title: How surgical mentors teach: a classification of in vivo teaching behaviors part 1: verbal teaching guidance.
abstract: OBJECTIVE
  To illuminate surgical teaching at a fine level of detail by filming intraoperative communication between surgical attending physicians and trainees and provide a naturalistic categorization and analysis of verbal teaching behaviors.
  
  
  METHODS
  Live, intraoperative verbal exchanges between surgical attending physicians and their trainees (residents and fellows) were filmed, and key verbal teaching moments were transcribed. In follow-up interviews, attending physicians and trainees watched video clips of their teaching case and answered open-ended questions about their surgical teaching methods. Using a grounded theory approach, we examined the videos and interviews for what might be construed as a teaching behavior and refined verbal teaching categories through constant comparison.
  
  
  METHODS
  We filmed 5 cases in the operating suite of a university teaching hospital that provides gynecologic surgical care.
  
  
  METHODS
  We included 5 attending gynecologic surgeons, 3 fellows, and 5 residents for this study.
  
  
  RESULTS
  More than 6 hours of film, 3 hours of interviews, and more than 400 verbal teaching utterances from our participating attending surgeons were transcribed. We found that attending surgeons used unique types of verbal guidance to describe relevant anatomy, explain the rationale behind a specific surgical action, command the trainee to perform the next step, reference a specific aspect of the surgery, and provide an indirect verbal construct. Attending physicians prefixed speech with polite terms and used terse language, colorful verbal analogies, and sometimes humor. Our participants denied a significant Hawthorne effect. Interrater reliability was high using Cohen κ with 0.77 for the verbal categories.
  
  
  CONCLUSIONS
  Our categorization of live intraoperative verbal teaching can provide a measurable, replicable basis for studying how spoken guidance can lead to the best intraoperative learning. Because surgical teaching occurs on a microscopic level, film review is important when analyzing intraoperative teaching behaviors.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, Pennsylvania. Electronic address: gsutkin@magee.edu.
authors.forename: Gary
authors.initials: G
authors.lastname: Sutkin
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Littleton
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Kanter
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006176:Gynecology / Q000193:education*; D006379:Helping Behavior; D006784:Hospitals, Teaching; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008611:Mentors; D008923:Missouri; D015588:Observer Variation; D009873:Operating Rooms; D013663:Teaching; D014741:Video Recording
keywords: Interpersonal and Communication Skills; Patient Care; Systems-Based Practice; attending physicians; fellow physician; medical education; resident physician; surgical education; video recording