011361:Professional Competence; D013663:Teaching / Q000592:standards*