title: Student-led learning: a new teaching paradigm for surgical skills.
abstract: BACKGROUND
  Competency-based education and simulation are being used more frequently in surgical skills curricula. We explored a novel student-led learning paradigm, which allows trainees to become more active participants in the learning process while maintaining expert guidance and supervision.
  
  
  METHODS
  Twelve first-year orthopedic residents were randomized to either a student-led (SL) or a traditional instructor-led group during an intensive, month-long, laboratory-based technical skills training course. A rigorous qualitative-description approach was used for analysis.
  
  
  RESULTS
  Four prominent themes emerged: instructional style, feedback, peer and instructor collaboration, and self-efficacy. Compared with the instructor-led group, there was more peer assistance, feedback, collaboration, and hands-on and active learning observed in the SL group.
  
  
  CONCLUSIONS
  The flexible and socially rich nature of the SL learning environment may aid in development of both technical and nontechnical skills early in residency and ultimately privilege later clinical learning.
authors.affiliation: Department of Surgery, McMaster University, A. N. Bourns Science Building Room 131, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
authors.forename: Jen
authors.initials: J
authors.lastname: Hoogenes
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Polina
authors.initials: P
authors.lastname: Mironova
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Oleg
authors.initials: O
authors.lastname: Safir
authors.affiliation: Department of Surgery, McMaster University, A. N. Bourns Science Building Room 131, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1.
authors.forename: Sydney A
authors.initials: SA
authors.lastname: McQueen
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Hesham
authors.initials: H
authors.lastname: Abdelbary
authors.affiliation: Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Markku
authors.initials: M
authors.lastname: Nousiainen
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Ferguson
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Kraemer
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Alman
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Surgery, Queen's University, Kingston, Ontario, Canada.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Reznick
authors.affiliation: Department of Surgery, McMaster University, A. N. Bourns Science Building Room 131, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: ranil@skillslab.ca.
authors.forename: Ranil R
authors.initials: RR
authors.lastname: Sonnadara
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003299:Cooperative Behavior; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D017145:Models, Educational; D009864:Ontario; D009985:Orthopedics / Q000193:education*; D020377:Self Efficacy
keywords: Competency-based education; Non-technical skills; Residency; Residents; Surgical education; Surgical simulation